A Physician’s Pandemic Perspective, Five Years Later: An Interview with Donald Landry

Public Discourse continues our commemoration of the fifth anniversary of COVID-19’s outbreak in the United States with the following interview of Dr. Donald W. Landry, Hamilton Southworth Professor of Medicine, Chair Emeritus of the Department of Medicine, and Director of the Burch-Lodge Center for Human Longevity at Columbia University, by Public Discourse Contributing Editor Nathaniel Peters.

Nathaniel Peters: When did you first realize that COVID was going to be a pandemic? Could you describe how you watched things go from distant news on the horizon to a crisis on your doorstep?

Donald Landry: In December 2019, reports appeared in the news about a respiratory illness that was spreading through parts of China. There was a lot of confusion about the implications of these reports. A statement by the World Health Organization that the pathogen was not transmitted human to human, but only through animal vectors, provided some comfort. But, fortunately, our government ignored that statement and banned flights out of China to the U.S. because the reality was just the opposite. The virus, as we soon learned, was enormously transmissible.

Over the next two months, we watched it spread through China—and beyond. It hit particularly hard in northern Italy, and we certainly knew by February 2020 that there was a major worldwide pandemic in the making that would eventually hit us. The virus was identified as a coronavirus in the SARS family, and this caused great alarm—because SARS killed almost 10 percent of those infected. 

As part of our preparation for what was coming, we had Zoom meetings with physicians from Wuhan, China and Brescia, Italy. They described a fulminant illness that compromised respiration and caused vascular collapse and low blood pressure. The loss of life among healthcare workers, particularly in Brescia, was startling, and the Brescian physicians expressed sorrow for us, knowing too well what we were about to endure.

It was in March 2020 when the first patients with this respiratory illness, ultimately named COVID, were admitted to our hospital.  

NP: What was your experience at ground zero for the COVID pandemic in America?

DL: The initial patients arrived in a trickle. But the virus was clearly in the community and spreading. Throughout March and into April 2020, the numbers slowly rose, rose rapidly, and then skyrocketed. Normally we have about 117 ICU beds. Anticipating the worst, we converted standard wards into makeshift ICUs and, with quickening pace, we filled those makeshift units. No local help was possible because all of New York’s metropolitan area—perhaps due to its population density which favored transmission—was overwhelmed. 

At our peak, the hospital was filled with nearly 700 patients with COVID, of which roughly 300 were in intensive care units beds on ventilators and almost 100 of these required dialysis for kidney failure related to vascular collapse. We kept track of the doubling time of our inpatient COVID population in fear of the moment when we would run out of beds or equipment. We thought the ventilators would be at greatest risk to run out, but the first piece of equipment in short supply ended up being dialysis machines. Fortunately, the CEO of Gambro North America was a friend, and shipments of dozens of machines and pallets of dialysis disposable appeared. We just barely avoided the desperation of triage.

Mercifully, the doubling time of our COVID census began to lengthen, and we plateaued by the beginning of May 2020. We breathed a sigh of relief that we would not be overwhelmed. But the peak of COVID was actually a plateau and trying to maintain that level of care to the multitude continued to stretch the staff to its limits. Into June and July, the numbers finally declined, and we had weathered the worst pandemic to hit New York since the influenza-based Spanish flu almost a century before.

NP: What was it like to lead the hospital during this time? Are there any particular stories or examples that capture what you and the team of doctors were doing at that time?

DL: As I described, the reports of extremely high mortality of healthcare workers coming out of Europe—also China—were extremely concerning. Beyond the personal losses of colleagues, friends, trainees, we feared a collapse of the physician and nurse workforce. There was inadequate information to know if any demographic would be spared, or impacted less severely. And so the entire MD workforce of the Department of Medicine was mobilized: almost 600 physician faculty, over 100 physician fellows, and 150 resident physicians.

I made a point of taking a history and examining the first patient with COVID admitted to a floor bed. The procedure to enter the patient’s room was to gown, mask, face-shield, and glove under the observation of another physician—both for the gowning and the de-gowning, to avoid self-contamination. The idea of seeing this patient and visiting the COVID ICUs was to accept some of the risk that I was asking others to accept. But over the next week or so, every time I cleared my throat, I wondered if I had actually made an enormous mistake in trying to set a good example. As I would later describe to all of my colleagues during our darkest days, this was a tiny sharing in the fear and uncertainty that they were all feeling. I told them “Make no mistake: I fully realized that if for every one patient with COVID that I saw, you have seen 100, then you were 100 times what I am, and you should know that.”

Amazingly, and a testament to the extraordinary care of my colleagues, we lost no physician to COVID at Columbia. Physicians did get infected and were hospitalized, and we had touch-and-go moments—but no one died. And all those infected ultimately returned to practice—some of them a few days later, and in the extreme, a few months later. Without a doubt, this was the department’s finest hour.

NP: Did the Columbia experience have any influence on the national response to COVID?

DL: Part of our plan to never break faith with our patients—to never give in to the extreme triage of withholding standard care—was to have as many caregivers as possible available if patients had to be manually supported in their respiratory failure. To that end, we wrote an op-ed for the Washington Post advocating that all medical schools in the country instantly graduate their current senior class—which at this time of the year were just taking electives, had already completed medical training, and would be reporting as interns in June—and advance them to the front lines for institutions that found themselves in a similar position to us in New York. The number of physicians suddenly added to the front ranks in this fashion could be as high as 20,000 nationwide. The proposal was implemented by a number of medical schools, including Columbia and Harvard.

NP: How did COVID either vindicate or change your understanding of your vision for the practice of medicine and the vocation of the physician?

DL: It was actually a reaffirmation of the fundamental commitment of the profession. There’s a marble monument at Columbia that now sits in the student common room. There is a Latin inscription on the top—”Haec mea ornamenta sunt”—followed by a list of fourteen Columbia medical students who died serving in the public hospitals during a flu pandemic. The tablet was originally thought to commemorate the 1919 pandemic, but further research confirmed that it was the 1859 pandemic. The inscription continues: “That the example of these martyrs to humanity may never be forgotten, and that physicians will never hesitate to hazard of life in the performance of duty.” 

Medicine goes back 5,000 years. Medicine is already 2,500 years old when Hippocrates articulates the Oath, and it hasn’t even started the infancy of its science. So for millennia, the medical profession has been in service of those in need—regardless of risk. Thankfully, it is uncommon for physicians in ordinary practice to risk death for others on a daily basis—but the pandemic cast in bold relief the sacrifice and service that is the practice of medicine. 

Image by Halfpoint and licensed via Adobe Stock.