Our Response: The American
Spirit
The response to contain or mitigate the effects of this pandemic has
been different in various parts of the world. When the first outbreak in
Wuhan, China was clearly erupting, the Chinese government imposed an
enforced lockdown in the entire Hubei province. This lockdown was
augmented with stay-home orders and limitations on population movement
across the entire country. These measures as severe as they may seem,
succeeded in containing the effects of the epidemic to Hubei province.
Resources such as medical personnel, equipment and PPE were then
mobilized to the one province where the epidemic was contained. The
result is that 90% of the 82,000 cases and the 3300 deaths in China
were limited to the Hubei province. 1 Major
metropolitan regions and cities such as Beijing and Shanghai, which
looked like ghost towns for at least 2 months, were largely spared of
being the next hot spots and experienced limited mortality. Other Asian
countries such as South Korea and Singapore had a different approach
that applied massive broad testing, case isolation, contact tracing, and
further testing and isolation of such case contacts. Both countries have
had the most successful results, with South Korea having a total of 186
deaths and Singapore only 6 deaths to date. 1 As the
pandemic spread to Western societies such as Europe and the United
States, strategies of social distancing rather than enforced quarantines
were more widely adopted with varying degrees of compliance. Testing
capabilities were not as robust as in Asian countries, and case
identification and contact tracing were less widely applied. In the
United States, broad population testing faced challenges and delays, and
uniform adoption of social distancing measures across the country was
slower. Stay-home orders continue to be at the state jurisdiction level
rather than a federal mandate. The global differences in response may be
the result of differences in culture, government, political structure,
values, and resources. Freedom, autonomy, and individual liberty are
precious values in the United States and form the basis of our democracy
that we all treasure. Over the years Americans fought to protect this
democracy and sacrificed their lives to maintain it, a choice I would
personally make if needed to preserve it. I pray that our freedom and
autonomy does not cost us avoidable and catastrophic loss of life in the
fight against this pandemic. At times such as these our collective
sacrifice of personal freedom for the good of our country and fellow
citizens is critical. During this unprecedented crisis we need to
demonstrate that our democracy is our strongest attribute not our
greatest vulnerability.
That brings me to my unshakable belief that in this country we will win
this fight because of a unique weapon we share, the
American spirit . This common spirit is routed in our
determination to face any challenge with a matching resilience. The
ingredients of this spirit are courage, faith, hope, and the commitment
to prevail. As the challenge raises so does our resolve. As a young
immigrant physician in the United States, I was awestruck by this spirit
when I started caring for patients with cancer. In many cultures the
diagnosis of cancer was considered too tough to handle by patients and
their families and, therefore, one that should be veiled from patients
or their loved ones to protect them from fear and anxiety. In contrast,
I observed that American patients wanted to know the gravity of their
cancer, available treatments and chances of success. They wanted to
gauge their challenge to match it with a determination to win.
Our response to this pandemic is already showing the best of this
American spirit. In New York alone, 40,000 retired physicians chose to
leave the security and safety of their retirement and go back to the
workforce facing the risks to their lives and heading in harms way to
save others. Most of them are over 65 years of age, and at least one of
them is 85 years old! A sports team from the state of Massachusetts, the
New England Patriots, arranged to have the team’s airplane transport PPE
and other supplies from China to support front-line health care workers
not only in their home state of Massachusetts but also their neighboring
state of New York. This involved complex collaboration between the
Chinese authorities; an American sports team owner; and two US
governors, one a republican and the other a democrat. Our military has
engaged all its might to stand along all of us in this fight, from
building hospitals in record times, deploying assets and personnel where
needed, and providing large-scale logistical support. Civilians in
almost every household, including mine, are producing homemade masks for
others that need them. These are just a few examples of countless acts
of service, courage, solidarity, goodwill, and unity, and many others
abound across our nation.
The American spirit not only embodies hope, faith and courage, it also
sparks unmatched innovation in dealing with challenging times of
crisis. For example, 3-D printing is being widely adopted in many labs
and hospitals to augment our PPE and other supplies. Several hospitals
and scientists are racing to develop faster, more reliable, and
high-throughput tests, new effective therapeutics and several vaccine
platforms, and innovative treatment approaches augmenting convalescent
sera for wide-scale therapy. The power of data technology is harnessed
to bring fast and deep learning about the epidemiology of the outbreak
and data modeling to combat it. Telecommunication is rapidly developing
to accommodate new ways of doing business, learning, communication, and
most notably innovative ways of health care delivery outside the
traditional hospital or clinic setting. Such changes will undoubtedly
enrich our health care system long after the pandemic is gone.
Finally, the American spirit inspires normal citizens to emerge as local
selfless and courageous leaders in times of crisis. This is seen
across the entire spectrum of our country but most notably in our health
care providers. You can witness this response in every hospital, clinic,
ICU, emergency room, operating room, and nursing home. Our profession is
one of sacrifice and dedication to save the lives of others, even at
times when it is at our own risk.
We also need to reach out and collaborate with colleagues across the
globe to fight this common enemy regardless of geography, nationality,
culture, values, or political system. Our department, like many other
departments across our nation, has received unsolicited donations of PPE
from our colleagues and alumni from China. These acts of kindness and
solidarity are uniting us with our international colleagues more than
ever. Many colleagues from China, Hong Kong, Singapore and South Korea,
eager to help, have shared their clinical protocols and regional
experiences treating COVID-19 and HNC during the pandemic. We thank all
of them for the help, kindness, generosity and support they extended to
us during this crisis. This special issue of Head & Neck ,
“Covid-19 Versus Cancer ”, is dedicated to providing and
disseminating information about the unique challenges of our patients,
who not only suffer from the burdens of HNC but now also face the added
risk of COVD-19. I would like to thank our publisher, Wiley, for making
this special issue available for full content download anywhere in the
world. Recommendations for managing these challenges are evolving and
undoubtedly will be updated as we gain more knowledge and experience
with this novel virus and its impact on patients with cancer. When we
prevail over this pandemic, we will have learned so much from each other
and will be ever more ready to face the next challenge. It is our duty
and our honor.