"You don't have to wear a mask around me. The pandemic is over. It's not like I have the plague."
One of my patients uttered these words to me this week in the department. I was surprised at how much it took me aback.
"It was a plague," I thought to myself, walking out of the room. I recognize looking back that my own experiences during the pandemic gave me a raw, visceral response to those words as I heard them.
Overall, the fatality rate of the Black Death was much more severe than that of COVID-19. Despite this, both required a profound public health response. While COVID-19 may not exactly have been a plague by definition, its significant impacts have and continue to permeate the health care profession, and especially emergency medicine as a specialty. There have been several pandemics during human history, but the history of quarantining dates back to the bubonic plague itself. This stems from an inability of the medical sciences at the time to understand the disease transmission, thus an inability to educate, prevent, and treat the disease. When a disease is as highly virulent as COVID-19, it takes significant public health measures such as quarantine as a response.
Some of the strategies utilized to combat COVID-19 have been learned from and improved upon from these prior epidemics, such as the bubonic plague. Personal protective equipment (PPE) is another important portion of control when looking into treatment of a disease process, and we are always taught in our training that if you do not protect yourself as a healthcare professional, you will be incredibly limited in those that you can help, because you will inevitably get hurt or become ill. There is maybe no more iconic example of PPE than the beak-like masks plague physicians wore to protect themselves.
Plague physicians worked for the government, which meant they were contracted to see patients who couldn’t pay and to go into the sickest of the plague-stricken neighborhoods. These physicians were often insulted and ostracized in the streets as they tried to warn and educate the public about the disease. With their cloaks, masks, wide-brimmed hats, they waded into illness in a similar way to what we do in emergency medicine. We see everyone and anyone, all the time. We adapt to changes in the culture and disease processes. We're used to change.
The patients aren't.
In our county emergency department, we take care of a variety of patients – from those with a tuberculosis exposure or confirmed test to immunosuppressed elderly patients with pneumonia. It is pretty common for staff to put on a mask when taking care of a patient. Though there may have been significant medical advancements since prior outbreaks such as the bubonic plague, smallpox, and the Spanish flu that have given an advantage in worldwide response, a few things remain similar: public miscommunication, misinformation, and disbelief or lack of trust.
It’s not as commonplace these days to see people wearing masks in public. Recent studies show that a majority of Americans believe the pandemic is over. However, ways of life have not returned completely to normal. People are adjusting to the "new normal" as we, as a society, begin to restore to pre-pandemic ways of life. As we adjust to this new normal, we are only beginning to understand the long-lasting impacts of the COVID-19 pandemic. Though many believe it is currently over, there is still a fear of re-emersion of the pandemic or of a different pandemic occurring.
There is solace in all that has been learned from the experiences during the COVID-19 pandemic, such as the research that went into rapid vaccination development and distribution. However, there is still much to be done as far as preparation for future disease. There is significant public mistrust of physicians, which is something we emergency physicians must be not only aware of, but proactively combat. We should heed the warnings of what we have already seen and look to develop trust among our patient relationships and the public, so that we can have an impact prior to any public health crisis. There is opportunity in our re-orientation as a society, and we should utilize it.