COVID-19: Deep Thoughts and a Little Therapy

I’m not really a crier. I mean, sure, there are moments in life that make me a bit misty.  Turn on those first 10 minutes of the movie Up and on go the tears (curse you, Pixar!).  But something happened Friday that made me realize how unusual and stressful these weeks have and will be for those of us in medicine and, in particular, hospital epidemiology. 

I have worked out with a bunch of dudes early mornings, outside (rain or shine) for the past 2 1/2 years. At the end of every workout, there’s a Circle of Trust where the group leader gives thanks to someone or something higher than himself (be he Christian, Muslim, Buddhist, whatever). On Friday, to celebrate my impending 50th birthday, I led the workout.  At the end, as we gathered, I started to give thanks but had to stop. I could feel this deep ball of tears and emotion well up inside.  Couldn’t speak. Tears flowed. In front of these dudes.  And that’s when I realized, I wasn’t crying because I was turning 50 . . . this was a massive release with people I trust, and it showed me how much the past 2 weeks in particular have affected me (and I imagine many, if not all, of you).

As Mike (see also his excellent post from yesterday) has noted in an email chain, this is likely the most stressful time many of us (save maybe the HIV epidemic in the early ‘80s) have experienced in our hosp epi careers.  I told a friend that it feels like I’m strapped into a massive roller coaster ride (which I hate), climbing up that hill, sensing what lies ahead from the screams of people ahead of us (China, South Korea, Italy, Seattle, San Fran, etc.), and wanting desperately to get off the ride, realizing we cannot. 

This week, as Vanderbilt started testing, the variety of emotions hit hard. Patient #1 is a close friend, a physician, whom I didn’t know had been tested.  He attended a school fundraiser, and by the middle of the week, 10 people from that event were positive.  But I also saw resilience.  Two weeks ago, Nashville and middle Tennessee had the added hit of a massive tornado, affecting many in the area. One of which, my colleague who is the hosp epi at an affiliated community hospital, had to leave his apartment and move to a hotel, most of his and his wife’s belongings locked in a damaged building.  The next day, his hospital diagnosed the first COVID-19 case in TN.  New to the job, he handled this with grace and professionalism, even when he had to borrow a tie for the press conference because his were all locked in the damaged apartment.

This will be a marathon, and I offer some simple advice as this gears up (and I am sure others have more to offer):
  • Delegate:  At first, I was hit with every question about this outbreak, from patient education, to clinical management, to employee furlough questions.  As the weeks progressed, more people joined in the fray who could help. I quickly learned what is under my expertise (IP) and what others can handle.  No need to micromanage. You simply can’t.  While there’s a core group working tirelessly on COVID prep, there are also many in our medical center wanting to help.  We’ve used our quality abstractors to assess if clinicians are correctly ordering COVID testing per our guidance.  Our stewardship team to work on treatment options.  And even though many of us are ID physicians, delegate the clinical management of these patients to your ID peers.  Focus on the IP stuff.
  • Be decisive:  ID docs are known for their ability to opine, think, review data, which is great.  But right now, the questions and decisions are coming so quickly, we have to make quick decisions.  Some may be wrong; some may change as you learn more. We’re building an assembly line as the cars have already started rolling down the track. Some might fall off, some might not run well, but we have to keep building quickly. Don’t overthink things.  Use the science but avoid the margins.  We won’t find solutions that fit every scenario, as overthinking things can be paralyzing. 
  • Develop a bench:  If you’re the only hosp epi around, figure out who you can train up quickly.  Another ID faculty member.  Ideally one who is even keeled, can know when they don’t know the answer and ask for help. 
  • Take time out: It’s imperative that we all take breaks from this work, to refresh mentally, spiritually, and physically. Spend some time with your loved ones, even if just for an hour.  Step away from Twitter/Facebook/etc. Go for a run. 
  • Deal with your emotions:  Cry in front of people you trust.  Meditate. Write. This is why I’m back on this blog – this is my therapy. 
I’m glad people pushed us to reignite this blog, as the collective insights can help the whole.  As always, we’re open for guest bloggers.  Stay healthy, stay grounded, and, of course, wash your damn hands.


  1. Wonderful post, Tom! I was tearful as I was reading it. You speak for so many of us. Thank you.

  2. Thank you! I too am not a crier. But I've been near tears with a pit in my stomach at every incident command, town hall, daily huddle over the past 2 weeks. Now the meetings have become virtual, of course, but that feeling (there must be a German word for this?) doesn't change.

  3. Great advice Tom, stay strong we are all with you and your colleagues
    Glenys Harrington
    Infection Control Consultancy (ICC)
    P.O. Box 6385
    Australia, 3004
    M: +61 404816434

  4. Tom, I'm grateful to hear what you are going through and I appreciate you taking the time to share right now. Unlike you I am a crier and have found places to do so over the few weeks as the stressful meetings, difficult decisions, universal anxiety, and sleepless nights add up. My weakest moments occur when I try to imagine what the future will be like for my young children.

    One of the challenges that provided a significant amount of stress this past weekend was the issue of testing. Right now we do not have an accurate idea regarding the incidence of COVID-19 but we certainly know there are many cases here in Georgia. This means that any patient with respiratory symptoms or FUO becomes a potential case and I have found myself to be the last line of defense for testing. And as I try to hold the line I find that each day that goes by the anxiety level slowly ramps up. And I'm faced with a decision:

    1. Do not yield! PPE is too valuable and the likelihood of COVID-19 in this patient is very low. Field calls from anxious physicians and staff and try to ignore the fact that the patient continues to be placed on droplet precautions as suspicions for COVID-19 continues to haunt them. Thus far if an alternative diagnosis is not made or the patient is not improving I have found I can only last about 24-48 hours before relenting.

    2. Test! It might only take 3 days through our commercial lab, I hope! Well, if I thought anxiety levels were high before I was definitely wrong. Infectious Diseases doesn't even know if the patient has COVID-19, how many of us are already exposed, why wasn't anything done sooner? And even worse than the spike in fear is that we are now burning through valuable PPE that should be conserved for staff caring for patients who actually have COVID-19. Am I putting more staff at risk by not testing and missing an unusual case or mild presentation or by testing and losing the protective equipment they rely on.

    Good luck to everyone. It is incredible to see the world wide effort to share and disseminate information. I'm particularly grateful to University of Washington which has shared a number of their protocols here (I'm sure readers have seen this website but posting just in case):

    1. Just wanted to add- I went through cases with our group today. I think it was helpful to hear who we would test and who we would not- and how we would react to new information. I suggest running through "patient under investigation" cases with your colleagues so that we can hone our skills with this new disease.

      Right now I am finding that #2 Test! is not at all wrong.

  5. Thanks for sharing your insights!

  6. wrote about a paragraph in response, and deleted--way too many emotions. bottom line, balancing family and protecting our patients and staff is a terrible position to be in - thanks to you all.

  7. covid is becoming a huge pandemic for all. Around the world, it is expected that over 50 million people will lose their jobs because of this global crisis.


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