January 23, 2022
coming like a freight train
I am gearing up for an intense week. This is my last week as a primary care doctor. I have such a full heart and mixed feelings about the ending. Saying goodbye to patients is heart wrenching, I am feeling their gratitude and their angst about the changes. The last few weeks I come home drained and exhausted, falling asleep by 9 PM. I expect this week to be even harder. I have a full schedule. I still have patients that need my help with new symptoms and diseases. I also am working to match them with the best fit for a new PCP. Not as easy as it sounds.
Being a primary care doc has its own challenges. These days we are sliced and diced with metrics regarding our performance, whether it is productivity or patient satisfaction or “quality”, a vague term that doesn’t actually guarantee good care. I am glad to let go of those things, but there are other things I will miss. From the response from my patients the past weeks, I have given them what they have needed and what they have wanted. I am gratified for that, but those results are harder for the healthcare system to quantify.
I imagine that I will still find a way to help out somewhere in medicine. I am mostly giving up the responsibility of primary care that is more burdensome now than I remember in the past. I have some ideas about where I can help and look forward to those opportunities.
I will continue writing as long as it seems to be working for you all and me. I hope to expand from this COVID pandemic to other epidemics. We shall see. I have enjoyed writing so much and hearing how helpful these updates have been. I know I sleep better when I write.
And we are still in this pandemic, which has swept us up in unexpected ways, like a tsunami. Who knew that conspiracy theories would actually be the biggest concern? We have weathered this so far, maybe not graciously, often with fear and pain, but I do feel as if things will be easing off. The numbers show that Omicron is peaking in most places in the US, and in some areas infections are falling quickly. Some cities are looking at sewage to see how much Omicron they find as a clue to how much is in the community.
Yes, Omicron is infectious and breakthrough infections are happening, especially in the unboosted. You can look at the peaks of prior surges and see how much higher Omicron peaks are. Now even though new infections are falling, hospitalizations are increasing, especially in the unvaccinated. Some people are wondering if they should catch Omicron and just get it over with. There are lots of reasons that is not such a good idea. Not the least of which is spreading infections to people who aren’t vaccinated or immunocompromised. When Omicron is described as mild, we forget that only means you might no be hospitalized but some people will feel pretty sick with flulike symptoms for a week. Others, may have minimal symptoms. Data does show that vaccinations do protect from long COVID, which is reason enough to be vaccinated.
For now it still makes sense to be careful. More infections can overwhelm the already stressed health care system. Especially in the unboosted and unvaccinated, complications can occur. A new peer reviewed study shows the locations where the risk of infection is highest. Being unmasked in unventilated areas has the highest risk of transmission. Talking, singing, and heavy breathing when exercising indoors are riskier. The safest scenarios were outdoors, being masked, and being quiet. A poorly ventilated movie theatre with unmasked people gave a 14% chance of infection if everyone was silent, but if there were talkers that risk increased to 54%. If everyone was masked and silent, the risk was 5.3% but increased to 24% with talking. That is a big reason I am silent in elevators at work.
I am reassured that the vaccines are protective and the boosters help prevent serious infection. Still I want to avoid infection so I can’t pass it on.
Wash your hands, cover your nose, be aware of ventilation, and get your booster if you haven’t yet.
And finally, my caveat is that this is my experience and my opinions, which are subject to change as more information is available, and not related to the organization I work for. Thanks for reading
https://www.seattletimes.com/nation-world/in-sewage-clues-to-omicrons-surge/
https://www.npr.org/sections/goatsandsoda/2022/01/19/1071809356/covid-booster-omicron-efficacy
https://ourworldindata.org/covid-metrics-previous-waves
https://www.washingtonpost.com/opinions/2022/01/12/want-just-get-omicron-get-it-over-with-heres-why-you-shouldnt/
https://www.npr.org/sections/health-shots/2022/01/15/1073075753/get-omicron-symptoms-precautions
https://www.theatlantic.com/science/archive/2022/01/omicron-mild-severity-immunity/621238/
https://www.seattletimes.com/nation-world/as-nations-decide-to-live-with-the-virus-some-disease-experts-warn-of-surrendering-too-soon/
https://www.seattletimes.com/nation-world/where-youre-most-likely-to-catch-covid-new-study-highlights-high-risk-locations/
https://www.mdlinx.com/news/study-shows-covid-19-vaccines-offer-lasting-protection/4sL9opwriA7KN3hbQ06M5q
https://www.mdlinx.com/news/breakthrough-covid-cases-overwhelmingly-mild-for-vaccinated-people-study/l4xxMzkgNOGewabRnBwCI
https://www.mdlinx.com/news/study-suggests-that-two-doses-of-covid-19-vaccine-may-protect-against-long-covid/7Hqle9NQZ2mLkSpEXSbO8m
https://www.nytimes.com/2022/01/17/health/cdc-omicron-isolation-guidance.html