A man is shown carrying a clear umbrella and wearing a face mask while walking with his left hand in his pocket.

COVID-19

Dr. Atul Gawande: Pandemic led to a ‘rethink on what matters’

Almost a year into the pandemic, societies are faced with immense contradictions: processing shocking death tolls while finding hope in promising vaccine rollouts. Surgeon, writer and researcher Dr. Atul Gawande speaks with The World’s Marco Werman about what it means to be human in this precarious moment.

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A man wearing a face mask walks through the Sensoji temple in the snow in Tokyo, Jan. 28, 2021.

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Hiro Komae/AP

It's a strange, confusing and difficult time for society during the coronavirus pandemic.

For nearly a year, we’ve watched the death toll from COVID-19 exceed 2.25 million worldwide. At the same time, new vaccines seem nothing short of miraculous.

Related discussion: Surging coronavirus cases and new vaccines

It’s tantalizing to think of a future — not living with constant anxiety. So, how do we process grief and also embrace a realistic amount of hope? For some advice, The World reached out to surgeon, writer and researcher, Dr. Atul Gawande, author of “Being Mortal: Medicine and What Matters In the End.”

Marco Werman: This seem to me like one of the oddest moments of the pandemic. We've just come off some record-breaking weeks of deaths and illnesses, and yet for the first time, there's a real possibility for some relief ahead. We also have people who are following the risk-mitigation guidelines — many who are not. How are you trying to make sense of the contradictions right now?  

Dr. Atul Gawande: Well, I'm not sure it's that contradictory to me. One of the things I track very closely is face-mask usage. And it was down in the 60% range in places like the Mountain West [region], where cases were exploding in September. That's up at 85%, 90%. That's the United States. But that's also the story in Europe where face-mask usage and limits on capacity and just people not gathering the same way we did three months ago — that has also changed. You go to India, where, in September, it was on its way to having the number one highest rates of spread of COVID[-19] in the world. And now it has among the lowest, because they got mask usage up to 99% in major cities. So, you know, you see people responding to the growth in cases in ways that, you know, people are starting to follow the science.

So, despite 2.25 million deaths around the globe, Dr. Gawande, I sense some optimism in your voice. 

I do have optimism. The basic tools have been the same. And when we use them, they work. We have major challenges ahead of us. We have mutant strains that are spreading from South Africa, from Britain, from Brazil, and in some cases cause vaccines to have a weaker effect. We have vaccines rolling out, so we're in a race to get ahead of the virus and the mutants. But I think we've got the tools in front of us, plus the vaccines. We can get out of it, it's always about as humans.

I mean, just getting by each day, though, requires so much ... compartmentalizing of horror — putting it in a box, trying to take care of oneself and one's family. I know the new vaccines help, but as you say, along come the worries about what mutations might bring. What is it like for you, moving from day to day? Are you holding your breath about what the virus is going to do next?

You know, we have consistently underestimated this virus. And at every step of the way, we have over-promised and under-delivered. And so my faith that we will prevail is never going to be unclouded by the reality of the brutal facts of where we've been and how difficult it's been to pull together as communities to make the right things happen. This is always the challenge. When it's terrible, we respond. And then it starts coming down, and we start seeing that things are better. And keeping our foot on the pedal long enough to get it so that it actually is stopped rather than just going to rebound again — that's our challenge over and over and over again.  

Do you find when you're talking to your colleagues and contacts in other parts of the world that there's a bit of a disconnect, like here in the US, [where] the virus is just raging. Other countries may have a better grip on things, but is this very traumatic moment universal?

It is largely universal. You know, there was a time when Europe could gloat and say, ‘What the hell is wrong with America?’ And then they became the highest spread, right up there with the United States spread. You have India, and my colleagues there wondering what's going on here. But, there was a time when they were terrible. There are parts of the world that got it right in the beginning and continue to get it right. Places like Australia and New Zealand, and also throw in Vietnam, Thailand — those have been the exceptions. Much of the world has been hit at one point or another and been behind the eight ball.

Even with vaccines, we're going to be facing outsized levels of death and a downward- spiraling economy going forward. I mean, the anti-grief advice I kind of give myself each day is to just put one foot in front of the other, give my family more hugs and kisses than usual.Generally, it seems to be working, but there are days when I get up and I am just miserable. I realize I haven't seen friends, I miss physical contact — and I know I'm not alone. I also know I'm in a pretty privileged position. What do you tell people who are out of a job or who have lost loved ones?

There's no way to salve the hurt. It is there. And the damage is real. The main thing is that I have total confidence that we will prevail. We have warmer weather coming. We have these vaccines, and we know the things that do work that allow you to start reconnecting again, including face masks and soon, vaccines. So, you know, it is just brutal. Life has changed in ways that were unfathomable this time last year. And I desperately miss all of the things you described, plus concerts, plus, you know, hanging out in a bar. And I'm so ready for that to come back. And I know we're going to get there — and that it's a long time away.

Concerts and going to a bar. Yeah, I'm feeling that. Do you think the pandemic has ... normalized death for some people? Made it less taboo to discuss? And is that an upside?  

I don't think we’ve become inured to death. I think we all have gotten to live most of our lives without fear that death could be around the corner. The pandemic changed that. That sense of fragility, that sense that you could — if not die — be made really sick in a very random way. I think [this] really did change people's perspective on their vulnerability. And for some people, they decided that the safest course was to completely ignore it — and consider everybody wusses for taking this seriously. For a lot of people, it led them to rethink what really mattered to them. And I'm seeing people make major career changes, seeing people change where they live, I've seen people change how they live because of what's happened in this pandemic. And I think that's going to be a lasting change.  

This interview has been edited and condensed for clarity. 

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