The long-term damage from COVID you’re not hearing about

It is certainly important to give children responsibility as they grow up. Chores are more than just a means to keep the house in order, they are a means of teaching children the importance of contributing to the family, of giving up their present desires for a higher goal. While this is all wonderful for parenting books and magazine articles it generally ignores a major problem with children, especially smaller ones, performing these essential household duties – they’re typically not very good at them. This was our first problem.

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Maybe you can get COVID twice

Our national 6-month coronaversary has arrived. It’s now been 6 months since our world turned upside down. The world is not the same place it was in January, a statement that is as obvious as it is disconcerting. It’s funny how something can seem like it was just yesterday and a lifetime ago at the same time. I think this summarizes the past 6 months:

  • Do you get the coronavirus from Mexican beer?
  • Where’s Wuhan?
  • There’s no toilet paper!
  • There’s nowhere to get tested.
  • You don’t need to wear a mask.
  • Fauci is our savior!
  • Hydroxychloroquine will save us all! Anyone who disagrees is part of the conspiracy.
  • Fauci doesn’t know anything!
  • You can inject clorox?
  • Everyone needs to wear a mask!
  • You can’t tell me to wear a mask!
  • Does anyone remember sports?
  • It’s all gone, let’s open up the bars and restaurants!
  • We shouldn’t have done that.
  • I’m getting a puppy!
  • I shouldn’t have done that.
  • Opening up schools is irresponsible unless it’s not.
  • I need an air hug.
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In defense of Dr. Fauci

I wasn’t sure what to do with her. She’d now been in the hospital with her COVID pneumonia and respiratory failure for 10 days when she started to rapidly deteriorate. The night before she was intubated which is never a good thing with this virus. When I saw her she was thrashing in the bed with a cacophony of beeping alarms and agitated nurses. Her blood pressure and oxygen saturation were dropping. Was this the COVID progressing? Was it a new infection? Did she aspirate? Was fluid backing up into her lungs? Should I change her ventilator settings? What if my ventilator changes worsen her oxygen levels and she codes? Should I give her diuretics? That may worsen her kidney function. Should I broaden her antibiotics? This may lead to side effects or induce resistant bacteria. Should I more heavily sedate her? This could lead to terrible brain dysfunction and worse outcomes if I give too much for too long.

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I hope the nonbelievers are right

It was another week working in the ICU and, even though it was August, it felt more like the previous April. We had a rise in the number of COVID-19 cases and were suffocating a bit trying to breathe through our surgical masks and N95 combos. It was a typical busy COVID Thursday morning, the bustle of doctors, nurses, and the rest of the ICU staff creates a buzz of activity. I was rounding with the team of residents, nurses, and respiratory therapists and we were nearly finished. Our last patient was a newly transferred, very anxious lady with COVID-19 who had rising oxygen requirements. We sorted out her medical problems and treatment plan and were relieved to be done with rounds. She was in room 16.

A few hours later we got a call about a woman in another part of the hospital who was deteriorating rapidly. In spite of being on 100% oxygen given through a high flow nasal cannula she still had very low oxygen levels. She was pale, sweaty, and breathing unnervingly fast. She was rushed into room 17.

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The vanishing ventilator shortage and how we are all biased

It is quite amazing how everything gets turned on its head so rapidly these days. Up becomes down and black becomes white. While it seems like years, it was only 4 months ago that no one was wearing masks, schools were shutting down, and Floridians were afraid of New Yorkers traveling south. Now our very own President said to wear (but didn’t actually put on) a mask, kids are starting to buy supplies for the fall, and New Yorkers run in fear from any senior citizen with a tan who is wearing colorful golf pants.

One of the major changes that I have noticed is that we have not been talking about the fear of ventilator shortages for some time. I remember sitting at COVID-19 emergency planning committee meetings back in March where we were scrounging to find every machine that could be jerry rigged to ventilate a patient. I was in contact with companies who make CPAP machines to see if we can rent them to ventilate COVID patients in an emergency. We were even coming up with crazy and unthinkable plans to put multiple patients on a single ventilator. The fear of having to choose who goes on a ventilator was in the forefront of all of our minds. These challenges dominated the news as well and motivated the government to invest $3 billion to build more ventilators as part of the emergency response.

