We who live and work in Seattle recently took note of two milestones: the first death of a patient from COVID-19 reported in the United States in Seattle on February 28, 2020, and recognition of 5,000 deaths from COVID-19 in the state of Washington on March 2, 2021. The juxtaposition of these two sobering events spurred me to look back over this horrible year and reflect on what we have learned as members of the National Cancer Institute (NCI)-designated comprehensive cancer center at the epicenter of the COVID-19 pandemic when it arrived in the United States.
Nancy E. Davidson, MD, FASCO
Fear of the Unknown
In the first weeks of 2020, we at the Fred Hutchinson/University of Washington Cancer Center were fearful of what was to come.
We had watched the reports out of Wuhan, followed shortly by the reports from Northern Italy, about the toll of COVID-19. We alternated between dismissing this as irrelevant to our own situation and learning about the data from our own investigators, Helen Chu, MD and Trevor Bedford, PhD, who provided incontrovertible evidence that the virus was already circulating in our community in January 2020. The tragic deaths of multiple older residents of a Seattle-area nursing home crystalized the reality of gravity of COVID-19–related illness for all.
As we activated our Incident Command structure on February 29, 2020, we confronted the fear that we felt for our patients, our community, our families, and ourselves. In retrospect, though we in Seattle were in the vanguard in the United States, we were by no means the hardest hit. A variety of factors meant that the approach to COVID-19 was more successful in “flattening the curve” in our region than in some other parts of the country. Rapid institution of COVID-19 testing, a lower population density, the decision of many companies to move to remote work in the first half of March, and a state government that is in invested in public health all helped to reduce the burden of COVID-19 in our region.
I recall the palpable fear that we all faced as we continued to care for our patients with cancer in the face of uncertainty and activated the special care teams that would take us forward to provide patient care during what we now know was the first surge. On March 2, 2020, we held what turned out to be our last in-person leadership meeting for the Seattle Cancer Care Alliance, our patient care arm.
On March 13, 2020, I participated in an unprecedented call through a new (to me) platform called Zoom, organized by principals of a Seattle venture capital firm that helped us to connect with a cadre of physician leaders from Wuhan, China. These health-care professionals provided concrete and real-time guidance to any physician who logged on about their experience in providing care for patients with COVID-19. We at the Seattle Cancer Care Alliance, in turn, wrote and spoke widely in real time about the algorithms we were instituting to maximize care for our patients and the well-being of our staff. In retrospect, these two events were the harbingers of events to come—the immediate move to virtual communication and the rapid global collaboration to study the biology, prevention, and treatment of COVID-19.
The decision to wind down is far simpler than defining the algorithms about how to return to routine patterns of care….— Nancy E. Davidson, MD, FASCO
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These first weeks were also punctuated by rapid decisions about how to dial back care for patients with cancer in a way that would maximize our ability to preserve precious in-patient resources and personal protective equipment without compromising patient outcomes. One thing we learned is that the decision to wind down is far simpler than defining the algorithms about how to return to routine patterns of care, a problem we continue to confront even today.
What We Have Lost
As we look back over this past—and in some ways lost—year, it is important to reflect on what we have lost. First and foremost is the incalculable human suffering that this past year has brought for so many. For those who practice medicine, there are also smaller but tangible losses. I regret the distance I feel when I must meet patients in a face mask and a face shield—a visual and actual barrier to our communications and connection. I mourn that so many patients have confronted their cancer treatment alone because of COVID-19–imposed restrictions on visitors and family in our care facilities. I worry about our loss of momentum in all aspects of biomedical research at a time when the promise to improve human health is real.
As a faculty leader in an academic medical center, I miss the cadence of academic life and the ability to celebrate important milestones. Graduation for our hematology-medical oncology fellows this past summer was celebrated via a Zoom call, an anticlimactic end to hard years of training and work, though it did allow us to include extended family members from far and wide. We welcomed a new class of trainees in July—some of whom had never visited Seattle—after an all-virtual recruitment season. I walk by empty conference spaces every day and miss the vibrancy of grand rounds, a constant feature of my professional life for several decades.
The Seattle Cancer Care Alliance, which I lead, broke ground for a major expansion in July 2020—via a virtual ground-breaking ceremony where two leaders of our team placed the proverbial shovel into the ground while all others watched remotely. The celebration of our 20th anniversary in January 2021 was marked by a congratulatory all-staff e-mail and an editorial in The Seattle Times, a far cry from the festive celebration we had planned before the pandemic.
What We Have Gained
Thanks to hard work and incredible adaptation, much has been learned through the pandemic. I would never have believed I could become a certified practitioner of telehealth in 10 days, an amazing transition that, sadly, could only be galvanized by something catastrophic like the COVID-19 pandemic. Telehealth has given me a view into the lives of my patients that I could never see before—and it has shown me in graphic ways the inequities and vicissitudes they endure. We have all become versed in the virtual world, with all its strengths and weaknesses—virtual grand rounds, grant reviews, national and international professional society meetings, and so much more.
The ability to toggle between the actual and virtual worlds to tailor care has been so beneficial for all.— Nancy E. Davidson, MD, FASCO
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The Zoom world has led to a marked increase in democratization and inclusion, but it has also contributed to our sense of solitude and loss of community. It has likely changed forever how we approach certain aspects of our work. For example, in our health system, we will transition to an Epic electronic health record platform on March 27, 2021, via an entirely remote learning and launch process—something that would have been unheard of 2 years ago but may well be the way of the future.
COVID-19 Vaccination and Hope for the Future
It is not possible to overstate how important the emergency approval of three COVID-19 vaccines has been to all of us over the past 2 months. The administration of the first vaccinations to our front-line providers on December 17, 2020, in a makeshift facility in a heated tent in a parking garage was truly a source of celebration and hope. The symbolism of administering those first jabs during the dark times of the winter solstice in the Pacific Northwest as we turned the calendar to 2021 was so clear. Our subsequent effort to repurpose and staff one of those empty conference spaces for a vaccination facility to vaccinate up to 7,500 individuals per week, according to state guidelines, has been nothing short of miraculous. It has also reminded us about how COVID-19 has magnified the impact of health inequities and the work we need to do to ensure that all communities have access to COVID-19 vaccine—and cancer care. At the same time, we are buoyed by the numbers—an increasing proportion of our population who has been vaccinated and a decrease in the number of diagnoses and deaths from COVID-19—and we hope for the future.
As we strive to return to “normal,” it will be important to retain the benefits that have been hard-earned from our ongoing pandemic experience. The ability to toggle between the actual and virtual worlds to tailor care has been so beneficial for all. We must accelerate our ability to provide our future care in the most effective and efficient way and location for the patient going forward. A continued shift to remote conduct of many aspects of clinical trials will accelerate progress in our field. Identifying the ideal blend of virtual and in-person scientific and professional meetings to spark creativity and maintain community (while addressing another crisis, global warming) will be crucial.
Above all, I hope we will retain our innate qualities of resourcefulness, resiliency, and teamwork, which were sharpened by our collective pandemic experience. Cancer certainly did not go away during the COVID-19 pandemic; rather, it retained all of its hallmarks of adaptation and evolution. We too must retain our ability to adapt and evolve to continue to reduce the burden of cancer in a postpandemic world.
DISCLOSURE: Dr. Davidson reported no conflicts of interest.
Disclaimer: This commentary represents the views of the author and may not necessarily reflect the views of ASCO or The ASCO Post.
