Fauci

The campaign against Anthony Fauci is a campaign against memory: the memory of what the nation went through in 2020-22 to be sure, but also against my memories of that period, and yours as well.

The memory of what it actually felt like to stand in an emergency department in the spring of 2020, before anyone knew what this virus would become, before there was a vaccine, before there were effective treatments, before we had enough evidence to distinguish what was useful from what was wishful thinking. It is worth reminding the public what the lockdowns, the masks, the vaccines, and all the rest were actually for. I’m not defending Fauci’s cringey diary, or decision to invoke his Constitutional right against self-incrimination, but I am defending him and public health officials more broadly in their attempts to save as many lives as possible. That helped save my patient’s lives, and who knows, may have helped save mine as well.

I was an emergency physician through COVID. I remember what the country now seems intent on forgetting.

We emptied intensive care units in anticipation of the first and the second wave. At the University of Vermont, we discussed storing bodies on the hockey rink if our morgue capacity was overwhelmed. That wasn’t melodrama. It was disaster planning. It was the sort of planning every hospital in America hoped it would never have to use, while praying it had planned enough. At the time, early intubation was thought to save the most lives, but was also the most likely procedure to aerosolize the virus into the respiratory passages of the healthcare staff. I can’t remember how many intubations I did with just a respiratory therapist, pushing the propofol and rocuronium myself to keep the nurse out, to keep as many people as safe as possible. But enough.

Absolutely no trainees allowed in, back in those days.

At the peak of the pandemic, I shaved my head. Not because anyone told me to, but because I thought it would make it easier to wipe myself down with hand sanitizer before walking out after my shift and into my house to hug my children. Looking back, was that necessary? Probably not. But that’s the point. We didn’t know. Every shift ended with another question that no one on Earth yet had the answer to.

People now speak about masks or distancing as though they emerged from some grand ideological project, but they didn’t. They emerged from uncertainty. They emerged from physicians, nurses, epidemiologists, and public health officials trying to buy time while a novel virus raced through a population with no immunity. We were trying to buy time to keep as many people alive as possible until science caught up.

We threw spaghetti at the wall because there wasn’t yet a cookbook.

Hospital protocols changed constantly because the evidence changed constantly. We tried combinations of medications that now seem strange in hindsight. Azithromycin and hydroxychloroquine was one of them. The protocol wasn’t written by fools but by internationally respected critical care physicians who suddenly found themselves confronting a disease that literally no one had ever treated before. They were experts in respiratory failure, shock, and critical illness, and there was a small study out of France showing benefit. When it was recreated prospectively in New York City, it was associated with harm. This was when the mass graves were on the news.

I remember being super pissed off that our hospital wasn’t using convalescent plasma a few months later, but guess what? That didn’t work either.

Medicine under crisis is ugly. I have a very smart friend from medical school. Stayed in Boston at the Brigham for residency and MICU fellowship. Was an ICU attending at arguably the best hospital in the world, and this is what he said to me on the phone, early-early in the pandemic: “I think we have to be really humble in what we think about this thing because we are going to be really wrong about some things.” You might think we sat around dispensing certainty from on high, but it's the opposite. It was making the best decision possible with incomplete information, then changing course when better information arrived.

I watched young people die. I watched old people die. They died alone, or alone in the sense their family was not there. They usually died behind closed glass doors with, if they were lucky, a gowned-from-head-to-toe anonymous nurse holding their hand. But for the vast majority of the unlucky, that’s not what happens when you die in an emergency. By fortune more than anything else, I never personally watched a child die from COVID. I remain grateful for that.

More than one million Americans ultimately died. A million is a number so large that it becomes abstract. Imagine their bodies laid shoulder to shoulder, stretching roughly from Boston to Kansas City. In case you missed it, that’s World War II level casualties, and that’s the context in which Anthony Fauci made decisions.

Were mistakes made? Not out of context. Some judgments were wrong, public messaging was clumsy. Fauci himself has acknowledged errors in retrospect, and historians will debate individual decisions for decades.

But here’s the way I see it: America showed its ass back then. So many people decided old people dying was an easy trade to get out of a menu of relatively benign sacrifices. I understand some people lost their livelihood; but that mark on the ledger is in pencil and correctable; the deaths are in ink.

I dunno man, we did the best we could, and, yes, we pissed off a bunch of people who exercised a right to be selfish, without any concern for so many anonymous others who would die.

I always thought none of this would have happened if Trump had stayed true to his principles and started selling red MAGA masks. It’s not too late for that, honestly. It’s just way too late for me to sign off on pretending we, including Fauci, didn’t do the best we could.