2020 Top Stories in Primary Care: COVID-19—Fear, Misinformation, and the Unknown

In my first commentary dealing with the novel coronavirus (SARS-CoV-2)—posted in late January, 2020—I cautioned, “With this evolving situation comes fear, misinformation, and many unknowns.”¹ These prescient words have come to describe the last 9 months.

Fear: On returning from a well-timed, early March family vacation in Mexico, we found our local grocery store stripped of toilet paper, flour, yeast, and chicken. Fear had gripped our small community. Since then, I have watch the dizzying toll of cases and of deaths. As of today’s writing, the United States has accumulated over 9 million cases and 232,000 deaths. Over 26 years of studying influenza’s effect on primary care practices, long-term care facilities, schools, and communities, I have developed a great respect for influenza; SARS-CoV-2 continues to scare me.

“I must say a word about fear. It is life's only true opponent. Only fear can defeat life. It is a clever, treacherous adversary... It goes for your weakest spot, which it finds with unnerving ease. It begins in your mind, always ...”  – Yann Martel, Life of Pi²

Misinformation:  Throughout this pandemic, significant and concerted efforts emerged to paint SARS-CoV-2 as little more than a bad case of influenza. Nodding to the wisdom of Calvin and Hobbes, I think of this as the transmogrification of COVID-19.³ There have been revelations of miracle cures and accelerated timelines. Amidst the sense of loss, and equally, the loss of control, some have chosen to lash out at the reality of our current situation. 

“The point of modern propaganda isn't only to misinform or push an agenda. It is to exhaust your critical thinking, to annihilate truth.” – Garry Kasparov (Russian chess grandmaster)

Unknowns: Where is this pandemic going? What are the best responses? We don’t know, but we have some hints.⁴ First, we do know that public health measures work. Physical distancing, masking, handwashing, testing, isolation, contact tracing, and quarantining all reduce the ability of this virus to transmit. For respiratory viruses with lower reproductive potential (R_o), nonpharmaceutical interventions employed for SARS-CoV-2 are so effective that they result in almost complete absence.⁵ Second, we have some experience with, and knowledge of similar viruses. Other betacoronaviruses demonstrate significant seasonality, and SARS-CoV-2 is behaving like its cousins. As we retreat indoors with shorter and cooler days, this virus will follow and increased transmission will occur. Finally, a complex interplay exists among infection and recovery, potential vaccines, and emerging therapeutics. The durability of immunity, be it from infection or vaccine, needs to be better understood. 

“Science is a very human form of knowledge. We are always at the brink of the known; we always feel forward for what is to be hoped. Every judgment in science stands on the edge of error and is personal. Science is a tribute to what we can know although we are fallible….” – Jacob Bronowski, The Ascent of Man⁶

We are all in this together: Early in this pandemic, I wrote to a couple of friends who were living in areas with significant COVID-19 activity, seeking their advice on how to approach the coming months. Although I was interested in the best evidence for primary care and public health practice, the most valuable thoughts were shared by a general practitioner in the UK:

“Remember we will emerge into the other side, and so we need to be positive about how we live today because there could be some upsides – maybe expectations will change – maybe we will decide to re-prioritise what is important to us and maybe this will mean greater community cohesion and less 'me-me-me' planetary destruction…remind yourself, your family, your friends and your colleagues of the key ingredients of well-being: take time to centre/ meditate (faith can be important here), time with people, time with nature, healthy food, exercise and sleep.” – Alastair Hay, MD (3/17/2020)

The pandemic of 2020 is not going away soon. It will continue for months, and, as we transit with it, we become part of it as it becomes part of all of us. Through this time of wonders as well as of pain and loss, it’s important to remember the importance of community and of human touch.^7,8