One Year Later: Coronavirus Update With Lisa Gilbert

Dr. Lisa Gilbert is a board-certified family medicine physician with additional certification in tropical medicine and infectious diseases, at Ascension Via Christi Family Medicine Residency in Wichita, Kansas.

As a member of the Ukrainian Catholic Church, she also brings a theological eye to her work, and is currently pursuing a master’s in Catholic clinical ethics through Georgetown University and Catholic University of America. 

She was interviewed by Abigail Woolley Cutter for TLC very early in the pandemic last year – March 2, 10 days before the NBA suspended its season and made the crisis real for many Americans. She already had been monitoring the virus for weeks, and spoke presciently about asymptomatic transmission, the coming shortages of hospital beds, and why this was more deadly than the flu. TLC’s Kirk Petersen caught up with her on February 24, 2021. The interview has been lightly edited.

Your interview from a year ago has held up remarkably well, in terms of the things you were on top of months before they became conventional wisdom. What do you see coming down the pike with the pandemic?

Overall, I’m really encouraged. All the trends I can see are going in the right direction. Hospitalization rates are going down, new cases are going down, vaccination rates are going up. We have reassuring reports that even one dose of the vaccine is probably more effective than the original studies indicated. All the markers we look at are trending in the right direction.

There’s certainly a lot of noise about variants, and genuine concern about the variants that could be circulating more widely than we know here in the U.S. That said, everything I’ve seen so far indicates that the vaccines are holding their strengths against the variants. And we’re going to have variants, that’s what viruses do.

“We’re not called to tempt God. We are called to be martyrs, in a sense, but we’re not called to put others at risk.”

Even if and when the variants do diverge from the vaccine protection, I still think we’re in a better place than we were a year ago. The mRNA vaccines can be easily tweaked to create new vaccines. [mRNA is a genetic material that stimulates the production of antibodies.] They were able to create the mRNA vaccine shortly after the original virus was sequenced, because that’s the nature of mRNA vaccines.

I kept hearing early on that it might take four years to develop a vaccine. Thanks be to God, we have it a lot sooner. Did that surprise you?

A little bit it did. I had been hearing more like a year and a half. I was thinking it would be this year – if we were going to have a vaccine that worked.  For me that was the biggest question, because they’ve tried to create coronavirus and other vaccines in the past, and ran into trouble for a variety of reasons. So that was my question: are we ever going to have a vaccine for this, or are they going to fail?

What else surprised you?

I was very surprised by the politicization of it. I also felt that people either overreacted in some regards, or under-reacted, just basically turned off and said “nobody knows what they’re talking about, I’m done, I’m just going to live my life.”

Probably what surprised me most was the division within the Church. I think I can speak for multiple branches of the church, given my interactions with others. Divisions about masking, about social distancing. It’s been discouraging for me as a parishioner and as a medical provider to see those extremes. I’ve seen churches where there’s no precaution taken whatsoever, there’s a sort of pride in that. You see other churches that have remained closed and had services online for months on end without trying to gather in safe ways.

That said, now that we’ve come through the elections, I’m hopeful that people are starting to come back together and recognize how even divisions in themselves are harmful.

I remember seeing ministers saying, “God will protect us if we get together for church.” Do you have a theological perspective on that?

I’ve seen that too. I’ve seen it within the Orthodox Church, within the Catholic Church, within various evangelical Protestant churches.

God certainly can protect us. He certainly has the power to do so. And yet, he doesn’t always protect us from disease, of any kind. We are rational creatures, and we are given wisdom from various sources that we have to integrate into how we live our lives. Part of that wisdom is coming from the scientific community. That doesn’t mean we necessarily accept everything that is being told to us by the scientific community, we have to understand that through the lens of our faith. And yet, we’re not called to dismiss that. We’re not called to tempt God. We are called to be martyrs, in a sense, but we’re not called to put others at risk.

You mentioned the change in administrations. What effect has that had?

I think it probably has led to more focus back onto the healthcare aspects of COVID, as opposed to the economic impacts. That’s a very broad generalization. I do feel like the Biden administration is really attempting to streamline getting vaccines to the states that need it, and making sure the states have the resources to get it to the most vulnerable.

I think there’s an enormous impact that hasn’t been addressed, of all the collateral damage of this. Domestic violence is up, child abuse is up, substance abuse is up, suicide rates are up.  All of this comes in part from the stress around the virus, the isolation, the loss of jobs. The waves of impact from this haven’t even fully hit yet, in terms of the economic impact downstream.

We’ve missed a ton of cancer in healthcare, and we’re going to start picking that up in the next couple of years, because there’s a lot of people who have missed their screenings in the past year. For some of them, it will be too late by the time that’s addressed.

