Five Years On

Reflecting on five years of COVID, medical memory, and The Pitt

As I’ve thought about building a new online medical education resource, I’ve been thinking back to the last time I tried something like this, when I was a medical student in New York during the first days of the COVID pandemic, and I’ve been struck by how little ceremony has marked the five-year anniversary of that nightmare.

The descent, quick in retrospect, felt halting at the time. I remember in late February noticing a few nurses in the emergency department wearing masks and whispering about case clusters at nursing homes in Washington. Even after that, though, I went to a work event for my old teaching job, where coworkers speculated that this new virus, like so many epidemic candidates before it, would peter out, leaving little more in its wake than a few anxious news articles.

Then the first patient was transferred to our hospital, bringing with them television trucks and the worried pride of being part of something that was starting to feel more like history. The closest parallel on our minds at first was the Ebola outbreak of the mid-2010s, when individual cases could still be newsworthy.

The hospital published a daily COVID data digest, and the rapidly upsloping line on the graph made clear that we would not be so lucky this time. I was on a gynecology team–my second-ever clinical rotation–and we were barred from scrubbing in to surgeries in an effort to preserve PPE. We heard murmurs about anticipated ventilator shortages and plans to draft researchers into clinical service.

In mid-March, we were summoned to a school-wide meeting–the plan, we were told, was for us to continue on our rotations for as long as possible. The next morning, we woke up to an email telling us to stay home indefinitely. We would not return to the hospital for three months.

Stuck in my apartment in Harlem with little more to occupy me than then city’s daily pot-banging ritual, I started a COVID reading list in a Google Doc, which I kept updated with a far-from-comprehensive assortment of academic articles and pieces from the lay press. I posted the link on social media and soon mustered another half-dozen contributors.

That effort gave way to something more formal as we stood up the COVID-19 Student Service Corps in an attempt to make something of the latent energy of all those homebound graduate students. Tasked with developing the Information Services arm of the organization, we put two hundred volunteers to work producing academic article digests, infographics, and document translations for distribution in the hospital. In a moment when it felt like things might finally be falling apart, we wrote a primer on COVID management and critical care for pediatricians redeploying to the adult hospital across the street.

The fact that we have allowed the anniversary of that grim moment to pass largely unrecognized is unsurprising, but I am still struck by how much we have collectively forgotten–or even started to dispute–about how that time felt. I remember the refrigerated trailers outside hospitals and the urban silence broken only by ambulance sirens, but those memories were reinforced by the things I saw after returning to the hospital that summer–the proned and ventilated patients, the keening families after each unsuccessful round of CPR.

Those images–of ICUs overwhelmed by unceasing tragedy–were not widely available to the lay public. Probably the best visual documentation of what COVID wrought on hospital wards emerged not from the United States but from Bergamo, Italy. It is hard not to wonder whether, by sparing the American public a a stark look at what its healthcare workers were battling, we laid the groundwork for the now-emerging denial that the pandemic was ever more than a cold.

This is one of the reasons I’m grateful for The Pitt, which offers the truest depiction–in both literal and emotional terms–I’ve seen of what it was like to work in a COVID unit at the peak of a wave. It has deservedly become the talk of my hospital and of online medical communities. At the end of the first episode, I had to take a minute to lay down and cry–and I was not alone. My hope, as we relitigate the meaning of the pandemic and the appropriateness of our response, is that it will prick the memory of some of those who have forgotten the terror and the danger of those first months.