The one-year mark provides an opportunity to prepare for year two by examining the mistakes and accomplishments of the last 12 months. I will focus only on medical decisions and dilemmas of year one and leave to others the task of evaluating the mostly disastrous political decisions that were made — though I will note without comment that the first anniversary of the US Centers for Disease Control and Prevention laboratory confirmation of the initial case falls on the exact day that the Trump presidency ends and the Biden administration commences.
Personally, the year has been extremely humbling. We infectious disease specialists have been wrong repeatedly — a predictable problem with a once-in-a-century event, but still. We are long accustomed to dealing with talk of a devastating pandemic from SARS, MERS, influenza, Ebola and smallpox to name a few. To keep calm and carry on, we have adopted an “oh now, not so fast, let’s just wait and see” tone better suited to the gentleman physicians who populated Victorian novels than 21st century global village realists.
These problems are sobering reminders of how difficult it can be to make decisions when incomplete information leads to incomplete understanding of an actively evolving situation.
On a much smaller scale, though, this is the challenge for any doctor taking care of a sick, unstable patient. The situation may change hourly as test results return and new bits of a patient’s history are uncovered; yet decisions must be made immediately despite uncertainty. This means that some of the decisions will be wrong.
This weighs heavily on any doctor. But despite the emotions around an error, doctors and public health experts have to wake up the next day and make more decisions, most of them also relying on incomplete information. And today’s decisions must not be colored by yesterday’s mistakes. Learning from a mistake is crucial but over-reacting to a mistake can be paralyzing. Knowing how to balance the two opposing forces is the largest challenge of all.
The looming issues — vaccine availability and safety, variant strains of the virus, waning immunity, when to loosen public measures after a critical mass of vaccinations — are fraught with uncertainty, incomplete information and enormous consequences.
But decisions must be made. Inevitably they will be imperfect and will draw criticism. Adjustments made as more evidence becomes available will be viewed as waffling; a change in course will be called incompetence; the need to reimpose restrictions would be labeled a colossal failure. But everyone must come to work the next day and make the best decisions they can. The buck must no longer be passed to states and counties and hospitals.
The Biden team surely is aware of what lies ahead. We can only hope that its decisions will rely on evidence, sound judgment and, most of all, the lonely humility of a doctor caring for a critically ill patient.