Selenocysteine

[carnegiemuseumnaturalhistory]

Herd Immunity and the Anthropocene

When is getting an infection actually a good or a bad thing? Let’s start by talking about herd immunity. What exactly is it, and why have we been hearing about it so much during the Covid-19 pandemic?

Herd immunity, as described by the CDC, is a situation in which a sufficient proportion of a population is immune to an infectious disease (through vaccination and/or prior illness) to make its spread from person to person unlikely. When a group has a high enough percentage of immunity in its population, transmission becomes increasingly difficult for a disease to spread to even the more immunocompromised members of the community.

Although, herd immunity is obtained at different levels of community immunity depending on the disease. Some highly infectious diseases, such as measles, require about 94% herd immunity to stop community spread. According to the Mayo Clinic, about 70% of the US population would need to have immunity from Covid to stop our current pandemic.

So how do we even get herd immunity? Well, we can achieve herd immunity through two different methods. The first method is infection. Herd immunity can be achieved by having a large amount of the population getting the virus naturally. The downside of this method is that the population has to get sick and recover. Depending on the disease, short or long-term side effects or mortality rate can be very detrimental to the population.

Germs have most likely existed for around 3.5 billion years (the age of the oldest living organisms, bacteria). Modern humans have only been around for about 130,000 years. Humans have only been around for a fraction of the time diseases have, but they are both a part of nature. However, in response to their presence, humans have developed immune systems that have been a part of a back and forth protecting us from harmful germs. Terrestrial vertebrates such as humans have complex immune systems that have evolved to protect them from new immunological dangers.  Getting sick is a part of life. Diseases have always been a part of nature, and that is especially true of the current time period, the Anthropocene. The Anthropocene is the current geologic age where humans have a substantial effect on their environment. During this time period, the way we interact with nature through contributing to climate change, deforestation, and urbanized lifestyles has increased the likelihood of pandemic-like illnesses to sweep over our communities. Deforestation causes loss of habitat; and with loss of habitat animals will be forced to come into contact with animals they originally wouldn’t have, including humans. This increases the chance for germs to spread to new hosts. Climate change and urbanization are also causing organisms to live closer together, allowing for diseases to spread more easily through communities. So, while diseases are a part of life and nature, occasionally there is one germ that can come around and have a profound effect on society.

I remember the news stories when NYC was first getting taken over by Covid. Medical personnel lacking PPE, hospitals overflowing, using ice trucks to store the deceased, and exhausted nurses and doctors. All of that resulted in just 22% herd immunity. At 22% herd immunity most of the population of NYC is still susceptible to Covid. If natural infection was the only way forward, so many more of NYC’s citizens would die or become severely ill. However, because this happened NYC was quick to understand the importance of instituting mitigating measures to slow the spread of the disease. Andrew Cuomo, the governor of New York, is similar to Rand Paul in that he is in a position that he can implement policies. When Andrew Cuomo, governor of New York, saw what was happening in his state, he used his ability to implement policies to follow scientific guidance surrounding closures, social distancing, masks, etc. As a result, the rates in NYC decreased. Not because of herd immunity, but because of serious measures against Covid. If we look at a different state, such as Florida, that did not take measures against Covid seriously, there were consecutive days in the state where they were having 10,000 to 15,000 new cases a day. This lacking approach to Covid caused thousands of preventable deaths. Even after months of lockdown the US is not close to herd immunity. All of the preventable deaths and long-term health complications that I’m seeing in people are going to continue with the natural spread. This is why the global race for a vaccine is so important.

The second method of reaching herd immunity is through vaccinations. By developing a vaccine for an infectious disease, we are able to reach herd immunity without having to subject our population, community, and families to the side effects and overall awful experience of falling ill. By using widespread vaccinations, we can also protect our most vulnerable members of society, like our loved ones in an older or younger age range, immunocompromised individuals, or those with allergic reactions making them unable to receive vaccines. Herd immunity is a good thing. When we have a disease like Covid, however, natural infection will cause crippling long-term effects in what were healthy people, and hundreds of thousands of preventable deaths. This is why herd immunity is good, but it depends on the method used to obtain it.

