S3E22: A Pandemic's Impact on Communities

Margaux: You guys, we sound so professional now with our new microphone.

Harjit: Chloe, can I tell you something? I'm going to get in trouble for it. Maybe I'll wait till the end.

Margaux: Did you tear your cover? Because I did too. And I can see that you tore yours.

Harjit: Yes, I did.

Margaux: I did too.

Harjit: I did. I'm so scared, Chloe. I hope you don't kill me.

Leen: Well, welcome to all our listeners to another episode of "Bundle Of Hers." This is the long awaited in a sense pandemic episode. We're all recording from the comforts of our own home, and we finally got mics. I think that's pretty exciting. We got some really fancy professional mics . . .

Bushra: Professional mics.

Leen: . . . so hopefully this will make the listeners happy.

I think I want to start off this conversation by talking about the biggest thing that I think has impacted almost everybody out there right now is the self-isolation. The quarantine, the six feet apart situation kind of talking about why, you know, we're initially doing this because we don't have a vaccine. We don't have medications for this virus. It's a very highly contagious virus. It's affecting so many people. Our death toll is constantly rising. New York is the hub of the crisis.

And I want to talk about, you know, the first thing is when everybody kind of anticipated that this quarantine was coming, that's when we started seeing the massive depletion or the emptying of all the grocery stores from all sorts of items, nothing that in particular made any sense. Hence, the toilet paper, we're forever going to be known for this.

But it almost made me realize that living in the USA we're an individualistic culture. And it made me realize how different societies respond based off of a very collective communal culture versus an individualistic culture. And I think this is not necessarily like my research done into it or anything. But my, from what I was seeing is the cultures that were very much more communal or the societies are more communal, we're having greater turnarounds than the individualistic cultures, the capitalistic cultures. What do you guys think of that?

Margaux: Yeah. So I think you're absolutely right, Leen. When I would say maybe it's three weeks, four weeks beginning of March, which feels like forever ago at this point, when, you know, it was very apparent that the coronavirus was coming here and that we were going to be just as impacted as other parts of the world, people did panic, and I think that is when you truly see values come out. And it was fascinating to me that more than like food or hand soap or other things, toilet paper was one of the first things to go, especially considering that coronavirus is not a diarrheal illness, right? That would make sense if it was diarrhea-based as a symptom, and I think part of it is that like maybe somebody, you know, just needed toilet paper and then somebody else saw them and then panicked. And that kind of started this chain of like, "Oh, if they need it, then I need it."

Leen: Snowballed.

Margaux: And I need to get it before everybody else gets it. And I think that's what you're talking about that individualistic, like I have to look out for me, and I don't care if my neighbor doesn't have toilet paper, at least I have 500 weeks' worth.

Leen: Right. And I think that's the biggest worry for me is when a society comes to a conclusion that it's more individualistic what I have is what I need for myself to survive. I mean, the one thing as I saw people in the in the stores that kind of freaked me out was, let's say, I have all the masks, I have all the disinfecting wipes, and my neighbors have none, then essentially the virus surrounds us. And essentially, we're not getting rid of it. We're just, you know, we're just one spot on the agar plate that is not going to be affected. Like that's when I started to realize how important a communal culture was, make sure everybody has what they need in order to survive this in order to be safe.

You can put that one little dot of antibiotic on the agar plate and there won't be anything there, but they'll still be surrounding. But if you put antibiotic inside the agar on the foundation, it's all gone, right? And that's kind of how I was thinking about it, like I just imagined all this on one big jelly plate. But it eventually got there. I feel like now we're seeing a lot of drives where there's . . . It freaked me out at first. I thought at first, with this individualistic culture, are we ever going to find the values to realize that this is a community issue? And I think we're getting there.

Harjit: Leen, I think this point is super important, and I think really kind of ties the foundations of this pandemic, because we really think about this difference between an individualistic culture and a communal one. And it kind of reminds me of going back to when we first, you know, graced this Earth as Homo sapiens. You know, to survive as a race, people had to work together. People had certain roles. People had certain things they had to do to make sure they survived in the wild. And in that sense, there was also a sharing of knowledge. It was either passed around with friends or passed down from generation to generation.

