A Doctor’s Dark Year
newyorker.com
newyorker.com
The sheer, unrelenting stress this has put on doctors, nurses, EMTs and other hospital staff is going to have long term consequences. Morale among those who graduated into the teeth of this is really bad.
But then seriously, my partner is a paramedic in a large North American city. He has been, to put in bluntly, lucky, because this non-American city implemented a reasonable sick plan, and he serves a chunk of the city that has not been hard-hit. (Which is to say: no warehouses, no food processing.) But just the constant hyper-vigilant PPE dance wears and wears you down. Nothing is “simple” now; the simplest slip-and-fall becomes a scene out of the Andromeda Strain, because you don’t want to get infected, and you certainly don’t want to pass something on when you are harboring the virus but not presenting obvious symptoms. (Too bad said city also had one hell of a testing bottleneck, and you couldn’t just test test test to make sure the front-line staff is virus-free.)
I'm an intensive care physician and also function part-time as a hospitalist (acute care medical floor patients). Yes, there have been some stressful, uncertain, and fear-driven moments. But I also chose to work at a place that has a physician-led and supportive administration, and I investigated those things as part of the interview process. We had adequate staffing, a robust peer-support system (look up the "second victim" phenomenon), and my colleagues and I seem to have good coping mechanisms in place, which I assumed doctors in these kinds of specialties needed as a basic requirement.
Bottom line, I'm doing just fine, and my inpatient physician colleagues, with some exceptions, report the same. This is a difficult job at baseline without COVID. It didn't change my approach at all.
Your positive experience seems to confirm that working in a place with good management has a positive effect on employee morale, although I'm not sure anyone was questioning that in the first place. It is however uplifting to note that workplaces like yours exist.
I also think it depends on the area you serve. I imagine for many hospitals COVID was a case of "do everything right and everything still goes wrong" - especially when you reach max capacity, it doesn't matter how good of a doctor you are, you can't heal people with your bare hands. Likewise, it doesn't matter how well you use PPE or social distance or stay at home if thousands of others in your area ignore the safety measures and get each other sick, and it doesn't matter how much you care about keeping people safe if your local or federal governments don't take the issue seriously. This has been a huge stress point not just for doctors but for everyone I think, the knowledge that so much misery and death could have been avoided if we just did what we knew we should do when this mess started.
But overall, I just like to point out to people that some of us in medicine and nursing are doing just fine through all of this. A lot of people assume that we're all miserable because we work in the acute hospital/ICU setting.
https://www.nytimes.com/2021/01/15/nyregion/filipino-nurses-...
Been a hard year for nurses. (And respiratory therapists. And paramedics.)
Just found this October 4, 2019 NY Times story: Australia Just Had a Bad Flu Season. That May Be a Warning for the U.S., https://www.nytimes.com/2019/10/04/health/flu-australia-amer...
From this NY times article: "This year’s Australian outbreak began in April [2019], two months earlier than usual, and persisted into October."
COVID-19 cases in the US probably started November-ish. COVID-19 was found in US blood samples from December 2019.
I had a day with an odd headache sometime around December 2019 or January 2020. I suspect I had a case of #EarlyCovid. Lots of other people in North America were super-sick in November/December 2019 and January 2020. Others have been using the hashtag for longer than I: https://twitter.com/search?q=%23EarlyCovid
Edit: At least 4 downvotes in 16 minutes. This indicates many of you do not believe SARS-CoV-2 could have been spreading before it was isolated in Wuhan China in December 2019, or that I and many others might have had a case of non-diagnosed SARS-CoV-2 before tests became available in the US in March 2020.
https://en.wikipedia.org/wiki/Timeline_of_the_COVID-19_pande...
"A September 2020 review noted "The possibility that the COVID-19 infection had already spread to Europe at the end of last year is now indicated by abundant, even if partially circumstantial, evidence", including pneumonia case numbers and radiology in France and Italy in November and December." - https://en.wikipedia.org/wiki/Timeline_of_the_COVID-19_pande...
What does it mean if the COVID-19 timeline is wrong?
- labs would get more flu swabs which test negative - there would be enough globally to make someone suspicious
- why did we see only one strain of covid initially if it was already spreading early (and as I understand it the strain hierarchy always points to the Wuhan one on top)
- we haven't seen the cases drop completely without special measures in any country (there's a drop in summer, but only partial) - why was Australia pretty much covid free initially with all the assumed 2019 cases?
https://www.cdc.gov/flu/about/burden/index.html https://www.cdc.gov/flu/about/burden/faq.htm https://blogs.scientificamerican.com/observations/comparing-...
