I haven’t written about the pandemic for awhile. I can imagine looking back on this blog some years from now and wondering, what? What is all this about roommates and puppy training and painting classes? Wasn’t there a world-crippling, deathly pandemic going on?
Uh-yep. But aside from a few selfies with masks on, what is there to say?
This is a personal news blog, for my friends and family. This pandemic isn’t personal news. It is global news – permeating all of our lives. That said, I’ve decided to post a well-written article by an emergency room doctor who started out in Boston and is now in New Mexico. Emergency room doctors have a unique, close-up perspective that the rest of us don’t have.
One of the things I found interesting in the article, was the doctor asking his covid patients – why didn’t you get vaccinated? The doctor said a lot of them just shrug. Of course they do. Because what could they say? “I didn’t realize.” Or, “They told me it was dangerous.” Or, “No one I knew was getting one.” Or, “My husband – my mother – my brother – my best friend – my pastor – my politician – the guy on the news – they said I didn’t need it.” And so they die.
I am reminded of when I ask myself, nowadays, why didn’t I get my colonoscopy done at age 50? I got it done at 53, and thus put my life in huge jeopardy. Why? I don’t know. I shrug. It just didn’t seem that important at the time. It seemed a little gross. Highly inconvenient. It was never on my to-do list.
It wasn’t until John was getting his done for the second time that I realized, huh, maybe I should do this. Now, if I survive this cancer – which it looks like maybe I will but we actually don’t know yet – if I do live, I have John thank for that. We do what the people around us do.
Of course the likelihood of dying of covid right now is so very, very much higher than the likelihood of getting colon cancer. Well, anyway, you all know that. Here’s the article:
https://www.newyorker.com/science/medical-dispatch/in-new-mexico-the-pandemic-rages-on
I’m also pasting the whole thing, for those of you who are allergic to clicking on links.
In New Mexico, the Pandemic Rages On
As unvaccinated patients overwhelm hospitals, health-care workers are being pushed to the edge.
December 9, 2021
At one of the hospitals where I work, in rural New Mexico, the covid-19 patients are often young. Many are extremely sick, and most are unvaccinated. Not long ago, I walked into a room to find a woman in her mid-thirties. (Patient details have been changed to protect privacy.) She was unvaccinated, and had tested positive the week before. Her oxygen saturation was just fifty per cent, and her chest X-ray looked terrible. She seemed resigned and scared. When I asked her why she hadn’t got the vaccine, she shrugged. Down the hall, I visited a man in his early twenties who was breathing forty times a minute. We were still waiting for his test results, but his chest X-ray also looked terrible. When I asked him why he hadn’t got immunized, he said, “I don’t know,” and shrugged, too. Outside, in the hall, I checked our status board. A ten-year-old had been checked in with worsening covid symptoms. Fifteen more patients were waiting to get tested. In New Mexico, it doesn’t feel like we’re experiencing a new “wave” of the pandemic—it’s more like we’re in the middle of an endless voyage, in twenty-foot seas, miles from land.
I’ve been working as an emergency-room physician all through the pandemic, first in Boston and now here. Taking care of unvaccinated patients stirs up complicated emotions in me. Severe covid-19 is now a largely preventable illness, and I often feel anger and frustration: I think, You couldn’t be bothered to do something as simple as schedule two shots, and now you might die—what is wrong with you? I contemplate the risk that each unvaccinated person poses to everyone around, including to me, and my family, and our nurses, and their families, and the hospital staff who will clean the virus-slick rooms, and their families—the risks branch out with dizzying complexity, like ice crystals forming in a cloud. I try to keep these thoughts to myself, for obvious reasons. Who wants to hear, after they’ve totalled their car and broken their legs, that they shouldn’t have been speeding? Sometimes, when I stand at the bedsides of young, critically ill patients who shake their heads when I ask if they’ve got the vaccine, I murmur, almost to myself, “I really wish you had.” But their past choices are no longer the most important thing. They are sick and afraid, and need our help as much as anyone else. I tell them that we’ll do everything we can to keep them safe. I never tell them that, for some patients, everything won’t be enough. Read The New Yorker’s complete news coverage and analysis of the coronavirus pandemic.
By asking people why they have avoided these incredibly safe and effective shots, I’ve learned a lot about how confusing the information ecosystem has become. Patients used to tell me that they worried about adverse effects, such as myocarditis or blood clots. (These effects are vanishingly rare.) Then, in September, I started hearing about a new concern: “the vaers report.” I heard more about it by listening to a conservative talk radio show; listeners kept dialing in to talk about it. They said that tens of thousands of Americans had died after receiving the coronavirus vaccine, and that this report proved it. My patients in the E.R. began saying this, too.
