Happy (COVID) New Year

Last week a few of us were reflecting – via Zoom of course – on the year that was 2020. One of my colleagues made a relatively simple statement: "We should remember, the pandemic has taken from many, but it has given to a few."

Much has been written about our transition to a new and more hopeful year, but few of these ruminations will match the simple profundity of this statement. We immediately grasp that COVID-19 has "taken from many." It has taken our health. Nationwide, we are now at over 325,000 dead. Perhaps the only hint of a hopeful sign is the national death rate may have flattened out last week, after steadily increasing for the past seven weeks. Let us hope this trend continues.

Last Spring, I remember thinking that I do not really know anyone well with COVID-19, but we all knew of someone who had it – a friend of a friend. Now, most of us know multiple people close to us who have been impacted. I fervently hope this is not how we will come to feel about COVID deaths in the Spring. Today, most of us know of someone who has died. As we slog through this long, dark winter, death will sadly become more commonplace.

It has taken our vigor. A number of people have survived the disease only to discover they are in the small but significant group of people with lingering fatigue, shortness of breath or other symptoms. Although the percentage of people with longer-term sequelae may be relatively small – not yet firmly established, but likely 5-10% - a small percentage of 20 million U.S. cases is still a very big number.

It has not taken – but has severely tested – the emotional and physical resilience of our front-line hospital workers. If you look at the Texas Medical Center numbers this week, there are no signs this current surge has peaked. New community cases are up. Test positivity rates continue to climb. The rate of hospitalization is increasing, and the total hospital census is climbing steadily, day in and day out. Our regional COVID-19 census peaked in mid-July at 2,455 patients. Two weeks ago, we were at half that level – today, 70%. In the next month or so we will exceed our July peak census levels. To say our providers have performed admirably seems trite. To hail them as heroes seems too easy. They are people who are neglecting their own well-being and families to care for us.

It has taken our livelihoods. Many small businesses lie in ruin. To many of us, the shuttering of a business elicits a casual response: "I wonder what will go in that space next?" To business owners, it represents the death of a dream, loss of financial investment, and sweat of their owners. Particularly hard-hit are people on the lower end of the economic scale working in service industries. Many are either out of work, or if fortunate enough to have kept their jobs in environments where their risk of SARS-CoV-2 infection is high.

It has taken – or at least damaged – our future. It is difficult to assess at this point the impact of the disruption to our educational system, but there will be an impact on our youth. This impact will echo well beyond the end of the pandemic.

Much has been taken.

But my colleague is correct. The pandemic has taken from many, but given to a few. Not all businesses are failing. Look at the share price of Amazon, Netflix or UPS. Since March, they have increased between 70-100%. While it may be true that some white-collar workers have worked harder than ever and sacrificed personal travel and vacations, some who are able to work remotely have actually been given a gift of time. You may love to complain about Zoom, but, for some, work-life balance has actually improved during the pandemic - no commuting, the ability to interact with family during downtimes, and enhanced schedule flexibility.

As I look around our own organization, I see opportunity given to many. We are doing work that, while hard, is meaningful and fulfilling. For many, work performed this year will define careers. I have seen fruitful collaborations develop between people in the organization who literally would never have met each other in normal times. Research grant funding is up. Publications are up.

Never in my life have I approached a New Year recognition – "celebration" seems the wrong word – that is so meaningful. As we enter the last year of our Great Pandemic, I ask that each of you ask yourself a question: Are you better or worse off today than you were this time last year? On balance, have you been "taken from" or "given to?" Do not overthink the question. For most of us, the answer will be intuitively obvious.

If you find yourself in the "given to" group – you and your family have not suffered significant health problems, you have not suffered financially – perhaps you have a degree of survivor's guilt. As we enter 2021 – a year that will see an end to this collective nightmare – I ask we do more than feel a vague sense of guilt. Let us do some small thing to give back:

• Give the gift of your patience. Be kind to others. You do not know what might have been taken from your colleague, co-worker or grocery store clerk. Assume everyone you meet has experienced some degree of negative COVID-19 impact.
• Give your time. For those of you who may have gained time through remote work, give some of that time back. Contact your not-for-profit of choice, or your child's school. Ask if they can use your time and tell them you can give them a day (in a safe and appropriately distanced way). Recall that Baylor provides a benefit to all benefit-eligible employees to take one paid day to volunteer.
• Give your financial support. Americans are a generous people. Look at your typical charitable contributions and give a little bit more. Make a modest, unexpected financial gift to people who have helped you over the past year – hairdressers, paper carriers, repairmen. When you eat out (out-of-doors and well-spaced) or order in, increase your new "normal" tip by 5-10%. Many of us would not miss a $10 increase on the cost of the meal, but it will make a real difference to the person providing you service.

