Keeping Pace with the Pandemic

We asked pathologists and laboratory medicine professionals to tell us how their professional and personal lives have changed during the COVID-19 pandemic.

Robert Smith?, Professor, Department of Mathematics and Faculty of Medicine, The University of Ottawa, Ontario, Canada

For possibly the first time in history [1], the mathematical modeling of a disease is front-page news. Governments have ordered lockdowns based on models of the disease, which naturally raises questions as to how reliable these models are – and what the point of them is.
_{[1] Well, there was once a big media story about a mathematical model of a zombie invasion, but let’s not worry about that.}

Mathematical models of infectious diseases date back to the 17th century, when mathematicians described the spread of smallpox. However, disease modeling really took a leap forward in the early 20th century, when it was discovered that mosquitoes – not swampy vapors, as previously believed – spread malaria. This news upset a lot of people, because it was well known that you couldn’t kill all the mosquitoes. Nor would you want to; they’re important for the ecosystem. However, modeling showed that you didn’t have to kill all the mosquitoes – just a critical number. This led to massive insecticide programs throughout the 20th century and is the reason malaria no longer exists in most developed countries.

A century later, our access to information is very different. We can sequence the genome of a new virus remarkably fast. We can monitor the number of cases and deaths of COVID-19 around the world almost instantaneously. In short, we have more data than we’ve ever had. But what do we actually do with this information?

Models have two components. The first is mechanistic: describing how interactions occur between different actors (be they humans, animals, viruses, something else, or a combination). The second is quantitative: determining the precision of those interactions (the transmission rate of a disease, the birth rate of a particular species, the rate of mutation of a drug-resistant virus…). Data informs both components – directly in the second case and indirectly in the first, where patterns must be discerned from the information at hand.

The great power of modeling is that it can predict the future. There’s nothing else that can do this (crystal balls don’t count.) What matters, however, is how well we can make those predictions, and that brings us back to the issue of uncertainty. If the data were perfect – that is, if we knew everything we wanted to know, measured it with 100 percent precision, and understood all the ramifications flawlessly – then we would be able to predict the future exactly. Sadly, we don’t always know everything we’d like to (and sometimes we don’t even know the right questions to ask), there are always errors in measurement (usually small, but nothing is ever precise), and our ability to interpret can sometimes be very weak indeed.

As a result, there are degrees of uncertainty in all models, and they tend to increase over time. Predicting tomorrow’s number of COVID-19 cases is easy and very likely to be accurate. Next week’s prediction won’t be quite as good, but it can be reasonable. Next month, we’re only talking ballpark figures. Long term? That’s about as accurate as knowing whether it will be sunny or raining this time next year.

Models are certainly useful, but it’s important to understand their limitations. We can improve on our predictions with a deeper understanding and better data, but we’ll never achieve perfect predictability. But that’s not really the point; as famous statistician George Box once said, “All models are wrong, but some are useful.” Just like I don’t need a map that shows every blade of grass to find my way home, we can still harness the power of modeling, despite its inbuilt uncertainty, and make sensible predictions about COVID-19 and potential future pandemics. Models are better than crystal balls, at any rate.

Dariusz Borys, Professor of Pathology and Orthopedic Surgery, Chief of Orthopedic and Pediatric Pathology, and Director of the Digital Pathology Lab, Loyola University Chicago, Maywood, Illinois, USA

Since the installation of safety precautions for the COVID-19 pandemic, pathologists who still rely on light microscopes have been able to continue diagnostic work; however, work requiring social interaction – such as consultations and teaching – has stalled. Although I believe our diagnostic work would be improved by creating fully digitized histological slides that allow remote case sign-outs, I would argue that the key application for digital pathology lies in virtual education.

As teaching faculty, I was scheduled to give lectures on bone and soft tissue pathology to my residents and fellows this March. I had scheduled lectures on Mondays, followed by unknown-slide sessions on Fridays. Then, the COVID-19 outbreak began to develop and traditional in-person lectures ended throughout the country. Although my lectures were canceled to avoid large group gatherings, this was no excuse to stop teaching young, bright people – so we started planning virtual lectures via online conferencing software with digital slides as a learning tool. Thanks to the availability of a whole-slide imaging system in my department, I was able to continue giving lectures on Mondays and digitally review scanned slides on Fridays to facilitate online discussions with my residents. Technology is helping residents continue with their studies and not feel as though their education has come to a standstill. In addition, the interactive aspect has had a positive impact on student wellness in these hard times.

Digital pathology has helped me continue my work during the pandemic and my success strongly suggests that digital slides can profoundly improve student learning in difficult times of isolation and beyond. The interest my residents showed in reviewing the slides digitally has encouraged me to champion digital pathology as a learning tool. Every pathologist should engage with technology, because it can become our strongest ally in promoting education and progress in our field.

Marisa Saint Martin, Medical Director at OneBlood, Inc., Jacksonville, Florida, USA

As the COVID-19 pandemic took the world by storm, my meditation and mindfulness practice brought me back to the core of my purpose.

I recently moved from my well-defined and structured academic position at Loyola Medical Center to a Medical Director position at OneBlood, a blood center with a strong presence in the southeastern US. Although I had a new job, a new city, a new state, and a lot of uncertainty about the future, I was adjusting to my new responsibilities. Then came COVID-19.

Fortunately, my new role, along with my mindfulness practice, allowed me to discover a sense of purpose in my profession as a pathologist, a blood banker, and a member of society. Practicing mindfulness and meditation in any situation, whether routine or occasionally, can help keep our thoughts tamed. In times of uncertainty and stress, like this pandemic, quieting the mind not only helps us cope, but also helps others as well.

The measures taken by our national and local governments may seem overbearing or give us a sense of not being in control – and it’s true; the pandemic clearly demonstrates that we are not in control. In times of peace and prosperity, we fight about elections and worry about what might happen in 10 or 20 years. A threat to our daily lives is right here, right now – and yet some still choose to focus on divisive rhetoric. Instead, I urge you: be an example. This is the time when our social duty must shine and we must work together.

Mindfulness is the simple awareness of the present moment, and there are many paths to it. Staying still in our minds when everything is so fluid is difficult but, as we practice, we grow more connected to our inner selves. The more we practice, the better we get at managing anxious thoughts. Being fully present for ourselves translates into wisdom when making decisions and creates openness for others who may be falling apart.

As a pathologist, transfusion medicine specialist, certified life coach, and concerned citizen, I try to foster an environment where everyone can get through these trying times. Some elective surgeries and procedures are resuming; if you are able, please donate blood. If you are a recovered COVID-19 patient, please become a convalescent plasma donor and help us fight this war.

Remember that fear is the core feeling of anxiety, and anxiety is the effect of future worries. Try to stay mindful and exist in the present instead of imagining a bleak future. We may not be in control, but we can always choose who we want to be and how we want to respond to challenging times.