Immunity is an important part of preventing diseases in my home. Herd immunity helps me protect my family, friends, and people I come across every day. When paired with vaccines, I am able to protect more people in my community. I have a small child in my home, and older family members who I come into regular contact with. My family (my herd) and I get our vaccines and flu shots every year to help protect those more immunologically vulnerable members of our family. By doing this, my herd is creating a mutually benefiting environment where our personal actions protect those around us. The actions that we take to protect our family also protect the members of our communities and your herd too.

Humans are a part of nature, and so are diseases. Individual actions have a larger inter-connected effect on surrounding environments and society. The same thing could be said about the Covid virus spreading through the country. Society as a whole needs to develop a larger scope of thinking about how the actions of individuals affect the environment and planet. The factors I mentioned earlier, climate change, deforestation, and urbanization, are keeping steady and increasing. If these continue as they are currently, we can expect more pandemic-like diseases in our future. And when it happens, society will have to come together again to figure out the best way of adopting herd immunity to combat the disease.

As for my advice for the rest of this year, think critically, look at scientific data, vaccinations work, and in the words of Mr. Rogers, “Real strength has to do with helping others.”

Hannah Smith is an intern in the Section of Anthropocene Studies. Museum employees are encouraged to blog about their unique experiences and knowledge gained from working at the museum.

Works Cited

Glossary

Acquired Immune Deficiency Syndrome (AIDS): A medical condition where the immune system cannot function properly and…

www.cdc.gov

https://www.cdc.gov/vaccines/terms/glossary.html#commimmunity

Herd immunity and COVID-19 (coronavirus): What you need to know

Understand what’s known about herd immunity and what it means for coronavirus disease 2019 ( COVID-19). Curious as to…

www.mayoclinic.org

https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/herd-immunity-and-coronavirus/art-20486808

Vaccines Protect Your Community

Did you know that when you get vaccinated, you’re protecting yourself and your community? This concept is called…

www.vaccines.gov

https://www.vaccines.gov/basics/work/protection

Anthony S. Fauci, M.D.

Dr. Fauci was appointed director of NIAID in 1984. He oversees an extensive portfolio of basic and applied research to…

www.niaid.nih.gov

https://www.niaid.nih.gov/about/anthony-s-fauci-md-bio

https://www.nytimes.com/2002/02/26/science/when-humans-became-human.html

https://www.nationalgeographic.com/science/prehistoric-world/precambrian-time/

https://www.britannica.com/science/immune-system/Evolution-of-the-immune-system

https://www.hsph.harvard.edu/c-change/subtopics/coronavirus-and-climate-change/

https://www.inc.com/geoffrey-james/45-quotes-from-mr-rogers-that-we-all-need-today.html

[dara-steine]

Hey if you’re COVID-positive or COVID-recovered...

there is a support group for you!

In this group, you can also help the citizen scientists.

To become a member, here is the form you fill out: https://docs.google.com/forms/d/e/1FAIpQLScM2EeJhgisTUdo5Op6euyx1PYu8O-aNeDVYhXuPFa_Gs9PnQ/viewform

Also If you’re a COVID-19 long-hauler and would like to find out how to get involved, there’s still time to take part in this survey!

some info about their work:  https://patientresearchcovid19.com/

A little blurb about their results and efforts here: https://directorsblog.nih.gov/2020/09/03/citizen-scientists-take-on-the-challenge-of-long-haul-covid-19/

[medschooltutors]

No joke. #FridayFunny #TheBestMedicine 

[socialdistancing]

[humanitymed]

We had a patient who looked like she was close to being able to come off the ventilator. There were plans to extubate her the next day. She was improving, then suddenly she nose-dived. Ruled out everything else and decided this must be cytokine storm. Her kidneys were completely shot, she had to go on dialysis. She died about a week later. I can’t stop thinking about what her middle school aged children must have been going through…one day their mom was being discharged from the field hospital because she didn’t need respiratory support, the next she went to the hospital and never came back.

