{"id":9731,"date":"2020-07-19T18:15:02","date_gmt":"2020-07-19T22:15:02","guid":{"rendered":"https:\/\/blogs.nejm.org\/hiv-id-observations\/?p=9731"},"modified":"2020-07-19T21:24:41","modified_gmt":"2020-07-20T01:24:41","slug":"reaching-out-to-id-doctors-in-covid-19-hot-spots-you-must-be-truly-exhausted","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/reaching-out-to-id-doctors-in-covid-19-hot-spots-you-must-be-truly-exhausted\/2020\/07\/19\/","title":{"rendered":"Reaching Out to ID Doctors in COVID-19 Hot Spots — You Must Be Truly Exhausted"},"content":{"rendered":"

\"\"<\/a>For us ID doctors in most of the northeastern United States (and Chicago and Detroit and some other northern cities), March and April hit us like a giant wave of never-ending calls, pages, emails, and crises.<\/p>\n

With COVID-19 case numbers increasing every day, the challenges crashed down on us in an endless torrent of hospital needs and responsibilities.<\/p>\n

The emotional toll of seeing so many critically ill patients for whom we didn’t have any proven therapies was only part of it. We were also the group to whom everyone turned for help — everyone had questions.<\/p>\n

We know you must be swamped right now, but …<\/em> started many a query.<\/p>\n

No surprise. This is an Infectious Disease<\/em>, after all. “It’s what you signed up for,” as one of my friends, a lawyer, put it succinctly with a shrug.<\/p>\n

But it’s also something none of us had ever seen in any of our lifetimes. No one is old enough to remember the 1918 influenza pandemic. No one really knows what to do, or how to do it.<\/p>\n

Which is why the work of handling COVID-19 can be endless.<\/p>\n

Want an example? Someone tallied what one of my extraordinary colleagues — she ran our “biothreats” response team — gave to the COVID-19 effort, which started for her in early March:<\/p>\n

\"\"<\/a>Wow.<\/p>\n

Needless to say, it came as an enormous relief when case numbers started to drop. For Boston, this started in early May.<\/p>\n

Here’s what Dr. Stephen Smith, writing in late June, said about his experience in northern New Jersey (reprinted with permission):<\/p>\n

In my private ID practice in northern NJ, 18 miles west of New York City, we have treated over 200 hospitalized COVID-19 patients, many in the ICU. We peaked in early April. Then in early May, it was as if someone turned off the spigot. Since then, we have been consulted on only 20 patients who tested positive for SARS-CoV-2, but only a minority was admitted with COVID-19 symptoms. We have not intubated a patient with COVID since early May.<\/p>\n

We are hesitant to use the “A” word (attenuation). Like the reverse of saying Lord Voldemort’s name, we are worried that if we say the “A” word, it won’t happen.<\/p><\/blockquote>\n

To what do we owe this lessening of the COVID-19 burden, especially now that cases are increasing in most of the rest of the country?<\/p>\n

While herd immunity might play some role — I remain hopeful, despite discouraging reports on low seropositivity in hot spots<\/a> — much more likely is that we’ve been adherent on a societal level with implementation of various low-tech strategies.<\/p>\n

Social distancing. Banning communal indoor activities. Closing bars and restaurants. Asking religious institutions to worship over Zoom, or outside. Wearing masks in public, especially indoors.<\/p>\n

These things, you know, actually work<\/em>.<\/p>\n

While we ID doctors in the northeast bask in this much-needed reprieve, our ID colleagues in much of the rest of the country — initially relatively spared — now have to deal with rising case numbers.<\/p>\n

And they must be truly exhausted. Really.<\/p>\n

Because it’s not as if they weren’t gearing up for this in the winter. When CROI (the most important national HIV meeting) converted to a “virtual” meeting in early March, many ID doctors from the south and west had already cancelled their plans to come to Boston — COVID-19 already loomed very large nationally to all us ID specialists, and preparation for it was underway everywhere.<\/p>\n

Plus, note I wrote that they were relatively<\/em> spared — they’ve also been seeing some cases right from the start, if not as many we initially did.<\/p>\n

So to all ID docs out there in Arizona, Florida, Texas, California, Alabama, South Carolina, Tennessee, Georgia, Louisiana, and all the other states experiencing a COVID-19 surge, I’m thinking of you.<\/p>\n

And so hoping that your community will get it together, and turn off that spigot soon.<\/p>\n

Because when it happens, it brings a relief the likes of which you won’t believe.<\/p>\n","protected":false},"excerpt":{"rendered":"

For us ID doctors in most of the northeastern United States (and Chicago and Detroit and some other northern cities), March and April hit us like a giant wave of never-ending calls, pages, emails, and crises. With COVID-19 case numbers increasing every day, the challenges crashed down on us in an endless torrent of hospital […]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,5],"tags":[4601],"class_list":["post-9731","post","type-post","status-publish","format-standard","hentry","category-health-care","category-infectious-diseases","tag-covid-19"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/9731","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=9731"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/9731\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=9731"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=9731"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=9731"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}