Letter for January 12th, 2022
Omicron update, brief I promise. And a story.
Aware [commentary on key news]
Hello there :) I’m going to share some Covid updates, and then a little story.
Primary care offices continue to deal with staffing challenges this week, including ours. Hospitals are in varying degrees of distress, redeploying healthy staff and cancelling elective surgeries. Yet here in New Jersey there are signs that the current surge is plateauing, albeit at a terribly high daily case rate… but might start drifting down from the stratosphere in the next few days. Some stats from our local hospitals this week match what you might have been hearing:
90% of people receiving inpatient care for Covid had not received a vaccine booster. On average, only 1 or 2 boosted people are in the ICU at any time (we all wish the vaccines could keep this to zero, but still a success story).
33 Covid-positive patients presently require ventilators. Omicron can still be quite severe.
Many women admitted for labor and delivery currently have Covid. On some days the infected rate has been 30%.
22 national organizations, including the American College of Obstetricians and Gynecologists, the American College of Nurse-Midwives, and the Society for Maternal-Fetal Medicine, jointly issued a statement which strongly recommends all pregnant women get vaccinated against COVID-19. Severe Covid is more likely in pregnant women.
Some people have understandably expressed frustration to me that the vaccines aren’t working, or with rates of infection being so high, asking what’s the point of getting vaccinated or boosted? I heard a good analogy about this today that might provide a clear answer. Consider the seat belt. It doesn’t prevent car crashes, and injuries are still common. But it has certainly saved lives. Studies have shown that seat belts reduce fatal injuries by 45%, and moderate to critical injuries by 50%. This is great, but way inferior to the percentages protected by Covid vaccines. Maybe we should think of getting vaccinated and boosted like buckling up.
Compared to the UK and Denmark, the U.S. is seeing a much higher rate of patients with Covid ending up in the ICU. This could be because of different baseline health and social demographics, universal healthcare, better social infrastructure, Omicron crashing on top of Delta here, and comparatively lower vaccination (especially booster) rates. The quick math is that 3 shots reduce hospitalization by ~90%. 2 shots by only 50%.
I’ve also heard the theme of capitulating to Omicron - it’s so contagious and rampant, that we might as well catch it and just get it over with. If you’re one of the people I’ve seen this week with Covid, hang in there, and most of you vaccinated folks are doing pretty well. But if you haven’t contracted Omicron yet, keep trying not to. Long Covid is still very common even with mild cases, and might soon be one of the world’s most common chronic illnesses, with many manifestations. Every person that gets Covid has the potential to spread it to more people. Pfizer announced they expect to have an Omicron specific booster ready in March (if we need/want it). Their pill Paxlovid is becoming more available day by day. Hospitals are not great places to be right now, and many people with other illness need to be there. We will see many hospitals across the country exceeding capacity in the coming days and weeks, and some models predict up to 3,900 deaths in this country per day.
Evidence is building that Omicron is better detected by doing a swab of the back of the throat in addition to the nose. It seems to show up a day earlier in saliva, which could have a major impact on early detection during the most infectious asymptomatic period. I’ve done 2 rapid tests now by swabbing the back of my throat, gagging, and then swabbing the inside of my nose. Feeling a wet, saliva-covered swab going into your nose feels kind of unpleasant. But pleasure is not the goal. I can’t recommend doing tests this way without some official cover, but thought I would add this for your consideration.
But despite the gloom, experts have pointed out that we are still fortunate to have developed highly effective and safe vaccines at a historic speed, Omicron could be a lot meaner, we have lots of booster shots available in this country, pills are on the way, and despite getting infected, our immune systems are responding with T-cell reinforcements that keep the majority of those infected with Omicron from suffering severe disease.
Human [resisting trends that diminish us]
~
Two Horses
She gathered her breath, scattered as it was in her chest, and slowly breathed out against the mask. It was a strange comfort to hear the exhalation, to feel the warmth reflected back onto her face while also feeling trapped. She caught her stethoscope as it tumbled off her shoulder. She was running about an hour late, and that’s exactly what it felt like. Not strolling, not ambling, not even jogging. One more breath to settle down, to smooth the wrinkles on her brow, before she opened the door to see her next patient.
“Hello,” she said, her smile buried beneath the mask that dug into her cheeks like reins. “I’m sorry to be running late. How are you today, Doctor?”
The elderly man sitting across the room mumbled something she could not make out. He spoke through a mask, and with facial muscles that were unhitched from his will to communicate. He had suffered a stroke a few years ago. As a former doctor himself, he well understood the neurological damage that had occurred, and the impossibility of gaining it all back. He was hunched over, reliant on a walker for balance, and dependent on his son to do most of the talking.
She listened to the concerns of the day, the fixable little things, and the unfixable laments. She reviewed pills, test results, and consultations from other doctors who had probably been in just as much of a hurry. Twenty minutes was allotted to sort through a life, a person, and a frail body needing much more than that.
As she spoke with the patient’s son and scrolled through the computer record, she kept eye contact with her patient as much as she could. He would nod his head in slow agreement at times, and his demeanor was very calm. He smiled with the wrinkles around his eyes, and held onto his walker while seated to help support his heavy head. She noticed a kind bemusement in his carriage - a retired physician watching the familiar scene between younger doctor and older patient. How did he end up on this side of the examining room, playing the part of the deteriorating old man?
Towards the end of the visit, she summarized the plan. It was a way of ensuring that the salient points of the discussion had been mutually understood. She tripped over some words, trying to speak too quickly, worrying about the next patient in the next room with the next set of concerns, and the next opportunity that she would have to repeat an apology for running late.
The old doctor nodded his agreement with the plan, and then raised both of his hands. He motioned with palms flat towards the floor, a gesture meaning calm down, slow down. He knew exactly how she felt trying to take care of someone as the clock mercilessly bore down upon her. He made a show of taking a deep breath, and while he could no longer speak the words, he said to her: try to slow the race. The clock is cruel. Don’t be in such a hurry to get to where I am.
She helped his son pull him up, and said goodbye to them both. She watched the old doctor amble away, past the hastily strewn holiday office decorations, heroically pushing his walker ahead into the unknown. She didn’t check the clock before entering the next room, and was able to bend and soften the uncomfortable prod she perpetually felt in her skull.
Whether I rush or not, I’ll get there, too.
“Hello,” she said, her smile buried beneath the mask that dug into her cheeks like reins. “I’m sorry to be running late. How are you today?”
~
Fabulous! You've done it again. ❤️
I needed that reminder today…thank you!