Family medicine resident perspectives on COVID-19 (March 30-April 10)

- Enkhee Tuvshintogs, MD, AFP Resident Representative

This post picks up where my previous post left off on the experiences of residents at my program during the pandemic.

“Where are you getting reliable sources of information?” asked a physician in a group tele-meeting. This, indeed, was the most imperative question. At this point, like the general public, we were being inundated. Over the past several weeks, my sources have varied from local and national news broadcasts, to organizational briefings, to first-hand accounts from friends and colleagues, as well as COVID-19 updates from American Family Physician (AFP), the Centers for Disease Control and Prevention (CDC), JAMA, and The New England Journal of Medicine - just to name a few.

As a whole, coronaviruses (CoVs) are not new to our medical education. As a JAMA article stated, CoVs “have long been considered inconsequential pathogens [until] 2 highly pathogenic human CoVs [SARS-CoV and MERS-CoV] emerged from animal reservoirs to cause global epidemics.” Three years ago, the “World Health Organization (WHO) placed [the CoVs] on its Priority Pathogen list, hoping to galvanize research and the development of countermeasures.”

The medical community is trying its best to rapidly produce valid and peer-reviewed information on diagnosis and management of COVID-19. Early on, I received posts, private messages, emails, and texts from concerned friends and colleagues, hoping that these bits of relayed information would help us all in some way. I am now seeing similar information come through the pipeline from well-known medical journals, including AFP's daily COVID-19 Research Briefs.

Thanks to community members who are practicing social distancing and “flattening the curve,” we have been able to “buy time for science to catch up.” We have gained time to discuss disease markers, symptomatology, patient populations, and medication trials.

Resident physician, Dr. Kim Le (KL) reminded me of important ethical questions: “How would we ethically and objectively chose who gets a vent and who does not? How can we accurately predict who is going to survive this or not, when there are even reports of young people dying?” Offering a different perspective, Dr. William Guthrie (WG) hypothesized about “ways to boost [patients’] immune systems” with micronutrient supplementation, rest, exercise, and other macro level methods to strengthen inherent body defenses.

Other residents, like Dr. David Hubbard (DH) and Dr. Sherry Liao (SL), are thinking about the future.

“We don’t know how this virus will evolve and how it will continue to behave in the community,” observed DH. Similar to influenza, coronaviruses can mutate: “From genetic sequencing data, it appears that there was a single introduction into humans followed by human to human spread. This novel virus shares 79.5% of genetic sequence with SARS-CoV.” The influenza virus changes or “drifts” every year; flu vaccines that are offered annually represent our best guesses about an ever-evolving endemic pathogen. In addition to the annual flu vaccine, will we need to develop an annual CoV vaccine?

On a planetary scale, the challenges we are facing now could be a sign of more to come. SL shared her concerns that “this could keep happening. Instances of crossover from animals to humans seem to be happening more and more often. Urbanization, deforestation, globalization, and climate change will probably cause more contact between animals and humans. We’ll probably have more events like this.”