When we first learned of the new virus circulating in southern China in late 2019, there are a few things we would not have expected in the intervening 20 months. First, we would not have expected the rise of a global pandemic that would infect hundreds of millions of people, hospitalize tens of millions, and kill millions worldwide. We would not have expected this pandemic could cause global economic devastation, social unrest, and unprecedented use of government power. We would not have expected a vaccine to be developed so quickly, and that this vaccine would be among the safest and most effective drugs ever produced. We would not have expected that, even with 4.9 billion doses having been given worldwide to more than 30% of the global population, nearly half of Americans would choose not to take advantage of the protection it offers because they have doubts.
Let’s be honest. The odds of having a poor outcome following an encounter with the coronavirus are slim. In Hancock County, since our first case in March 2020, 48,000 people have been tested with 9,400 (1/8th of the county population) having been found positive for infection. Of these, 600 have been hospitalized and 150 have died, most of them over the age of 70. Given that the overwhelming impact has been on fragile and aging populations, it is no surprise that more than 90% of individuals over the age of 65 have been vaccinated in our county. And it is a good thing they did, because the virus has now mutated and become even more infectious than the original strain. In fact, it is estimated that the current variety, the “Delta Variant”, is 10 times more infectious than the original and is now as easy to catch as chicken pox.
Now that the coronavirus is so much more transmissible, it is unlikely that it can be stopped from becoming endemic. This means that eventually everyone is going to catch the virus. At the current rate of spread it will likely take many years for that to happen and during those years, additional residents of our county will be hospitalized and die in roughly the same proportion we have witnessed so far. Since one-eighth of the population has been infected so far, it would indicate that eight times more people will be hospitalized (4,800) and die (1,200) in that period. Fortunately, the vaccine has proven incredibly effective at preventing hospitalization and death, so it is very unlikely that county residents who are vaccinated will suffer this fate. The current experience of hospitals in our region substantiates this fact, with the vast majority of those hospitalized with COVID-19 being unvaccinated. Here’s the bottom-line. The disease can no longer be stopped, but the worst effects can be prevented with the vaccine.
The spread of the disease through the population will not be smooth, it will come in waves. We are in one of these waves right now in central Indiana, and it has taken hospitals to the brink of their capacity. The large downtown hospitals are full and often “on diversion”, meaning they are not able to accept patient transfers from other hospitals. The smaller hospitals in the suburbs are also full and our emergency departments are often holding patients overnight waiting for inpatient capacity to open. In the past, “capacity” usually referred to the availability of beds. In the pandemic era, it more often refers to the availability of staff.
Healthcare, like all other industries, is facing a significant staffing shortage. While we experience the same issues as other industries related to an aging workforce (with the associated increase in retirements), and to odd economic conditions that are currently persuading people they are better off staying at home than working, there is an additional factor at play. This factor relates to PTSD associated with treating very sick patients for long periods of time. COVID has caused this PTSD to run rampant among front-line healthcare workers. Following the exhausting, and very large, surge of COVID patients over the holidays, the much lower numbers of infections during the spring and summer gave health care workers hope that the worst was over and those holding off on retirement made the decision to leave.
Then, a few weeks ago, we experienced another surge. Numbers of patients in the emergency room suddenly swelled to their highest level since the beginning of the pandemic. The number of patients with COVID admitted to the hospital reached its highest number since January. The number of patients requiring ventilation surged to its highest number ever in our hospital. And there was one thing almost all of these patients had in common – they were not vaccinated.
Imagine being a nurse who held the hands of dozens of patients with COVID-19 over the past year, watching many of them gasp their last breath, then die. Imagine the toll this took on their minds, their spirits, their bodies. Then imagine the same scenario happening in front of you again, only this time with a person whose illness could have been prevented by simply taking the vaccine.
The physician, the nurse, the therapist, the tech, still holds that hand and they do all they can to save the patient, but by that time there is little that can be done. Many front-line health care workers in hospitals are simply saying, “I can’t do this anymore, I can’t watch another person needlessly suffer and die…” They are leaving the hospital environment and finding jobs in clinics or administration, places where they won’t be haunted by the faces of those they lost. Many are simply leaving healthcare altogether.
So here is our ask – be careful. Hospitals are being taxed to the limit. Not all the time, it comes and goes, but when surges happen, they are exhausting. We did not expect this to happen in August, so it is a wakeup call for what may be coming our way this winter. We ask you to be careful. If you have been waiting for FDA approval of the vaccine, it has arrived, so now is the time. If you choose not to be vaccinated, make sure it is an informed choice, and be especially careful. Beware of crowded indoor places, wear your mask, wash your hands. Eventually, we will all catch the disease. Vaccinated folks will get it too, but the odds of a good outcome for them will be strikingly better than for those who choose the other path.