This has been a year like no other. I look with hope to the future. This current surge has not peaked but eventually will recede. Over the next several months, vaccinations will start to make a difference. The pandemic will end. The past year will no doubt be remembered as the year much was taken. Let us all come together to make sure 2021 becomes the year much is given.

Happy New Year.

 

(Note:  Between June 2020 through November 2021, I wrote weekly COVID-19 pandemic updates seen through the lens of a health sciences university.  My intent was to provide reliable information, acknowledge legitimate concerns, console, and encourage.  Each posting reflects issues our community was experiencing at that moment in time.  I have reproduced selected examples on this site).

 

Frivolity

 

This week I have a special holiday gift for everyone. I will subject you to neither tortured analogies nor strained literary references. As I work to get myself into the holiday spirit – in this environment that is not particularly conducive to celebration - today’s theme is, perhaps ironically, frivolity.

First, our not-even-close-to-frivolous COVID-19 update for the week. The vaccine news continues to roll in, almost all of it good and encouraging. This situation is too complex and evolving to cover in this space, so please look for other communications from me or the Incident Command Center for ongoing vaccine information. Bottom line, our affiliate hospitals were incredibly supportive and collaborative when Baylor had no allocation of vaccine. We now know Baylor will be allocated the Moderna vaccine and will work to distribute it per priorities mandated by Texas health authorities.

Regarding our numbers this week, please refer to the TMC website. Community cases continue to climb at a daily rate equal to July surge levels. Nationally, weekly deaths continue to increase, as they have for the past two months. Test positivity rates, a general gauge of community disease prevalence, continues to climb. We will only recognize the peak to this winter surge when we are on the backside of it. Unfortunately, there is no trend I see that hints we are headed down.

It also feels differently. In July, I heard about people who had COVID-19. Now, I can name 5 people I know well who contracted the disease in the past week. Personally, as careful as I try to be every single day, I experienced an exposure. Thankfully, I remain negative to date, but am self-quarantining until I am certain I am in the clear. This is what a high prevalence environment feels like, and I expect it will get worse. When one person out of one hundred has the disease (a one-percent prevalence), you can roam around the community and not actually come across someone infected. When 10 out of 100 are infected, on a statistical basis, you will almost certainly come in contact with someone actively shedding the virus.

Implications for all of us? Double down on safe practices. Mask and distance. Do not congregate in indoor public places. Assume everyone – everyone – you come into contact with is potentially infectious. If you have symptoms, do not come to work, do not expose yourself to others. Be extraordinarily careful over the holidays, and avoid gathering people together from different households. If you did the detailed work over the past couple of weeks to form a holiday bubble, good for you. Make sure you stick scrupulously to the plan. If you did not, it is too late to start a bubble (unless you want to push out your celebrations into January).

Back to my theme. Frivolity. It may seem a little tone-deaf after reading the preceding paragraphs, but I will argue that a little frivolity at this particular moment is a good and important thing. We have been at this a long time. I do not know anyone who is not experiencing COVID fatigue. Rationally, we know the end is in sight, but we are still caught up in the daily grind. Our providers are bending, but not breaking, under the strain of this prolonged surge. Does life get back to normal in the Summer? The Fall? It will, but relief seems remote. Inevitably, many of us are wearing down.

This is the season of giving. All I ask of you during the holidays is to give a small something to yourself. Do something mindless and frivolous. Something effortless that gives you pleasure. Something that has absolutely nothing to do with SARS-CoV-2. I do not mean to suggest we act selfishly during the holidays (next week I will touch on giving to others), but many of you have given so much to so many over a sustained period of time, it is important to pause and make a deliberate effort to take care of yourselves.

With that recommendation in mind, I will finish by sharing with you my little bit of frivolity. Sincerest apologies to Clement Moore:

A Visit From Dr. Fauci

‘Twas the tenth month of COVID, outside the med school,
The virus was surging, making us look the fool;
Our screeners took temps and filled out our checklists,
In hopes Dr. Fauci would soon pay us a visit.

