May 7, 2021

cautionary tale

I have not written as much lately. Maybe because of increasing intensity of my day job as a family physician as patients feel safe to be seen again. But also because the reality of the business of medicine is glaring me in the face and my discomfort with that reality eats at me. Consequently, I am spending more effort on improving the lot of doctors and other clinicians who are bordering on burnout. I have been there myself. The corporate good does not always align with physician wellbeing. I have been spending energy to help change that reality. Slow progress is happening. I may write more about that another time.

This work reminds me that I need to care better for myself, so I took the last three days off and went camping. Jamie and I took our “old tin can” and drove over the pass, east towards the Coulees. The Coulees are part of the Channeled Scablands caused by the floods of Glacial Lake Missoula. Glorious and more interesting than I imagined. Very different than my beloved desert Southwest canyons that took eons to form. I like it when I get an unexpected lesson, this one geographic. I really had no idea about this area.

We met four friends for a first post-vaccine meet up at Steamboat Rock State Park in the Grand Coulee, not far from the famed hydroelectric dam. It was glorious to be with friends outdoors without masks and to play tunes for hours together, sitting close enough that we could actually hear each other. Such a treat after our year of isolation.

I felt safe doing this. The data is reassuring that we each are protected by our double doses of mRNA vaccines. We are all healthy enough and not on immunosuppressants. We have no high risk exposures or have others at risk that we might infect.

But we all do need to remember that certain people are not mounting a strong immune response to the vaccine, mostly people who have had organ transplants or on strong immunosuppressants or have other reasons to not respond strongly to the vaccines, such as the very old. This decreased immune response can leave them more vulnerable. Crucial analysis and data collection are being done to find out why other breakthrough infections of SARS-CoV-2 still occur in some people without these risks factors. We already have data that show that older people who are immunized are much less likely to be hospitalized if they do catch COVID-19 and also data that shows that unvaccinated seniors are 10 time more likely to be hospitalized with COVID-19 than someone who was fully immunized, at least in Washington State. We also know that younger people are the ones getting sicker now than older ones, mostly because the vaccines have been given to more seniors and the newer variants are more infectious to the unvaccinated.

What this means is that breakthrough infections can occur, not often, but enough to stay cautious, especially if around someone who is more vulnerable because of their immune system or if they are un-immunized. We have vaccinated friends who went to visit a beloved (vaccinated) aunt at her nursing home. They visited without masks to help with hearing, feeling safe. They learned a day later another resident had COVID-19, despite being vaccinated. A staff member was diagnosed too. Fortunately, all good so far with them, but a sobering reminder.

All this means is that we can relax some of the time, but when you are with someone more vulnerable, remember to be cautious.

I still recommend “wash your hands, cover your nose, and keep safe six” in some cases, depending on your and your contacts risk. Other times, it is safe to be with others who are vaccinated unmasked, like when we met at Steamboat Rock State Park, where we, all vaccinated, visited, hiked, played music together outdoors, but slept in different camp sites. You can enjoy being with your loved ones again. It is a true gift and the antidote to burnout.

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.washingtonnature.org/fieldnotes/2017-science-two-minute-takeaway-what-is-a-coulee

https://en.wikipedia.org/wiki/Lake_Missoula

https://parks.state.wa.us/225/Ice-Age-floods-in-Washington

https://en.wikipedia.org/wiki/Steamboat_Rock_State_Park

https://en.wikipedia.org/wiki/Grand_Coulee

https://www.npr.org/sections/health-shots/2021/05/07/994260770/vaccination-against-covid-does-not-mean-immunity-for-people-with-organ-transplan

https://www.seattletimes.com/nation-world/scientists-scramble-to-see-why-in-rare-cases-even-the-vaccinated-can-get-covid-19/

https://www.seattletimes.com/seattle-news/health/fully-vaccinated-seniors-are-far-less-likely-to-be-hospitalized-with-covid-19-cdc-study-finds/

https://www.seattletimes.com/seattle-news/unvaccinated-people-65-and-up-hospitalized-with-covid-nearly-10-times-more-often-says-state/

https://www.seattletimes.com/seattle-news/health/younger-people-are-getting-sicker-from-covid-washington-state-hospital-leaders-say/