July, 2020


By Michael J. Katin, MD

Note: June, 2020, was to have been the final column dealing with SARS-CoV-2. Consider this month's column the first column of the second wave.

Also Note: Since Richard Nixon there have been dozens of persons named as "czars " overseeing specific projects, including an Ebola czar, an economic recovery czar, drug czar, energy czar, a Mideast Peace czar, even a TARP czar. Why no SARS czar?

So far in 2020 we've had to deal with Presidential impeachment, a worldwide pandemic, significant impairment of international and even domestic travel, record-setting heat, giant Asian murder wasps, Saharan dust storms, protest, and monumental disruptions, but the most insidious development has been.....the proliferation and acceptance of virtual event scheduling.

As with many other debacles (the introduction of rabbits into Australia, the League of Nations ) this one started with good intentions. Once it was established that most people didn't have the perspicacity to adopt behavior patterns to prevent against spread of SARS-Co-2, and, to be fair, with wildly inconsistent recommendations from the World Health Organization and the US Centers for Disease Control, the medical overlords decided to take matters into their own proverbial hands to try to protect physicians. This was necessary considering that physicians tend to be, as a group, the least cognizant and open-minded about taking direction and changing behavior patterns.

The first two interventions included keeping patients away from doctors and then keeping doctors away from other doctors. Telemedicine may be the wave of the future but in the recent past was used only when availability of practitioners in a geographic area was limited, or when a highly complex medical condition was involved. Patients were already concerned about making extra trips out of their homes and risking exposure to SARS-CoV-2, except for essential trips to the grocery store, hair stylist, or golf course, and were amenable to having medical appointments through Facetime, Skype, Doxy-me, or other modalities. Physicians were accepting of this since it eliminated the need to actually touch the patient and restricted access to spouses and other persons who could interfere with keeping appointments on schedule. The next part was to protect doctors from other doctors. It seemed improbable that holding hospital staff meetings and tumor boards could be done without attendees being able to refrain from coughing on each other, touching each other, hitting each other, or sharing Styrofoam cups. The solution was to minimize or eliminate department meetings, to free up administrators to do whatever they want without physicians interfering, and to hold virtual tumor boards, still able to show imaging and pathology studies on line without everyone having to be in the same room. This is now the situation in the vast majority of hospitals, still allowing input by multiple specialists into management of a case but without discussion on the way out of the room about what they really think of each other's opinions

Unfortunately, the desire to protect medical personnel from each other and from humans then took a major leap forward, with, one by one, cancellation of national and international meetings. Lollapalooza, the Montreaux Jazz Festival, Reading and Leeds Festivals, South by Southwest, Coachella, Bonnaroo, and even Cruel World Fest were all axed. The April, 2020, edition of this column presciently questioned whether the annual meetings of the American Society of Clinical Oncology and American Society for Radiation Oncology would be cancelled, and, indeed, that has occurred, and, for good measure, the annual meetings of the American Association of Cancer Research and the Large Urology Group Practice Association as well (fortunately, the Association of Freestanding Radiation Oncology Centers 2020 Annual Meeting is still scheduled for October 2). It will now be determined whether progress in oncologic science can be achieved when scientists are not brought into contiguity with each other, particularly over social events sponsored by altruistic pharmaceutical industrialists.

Despite trepidations, I checked out the website for the American Society for Radiation Oncology Annual Meeting, with the slogan, "Global Oncology: Radiation Therapy in a Changing World" -- could that be any more ironic. It is possible to register for "a full Annual Meeting experience," including admission to educational sessions and the Exhibit Hall, with all the special events, including the Presidential Symposium, Keynote sessions, and even Master Classes and eContouring sessions (at a slight additional charge). I would be particularly interested in participating in the Exhibit Hall Virtual Happy Hour (I'm not making this up) in which, I assume, the atendee has unlimited access to one's own refrigerator and liquor supply, unless ASTRO has arranged for DoorDash to deliver refreshments to each person's home at that very hour.

It is certainly hoped that in a few months SARS-CoV-2 will have run its course and activity can return to 2019 standards. Continued social distancing might have some advantages, however. When performed adequately, there will unquestionably be a decrease in other transmissible diseases, including Influenza A and B, chlamydia, the common cold, bedbugs and impetigo, although offset by a rise in malaria in countries outside the United States where hydroxychloroquine is no longer available due to stockpiling by boomers.

In the meantime, our virtual existence will continue. It is noted that the adjective "virtual" is defined as "almost or nearly as defined, although not completely," derived from the Latin virtus, meaning 'requiring multiple condescending IT persons to produce." In other words, the definition indicates that virtual projects are close to being ok most of the time, sort of like knowing the airliner you're on will have a 90% chance of safely landing. Probably close enough for government/medical work.
Although I'm still somewhat concerned about the outcome of my virtual dental appointment coming up on Tuesday.


To the tune of "Son of a Preacher Man"

2020 had just begun
And a global pandemic was coming on
People feeling short of breath on walking
Couldn't taste and started coughing
WHO had all the wrong opinions
Someone needed to make decisions.

The only one we should have to guide us
Is the head of the CDC
To work with facts and without a bias
Is the head of the CDC
Yes, it should, it should, it should
Oh, yes it should.

So the virus kept propagating
The obvious was denied
Most people were vacillating
Couldn't keep from congregating
Wearing masks was emasculating
Essential jobs were ill-defined.

Then who was picked as the one to lead us
It was the President's son-in-law
Well-equipped with the skills to teach us
It was the President' son-in-law
Good choice, good choice, good choice
Obvious choice.

Now we're still in the middle
Of figuring how we're coping
Locking down and reopening
Trying hard to make it work
Dr. Fauci and Dr. Birx
Dr. Oz and Dr. Gupta
Who you believe is really uptya.

But the only one who should really guide us
Is the head of the CDC
"Disease Control" is the giveaway
In the name of the CDC
Oh yes it is, it is, it is
Obviously it is.

Asteroid JF1 Countdown: Asteroid JF1 will be impacting with or passing by Earth May 6, 2022, which, counting May 6, is 675 days from now. Plenty of time left to stock up on batteries, plywood, hand sanitizer, and bubble wrap.

Thanks to Randolph Knific and Mark Sobczak for valuable input regarding this month's column.