Two Years of COVID: Meeting the Many Challenges

Michael Schrader, MD, PhD

(Dr. Schrader’s remarks at the SFMMS Gala were especially well-received, outlining our multifaceted response in a time of crisis. We asked if we could share them here - The Editors)

One in 400 Americans have died of Covid-19. We are nearing the milestone of 1 million American deaths which is almost certainly an undercount. But a recent model has projected that 2 million Americans were saved from Covid deaths by our efforts.

People ask me if I could ever have imagined the Covid pandemic. Of course, I reply. We have seen pandemics and near misses. Polio, AIDS, Zika, Ebola, WestNile,SARS,MERS,Swineflu.Beforethat,smallpox,1918flu, Bubonic plague, cholera. It has happened before. It will happen again. It is still happening.

I came to San Francisco as a medical student and then an intern and resident during the AIDS epidemic. I was drawn to the AIDS crisis because I thought it was the most important health issue of the time. As a 4th year medical student I went to Africa for 2 months to witness the care of AIDS there. I learned HIV care in Ward 5A and Ward 86 of SFGH and later in Floor 5 NorthAatMtZion.Wewerefightinganimpossiblebattlewith nodefinedend.Andsomehowitendedwithproteaseinhibitors, a pharmacological revolution.

Those were tough times: an end stage AIDS patient was an incredible time and emotional investment, and a learning experience.AIDSpatientswerevilifiedanddiscriminatedagainst andfeared.Ican’tdescribewhatit’sliketoworkonthecuspof life and death of young patients. But we lived this: succeeded and failed and lived the drama of life and death every day. I would like to think we were better for the experience but no doubt it changed many of us forever. I trained as a physician scientist and when IfinishedmyresidencyIbrieflyflirtedwithbecominganAIDS researcher. Ultimately being a clinician is what I enjoy most.

George Santayana said: “Those who cannot remember the pastarecondemnedtorepeatit.”It’sactuallythesamedealfor those who do remember the past but at least it gives us some perspective.WefirstheardaboutCovid-19alittleovertwoyears ago.AnotherSARScoronavirusinitiallyidentifiedinWuhan, China. Wuhan was locked down. And we waited for whatever would come next. Waited for that inevitable ill wind to blow it ashore. There was an outbreak on a Princess cruise ship and the passengers were stranded offshore waiting. Governor Newsom formulated a plan to offloadthemintoquarantinein the east bay. He called the CMA and they called SFMMS for some white-coats to stand behind him during his press conference. This was a successful containment operation but it was too late to stop the tide. It was already here. Next Covid was seemingly everywhere, sweeping through our nursing homes and infecting our front line physicians. We navigated the quickly changing recommendations to attempt to slow the spread and avoid overwhelming critical care. Dr Ameena Ahmed had SFMMS commission a graphic video explaining the rationale for slowing the spread.

Dr Grant Colfax and Mayor Breed declared a city and county lockdown ahead of other municipalities. Dr Matt Willis organized the Covid response in Marin and was an early victim of Covid himself. He recorded and published his personal account of illness. Our frontline physicians in the ED, hospitalists, critical careandinfectiousdiseasewereamongthefirsttofaceCovid. Covidtestswereinshortsupplyanddifficulttoobtain.SFMMS provided information and guidance about availability.

Physicians were rapidly running short of PPE. The SFMMS secured a supply of K95 masks from China. Longtime member Dr Sandra Hernández facilitated a major grant to fund them. They are stillbeingdoledoutfromSteveHeilig’sgarage.CMAdistributed millions of dollars of PPE through county medical societies. SFMMS members loaded boxes into cars at AT&T ballpark for both member and nonmember physicians.

Then-President Donald Trump gave destructive wrong advice about hydroxychloroquine and bleach. People died from following his wrongheaded nonsense. We debunked this misinformation as fast as he could spew it. We reached out to media. We educated our patients. Then Trump tried to change Covid into a racial epithet callingittheKungflu.Therewasanupsurgeofanti-Asianand PacificIslanderhatredfueledbythiscarelessandcruellanguage. Dr Joe Woo organized a press conference at Chinese Hospital where many prominent politicians and several SFMMS members spokeoutincludingDrWoo,DrBethGriffithsandDrBrianGrady.

School closures were a continuing source of controversy and were less than well managed by the SFUSD. Dr Kim Newell Green advocatedforschoolreopeningforthebenefitofthehealthof children. In addition Dr Newell Green moderated the ongoing CMA Covid webinar to keep us abreast of the latest thinking and developments. WhenthevaccinesfinallybecameavailablethroughTrump’s operation Warpspeed many of us volunteered and vaccinated at the City College Drive Thru and later at Moscone Center. Dr Monique Schaulis worked at this Kaiser and Dignity sponsored vaccination effort. Dr Joe Woo and Self Help for the Elderly led an effort to vaccinate the homebound. SFMMS co-sponsored and many of us volunteered to vaccinate people in their homes.

Throughout all of this our doctors have tested and treated patients in our clinics, nursing homes, and hospital wards. We have disseminated information and debunked misinformation. We have provided comfort to our patients and support to each other. I am honored to serve you as the President of the San Francisco Marin Medical Society. SFMMS is a professional collective founded more than 150 years ago to improve our profession.Werecognizethattheindividualisbenefitedthrough thepromotionofthecommongood.Webenefitwhentheleast among us is protected. I want to thank all who came before and all who will continue to carry SFMMS forward through the next 150 years. I want to thank the SFMMS staff and leadership for their hard work and mentorship.

Physicians and our medical society have played an important role during the past 2 years of Covid. This is who we are: physicians doing our job. Working together to achieve a common goal. Medicine is a noble profession: Thanks to all of you.

Dr. Schrader chairs the SFMMS delegation (with Dr. Ameena Ahmed, newly-elected vicechair) and is president of the SFMMS.