In November 1664 the bubonic plague arrived in London. Known as the Black Death for the discoloration of the swollen affected lymph nodes (buboes), when the pandemic subsided 18 months later, fully a quarter of London’s population lay dead. Several years later Daniel Defoe, of Robinson Crusoe fame, recalled the event in A Journal of the Plague Year. While full of statistics of who died where in London, it also offers insight to human behavior when faced with something unknown and terrifying. Are things really different now?
March 2020: It’s out there. And it’s coming. No one knows exactly when or from where. But the stories are everywhere and multiplying by the day. In the clinic we are trying to figure out how to triage patients, where to put them, what to wear for protection. In London that fall Defoe and others knew the plague had reappeared on the European continent, and would soon be on their shores. It didn’t matter from which country. On a personal note: It looks like I won’t make it to dad’s grave on the first anniversary.
April 2020: Shutdown. Almost complete and total. Very few patients allowed in the office, and then only after rigorous screening. Video visits explode exponentially. For a quasi-Luddite like me, it’s another battle with technology. But the staff does such a wonderful job preparing things, with 2 clicks I’m off and running. I have stopped wearing ties to work – with everything turned on its head it seems the right thing to do. I also need to find a mask that isn’t trying to pull my ears off.
May 2020: We get in-house COVID testing, which allows for more sick patients to come in. It also leads to a major reorganization of our lab space and which rooms we use for the sick. Most of the kids I see who are out of school are pleased the year is done early; only those who are graduating are unhappy. My niece, who graduated at the top of her college business school and was to give an address, has her graduation postponed until the fall. There are reports of people literally trying to run away from this scourge – leaving large crowded cities for the countryside. Defoe’s relatives beg him to leave London, but he stays put.
June 2020: As summer approaches we are told by some the warm weather will lead to a decrease in cases. This does not happen. In London the 3rd month is in the dead of winter, and cases do decline, due to people staying indoors. This leads to the hope all is well. Spring proves otherwise. With cases here only expected to rise, my wife makes the decision to visit her elderly parents, not knowing when she will see them next. The planes are almost empty. I have some minor surgery I’ve been putting off, figuring the number of surgical cases will be low and hence so will exposure. While I have forgotten most of my neuroanatomy, I’m pretty sure the COVID test beforehand reached high enough to sample my frontal lobe.
JULY 2020: It’s hard to remember what phase of isolation we are in at times. Defoe related the isolation and cleaning measures the London City Council puts into place. The clinic brings in teens for sports exams, hopeful of competition in the fall. One of my favorite parts of summer, talking to families about their summer vacation plans, is shot. I have found a mask that fits better.
August 2020: We are now averaging over 100 COVID tests per week in my clinic. Our positivity rate remains low. I let my beard grow – why not? My face is always covered so no one can tell if I look like a bum as it fills in. For the first time in her life my wife cannot make her yearly trip to her family’s cottage in Canada. Here first trip was when she was three months old. I myself have been going there for almost 40 years. I proposed to her there.
September 2020: We have settled into an efficient routine in the office. One cannot let fear get in the way of your calling. Defoe speaks of the physicians and buriers who “venture everywhere without hesitation” to do their work. I go see mom – maybe not the wisest thing, but I have to see for myself that she is okay. Planes are getting pretty full. I get tested before and after the visit –the newer tests are much less offensive. My niece’s graduation is canceled. I see my first case of MIS-C, a poorly understood life-threatening complication seen in children with SARS-CoV-2. Rare cases are always fascinating to read about, and absolutely terrifying to deal with in person. All of a sudden it’s not so rare. With my partners and the pediatric medical community to help, the patient recovers fully.
October 2020: I am starting to see more and more patients who, because they are unable to attend school in person, are presenting with anxiety, depression and behavioral problems. I review the treatment recommendations. I am amazed at how my younger patients have adapted so well to wearing a mask. They just pushed back the release of the new Bond, James Bond movie. That was my chance to go see a movie this year.
