After Episcopal

Inside D.C.'s Battle Against Covid-19: Dr. Allen Roberts '72

Dr. Allen Roberts ’72 grew up wanting to be a doctor like his father, Jack Roberts, a general practitioner who was Episcopal’s doctor for more than 30 years beginning in the mid-1950s. By the time Roberts graduated medical school at George Washington University in 1983, he dreamed of a life as a country doctor working in a rural hospital in a town like Culpepper, Va., and living in a Victorian house with a golden retriever. 

“But life never works out the way you plan it,” he says. Today, Roberts is a pulmonologist and critical care specialist at Georgetown University Hospital, where he is leading efforts to prepare for a wave of cases that could severely strain the capacity and resources of Georgetown and other Washington-area hospitals. A former U.S. Navy physician whose 20 years of service included a stint as White House physician for President George H.W. Bush and time on the USNS Comfort hospital ship, he is helping to plan the potential conversion of a large D.C. facility into a field hospital, like New York City did with the Javits Center. At Georgetown, he chairs an ethics committee that is assembling a plan that will rely on data, not subjective criteria, to determine how resources such as ventilators would be allocated if they become scarce.

Roberts also is caring for a number of Covid-19 patients, as is his wife, Afsoon, an infectious disease specialist at George Washington. Both understand the risks they face as medical providers working at the heart of the pandemic. “This is a time for prayer,” he says. His two college-age daughters, Ariana and Sara, are home now, and while the family can’t go to church because of the region’s “stay at home” order, they pray regularly. “We know our dependence on God right now perhaps more than ever.” 

On the novel coronavirus and Covid-19 disease
Nobody's ever seen anything like this. The beast here is that this disease runs the gamut, from being absolutely asymptomatic in about 25% of cases to being highly lethal in a small subset of patients. 

On the role of pulmonologists
Patients that come to us have, in addition to fever and cough, what we call hypoxemia, which is a severe drop in the oxygen level in the blood. In other diseases, part of the lungs themselves become inflamed as a result of the infection, either systemically or because of pneumonia. But this virus can involve the entire lung. It's very hard to oxygenate and ventilate these patients; we have to position them differently and use advanced modes of ventilation. 

With someone who gets pneumonia, we treat them with antibiotics for three to seven days, and they typically go off the ventilator and get better. What’s unique about this disease is that patients are stuck on the ventilator for weeks. And 80% of people who get on the ventilator will not survive to come off the ventilator.

On establishing ethics guidelines to determine allocation of medical resources 
We want to avoid a subjective evaluation of worthiness and guidelines that say, “This person is 70 years old, and that person is 25. Therefore, the life of the 25 year old is of more value than the 75 year old.” You must use scientific data to inform decisions such as who gets CPR and for whom is CPR futile, who gets to keep the ventilator and when do you remove the ventilator.

We want to preserve the ethical principles of medicine, which are based on the absolute sacredness of every single person. Those principles don't change just because the circumstances change. There are a lot of writers who say, “The circumstances dictate the ethics.” But at Georgetown, we say, “That's the wrong way to look at it. The ethical principles dictate how you conduct yourself in the circumstances.”

On making data-driven decisions  
We're still in the steep part of the learning curve about this disease, but with any given patient with any given disease, we make decisions based on the patient's physiology. If one organ system goes down, for instance, you know that you’re dealing with a certain percentage chance that the patient will die. If two systems go down or three systems or four systems, you move closer to a 100% chance of mortality. At a certain point, you know the patient cannot survive this. You’re not saving their life; you’re prolonging their death.