[theglowstickchronicles]

As a nurse I don’t usually tell families when their loved one has died because they are either 1) at the bedside or 2) the provider calls. Sometimes I happen to catch them as they are returning from a quick trip to the cafeteria and their family member passed quickly but that’s few and far between.

But I will never forget having to tell my patient’s daughter that he had died, surrounded by me and a family medicine doctor (a PCP! On a stepdown unit!) and a respiratory therapist, only 48 hours after his wife had also passed from covid.

I will never forget arranging the visitation times of another patient who was dying NOT OF COVID, and we could only allow 2 people at a time. Please remember that covid is terrible and it kills people in a horrific way, causes unknown long term damage in many, and spreads like wildfire…. but E V E R Y O N E is suffering because of this pandemic regardless of whether you get it or not. And the longer we continue to refuse to wear masks or appropriately socially distance, the longer that every single person in this country suffers.

[dara-steine]

Racism, Not Genetics, Explains Why Black Americans Are Dying of COVID-19

Some scientists and politicians have invoked baseless ideas about unknown genes, ignoring systemic inequality and oppression

the overall death rate from COVID-19 is 2.4 times greater for African Americans than it is for white people. If Black people were dying at the same rate as white Americans, at least 13,000 mothers, fathers, daughters, sons and other loved ones would still be alive.

How, then, do we explain that “black” and “white” still predict biological endpoints like hypertension, diabetes or—now—COVID-19?

Hint: it’s not because of any deep-seated differences in our DNA. It’s because our social structures and attitudes promote the well-being of some and devalue others.

[islamic-art-and-quotes]

قرر الفقهاء: أن المتفرغ للعبادة لا يأخذ من الزكاة، بخلاف المتفرغ للعلم، لأنه لا رهبانية في الإسلام، ولأن تفرغ المتعبد لنفسه، وتفرغ طالب العلم لمصلحة الأمة.The scholars decided that those who dedicate themselves to worship will not be given a share of zakat (alms), as opposed to those who dedicate themselves to science (who do get a share), because there is no monasticism in Islam, and because those who dedicate themselves to worship are doing it for their own benefit, while those who seek knowledge benefit the entire nation.

Yusuf al-Qaradhawi (via islamic-art-and-quotes)

[medxclusive]

Chagas Disease: Quick Review

medXclusive Learning

Trypanosoma cruzi causes Chagas Disease, also called American trypanosomiasis and is carried by triatomines (the reduviid bug) or “kissing bug.” An infected kissing bug feeds on a human and during night deposit its feces near the site of the bite (chagoma). T. cruzi trypomastigotes, present in the feces of the bug, enter the human blood via open wounds or mucosal membranes and infect different organs.

Acute infection can last for 4-to-8 weeks and will resolve without treatment. It is usually asymptomatic or characterized by mild illness. However, the acute infection will evolve into an underlying chronic infection. Chronic infection may also be asymptomatic for years or decades. Even though asymptomatic, the carriers can pass on the disease through blood transfusion or through transplacentally. 

Chagas Disease in its chronic form can cause dilated cardiomyopathy, megacolon, and megaesophagus. The disease in endemic in South America and Central America. However, it is estimated that approximately 300,000 Latin Americans living in the US might be infected without even knowing. When taking history, it is important to keep in mind that in Latin America, the triatomines are known by other names – this includes “kissing bug,” “benchuca,” “vinchuca,” or “barbeiro.”

