An I.C.U. Doctor’s Message of Hope Amid Omicron
"Almost exactly one year ago, my colleagues and I buzzed with excitement as we lined up for our first shots of the Covid vaccine. Even as we postponed holiday gatherings, we posted our vaccination photos on social media as promises to ourselves that 2021 would be different.
And it has been. Vaccines and declining case numbers have allowed even the most vulnerable among us to re-enter the world, to cautiously plan travel, to hope. But now, with the highly infectious Omicron variant sweeping through the country, it is easy to feel defeated. As I scroll through the news on my phone, I find myself swinging between an exhausted sort of apathy, anxiety and frustration.
But the story of Omicron is not a story about the failure of the vaccines or a sign that our lives must be forever dominated by this virus. On the contrary. We are not where we thought we might be a year ago, but there is reason for hope. We have the tools and the knowledge that should allow us to stay safe and to protect others despite the ongoing presence of this virus. The greater challenge might be in maintaining our collective humanity during what could become yet another surge of illness among the unvaccinated.
The science is developing quickly, and the past two years have taught even the most confident among us to be humble in our predictions. We do not yet know whether Omicron itself causes milder disease, or whether the milder infection we’re observing is the effect of vaccination and immunity from prior infections. But all the evidence so far indicates that a majority of those of us who are fully vaccinated (including with a booster) and are otherwise healthy will face relatively mild illness.
This does not mean that we should become careless, as there is still so much that is unknown, and every decision we make affects countless others. But with vaccination, high-quality masks and access to rapid testing, we are better equipped to manage risk without placing our lives completely on hold.
We also know now that placing our lives on hold comes at an immense cost. When I think of the suffering this virus has wrought, I do not just think of my patients with the coronavirus, but of an elderly man who was found alone in his apartment and brought to my hospital profoundly malnourished. He had not spoken to another person in months. I think of nursing home residents, deprived of human touch, their dementia accelerating. I think of drug overdoses and alcoholism and untreated psychiatric disease, the shadow pandemic of these two years.
We are not built for prolonged solitude, and I do not believe that we would be willing to return to that harsh reality. While local restrictions may differ, our policies should prioritize keeping people safe while maintaining connection.
But that risk is not the same for all of us. With just over 60 percent of the country vaccinated, the increasing prevalence of this variant means that hospitals expect a surge of patients who are unvaccinated and critically ill. And those who are immune-compromised from cancer or transplants, or frail because of age or chronic conditions, remain at greater risk.
This leads to an increasingly complex set of questions to grapple with, questions with no easy answers. Our lives are all interconnected. Yet when my own health is not at stake to the degree it once was, how do I balance the tension between personal choice and responsibility to others?
Walking through the intensive care unit on one recent afternoon, I took in a familiar sight — half a dozen patients intubated and sedated and alone, most lying on their stomachs. One of the nurses exited a room, quickly removing her N95 and donning a surgical mask in what is by now a well-practiced choreography. “They’re all unvaccinated,” she said, and when I felt momentarily reassured by this fact — maybe I was safe after all — I wondered whether perhaps one of the greatest risks of whatever surge comes next will be compassion fatigue, the dwindling ability to feel empathy for the unvaccinated.
Down the hall, a colleague called me over. A patient I had cared for one night some weeks ago, a mother in her 30s with the coronavirus and severe respiratory failure, was finally being discharged to a long-term acute care hospital. I peered in behind the curtain. She was awake, profoundly weak, but alive.
Earlier that day, my colleague had explained to her what had happened during her long hospital stay and what might come next in rehab. Then he paused and shifted his tone, telling his patient that she should let go of whatever guilt or shame she might be carrying over not getting vaccinated. She had made a mistake, but what is a hospital if not a place where we care without judgment for the many consequences of human fallibility? She started to cry. And then she asked him if she could get the shot. She received her first dose shortly after.
When my I.C.U. colleagues and I talk about our patients on rounds, we distill them into one line that includes their name, age and pertinent medical history. These days, we often include vaccination status. “A 40-year-old unvaccinated man with severe Covid pneumonia.”
I wonder about this, about what impact it has. Though framing a patient as vaccinated or unvaccinated doesn’t change the ventilator settings or the medications we give, I worry about the insidious effect of the frustration that we feel and how we balance that real and understandable anger with empathy. And if our units fill with coronavirus patients once again, further stretching a health care system that is on the edge with severe staffing shortages, it will become even harder to navigate that tension.
On the afternoon of the winter solstice, a small crowd of nurses and doctors gathered to strap a coronavirus patient into a gurney and prepare to wheel her out of the unit, on the way to rehab. I remember early on, when the hospital used to play music on the overhead, and we would crowd into the lobby to clap and sing when each patient left. Surviving critical illness from this virus is, thankfully, far less remarkable now. But still the residents clapped for a moment to celebrate the victory before returning to the work of the day.
What will victory over this virus look like? I used to think that I would care for one final coronavirus patient, but I realize now that is not the case. This virus will become endemic, as some viruses do, and when each winter comes, I will see a few patients with Covid-19 who are sick enough to wind up in the intensive care unit, the unvaccinated or the immune-compromised or the unlucky. We will care for them using the protocols that we have honed over the past two years. No one will react with panic or fear or anger; it will be expected, as it is with influenza or a host of other respiratory viruses.
That is not where we are yet. But we will get there."