President's Message/Editorial: The Year of the Fires

EDITORIAL Brian Grady, MD, and Steve Heilig, MPH

THE YEAR OF THE FIRES

This past year began relatively normally in January but already with rumblings of a new pathogen spreading around

the world. The rest, as they say, is history, but we are still very much in the midst of it. As we write this what looks to be a bigger surge in infections and hospitalizations than first experienced last spring is building. Our region at least succeeded in heading off the worst of it last time, and we hope that experience repeats. But there are no guarantees, and our fear is that the influenza pandemic experience of a century ago, when the autumn surge brought far more morbidity and mortality than the first one, might be repeated to at least some degree. Back then, people let down their guards, shunning such relatively simple interventions as masks and distancing, and the results were dire.

Our state has already had far too many Covid cases and deaths; at this point, further mortality largely should be seen as failures of prevention, as we know better about how to avoid transmission. But widespread misinformation, political malpractice in high places, and human stubbornness, to name it politely, has bedeviled our nation’s response with some devastating results. It is something to mourn deeply – and to work to ensure it does not happen again. And here we must acknowledge that even some of our own leaders, who otherwise have done so well, can slip up. We are confident that lessons are learned and better behavior modeled for all.

That said, our own medical, public health, hospital, and political systems are again mobilized to minimize harms. If there is an upside to this pandemic that we see regularly, it is in how so many have responded so well. By February our local public health leaders were warning of what might be coming and considering hard choices in prevention. Capacity planning at hospitals and health systems was mounted at a crisis pace. Education of clinicians and others about all aspects then known about Covid-19 was quickly underway. And soon shelter-in-place and other community restrictions were enacted that seem to have had a major preventive impact, even though the major economic disruptions cannot be denied. Again, we are very concerned about ICU and staffing capacity here, but hoping and working for the best.

Crucially, two of the most impressive medical responses of modern times are already coming to fruition. Treatment advances, arrived at via necessity and innovation as the first wave hit, have made it so survival rates among those most acutely ill and hospitalized look to be significantly improved. Second, the development of what look like very effective vaccines has occurred at unprecedented speed. These are heartening and inspiring developments, for which we are grateful. We are speaking out so that vaccines get first to those who need them most, including frontline clinicians. Locally, our SFMMS rapidly presented much COVID-related education and advocacy, often in partnership with other key organizations such as the San Francisco Department of Public Health and UCSF. We have also tried to help in pushing for safe re-opening of schools, and have provided PPE to fill in some gaps. Local physicians have expressed much gratitude for these efforts, which makes it all worthwhile. But we are acutely and sadly aware that many practices have been severely strained, and even shut down, by the pandemic. We have tried to offer some assistance there, and to provide some “wellness” resources that at least somewhat ameliorate the undeniable stress and burnout this pandemic has only worsened. We will continue those efforts, on everybody’s behalf.

This epidemiological crisis is far from over. The varied responses, depending upon where you look, have been both superb and disgraceful, effective and disastrous. It is not overtly “political” to note, as related in these pages, that healthcare was on the ballot in the recent national elections and that medicine and public health, as professions, now see some hope of much improved national leadership. A pandemic outbreak can be likened to an explosion of fires, requiring all hands on deck to extinguish, and vigilance to prevent further outbreaks. All first responders and “essential workers” deserve our gratitude and support.

Taking inspiration and solace wherever it might be found, we close with a quote from none other than Gandalf the Wizard, of J.R.R. Tolkien’s Lord of the Rings, named the best British novel of all time by those who know. The actual fires and smoke that enveloped our region this year reminded many of the darkness threatening his imagined Middle Earth. Tolkien himself fought in some of the worst battles of World War I, and then lived through the horrors of WWII. Those experiences no doubt informed his storytelling, wherein he had one reluctant hero lament about war that “I wish it need not have happened in my time.” Gandalf replied, "So do I - and so do all who live to see such times. But that is not for them to decide. All we have to decide is what to do with the time that is given us.” Wise words, and we thank you for all your own contributions, and hope for a healthier, safer future, including whatever holidays you may be able to carve out and enjoy. Our best to all for the coming year. May it be a better one.

SFMMS President Brian Grady, a graduate of UCSF medical school, is a urologist practicing for two decades at CPMC, CPMC/Mission-Bernal, Saint Francis, Saint Mary’s, Chief of Staff at Seton, and has been an SFMMS delegate to the CMA, president of the CMA resident physician section, and a longtime SFMMS board member.

Steve Heilig, MPH is the Director of Public Health and Education for the SFMMS.