Seeing Light at the End of the Tunnel: Gregg Coodley Of Atmosphere Press On The 5 Reasons To Be Hopeful During The COVID Crisis
An Interview With Fotis Georgiadis
Our preventative tools are extremely effective. The Moderna and Pfizer vaccines and to a degree the Johnson and Johnson vaccine remain very effective in preventing severe illness, hospitalization and death. While we talk about the drop in antibodies over time, we often fail to note that vaccination gives the body a lasting memory of the virus that will allow it to meet repeat infections with boosted immune defenses, preventing the worst disease.
As a part of my series about the things we can do to remain hopeful and support each other during anxious times, I had the pleasure of interviewing Gregg Coodley.
Gregg Coodley is a primary care physician and director of the Fanno Creek Clinic. He is the author of three prior histories, most recently, in collaboration with David Sarasohn, The Green Years 1964–76: When Democrats and Republicans United to Repair the Earth.
Thank you for doing this with us. Our readers would love to get to know you a bit better. Can you share with us the backstory about what brought you to your specific career path?
My career has been guided by a deliberate decision, to become a primary care doctor, as well as by a series of chance events. First, a chance where I took my first job led me into the care of HIV patients, confronting my first epidemic. Circumstances led me to become director of the University General Medicine clinic, where I discovered skills and inventiveness to convert the clinic from a money loser to a revenue source while tripling the number of patients seen. My success there gave me the confidence to later leave to start my own clinic accompanied by many of the doctors and nurses who worked under my leadership as then chief of General Internal Medicine at the university. Twenty years later it still surprises me to have seen the business grow and prosper so much.
I started writing books first to entertain my kids, with the first two books a fantasy of them going on an adventure with our pets. From there, I branched out into writing history which had always been my favorite subject. In November 2019, I decided to make my next book marry my interest in medicine, specifically epidemic diseases, with history to write a book chronicling the effect of major infectious diseases on American history. Two months later, Americans first heard of Covid-19. Like most doctors, my last two years have been shaped by the challenges of the Covid epidemic.
In researching my book on infection in American history, published last month, I learned so much I did not know from a whole host of well-written, interesting books dealing with specific disease episodes in the United States from smallpox in Boston in 1721, yellow fever in the then national capital of Philadelphia in 1793, plague in San Francisco in 1900, to AIDS in New York in the 1980s. It is encouraging to know that confusion about treatment, scapegoating of those blamed for the disease, fear and disruption didn’t start with Covid, but were present in so many of our past episodes. The Anti-Mask League started in 1919 San Francsico, while firing cannons was viewed as the best way to dampen the spread of yellow fever. In learning that our mistakes and stumbles during Covid mirror past American experiences, one also learns that Americans rose to the challenges of these epidemics. Each pathogen, through a combination of public health practices and medical advances, has been eliminated or brought under control. This gives us concrete reasons and evidence for hope.
Ok, thank you for all that. Now let’s move to the main focus of our interview. Many people have become anxious from the dramatic jolts of the news cycle. The fears related to the coronavirus pandemic have heightened a sense of uncertainty, fear, and loneliness. From your perspective can you help our readers to see the “Light at the End of the Tunnel”? Can you share your “5 Reasons To Be Hopeful During This Corona Crisis”? If you can, please share a story or example for each.
There are indeed five reasons to be hopeful about the future with Covid. First, it will never be as bad again. Even were the virus to mutate further, we will never be without the tools we have gained to deal with it. Even with the onslaught of the most transmissible variant yet in Omicron, it is not the same killer it was. While 300 deaths a day in the United States remains too many, it is not 3000 a day. The number of Covid infections in the United States may be as high as at any time in the pandemic, yet the number hospitalized and the number seriously or critically ill is far fewer. The preventative tools and treatments we have learned means that Covid going forward is currently more like a bad year of influenza, taking a toll among the elderly and debilitated, but not the massive killer of 2020 and 2021.
Second, our preventative tools are extremely effective. The Moderna and Pfizer vaccines and to a degree the Johnson and Johnson vaccine remain very effective in preventing severe illness, hospitalization and death. While we talk about the drop in antibodies over time, we often fail to note that vaccination gives the body a lasting memory of the virus that will allow it to meet repeat infections with boosted immune defenses, preventing the worst disease.
