Last week, many people were astonished to hear that Dr. Kurt Kloss, an emergency room physician in New York, reached out to a Facebook group for some 20,000 of his colleagues seeking advice about how to handle the coronavirus outbreak. “If you were in charge of Federal response to the Pandemic,” his post began, “what would your recommendation be?”
The question wasn’t just hypothetical. Dr. Kloss’s daughter is married to the brother of Jared Kushner, who had been put in charge of the White House response to the pandemic. But many people commented in alarm: Crowdsourcing medical advice on social media, is that a reliable way to get life-or-death health information?
As an emergency room doctor at the front lines of the pandemic, however, I wasn’t surprised. I’ve been working back-to-back shifts at NewYork-Presbyterian Hospital, where the state’s first patient hospitalized with Covid-19 is being treated, and have had several patients test positive for the novel coronavirus. And like many of my colleagues, I have been gathering information from Facebook, Twitter and other social media outlets.
One private Facebook group I’m a member of, created by Dr. Kabir Rezvankhoo, an E.R. and intensive-care-unit doctor in Texas whom I used to work with, is reserved for doctors who have or are likely to care for critically ill patients with Covid-19. The group quickly grew to nearly 15,000 members. When I asked Dr. Rezvankhoo why he initiated the group, his reply was simple: “Because information on the new coronavirus is difficult to come across.”
He’s not the only one who feels this way. Another Covid-19 Facebook group I recently joined, which is less restrictive and intended for all health care providers, has more than 100,000 members. The group’s administrator says hundreds of posts come through every hour.
For the past few weeks, after I get home from my shifts in the emergency room, I scroll through Facebook pages on my laptop, getting firsthand stories from doctors in Italy, China and Iran. I scan through their patients’ ultrasound and CT scans, review their blood tests, read day-by-day accounts of their clinical progress and listen to retrospective thoughts of what worked well — and what didn’t.
Then I open another browser tab and pull up Twitter, perusing the page for any new information. I pause at a small study here, a letter in an academic journal there. Any clinical information I can find, even an anecdote about a single patient, feels very useful.
This is a new virus, and best clinical practices about how to treat the growing caseload of infections is scarce and evolving. I don’t say this to frighten patients; I understand how they feel.
I, too, am distressed by the ever-changing guidelines, the seemingly inconsistent messages, the uncertainty. One day it is strictly mandated that we are to wear one type of mask; the next day, we’re told they’re unnecessary. Each evening, different instructions arrive by email, as policymakers try to piece together the latest evidence as fast as they can.
But as I continue to open the Facebook group page each time a bell alerts me that a new post has appeared, I realize that doctors have to readily concede that we don’t always know what to do next, that we still need to figure out the best way to care for patients.
More than a century ago, Dr. William Osler, a founder of Johns Hopkins who revolutionized American medical education and training, said, “Medicine is a science of uncertainty and an art of probability.” He understood that medicine is not exact. It requires asking questions and openly expressing our concerns and our doubts — a surrender of confidence in our own knowledge, an admission that we may find ourselves in unfamiliar territory.
Today, doctors are fortunate to be able to do this in online forums that span the globe. We are able to freely admit what we don’t know about this new virus, to try to translate what our colleagues in Italy and around the world have learned to the hospitals where we currently work.
I also get to gauge how my fellow doctors are doing mentally and emotionally, how we’re coping with the uncertainty of what’s to come. Many compare their experience to being sent to the front lines of war, in some cases unarmed as supplies of masks and hand sanitizers run low. Others ask if they should move out of their homes so they don’t potentially expose their families to infection. We wonder how the two critically ill E.R. doctors in Washington and New Jersey are doing.
Under normal circumstances in the emergency room, before this pandemic, I admit that I often felt too busy to consistently make eye contact with my colleagues as we rushed about to care for our patients. But since the coronavirus outbreak, we all somehow manage to look at one another.
With only our eyes showing behind our goggles and face shields and the rest of our expressions covered by masks, my colleagues and I are still able to communicate without saying a word. Sometimes, we exchange looks of bewilderment and confusion. Other times, I see the same fatigue and frustration reflected back at me. Occasionally, I glimpse my own fear in their eyes.
Most often, though, I see the conviction that we will get through this. We may still be trying to determine the specific clinical prescription to follow to most effectively care for patients critically infected with the new coronavirus. But we will continue to treat the sick as we have always done, even in the face of great uncertainty.
Helen Ouyang (@drhelenouyang) is a writer, doctor and assistant professor of emergency medicine at Columbia University.
