In the early 2000s, I was a surgical trainee in New York City. One afternoon, I met two patients. The first was an affable gentleman with a Staten Island brogue and a painful pre-cancerous patch on his tongue. “Doc,” he said, “I know what you’re gonna tell me. I need to stop smoking. “Well, save your breath. You doctors are smart, but it’s my body and I’ll do whatever I want.”
The next time I saw him, his tongue had been removed and replaced by part of his thigh. He breathed through a tube in his neck and ate through one in his stomach.
The second patient also had cancer. Hers grew off the left side of her face. It was small; it wouldn’t have taken an hour to excise. Unlike her neighbour, she didn’t deny its existence. She wanted it treated-but only after she tried lavender oils. The next time I saw her, the tumor had paralysed her face and had sent emissaries into both sides of her neck. Her surgery took half a day.
I can’t stop thinking about these two patients as I watch the US and Ireland manage a pandemic. Saturday, Ireland logged one of its highest single-day case numbers ever. "All the important indicators of the disease are deteriorating," Dr Tony Holohan, the chief medical officer, tweeted.
Ten days prior, Donald Trump announced that he’d joined the 7.5 million Americans who tested positive for COVID-19. His lack of response was painfully predictable: so far, at least 34 other people in his orbit have been infected, and he may have exposed thousands of others.
"Normal life!" The president opined. "We want to get back to normal life." Under his eye, governors in Texas and Florida have obeyed, opening their states despite worsening indicators. No virus will strip Texans of their freedom!
The US is my first patient, intent on his right to smoke, cancer be damned. Over two hundred thousand Americans have died at the altar of this red, white, and blue hubris. It’s easy for us in Ireland to judge America. But so far, we’ve been the second patient. Though we’re softer about it, we hold just as strongly to our ideals: liberal democracy and the protection of the life, person, good name, and property rights of every citizen.
Our Government replaces the orange-tinged bombast of a reality-TV president with the soothing scent of lavender. As numbers rise and NPHET's recommendations become more strident, the strongest message it’s able to muster is to use your best judgment. Maybe there’ll be fines, too, but those won’t happen until the end of October.
We’d never yell at the virus like my fellow Americans. Instead, we hope to reason with it, to slalom between its infectiousness and our values.
Neither strategy works-Saturday, we logged over 200 cases per million people; the US logged 165-ours just smells better.
The virus cares as little for our ideals as it does for American individualism. It is a lifeless piece of genetic material encapsulated in a few proteins. It doesn’t reason. It isn’t sophisticated; the only thing it knows is how to spread.
And it spreads when we let it.
It spreads asymptomatically. It kills 3-5% of diagnosed patients. Its scythe falls most heavily on poorest, oldest, and most vulnerable, but children and young people aren’t immune. They may, in fact, drive spread.
These facts are incontrovertible. We can’t slalom them away; we can’t negotiate with them.
The good news is that we also know what to do about them. We know that masks work and visors don’t. We know that social distancing works and indoor dining doesn’t. And we know that early lockdowns prevent death.
None of this is hard. As Dr Anthony Fauci, the US Government’s main infectious disease adviser, put it: "It’s so frustrating because it’s not rocket science."
But it is distasteful. Nobody wants another lockdown. That’s why lavender oils are so tempting.
The US is well on its way to its third wave because it’s run by people who’ve consciously sent it there. On the other hand, we’re well into our second wave because we’ve done the opposite: we’ve crossed our fingers, bathed in lavender, and hoped.
It was never going to work.
It’s time to put aside lavender oils. It’s time for surgery.
But here’s the thing: surgery may have been the primary treatment for both my patients, but it wasn’t their only treatment. They also got chemotherapy and radiation. And nutritional support. And rehabilitation. And physical therapy.
Their recovery depended on a holistic response to their disease. Ours must as well. It’s not only time for surgery-it’s time for everything that goes with it.
Lives will be lost if we don’t lockdown, and livelihoods will be lost when we do. That’s the slalom we’re actually skiing.
Pandemic response has been portrayed as an either/or-either we care about lives or about livelihoods. A true response must do both.
It must lockdown, now, to save lives, and it must support publicans and restauranteurs, shop owners and small businesses, to save livelihoods.
As daylight hours shrink, it must be proactive with mental health. Instead of waiting for suicides to increase, it must actively reach out to the citizens of this State. When South Korea locked down six months ago, the government sent care packages. We must be as creative.
The one thing we can’t do is wait. As the saying goes, the best time to plant a tree is twenty years ago. The next best time is now.
The time for lavender oils is over.
This article was originally published in The Irish Times on 15 October 2020.
Prof. Mark Shrime is the O’Brien Chair of Global Surgery at RCSI and Lecturer in Global Health and Social Medicine at the Harvard Medical School.