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Should kids go back to school this fall?

In our home we have transitioned from home school to home camp. This has not been a dramatic shift. The main difference for the kids has been a combination of less time on zoom and a major relaxation of hygienic standards. The famous psychologist Abraham Maslow created a pyramid categorizing a hierarchy of human needs from the basic physiological needs to the lofty need for self actualization. With this as my inspiration, I have created a COVID-19 parenting hierarchy of needs moving from most basic and necessary to what have become lofty aspirations.

  1. Food and water. This is the lowest level neglected by only the most deplorable of parents. This, as of now, has not been impacted by the pandemic in quantity although quality has certainly suffered.
  2. Injury Prevention. This includes preventing the children from injuring themselves or their siblings. It also includes maintaining parental sanity so the parents don’t injure the children. The pandemic has, only on rare occasion, challenged this rung of the hierarchy. After several dozen interjections, at some point even the most patient of parents will be resigned to let the kids fight it out to resolve the dispute. This can occasionally lead to injuries but casualties are unavoidable in wartime.
  3. Clothing. Under normal conditions, putting clothing on the children is typically mandatory. This was abandoned early on in the pandemic. The 4 year old is free to wander naked so long as he only pees on the tile flooring.
  4. Bathing. We have now achieved a level where as long as there are no visible maggots or obvious foul odors this has become completely optional.
  5. Education. This has been handed over entirely to the internet.

It is clear then why most parents are awaiting their school districts’ plans for the fall with great anticipation.

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We chose the bars over the schools

It appears that the limit of our national vigilance is somewhere around three months. We descended from the unified heights of staying home and supporting those of us on the front lines to a fit-for-cable news battle over the political philosophy of a face covering. It was only three short months after the shut down that many states decided that the crisis was over and the people had had enough. The push to get the economy going again led to the opening up of bars, salons, restaurants, and public beaches. This was in spite of the fact that the cases in those states had not been falling for very long and were far from zero. The coronavirus had different plans. These states are now shutting back down again.

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There Will Be No Second Wave

There has been talk from the very beginning of the pandemic of a concern of a “second wave” of infections that could hit after the first surge dies down. The idea that the virus could come back again after going away is based on historical precedent. The spanish flu had such a pattern. There were 3 distinct waves of illness during that pandemic, starting in March 1918 and subsiding by summer of  1919. The pandemic peaked in the U.S. during the second wave, in the fall of 1918. This highly fatal second wave was responsible for most of the U.S. deaths attributed to the pandemic and was reason for concern with COVID-19. Considering how bad the first wave was it was quite scary to think that this first wave was the “small” bump on the graph. There will be no second wave.

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Do masks really help?

I have had a recent change in uniform at the hospital.  Just like everyone else I continue to wear a surgical mask all the time (unless I’m in my private office) but previously, when going into the COVID-19 patients’ rooms, I would double mask with a surgical mask on top of an N95.  If you want to try this at home, put on an N95 mask then a surgical mask on top of that.  Then put on a gown and gloves.  Next, go into a room with a negative pressure device that makes as much noise as industrial fan.  Alternatively, put a garbage bag over your head, tie it around your neck, turn on a vacuum cleaner, and then try to have conversation with someone who is deathly ill.  You have no idea the extent of the heroism of frontline health workers in this pandemic who suffer through this for hours upon hours, day after day. 

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New (old) drug proven to save lives

He was a very pleasant and healthy 42 year old guy.  He was a bit overweight and had mild diabetes, but otherwise had no real problems.  He had plans to get married in just a few months to his long time girlfriend.  Then the coronavirus hit the nation . Then it hit him.  He got sick in the beginning of May but had it not so bad at first.  He had a mild cough, aches, and fatigue but he wasn’t completely incapacitated.  It was nothing like the horror stories he had seen on TV.

Then, one morning he woke up and something was different.  He had a high fever and felt terrible, much worse than the previous few days.  It was the fact that he was a little short of breath that was most concerning.  Being engaged to a nurse meant that ignoring the symptoms was not an option and he was convinced to go to the ER under a bit of relationship duress.  He got the usual workup – x-ray, blood tests, vital signs.  The ER doc thought about sending him home because he looked so good but his oxygen was a bit lower than normal so, she thought the better of it and he was admitted under observation.

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