And, you know, it's very shocking because now we have all the webs of sharing knowledge, but it just doesn't have the same depth and feel because I think that knowledge came from love. And I think that's kind of the biggest focus that I see between the individualistic and communal culture. And I sometimes don't blame the people that grew up in America because as we have reiterated 100 times on this podcast that systems really influence the way people think. I remember even thinking in medical school, even if you didn't want to be competitive, you would become competitive. And everything is very focused on yourself.

And I think that this is to me the world saying that, no, we're all interconnected. Back in the day humans were connected to the nature. They were connected to, you know, the atmosphere, the skies. I think Native American culture really talks about that beautifully, how we're all interconnected. And coming back to my spirituality as a Sikh, I believe that those connections are really, really, really important. And there has been a break in that balance. And that's why it's so hard for us to really be our best during this pandemic.

Margaux: Harjit, I think that's so true. That when we have this mindset that we're all connected not only to each other as humans, but also to the environment and every being that lives in that environment, it gives you a different perspective. And when it comes to the pandemic, like you were saying, Leen, when you're that one person who buys the whole Costco pack of hand sanitizer and toilet paper, leaving none for your neighbors, you're leaving the person who works at the grocery store to be exposed or more exposed to the virus, and then they get sick and then they can't work at the grocery store.

And same for the post office worker and same for the doctor down the street and everybody who has, you know, an essential role in helping you live your life. And when you have this individualistic idea of like, "I need toilet paper, and I need hand sanitizer, I don't care about other people," it will come back to affect you.

Leen: I think to add on to the point the importance of coming together as a society, and that was the only way that humanity ever flourished was when we finally came together and we identified the roles that we all play and how it's interconnected. Sadly, with this coronavirus, speaking back to recognizing how interconnected it is, a lot of discrimination and prejudices have arisen with this pandemic. And part of that individualistic view is looking for something or someone to put the blame on for this crisis. Ever since the increase of cases and when we start first started getting reports out of China, there's been major increases in anti-Asian hate rhetoric. And that's coming from all spectrum of power, for instance, when the President started saying, "Wuhan virus."

I was following the situational reports from the World Health Organization all the way back in January. I was . . . you know, I'd open them up every day. I remember seeing one clause about how the World Health Organization is recognizing that there's increased anti-Asian hate rhetoric and that it needs to be put to a stop. And then I remember on February 11, there was a link on how these viruses are actually named. And it turns out that there's a whole entire system. There's a whole coalition, a whole collaboration between major organizations, and they've established rules for how viruses should be named. And I think it was very interesting because part of these rules are you need to aim to minimize unnecessary negative effects on nations, economies, people and animals.

There's been major increases in anti-Asian hate in the United States, especially, the most is verbal. And I know I have a personal friend who's actually been affected by this. But it ranges everything from being barred from establishments, from transportation, coughing and being spat on. It's ridiculous. It's absolutely ridiculous. And I think as healthcare providers, we need to be the leaders that put a stop to this, and we need to make sure that we are the ones who are out there saying you cannot do this.

Margaux: Yes, Leen. I think it's very important to be very cognizant about the way that we think about one to have blame and a source for all of this, I think because there's so much unknown about the virus. And part of the, you know, seven stages of grieving is anger and blame, you know, the coronavirus, being a pandemic that affects us all, we're naturally going to go through a grieving process and try to find blame. And when we're in an individualistic society or mindset, I think it's easy to point to where the virus originated, allegedly, right. We still don't even know if . . . China's just where most of the cases started happening. It is very possible that it started in Italy or somewhere else. We don't have that evidence yet. I think we just have to be cognizant about why it's so easy to blame those who are visibly different than us.

Harjit: Margaux, I think that it's really important that we understand that question. Now, I'm thinking about any major event that has shook an entire country, this is like shaking our entire globe, but the last one that comes to my memory was what happened in 9/11. And even then, the blame was placed on another group, because I think it gives some type of peace to people to know that they're not a part of the problem.

