Boston Doctor Laments That Recent COVID-19 Surge Was Preventable | CAI

Boston Doctor Laments That Recent COVID-19 Surge Was Preventable

Nov 19, 2020
Originally published on November 19, 2020 2:45 pm

More than 250,000 Americans have now died from COVID-19, a devastating milestone that was "absolutely" preventable, according to Dr. Abraar Karan, an internal medicine physician at Brigham and Women's Hospital in Boston.

"We saw this all over the world. We have so many lessons we could have learned from other countries, right from the start," Karan tells NPR's Morning Edition. "These deaths were preventable."

He says he treated patients during a virus surge in Boston in the spring, and he thought if "we shared our experience, that we could prevent this in other parts of the country. And it's unfortunate to see that that wasn't the case."

Karan says that that while potential vaccines and medicines sound promising, treating so many virus patients for so long is taking a toll on hospital staff.

"At this point, it's going to depend on more than just the availability of drugs, but the availability of staff," he said. "A lot of us are exhausted."


Interview Highlights

On if he is surprised that 250,000 people have died from the pandemic

I mean, it is frustrating, but this is also the third surge that we're in now. And so after the first surge, when it happened again, despite the experience of the Northeast and us trying to put those red flags out to the rest of the country, it sort of happened again. We saw cases spreading. We saw hospitalizations then increase, and then we saw deaths increase thereafter. And so at this time, it's really frustrating more than anything.

On how 250,000 people have died despite recommendations of masks, social distancing, testing and contact tracing

The name of the game is to shrink the epidemic, to get the reproductive number below one consistently. And what that means is one person on average is going to not infect more than one other person, ideally less than one other person, so the epidemic shrinks. There are a lot of paths to get there. There's a lot of potential ways to get there. But you have to have a coordinated response and do at least a few of those things really well and consistently. And when you don't do that, what happens is cases start to rise again. And remember, they don't rise in a linear fashion. They rise exponentially. And so you have a very slow increase and then all of a sudden it starts going through the roof.

On if it is enough to get tested before going to a large Thanksgiving gathering

Unfortunately, it's not. So we have to remember, what does a single test tell you? It's a snapshot in time. It'll tell you that the day that you got the test, if you had detectable amounts of virus, if you are infectious on that day, but I could get a test today and then a few days later I may go and see my family or head to a Thanksgiving dinner, and I may be infectious at that time and I may not be showing symptoms yet.

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RACHEL MARTIN, HOST:

We're going to bring in Dr. Abraar Karan now. He's an internal medicine physician at Brigham and Women's Hospital in Boston and at Harvard Medical School. He has been treating COVID-19 patients since the spring. He's also worked on his community's public health response. Thank you so much for being with us, Dr. Karan.

ABRAAR KARAN: Thanks so much, Rachel. Happy to be here.

MARTIN: So here we are on this day marking 250,000 people who have died from the pandemic. That was a number Dr. Anthony Fauci predicted back in the spring that we could get there. And here we are. Does any of that surprise you?

KARAN: I mean, it is frustrating. But this is also the third surge that we're in now. And so after the first surge, when it happened again - despite the experience of the Northeast and us trying to put those red flags out to the rest of the country, it sort of happened again. We saw cases spreading. We saw hospitalizations then increase. And then we saw deaths increase thereafter. And so this time, it's really frustrating more than anything.

MARTIN: How did it happen? I mean, even if people could've predicted that we were on a pace to hit these kinds of numbers, there were all kinds of recommendations about masks and social distancing and testing and contact tracing. Did those things - just didn't happen in the way that we needed them to?

KARAN: Absolutely. So I think the name of the game is to shrink the epidemic, to get the reproductive number below one consistently. And what that means is one person on average is going to not infect more than one other person, ideally less than one other person, so the epidemic shrinks. There are a lot of paths to get there. There's a lot of potential ways to get there.

But you have to have a coordinated response and do at least a few of those things really well and consistently. And when you don't do that, what happens is cases start to rise again. And remember, they don't rise in a linear fashion. They rise exponentially. And so you have a very slow increase. And then all of a sudden, it starts going through the roof.

MARTIN: I want to be clear. You think 250,000 people dead in America, that could have been prevented?

KARAN: Absolutely. Absolutely. We saw this all over the world. We have so many lessons that we could have learned from other countries from - right from the start. These deaths were preventable. You know, I treated patients throughout our surge here in Boston. And I remember so many stories, so many tragedies back in April. And I really thought that if we - at least here in the Northeast, if we shared our experience, that we could prevent this in other parts of the country. And, you know, it's unfortunate to see that that wasn't the case.

MARTIN: Let's look, hopefully, towards some light in this conversation. What about treatments? They've improved since the spring, haven't they? I mean, remdesivir is a drug we hear a lot about.

KARAN: There have been a few treatments. So remdesivir is a drug that has been put out in a couple of trials. One of them was an ACTT trial, which showed a trend towards improvement in mortality. But it did not hit significance. And then it did show a reduction in the duration of hospitalization. The other one is dexamethasone, a commonly available steroid. And that showed that in patients who are on ventilators, 29% versus 41% in terms of incidence of mortality. So there was a reduction in mortality for those patients.

And then also for those on oxygen, 23% incidence in mortality versus 26%. So slight improvements there. They're both significant. We are using dexamethasone in the hospital. But again, you know, we're still waiting on a lot of other stuff to come help us. And at this point, it's going to depend on more than just the availability of drugs but the availability of staff. A lot of us are exhausted.

MARTIN: One week from today, Americans will gather to celebrate Thanksgiving, to give thanks. It's going to look different. We all know we need to keep it small to our respective households. Although, a lot of people are trying to make plans where they get a test beforehand - right? - and then they think it's safe to go visit family. Is that OK?

KARAN: Unfortunately, it's not. So we have to remember, what does a single test tell you? It's a snapshot in time. It'll tell you that the day that you got the test if you had detectable amounts of virus, if you were infectious on that day. But I could get a test today. And then a few days later, I may go and see my family or head to a Thanksgiving dinner. And I may be infectious at that time. And I may not be showing symptoms yet.

MARTIN: How are you spending the holiday yourself?

KARAN: I'm going to be working in the hospital. You know, a number of us have already been called to back up. And we don't know what's going to happen. But I can predict and I'm afraid it's going to look a lot like what happened earlier.

MARTIN: Dr. Abraar Karan, internal medicine physician at Brigham and Women's Hospital in Boston. Thank you for your time.

KARAN: Thank you so much. Transcript provided by NPR, Copyright NPR.