Hope is not the conviction that something will turn out well but the certainty that something makes sense, regardless of how it turns out – Vaclav Havel

I know, I know.  I wish this note was one spelling you off work because we were out late drinking beer, but it’s not. That would be neither ethical nor timely.  This is about something else: hope.  

Like so many of my colleagues, I’ve headed towards the interface of health and disease since I knew there was such a thing. Conflicts, malnutrition, poverty. Outbreaks. If I can reassure you about one thing, it is this: Covid-19 doesn’t stand a chance.  

We are too formidable. At the instance of infection, as the virus hijacks our own inner machines for its puzzling and short facsimile of a life, our body responds. Interferons and killer cells take the battle to the blood, and nearly every time, not only beat it back, but emerge so much wiser, the same virus doesn’t even get past the skin next time. It’s why children are sick so much. They are learning. And as is often reported by parents of an infant, after the fever: growth. 

What contributes to the healthy version of it, at an individual level, often (though not always) maps on to the larger system in which she is nested. What is good for cells, is often (though not always) true of your body. What allows a body to thrive, often true for a family, that family’s health linked to its community, city, country, planet. As we come together, like it is for our immune system, we form a more effective response and emerge stronger. That strength looks less like hoarding toilet paper, more like giving away your second last roll.  

Second last. No one really likes a martyr. Difficult to trust their motivations. Not that fun at parties. The good news is, though, taking care of ourselves looks very much like taking care of our family and friends, through them the community, and on like that. I want to tell you what I know about it, but first, a couple words about the epidemic.  

I’m no expert, but have lived through a couple. In Sudan with MSF, measles, and at home (SARS). I was also working as a medical editor for the latter, and it was my job to follow the curves, the scientific collaborations that addressed it. A good friend of mine contracted SARS. She is well now, and I work beside her almost every day. 

I’m fond of the metaphor of systems repeating themselves in larger more complex ways, and one of my conceits is to think of cities (and countries) as living things. One of the early lessons you learn when studying epidemiology, in an effort to integrate science into a clinical practice, is to answer the question “is this data talking about my patient?”. Meaning, is what happened elsewhere likely going to repeat itself in front of me? Right now, I would say….not necessarily. Or at least too soon to say. 

We’re definitely on guard, and it is impossible to describe the gratitude I feel for those of you who have truly engaged in physical and social distancing.  You have saved the lives of me and my friends who work in the ER. Not just doctors and nurses, but unit clerks, security guards. The people who bring food to a person’s bedside.  Your commitment to stay home, stressed as worried as you are, has given us the opportunity to prepare. We have cleared out beds, and are finding space for the homeless who have no places to self-isolate or sleep.  You did this. You. Thank you so, so much. Some of you in this community know I am mourning my mother, suddenly and too soon gone. She would be so reassured that in her absence, there are many who are taking care of me.   

And not just me. Others, all over.  While people may be similar enough around the world to be susceptible to this infection, two factors remain different. The health system, and timing. In China’s case, so many cases occurred quickly. In Italy’s the same. Through you, we have time to steel ourselves, from SARS, lived experience, a highly integrated public health system, clinical trials on treatment and prevention, some on vaccine that the smartest people in the world are smithing right now.  Even with these, we have something even more likely to flatten out the curve on the way: spring. 

Viruses don’t do great in the sun. Further, transmission is less as people spend more time outdoors. While it is common to see a flu outbreak in January, it is quite rare to even see a case in June. Can’t say this will be true of coronavirus, but if I was an odds maker, it would be a strong consideration. 

All that to say, like any aspect of the future, what will happen is fundamentally unavailable to even our best guesses. The software program of our humanity has embedded in it a negativity bias, which is great if you are deciding whether to climb a rotten tree, but not so good if you’re scanning news items designed exactly to exploit that bias, so you click and share and instead of getting closer to the truth, you get more advertisements. I would say, in the absence of divination, we are wisest to prepare the best we know how at the moment.  

For now, this is what I mean by that: stay at home.  Please please please. Wash your hands. A lot. If you are symptomatic and live with others, wear a mask.  They should too. My friend who got SARS was quarantined with her husband, when she was at her most infectious, and she was such a boss about it, he didn’t get it.  That’s love. Be that person. Lots of tips here

Though my jam is allopathy, ie, finding disease and beating it back, there is another valid approach: strengthening the host.  The easiest win? Get out of your own way. Stop vaping/smoking. Each causes turbulence in the immune system in the lungs as you inhale that junk, and the virus can party its way right in.  F that virus. Shore up the systems. Eat well, mostly vegetables, not too much. Drink water. Meditate .  Take frequent and well-spaced walks outside.  Learn the primary series of ashtanga. Hug your kids. Organize your photos. Write a thank-you letter. Listen to my book. Ok, ok, any book. I’m really enjoying this one. Spellbinding.   

Lean into this time. It is a special one, and through it, we will better know ourselves.  Our bodies, our neighbours and friends, the people on our street who smile and cross when you approach on your well-spaced walk.  In the end, it will be well. I know we are looking to the future with anxiety, a feeling often indistinguishable from excitement. What will occur? Who will we show ourselves to be?  

Resilient. Adaptable and responsive. Like our white cells, stronger together.  It is when we lose the integrity of a body, a family, a community, a city, a society, a planet, that sickness creeps in, makes us less than what we are.  

It is at times of challenge, like the viruses tumbling through our blood, that we find out how capable we are. Hoarding things for ourselves will make us sick. Sharing the best of what we have makes us well, even in the face of illness. That is what will turn this around. That’s what did it for SARS. Watching collaborations supersede nationhood and the typical academic poisons was one of the most beautiful things I’ve witnessed.  There is something that moves through us when we come together in this way, to support the health of strangers even far away, that moves us closer to a world that makes sense. I’m not sure what that thing is, but I have dedicated my life to it.

Easy to say, tough to live.  Like it has been with every epidemic since the beginning of time, it is the vulnerable and weak who take the eventual toll. So it will be with this. A very small part of me wants us to see what it’s like to have health systems overwhelmed with cases, so when it’s over, we can point to Ethiopia and places like it, say  “Look. It’s always been that way. Now that we’re cool, the work’s over here.” A larger part of me, though, wants my dad to be well, you, my Ethiopian friends, so we can avoid the pain of losing someone close to us before they let loose all the love they hold into the world. 

I will do what I can to keep you updated on what it looks like from my angle, inside the Covid clinic.  I have been doing daily facebook “live” updates on the situation there and in the ER, what I have learned from looking at the curves and watching the science.  We then do a 40 minute meditation. There are some up on my page right now if you want to get a flavor, and see if they suit.  

Oh, Jeff is back from Costa Rica, isolating and well, missing his family like crazy.  You’ll hear from him soon. Erin is just up the street, and is working hard on making CEC happen on the regular, moving us online for the time being.  We’ll let you know if this summer’s retreat is a go, because I know we would all love to sit with you.  

Until then, may this time tell us more about who we are, and what we need to be free. May the growth after be healthy and long, and it turn our minds towards what else holds us back. Love.