Now, that's where I want to challenge everybody, because the truth is, if we think about this is a problem, let's work together to fix it, right? So that means I am also a part of the problem, and how can we work together and make sure we overcome that? It's really sad, because the people that are marginalized get that blame because it's just easier. They don't have the power. They don't have the media. They don't have things backing them up where their voices matter.

And this is why it's so important that every voice is a part of the conversation. That's what we've always been believing and fighting for. This has happened. We all have a part in it. And we've talked about this before. You can make the slightest change and impact thousands of people. One person had this virus and millions have gotten it, right.

Margaux: This is impacting all communities. But I want to point out that all communities are impacted differently. So, for example, we've been getting a lot of reports now that we've had a lot of the death toll in the United States has been going up. There's a lot of evidence to show that it's disproportionately affecting black Americans in the death toll. So I think that's something that needs to be analyzed and assessed as the root cause of that. And maybe, you know, not blaming, but like using it as a lens to understand the discrepancies not only in healthcare, but in our society, in our community as a whole.

Leen: The numbers are staggeringly different among African-American and black Americans. Yet I see a lot of posts on social media saying, "Oh, but the regions that have this much high number is because there's a high number of African-American and black Americans in that region." That in itself already puts them more at risk. You have a system that's not supporting them. And now you have a system that's honestly the healthcare system is kind of crashing in its systematic format. So it's definitely not going to support them. If it didn't support them at its best, it's not going to support them at its worst.

Bushra: This is an America problem, right?

Leen: Right.

Bushra: The historically disenfranchised will be continually historically disenfranchised. It just shows you the effect of I mean, you name it, the economic depression, healthcare, pandemic. Any aspect of societal life that affects people of color more, you know, a pandemic is not going to change that. It's also going to affect them disproportionately. And when you compare that to other places, you see the issue is an America problem.

Leen: You know, that goes to be said in the last four years of medical school, we always have conversations about healthcare availability, reaching those who don't have healthcare access. And in times like these, these are the populations that are going to be more affected than anything. As of right now, rural America, it's very worrisome. We're wondering if that's going to be the next big crisis after the Northeast.

Now, we have places that don't have ventilators, don't have ICUs. These people live very far apart from each other. They don't have healthcare access. There might be some even chronic conditions that are unrecognized in these populations. And now, this virus is going to hit them, and there's not going to be help for them. In med school we always talk about, we always say, "We need to reach these populations. We need to reach people underserved populations." And that's when we're living in a very good life when there is not a pandemic. And here we are in a crisis and they're going to fall through.

Margaux: We come into a very dangerous space to allow implicit bias when we move into what is so-called our crisis mode, where you have to make decisions about who gets a ventilator and who dies as a healthcare provider. That is a very dangerous space where implicit and unconscious bias can come out, because it's a very pressured system where you are making rapid decisions.

And I have mixed feelings about this, because I've heard, you know, on the radio, some people discussing and debating how these models and protocols should be made to allow for that. And I don't think it's enough, though. And I don't even know what do you guys think is right, and how do you feel about possibly having to make that choice of who lives and who dies knowing that other, you know, that implicit bias might be affecting it?

Bushra: Margaux, in the arena of access to testing, we see people who have wild access to resources just being tested for the virus in and of itself. And so for me, that makes me think if this is just the testing part of it, what makes me think that when it comes to allocating resources, such as ventilators, that people might need, who's going to get that?

Harjit: It's a step by step. That's how like they think marginalization works. It's not just one theme. It's like the whole pipeline of them getting a diagnosis to their treatment, or even before that, before they get their diagnosis, that whole thing. It's just compounding and compounding and compounding. And I think this is a great example of what it means to have privilege.

Margaux: Yeah, and like you guys are saying the impacts are there, and it is disproportionately affecting people. But I'm curious how you guys, we're almost doctors, we may be called to the frontlines, very possibly a reality for us. And we may be the one who's sitting there helping make the decision who gets that resource and who doesn't. And I think there's a lot to unpack in this oath that we should talk about which is (a) like how we feel about going in and risking our lives when there is not enough PPE.