In immunocompromised patients, Chagas disease can reactivate as a febrile syndrome that may be accompanied by skin lesions, meningoencephalitis, or myocarditis. The worldwide standards for antiparasitic treatment are two drugs – nifurtimox and benznidazole. These drugs are not approved in the U.S., but are available from CDC for use under investigational protocols for compassionate treatment.

[junflower123]

[dara-steine]

‎1619: Episode 4: How the Bad Blood Started on Apple Podcasts

‎Show 1619, Ep Episode 4: How the Bad Blood Started - Sep 13, 2019

[dara-steine]

Lisa Cooper on Why the Racism Roiling America Is a Public Health Issue

America, reeling from twin crises brought on by police brutality and a virus that takes disproportionate aim at people of color, must now reckon with the racism that paved the path for both.

To understand the challenges, Global Health NOW turned to Lisa Cooper, MD, MPH, a Bloomberg Distinguished Professor and director of the Johns Hopkins Center for Health Equity at the Johns Hopkins Bloomberg School of Public Health.

Also a practicing physician and director of the Johns Hopkins Urban Health Institute, Cooper has spent decades working to make health equity a core principle of all public health work. In this exclusive Q&A, she shares her thinking on racism's role in poor health outcomes for African Americans, why they have suffered more from COVID-19, and the search for solutions.

What do most people not understand about how the persistent experience of racism impacts the health of African Americans, and why is racism is a public health issue?

We just have so much evidence that racism negatively impacts health.

There have been centuries of a system that has created inequities in opportunities for people of color—and for African Americans, in particular—in this country. Having been brought to this country as slaves and subjected to forced labor and atrocities, there is that whole backdrop. And even after emancipation, there were laws put in place that preserved that system of inferiority for an entire race of people.

One really common form of institutional racism in our country has been racial segregation. And those neighborhoods didn’t have social investment, access to healthy food and safe environments from crime, education and employment opportunities, and access to health care. All of those things that determine whether or not people can be successful in society.

There is this myth that America is the land of equal opportunity, but it’s not.

The data on racial differences in health are tragic. Life expectancy for African Americans, for example, is 3.5 years shorter than for white Americans. What other disparities should people be aware of?

It starts from infancy. African Americans also have the highest infant mortality rates. African-American babies die at twice the rate of white babies before their first birthday.

And before birth, maternal mortality rates are about 3-4 times higher for African American mothers. African American children suffer more from conditions like asthma. Death rates from heart disease, diabetes are all much higher among African Americans than whites.

As a physician, have you seen African American patients suffering more?

I see them every week. I see women who are in their 30s who have heart disease, who had a stroke, or who have diabetes and are on the verge of having an amputation, of going blind—women and men of color.

I see young African Americans with kidney failure on dialysis not even 50 years old yet, who are disabled. It’s just incredible. When I see people, I’m often really shocked when they tell me how old they are. I expect them to tell me they’re older than I am, and I find out they’re 10 or more years younger.

Is it a coincidence that we’ve seen massive protests against racism during the COVID-19 pandemic?

I think it’s happening in the backdrop of this pandemic that has already created a lot of additional stresses and hardships on people of color.

People of color are overrepresented among frontline, essential workers, so they’ve been exposed to the virus from having to go to work at a time when a lot of other people can stay home or work from home.

The relationship between law enforcement and communities of color has been problematic for centuries as well.

The data shows that when there’s violence against minority communities by law enforcement, it impacts the mental health of that entire community.

Why are more African Americans dying of COVID-19, and suffering more from hardships related to the pandemic?

Before COVID-19, minority communities were already disproportionately impacted by social inequities. People in those communities already have higher rates of obesity, diabetes, heart disease, lung disease—so these are the folks who were actually going to be at more risk of getting seriously ill with COVID-19. And all the stresses: the financial stresses of being poor, the social stresses of being from a marginalized group with a history of institutionalized, sanctioned mistreatment by law enforcement and other large societal institutions.