How would you evaluate the job President Trump and his administration did in combatting the virus?

I hesitate to be unduly critical because I was not in the room making all the decisions. I do think the Trump administration was very concerned about the economic and other impacts of the social distancing and the other measures. To be fair to the Trump administration, the information coming out of the WHO [World Health Organization] at the very beginning was, “China’s got this, this is under control, it’s not going to be a major deal.”

“The changing nature of what we understood about the virus was really confusing for public officials.”

That said, I did not feel there was consistent messaging [by the Trump administration]. There were a lot of areas left unaddressed, that should have been more consistently addressed throughout his time in office. At the very end I felt like he wasn’t really engaged at all in coronavirus, in the last three months of his presidency, and that was a real loss.

The changing nature of what we understood about the virus was really confusing for public officials. I feel for our public officials who are suddenly thrust into a world of epidemiology and infectious disease, with no background to understand how to translate that into public policy, and unclear and changing scientific knowledge muddying the waters.

A number of public health officials have stepped down this year, and there will be a lot more in the next year. They have borne the brunt of so much criticism on both sides that they are very drained. I’m concerned about filling those voids in our public health systems with new people in positions of leadership.

What about front-line healthcare workers? Has the pressure let up on them in any way?

It has changed significantly. The initial pressure was an unknown disease with unknown treatment guidelines and very critically ill patients, with reports coming from other countries of healthcare workers getting sick and dying – and all of that in a setting of lack of resources. Initially there was not even enough personal protective equipment, PPE, and genuine concern about lack of oxygen and ventilators.

Healthcare workers felt very insecure. They felt they may be putting themselves at risk, they might have vulnerable family members at home, or they were concerned that “I’m going to spread this to my patients, because I may have this and be asymptomatic.”

So there was a lot of moral distress over that initially, that conflict between the duty to care, and the duty for self-preservation and for one’s family, and the worry about spreading it to others. I think most of these initial pressures have lessened because of better resources, better policies and protocols, and better understanding of the virus.

That said, there are ongoing pressures, and new ones. Initially healthcare workers were supported by communities and looked up to as heroes, and now there is some backlash where healthcare workers are seen as contributing to the politicization, or to restricting people’s ability to live their lives. This is especially true when healthcare workers try to advocate for policies to reduce viral spread. I think this is hard for healthcare workers who are used to being respected and trusted by their communities.

There’s also a lot of grieving among healthcare workers. They formed such intense bonds with patients, because they were the only ones there. Especially in the ICU, where patients linger for weeks while they’re recovering, because they’re on high-flow oxygen [pressurized, nearly pure oxygen].

We saw a lot of post-traumatic stress issues for healthcare workers after SARS [an earlier pandemic that began in 2002]. The attrition rate after the epidemic was over was extremely high. Most people can get through an emergency situation, but then there’s a let-down period. During that time, it can be really difficult to process some of that moral distress, that sense of fragility. I think what most healthcare systems need to realize is, it’s going to be a year of recovery for many healthcare workers, if not more, after this is all over.

You say a year after it’s all over – when will it be all over?

This is my own opinion, I don’t speak for any institution. I think it’s fair to say, though, that no one expects this coronavirus to ever disappear from the human population. It’s worldwide, it’s in every country – even if we get vaccinations to the majority of people, there will still be people that are unvaccinated, and immunity does wane with time.

“We keep talking about herd immunity. I don’t put a lot of stock in that, in the sense of stopping community spread altogether.”

We keep talking about herd immunity. I don’t put a lot of stock in that, in the sense of stopping community spread altogether. I do think we will mitigate it significantly through vaccination, and through immunity after people have been infected. If we have enough people who have some circulating antibodies to it, it won’t get to the point that it overwhelms healthcare systems and spread in communities will be very low.

But I don’t think we’re ever going to reach that [herd immunity] in the U.S. in the same sense as we do with, for example, pertussis, and certainly this will not happen worldwide. But I do think that if we can adequately protect the people who are most likely to be severely affected by this and have very low community spread, we will have done really well as a society and can resume a normal life.

We’re going to publish this in the Easter issue of The Living Church. As a person with theological interests and a healthcare worker, does Easter say anything to you about where we are?

I think back to this time last year. It feels like a very long year of Lent, and we’ve just re-entered Lent, and it doesn’t quite feel fair, to be honest…

However, I think the beauty of the Resurrection has struck me even more throughout this last year. Many of us have had to sort of die to ourselves in one way or another. Something has impacted every single person. We’ve all had something we’ve had to give up. And every Lent has its Easter.

So I think focusing on the Resurrection of our Lord is something for us to hold onto in recognition that this world, with all its brokenness, is not our home. We are also called for resurrection and for new life in Christ, and there’s such a hope and joy in that.


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