2. Figuring out if a person has a strain requires genetic sequencing of samples that tested positive for generic COVID-19. I don't know when this became possible.
https://www.ctvnews.ca/health/coronavirus/how-are-covid-19-v...
3. Some populations are healthier than others. I think 'Special measures' are mostly theater.
The flu statistics are estimates based on a few sources - some including testing. There's still a number of swabs from people with flu symptoms being tested. In the proposed situation, the labs would register a large number of tests for flu coming back negative for both flu and common cold. There are people whose job is to notice trends like that.
2. It doesn't matter when the testing became possible. If multiple strains existed before, we'd likely see some "sibling" strains and common ancestors to the Wuhan and X strain. Both the siblings and X seem to be absent.
3. If you're ready to put the fall of infections right as the lockdown were implemented to a coincidence / healthy population, then I'm not sure it's even worth discussing the other aspects.
Btw, the context here is Australia. (You posted links to CDC)
CNN Exclusive: WHO Wuhan mission finds possible signs of wider original outbreak in 2019 - https://www.cnn.com/2021/02/14/health/who-mission-china-intl...
The investigators found evidence of 13 virus strains in Wuhan in December 2019:
> As a result, they were able to gather for the first time 13 different genetic sequences of the SARS-COV-2 virus from December 2019. The sequences, if examined with wider patient data in China across 2019, could provide valuable clues about the geography and timing of the outbreak before December.
> ...
> Prof. Edward Holmes, a virologist at the University of Sydney, in Australia, said: "As there was already genetic diversity in SARS-CoV-2 sequences sampled from Wuhan in December 2019, it is likely that the virus was circulating for a while longer than that month alone."
The point I'm trying to make here is that there's certainly a lot of facets of the pandemic that haven't been properly explained.
This is complete BS on par with 5G conspiracies. We know how quickly this virus spreads if left unchecked and someone would have noticed the excessive amount of dead bodies piling up. We also know it spreads very well via air travel, it would have been all over the world not long after it was spreading wildly across Australia. And if we had some sort of immunity already from a bad flu season, then why did it spread so fast when we did have outbreaks? There's absolutely no way this virus was spreading in Australia in mid-2019.
The idea it was in Australia earlier is created by people that don't like the solutions we used so they work backwards to create other explanations, quite often paired with a large dose of American Exceptionalism. Things Australia did that worked: Border closures (intenrally and externally), contact tracing, masks and lockdowns.
The number of people allowed back into the country is minuscule and right now, foreign business travellers get priority on flights because they can pay more for seats.
here's a crude model as a straw-man thought experiment:
australia has a federal government with some degree of control but the 8 local state/territory governments still get a reasonable amount of ability to make local decisions. The states often disagree with the federal government, and with each other, and have disagreed about the appropriate responses to covid in many cases.
Suppose the federal government has no ability to control anything. Each local government has a 95% chance of doing something reasonable in response to a pandemic and a 5% chance of doing something stupid. If we make the poor working assumption that each local government decides what to do independently of the others, then about 2/3rds of the time we would expect all 8 australian local governments to do something reasonable, and 1/3 of the time one or more local government will respond to the pandemic in a stupid way. So maybe we got to see the 2/3rds outcome in australia -- or perhaps we actually saw a 1/3rd outcome where stupid decisions were made that dramatically elevated risk, but we simply got lucky.
In contrast the US has say 51 local government regions, so there's about a 7% chance that they all do something reasonable and a 93% chance that at least one local government region does something stupid.
Then if it is hard or impossible to isolate the impacts of bad decisions to each local region, the impact of poor decisions in one region can help outbreaks spread in connected regions.
On another hand, a downside of having a strong central control of the entire country's response is that if that central response is stupid, then the entire country starts cohesively doing something stupid, whereas a country with more fragmented/decentralised decision making might fare a bit better locally.
(assuming reasonable means policies that mitigate and slow down the spread of COVID19, but I'm not saying anybody else reading this has to subscribe to that thought or the idea that COVID19 is worthwhile to slow down)
Isn't Vietnam a highly authoritarian country too?
I would say there is a much greater acceptance of control than in the West. If the govt decides to lock an apartment building up with residents inside to control Covid you won’t here many protests.
Seems like the main factors for success are: 1. Geography 2. Density 3. Freedom (or lack thereof) 4. Masks 5. Money
Only if a nation is incapable of controlling their land borders, and that doesn't have to mean fully closed.
All of those countries have had outbreaks and a single case in a country is enough to negate any advantage being an island brings, all have successfully controlled the virus even after it got a beach head.