There’s a confluence of all these different factors—not having access to food, not having access to good quality housing, crowded in small houses where there are multiple generations, unable to engage in social distancing, stock up on groceries for several weeks at a time, or having to use public transportation.

What can the public health community do to counter stigma against people of color with COVID-19?

What we can do is make the links between social conditions and health clearer.

A lot of the pushback emphasizes individual responsibility. So, if African Americans would just stop overeating and engaging in unhealthy behavior they wouldn’t be in that situation. But it isn’t that African Americans don’t know what they should and shouldn’t be eating, but that society has thrown up obstacles to choosing healthier behaviors.

What can be done right now to ease the toll of COVID-19 on black and minority communities?

Keeping an eye on the data is an important priority: knowing who is impacted, where they’re impacted.

Communication is also really important—making sure that the public understands why we might be seeing these patterns, and that it’s more about our society and the way our resources and opportunities are allocated than it is about individual behaviors. We need to do what we can to better understand the challenges of those communities and show empathy and concern.

We also need to focus on the frontline workers, and the low-wage workers, and understand their needs—providing protective equipment, safe spaces to work, paid sick leave, hazard pay, or health insurance and access to testing and care.

Let’s talk about solutions. Racism is so deeply ingrained in American life and so are the many social and economic inequities. What should the public health community be doing about racism?

We need to bring some of the health equity and social justice aspects of public health more into the mainstream of the curriculum—not just in courses and concentrations. It needs to be brought into all of our work.

Public health can also help set the tone for others to follow—like health care, law enforcement, transportation, housing—by exemplifying those principles in all of our work.

At the Urban Health Institute, our first goal is to facilitate collaborations and offer training and capacity building for academics and for communities to work together toward these evidence-informed strategies and to build “communities of opportunity.”

We’ve developed courses and workshops, and we’re exploring how to enhance them and make them more accessible to more stakeholders.

One thing I’m particularly excited about is the focus on anti-racism training for bystanders; that’s a very promising strategy for changing social norms. If someone is perpetrating racist and biased behavior, ensuring people around them are equipped to respond in such a way that it doesn’t go unchecked.

We’re also working hard to connect the resources of academic institutions and the health care system with policymakers in Baltimore to bring that translation of evidence into policy.

What makes you hopeful about the future?

I see people coming together in a way that they haven’t in a very long time. I see a lot of empathy and connections based on our shared vulnerability at this time.

Even if it seems unprecedented, there have been times in the past that our country and the world went through similar challenges. We are strong and resilient, and we have so many tools at our fingertips now that we didn’t have then. I think that there is hope, and we need to seize on that and not despair.

This is also an opportunity to remember how interconnected we are. Our fates are intertwined. The pandemic has shown us that more than ever that what happens to one of us affects all of us. If we want to be healthier and have more opportunities, it’s not enough to just worry about ourselves. We have to think about how what we do affects other people.

Source: https://www.globalhealthnow.org/2020-06/lisa-cooper-why-racism-roiling-america-public-health-issue?utm_source=Global+Health+NOW+Main+List&utm_campaign=10cc59cabd-EMAIL_CAMPAIGN_2020_06_04_04_27&utm_medium=email&utm_term=0_8d0d062dbd-10cc59cabd-2980849

[mymedlife]

Black patients with heart disease receive older, cheaper, more conservative treatments than white counterparts.

We can do better. 

[dara-steine]

Visit Original Link

Dermatologists look for problems that are literally skin deep. That can be complicated when your skin is darker.

Dermatologists presented with a new patient have a number of symptoms to look at in order to diagnose. Does the patient have a rash, bumps, or scaling skin? Is there redness, inflammation, or ulceration? For rare conditions a doctor may have never seen in person before, it’s likely that they were trained on photos of the conditions—or can turn to colleagues who may themselves have photos.

But in people with darker, melanin-rich skin, the same skin conditions can look drastically different, or be harder to spot at all—and historically, there have been fewer photos of these conditions on darker-skinned patients. And for these patients, detection and diagnosis can be life-saving: people of color get less melanoma, for example, but are also less likely to survive it.

