Prologue

At some point, you have to stop writing. Even if you don’t stop thinking about what you’d write. I closed the book, so to speak, in March of 2021, just over a year after my first entry. It felt right. One viremic orbit around the sun comingling with the dawn of a different pandemic trajectory. Hope born by the lightening quick development of vaccines, years faster than any prior immunization miracle. Hope dashed by the further decay of civility and mutual respect. Somehow, in too many ways, the virus stopped being the enemy.

It’s easy to forget the beginning. In the spring of 2020, as an ER doctor, I assumed I’d get Covid-19, and then just wish for the best. The reports out of Italy were chilling. Doctors, nurses and priests dying by the scores. Being at the bedside had taken on new meanings: a stark personal risk as well as being a vector of disease to any and all in my sphere. It wasn’t until March 21, 2020, that I wore a blue surgical mask during a shift and, even then, it was a bit of a wrestling match with the infection control department. We had limited quantities and no predictable resupply. In other notable metrics, we had barely any testing and no meaningful turn-around time in results. We had no experience diagnosing or managing this novel disease and no specific treatments of any kind. Each day seemed to herald a new shortage of medications and/or equipment. On a personal level, despite being in my third decade of emergency medicine, it was difficult to trust that I knew what I was doing.

Early on, even young adults were being hospitalized in large numbers for hypoxia (low oxygen saturations). The Covid hot spots were straining their health care systems and those charged with caring for the ill were themselves getting sick. And the ultimate bottom line…we had no idea how much worse it might get.

Life had just gotten exponentially more uncertain, save one bedrock. Essential workers in healthcare and in other frontline endeavors such as cashiers, people stocking shelves, truck drivers and those fulfilling orders in warehouses kept showing up at work. They kept shouldering the personal and family risk to make sure that everybody else had the necessities: food, water, power, transportation and healthcare.

When I stopped my regular journal entries in the spring of 2021, the more transmissible Alpha variant was soon to be the dominant strain. Then Delta brushed it aside just a few months later, and many thought Delta was about as infectious as Covid might get. Just half a year later, Omicron would render Delta obsolete a month after landing on any shore. Now, the multitude of Omicron sub-lineages are even more contagious and demonstrating an evolving patchwork of immune escape. Nobody, regardless of their politics, education or intellect, can assuredly predict the future.

As I write these words, in May of 2022, well over two years into the pandemic, I’m amazed by the lack of humility exhibited by so many. If people look in the mirror and think they haven’t been Covid Wrong several times, well, it’s hard for me to take them seriously. I’ve definitely made my mistakes. At this point, I’m certain of only two things. First, if the virulent Delta variant had emerged before any vaccines were available – either its de facto wave in the summer and autumn of 2021, or sometime earlier in the pandemic – it would have been a blood bath. Second, if a far more deadly variant or disease emerges and sweeps around the world, little will change. If it’s ten or fifty-fold more lethal, or kills children at a dizzying rate, I don’t expect people’s behaviors to be much different. A pervasive anxiety will again envelop a large swath of the population. For a great many others, the megaphones of hoax, disinformation, scapegoating and personal liberties will be at least as prevalent.

Everybody now sees the world as getting more autocratic, though each side points accusingly across the divide. We are no Michelangelo fresco…fingers destined to touch in creation rather than destruction. Covid has been like those harsh crackling tones that startle us when they burst forth from our car radio, announcing a test of the emergency broadcast system. Covid has been a test. A test about whether we are willing and able to evolve. In this moment, it seems tragically ironic that instead of utilizing what this virus can teach us about our common humanity and shared destiny, we are instead willfully embracing false gods of global interconnection.

In just over a handful of years, as distant relatives of Covid still circulate among us, about 1 in every 15 lights in the night sky will be a satellite. A circumstance to ponder. In an effort to facilitate greater connectivity we will instead dissolve our most elemental bond: the unadulterated night sky, the most universally shared experience that has ever graced our planet.

Beyond taking people behind the Covid veil of an emergency department and doctor, I hope this book will, in some small way, birth or strengthen the resolve that we must find a way forward together. Alas, for now, the planetary Covid nose swab has been performed and the results are in. We have chosen to be separate and apart from each other and all else. Unless we change, such will be our fate.

Steven Zlotowski, MD
May 2022