Our masks were in place over both mouth and nose,
In full PPE from our heads to our toes;
And I in my N95 – quite well fit –
Had just settled down to rest just a bit.

When suddenly I started to get texts non-stop,
I jumped on a Zoom call to see what could be up;
And who should I see in the box, upper right,
Than a crack immunologist, oh what a sight.

Bespectacled, bemused and a tiny bit grouchy,
I knew in a moment this was Dr. Fauci;
At first he was “on mute,” the mic icon all red;
But once that was solved, I recall what he said:

Now Baylor, now UPenn, now Duke and now Vandy,
On Hopkins, on Harvard, on Mayo and Emory.
Learning Health Systems – this is your finest hour,
In our battle with COVID, you hold all the power.

When we had zero testing, no testing at all,
You spooled up research labs to answer the call.
From lab bench to bedside treatments poured out tout suite,
A remarkable feat that was really quite neat.

Need a vaccine? You gave us three, four or five,
That promise did so much to keep hope alive.
New treatments emerged in a chaotic stew,
Phase three clinical trials helped us know what was true.

Young doctors in training, PAs, nurses, et al,
Learned in a pandemic, an order quite tall.
With a passion for learning that must be life-long,
CME helped all doctors discern right from wrong.

And finally, a nod to providers front-line:
This truly has been your moment to shine.
Your safety, your families, and your own burdened hearts,
All took backseat to your blest healing arts.

You battled at onset, you battle on still,
You’ll battle to the end, and please know that it will.
The challenge is not ended, it continues today,
And we owe you a debt that we never can pay.

His eyes were quite moistened, and his voice all aquiver,
He said, “thank you, thank you” for the care you deliver.
And just before clicking on “End Meeting for All,”
Added “Academic Medicine, we’re proud you’ve got this ball.”

I hope you and your family have a safe, joy-filled – and slightly frivolous - holiday.

 

(Note:  Between June 2020 through November 2021, I wrote weekly COVID-19 pandemic updates seen through the lens of a health sciences university.  My intent was to provide reliable information, acknowledge legitimate concerns, console, and encourage.  Each posting reflects issues our community was experiencing at that moment in time.  I have reproduced selected examples on this site).

 

 

COVID vaccination: My own personal risk-benefit analysis

 

This has been a truly momentous week, as the nation started mass inoculations against SARS-CoV-2. Up to now, all of our public health efforts have been around containment (which failed spectacularly world-wide) and mitigation. We should all pause to celebrate this event: the first public health intervention taken since the start of the pandemic designed to bring it to an end.

Mitigation is like giving chemotherapy to slow the growth of a cancer that cannot be cured. For the first time we have a path to actually curing our societal cancer.

When the Vaccines and Related Biological Products Advisory Committee (VRBPAC) met last week, they considered a single question: "Based on the totality of scientific evidence available, do the benefits of the Pfizer-Biotech COVID-19 Vaccine outweigh its risks for use in individuals 16 years of age and older?" They performed a risk-benefit analysis. As every probably knows by now, that answer was "yes."

Vaccine supplies will be limited at first, and there is still much we do not know about how it will be distributed. To get a rough guess of where you fall in the expected allocation plans, the New York Times published a useful widget. If you are towards the end of the line, do not worry. Like the annual melt of the Rockies ice pack, our vaccine trickle will soon become a substantial stream, and by the springtime, it will be a flood.

By April, if all goes as expected, I suspect most people who want to be vaccinated will have access to vaccine.

Suddenly, we are all faced with our own VRBPAC-like question: "Does the benefit of vaccination outweigh the risks to me?" Today I want to share my personal risk-benefit assessment.

First, I need to review our recent numbers. We remain in a major surge. We did not experience a major Thanksgiving bump, and there are some encouraging signs.  

The regional R(t) dropped below 1.0 (suggesting viral spread is decelerating) for the first time in several weeks. On an average basis over the past week, new community positive cases actually dropped (2,373 vs 2,040 for the weeks ending Dec. 6 and 13, respectively). This is encouraging, especially given this drop occurred during the time we should be seeing Thanksgiving induced spread. However, it is far, far too early to declare victory.

Numbers are still at near-record highs, and in our June/July surge we saw many examples of one-week dips followed by new-record highs. Our hospital COVID-19 census continues to inch up daily, and hospitals and providers remain on surge footing.

National daily death rates have declined for the past three days, and hard-hit communities like El Paso have seen their case rate numbers fall. Again – to be crystal clear – it is too early to say we are on the declining side of the surge.

