Post by Nadica (She/Her) on Oct 23, 2024 0:58:11 GMT
Did I not get the memo? - Published Oct 21, 2024
By Sabra Gibbens, MD
It wasn’t always lonely out here. I have been the only permanent doctor in my little country clinic north of Kingston for eight years now, and I previously felt tremendous camaraderie and connection with my hospital-based specialist colleagues and other family physicians in the area. But in the past two years, I have begun to feel alone.
My diagnosis of long COVID came in 2022, after months of investigations. The results of the bloodwork, pulmonary function tests, sleep study, head CT, Holter, and exercise stress tests all came back normal. When I met with a cardiologist to review my symptoms and the abnormal echocardiogram, she confirmed that the persistent shortness of breath, postexertion malaise, insomnia, headaches, and brain fog were caused by long COVID. She never attributed them to anxiety. I was grateful for the validation.
Thankfully, my symptoms have largely improved over the past two years, but because of this experience, I take prevention seriously. I am the weirdo who still requires masks or respirators for all staff and patients in the clinic. I am the outlier who has HEPA filters in the waiting room and exam rooms, who monitors CO2 with my air quality monitor, who cracks the windows, and who asks patients with respiratory symptoms to do rapid SARS-CoV-2 tests at home before they come in.
The primary focus of public health throughout the pandemic has been to prevent severe acute disease and to preserve hospital capacity. Prevention of long COVID, or post-acute sequelae of SARS-CoV-2 infection (PASC), has always seemed like an afterthought, if it gets mentioned at all.
Why do emergency department reports and hospital discharge summaries not mention that my patient tested positive for SARS-CoV-2 (or had “a really bad cold” or “the worst flu ever”) 1 month before they presented to hospital with weakness, falls, confusion, dyspnea, heart failure, acute kidney injury, or non–ST-elevation myocardial infarction? Doesn’t that seem relevant? It does to me.
With the blessing of provincial medical officers of health and regional public health units, most institutions and the general public have adopted the “vax and relax” strategy, When it comes to COVID-19, most public health officials seem more concerned with meeting people where they are and with keeping people calm than with informing and guiding people about risks to their health. I wish I didn’t, but I now have doubts about the willingness of these officials to inform and guide physicians and the public about the next epidemic or pandemic.
The department of family medicine where I trained, as well as most family medicine clinics in my area, made masking and other precautions optional long ago. How quickly optional became rare, then peculiar.
In February 2023, I attended a recruiting event with dozens of local family physicians and residents. Rates of SARS-CoV-2 infections and wastewater levels were very high in our region at that time, so I wore a KN95 respirator. I did not expect to be the only one, but I was. Dang. Awkward.
Social media constantly reminds me that most of the medical community has moved on. It’s a steady stream of pictures of parties and crowded conferences and medical school classes with no one masking. My feed is occasionally interrupted by posts from similarly COVID-conscious physicians who are trying their best not to get COVID-19 or transmit it to patients under their care. Scattered across the Twitterverse, each one of us is a little island of perseverance.
I stopped attending in-person medical events because it is psychologically too difficult. I expect to be the only one masking in the movie theatre or grocery store, but among physician peers? Did they not get the memo? Did I not get the memo?
It wasn’t just one memo; 24 000 papers on the sequalae of COVID-19 have been published since the pandemic started.1 The British Medical Journal published an update on long COVID for primary care in September 2022, and guidance includes a time- and resource-intensive protocol for bloodwork, stress tests, pulmonary function tests, CT scans, and specialist consultations.2 Ontario Health published summary guidance for primary care regarding PASC in December 2022, but it has not been updated.3 The absence of any newer guidance suggests that interest in or funding for this topic has dwindled.
Anyway, I’m headed to a conference in a sunny place next week. It’s mostly an excuse to get away with my family while I brush up on some topics of interest. Of course, I am packing respirators, a CO2 monitor, and a portable HEPA filter. Weirdo? Outlier? Yep. Don’t care. Maybe I feel comfortable doing that for this conference because I’m unlikely to have any ongoing relationship with the other conference attendees. I care more about preserving my health so that I can continue practising medicine, taking care of my community, and enjoying my family than what others might think of me.
I do miss the camaraderie. What would it take to get that back? I had been hoping that the whole medical community would come together to advocate for clean-air standards, masking to protect against airborne pathogens, better vaccines, diagnostics, and therapeutics for PASC. I now realize this is unlikely to happen. I cannot wait for the world to change. I’ve got to find something in me, a mindset that will enable the reconnection, the old sense of belonging and shared purpose. I’m looking. I’ll keep looking.
References
↵Al-Aly Z. Long COVID puzzle pieces are falling into place — the picture is unsettling. The Conversation 2024 July 18. Available: theconversation.com/long-covid-puzzle-pieces-are-falling-into-place-the-picture-is-unsettling-233759 (accessed 2024 July 25).
↵Greenhalgh T, Sivan M, Delaney B, et al. Long covid: an update for primary care. BMJ 2022;378:e072117. doi:10.1136/bmj-2022-072117.
↵Post-COVID-19 condition: guidance for primary care. Toronto: Ontario Health; 2022. Available: www.ontariohealth.ca/sites/ontariohealth/files/2021-12/PostCovidConditionsClinicalGuidance_EN.pdf (accessed 2024 Aug. 5).