November 2020: We are now over 200 tests per week. One thin silver lining – when most parents learn their child does not have COVID, they are content with letting respiratory illnesses run their course without antibiotics. Any time we can prescribe less is good. The pre-thanksgiving travel office visits are muted. I break out a US flag tie on Veteran’s Day to honor my father. Stories abound of COVID scams – home testing, coronavirus insurance, miracle cures, charity scams, faux N95 masks. Defoe describes the “quacks, fortune tellers and mountebanks” who promise both plague cures and prevention. They make a tidy living exploiting a crisis. The more things change…
December 2020: If there was ever a year to work both the Thanksgiving and Christmas holidays, this would be it. Not only it is unwise to travel, but very quiet in the clinic. My Christmas ties hang silently on their rack. The vaccine arrives, and I am grateful to be on the early list to receive. That’s another small silver lining. At this point in London societal norms are starting to fray, with all manner of crimes increasing, and degradation of those near death. One humorous story (we need humor always): when seeing my PCP for my annual well check, I answer “yes” to whether I have been in contact with anyone with a positive COVID test (I had a patient test positive a few days before). This throws the office into a bit of tizzy and it is several minutes before I can be roomed.
January 2021: We are at 300 tests per week, but the positivity rate remains low. Flu is nowhere to be found – that’s to be expected with little in-classroom schooling and everyone masked and not shaking hands. My anxiety/depression cases continue to increase; it is practically daily now. The cold weather does not lead to a decrease in cases. I am told my glasses do not constitute adequate eye protection, so I need to find a new mask with a face shield. My facial hair seems to come in sideways, perpendicular to my face. What’s up with that? There must be a bigger mask out there to hide everything.
February 2021: The end of year one approaches. While death numbers increase, the overall number of cases decline, more people get vaccinated, and perhaps a realistic timeline of achieving normalcy can be proposed. Provided of course the vaccines are successful against the new variants. One has to admire the ingenuity of viruses – unable to live on their own, their ability to adapt and survive is without parallel. Could they actually be smarter than us? In London, there is no end in sight. Like most plagues in history, it needs to burn itself out. It will be another 230 years before the bacterium that causes plague is identified, and another 50 before a cure is found. Within months of being described, the SARS-CoV-2 genome is sequenced, and within a year several effective vaccines are available.
I have a new mask.
March 2021: I am puzzled by the fact that a year filled with long slow days could have passed so quickly. I imagine Einstein somewhere in his writing had an explanation but I was never keen on physics. Some unsettling news: it appears that Canada is significantly behind in their COVID vaccine distribution due to numerous issues. My Canadian friends are frustrated and furious. Perhaps if I show up at the border with a freezer full of vaccines they’ll let me in. My prospects aren’t good.
April 2021: Schools are starting to open back up, and we are seeing the usual illness associated with this: sore throat, “stomach bugs”, viral colds. I am starting to see one other thing – reluctance for some children to return to school. I had hoped re-entering the classroom would alleviate the anxiety and depression I had been seeing. But I guess my glasses were too rose-tinted. There is fear of not only being infected with COVID, there is also the worry about interacting in a large social group again. Who can blame these kids? We have not been consistent in the message we send them. Whether it’s how many days you can go to class per week, or how far away from each other they need to be, they can sense how unsure the adults are. When people speak of long COVID, this needs to be included.
May 2021: Here’s a better Mother’s Day – with her safely vaccinated I am able to spend the holiday with mom. While a proud expatriate Floridian, I am still amazed every time I go “home” as to what a different world the Sunshine State is. Restaurants and stores are packed, masks are a lot less common. It’s a bit odd to see, but in keeping with what I’ve come to expect. Florida seems to play by its own rules at its own pace. Time will tell if they had the right approach all along.
June 2021: In slightly over one year, we have gone from having the COIVD test in the office to having the vaccine available for patients. This presents a novel situation: whenever I have prescribed a medication or vaccine, I have had the reassurance of years of use on thousands of patients. Here. the waters are to a certain extent unnavigated. Since the vaccine is new, I will need to listen carefully and better understand my patient’s concerns, provide them with the most recent information, and ensure that I guide them at a pace they are most comfortable with. Like London in 1664, we are faced with a new world wherein we all need to be brave.