For Whom the Pandemic Tolled
In November of 2020, with both the holiday season and pandemic looming, I asked the public to continue wearing masks to protect themselves and to honor their communities, and to honor those working diligently to save the lives of patients infected by the SARS-CoV-2 virus.
I spoke from personal experience, having had COVID-19 myself, fortunately, a mild case, but exhausting nonetheless.
I encouraged families to have difficult conversations while in good health to identify surrogate-decision makers and to consider executing an advanced directive. With the promise of effective vaccines, it seemed like the final push toward the end of a tumultuous era in world history.
Yet through December and January of 2021, some of our worst fears were realized in the unprecedented numbers of critically ill patients admitted with COVID-19, both locally and nationally. A cursory look at COVID-19 hospitalizations suggests these numbers fell dramatically in February and March as vaccination efforts expanded, but lost in translation was the great emotional and societal costs hidden behind these numbers.
As a critical care physician, dealing with death and dying is as much a part of my job as saving lives. Navigating conversations with families when patients fail to improve or progressively worsen is an acquired skill that my colleagues and I work hard to execute with compassion and empathy.
But many did not, despite the most aggressive forms of intervention, novel therapies and state-of-the-art life support.
There remain significant public misconceptions about the victims of COVID-19. Maybe they were chronically ill or knowingly participated in some risky behavior that lead to their illness, but I can assert with confidence that the vast majority of patients my colleagues and I treated were ordinary people of all ages: parents, children, sisters and brothers, grandparents, hard-working, bread-winning, contributing members of our society. They disproportionately represented minority groups, often from underserved communities. We must work harder to understand this epidemiology and its implications for future pandemics.
We are extremely fortunate that as vaccination rates have risen, we have not replaced many of those lost to COVID-19 with equal numbers of new patients —though we still admit new patients every week. Now, we face a different epidemic: those suffering from chronic critical illness. There are many patients who linger in intensive care units across the country or in long-term acute care hospitals. These patients and their families live in limbo, waiting to see whether the body will heal with more time or ultimately require drastic action, such as a lung transplant. If the worst happens, and they succumb to their disease, we feel this even more acutely, having cared for them and their families often for months on end.
As I write this, the numbers of vaccinated individuals are rising, perhaps to reach the moving benchmark of herd immunity. But there persists a spectrum of hesitancy, which cannot impinge upon maximum
effort to protect those who are vulnerable not by choice, from children not yet eligible to be vaccinated to those with compromised immune systems who may not be able to produce a robust response to vaccination.
For many of us, not just frontline workers, but all of those who have grappled with the demands of work, life, school and childcare throughout the pandemic, a fog of exhaustion persists. Processing the experience of the last year and a half will take time, and there remains much to be learned medically, scientifically and personally. My hope for all is that as we return to some semblance of normalcy, we do so with a renewed sense of gratitude and awe for what we still have and deep reverence for all we have lost.
That, to me, will feel like real progress.