'Grey's Anatomy's' Medical Expert: "COVID Is No. 1 on the Call Sheet" in Season 17

Ellen Pompeo on 'Grey's Anatomy' and inset of writer Zoanne Clack
Courtesy of ABC; Catrina Maxwell/Getty Images

Grey's Anatomy, television's longest-running primetime medical drama, has dedicated its 17th season to front-line workers battling the novel coronavirus pandemic. It is also not shying away from accurately depicting every facet of how COVID-19 is impacting medical professionals, patients and their families.

Since Grey's returned for its current season in mid-November, many of the headlines have focused on the surprising return of former leading man Patrick Dempsey, whose Derek Shepherd was shockingly killed off in season 11. But for Zoanne Clack, a doctor, writer and exec producer who has been with Grey's since the pilot, COVID-19 is the season's real headliner.

Clack, who spent a year working with the CDC after her residency in emergency medicine at Emory University before following her dreams of writing creatively, is among those charged with overseeing medical storylines on Grey's. After Meredith Grey (series star Ellen Pompeo) was hospitalized with COVID-19 during the Nov. 19 episode and became the second doctor on Grey's to have the virus, Clack revealed that the show's fictional infection rate was similar to the world's and that the show is "going all in" on its portrayal of the pandemic.

Below, Clack — interviewed via email — talks with The Hollywood Reporter about the lengths to which Grey's Anatomy is going to accurately portray all the ways the pandemic is impacting medical professionals, why the show won't politicize the pandemic (or mask wearing) and her hopes for what the audience takes away from seeing an accurate portrayal of history onscreen.

Krista Vernoff has said she previously didn't think Grey's should tackle COVID-19. As a doctor and a writer on the series, why did you feel it was important for Grey's to not only portray the pandemic but to do so as accurately as possible?

We were definitely concerned about COVID fatigue from the audience: living with COVID news day-to-day and watching it on a fictional show was a hard barrier to cross. But talking to front-line health care workers pushed us forward onto our current path. On our show, I've started a program called the Medical Communications Fellowship that allows active surgical residents to spend three to six months with the writers during the research years of their residencies. This has led to a few of them staying on as consultants, and we also always have working residents in our midst. Those doctors, in addition to some of our tried-and-true consultants that we go to for advice and expert opinions on every episode, pressed upon us the overall life-changing effects COVID is having and will continue to have on our medical system. We also spoke to a number of other physicians once we decided to go in that direction and we felt their stories had to be told.

This pandemic is the single-biggest medical story of our time and likely a permanent game-changer as to how we practice medicine and how we look at the world. Being a medical show that focuses on our doctors' professional and private lives and one that takes great pride in being a voice for the voiceless and understanding that responsibility, we felt compelled to tell the stories of loneliness, fear and bravery that our health care workers and the patients are going through. Of course, we were scared that people would not want to go through the misery of COVID once more, but I think we've found a nice balance of keeping a Grey's vibe on the episodes. It's not all COVID, all the time, but COVID is always the backdrop. As I've heard people say, COVID is No. 1 on the call sheet. I also believe that going through the pandemic with these characters, whom people love dearly — or love to hate — makes the audience feel like they're going through it with friends, which makes me think it is felt more deeply, and not just a rehash of the constant roll of statistics and mortality rates. The audience is seeing real stories by characters played by real people that they can relate to, and bringing these stories into their homes and feeling like we're all in this together can actually be comforting.

Through two episodes, the series has not politicized the pandemic or wearing masks. As the medical community continues to post videos encouraging things like social distancing and mask wearing, is that territory Grey's will explore?

