Dr. Dave Campbell, Chief Medical Correspondent Morning Joe/MSNBC
Assistant Professor of Orthopaedic Surgery, University of Central Florida College of Medicine
Jacqueline Phillips, Pre-medical Student, Florida Atlantic University, Boca Raton, Florida
April 27, 2020
Frontline healthcare workers in the battle against COVID-19 were once pre-professional students, many filled with a sense of awe and passion for their chosen field of healthcare. They work shoulder to shoulder as physicians, nurses and physical therapists, in the ER, ICU and wards, supported by myriad equally compassionate support staff, managing the physical and mental manifestations of this viral infection. For many, the aspiration to be healers, to treat the victims of disease and injury with safe, compassionate and quality healthcare was all consuming. Some envisioned a life in which they became part of the solution in the never-ending human struggle against public health calamities. None could have foreseen the novel coronavirus pandemic that started in Wuhan, China in 2019 and continues to sweep the globe months later.
The Spanish Flu pandemic of 1918 came and went, infecting an estimated 500 million people worldwide, with the diseases caused by the H1N1 virus killing an estimated 20 million to 50 million in its wake. Pre-professionals today, eager to enter medical, nursing or physical schools soon, are faced with another pandemic, this time affecting them in the here and now.
The World Health Organization has now published guidance regarding using antibody testing as an immunity passport to reengage society, reenter the workplace, and relax social and physical distancing standards. They caution that merely identifying antibodies to the SARS-CoV-2 virus is not a passport to reopen the world. WHO state, “There is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection.” That statement was found to be confusing and quickly retracted, and a second posting clarified that the scientific community does not know enough yet regarding immunity to subsequent infection to make blanket statements. The WHO postings come on the heels of learning that a sizeable percentage of people infected with COVID-19 are asymptomatic, or minimally symptomatic, and are contagious during the early days after inoculation and infection with the virus.
What an ironic time to be studying biology, thinks Jackie Phillips, 36-year-old English teacher, mom, and more mature than average pre-med student, as she kneels in the rich, black dirt of their chicken coop and scoops eggs from under a hen. Am I a lunatic for still planning on med school, even with this crisis going on? A 39-year-old healthy man just died from COVID-19, and he hasn’t been the only young one. Doctors and nurses working in emergency departments, ICUs and hospital wards are contracting the disease right and left, and some of them have died. Is this passion to attend medical school fair to my three children, still in school themselves?
It’s an unusual paradox, studying to enter a field where the sick being saved may inadvertently pass their infectious disease to their physicians, nurses and physical therapists. The fields of epidemiology, virology and infectious diseases have become intriguing scientific and clinical fields reserved for the academic elite. Pre-professional healthcare students across the country must be seeing an entire world of science and medicine open-up before their eyes. It’s not every day that the minutiae of college biology classes immediately help to understand a current global pandemic. Just this week the Scripps Research Institute in Jackie’s hometown reported they may have a lead on a COVID-19 vaccine.
Jackie’s pre-med studies are oddly keeping pace with the explosion of scientific information blasted out through the media. Pre-med studies have never been more exciting and relevant.
Back on the home front, back to reality for Jackie, she is leaving the coop, eggs folded in her shirt as she sees a dirty head pop out of a freshly dug hole in the backyard. “What are you doing?” she asks her tween-aged daughter. “You have an algebra Zoom in five minutes. Take a shower and get back to school.” Jackie looks down at her own mud-caked knees and thinks, this is such a weird time.
Jackie thinks about the images on Facebook of the nurses and doctors in Italy and New York. You know, the selfies of their face-mask bruises. It makes her feel guilty. She doesn’t wear a mask because she is not out in the public. Instead, she’s safely isolated at home with her family, and good health, while those frontline heroes are exhausted and sometimes infected. It doesn’t seem fair.
Sliding open the back door to the house, she sees her two young boys are stick-fighting next to their open laptops and leftover scrambled eggs. And as Gerald, the rooster, crows behind her, this quarantine-era pre-med mom knows she’s stepping off the farm and into the human zoo.
