We have plans for that. But we don’t want to have to have plans for that. The only way we stop that situation from developing, the only clear way, is that our entire society sort of voluntarily commits—that’s the individual, the corporation, the public institution, town leadership, state leadership, and federal leadership—commit to slowing that process down so that we don’t have all of those patients beginning to crash the ICU beds at the same time.
Foer: I know doctors spend a lot of time thinking about the ethics of rationing care. How does it feel to go from academic exercises to the real deal?
Horn: My mood vacillates. Leaders have not stood and told people exactly what they need to do. But also, I’m filled with hope and inspiration about what we’re doing to get ready for this. We’re actively redesigning our whole health-care system to accommodate patients with other upper-respiratory illness and suspected coronavirus.
Foer: What does redesigning health care on the fly look like?
Horn: We are trying to rapidly deploy virtual-care capabilities—with regular phone and video check-ins—to all of our physicians, starting with physicians who care for our most complex or highest-risk patients, patients that we want to keep out of a health-care setting right now, like patients who are immunocompromised, patients who have had transplants, patients who have cancer. If we can keep them out of health-care settings and move them to video-based care immediately, we know we will save lives. Of course, there will be programs like you’re seeing working in Hong Kong and in South Korea, where we can start doing rapid mass testing to start guiding people who need to be home and who can be out in the workforce.
Foer: Is there a sense of foreboding among the staff of the hospital?
Horn: The truth is, I don’t think I’m ready to comment on that, because of our internal policies. But to stick to the thesis here: Aside from not overwhelming our emergency rooms and ICUs, the main reason for comprehensive social isolation right now is because if you expose a health-care worker to the coronavirus and that becomes a documented exposure, they will not be able to work for 14 days. And if they are not able to work for 14 days, then we will not have a health-care workforce to take care of you. That’s the key point there.
Wajahat Ali: Where are the masks?
Foer: Doctor, can you help resolve a question that has emerged in my household today? My family was talking about going on a hike or walk with another family. Is there a way to do that safely, or should that all just be shut down right now?
Horn: I think outdoor space … I think being outside will be really crucial through this period of time—getting fresh air, getting exercise. I think that even in that context, I would advise that people still try to stay three to six feet away from each other, and certainly don’t do an activity like that if they have even a mild cough or cold.