My approach toward the pandemic in the beginning was purely logical and fact-based. I treated patients based on algorithms – reducing fevers with Tylenol, killing bacteria with antibiotics, and increasing low oxygen levels with a ventilator. I perused reports of patients’ vital signs and laboratory values.
However, during the first surge, I realized that there was one aspect of this disease about which we still have much to learn – our own psychology. We have seen the coronavirus infect nearly all of the organ systems in the body, but how does the virus affect our thinking and behavior? How does it influence our basic decision-making such as whether to shake people’s hands or to attend social gatherings? Does it change common-sense behaviors such as calling the ambulance and going to the emergency room when we experience chest pain, or performing CPR if a stranger walking down the street were to suddenly drop to the ground?
The fear of the virus is a powerful influence. We asked one of our patients who had been experiencing worsening shortness of breath for several weeks why they had not come into the hospital earlier. The patient thought they had caught COVID-19 and did not want to cause harm to other people by leaving home. They planned to self-quarantine until feeling better, but their symptoms eventually worsened. It turned out the patient had developed a massive pulmonary embolism, a life-threatening condition where a clot is lodged in the major arteries going to the lungs. The patient had to be taken to the operating room immediately. Thankfully, the diagnosis was made just in time before the heart gave out.
Another patient in their 50s similarly experienced crushing chest pain at home but delayed coming into the hospital for three days. They turned out to have had a severe heart attack and because of their delay in seeking treatment, they experienced a life-threatening complication called a papillary muscle rupture — a condition where the loss of vital tissue in the heart has severely compromised the function of one of the valves. Therefore, what could have been most likely fixed with a short, less invasive procedure, instead became an emergent open-heart operation. Thankfully, the patient survived and was discharged from the hospital after a week, but one cannot help but wonder what may have happened if they had waited any longer.
I heard many more stories during the first surge that conveyed the complex psychology of this pandemic. A young patient with appendicitis waiting to come into the hospital due to fear of COVID-19 ultimately experienced a ruptured appendix. A patient with an implantable defibrillator that was frequently firing at home, the feeling of which some people describe as being kicked in the chest by a horse, waited for several months to have the device fixed. Some people were more willing to tolerate pain or risk before coming into the hospital in fear of catching the virus. For most doctors and hospitals, this poses a new gray factor in how we typically treat diseases.
On the other end of the spectrum, many are also becoming desensitized to the threat of the virus, exhibiting “COVID-19 fatigue.” The number of new cases, which have skyrocketed in this country over the last few weeks, has become just a statistic. The virus has also become overly politicized, which is diluting the interpretation of facts.
This is undoubtedly one of the most traumatic and formative events of our lives. As we prepare for another surge, let us be mindful of its impact on our psychology. We need to overcome not only the virus itself but also its sway on our behavior and emotions. We need to follow the scientific evidence as best we can in ensuring everyone’s safety. For now, that means to practice social distancing and to brace for the coming impact, feeling the gentle tug of the mask around our ears, and its soft veil over our faces.
Jason Han is a cardiac surgery resident at a Philadelphia hospital.