Living through a pandemic - A time for clarity, courage and truth.

December 31st 2019, Hogmanay, Glasgow, Scotland. A stunning, clear blue‐sky winter's day marking the last day of the year and I am looking forward to a new decade and a new year. A busy year promising international travel to conferences and meetings, and, with some sadness, my 2‐year term as ISTH President coming to an end in July, in Milan at the ISTH 2020 Congress. I was excited and happy. Reports about a mystery new virus in Wuhan, China causing severe pneumonia started emerging mid‐January with little in the way of a global response or reaction and certainly no sense that the world would soon be in the throes of a global pandemic creating a tsunami of illness and death, economic hardship and a global recession. In just short of 6 months, the virus, Sars‐CoV‐2, has caused the illness COVID‐19 in over 5 million people and the death of at least 330 000 worldwide. Throughout the world, to a greater or lesser degree, people have been largely confined to home, if not to their town or city.

May 25th 2020, Auckland, New Zealand. I have been here in lockdown for the last 2 months not even venturing out of the city, never mind the country. New Zealand is a diverse nation of 5 million people in the South Pacific. On March 23rd our Prime Minister, Jacinda Ardern, announced the country would go into lockdown at 11.59 pm on March 24th – all non‐essential business would stop, people had to form “bubbles” of family or friends in a single household and would remain socially isolated in that bubble until the threat of infection with Sars‐CoV‐2 was gone. At that time NZ had recorded only 102 cases of COVID‐19 but, ominously, the infection rate was following the exponential trajectory of other countries in the world.

As of May 25th we are emerging from national lockdown; in New Zealand just over 1500 cases of COVID‐19 have been reported, with 21 people having died as a result. The combination of relative global isolation with exemplary political leadership and proactive enforced social isolation measures have protected our population from the worst effects of the pandemic. We went hard and we went early.

New Zealand is one of a few countries in the world where numbers of people infected with Sars‐CoV‐2 have been limited but its population has not been spared the fear and anxiety that the pandemic has provoked. At such times it is evident that people require clear, unambiguous, and consistent information about the threat they are facing and what they need to do to manage their risk and stay safe. In addition to clarity, leaders must also have courage in that message and keep speaking the truth even if does not suit the political moment. One doesn't need to look far to see stark contrasts in the ability of global leaders to deliver such information to their population and to see how this has impacted on their ability to curtail the spread of SARS‐CoV‐2 during the pandemic and guide their citizens to a place of greater safety.

Scientific and medical leaders also play a critical role in providing clear and coherent information and guidance about the pandemic. They too must step up to the challenge of truthfully interpreting the avalanche of evidence from across the world about transmissibility of the infection, about risk factors for disease severity and clinical complications, potential effective therapies and therapies to avoid, recognising that this requires careful distillation and interpretation to guide decisions and allay fear. Organisations such as ISTH with its global network of scientists, clinicians and researchers also play an invaluable role in interpreting and disseminating emerging information and can also provide direction and advice about the important clinical questions that need to be addressed. Specifically with COVID‐19 it has become clear that thrombotic complications are a frequent feature in hospitalised patients and there are uncertainties around the optimal approach to thromboprophylaxis in this clinical setting. Currently there are many more questions than answers but we can be hopeful that in the months and years to come such research will help provide greater clarity and guidance. Societies like ours with their journals will play a pivotal role in the dissemination of this information. We have an obligation to do so with clarity, and given its global significance should make this widely accessible and at no cost.

Arundhati Roy recently wrote that a pandemic forces us to break with the past and imagine a different future. That a pandemic serves as a “portal, a gateway between one world and the next” and that we can choose to leave prejudice and dead ideas behind and walk through the portal “lightly, with little luggage, ready to imagine another world.”

However, I believe we should also remember what was valuable and worthwhile from before, and embrace that.

Across the world, face‐to‐face meetings and consultations have been replaced by a new “virtual” meeting space. Skype, Microsoft meetings and Zoom have taken the place of laboratory and clinical meetings, of lunch and dinner and coffee, of patient consultations, and school lessons and university lectures. Having cancelled the Milan 2020 Congress, ISTH is moving ahead with a Virtual Congress July 12‐14. Until an effective vaccine is developed and available at a global level, virtual meetings will undoubtedly play a growing role in the dissemination of ideas, research and education and some might argue that these are the way of the future and will ultimately replace the need for IRL (in‐real‐life) interactions.

But what might be missed at a virtual meeting? Those wonderful, serendipitous opportunities when you bump into your thrombosis and haemostasis hero in line for coffee during a break at ISTH Congress or poster session is unlikely to happen on‐line. There is also something exciting and valuable about travelling to the city where the Congress is being held, walking into the Congress Centre each day, catching up with friends and colleagues from across the world, people who you only see once or twice a year at conferences but with whom you form lasting friendships, watching the presenters in real time and talking with them after. But it is much more than that. Those casual conversations with colleagues and friends, old and new, can be the nidus for important research ideas and collaborations, or when solutions to seemingly intractable problems can be glimpsed.

Such chemistry will be missed with a virtual congress but at a time when the potential to spread infection is high, we have little choice. While a virtual congress will make it easier for people to “attend” it will also highlight inequities in access to effective internet and personal computers, difficulties in choosing a workable time‐zone to hold a meeting with a global audience (NZ time zone will not be selected, I wager) and issues being granted leave to attend.

Thinking back to my first ISTH Congress in Paris 2001 where I met my clinical hero which gave me the confidence and courage to continue on my chosen path gives me pause for reflection. Before rushing headlong into a world of diminished virtual interactions, we must recognise the essential nature of human, personal interactions in medicine, science, and politics and find a way to carry these forward into our new now.