Recap and Regroup
Hello, dear readers! I’m back, and I’m ready to roll.
This month I enjoyed a much-needed hiatus with my family where I did a whole lot of NOTHING. Okay, “nothing” is an exaggeration. It actually took me about a week to sink into full relaxation mode. Like many of you, I was burned out. (I wrote an article about it for the Atlantic just before I left on vacation.)
The catalysts to calm? Temporarily handing over this newsletter to two doctor friends (OBGYN Dr. Amanda Williams and geriatrician Dr. Clay Ackerly), asking for help with my social media feeds, and announcing to my Twitter followers that I’m taking time off. Delegating — and taking things off my plate — felt great.
I pressed pause after 16+ months on the high-alert response that the pandemic has required of physicians — and of moms and humans in general. I was able to slow down, sleep in, and soak up the sun. I took time to contemplate where I’m going from here. Without the pressures of headlines and hashtags, one day I went hiking and pondered the existential questions of life. I spontaneously decided to record this little video about where I’m heading, during which I actually got lost.
I’ve been writing about COVID-19 since March 2020, but COVID commentary isn’t my end-game. Coronavirus simply gave me permission to follow my dream of helping people beyond the walls of my office replace fear with facts; reckon with their vulnerabilities; and recognize the relevance of mental health to our whole health. After all, COVID has laid bare the critical importance of facts, trust, and nuanced guidance when it comes to caring for ourselves and our families.
So what’s next for me? YOU!! (With me alongside you).
My specific plan? To keep writing this newsletter once a week (on Mondays — I love a jump start to the week). I’ll continue to update you on COVID-19 but will broaden the lens to help redefine what it means to be healthy. We’ll talk turkey about the various and interconnected layers of our health — from managing stress and considering our relationships to nourishing our bodies, moving our skeletons, and interpreting medical data. In short, I’ll try to help you in the same way I’ve been helping patients for 20+ years.
But for today, an update on the plentiful COVID-19 news:
Over 99% of hospitalized patients with COVID are unvaccinated.
COVID-19 continues to wreak havoc mostly on unvaccinated adults and their unvaccinated contacts. The upshot? Get vaccinated to protect yourself and others around you.
The more “fit” delta variant puts unvaccinated folks at even higher risk of infection — meaning that unvaccinated adults who got away with riskier behaviors and didn’t get sick before delta arrived on the scene might not be so lucky this time.
So far the evidence suggests that delta does cause more severe disease than the “original” coronavirus, but this is very difficult to study given multiple confounding variables (namely human behavior).
Vaccinated people continue to be well-protected against COVID-19 and from transmitting the virus to others. All of the vaccines continue to be marvelously effective at preventing death and hospitalization.
A new study shows that immunosuppressed patients and patients with active cancers have nice — albeit reduced — protection against COVID-19 after vaccination. In other words, patients who have zero or low measurable blood antibodies levels after the vaccine aren’t unprotected; as expected, testing for antibodies does not give us the full picture of our immune response to the vaccine. (See my newsletter about the breadth of our immune system to understand how deep and wide our immune system is; hint: it’s not just about antibodies.)
**We cannot be surprised when we hear stories about the tiny fraction of vaccinated people who develop COVID-19.** We can be sad and upset when vaccinated people get sick, but a small percentage of vaccinated people getting sick is exactly what we expect with a vaccine that is near-perfect but not 100%; per CDC’s own data, the risk of getting symptomatic COVID-19 after vaccination is 0.002% = 2 in 100,000, though I suspect this percentage will increase as delta continues to circulate. (This small risk is the reason I have trouble with the notion of mandating masks for vaccinated people; in my humble opinion we should be able to assess our own risks — and mask up as desired — based on our unique medical conditions, age, and risk tolerance.)
If a vaccinated person gets COVID-19 and doesn’t die or need hospitalization, that is a vaccine success story and not necessarily a cause for alarm; it’s yet another reminder to unvaccinated people to get vaccinated in order to stop the spread of coronavirus to other unvaccinated people (and to a small share of unlucky vaccinated folks).
Note 1: The risk for long-COVID is greatly reduced in vaccinated individuals who get COVID compared to unvaccinated people. (This is because a major risk factor for long COVID is the “viral load” i.e. the amount of virus in a person’s nose — which is reduced if reinfected after vaccination.)
Note 2: The risk for long-COVID is lower in children than in adults. (Same reason; kids tend to have lower viral loads than adults.)
Note 3: Stating the fact that vaccinated individuals tend to get less sick with COVID (if they do get sick), accepting unpleasant realities, and communicating relative risk are not mutually exclusive with empathy toward sick people or vulnerable populations. (H/t Twitter.)
Kids can get COVID-19, but the risk of death and severe disease is vastly different for kids than for adults. The best way to protect kids from COVID-19 is to limit their exposure to the virus by vaccinating adults and teens ages 12 and above (with consideration of delaying dose #2 in teen boys to reduce the small but real chance for vaccine-related myocarditis).
Note 1: I continue to disagree with mask mandates — not with masks themselves. I am happy to engage in constructive conversation about this hot-button issue. I’m also willing to be convinced otherwise if our conditions change or if new scientific data emerges. I am all ears!
Note 2: I’m delighted that CDC’s school reopening guidelines prioritize bringing all children back for in-person instruction. I think we can all agree that protecting kids from diseases as well as from learning loss and emotional distress should be top on our national agenda.
The short story? COVID-19 isn’t going away. Unfortunately we have to learn to live with it. We need to mitigate death and disease while at the same time limiting the collateral damage from pandemic restrictions themselves — using facts, science and nuanced guidance. This is the nature of practicing medicine and the gist of public health.
Similarly, our underlying health isn’t going away. My patients have cancer, diabetes, heart disease, depression, and dementia separately from (though commonly exacerbated by) the pandemic. And whether we know it or not, our everyday thoughts, behaviors, and habits drive our health outcomes. Now is a good time to take a step back and consider our lives — to zoom out and ponder the things we can change, the fixed realities we cannot, and to work on the issues that will help us be healthier.
I will continue to advocate for an evidence-based and commonsense approach to healthcare. I’m also taking a dose of my own medicine. If the pandemic has taught us nothing else, it’s that we all need to think about what gives us meaning and purpose. As we emerge from our extended time of high alert, I challenge you to spend time taking stock of where you are, mentally, physically, and in relation to your family, friends, work, and community.
I’d love it if you’d write back and tell me: what’s ONE thing you’re doing these days to get back in the driver’s seat of your own health? I’m all ears.
I will see you in a week. Until then, be well.
P.S. Before I left, I hopped on one of my favorite podcasts to date with the amazing ZDoggMD, where we discussed my favorite topic: addressing physical and mental health in tandem. I hope you take a listen and let me know what you think!