Australia and New Zealand are of course an awful lot closer geographically to Taiwan, Japan and Korea than they are to Europe - and there's a huge variation between all those countries in terms of the other things you might think affect Covid, like willingness to lock down, culture, level of testing, etc..
Australians care far, far more. I saw more people wearing masks on Sydney trains at zero cases than I did in a US supermarket at the peak. Politics don’t play into whether or not you wear a mask in Australia. In addition, Australian’s have made sacrifices for the greater good of all in the past (giving up guns for example). This just isn’t a thing in America. While both are western countries, there are major differences in mindset.
When I tested positive in Australia, I was immediately moved to my own private apartment dedicated for covid patients, free of charge. I wasn’t allowed to leave, but was fed and had doctors visiting me twice a day for vitals. I had very mild symptoms through all of this, but they treated it very seriously. In America they just send you home. Australia invested more up front to keep the curve low.
Despite having some complications with the duration of my stay, which lead me to be quarantined for 31 days[1], I vastly prefer Australia’s approach to the pandemic.
[1] https://www.abc.net.au/news/2021-01-15/sydney-man-covid-poli...
It exists to various degrees in pretty much any culture (even highly collectivist cultures like some Asian countries), but in the USA, I think it's seen as a bedrock upon which the country was founded on and successful with. I don't disagree, and I think this individualist go-get-em culture contributed to some of the country's successes, but in times like this, it certainly shows its dark side.
You could chalk up the whole US healthcare system fiasco to this too.
Doggy bags discouraged: https://www.foodsafety.com.au/blog/are-restaurant-doggy-bags... (That would astound most SA’ns)
First mandatory cycling helmets: https://www.mondaq.com/australia/crime/899922/are-cyclists-i...
- Major political figures publicly flaunted their own mask mandates and lockdown rules, with zero consequences.
"The rules are for you, not us" is not how you get people to come together to fight a pandemic.
- Media condemning social gatherings as super-spreader events, while at the same time, endorsing only very specific riots/protests.
- At the start of the pandemic, everybody wanted masks.
The CDC then stated masks were ineffective.
After that, if you tried to get ahold of masks, you were attacked for doing so. I personally witnessed this tens of times. The same people then flipped around and attacked you if you didn't wear a mask.
It was straight out of the last scene in Orwell's 1984. It was spooky.
Later, the CDC came out and said, "Hey, we lied to you to guarantee a supply of masks for medical personnel. But you should totally trust us now!"
- Media in the US was and is literally nothing but fearporn, which has largely bifurcated the population into "living in terror" and "fresh out of fucks to give".
There's plenty more examples, but I'll stop here.
The inconsistency would have been workable if it wasn't for the violence and anger. Your ability to publicly change your mind without sacrificing credibility inversely correlates to the violence of your opinion.
> The same people then flipped around and attacked you if you didn't wear a mask.
I'm of the opinion that the CDC definitely shot itself in the foot w.r.t. the mask issue initially, but I feel it's important to note that the especially belligerent individualists wanted masks when they thought they would protect themselves, but were completely uninterested in their use when they were determined to primarily be effective as a form of source control to protect others.
The most violent people I observed were the ones that flipped from "you don't need a mask, and you're too stupid to wear one anyway: they're complex medical equipment that requires training" to "if you don't wear a mask you're literally killing grandma".
It was amazingly counterproductive.
The goal is to get people to mask up. If they believe doing so will protect them, then good. If they believe doing so will protect others, also good. It does not matter which of these they believe.
I'll readily admit that my assertion was based on anecdotal experience, and was probably worded with more objective confidence than warranted, but my experience was that those hostile to the idea that masks were most effective if reserved for front-line medical PPE, were also those hostile to the idea of being obligated to wear a mask for others' sake.
> The goal is to get people to mask up.
Is this a bad thing? Do you believe that there is some ulterior motive in this beyond expected improvements in infection control?
I suspect it's a hangover from our earlier days, which were recent enough they still live on in popular culture. Also it's not an image we've exactly tried to suppress, since outside of an event like covid it's generally seen as a positive thing.
Where was this though? I am in chicago and even now I've never seen anyone in a grocery store without a mask. All the store require people to wear masks and have mask policies.
which supermarket was this ?
> . In America they just send you home.
https://www.health.qld.gov.au/news-events/news/what-happens-...
> If your symptoms are manageable without medical supervision, your doctor will instruct you to look after yourself at home in isolation.
https://www.coronavirus.vic.gov.au/what-do-if-you-have-coron...
> I have received a positive test result for coronavirus (COVID-19). What should I do?
> If you test positive for coronavirus (COVID-19) you must immediately go home and isolate
Why were you put up in an apartment if you only had 'very mild symptoms' when they advice everyone else to isolate at home?