Everyone has their own story during this time. We keep hearing about the healthcare workers struggling to save lives on the frontline. We know of first responders arriving at homes to find deceased victims of COVID-19, who died alone and lonely, cordoned off from friends and family. It is crucial we do not lose perspective on the fragility of life in this time of pandemic.
Pre-meds and pre-nursing students must now consider their choices through the present-day lens of a pandemic, rather than just reading about Spanish Flu, polio, smallpox, HIV/AIDS and Ebola. Some will have a newfound sense of concern for their chosen field. Those in line to attend physical therapy school know that PTs are at the frontline of healthcare every day. All these pre-professionals can take heart that the fields of medicine, nursing and physical therapy bring immense joy to both the healthcare providers and the patients under their care. Even in a pandemic, or in a natural disaster, or just doing a house-call, one human tending to the health needs of another is like no other human endeavor.
Haley, a young Doctor of Physical Therapy realizes that she and her colleagues are the only source of human contact for their patients, most of whom are elderly and at-risk. She is aware of the perfect storm: beach-loving spring-breakers who have recently flocked to Florida, thereby potentially increasing community-spread of COVID-19 to the expansive population of elderly with underlying health conditions sequestered in the confines of skilled nursing and assisted-living facilities. Sometimes the older folks are living in the home of their children, with tweeners, teens, and spring-breakers creating a clear and present threat of bringing SARS-CoV-2 into the home. The perfect COVID-19 storm.
“Due to the required isolation and restriction on visitors,” Haley said, “we as healthcare workers are now the patient’s only in-person interaction, for days or weeks on end. We no longer allow patients to have any visitors. At times, we have led guests to see the patients outside their windows to visit through the glass. This is always hard, as a lot of the time the patient has already been in the hospital for weeks without visitors, and now they might be feeling better and are still unable to see their friends or family while they recover. This has made me even more aware of the responsibility healthcare workers have to provide emotional support when needed.”
Haley’s professional role, and that of other PTs is not confined to physical rehabilitation. During this time of isolation, her patients deeply need the human interaction they get with her. She said that the next generation of physical therapists, those in pre-physical therapy college courses now, will be well-served to take a good look in the mirror, and be sure they have the compassion needed to be as much behavior therapist and confidant as musculoskeletal recovery specialists.
Haley’s husband, CJ, was a pre-PT student just last year. He has now completed his first-year of physical therapy school and longs for in-person patient interaction right now. Like other schools across the United States, his program has been 100% virtualized due to the coronavirus epidemic, with frustrating consequences similar for most medical, nursing and physical therapy students during this time.
“What is missing is real world application of the concepts we are learning,” CJ said. “Physical therapy requires proficiency with manual/physical techniques, but right now we have to learn through a computer without any hands-on experience. Our first clinical rotation experience, where we were supposed to learn what it is like being a working PT, was canceled as a result of COVID-19. Now, that experience has been moved to an online Zoom meeting twice a week. While teachers are trying to do their best to supplement the loss of learning, there is no doubt that we are missing valuable professional experience.”
In hands-on healthcare fields, like medicine, nursing and physical therapy, social isolation has created the need for resourceful solutions. Technology has yet to realistically simulate authentic human interaction.
Back at The Phillips Zoo, Jackie’s middle son is typing a response on Google Classroom to the prompt, “Give an example of an essential business and describe what makes it essential,” her oldest daughter is singing “Happy Birthday” over Zoom, while the choir director tries in vain to synchronize fifty virtual voices, and her littlest boy is chasing a bunny rabbit that was brought into the house, unbeknownst to mom, as it runs in circles around the couch.
Pre-meds, pre-nursing, pre-physical therapy and every other college student aspiring to a career in healthcare may be re-assessing their decisions. As a physician with over thirty years of clinical experience, which spans the HIV/AIDS epidemic that threatened his surgical training program in Miami in the eighties, years of experience in the military, and countless patients with every imaginable disorder, Dr. Campbell would tell every one of those young, and not-so-young pre-professionals to buckle up for the most fulfilling ride of your life. Being a healthcare professional is the singular most rewarding career on the planet. Whether a pandemic, hurricane, social, economic or family crisis, hurdles to be met with resilience, there is no better career than one in which one human tends to the health needs of another. That is truly what makes the world go around.