Critically, our nascent vaccine rollout will do virtually nothing to impact the current spread. We need to maintain our viral control practices and plan for safe December holidays.

But, back to my personal risk-benefit analysis.

On the risk side, my personal assessment of the risk if very, very low. I will confess, I have confidence the clinical trials process, and in our regulatory approval processes. A collection of our best clinical and scientific minds has looked at the available clinical trial data, put it in the context of decades of experience with rolling out new vaccines, and concluded it is safe and effective.

I have confidence in our own Baylor vaccine scientists and infectious disease experts, who have independently looked at the available data and are comfortable with the vaccine's safety profile. I have also reviewed the data myself, which is publicly available. I encourage you to do the same.

More than 40,000 people received the vaccine in the Pfizer trials. The subjects included people with a range of chronic conditions - diabetes, pulmonary disease, heart disease, hypertension and others. The most common adverse reactions were local soreness at the injection site, headache, muscle pain chills and joint pain. I am not even sure I would classify these as "adverse reactions." They are signs your body is mounting an immune response, which is what a vaccine is designed to do. There were no major adverse reaction reported.

Once actual non-trial vaccine administration began in Great Britain, there were two widely publicized allergic reactions. I have not seen the details reported yet, but both individuals apparently had a history of severe allergic reactions and carried Epi-Pens. At this point, if you have a history of severe allergic reactions (trouble breathing, skin rash) out of an abundance of caution I would suggest you wait to be vaccinated. I believe there will be much more clarity regarding these reactions in the next days to weeks.

In summary, the rate of a significant adverse reaction is very, very low. There have been no deaths, and even the two allergic reactions were easily treated. I am personally very comfortable with this level of risk. However, I am respectful of those who remain cautious. My advice. Wait a month or so. You do not have to get vaccinated today. The vaccine was approved based on the experience of tens of thousands. Within a week, our experience will expand to hundreds of thousands. Within a month, millions. If our experience continues to hold when a million people are vaccinated, I am probably far more likely to be severely injured driving my car to work than I am to experience a major vaccine-related complication.

That is my assessment of my risk. What about my perceived benefit?

Part of my motivation is – as I think it is for most early adopters – at least partially altruistic. I have no major risk factors. I do not want to get the virus, but I am vigilant about my distancing practices and do not necessarily fear contracting it.

However, I do feel – especially as a physician – an obligation to receive the vaccine. In a very small way, I am protecting the more vulnerable in our population. It will require tens of millions of individual small decisions to see this end.

I will confess, much of my motivation – much of my perceived personal benefit – is selfish. I have an 82-year-old father in North Carolina I would like to be able to visit without fear of infecting him. I have a niece and nephew – three-year old twins – I would like to see in person rather than on FaceTime. I have two "pandemic baby" granddaughters that I want to steal from their mothers ever now and then to have small adventures together. I want them to be able to meet and play with other children their ages. I want to go to church on Sunday morning in vivo, instead of on YouTube.

As I write this, it strikes me that this is not particularly revelatory – the pandemic has robbed all of us of something important. Health. Economic security. Companionship. Human connection. Selfishly, I miss my pre-pandemic life, and want it back. My individual decision to receive the vaccine will not get us there, but millions and millions of individual decisions will.

Let's get our lives back.

Stay well.

 

(Note:  Between June 2020 through November 2021, I wrote weekly COVID-19 pandemic updates seen through the lens of a health sciences university.  My intent was to provide reliable information, acknowledge legitimate concerns, console, and encourage.  Each posting reflects issues our community was experiencing at that moment in time.  I have reproduced selected examples on this site).

 

 

Heroes (are sometimes not who you think)

 

Shortly before I sat down to write this message, 90-year-old Margaret Keenan quietly stepped out of anonymity and into the history books as the first person in the world to be vaccinated against COVID-19. One down, a few billion to go.

It is said that a journey of a thousand miles begins with a single step. On our journey to world-wide herd immunity, we just took a small but critical step. Ms. Keenan performed a very small act of personal heroism, in a pandemic that has been marked by countless acts, large and small. Today, I want to highlight some of our less visible heroes at Baylor.

First, a word about vaccines and our current numbers. Just a word about vaccines, because there will be many words to come. There is still much we do not know, and the situation is constantly evolving. As we have information, we will push it out to our community. It is my goal that you know what I know. As vaccines become available to Baylor and our affiliates, we will get everyone vaccinated as rapidly as possible.