I would say it's not only possible, but likely that some of these chains used a pro/con mask stance to distinguish themselves in certain regions of the U.S.
I, too, have seen 100% mask compliance in grocery stores.
And when I was downstate for a non-COVID family medical emergency during the December peak, I saw 100% compliance…in the grocery store. The gym? Ha. Nary a mask in sight. They actually scoffed at me when I asked when I went in for a day pass. And this is a franchise of a national gym.
And from friends’ experiences, you had to go all as far as Indiana to experience maskless in Meijer.
As an American it is absolutely astounding to hear about things like this. My girlfriend fell off her bike last year and needed stitches and before we let the doctors at the hospital do anything, we were on the phone with her insurance agency to try and figure out the cheapest way to get them. Of course we had no idea what it would cost in the end, so we had to worry for the next few weeks until we got the bill.
> I saw more people wearing masks on Sydney trains at zero cases than I did in a US supermarket at the peak
That's because NSW had legislated the wearing of masks on trains until a couple of weeks ago. It wasn't voluntary, it was either wear a mask or get fined. And since the mask mandate was taken off -- surprise, surprise -- the overwhelming majority stopped wearing them on trains.
> Australian’s have made sacrifices for the greater good of all in the past (giving up guns for example)
"Giving up guns" never happened, what did happen was the forceful buyback of self-loading weapons from law abiding people who followed the law and turned them in. The people who didn't follow the law -- that is, the people who are actually responsible for the violent crime in the first place -- kept their guns and that's why self-loading firearms continue to be seized today from drug dealers and gangsters.
For some general statistics:
1. The number of homicides (and all violent crime) went up after the 1996 firearms buyback[0] and didn't go down until the police took actual action against crime in 2001
2. We have more firearms in 2021 than we did in 1996[1] and, surprising only some, less crime
The major difference in the Australian mindstate is how both major parties are centre-left so it's rare for major issues to be politicised, instead we just have politicians supporting the same things and bickering over otherwise trivial implementation details.
[0] https://www.macrotrends.net/countries/AUS/australia/murder-h...
[1] https://www.smh.com.au/national/more-guns-in-australia-now-t...
https://i.redd.it/pmori9td3ar51.jpg
I hate just drive-by posting an image of a tweet from Reddit, which may not even be true, but I think it's succinct.
If the choice is to become homeless, along with all the difficulties that presents; versus maybe die of a nasty disease at some indefinite future point, I think the majority would choose the latter. That's just pragmatism, not heroism.
Personally, I like to interpret people's actions in a framework of maximum charity and compassion. Their work benefits others at risk to themselves, so why not take the opportunity to give them credit for that?
You can do that while simultaneously criticizing the financial systems that make doing that work a less than perfectly free choice.
We've gone from using the word to describe people who have taken a concrete action that makes them deserving of that description to using it to describe anyone that does a job that some people sometimes end up being heroes while doing them.
Do I think most grocery store workers are heroes? No. I think it's possible to be one, but many essential elements are missing. Is that store in danger of closing because they don't have enough people to run it, and it's the only real method for people in the area to feasibly feed themselves, and while that worker really doesn't want to expose themselves, they see it as their duty to make sure the store stays open so the people around them have a way to feed themselves? That's a hero.
If it's something you would do to help others at danger to yourself when presented to you even if money was taken out of the equation? You might be a hero. I think a great many police officers and firefighters would intervene in a situation they knew they could help in even if it was dangerous, and they were off duty. I don't think that makes every police officer or firefighter a hero.
I am grateful for the people that continues to do their jobs even when it became more risky. I'll acknowledge that and I agree they helped us all, and I appreciate that and them. I don't think that makes them heroes.
The Doctor in the article might feel somewhat offended if what she went through were deemed similar to what a grocery store worker went through. If I was a grocery store worker, I would feel ashamed and embarrassed if someone tried to equate what I went through to something like what medical staff in an ICU go through. Yet, when we use the same word to describe the achievements and sacrifices of them both, and it's the highest praise we have for that, how are we not doing exactly that to some degree?
A trauma surgeon expecting gunshot wounds could well find it much more challenging to be working as an ICU physician, where you can't detach yourself as easily, and where you can't use your most-practiced skills, and where you can't know by the end of the procedure whether the patient's odds are good. They specifically didn't sign up for that.
It's easy to say "don't get personally invested" but even if you're not getting attached to particular patients, it's demoralizing to go from an environment where you see a range of outcomes (including some bad ones) to one where you're constantly surrounded by patients near death with little chance for improvement and where your skills don't necessarily seem to matter. That's not about being invested.