As if on cue, I received an e-mail from a woman I didn’t know offering to send me information on the hidden dangers of the vaccines. She included a link—just, she wrote, a “snippet of what is going on.” I clicked through to a video featuring Jessica Rose, an independent researcher who studied computational biology at Bar-Ilan University, in Israel. In the video, Rose says that the Vaccine Adverse Event Reporting System, or vaers, has shown an increase of more than a thousand per cent in reports of people saying that they were harmed by vaccines in the past year. In a separate twenty-three-page document posted online, she and a co-author claim that the vaers data suggest that as many as a hundred and fifty thousand people have died after getting immunized against covid.
vaers is real: it’s a public database, administered by the C.D.C. and the F.D.A., that allows anyone to submit a report about potential adverse events that they think might be connected to a vaccine. Early accounts of myocarditis associated with the mRNA vaccines came through vaers, and were later confirmed after closer investigation. By the end of September, vaers had received reports of 8,164 deaths after vaccination. That might seem like a lot, until you realize that more than two hundred and thirty million people in the United States have received at least one dose, and that about eight thousand deaths occur every day in the country—one every eleven seconds. Those two populations—the vaccinated and the dead—will inevitably overlap, but that doesn’t mean the vaccines caused the deaths.
Rose seems oblivious to this fact, and she and her co-author deploy a lot of charts and math to lend scientific embroidery to a baseless idea. They derive an “under-reporting multiplier” from a single unrelated study of anaphylaxis, and use it to inflate the number of reported deaths nearly twentyfold. Rose’s document underwent no peer review and was not published by any journal. As a work of science, it’s worthless. But, as an emotional screed disguised to look like a scientific paper, it’s very good. If you don’t have experience interpreting research, it seems like the real thing. It’s not hard to imagine someone on Facebook reading it and thinking, Holy shit.
One of the most striking graphs in the paper shows a huge spike in vaers reports soon after the covid vaccines were introduced. Rose interprets this as a signal of harm, but the political scientists Matt Motta and Dominik Stecula have a different take. “Because vaers claims are self-reported, they tell us something about what ordinary people, as opposed to doctors and medical researchers, think about vaccine safety,” they wrote, in August. “People may be more likely to report side effects, for example, in response to media stories about vaccine safety concerns.” They aren’t noticing harm from the vaccines—they’re looking for it. In this sense, Motta and Stecula argue, “The reporting system may be functioning similarly to a public opinion poll.” Now, in the E.R., I’m seeing the consequences of those opinions.
Not all of my coronavirus patients are unvaccinated. Breakthrough infections now account for twenty-three per cent of hospitalizations in New Mexico. Last month, I took care of a man in his sixties, vaccinated but suffering from covid, who had been sick for a week. His oxygen saturation was seventy-three per cent. I found out later that the patient in the neighboring room, who had come in the night before and been intubated with a severe breakthrough infection, was his sister. My breakthrough patients are almost always older, and have additional medical problems. They were among the first in line to receive their vaccines, and often look crestfallen when I tell them that they’ve got the virus anyway. Many have lost friends, siblings, even children. I can’t help but feel that, collectively, we’ve let them down.
Do these awful breakthrough cases mean that the vaccines aren’t working? Vaccine skeptics have cited rising numbers of breakthrough cases as evidence that the shots are ineffective. But the truth, as usual, is more complicated. As more people get vaccinated, the number of breakthrough cases will rise for reasons of simple arithmetic, in just the same way that a large country will have more cases of cancer each year than a small country: only a small proportion of vaccinated people will end up with severe breakthrough covid, but that translates to a fairly large number of actual patients as vaccination rates rise. And how widely the virus is circulating matters, too. Vaccines are like a city wall: they can repel invaders, but they’re not impervious. The size of the attacking force matters, and the longer the siege, the more likely that the city will fall. Community transmission remains high throughout the country, and, in New Mexico, because so many people—about four in ten—are still unvaccinated, every time a vaccinated and an unvaccinated person meet, it’s an opportunity for a breach to occur. The idea that we can partition people into two separate worlds, vaccinated and unvaccinated, is an illusion. We are all in this together, vaccinated or not.
I circled back to the man in his twenties. He was now on oxygen, and no longer breathing forty times a minute. I told him that his covid test had come back positive, and that his chest X-ray showed severe inflammation in his lungs.
“Oh,” he said, looking down at his blue hospital blanket. “Can I go home?”
“No,” I said. “I’m afraid not.”
I stepped out to start making phone calls. Before the coronavirus, our hospital sometimes transferred patients to other, larger hospitals for speciality services, such as cardiology or gastroenterology. Usually, that meant one or two phone calls. Now we transfer patients because we simply don’t have room, and arranging transfers takes ten, fifteen, twenty calls or more, because nobody else has room, either. It’s a rare victory when we can find an in-state bed for a patient, and I routinely fly patients five hundred miles to Nevada. A few days ago, one of my colleagues called thirty-eight hospitals across seven states. When he handed the patient over to me at shift change, she was on twelve hospital wait lists. “We considered Timbuktu,” he said, with what I imagined was a wry grin under his N95. The process is hell for families, who often look at us in disbelief when we tell them that we’ve found a bed in Nevada or northern Colorado or Texas. Sometimes patients die alone in these distant hospitals, and families struggle to get the bodies back.
