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in their words

‘Living in the Twilight’

BY DAVID S. P IS ETSKY, M.D., PH.D.

A

brief email on March 6 from my service chief informed me that I was at high risk for infection by the COVID-19 virus and had to avoid direct contact with patients with a fever, a cough or wearing a mask. While I consider myself healthy, my age is a big negative in the defense against the virus. I would have to sit out the pandemic on the sidelines. Although my face-to-face contact with patients has dwindled, I am not alone in trying different methods for patient care. I work at both Duke University Medical Center and the Durham VA Medical Center. Both institutions have established ways to reduce all exposures in the health care environment. Phones and computers are now the avenues for communication, allowing conversations and even guided patient self-examinations. The changes seem to be working and will likely impact health care delivery in the future. When I first came to Durham in 1978, there were few rheumatologists in the state, and I saw patients who had driven 250 miles for a routine outpatient visit. I felt guilty about the enormous effort they had expended, especially if all I did was reassure them or renew a prescription. Now those visits would take place in a few minutes on the phone or computer.

T H E AUT H OR I S

A D UKE P ROF ESSOR OF MEDICINE

A N D I M M UNOLOGY WH O H A S LI VED

I N D URH A M SI NC E T H E L AT E ’ 7 0S.

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When the pandemic ends, or at least subsides, I cannot imagine that patients will want to go back to the old ways and put up with the hassle of driving, parking and walking in, and then undergoing the rigmarole in the clinic only to get stuck for blood. While many commentators do not like to analogize the viral pandemic to a war, effectively, that is what it is. All hospitals have had to undergo drastic reallocations of resources, staff and space to create intensive care unit beds for the mass of critically ill patients expected to arrive during a surge. The hospitals are as close to war footing as a civilian facility can get. Both Duke and the VA have done an outstanding job preparing to care for COVID-19 patients and, importantly, have kept the staff informed and morale high. The leaders deserve great credit for meeting an extraordinary challenge. During World War II, an unusual period occurred at the onset called the “Twilight War” by Churchill (and the “Phoney” or “Sitting War” by others). Europe was at war, but there was very little actual fighting for months until Germany invaded France and the Low Countries in 1940. To some extent, March and April in Durham was a period of twilight war. While many people have been hospitalized and some have died from the virus, the frightening surge predicted in some models did not occur (and, hopefully, it won’t), and the hospitals were able to meet the demands. Hospitals are usually frenetic and crowded places; during this twilight period, the halls and clinics have been empty. There are special wards for patients with the virus, and I stay far away. Duke itself is a different place. The students are gone; the laboratories and classrooms are closed and empty; all communication is accomplished by phone or computer. Zoom, Skype, GoToMeeting and other platforms are technological marvels. Without them, academic life would have totally crashed. Durham has also changed. It is quiet

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