• Fresh Perspectives

    Can We Create a Space of Moderation in This Pandemic? 

    September 20, 2021, 1:45 p.m. — My family flew back from Hawaii in early August, and I had appointments scheduled for all five us to be tested for SARS-CoV-2 at my clinic on the day of our arrival. Not because I suspected anything, but because I was being vigilant. I was supposed to teach at the medical school the next day, and my kids were scheduled to start camp.

    young female physician and young male patient

    A colleague called me right away.

    “You have COVID,” he said.

    Not just me, my whole family.

    My husband and I had been immunized early in the vaccine’s rollout, me as a doctor (Pfizer), him as a veteran (Moderna). But the kids are too young — an 11-year-old daughter, a 9-year-old son and a 6-month-old daughter.

    The benefit to all of us having caught it is that we didn’t have to isolate from one another. (My husband, Jason, and I had planned for multiple scenarios that included isolation if that were to ever become a need last year.) So we hunkered down. Jason and I experienced what I can best describe as weeklong head colds with brain fog. No fevers, no shortness of breath, no myalgias. We lost our sense of smell, which has since come back almost fully. The girls had mild fevers (up to 101 degrees), a day or two of nausea, mild congestion and sore throats. My 9-year-old was nauseated for two days, and that was it for him. No one had shortness of breath, no one got hospitalized, no one died. We all recovered within a week and feel back to where we were at baseline.

    Afterward, my 11-year-old turned to me and asked, “That’s it? That’s COVID? This is why we were so scared? That wasn’t even as bad as the flu.” And for us, she was right.

    My family is statistically average in our n=5. Jason and I are generally healthy vaccinated adults, and we had mild breakthrough cases. Our generally healthy children (our son has mild asthma) had mild cases. I had a glimpse of understanding, for the first time, those who think that COVID is not a big deal. Indeed, just as the discussion around COVID seems to have no moderate ground, neither does the virus. Approximately 25% of cases are completely asymptomatic, and up to 17% of patients with COVID require hospitalization. And then there are the long-term effects, which we are still learning about.

    My daughter experienced a different world of COVID through me. A world of patients decompensating on the floors, high-flow nasal cannulas, talking to families — preparing them for unimaginable loss, intubating pregnant patients, etc. For 18 months we had been trying to outswim a shark. I have never stopped treating patients with COVID. And I had never caught it at work. Our children went to school (with masks!) and never caught it. And finally, on our first flight and vacation, the shark caught up, and our bites weren’t bad.

    How can I reconcile the unimaginable devastation that COVID has and is continuing to cause with the mild cases my family experienced and the weight of the world wanting to normalize? Add to that the question: Do we really think what was normal before is good for us now? And we hit a conundrum.

    I keep coming back to two thoughts:

    1. This isn’t a zero-sum game.
    2. There is a cost to everything.

    I’ll start with the first point. SARS-CoV-2 is a type of coronavirus, and coronaviruses have always claimed lives. The original strain of SARS-CoV-2, and now its mutated strains, are creating a global devastation that I could have never imagined. I have seen the worst-off patients, I have held their hands and I have cried with their family members. Viruses will always claim lives. And yes, they will always claim the lives of the more vulnerable. That is not a judgment; that is a fact — just like I knew, when I decided to work full-time doing COVID inpatient care, that I was doing so as person with obesity and asthma, which meant that I had higher risks of severe illness and of death than many of my colleagues.  

    You may blame me for my obesity (we can correct that thinking later), but you definitely can’t blame me for my asthma. (Patients should not be blamed for their disease processes, and diagnoses should never come with judgments.) Ironically, working directly with patients with COVID is not where I caught the virus, even during the first weeks of the pandemic when we didn’t have adequate personal protective equipment.

    A silver lining of this pandemic is that we have learned small interventions that can help the vulnerable in our communities — namely not going out when having symptoms, better sanitation, ventilation and masks. Workplaces have had to create new policies allowing sick time and working from home if possible, and those that haven’t have been lambasted publicly.

    The second point: there is a cost to everything. I have had family members, friends and colleagues lose jobs and incomes. The pandemic has quickened the rich getting richer and the poor getting poorer. People have had to leave work because of children who are unable to go to school. We have seen the disparity in education growing. I take these losses and put them against the losses of life. I know so many people who have died. I know so many people who have lost loved ones. I both experienced personally, and witnessed daily, how it is for patients to go through medical hardships alone because we were isolating people in the hospitals and clinics to reduce transmission.

    I find myself on social media looking at the fear-mongering and the conspiracy theory posts that are dissuading people from vaccines and masks. I want to yell at both sides. Yes, most people who catch COVID will be OK. Yes, some who catch COVID will get really sick, and some will die. No, it isn’t as simple as age and comorbidities; my first patient to die was a man in his thirties, and I knew women in their nineties without symptoms. Yes, vaccines will absolutely help decrease your risk of serious infection, hospitalization and death. Yes, masks protect all of us. No, masks do not make your oxygen levels go down. Yes, masks are safe for children. Yes, most kids do better in school compared with remote learning. Yes, working parents need schools to be open, especially those that have no other options for child care. No, people should not have to go into offices if they don’t need to physically be there to do the work.

    I cringe at the fact that the solution is coming in mandates. On my first day back from maternity leave, my first two patients were unvaccinated, for no real reason other than the fact that I’d been out, and no one had talked to them about it. And after conversations with me that day, they both left vaccinated.

    I think our outreach needs to be more personal and diffuse and less paternalistic and draconian. With that thought in mind, I encourage you to visit places like the Academy’s COVID-19 Vaccine Patient Education webpage, which provides resources for how we can talk with our patients about vaccines and help relieve some of their concerns.

    On the other hand, I understand the mandates. Schools need to be safe places. Hospitals need to be safe places. Risk needs to be decreased. And unvaccinated individuals are at much higher risk of acquiring and spreading infection. If individuals don’t take responsibility for decreasing the risk for the vulnerable, it is the place of government and society to do so.

    I am not naïve enough to think that people will put aside 18 months of polarizing information and disinformation. I hope that by continuing to engage in dozens of personal interactions a day with patients, colleagues and community members, I can encourage a space for moderation — a space of critical thinking and understanding of disease risk and mitigation strategies — that will help move us forward in achieving our goals.

    MaryAnn Dakkak, M.D., M.S.P.H., practices full-scope family medicine and is a clinical assistant professor at Boston University Medical Center. She is Women’s Health Director at Manet Community Health Centers. Her views do not represent those of the organizations with which she is affiliated.

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