• Dr. Kemia

We Repeat What We Don't Repair

Dear Everyone: I don’t have the ‘Rona. Thank you all who reached out over the last 24 hours to check in. Y’all are generous and kind, and I appreciate your concern. I and mine are well. I had promised myself a 48-hour break from it all, and it somehow morphed beyond that - not because I didn’t have anything to say (you and I have had many conversations in my head) but, frankly, because I was feeling a bit overwhelmed by HOW MUCH needs to be said. How do we distill all these science-y, public health-y, resiliency things that need saying into something interesting and digestible? I'm game to give it a go, but first here is ME checking on YOU:

  • You hydrated? No. No you’re not. Go get a glass of water or brew a cup of herbal tea. I’m a patient woman (that’s a lie) I’ll wait…

  • Mother Nature remains off her meds in Central Illinois, and after peaking at 80 degrees last week, today’s 40 feels like the 4th level of icy hell. That said, you still need fresh air. You don’t catch a cold by getting cold – I don’t care what your Gigi says. Bundle up and go for a walk, however short. I’ll be here when you return.

  • I say this with all love: throw away the rest of the Easter candy. It’s Tuesday (yes. I checked. I know it is increasingly difficult to discern “Thisday” from “Thatday”)

  • Who have you called today? Who did you *really* connect with? Who are you missing? Who might be missing you? The biggest mitigator we have in all of this is each other: Connect. Check on your people.

