Dr. Bow Tie
COVID-19: ROUND 2 (or 3, technically)
We flattened the curve. The curve rose again. I'm not being dramatic.
I spend 1/3 of my work time at a COVID-19 Treatment Center. At peak pandemic, we had converted multiple floors to COVID-19 medical floors, and converted the entire emergency department, the PACU, and pre-op holding area to ICUs (in addition to the small one we already had). Then people took precautions and we did our best to at least partly lock down. Case numbers did drop significantly. In June and July we saw lower numbers. By August, when we were able to return to one ICU and one COVID-19 wing (not the whole floor, just one wing) and open back up to non-COVID patients, we all breathed a sigh of relief. That relief is gone now, because we are forced to reopen more wings to be COVID floors again, and the hospital is going back to COVID-only. My colleagues all over the country have been seeing hospitalizations rise again, and now it's hitting my current city, which had been doing well in one of the states that struggled the most in March and then turned it around the hardest, despite people feeling controlled by the governor's restrictions. The third wave is here (first wave in Feb-March, second in the summer when some places first tried to reopen...now it’s #3).
In the last month, case rates rose to over 1000 per day, and then beyond. On November 7th there were over 3500 cases. And before you ask, hospitalizations have followed suit. According to the COVID Tracking Project, a volunteer organization (because we needed a volunteer organization to track this more effectively), total COVID-19 hospitalizations are over 60,000 - averaging 1,661 NEW hospitalizations every day. Read that sentence again. Now read this one: That's over 1,600 PEOPLE. So many of those people will not make it home, and even the ones that do make it have heavy complications that make their lives so much harder for a long time. https://covidtracking.com/
We all have pandemic fatigue. People are tired of taking these precautions, and tired of people like me repeating them. People are tired of feeling like they’re being restricted even though this is not about control - it’s about community and public health. So why bother? Why not just live our lives and take what comes? We have treatments now, don’t we? And a vaccine!
We have learned from our mistakes. Our preventative strategies changed, and treatment options evolved. Still, our best treatments start from behind, and they certainly don't prevent the complications I mentioned above. We hope that they stave off death, at most. The vaccine is looking promising, but it’s a long way from being fully vetted and even longer from distribution. And who knows if everyone will accept it (I have seen too many people that have already rejected it outright just based on who might be recommending it to them). The best way to beat COVID-19 remains prevention. As the weather turns colder and we move indoors, it is more apparent than ever that wearing a mask, maintaining distance, and most importantly avoiding large gatherings remain essential.
Hospitals are still not equipped to handle another surge. We are rapidly filling beds that then cannot accept other non-COVID patients, even though those are still coming. We are entering flu season, and the possibility of simultaneous infections is potential for disaster.
And more to the point - even if you create more beds, even if you set up makeshift hospitals or bring in a ship - that’s a logistical nightmare. We don’t have the staff. Every bed in a hospital demands a doctor/NP/PA, nurses, medical assistants, a respiratory therapist, a physical and/or occupational therapist, a speech and language pathologist/therapist, a social worker and/or discharge planner, and many others.
Now, take those hospitals trying to create more beds, and stretch them to over capacity, but make it so they don’t have the money to hire new staff (because they can't do indicated elective procedures to make money and insurance reimbursements don't pay that well despite what certain presidents allege), especially given that they were understaffed before. Now add in that healthcare workers, despite doing our best with PPE, are getting sick, and in some places being made to come to work anyway, running the risk of infecting others (or sacrifice vacation time/pay to quarantine/isolate when needed - I haven’t seen it where I work, but it’s definitely happening elsewhere).
And add to that the fact that we are still conserving (and in some places do not have sufficient) PPE. Masks are no longer single-use, even though that’s how surgical masks were originally designed. Some places have some employees utilizing the same N95 for weeks or longer. HCWs in some places are gowning up in trash bags.
Do we need more and better PPE? Absolutely.
Can widespread testing and contact tracing still make a difference? Absolutely. Trump's Chief of Staff went on CNN to announce they would throw in the towel, but I still believe we can work to control this spread, if we have the resources to do so.
Do I think we need a national mask mandate? We needed a national mask mandate months ago, but yes. Now more than ever. Check out this article in which Goldman Sachs presents the financial benefits of a mask mandate. It's hard to argue with business logic, even if you want to argue with science. https://www.goldmansachs.com/insights/pages/face-masks-and-gdp.html
Do I think we need a national lockdown? Honestly, yeah, but we don't have the resources to maintain that. We should have utilized a better stimulus, beyond $1200 once. But that would require Mitch McConnell getting off his obstructionist ass (until proven otherwise, Trump has been voted out, so all my wrath is now aimed at Mitch - for making things harder for Americans).
So in the meantime, we have to do these other things. Wear a mask, maintain a six-foot distance or more whenever possible, and honestly...don't have large gatherings. I know 10 or less seems cruel especially with the holidays coming up. But exposing and infecting our loved ones, especially our vulnerable elderly or immunocompromised loved ones (or even our healthy loved ones, because this virus doesn't give a damn) will feel a lot worse even if one infection comes of it - because one infection is all it takes. Everyone is being careful, but all it takes is one exposed person to go to another location. COVID-19 is back, for real. Please take it seriously, and please try and stop the spread.