I’m writing this half asleep having just finished a night shift in the ICU. The air in the hospital had been much more relaxed over the past few weeks. After several weeks of double digit COVID patients in the ICU, we were down to only one. There was a period where the ER had not seen a new case in several days. The masks were getting a bit looser. The situation was even more relaxed around town as the governmental restrictions are easing and we are moving through the “phases”. All the doctors and nurses I know, however, were not at ease. After watching the protests over the killing of George Floyd, we worried about the triggering of a second wave.
This was the situation I was living in when I arrived at the hospital for my shift. I was doing my thing trying to save a guy in hemorrhagic shock from a massive gastrointestinal bleed when I asked the ER nurse what the COVID status was. It was to my great chagrin when she told me they had five new cases in the ED that shift. We then admitted two in respiratory failure to my ICU overnight. This was disconcerting to say the least. The timing corresponds to what would be expected if the protests were to trigger a surge.
It’s not the protests that are to blame entirely. I’m not sure how they could have been stopped safely. I’m certainly not saying they should have been stopped even if possible. In reality it was inevitable that there would be something that triggered a rebound. A spike from the protests could actually be a good thing in this regard. Because of the expectation that they will trigger a surge, we in the hospital were more on guard making us less likely to miss cases. Furthermore, if there is a nationwide spike that happens at the same time it can lead to a more coordinated response than if there were pockets of outbreaks in various stages and in various locales. The complacency is spreading as fast as the virus did initially and was starting making many of us nervous. If there was a few cases here and there it might not lead to the same media publicity and public awareness that a bigger spike would. A nationwide surge in cases could motivate the population to be more careful and convince government officials to move with more caution.
we tend to assume that our current situation will continue without change.
The complacency highlighted a common flaw of human nature which has been threatening our response to the pandemic on the whole. We tend to be overly present centered. What I mean by that is that we tend to assume that our current situation will continue without change. When things are bad we assume it will never get better and when things are good we assume they’ll never get worse. Unfortunately we experience and respond to this fallacy on a deep emotional and subconscious level. This quite obviously leads to major mistakes in judgment. Among countless other systematic errors it leads to, it explains why we do poorly in the stock market. When the market is going up we assume it will go up forever and when it’s going going down we assume it will go down forever. We end up buying high and selling low. This is not a recipe for success. We do the same thing with our relationships, job situations, and countless other things in our lives.
This human flaw manifests in medicine on a nearly constant basis. People go to the doctor with a specific problem for which they are prescribed a medication. The medication solves the problem. They then stop the medication because they feel better not realizing that the medication was the reason for them feeling better. People stop their psychiatric medications when their mood improves only to relapse; people stop their antibiotics early when they feel better putting themselves at risk for resistant bacterial infections; and people stop taking their blood pressure medication because their blood pressure improves only for it to rise again after stopping.
In this pandemic, this human flaw feeds spread of the virus. As the cases have declined people are consciously or unconsciously behaving as if the declines will continue indefinitely. They assume that the phases can only progress forward not backward. Unfortunately, there is nothing about the nature of this virus which would make that true. COVID-19 is down but certainly not out. As long as there are still cases in the community we can end up right back where we started.
Just think for a moment. One person flying from Italy to New York nearly destroyed the health care system of the largest city in the country. There are more active cases now than there were at that point in time. Even though the numbers are declining there is no reason to think they won’t rebound. We assume that as long as they are going down they will continue to do so.
The virus is giving us a national reminder that it’s still there.
There is reason, however for optimism that these few cases I saw in the hospital last night are not the start of a new trend. Most importantly, people are still, even if not to the highest degree as previously, observing mask wearing, staying at home when sick, and maintaining good physical distancing. Even as the government is easing restrictions, many individuals are still being careful. This is the main distinction between now and March. This may change this from a surge to a blip.
The virus is giving us a national reminder that it’s still there. If we let down our guard it may come back. This is not to say that we need to be on total lockdown. If we continue with physical distancing and masks when appropriate, comply with contact tracing, and isolate when sick or exposed we can maintain the balance of keeping things open and keeping things safe.
Remember, the virus doesn’t live outdoors so spend as much time as you can outside. You should still spend time with loved ones and friends. Outside is fine if you keep a safe distances but you would be wise to be more careful indoors. Open windows and stay 6 feet apart. If you’re high risk a mask indoors would be a good idea when you are around visitors. The same is true with going to the store. You don’t need to be in prison. Go shopping. Just keep your distance, wear a mask indoors, and wash your hands. If we continue these things the virus will not get out of hand to the point where we do need to lock down again.
Until the vaccine comes through we must hope as if everything is getting better but act as if it is not.
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Well done. The best article i ve seen about boosters. Say hi to your dad Ron Fischler MD