It has been disappointing that neither vaccination nor infection provides lasting immunity. As such, as currently stands we face a future where we are likely to need regular boosters to strengthen our immunity. Still, this is the worst case scenario. It is likely that we will develop even more effective vaccinations. Researchers are studying the possibility of vaccines that would target parts of the virus that don’t change so that immunity might be longer-lasting. Other research is looking into an intranasal vaccine, which would create maximum antibodies at the site of viral entry to reduce the frequency of infection. The knowledge we have learned about the virus isn’t going away; knowledge about vaccination will only increase over time.
Third, we now have effective treatments for Covid. When the pandemic started in early 2020, there was no treatment, leading to the advocacy of a host of untested and too often ineffective snake oils. All medicine could offer was supportive care such as oxygen and all too frequently intubation to help people survive critical respiratory compromise, and too many people died. We learned simple things first, like how to position patients for optimal oxygenation. The first anti-viral agent, Remdesivir, had modest benefit for hospitalized patients. From Britain we learned that dexamethasone, an inexpensive steroid, would dramatically cut the death rate among hospitalized patients. The next major advance was monoclonal antibodies that were shown to reduce patient deaths. All of these treatments were, to different degrees, difficult to administer except in a hospital setting.
Now, however, we have effective oral drugs, most notably Paxlovid. A study showed that Paxlovid reduced the chance that a Covid-infected patient would be hospitalized or die by almost 90%.
For many specific antiviral or antibiotic therapies, the organism can develop resistance over time. However, it beggars belief that our options for effective treatment will not continue to increase even further over time. This has certainly been the case for other viral infections, such as HIV, hepatitis C and herpes. The history of other infections suggests that the percentages of Covid-infected people who suffer severe illness or death will only continue to decrease over time.
Third, in early 2020 we knew very little about the virus. At first we did not know that infections could be asymptomatic or how the virus was really transmitted. We have learned much. We now know that masks do reduce transmission. We know that transmission is mainly respiratory rather than occurring by touching surfaces contaminated by viral infection. We know that infection is far more likely indoors than out. We know which activities, by spreading the virus into the air, are more likely to cause infection in others. Some might argue that too many of us don’t apply this knowledge, refusing to mask or now, after two long years, increasingly giving up on masking. Yet knowledge is never useless. At least those at highest risk know that they can reduce their risks by masking and avoiding activities, such as crowded indoor venues, most likely to cause infection.
Most importantly we have not learned all that we can or will. Our knowledge about the “long Covid” where disease symptoms persist is rudimentary. This will change, just as we learned what the complications of chronic HIV infection were once so many people were no longer dying of AIDS. We will understand Covid more and develop ways to treat it. Knowledge and understanding grows.
Fourth, we were woefully unprepared in so many ways for the onslaught of Covid. Doctors and hospitals were short of masks, short of ventilators, and short of the materials needed to do Covid testing. We know now what we were lacking and have taken steps to address these deficiencies. We have learned that amidst a global pandemic we could not simply rely on foreign suppliers for scarce items that everyone wanted. I believe that American production of many of those items found short has been ramped up. The powers that be will need to stay vigilant to make sure that we have adequate sources of needed medical equipment. I think this lesson has been learned to a far greater extent than pre-pandemic.
For now we are no longer short of test kits, vaccines, masks, ventilators or many other items. There are still medical supplies that are in limited supply due to supply chain issues, a euphemism that covers corporate decisions to manufacture so many medicines and other health care items in cheaper locations across the ocean. I am hopeful, if not completely confident, that this problem will never be as bad again as it has been. We do need to make critical drugs and other items in America, even if this imposes a (small) higher cost.
Public health has been crucial in the fight against Covid. I hope that we will build up our public health infrastructure to be better able to handle other diseases.
Fifth, the knowledge we have learned from the fight against Covid will be of great benefit in many other ways. The development of M-RNA vaccines that could be created in weeks will not simply allow for new Covid vaccines. The same technology can be used to quickly create new vaccines against other pathogens, both new and old. For example, for the infection of monkeypox, we know that our smallpox vaccines will be effective. We also could quickly make a new monkeypox vaccine using the new technology. The prospect is that future novel or newly spreading pathogens can be much more quickly prevented by quick development of vaccines.
