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2020 MEDICAL YEAR
IN REVIEW

the reports of a novel virus with severe health consequences for the tually to friends and family, or do other things, online of course. I am
elderly and rapid transmission but continued to feel confident that it not making trips out and am sheltering in place as we have no idea of
would be contained. I traveled to San Francisco for a medical meeting the time course or seasonal pattern of this virus. Bexar County Medical
early in the month. There I stayed with family in Oakland and traveled Society (BCMS) meetings are online, so no more fighting rush hour
each day on public transportation to the meeting. I began to be con- traffic around 1604. Friends are” Zooming” 2-3 times a week to check
cerned about seasonal influenza from people near me coughing and in, and grocery stores are going online for store pickup or delivery.
sneezing but took no precautions beyond cringing. As the month went Small businesses and restaurants are closed and in a panic. People are
on, a few cases were identified in the U.S. and some precautions were losing their paychecks, jobs are shutting down and Congress is meeting
taken, but travel was not banned. emergently. Death and infection rates are rising as the U.S. becomes a
major world focus, a title dubiously given by monthly infection and
March 2020 death tallies. A global pandemic has been declared by WHO. Travel
I left the office to work from home in mid-March. I turned off the
lights, closed the door and thought of Pompei. Cancelled: leave re-
quests for weddings of nieces, a weekend with out of town friends in
the Hill Country, homeowner’s association meeting with neighbors,
golf with friends, gym workouts, grandchildren’s schools and haircuts.
My older brother died suddenly and catastrophically in a California
nursing home, was buried in Chicago next to his wife, and we have de-
layed the memorial. We do not know but wonder about the infectious
cause of his death.
We stocked up on toilet paper, hand sanitizer, canned foods, clean-
ing supplies, dried beans, rice, and nuts to prepare for the great un-
known. Religous services and classes left the buildings and transferred
to video conferencing. The virtual world has become more complex.
We see images of people, hear familiar voices, but are not as coordi-
nated as we were; a new asynchrony.
People are infected and dying in greater numbers but the death rate,
testing, protective equipment, and ethical decisions as to who gets ven-
tilators are unclear. One of my older mentally capable friends voiced
concerns about whether he would receive ventilator management if
needed or whether he would be a “low priority”. The national approach
is to let each state respond in their own way, but is this the best or most
equitable approach? Other countries have had national coordinated
responses. Travel is unlikely for a long time. Those at greatest risk are
living or working at nursing homes, homeless shelters, prisons and jails,
meatpacking plants, and anywhere one is unable to social distance,
wash hands, or take other precautions to prevent airborne spread.
Clean water, soap and sanitizer, nutrition, safe housing and access to
medical care have become essential to prevent infection; these are
clearly the social determinants of health. Containment now is an un-
likely goal.

April 2020
Basketball tournaments are cancelled, pro sports are halting as play-
ers turn COVID-19 positive, and my sports viewing habits are chang-
ing as I wean off televised games. On the plus side, I have freed up
10-20 hours each week to read, watch dramas and mysteries, talk vir-
continued on page 20
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