Will Our Country Ever Be The Same?

By John Miller, MD

I feel very fortunate.  I am staying one step ahead of viral transmission. With my career in transition, I have worked in three settings over the past three months.  

I volunteered in Zambia for three months at a rural clinic near South Luangwa National Park.  The infection had started to spread from China by the time I left, but there was hardly an inkling of what was to come at that point.  Two months after my departure, Zambia shut down and many of the expatriate workers returned home.  The clinic where I worked had very limited testing capabilities (Hgb, glucose, urinalysis, malaria, HIV, and a send out test for TB).  They make do working with limited information.  They also trust authority and abide by the government, both of which will help control viral transmission.  For a country dependent on tourism and foreign aid, how long until things get back to normal?

A month ago, I was working in the urgent care in Zuni, New Mexico. It was very busy with a lot of patients with cold and flu symptoms.  The hospital had started separating sick from well and asking patients with symptoms to wear masks.  I remember feeling thankful for that.  I saw a patient with cough and body aches who I would have liked to test for COVID-19.  He had recently traveled to Oklahoma to California and back trading feathers, but did not have an adequate fever for us to get one of the limited tests from the state lab.  The first three positive test results in New Mexico came the day after we left.  Several cases in the area then came out of a church revival in the Pinehill area on the Navajo reservation near Zuni.  

 The risks of infection are much higher on reservations than in other parts of the country.  There is a huge burden of chronic disease as well as chronic underfunding and staffing shortages in the Indian Health Services.  In addition, households are multigenerational and extended families are inter-reliant to meet basic needs. Despite this and having positive tests among Zuni tribal members, religious leaders controversially decided to hold their traditional night dances last weekend before imposing a curfew two weeks after the statewide stay at home order by New Mexico’s governor. Zuni’s first death from COVID-19 was reported today.  How many cases and deaths in Zuni will there be in a week?

 I am now working in the ED on the Blackfeet Indian Reservation in Browning, Montana.  There are no known cases on this reservation, and we have been testing.  There was a nursing home outbreak that led to three deaths in a neighboring county to the east, but now there are no new cases in three days.  To the west, a more populous county continues to have new cases.  I read that the statewide stay at home order is seen by some as an infringement of their constitutional rights.  Should church services and the right to assemble for any reason be considered essential?  “Will our country ever be the same?”

I was a bit slow to accept the need for social and physical distancing.  Our spring break ski road trip with another family was only cut short when all of the resorts closed.  As I write this though, I am on a break in the ED, wearing mask and goggles as I do at all times.  With no COVID-19 cases and the hospital encouraging people to stay away, the ED has been slow.  Most of the ED cases have been patients who need emergent evaluation.  It has been nice.  It leaves time to reflect and try to prepare for what is coming.

I know it is coming, even to one of the most remote counties in the country.  I am told that there is a flow of methamphetamines from Seattle to Spokane to Browning.  It seems like just a matter of time.  I am healthy, adaptable and flexible so know I will get through this.  As an introvert, I am actually enjoying the additional time to myself and with my family.  That part has been really great.

I am challenged, though, to accept those who denied this was coming, and who are still denying it.  Even more disturbing are those who know it is coming but still want to assemble, to grandstand shouting “Give me liberty or give me death!” through some grandiose view of themselves and their struggles.  This is not the revolutionary war.  It’s not except for a small number of anti-government folks who are actually not that far from main stream in the mountain west. 

This comes up from time to time, living on a blue island in a sea of red.  That is Missoula in western Montana.  One former physician colleague is still comparing the number of flu deaths last year to the number of COVID-19 deaths.  He is not alone in these parts, and they get to have it both ways.  Oppose the current mitigation as unnecessary and then tout the results of it as evidence that denial was justified all along.  They might say it is just their “personal, educated opinion” but it seems their concern for their beleaguered President’s reelection chances exceed their concern for the health of their neighbors and patients.  

 I guess it shouldn’t bother me so much, but I guess I expect more, at least at a time like this.  Can’t we all just put politics aside?  “Will our country ever be the same again?” We can only hope that some things change.

John Miller, MD is a family medicine doctor in Missoula, MT.