Dermatologist Jenna Lester, who started one of the few clinics in the country to focus on such patients, explains the need for more dermatologists trained to diagnose and treat people with darker skin tones—and why the difference can be both life-saving and life-altering.

[plannedparenthood]

Today is National Black HIV/AIDS Awareness Day — a Call for Equitable HIV Prevention

February 7th is National Black HIV/AIDS Awareness Day — an observance created in 1999 to raise awareness about HIV prevention, education, testing, and treatment for Black communities. 

According to the Centers for Disease Control and Prevention (CDC), Black Americans make up 13% of the US population, but 42% of new HIV diagnoses. It’s clear that there’s a real disparity in health care access and HIV prevention methods for Black communities. Fortunately, providers, educators, advocates, and organizations like Planned Parenthood have identified the tools to address this public health crisis.

HIV PREVENTION & EDUCATION

Education is key to prevention. Black gay and bisexual men and Black men who have sexual contact with other men account for the highest rate of new HIV diagnoses.The CDC estimated 44% of Black transgender women live with HIV, and 26% of Black people who received an HIV diagnosis in 2017 were cisgender women. Structural racism and implicit biases in the medical field impact Black people’s access to quality health care and creates barriers around getting information and support. These inequities often result in delayed diagnoses and higher rates of HIV, while stigma and miseducation can leave Black communities without preventative tools and lifesaving treatments. All of these barriers ultimately restrict Black people living with HIV from getting the care and support they deserve. 

HOW TO GET TESTED

1 in 7 Black Americans are living with HIV and are unaware of it. Most people who have HIV don’t show any symptoms right away. That’s why regular testing is important — it can lead to early diagnosis and treatment. Planned Parenthood health centers offer compassionate care, including HIV testing and counseling.  The staff at Planned Parenthood are nonjudgmental and can answer your sexual health (even the ones you may be afraid to ask). Learn more about making an appointment.

If you’re not able to reach a health center, you can test yourself for HIV using an at-home HIV testing kit. With the OraQuick In-Home HIV Test, you swab your gums and test the sample yourself. You get results in 20 minutes. With the Home Access HIV-1 Test, you prick your finger to get a small amount of blood. You mail your blood sample to a lab, and get your results in about a week. 

At-home tests are totally anonymous — you’re the only person who will know the results. And both types of tests help connect you with counselors who can give you support and advice about treatment if you test positive. Knowing your HIV status is essential to staying healthy and taking control of your sex life. 

TREATMENT

All STDs, including HIV, are treatable. However, you can’t get treatment if you don’t know your status. If you think you may have been exposed to HIV, make an appointment with your nurse or doctor or at a Planned Parenthood health center to find out if post-exposure prophylaxis (PEP) is right for you. PEP is a series of pills that you start using within 72 hours of being exposed to HIV. There is also pre-exposure prophylaxis (PrEP) — PrEP is a daily pill that can help prevent HIV. Taking PrEP every day can lower your chances of getting HIV from sex by more than 90%. Both PrEP and PEP can help people  live healthy and safe sexual lives. 

WHAT HIV PREVENTION WORK IS PLANNED PARENTHOOD DOING FOR BLACK COMMUNITIES?

Some Planned Parenthood health centers provide PrEP and PEP, and all health centers can connect people living with HIV to treatment options so they can get the care they need. 

In 2017, we launched our HIV Prevention Initiative in partnership with the Black AIDS Institute (BAI), a national organization working to stop the HIV epidemic in Black communities by engaging and mobilizing Black institutions and individuals. This initiative allowed us to expand our comprehensive HIV prevention and education efforts for communities that face the most barriers to accessing equitable health care, education, and treatment. 

To find a health center near you and learn more about HIV prevention, go to plannedparenthood.org.