We will never politicize COVID because COVID should never have been politicized in the first place. We are dealing only with science and facts, not conjecture. We take our information from first-hand experience, medical journals and experts. We will always model mask wearing and social distancing even when we are not directly saying the words. There's a theory in public health that I feel validates my existence being a writer instead of a doctor on the front lines, and that is Bandura's Social Learning Theory. It basically says that a lot of human behavior is learned observationally through modeling, especially when the modeling is done by beloved people or characters to which the learner — or in our case, audience — has a particular attachment. In the case of Grey's Anatomy, people have grown with these characters — some have literally grown up with them over 17 seasons! — and the actions that these characters take can be very impactful. We never question the validity of COVID. Every character, like the medical profession, takes it as fact, and it is our hope that the audience does too and goes along this ride with us. And yes, there will be times when it is said outright that people need to wear their mask or stay 6 feet away — it was done in the first episodes — but we try to make it flow as easily into the stories as the medicine always has; it should never take you out of the story being told. Washing and sterilizing hands is also a big backdrop of the season. There should be a bingo game where you can mark off every time a character uses sanitizer or washes their hands while they're doing their regular dialogue or moving in and out of scenes.

You tweeted that the COVID infection rate on Grey's is similar to where things were at the time in the real world. What have you specifically pushed for in depicting how the pandemic impacts first responders at a hospital?

We have been trying to strike a balance between our characters contracting COVID and the rate at which health care workers are contracting it. I wrote that tweet actually coming off of finding out that Koracick (played by Greg Germann) had tested positive for COVID. That story served a double punch: first, that people can walk around asymptomatic and spread the disease unknowingly; and second, that health care workers are out there every day working hard and being exposed — especially since this was our second character to contract COVID. It shows that anyone can get it and that it spreads easily. Our decision to start just a bit after the pandemic began in America was a wise one, because we never have to worry about being ahead of the reality. We are basing our characters' actions on what was known early on, and we get more information and integrate it into the show as the world got more information and integrated it into their practice. Fortunately, we have many more therapies now and a decreased mortality rate, but sadly the positivity rates are still increasing exponentially. Historically, people will be able to watch this season of Grey's and see the medical story of our lifetime unfold.

The docs are all in these big almost helmet-like masks with tubes down their backs. Are those an invention of the show designed to see the actors' faces or are they working masks being used in hospitals to battle the pandemic?

Those helmet-like masks are real and are called PAPR — but of course we wanted to see their faces as much as possible! "PAPR" stands for Powered Air Purifying Respirator. In the real world, they are used when individuals have the potential to be exposed to airborne pathogens and are convenient because they don't have to be "fit-tested" like an N95 mask does. I thought they did get fogged up sometimes early on but I asked someone in production and he said it was never a problem — probably because they do allow airflow in and out of them. But we had to do a lot of figuring out about how to light them properly to prevent glare and we ended up with some kind of anti-glare material that was fitted into them.

In two episodes, we're seeing the pain of the pandemic told from two COVID-positive doctors in Meredith and Tom, one of whom is on death's door and seeing visions, and the other is asymptomatic. Why is it important to portray both ends of the spectrum?

This goes back to how our knowledge of COVID is increasing daily. New symptoms, no symptoms, asymptomatic spread, less spread from surfaces … these are all things we learned as we went and our doctors on the show are just learning. Since testing was — and still is in some areas — so unavailable at the start, we didn't realize that people could basically be asymptomatic but positive and spreading the disease. Tom Koracick even says, "I'm not symptomatic," when he's told to go home and quarantine. As the episodes unfold, our doctors will see all — or at least very many — of the complications of COVID as we learn like science learned that it is very much a vascular disease that attacks blood vessels and the consequences from that. We'll see people who recover, people who die, people who have mild symptoms, people who have post-COVID syndrome in one way or another — the full spectrum. On the one hand, it's a very complicated disease, mostly because it's new and unheard of and we're still trying to figure it out. On the other hand, it's a virus. It spreads like a virus. Once we learn more, we integrate more, we learn how to live with it and how to treat it better, and that journey will be reflected on the show. 

Many of the headlines are focusing on the return of Patrick Dempsey. How much of Meredith's visions of Derek are inspired by what COVID-19 patients are experiencing — i.e. seeing visions, having visceral dreams?

