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.