  • How are you sleeping? Mine has been a little fractured, lately. I think my mind is working things out in the middle of the night that it can’t quite seem to get ahold of during the day. Be gentle with yourself in this – sleep may be a little weird for a while. That said, getting yourself back on a schedule is a good idea, too. It’ll help with the sleep disruption, is better for your physical health and resilience and will help with re-entry (yes. We’re going to start touching on the topic of re-entry!) Resiliency is our capacity to take in stride and self-regulate in acute and chronically toxic environments, and to bounce-back or heal after trauma. We’ve touched on many aspects of this over the last month, but this is my gentle reminder that the basics are so labelled because we cannot change biology: Breathe. Hydrate. Sleep. Play/Move. Connect. ----------- First of all: what did I do on my 96-hour hiatus? I am so glad you asked. I grieved. Deeply. It felt like it was time. We have simultaneously lost and learned so much, and I worry that in our exhaustion, our worry, our pain, our anger, our fear, our frustration, our desire for a return to “normal” that we will focus only on restoring “the loss.” I worry we will lose the lessons. We’ve learned how inexorably interdependent we are. We’ve learned that #ScienceMatters and public health initiatives are critical, life-saving and terrifyingly underfunded. We’ve learned just who is really an #EssentialWorker. We’ve learned that we are more resilient than we thought, more vulnerable than we ever feared, and capable of incredible, shocking acts of kindness, solidarity and benevolence. As those of you who know me might imagine, the last many weeks have been steeped in both individual and institutional trauma work; this is the most gratifyingly challenging work of my life. The simple phrase, “we repeat what we don’t repair” is an oft repeated truth, and it can be broadly applied to self and interpersonal interactions, as well as societally. It was in this headspace that I read the following last Friday afternoon: “What the trauma has shown us cannot be unseen. A carless Los Angeles has clear blue skies as pollution has simply stopped. In a quiet New York, you can hear the birds chirp in the middle of Madison Avenue. Coyotes have been spotted on the Golden Gate Bridge. These are the postcard images of what the world might be like if we could find a way to have a less deadly daily effect on the planet. What’s not fit for a postcard are the other scenes we have witnessed: a health care system that cannot provide basic protective equipment for its frontline; small businesses — and very large ones — that do not have enough cash to pay their rent or workers, sending over 16 million people to seek unemployment benefits; a government that has so severely damaged the credibility of our media that 300 million people don’t know who to listen to for basic facts that can save their lives.” - Julio Vincent Gambuto - We repeat what we don’t repair. ------------------- By Friday night the waves were well over my head. There’s so much we need to be DOING as a community and as a nation in order to prepare for what’s next. Now is the time to begin shifting gears and preparing for a month from now. For three. For six… But in many respects we are still reacting to what happened one month AGO. I ended my last zoom (godblesszoom, Ihateitsomuch) meeting at 6 p.m. Friday night utterly overwhelmed by it all. From the beginning I’ve said this is not an “equal opportunity virus.” They never are - there is no such thing. The most vulnerable among us are ALWAYS the most vulnerable among us, and this pandemic is no different: African Americans, Latino Americans, Native Americans… this virus is hitting people of color the hardest. As we review the (trickle) of racially quantified data coming county by county, those numbers reveal not-shocking racial disparity: time and again, black and brown Americans are overrepresented amongst the infected and dead. In Chicago, where black Americans represent 23% of the population, they account for 70% of #COVID19 deaths. I grieved because I want us to do better. I want us to BE better than this, America. If I have learned anything in four+ decades of life it is this: there is no “handling” grief - there is only submitting to it, experiencing it, trusting that, in the way of the tides, the grief that floods every corner of our soul will recede. Trying to resist the grief is as futile as trying to hold back the tides… Better to submit and wait, knowing that grief, like the tides, charts its own course and that while the waves of it may drag us under, we will eventually surface again. We cannot run or hide from this vulnerability – it is the very essence of our nature. It’s the waiting though. Right? The waiting and trusting that a path forward still exists. That this dark night of our souls won’t become permanent. Grief cannot be controlled or predicted - it doesn't follow a schedule, it doesn't bend to my will. It refuses to be handled. If you’re grieving, know you are not alone. Your pain or hopelessness or anger are not pathology, they are a part of our path. ------------- I told you last week would be bad. It was. This week is not much better though, believe it or not, as a nation we are on the downslope of the curve. The death toll will continue to rise, daily, for a bit longer because death lags infection, but our states have, by and large, gotten it “done” in flattening the curve through institution of a 3-4 pronged #Suppression strategy. Hot spots will still be hot for a while, but in NY we are hearing reports that National Guard physicians and nurses are being reassigned from mostly empty field hospitals to relieve beleaguered ER and ICU physicians in city hospitals. If you’re frustrated by the ever-changing numbers in modelling, please remember that the more data we have to feed into a model, the better its predictions. Early epidemic modelling for the US did not account for what we now know to have been a high degree of early community transmission and what we now expect to be a large denominator of asymptomatic or mildly symptomatic cases as well as massive under-testing (and therefore undercounting) of those with suspected Coronavirus who simply ride it out at home. Make no mistake, early public health interventions helped get ahead of the curve. While our biggest cities had earlier and much hotter peaks, the suppression strategies put in place have successfully flattened the curve. In disaster medicine, the greatest concern is that the number of patients needing care at one time exceeds available resources. The #Coronavirus pandemic has been a slow moving mass casualty incident, and the point of all these measures was to slow and spread out the rate at which patients who would become critically ill would need care, and to #BuyTime for hospitals and systems to expand capacity to meet potential demand. This has happened. Our #PatrioticIntroversion is working. Which begs the question: what’s next? In order for us to lift social distancing restrictions without an immediate flare-up of COVID-19, we must feel certain we have reasonable degree of herd immunity. What percentage of the population needs to be in that “Infected->Recovered->Now Immune” pool and thus contributing to herd immunity varies by disease and is connected to the infectivity, the R-naught (how many cases a single case generates) and to social contact. What we need now is a massive, nationally organized plan for aggressive antibody testing. We need to know the true denominator of this disease. We need to know who has been exposed and is recovered and is thus safe to go back to work without fearing harm to self or others. We need planning that allows for the risk-stratification of returning workers and their jobs, planning for reducing interactions and ongoing physical distancing in the workplace. We need a comprehensive public health plan that allows for immediate and aggressive contact tracing when flares occur (they will) and policies for quarantining those who have been exposed. Risk-stratified reopening of America is crucial, and these are some of the things that can be done to mitigate (not eliminate) the risk posed by Covid19 in the months until we have a vaccine (promising news on that front, too!). The health of humans has been my life’s primary concern. But it should not escape any of us that joblessness, poverty, homelessness and economic devastation exact a toll on health and life-expectancy, too. The health and the wealth of a nation are entwined, and good public policy weighs both. ----------- To those of you who made it to the end of tonight’s missive, I hope you hydrated throughout. You most certainly are due to get up and stretch. I’ll leave you with the gentlest of reminders: We can fix anything but dead. Keep being brave and generous and kind, always. More soon(er or later – no promises on timing!) K #America #FlattentheCurve #PatrioticIntroversion #TrustScience #TrustDoctors #PatrioticIntroversion #WeCanFixAnythingButDead


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