I feel safest in my hospital

“No thanks,” my patient said to me. “Two is enough.”

I was surprised when I first recommended a COVID booster shot and heard this response. “What do you mean, it is enough? Do you throw away half your heart medication? In the middle of your hernia surgery, do you say, ‘Eh, that seems enough’?”

I get this answer more and more often these days. “Two is about right.” “I’ll stick with two.” These people are not vaccine skeptics. I work in a public hospital in New York City and my patients come from communities hit by the coronavirus. Most lined up for the shoots as soon as they became available in early 2021, undeterred by logistical barriers or social media rumours. A year later, like most Americans, they appear to have moved on despite the sharp rise in cases due to the BA.2 variant.

We health care workers have watched with pangs of unease as communities abandon public health actions. We even feel a pang of envy and wish we had the luxury of saying we’re “done” with COVID. It can not be just which we don’t think about anymore, but COVID is still part of every staff meeting, every communication, every clinical day-to-day. Case numbers in New York are rising again, and COVID is now the third leading cause of death in the United States. Our COVID test tent, which was hastily erected in our hospital yard in March 2020, is still in active service. Keeping up with changing viral trends and treatment protocols remains paramount. Our meetings are largely absent and we have never stopped wearing masks.

Oddly enough, I now feel safest in my hospital, where everyone has a healthy respect for viral power. This irony does not escape me. I remember how, at the beginning of the pandemic, hospitals were viewed as meltdown zones and medical staff walking into those conflagrations were treated as a mix of conquest hero and typhoid Mary.

One of my children recently took part in a sports tournament and the consent form warned me that “neither obtaining a COVID-19 vaccine nor proof of a negative COVID-19 test is required” and that I “accept my child’s risk”. must be exposed to COVID-19.”

I read the form both confused and angry. Yes, of course I could accept the risk of COVID exposure – that’s life every day – but why didn’t the tournament organizers make the slightest effort to reduce that risk? After suffering for so long without adequate testing, we are now being inundated with rapid COVID tests: schools send them home in backpacks; hospitals give them out for free; Test cars are parked on every second street corner. If you packed a hundred teenagers into an enclosed space for a whole day of huffing, sweating, and jostling, why not give everyone along the way a test kit along with their Gatorade? Rip open the windows and hand out masks in school spirit colors. Everyone’s safety would have been improved. But instead they just seemed to throw in the towel.

This collective shrug confuses me. why would not we take modest, non-mandatory measures to make COVID infection less likely?

As we stagger into our third year, we have no choice but to grapple with the dwindling public awareness of all things COVID. It is slipping, albeit clumsily, into the ranks of diseases like tuberculosis, malaria, heart disease and diabetes — epidemics hiding in plain sight; Epidemics that rely on narrow stakeholders to gather resources, fund research, and formulate policy. In my clinic, I have to deal with the growing gap between my patients’ attention to COVID and my own. To a degree, this is not unlike other divisions we face. I often hear “no thanks” in response to my recommendations for a colonoscopy, insulin therapy, or eliminating processed meat from the diet.

But COVID feels like a volcano whose recent eruption is too fresh to become commonplace. For frontline clinicians involved in direct patient care, the tipping point from crisis to chronic disease can be painful. Patients cast far longer shadows on our professional lives than statistics, and seeing an illness revert to the mundane feels almost like a betrayal of those we’ve cared for and lost.

A long-term patient recently came for a check-up. He is obese, which puts him at higher risk of severe COVID, but he even refused the first dose of the vaccine. “I’m not ready yet,” he told me, as he has told me on each visit for the past 18 months. A part of me wants to jump onto the exam table and wave the cover of That New York Times with his headline marking 1 million deaths and yelling, “What exactly are you waiting for? Two Million?”

Protocol requires that I be a little more measured in my approach. But I also know that easily a third of those 1 million deaths were preventable – people who refused vaccinations even though vaccines were freely available, people like the patient sitting in front of me.

I listened to my reluctant patient’s concerns, answered his questions, reviewed the data, and described why I thought he would benefit from the shots. We spent more than half of our visit talking this through, but we ended on the same point. “I’m just not ready,” he told me.

If I look back over the past two years — the funerals of my patients, the exhaustion and burnout of my colleagues, the grief of the hard-hit communities — and then watch the numbers soar again, I suppose I could say the same thing about the carrying on of COVID. “I’m just not ready.” I feel safest in my hospital

Jessica MacLeish

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