This has been nurse’s week and this column is dedicated to the amazing nurses I’ve worked with throughout my career, but particularly over the past 15 months. When I was singing their praises this time last year, we really had no idea how bad or how long the pandemic was going to last. Now we know. Nurses are simply amazing. Early on, as doctors, we were getting patient’s histories over the phone at times and then only spending a little bit of time in the room examining patients, while nurses were in PPE and often wearing uncomfortable “gas masks” doing the work of starting an IV, getting blood, administering meds, adjusting oxygen, and providing care and comfort to patients while putting their own health and safety at risk. There has been a considerable amount of burnout among frontline workers over the past year. It’s certainly more physically and emotionally exhausting to be a nurse now than I’ve seen in my career. It takes an amazingly special person to be a nurse (even prior to COVID let alone now) and I’m a much better person for having worked so closely with them for over 25 years.
I’ve had a very unusual week. I don’t get sick often but was out with a GI bug on Monday. Wow was I sick. It was really bad for about 6 hours and then I just slept for a day. At first, my wife was pretty convinced I had food poisoning from our venture to a restaurant on Sunday. (I personally think it was my body revolting against the diet I’ve been for a few weeks). Although I always consider food poisoning as a diagnosis when patients come in with nausea, vomiting, and diarrhea and tell me they think they have food poisoning, it’s not common for me to make that diagnosis based on the clinical data. However, given that my wife and ate pretty much the same stuff (except for one seafood item which I ate) all weekend, it seemed reasonable. Then I heard that some staff might have been out sick. Then, my colleagues told me they’ve started seeing patients with the same types of symptoms. Now, late in the week, and days after I was sick, my son got sick. It’s pretty awful. It’s not COVID. And it’s the kind of thing we used to see regularly before we all started washing our hands 100 times a day. As one of my colleagues said, maybe it’s a sign the pandemic is coming to an end since we’re starting to see GI bugs in the ER again. I’m pretty careful about hand sanitizer at work, don’t really spend time in the ED breakroom, wear a N95 the whole shift, wear gloves with patients, so I don’t know how I picked it up. But I hope everyone will take this a reminder that good hand hygiene prevents all kinds of illness besides COVID and there’s other contagious illnesses out there.
Although about a third of our ER patients get COVID tested, the amount of care we’re providing to actual patients with a COVID diagnosis continues to decline. The number of patients who require COVID isolation is almost as low as the early fall, after her second week in a row of declining numbers. The number of symptomatic patients who require testing continues to decline, though the number of positives in this group is steady for the last couple weeks. Overall, the number of patients that we diagnosed with COVID this past week is the second lowest total number since I started keeping track in April 2020. You have to go back to mid-June to find the only other week where the number was a touch lower. Of course, the week after that last June, the cases started to double and we saw a small spike in the summer. I am not anticipating that going forward as patients continue to get vaccinated throughout the area. Our inpatient hospital census is even lower than last week. However, there are COVID patients in the ICU, patients continue to require admission, and some patients continue to die. We’re getting better, but COVID is not gone.
I read an interesting report presented at the American Academy of Dermatology (virtual) Conference. I’m sure you can imagine there’s some serious sunscreen used at their regular spring meeting. They looked at rashes associated with the vaccine. Data has been collected in a registry to track all the different types of skin reactions to the vaccine. There’s been about 400 documented skin reactions, more so with the Moderna vaccine than Pfizer. Often, these are delayed after the vaccine and have been confused with cellulitis (skin infection). Fortunately, rashes related to the vaccine are rare and generally benign.
We are making progress on vaccinations. First, Pfizer has requested full FDA approval. I hope it give the public more confidence in the vaccine. It may also make it easier for schools and jobs to require vaccination. As a nation, we’re up to about 60% of adults being vaccinated. There were two recent studies in JAMA online based on healthcare workers looking at the infection rate between vaccinated and unvaccinated peer groups. The first study was based out of St Jude Children’s Research Hospital and researchers “determined that people who’d had at least one dose of vaccine were 79% less likely than their unvaccinated coworkers to become infected.” These workers “were also 72% less likely to develop an infection that was asymptomatic.” The second study comes from Israel where researchers “calculated that people who were fully vaccinated were 97% less likely than their unvaccinated peers to develop an infection with symptoms.” Moreover, “even among those who were only partially vaccinated, the risk of a symptomatic infection was 89% lower.” Vaccinated workers were 86% less likely to have an asymptomatic infection. And now it seems like we’re days away from the 12-15 year old age group being approved for the Pfizer vaccine. That’s certainly a biggie for my household but also big for getting more people eligible for the vaccine. Herd immunity is based on 70+% of the nation’s 330 million people, not based only on the adult population. Kids younger than 12 are targeted for approval by September. Vaccinating children is critical as 22% of new infection are made up of pediatric patients. A year ago, this was only 3%. The CDC released a paper earlier this week, saying they are optimistic that America can be much closer to normal by July if we continue along the vaccination pathway. The map to normalcy is easy. Get your vaccine. Encourage others to do so as well. But we still need to worry about the rest of the world.
I’ve been asked to comment more on what’s going on in India. I wish I had the knowledge to dive into the economic implications but I’ll focus on the medicine. They’re having staggering amounts of infections and deaths. World records of daily infections and death. They’re running out of oxygen. 300,000 new cases a day and the 1% mortality rate will be a lot higher if you don’t have oxygen to keep people alive. As I look at the videos of the sick, it’s clear the patients are in respiratory distress. Hospitals don’t appear to have the resources to care for the sick. People who require CPR for COVID rarely (if ever) live. Early in the pandemic, we had some very morbid meetings about what would happen if we had to ration beds or ventilators or oxygen. We based it on age, co-morbid conditions, and response to treatment. It would have caused tremendous anxiety and depression to have been the ICU doctor to have managed the list of patients who may have had care withdrawn. Besides the overwhelming amount of illness, family grief, and death taking place in India, with the population there and the amount of disease spread, one can only imagine how many variants will result. And which of these variants will penetrate our vaccine’s effectiveness? COVID is global and while we focus on what’s going on at home, I’m thankful world leaders are helping with aid.
An old college friend messaged me Wednesday to ask if patients who recovered from COVID still need the vaccine? He’s vaccinated but trying to convince friends. Then I read an interview between two prominent virologists published on Wednesday, so I imagine it’s a topic worth covering. The short answer appears to be an absolute yes. The vaccine strengthens your immune response and gives it added longevity compared to natural immunity. The vaccine also appears to offer more protection against variants. There’s a lot of science behind those statements but the bottom-line points to the benefits of vaccination over natural immunity. In the long run, we’re all better off as more people get vaccinated.
Science matters. Wear a mask. Practice physical distancing.