By Sabra Gibbens, MD
It wasn’t always lonely out here. I have been the only permanent doctor in my little country clinic north of Kingston for eight years now, and I previously felt tremendous camaraderie and connection with my hospital-based specialist colleagues and other family physicians in the area. But in the past two years, I have begun to feel alone.
My diagnosis of long COVID came in 2022, after months of investigations. The results of the bloodwork, pulmonary function tests, sleep study, head CT, Holter, and exercise stress tests all came back normal. When I met with a cardiologist to review my symptoms and the abnormal echocardiogram, she confirmed that the persistent shortness of breath, postexertion malaise, insomnia, headaches, and brain fog were caused by long COVID. She never attributed them to anxiety. I was grateful for the validation.
Thankfully, my symptoms have largely improved over the past two years, but because of this experience, I take prevention seriously. I am the weirdo who still requires masks or respirators for all staff and patients in the clinic. I am the outlier who has HEPA filters in the waiting room and exam rooms, who monitors CO2 with my air quality monitor, who cracks the windows, and who asks patients with respiratory symptoms to do rapid SARS-CoV-2 tests at home before they come in.
The primary focus of public health throughout the pandemic has been to prevent severe acute disease and to preserve hospital capacity. Prevention of long COVID, or post-acute sequelae of SARS-CoV-2 infection (PASC), has always seemed like an afterthought, if it gets mentioned at all.
Why do emergency department reports and hospital discharge summaries not mention that my patient tested positive for SARS-CoV-2 (or had “a really bad cold” or “the worst flu ever”) 1 month before they presented to hospital with weakness, falls, confusion, dyspnea, heart failure, acute kidney injury, or non–ST-elevation myocardial infarction? Doesn’t that seem relevant? It does to me.
With the blessing of provincial medical officers of health and regional public health units, most institutions and the general public have adopted the “vax and relax” strategy, When it comes to COVID-19, most public health officials seem more concerned with meeting people where they are and with keeping people calm than with informing and guiding people about risks to their health. I wish I didn’t, but I now have doubts about the willingness of these officials to inform and guide physicians and the public about the next epidemic or pandemic.
The department of family medicine where I trained, as well as most family medicine clinics in my area, made masking and other precautions optional long ago. How quickly optional became rare, then peculiar.
In February 2023, I attended a recruiting event with dozens of local family physicians and residents. Rates of SARS-CoV-2 infections and wastewater levels were very high in our region at that time, so I wore a KN95 respirator. I did not expect to be the only one, but I was. Dang. Awkward.
Social media constantly reminds me that most of the medical community has moved on. It’s a steady stream of pictures of parties and crowded conferences and medical school classes with no one masking. My feed is occasionally interrupted by posts from similarly COVID-conscious physicians who are trying their best not to get COVID-19 or transmit it to patients under their care. Scattered across the Twitterverse, each one of us is a little island of perseverance.
I stopped attending in-person medical events because it is psychologically too difficult. I expect to be the only one masking in the movie theatre or grocery store, but among physician peers? Did they not get the memo? Did I not get the memo?
It wasn’t just one memo; 24 000 papers on the sequalae of COVID-19 have been published since the pandemic started.1 The British Medical Journal published an update on long COVID for primary care in September 2022, and guidance includes a time- and resource-intensive protocol for bloodwork, stress tests, pulmonary function tests, CT scans, and specialist consultations.2 Ontario Health published summary guidance for primary care regarding PASC in December 2022, but it has not been updated.3 The absence of any newer guidance suggests that interest in or funding for this topic has dwindled.
Anyway, I’m headed to a conference in a sunny place next week. It’s mostly an excuse to get away with my family while I brush up on some topics of interest. Of course, I am packing respirators, a CO2 monitor, and a portable HEPA filter. Weirdo? Outlier? Yep. Don’t care. Maybe I feel comfortable doing that for this conference because I’m unlikely to have any ongoing relationship with the other conference attendees. I care more about preserving my health so that I can continue practising medicine, taking care of my community, and enjoying my family than what others might think of me.
I do miss the camaraderie. What would it take to get that back? I had been hoping that the whole medical community would come together to advocate for clean-air standards, masking to protect against airborne pathogens, better vaccines, diagnostics, and therapeutics for PASC. I now realize this is unlikely to happen. I cannot wait for the world to change. I’ve got to find something in me, a mindset that will enable the reconnection, the old sense of belonging and shared purpose. I’m looking. I’ll keep looking.
References
↵Al-Aly Z. Long COVID puzzle pieces are falling into place — the picture is unsettling. The Conversation 2024 July 18. Available: theconversation.com/long-covid-puzzle-pieces-are-falling-into-place-the-picture-is-unsettling-233759 (accessed 2024 July 25).
↵Greenhalgh T, Sivan M, Delaney B, et al. Long covid: an update for primary care. BMJ 2022;378:e072117. doi:10.1136/bmj-2022-072117.
↵Post-COVID-19 condition: guidance for primary care. Toronto: Ontario Health; 2022. Available: www.ontariohealth.ca/sites/ontariohealth/files/2021-12/PostCovidConditionsClinicalGuidance_EN.pdf (accessed 2024 Aug. 5).