But first, I'm curious to know how you guys feel about having taken the oath "Do no harm" but then being faced with the question of who dies and who lives, because I don't know how I am going to handle that.

Leen: I don't think anybody knows how to handle that. I mean, that's a question that comes up in every single ethics lecture that we've had in our last four years. It's come up in our disaster medicine class. It's kind of that ethical dilemma of no answer, right?

Margaux: It's different when it's real in front of you.

Bushra: There is no right answer. There isn't. All you can do is do your best to make good choices. And then after that, say to yourself all the mistakes that you've made, what you've learned from that situation. This is the first time we're seeing this in our lifetime ever. And so we're going to make a lot of mistakes. But I'm hoping that this sets up the stage for us to setting up better protocols and better guidelines to deal with something at this scale.

Harjit: It is really scary even for us being in a variety of different fields. Some had to make harder decisions than the others. But now we might all be on the same level field because we need help. And every single person has to like make that decision if we are called on the frontlines. I think that I will go back to how I would handle this situation. It'd be like I'd handle any other patient. I know that a person's life is complex. I would try to understand every single factor. In the end, you take a decision. But the scary thing is none of us know what's the right decision, right? Sometimes you just have to think that I have to do this. I know this maybe isn't what I expected to be doing, but I have to do it.

And the best way that I think I could do it is really understanding my patients. Now, the difficulty even with that is some people are coming into the emergency rooms in respiratory failure. You don't even have time to even think about these things. When that happens, I will say I will be leaning on the people that are actually my seniors, and I'm hoping they're the one who is taking the decision. But when push comes to shove, say I'm the only doctor available and I had just graduated, then you do have to take the decision. And that is a reality of the field of medicine. I think a lot of people don't think about that when they start medicine, but it's the truth.

Bushra: I'm going into emergency medicine. Leen is too, obviously. I'm going to have to put myself in harm's way, which I never ever in a million years thought I would have to do, but it comes with the territory. It's the job that we signed up for. We're doctors. We're supposed to be helping people. Part of me my brain tries to rationalize everything that's going on. And it's like, "Okay, I signed up to take care of patients, so that's what I'm going to do, but at what costs?"

We see healthcare workers having to work without that PPE and how useful it is for them. And they're not protected. They don't . . . we know they keep saying that healthcare workers are their frontline soldiers. But soldiers are protected. They have armor a lot of the times and a lot of facilities. Doctors and nurses and the people who are, you know, the environmental services, people who clean up, like they don't have that same PPE. It's hard for me to think about that I might put myself in harm's way with no way of protecting myself. And then the outcome for me could also be, you know, the ultimate result, which is death.

Leen: I mean, I don't think ever in the history at least, I've never seen doctors and nurses and staff crying, telling us of the dangers and how hard it is for them to be in such an environment where they're intubating each other's colleagues. They're taking care of each other and not just patients. And the World Health Organization actually has a list called the rights, roles and responsibilities of healthcare workers. And they talk about how they need to assume responsibility in order to minimize risk. And part of that is that they must be provided with adequate PPE and supplies in order to take care of those around them and take care of themselves. And it's shocking to see that that's not happening.

Harjit: That kind of goes back to our whole original point. It's like to each their own. You know, if we are thinking about solving this problem together, we also need to work together to make sure that we are minimizing the risks. It's really sad for me to think that there's other interests above someone's life. There's a couple of residents that have passed away due to coronavirus. There are people that are 26 years old that have just graduated from their residency, and they've passed away. Yeah, that is a reality that all of us have going into this field of medicine, but it's really sad that it could have been prevented.

Leen: Right. It didn't have to happen.

Harjit: It didn't have to happen. I just want to take a second to honor those people who have passed away and just express so much love and gratitude for the work that they've done. And the scary thing for me too is that, yeah, I'm doing a residency in psychiatry. But I see you Leen and I see you Bushra, and me having to imagine two of my best friends going into emergency medicine and that they could possibly contract the virus and pass away, that's so freaking scary.