-Jocelyn and Leanna at Planned Parenthood 

[moncegonzalez-blog]

Obamacare changed the lives of many who were feeling hopeless. About 23 million people now have health insurance through Covered California. Now, more people receive treatment, and medications. As Article 25 of the UDHR makes clear, more people have the right to health care. Although more people have their right to health care, others still do not have access to medical treatment. The fact that the Trump administration wants to modify the Affordable Care Act means we will be reverting back to greater disparities.

Works Cited:

“Gains In Health Disparities,” American Heart Association, 27 Jul. 2015. U.S. Department of Health and Human Services, newsarchive.heart.org/much-done-much-still-to-do-30-years-after-heckler-report/0727-feature-30-years-after-heckler_graphic-01/. Accessed 22 November 2019.

[dara-steine]

Kansas has largest racial disparity in COVID-19 death rates, study finds

Nearly a third of the state’s COVID-19 deaths have been black Kansans, although they account for only 5.6% of the state’s population. The UC Berkeley researchers have provided comparisons between states through a heat map that shows racial disparities by state.

Wichita City Council member Brandon Johnson said he suspects the racial disparities in COVID-19 deaths are a product of America’s long and racist history surrounding housing, wealth and health that have not been adequately confronted in Kansas.

“We just continue to say, ‘Everyone’s treated equally,’” Johnson said. “But the reality is we have to focus on certain areas, invest more in certain areas. To equalize takes more investment.”

Read more here: https://www.kansas.com/news/rebuild/article242680156.html?fbclid=IwAR1NL2ommkCcD6i1FLIAzqb_O6ISxbvk1J8Lv5bY8Q7SmYW4qKeda4j74L0#storylink=cpy

[yoojkim]

Notes from the Pandemic #14: If the United States and its leadership doesn’t figure out #COVID19 soon, I may end up practicing post-apocalyptic medicine. (Inspired by my favorite New Yorker Cartoon “Yes, the Planet Got Destroyed,” by Twitter @t_b_toro)

[thedisagreeabledoctor]

Everything has changed. Every encounter is now eyed with skepticism as we mask and gown to enter a room. Patients look to me, terrified about why the infectious disease doctor is wearing full PPE. After all, they just came for a pneumonia, right?

It is hard for me to understand the full extent my life has changed. As an infectious disease fellow I am an essential employee - which means my work has not changed. I go and see patients and do the best I can for them. However, I now do this without vacations, with less oversight and with less support. Many of the attendings have been pulled to help on a system wide, and sometimes global, scale. What remains is the core of our clinical staff - fellow run teams and rotating faculty. Since all “unessential care” has been postponed we have overall fewer consults. But we also have fewer teams and the consults we are seeing on balance are sicker.

I have certainly seen my share of COVID patients. Unfortunately those are the easy consults - continue supportive care. Nothing more to do. I try to reassure them. To hold their hand when I can. But most interactions are happening through phones, windows, and, when in person, behind a thick veil of PPE. It is hard to be reassuring in those situations. I have exercised my skills in goals of care - helping families understand the quagmire that awaits intubating their 83 year old grandpa. We quickly sign off, knowing their patients will languish for 2-3 weeks before ultimately succumbing to their disease.

The rest of my patients are just as unfortunate. Young 20 somethings with surgical disasters. IV drug users with Staph bacteremias. Homeless HIV patients who can’t afford their meds. I worry even more about those who aren’t coming in. Who have mild symptoms but think they will tough it out until the stay at home order is over. The elderly who have no one checking in anymore. There will be a reckoning down the road - not just of those lost to COVID but of those lost to diseases that did not get care during the time of COVID.

This was already the hardest year of my life. No one anticipated we might add in a pandemic. But at the end of the day I don’t complain out loud. I am healthy. I am employed. And I have something to offer in a time where many feel helpless. Everything has changed. At the end of all this, that’s all I can wrap my head around.