When I say that all of the hospitals are full, they’re not full in the way you might think. As my colleague Dhruv Khullar has written, what determines a hospital’s capacity isn’t just physical space but personnel. Good care requires not just beds but also doctors, nurses, technicians, and support staff. Health-care workers are in short supply all over the country. An article in our local paper reported that four hundred and fifty hospital beds across the state were closed because of staffing shortages. We’re having the same problem at my hospital. We have empty beds upstairs, but we can’t find nurses to staff them. Some nights, we barely have enough nurses to staff the E.R.
A survey conducted in September estimates that eighteen per cent of health-care workers have quit their jobs during the pandemic, and that another twelve per cent have been laid off. Among those still working in health care, thirty per cent said that they were considering leaving their jobs. Another survey, of nearly ten thousand nurses, found that a quarter were planning to quit within six months, and a third were considering it. These departures propel a destructive feedback loop: as more nurses leave, the burden of patient care falls more heavily on those who remain, prompting more nurses to leave. The American Nurses Association estimates that there will be a deficit of 1.2 million nurses by next year.
A major cause of this exodus is said to be burnout. There is some disagreement over what burnout actually is; one of the first academic articles to address the phenomenon, published by a psychologist named Herbert Freudenberger in 1974, described fatigue, cynicism, irritation, and a quickness to anger. “The person looks, acts, and seems depressed,” Freudenberger wrote. But Christina Maslach, a professor of social psychology at the University of California, Berkeley, who studies burnout, maintains that it is not depression. In the nineteen-seventies and eighties, she led an effort to study burnout rigorously; she now defines it as a combination of exhaustion, depersonalization or cynicism, and diminished efficacy. As the field of burnout research expanded, subcategories proliferated: wear-out, brownout, frenetic burnout, underchallenged burnout. Compassion fatigue can result from exposure to traumatized individuals; moral distress and moral injury are newly ascendent concepts, occurring when workers are forced to act in ways that contravene their values or ideals.
I’m glad that researchers are trying to study what repeated exposure to traumatic experience does to us. The topic deserves illumination. But I don’t know that any of the categories I’ve read about fully captures what it’s been like to spend twenty months on the front lines of a pandemic, as social coherence breaks down around us, as unity devolves into acrimony, and as health-care workers receive threats of violence rather than overtures of appreciation. Freudenberger may actually have come closer to capturing the experience than anyone else. “If your idealism . . . has been lost, then the burn-out has also within it the dynamics of mourning,” he wrote. “Something has died. There has been a real loss.” A few days ago, I heard a nurse in another room talking. I don’t know whether she was speaking to a patient, to a colleague, or to herself. “We are witnesses to human suffering,” she said. “We are witnesses to human suffering.” I listened, thinking of the patients’ suffering, and of ours.
Not long ago, I sat down to take the Maslach Burnout Inventory, or M.B.I.—a questionnaire, developed by Maslach, that is now a standard part of academic research on burnout. I registered online, for twenty dollars, and spent about ten minutes answering twenty-two questions.
When I was done, the Web site gave me an assessment. “Your profile matches the Disengaged profile,” it told me. “A higher Depersonalization score can indicate reduced capacity to connect emotionally, socially, or cognitively with the job and the people in it, including colleagues and patients.” This struck me as fairly accurate. In the worst moments of the past twenty months, I have felt sensations of deep exhaustion, of heaviness and weight, of detachment, of numbness and isolation. At times, it’s been difficult to smile. On especially bleak days, burnout can mean you might struggle to care whether a patient makes it or not—an experience that would be mortifying if you didn’t feel so anesthetized. Of course, that’s not all of my experience. I still find joy, satisfaction, and meaning in my work—sometimes in moments directly following those when I feel most exhausted or despondent. Despite the terrible things I’ve seen, I’m grateful to be working as a physician. But I do wonder whether I can do it forever. I understand why people want to leave.
Sometimes I wonder whether we’re all burned out on the pandemic—not just health-care workers, but everyone. I picture my unvaccinated, critically ill patients who just shrug when I ask why they haven’t got the shots. I can’t think of a better gesture to capture what burnout feels like. The virus is still surging, and a new variant is here. My dying patients are younger than I am. How did past generations get through their own crises? Perhaps they had a better sense of common purpose, or a more unifying story.
The pandemic has divided and isolated us. But it’s also shown that we are all in this together, and always have been. The fight, for each of us, is to believe this, to feel it. The next time I’m standing at the bedside of someone young and critically ill, I’ll try not to say that I really wish they’d got their shots. I’ll say something else: you are not alone.
(End of article – credit Clayton Dalton)
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