Margaux: And I would like to offer the perspective to that not everyone who goes into war is always prepared. Usually it's the side who has something to be gained and benefited planning the war that is usually protected and prepared. So for example, like when white people came to the U.S. the Native Americans were not "armored," right. And so they still persist and endured and are still very much alive today. So I think the reality of the situation is we are in a fight that we were not prepared for. And that sucks for all the reasons that you guys mentioned.

Something that Dr. Hussain impressed on me, when we recorded the Global Health episode with him, is that we should not judge people for the decisions they make. We did take the Hippocratic Oath to "Do no harm" and to take care of patients. However, when we are faced with a decision to put our own self at risk in this environment in this situation, we have to respect those people who choose to not go into the frontline and not help because they have so much to lose, and at the same time respect the decisions of those who are going out there and who are fighting without protection. And then there's a whole group of people who are fighting to get that protection.

So I think every space and aspect of this "battle" metaphor that we're using needs to be honored, I guess and not judge people for the decisions they choose when faced with this difficult decision. And like we talked about, there is no right or wrong answer.

And Leen, when you were preparing this episode, you put a link in the outline of a list of healthcare workers who have died on Medscape. And that was the first time I'd actually seen that list. And it really landed with me. There are so many names on that list from people in their 20 somethings, like you were talking about Harjit, the residents to people in their 70s who came out of retirement to help. And that list, I think, is super important to know and to honor those who have put themselves out there to help their community.

Leen: And part of the self-quarantining and I think with all these decisions weighing on our minds and we're constantly thinking about it, especially, you know, as fourth-year med students, this could easily be our foreseeable future in the next couple months. I think taking care of our mental health is super important right now.

Margaux: And then another point too is that it's important to be mindful that not everybody gets to quarantine with . . . I feel like I have a lot of privilege that allows me to quarantine comfortably. But there are people out there who are (a) not able to quarantine because they have to work to support themselves, or (b) people who are quarantined with abusers, especially in the context of domestic violence. And that is something to be very cognizant about that maybe even people you know that this is happening to. And in non-pandemic situations, it's mitigated by the fact that the abuser goes to work and the victim gets to have at least a little bit of reprieve in their day.

And domestic violence is an incredibly complex topic that we could spend a whole podcast season talking about. But there have been some things set up, like in France, they set up a system that people can call in, or here I saw in New York, there was a hotline where you can call and they will find you a safe place to live. However, that all comes with risk. You know, you may not be able to call. And so I just say keep an eye out for your friends and people in your neighborhoods, your community, bringing it back to community, right.

Harjit: Kind of talking about a lot of these mental health issues, a lot of these issues of stuck in the situation that you are and understanding that a lot of people's lives look different, I also want to say there are also a lot of people that are homeless who aren't, maybe can't do self-quarantining. So that's another thing to think about. As far as mental health goes, I have realized that, you know, when you have space to sit at home, and there's so much going on in the world, it also sometimes can cause a person to think a lot. And, you know, there's always a need to take a break and do whatever you want, live your life however you want, and not having to feel the pressure that you have to be a certain way. I think that's like something that we all should focus on.

And I did want to come back to this kind of community thinking. Throughout this episode, we said how important it is and how as a larger society, we are kind of more on the individualistic spectrum. I do want to recognize that there are a lot of people that are doing a lot that is putting forth to the community effort. I'm saying this because I know that I was critical of a lot of the ways and the actions that people have been taking throughout this time of coronavirus. But I also want to respect and honor that there are a lot of people who think about the community.

Margaux: And on that note, we had started #formycommunity, so use that on Instagram.

Leen: And so in terms of for my community, thank you all for listening. You are all our Bundle community, and we appreciate your input and you taking your time to listen to what we have to say. If you have any thoughts, comments, questions, anything you would like to hear from us, anything you want to talk to us about, you know, the self-isolation can get very boring. So we're also here on the other end, so please reach out to us and stay safe, everybody. We got this. We're going to make it through this. Okay? All right.

Margaux: Bye.