From the small amount of research that I've done on visceral "COVID dreams," they seem to be the stuff of non-COVID victims, just people going through this pandemic, whether they have COVID or not. We actually started early in the season talking about different characters having very vivid, very surreal COVID dreams in each episode, but it evolved to what you see on your screen. Mer's COVID dreams are more like her experience in season three, where she's kind of in limbo between life and death, holding on to one and reaching out to the other. And it's a chance to bring some joy into the abyss that is COVID and that is 2020. I loved how people on Twitter were saying that Grey's saved 2020 for them. One of our writers said we were making America Grey's again.

This season started by portraying events in April and continues to reflect the early days of the pandemic. Will the number of docs who test positive for COVID continue to be portrayed by the rates hospitals are experiencing?

Yes, we will try to reflect the reality of what's happening out there in the real world. Grey's Anatomy is letting people know that we're all living through this together, and no one is alone, no matter how isolating it might feel.

Creatively speaking, will the season always be a few months behind where we are in the pandemic? How are you talking about ending a season given the uncertainty around rising COVID cases and hospitalization rates and the evolving news around vaccines?

Honestly, the season is ever-evolving, day to day. Some days we think the season will span two weeks, other days we say we're going to catch up to present time. We really just let the stories be our guide. The vaccine looks so promising that maybe there will be a way to integrate it in the future, though we haven't discussed that possibility yet or how we would tackle that subject, if at all.

As you were researching the impact of the pandemic on hospitals, what was the most striking thing you discovered?

Oh, so many things! In speaking with front-line providers, we learned how this pandemic is fundamentally and perhaps permanently changing medicine. The use of masks in hospitals may become permanent because they've noticed other infection rates — ones that historically spread within hospitals — have gone down. The advancement of telemedicine has led to the ability to perhaps expand access to care in the long run. The creative ways that people were working together to expand their hospitals has led to using cafeterias and ORs for COVID patient care even after we were initially so unprepared for such devastation. And seeing, reading about, and conversing with people has shown us the utter strength and resilience of mankind, especially our health care workers who have been working tirelessly during this pandemic and suffering unfathomable mental and physical strain because of it.

The series is also portraying the emotional impact on doctors who are losing an ungodly number of patients with Maggie's (Kelly McCreary) character. How closely is Maggie's journey adhering to other doctors you've spoken with?

One-hundred percent accurate. We're portraying the emotional impact with most of the characters in one way or another. During our pre-writing research time, we watched a lot of video diaries of doctors and read innumerable articles about what they are going through. We talked to a lot of doctors ourselves also, and made a point to speak with a lot of doctors of color since, as you know, COVID is disproportionately hitting marginalized communities. We took a deep dive into that aspect of it and all the rage and sadness that surrounds that fact, and that's a lot of what Maggie is portraying. But I would say that Meredith also had her moment of throwing things around before she got sick, and the audience can see the strain of the shortage of PPE with Koracick beating up boxes with a golf club … they're definitely all feeling it.

There's also the grief of having to see patients dying alone as their family members are not permitted in to visit them. What have you heard from other fellow medical professionals about how this especially devastating part of the pandemic is impacting patients and their families?

This was one of the biggest points echoed throughout most of our consultations. The fact that so many people were dying alone. Many doctors were and are trying to make concessions and have family come and see their loved one if they are near death. I had that kindness afforded to me when my own mom was sick in the hospital with COVID. They arranged it so that I could see her and be with her for a short period of time when they thought it was potentially her last day. My mom ended up becoming a COVID survivor but that was after spending many, many weeks in the hospital. But even with that visit, I wouldn't have been able to be there at the moment she took her last breath if that had been the case. I got my hour visit, and then waited for the call that fortunately did not come. The loneliness is on all sides — patients dying alone, health care workers not seeing their families for days or sometimes weeks at a time, those that have to quarantine if they're positive. People maintaining 6 feet and avoiding hugging, friendly cheek kisses or even handshakes. This whole disease is isolating and scary.

Grey's Anatomy airs Thursdays on ABC. This interview has been edited for length and clarity.