• Fall 2021 Editorial - Reentry


    As I write this, several weeks before publication date, I’m hard pressed to give the latest information about our COVID-19 pandemic. It keeps changing.

    But I hope that we will be seeing some measure of a winding down of the COVID-19 crises, at least in the U.S. I want to now speak of reentry.

    As of this writing, the death toll from COVID-19 in the US is more than 700,000. That’s already 50% more than all the Americans who lost their lives in World War II. The economic and personal tolls this pandemic has taken are also horrific. Although the stock market and large companies seem to have largely recovered, there are millions of Americans who have lost or changed their livelihood.

    Even ophthalmologists have been severely, though not evenly, impacted. About one-third surveyed say that their income has been significantly reduced because of COVID-19. This doesn’t even consider how measures of caution and austerity have changed and reduced the pleasures of work. And then, there’s the personal toll. We aren’t going to meetings, traveling for pleasure, visiting our grandchildren or even, in many cases, dining indoors anymore. But, there is also evidence of some return to normalcy as we begin to consider ways that we can resume these daily acts that help characterize our lives.

    Astronauts will tell you that after leaving the confines of earth and hurtling about in orbit at nearly 20,000 mph, they look forward to their return to home. But first, they must pass through reentry which is, by many accounts, the most grueling ordeal. The high velocity space craft must endure atmospheric drag and overheating which tests the structural integrity of the craft. There is severe shock layer turbulence on reentry. We should now consider what COVID-19 reentry might look like. It might not be so smooth.

    Having survived the threat to our bodies, our pocketbooks and our lifestyles, we must now survive this reentry that carries its own set of challenges. First, let’s understand that things will not return to where they were. Many things are gone forever and the new normal is going to be very different from the old normal. It will serve us well if we don’t set our expectations too high. I always shook hands with my patients before and after I examined them and often added in a hug. Those days are gone and I know I will miss them.

    My wife used to have me attend many social functions and parties where I would be seated alongside strangers. I confess a certain relief that those days may also be gone. And I’ve always hated long lines at events or shopping. So, I won’t miss that now that most venues are sensitive to how this looks and will be more tuned to alleviating social congestion.

    Other things will just be different, and maybe better. I’ve always been partial to outdoor dining and have the good fortune of living in Southern California, where we don’t experience much in the way of inclement weather. Surviving restaurants have accommodated to COVID-19 with imaginative ways to provide cover in an outdoor patio and if my wife can get the seat by the heater, we’re all happy. But, of course, many of my favorite restaurants have not survived. So, in short, things will not return to what they were, and we must be careful to see the glass half full.

    We may not have much of a voice on how society adjusts to travel and recreation. But we will, in the aggregate, have some interesting choices to make as we vote with our feet. The process of adapting in the time of COVID-19 has given us lots of alternatives for the way things used to be and some of these things learned are useful.

    I have become facile with Zoom which I use three to four times every day. This includes my lab meetings that used to only involve seven or eight people, but now has expanded to double that size since several of my collaborators in Europe and South America can attend. We had to move it from late afternoon to earlier to accommodate the time zone changes as most of my collaborators live to my east. But we’ve also compromised some things that we used to have at my old lab meetings.

    I miss the cake and ice cream when it was someone’s birthday. The new meetings are an improvement in convenience but not as socially rewarding. When COVID-19 abates, will we go back to in-person lab meetings? At minimum, we’ll have to offer our distant collaborators a means of joining us by Zoom into what might be called a hybrid meeting. But while we’ll see and hear them fine, they will have, on their tiny Zoom square, a picture of our entire conference room and not be able to see our individual faces. Or should we take along our laptops and Zoom in as individuals even as we gather together around one table? This might resemble the young people we see at restaurants whose attention is focused, not across the table at their dates, but at someone on their iPhones. So, we are now projecting the Zoom gathering on a large screen that used to be used for slides.

    I won’t even consider the controversial issue of virtual medicine in ophthalmology. I don’t like it but some of my colleagues, and many patients, love it. What if patients demand it even after it is shown to lead to more medical errors? That subject deserves its own editorial.

    Having things more convenient, or being more economical in time and money, is likely to be a huge lure that competes with what was the real thing. It’s natural to have a tradeoff between expediency and high standards. How much are we willing to sacrifice? And will we descend to the lowest common denominator? If in-person lab meetings exclude some, wouldn’t the majority go along with virtual meetings even if less satisfying? A hybrid lab meeting is a compromise that will fundamentally change the character of the whole.

    This brings me to what will probably happen to professional meetings. I used to attend these at the rate of about one per month. This includes the Academy. Those who attended last year’s virtual annual meeting, which was supposed to be in Las Vegas, may have missed out on personal get-togethers, alumni meetings, etc. But they probably loved the savings. Not having to close down our clinics for a few days, not having to fly across the country, not having to wait hours for a taxi from the airport, not having to pay for a hotel — there’s a lot of time and money saved. After we compute this cost next year, will we all want to return to the old ways? And even if most of us say yes, what about the third who will view virtual as a good deal?

    The likely option may be to offer a hybrid meeting and allow the membership to choose for themselves. I’m afraid of that, insofar as I’ll be there in person but will miss many of those who only attend virtually. I suspect that my older colleagues in academia will be there. But maybe not as many of the newer members who are more adaptable to our brave new world and see the cost savings as substantial. And I fear that this may be a growing body.

    As the meeting goes virtual, a larger percentage may find that convenience and savings trumps what the real-time experience offered. As the value of the meetings go down, the savings make more and more sense. It reminds me of the 1960s when steak aficionados bemoaned the arrival of McDonalds that offered great savings but at the cost of some steak houses. Maybe expanding the hamburger experience to everyone and often, was a legitimate tradeoff. I, for one, would advocate for many of the meetings going alternate years. We all go virtual one year and show up for the next. Naturally, there will be those that favor one over the other. But alternate years could preserve the steak experience for some for some years.

    Finally, I think we should think hard about what some of these new tools and ways of doing things affects the world of education. I love giving lectures. I’m at my best when I give didactics or, even more so, teach Socratically. For a couple of months after COVID-19 arrived, I found myself completely stripped of medical students, residents, and fellows, so I called in the techs and the patient’s family members for impromptu rounds.

    But years before the pandemic, there were already calls from the education community citing studies that our old-fashioned way of teaching was good for us, the professors, but not so good for millennials. Studies showed that the flipped classroom worked better. Students learned better when they heard the lecture online, at home and at their convenience. Classroom time was better spent going over the details and problematic issues. Learn at home, study in the classroom — flipping the old script. We are doing this now with our residents at UCLA and, I expect, across the country.

    Every challenge brings new opportunity as well. Foreign students who could not afford to travel and study at the Ivy Leagues are now getting Ivy League online education from their dining room tables around the world. And we may find out that our universe of educational and social opportunities has never been bigger. Grand Rounds at UCLA now has more than twice the audience of pre-COVID-19 days. Retirement, or partial retirement, now will include options that allows us to remain not only involved, but truly engaged in intellectually stimulating opportunities. So, let’s buckle our seatbelts, absorb the turbulence, and show some pluck as we reenter.