“To heal when possible; to alleviate when necessary; to always comfort”
These are Hippocrates’ sentences, to whom, doctors, we take an oath to. The Medical School of the Universidade de São Paulo materializes the Hippocratic principles as sycamore from the Kos island, where medicine as we know has begun, which is planted in our headquarters, the House of Arnaldo.
Following these millenary precepts, we inform in facing the COVID-19 pandemic, caused by the SARS-COV-2, there is not yet a scientifically effective treatment in any part of the world. As it always happens in dramatic situations such as this, false or scientifically unproven hopes rise as the cure for all ills. Governing authorities leave out their constitutional obligations to travel through easy paths, which invariably reach a dead end. It is up to us, doctors, to show there is not a solution outside of science.
Doctors and scientists all around the world are looking for a solution for the treatment of the coronavirus. We hope a medication emerges for the treatment of COVID-19, such as the antibiotics that reduce the main causes for the suffering of humanity, as far as the middle of last century, such as syphilis and tuberculosis. For the discovery of this medication, we have learned decades ago the choice of an effective treatment depends on very well established and controlled steps to ensure the innovative medication is both effective and it doesn’t bring damage to those who use it. The fact we don’t have a medication for the coronavirus doesn’t mean we cannot reduce the impact of the infection caused by the virus. The knowledge in treating respiratory insufficiency has allowed to highly reduce the lethality predicted for the COVID-19.
The infections reach the human beings compromising different organs in different ways. The coronavirus causes a sever pneumonia, which motivates respiratory insufficiency that can lead to death. Therefore, the treatment of respiratory insufficiency is the most important step to reduce the casualties due to COVID-19. For the assistance in respiratory insufficiency to be available to all the populations affected by the serious form of COVID-19, it is necessary a health system which distinguishes the simpler and the graver cases.
To achieve that goal, the Hospital das Clínicas of the Medical School of USP has accomplished its most audacious operation in its 76 years of existence. It transferred all the beds of the Central Institute to the other institutes and, by doing so, provided vacancies to the population with suspected or confirmed infections by of COVID-19 with the largest intensive therapy unit in the country, with 200 beds. This way, we prioritize the care of these patients with COVID-19, still caring for other patients with serious conditions in our HC Complex.
For the success of this endeavor, besides the structure and equipment, it is paramount the presence of the doctors, alongside nurses, taking care of each of the patients, physiotherapists adjusting the respiratory ventilators, nutritionists, pharmaceutics, laboratory and radiology technicians. A whole army of professionals who takes risks in this moment to fulfill their duties. We, the doctors, are aware without them, in the art and the mission we have of diagnosing and prescribing, the treatment wouldn’t happen.
Thus, we have a team that evaluates the suffering of those committed to our intensive therapy unit, as well as the care of their relatives by our hospital assistance team, social service and psychology. Besides, an on-line attendance was created for our doctors and collaborators for their emotional health care.
Another point in our oath has been to always comfort. We understand that many times medications or other non-medicated actions, although not having any confirmed benefits, can mean to our patients a sense of relief from the suffering. This is the moment when science leaves us, so that art establishes itself. It is a sublime moment in the doctor-patient relation. An intimate moment, where privacy is fundamental, and no one can demand what occurred in this relation to be opened to public scrutiny, questioning if there was prescription of so or so medication.
Unlike what is being claimed, our conviction, solid in scientific principles, does not imply a contraposition to spiritual actions. At this moment, we would like to manifest our compassion, with our deepest sentiments, to the families of the more than a thousand deceased Brazilians. At the same time, we want to share the hope with those who are suffering in the intensive therapy nursing wards, for them to overcome this phase and to recuperate. Let all beliefs unite their prayers. Within the principles of mutual support to all of those who suffer, be it in the hospitals or in home isolation.
The COVID-19 represents the biggest challenge of our generation. We will win it with collective actions of prevention and with a medicine based on scientific knowledge, the commitment to ethics and the empathy with the patients. These are the principles we inherited from our masters. As Titular Professors from this House of Arnaldo, thus, we manifest to our undergraduate and graduate students, residents, health professionals, to our patients and families and to the general population.
Let our union, in this critical moment, allow us to stand the sacred principles of our investiture as doctors.