Our newly developed drugs against Covid offer a reasonable hope that the same therapies could be rapidly developed against other diseases. Indeed Paxlovid is a combination of a specific anti-Covid-19 antiviral agent and a booster agent, Ritonovir, which came out of the treatment for HIV infection. We can learn from what has worked before to deal with other current and future infections.
Similarly we have learned that masking reduces the spread of respiratory infections. It is a tool that we can use, should we choose, to reduce the spread of everything from influenza to respiratory infection a, b and c of the future.
From your experience or research, what are five steps that each of us can take to effectively offer support to those around us who are feeling anxious? Can you explain?
It will be hard for us to forget the cost of Covid, especially for those who lost friends or family to it. Katherine Ann Porter, author of Pale Horse, Pale Rider, wrote of the 1918 influenza pandemic that sickened her and killed her boyfriend, “It simply divided my life, cut across it like that.” I think that we can draw from the lessons of history to support our friends, family, co-workers and others left anxious and stressed from the Covid pandemic. It helps to remember that we are not the only generation to be struck down by a great plague. Those in the past, with fewer resources and much understanding, persevered. Things do get better. We can tell people with complete accuracy that the worst of Covid has passed, that it will never get that bad again and that we are not the people so woefully prepared to confront Armageddon.
I think anxiety has been heightened by all the other world and national issues that have happened concurrently, from the invasion of Ukraine to natural disasters to shootings. I think it is helpful to try to replace the feeling of helplessness, which greatly aggravates anxiety, with the knowledge that each of us can help repair the world. Rather than feeling that the problems are overwhelming, it is empowering to feel that every effort, no matter how small, can help, that he or she who saves one life is as if they had saved the world. I often encourage my patients, if they have time, to volunteer in some activity they find interesting, for whether or not they help others, the effort often helps them.
What are the best resources you would suggest to a person who is feeling anxious?
I encourage people who are feeling anxious to try to reach out to family, friends or others. There is strong documentation that these social connections reduce anxiety and depression and improve our sense of well-being. To borrow a line from an old movie, “ Man needs his own kind, like them or not.” I also encourage all of my patients to find things, whether exercise or meditation or hobbies or otherwise, that makes them feel better when they are feeling badly. We all will have hard times and having these tools can be very helpful.
Can you please give us your favorite “Life Lesson Quote”? Do you have a story about how that was relevant in your life?
In The Lord of the Rings, Frodo says, “I wish it had not happened in my time.” Gandalf replied, “So do I and so do all who live in such times. But that is not for them to decide. All we have to decide is what to do with the time that is given us.” I find this quote helpful when I am feeling discouraged or feeling sorry for myself. It reminds us that our challenge is to make the best of our situation and think about what we can do about it.
You are a person of great influence. If you could start a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂
I think we would most benefit if we could do our best to be tolerant of others and their differing views and perspectives.
My personal view is to think that as individuals and society we pay too much attention to what will make us happy no matter the consequences. I would argue to emphasize more our responsibilities rather than just talking about our rights. I think the fact that almost every religion and philosophy emphasizes the importance of right of honorable conduct as the path to a good life cannot be easily dismissed. I think trying to do good would be a good path for many people, but I also accept that my views are not those of everyone and would not presume to tell others how to act or think. I will leave starting a movement to others.
This being said, the consistent theme of my books is that progress is possible and that hope is not a misplaced emotion. I am more interested in the silver linings than the clouds. In writing about unsuccessful reformers in The Magnificent Losers, I looked at how their ideas often came to successful fruition later. The difficulty and the magnitude of the problems facing us cannot be a reason for inaction.
What is the best way for our readers to follow you online?
The website of the book TamingInfection.com is one way to contact me, particularly with regard to Covid and other infectious disease issues. There is a similar website for my most recent prior book The Green Years 1964–76: When Democrats and Republicans United to Repair the World, which looks at the years when most of the major environmental laws were enacted. My upcoming book Patients in Peril: The Demise of Primary Care in America looks at the problems of a crucial segment of American healthcare and offers a list of solutions. A website for this should be forthcoming.
Thank you for these fantastic insights. We wish you only continued success in your great work!
Seeing Light at the End of the Tunnel: Gregg Coodley Of Atmosphere Press On The 5 Reasons To Be… was originally published in Authority Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.