I Feel Safest (re Covid) in My Own Hospital

by Danielle Ofri
The Atlantic

“No thanks,” my patient said to me. “Two is enough.”

I was caught off guard the first time I heard that response to my recommendation of the Covid booster shot. “What do you mean, it’s enough? Do you toss out half of your cardiac meds? Do you say, ‘Eh, that seems like enough” partway through your hernia operation?”

But I’ve been receiving that response more and more these days. “Two is about right.” “I’ll stick with two.” These folks are not vaccine skeptics by any stretch. My patients hail from communities that were pummeled Covid and most snapped up the vaccine as soon as it became available in early 2021, undeterred by logistical barriers or social media rumors. But a year later, despite cases rising sharply due to the BA.2 variant, they—like most Americans—seemed to have moved on.

We healthcare workers, however, don’t have the option of moving on, as Covid is now the third leading cause of death in the U.S. Covid may not be the only thing on our mind as it was at the outset, but it’s still part of every staff meeting, every communication, every clinical day. Our Covid testing tent, hurriedly erected in our hospital courtyard in March of 2020, is still on active duty. Keeping up with shifting viral trends and treatment protocols remains top of mind. Our meetings remain largely remote, and of course we’ve never stopped wearing masks.

We’ve watched communities fling off public health measures with a darting unease. There’s even a tinge of envy, as we wish we had the luxury of declaring ourselves done with Covid. But mainly it’s concern. Case counts in New York on are the rise again, yet people are sardined into indoor restaurants, clubs and stores, sans masks, partying like it was 2019.

One of my kids is competing in a sports tournament and the consent form warned me that “neither receipt of a COVID-19 vaccine nor proof of a negative COVID-19 test is required” and that I must accept “the risk of my child being exposed to COVID-19.”

I read the form, both bewildered and livid. Yes of course I can accept a risk of Covid exposure—that’s life everyday—but why were they not making the slightest effort to decrease risk? After suffering so long without adequate testing, we are now awash in rapid Covid tests: schools send them home in backpacks, hospitals give them out freely, testing vans are parked on every street corner. If they’re about to pack a hundred sweaty teenagers in a closed space for a full day of contact sports, why not hand everyone a test kit along with a Gatorade on their way in? Yank open the windows and distribute masks in school-spirit colors. Even if a portion of participants opted out, the risk for everyone would still be lowered. But it feels as though they’re just throwing in the towel.

This collective shrug baffles me. Why wouldn’t we take modest, non-coercive measures to make Covid infection less likely?

Oddly enough, I feel safest now in my hospital, where everyone wears masks, washes hands, and maintains a healthy respect for viral might. This irony is not lost on me, remembering how hospitals were seen as nuclear meltdown zones at the start of the pandemic, with healthcare workers who strode into these conflagrations treated as a cross between conquering hero and Typhoid Mary.

As we lurch into year three, we have no choice but to contend with waning public attention for all things Covid, despite a pandemic that is still very much present, as the one-million mark for American deaths somberly reminds us.  Covid is sliding, however fitfully, into the ranks of diseases like tuberculosis, malaria, heart disease, and diabetes—epidemics that are hiding in plain sight, epidemics that rely on narrow interest groups to rally resources, fund research, and formulate policy. But for frontline clinicians involved in direct patient-care, the inflection point from crisis to chronic can be awkward to navigate. Patients cast far longer shadows in our professional lives than statistics, and seeing a disease recede into ordinariness feels almost like a betrayal of those we’ve cared for and lost.

When HIV staggered from cataclysm to manageable disease, it was an enormous relief. But our emotions palpably lagged. The public’s attention may have moved on, perhaps justly, but memories of our patients’ decimation remained potent. Embers of the epidemic were still flaring, and there were still so many patients out there, about to experience the pain we knew so intimately. It felt unseemly, almost traitorous, to move on.

In my clinic, I have to grapple with the growing divide between my patients’ attention for Covid and my own. To some degree, it’s not dissimilar to other divides we confront. “No thanks,” is a response I often get in response to my recommendations for colonoscopy, or insulin therapy, or eliminating processed meats from the diet. But Covid feels like a volcano whose recent eruption is too fresh to render quotidian.

The other day a long-time patient of mind came  for a check-up. He’s significantly obese, which puts him at higher risk for severe Covid, but he’s declined even the first vaccine dose. “I’m not ready yet,” he told me, as he’s told me at every visit for the past eighteen months. Part of me wants to leap onto the exam table, brandishing the front page of the New York Times with its double-page headline marking one million deaths, and holler, “What exactly is it that you are waiting for? Two million?”

Protocol demands that I be a bit more measured in my approach. But I also know that easily a third of those one million deaths were preventable. These were deaths in people who declined vaccination even when vaccines were freely available. People like my patient in front of me.

I listened to his concerns, answered his questions, reviewed the data, and described why I thought he would benefit. We spent more than half of our visit talking this through, but we ended at the same point. “I’m just not ready,” he said to me about the vaccine.

As I survey these last two years—the funerals of my patients, the exhaustion and burnout of my colleagues, the grief of hard-hit communities—and then watch the number tick up again, I suppose I could say the same thing about moving on from Covid. “I’m just not ready.”