I had several COVID positive patients this week, all vaccinated. All relatively speaking mild (i.e. no respiratory distress), including members of my family. COVID is constantly mutating. It would appear that one of the mutations is responsible for the new wave; but for sure it is all propelled by the large disappearance of masks from indoor use and low vaccination rates. A significant percentage of these patients will develop Long Covid; we are beginning to understand the long-term ramifications, with a large percentage, for example, of those on respiratory support developing  chronic lung problems.  

We hit a tragic milestone since the last COVID notes: a million (understated) COVID deaths. It is an unfathomable tragedy. I met with one of my diabetic patients whose son died of COVID. The son was in his 30s and had a family of his own. My own patient has suffered terribly with ongoing chest pain necessitating an ER visit. I am currently evaluating the cause, but emotional “heartbreak” is real.

Cruises are back in style. That doesn’t mean that COVID has left cruise ships alone. The CDC’s cruise ship status report shows that 76 of 92 ships have reported cases of the coronavirus on board.

I’ve previously referred to the path, highlighted in a recent NYT article, that Australia took in dealing with the COVID pandemic which resulted in a death rate 1/10^th of that in the U.S.  Despite our scientific innovations, our vaccination rate continues to be much lower than any other industrialized country. There are differences between regions with the Southeast having the highest death rate in the country – together with high poverty rates, very low vaccination rates, and high percentage of people with multiple chronic illnesses.

The issue is trust – between people, trust in government, trust in science. Trust in government is not an empty phrase. How should we move forward on this objective? Biden, Jha (the new Biden Covid leader), and other government leaders should personally ask Democrats and Republicans (D and R) to reach across the aisle – politicians and health professionals. Government leaders need to work with our remarkable scientific industry and convince them to license the vaccine technology to ramp up worldwide vaccine production. This should have happened at the Global COVID summit that Biden held last week. No matter, Biden should call a 50 state COVID summit (I get it not all states would come) and, in advance, identify D&R politicians, D&R scientific/ medical leaders willing to work together. Let’s not forget COVID and other pandemics are here to stay and will continue to have a dramatic impact on history – with so many of these tragedies being avoidable.   

I also understand that there are limits – there will be no national COVID policy. Instead states and localities can take the lead; AND is trying to contribute to state health policies. But while there will be no national COVID policy, there can be  national- state collaboration. Wastewater analysis is an excellent example. From this excellent Government Accounting Office report (short and great graphics): 

“Wastewater surveillance, also known as wastewater-based epidemiology, is the monitoring of pathogens (e.g., viruses), as well as pharmaceuticals and toxic or other chemicals by testing sewage. Public health officials can use this approach to monitor for outbreaks, identify threats (e.g., antibiotic-resistant bacteria), and, in response, support the mobilization of resources… Australia, for example, is using a wastewater surveillance program to track the amounts of illicit drug use in the population to estimate the effectiveness of law enforcement efforts to seize drugs” 

Building on an article that nurses and AND leaders recently published, AND approached a state medical society last week suggesting that D and R physicians appear together throughout the state. Last week, AND submitted an op-ed to a small town newspaper in PA advocating new COVID state policies. We will learn from this experience and try to replicate anything positive that occurs in other states. I will personally continue to reach out to each and every one of my patients who are still unvaccinated – one a Republican; several who place their faith in God; many vaccinated patients of mine don’t know about the booster. I keep asking them whether they trust me and tell them openly that everyone in my family has been vaccinated. When it doesn’t work – I contact them again and again. 

Norbert Goldfield, M.D.