Hope and Caution aren’t Mutually Exclusive
I’m THRILLED, once again, for a number of reasons.
But first: to lend credibility to my seemingly endless optimism, I assure you I’m often NOT thrilled. From the proliferation of scientific misinformation to my front-row seat watching patients in crisis to my bleeping stubbed toe that hurts like hell today, I’m fully capable of angst.
I also continue to prescribe caution when needed. Dispensing false hope is of course dangerous — in medicine it can mean the difference between life and death — but hope and caution aren’t mutually exclusive.
When good news is rooted in science, it’s appropriate to dispense it. Here is today’s double dose:
First, USA Today just published my opinion piece about the critical importance of addressing mental and physical health in tandem. While the vaccines are here, no one is immune to the stress of COVID. I feel it, too. Over the last year, we’ve lost loved ones, jobs, school, and our sense of normalcy. Stress has become a universal health condition. And it’s making many of us sick.
As we emerge from this collective trauma, we need to be seen, heard, and helped — ideally arm-in-arm with our doctor.
“The prescription for our patients’ recovery is clear: it is to name, normalize, and help navigate mental health issues as an essential part of overall health. It is to provide a safe, non-judgmental space for listening and healing. It is to treat the high blood pressure and the anxiety that drives it.
After a year in distress, we are wired and tired. We need nuanced medical guidance and someone to trust. We need a dose of reassurance and a plan for recovery. We need science under our feet and doctors at our back.”
Why am I so excited to share this piece with you?
It signals renewed interest in a fundamental concept I hold dear: that mental health is an essential part of our whole health. It brings me hope that change is afoot — that someday mental health care will be woven into the fabric of healthcare (as it should).
It’s a dream opportunity for me to reach an even wider audience about the relevance of our everyday thoughts, feelings and behaviors on our medical outcomes. YOU, dear readers, have been the wind beneath my wings to get here.
CHANGE FEELS GOOD!!! When we abandon shame and ask for help, change is possible. We are healthier, mentally and physically, when we acknowledge the universality of suffering and trust others to help us through it.
Second, it’s increasingly clear that the vaccines are our ticket to normalcy.
Pfizer just released its six-month update: ZERO hospitalizations among the vaccinated group versus 32 among the placebo group (n = 46,307). Also, real-world data from South Africa, where the B.1.351 variant is dominant showed zero cases of COVID among the vaccinated versus nine in the placebo (n = 800).
After vaccination, death and severe disease are essentially off the table. The risk of getting COVID — even with the variants — is dramatically reduced. The risk of transmission also goes way down. In short, after vaccination we can start to reclaim our sense of safety and sanity.
To be clear, the risk of infection from SARS-coV-2 isn’t zero after vaccination. Nor is the risk of transmission reduced to zero. We should NOT be surprised whatsoever when we hear stories of vaccinated people getting COVID-19. A reduction of risk to zero — e.g. vaccine perfection — was never on the menu.
But for the small percentage of people who do get COVID-19 after vaccination, they’ll mostly likely have a cold or mild flu. Could it be worse for some? Of course. Will people with underlying health conditions be at increased risk for the odd-ball chance of a bad outcome from COVID? Sure thing. Might someone even die from COVID even after vaccination, even though the it-cannot-lie-because-it’s-real-world data shows that no one has died from COVID after vaccination? Sure thing.
We’ve never been guaranteed a risk-free existence.
Risk is everywhere. And because each of us has unique health issues, we need a place to marry broad public health guidance with Dr. McBride’s (justified!) optimism with your unique body and brain.
This, in my humble opinion, is the reason to have a doctor.
Nuance is everything in medicine. There is no one-size-fits all prescription for every patient. Your primary care doctor is there to put data into context, to dispense tailored medical guidance, and to see YOU amidst the public health landscape. If you get COVID, for example, you’ll need nuanced advice on testing, isolation, and quarantine. (As I briefly alluded to in last week’s newsletter, testing symptomatic people for COVID using an antigen, or “contagiousness,” test in a vaccinated person is probably the most appropriate, however this recommendation will naturally vary depending on the clinical context. Similarly, PCR testing still plays an important role in this evolving landscape, but the when and if of testing is a perfect conversation with your own doc.)
We have learned so much over the last year. We’ve learned how to contain a deadly virus and ultimately how to defeat it. We’ve learned that science has our back. We’ve learned that taking fear out of the driver’s seat keeps us healthy, safe, and sane. We’ve learned that facts save lives.
We’ve also learned a lot about ourselves. Our vulnerabilities have been exposed, our reserves stripped, our faith tested. We’ve naturally been anxious. We have doubted the facts and searched for the truth. With so many megaphones, it can be hard to hear ourselves think.
We’re on the cusp of normalcy. Some of us fear normalcy while others revel in vaccinated glory. But regardless of our personal pandemic story, one thing is certain: the more we blanket the country with vaccines, the better off we’ll all be.
As I say to my patients (and wrote in my recent piece), it’s time to start planning our post-pandemic recovery. It’s time to reflect on our pandemic story, recognize the lessons learned, and draw up a road map for re-entry. It’s time to address our mental and physical health in tandem.
I will see you next week. Until then, be well.