COVID-19’s Human Toll, New Knowledge, Challenges Ahead 

Several of my patients have died of COVID; others hospitalized butt survived. Many more were COVID positive and for reasons that we are only beginning to understand survived with few aftereffects. Food insecurity is a new standard question whenever I speak to a patient. I’ve spoken in past COVID notes about one patient in his 30s who luckily survived weeks of intubation. While I’ve spoken to him almost on a weekly basis, I saw him for the first time only yesterday. Outwardly he looks the same. Yet he is permanently scarred – both physically and emotionally. He will likely never work again. He is undergoing rehabilitation and more procedures such as taking the filter in one of his major veins that was placed during his hospitalization for the blood clot in his leg that, in turn, was caused by COVID.  Almost all my patients have an overarching sense of anxiety. I wash my hands incessantly with sanitizer; I wear a head screen over a mask whenever I am with a patient. When I come home, I undress and take a shower.  

You’ve all heard about the fact that the executive branch politicized even our CDC guidelines.  The vocal disagreement between the executive branch/ Republican members of Congress and scientists reached a crescendo this week with one senior HHS official taking medical leave after accusing scientists of sedition. Then executive branch leadership repeated many of the same accusations, without taking medical leave. Other challenges continue. Because we do not to date have a national COVID policy, we continue to have shortages of PPE equipment months and months after the outbreak. But the deficiencies are very solvable — “if the federal government gives the Strategic National Stockpile agency greater clout, provides it with access to better information and technology, and beefs up its expertise.” The cost of testing continues to be a challenge with individuals getting astronomical bills for COVID testing; more and more people living in the United States are going without health insurance. This in turn will have a serious impact on our health care system with the economically vulnerable among us suffering the most such as, for example, hospitals located in low income areas. This is particularly distressing as we learned this week that “Hispanic, non-Hispanic Black and non-Hispanic American Indian/Alaskan Native person accounted for 94 (78%) of the 121 deaths aged <21 years reported to the CDC.”   

We are getting better at treatment of COVID 19 but have a long way to go. We are also getting better at our understanding of our bodily response. In a study with an accompanying editorial of the homogenous population of Iceland: “Whether antibodies that persist confer protection and retain neutralizing or other protective effector functions that are required to block reinfection remains unclear. Nevertheless, …the data point to the utility of antibody assays as highly cost-effective alternatives to PCR testing for population-level surveillance, which is critical to the safe reopening of cities and schools, and as biomarkers and possible effectors of immunity — useful tools…while we scan the horizon (and the pages of medical journals) for the wave of vaccines that will end the pandemic of Covid-19.”

Yet we of course realize that even with a vaccine, we will fall down yet again because we have no national policy. Though challenging, I am still using my minute leverage to encourage the National Academy of Medicine to be involved. In addition, Ask Nurses and Doctors is totally focused on the upcoming election. We are organizing health professionals in Fl, PA, and Michigan on behalf of Biden via the videos that will be circulated (Dr Abdul El-Sayed who did this video lives in Michigan and ran for governor of Michigan 2 years ago). If any of you are health professionals and would like to do a similar video – it will take no more than 10 minutes of your time. The organization AND is working for is identifying voters motivated by health care issues. Just contact me and/or spread the word. Among other activities, AND continues to work on several Congressional races from Iowa to Maine. 

If you are celebrating the Jewish New Year (starts tonite!) – may it be as sweet as possible while understanding that whoever wins the White House and Congress will have many challenges. In the spirit of resolution, this is mine: which my friend Isa Aron passed on to me: 

Question what is

Imagine what can be

And then do it

Lets do it together! I am lucky to know all of you. 

Norbert