Commentary: What If There Is a Virtual ACC and Nobody Cares?

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MARCH 25, 2020 -- In normal times, I write a preview the week before a major cardiology meeting.

These are not normal times. The coronavirus pandemic consumes everyone's attention.

As a virus, SARS-COV2 is nearly perfect. It does not often kill its hosts. The terrifying part for us is its capricious ability to cause pneumonia and death. While the data try to tell a reassuring story—a 1% case fatality rate seems low—the absolute numbers of deaths plus the well-publicized anecdotes of healthy people who have died foster anxiety and dread.

There will be many lessons from this crisis. One will surely be about how humans feel risk.

Then there are the surreal societal interventions. The perfect virus easily spreads from host to host. The only way to stop it is to stop life as we know it. Stark images of barren subways, airports, and city boulevards the world over distract your mind.

Healthcare workers earn a living in the hospital and clinic, but we, too, worry what 20% unemployment does to the world we live in.

Think about the contrast with the act of going to a meeting like the American College of Cardiology (ACC) Scientific Sessions. We fly there, stay in hotels, eat food, drink coffee, walk the streets, meet with friends, and enjoy the mental space to perseverate on the nuance of clinical science. In a COVID-19 world, none of this exists.

A few weeks ago, the ACC decided to change to a virtual meeting. A few weeks ago is a century in COVID-19 time.

I was scheduled to talk at the ACC on atrial fibrillation therapy. It was an honor to be included in a session with esteemed leaders. When the ACC asked us to record our talks for a virtual program, the response came in different levels of candor but was essentially unanimous: Our lectures are meaningless in a COVID-19 world.

A few weeks ago, the surges of COVID-19 illness were thousands of miles away. Now, they threaten to turn New York City into northern Italy or Wuhan.


The virus has taught the United States about exponents. When there are two cases in a community hospital, there are soon four, then eight, and, after that, fear.

Mixing the notion of exponents in a world with a shortage of personal protective equipment (PPE) rightly terrifies healthcare workers. The influential writer/surgeon Atul Gawande MD wrote approvingly in the New Yorker about a mask-for-all policy in the Brigham and Women's Hospital in Boston. But then a preprint from China documented that the virus lives on keyboards, doorknobs, and even hand sanitizer dispensers.

Two movies play in my brain: One movie says we need more PPE to protect ourselves; the other says we are all getting this and it's a numbers game as to whether it kills us. Neither movie leaves space for anything else.

In Kentucky, where I practice, we have been gifted time. We can prepare; we can split into teams, some working in the hospital, others at home. We can cancel cases, open hospital beds, and then wait. That is good.

But the waiting is hard. Gosh, 2 months ago, I wished I had this much free time. I could catch up on manuscripts or book chapters. But it is not free time. In a COVID-19 world, the brain cannot focus on nonviral topics.

This is why the upcoming virtual ACC meeting is moot. Weeks ago, when the late-breaking science was revealed, I reviewed the studies. At that time, there were things to say about the clinical science: nifty trial designs, interesting sub-studies, and some new therapeutics.
These can wait.

It seems tone-deaf to discuss science-that-can-wait while colleagues across the world fight this challenge.

In hospitals, we have postponed the elective to make room for the coming surge. Shouldn't ACC do the same? After the crisis passes, we can have a virtual meeting with a proper discussion of the science.

John Mandrola practices cardiac electrophysiology in Louisville Kentucky and is a writer and podcaster for Medscape. He espouses a conservative approach to medical practice. He participates in clinical research and writes often about the state of medical evidence. 

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