For now, I would offer a few general comments. First, if you are presented with an opportunity to be vaccinated, take it. Many in the Baylor community, especially those involved in direct patient care, will be vaccinated by our affiliate institutions. Second, initial supplies of vaccine will be limited and prioritized in line with CDC and State of Texas guidelines. Be patient.

It appears likely the initial trickle of vaccine supply will grow to a steady stream– I am confident we will have ample supply for our needs in the next couple of months. Finally, and critically, this is not over. I have to confess it gives me an incredible sense of relief that we are finally doing something to end this collective nightmare. For the first time, we are not just bailing out our sinking boat, we are repairing the hole in the hull. But until we get a substantial portion of the population vaccinated – probably sometime in the summer – we cannot relax our discipline around masking, distancing and safe viral control behaviors.

Our numbers bear out the need for continued vigilance. Last week, on an average daily basis, Harris County and surrounding communities added new COVID-19 cases at a rate of 2,373 per day, an increase of over 350% in eight short weeks, and a rate that exceeds our previous July peak. During that same eight-week time period, new admissions to hospitals grew to 174 per day, an increase of “only” 69%. The relative slow growth in hospitalizations compared to community cases is a bit of positive news, but the flood waters are still steadily rising at this point. Our hospitals and providers – our front-line heroes – are once again feeling the strain.

I wrote about those front-line heroes – our physicians, nurses, trainees and other providers – almost four months ago. They described to me their personal anxieties and sacrifices, but also their sense of pride and joy of teamwork in battling the pandemic.

As I said, today I want to try and recognize another group of essential personnel – those at Baylor who keep us safe. Those who keep us fed and keep our work environment clean. Those who keep our buildings in good repair. 

These are people who cannot do their job on Zoom; people who quietly and without fanfare show up day-in and day-out to do what needs to be done. In preparation for this piece, I spoke with about a half-dozen of these folks – people working in security, housekeeping, facility maintenance, the front desk and the cafeteria. Here is what they told me – their words, not mine:

How has the virus impacted your life? What are your greatest fears or anxieties?

• I worry mainly about my family. I have an elderly parent I want to protect.
• I no longer take my health for granted. I am not as young as I used to be, and I worry about my outcome if I did catch it.
• One of my cousins died – he didn’t take it seriously. I have other family members with medical problems. I need to protect them, and I need to protect my grandchildren.
• I take this very seriously. I am much more obsessed with cleanliness at home. I wear a mask, and I keep my distance. No one visits our home anymore – FaceTime and telephone visits only.
• I know many people who have lost their jobs and are suffering economically.
• I feel isolated. I am used to visiting my family regularly, and I like to go out dancing a few times a week. Now I am always at work or at home.

Why do you continue to come to work?

• It’s my job. It’s what I do. I get up every morning and go to work.
• There are still things that need to get done. There are so many people here who are doing so much to fight this virus. They have needs, and it makes me proud to help.
• People at Baylor are so smart and so educated. I learn something every day when I come to work.
• I need to eat…I have to work!
• I feel safer at work than anywhere.

What gives you hope?

• The vaccine!
• We are doing a good job keeping people safe. I work screening people as they come into the building. A few people still give us grief. Please tell them we are just doing our job.
• I know by protecting myself I am protecting other people.
• My faith. God will keep us safe.
• It has been an incredible time. I have seen great teamwork and great planning turn into action in record time.
• Everyone is working towards a cure; I am proud of the work Baylor is doing on behalf of our community.

After spending time discussing experiences with front-line healthcare workers and representatives of our support staff, there are certainly big differences. However, I am struck more by the commonalities. Concern for family. Hope for the future. Pride in the role Baylor College of Medicine – more specifically, the people of Baylor – has played in this struggle.

I will close by asking a favor. When you are at work today – at your desk, in your lab or classroom, walking the hallways – stop for a moment. Look up. There is someone you have seen day-in and day-out. Someone keeping you safe, keeping you fed, keeping you comfortable so you can do your work.

Say thank you.

Stay well.

 

 

(Note:  Between June 2020 through November 2021, I wrote weekly COVID-19 pandemic updates seen through the lens of a health sciences university.  My intent was to provide reliable information, acknowledge legitimate concerns, console, and encourage.  Each posting reflects issues our community was experiencing at that moment in time.  I have reproduced selected examples on this site).