Emergentology: A Letter to My Future COVID-19 Self : Emergency Medicine News

Thanks to the magical fourth dimension of time (and a delay before my articles go to print), I’m writing a letter to my future self. It’s a little bit Nostradamus, a little bit of a gamble on the future, and entirely inspired by some positive vaccine news in November.

Dear Graham Austin Walker,

How’s February? We just finished Thanksgiving here in 2020, and I thought I’d check in. Things have to be better by now, right? America just has to be better. We all have so much hope for 2021. The year 2020 has been a dumpster fire with few high points. If things are as rosy as I’m hoping just two months from now, maybe this letter will remind you to appreciate what you’ve got in a Thanksgiving kind of way.

The Good

You got married recently, newlywed! Hopefully you and AJ are planning a honeymoon and celebration (or at least a trip), maybe for the end of 2021 or early 2022? I imagine there is probably a whole testing protocol being developed around the world for travel, right? If not, someone should start one.

Wow, those apple fritters you made were good. Keep that recipe in your back pocket for next fall.

You saved that testicular torsion a few shifts ago! (February can be a rough doldrums month, so I wanted to cheer you up and remind you that you’re a good doctor.)

We’ve got a new president! I’m hoping that Joe Biden has implemented policies for testing, treatment, masking, and PPE, and that he appreciates what a stressful, challenging time this has been for health care. I would love to see some sort of recognition for us from the president. (A genuine thank you would be nice at this point.)

You got vaccinated, right? The news here in November was really promising about the Pfizer and Moderna vaccines (with some controversy about Astra Zeneca’s). As an EP, I imagine you got the vaccine in mid-December, and after reviewing the data and seeing a good safety profile, you’re now done with both doses and have a pretty good chance of immunity to COVID. There’s no way we’re not all still masking in February because I imagine we have vaccinated only a small portion of the population so far, but at least you’re much less likely to get COVID or bring it home.

The Bad

The country is doing really badly in terms of COVID, and it’s been hitting me pretty hard, feeling so powerless to stop it. It’s hard to feel so helpless when your home state of Kansas is being decimated by the virus. It seems like everywhere is getting worse, even San Francisco, but there are still too many places that aren’t taking a hard-enough stance on masking. (Masking, for crying out loud!) Right now, places like Australia, New Zealand, and southeast Asia are back to normal; they’re going out without masks and having normal lives because they have things under control. Hard not to be jealous of them too. Is there a mask mandate yet? Here’s what’s happening recently in the world:

• The governor of Florida just extended a ban on mask enforcement. What?
• A bunch of state governors implemented some lame, ineffective masking policies, like closing bars and restaurants at 10 p.m. Doesn’t seem like it’s going to do anything, but I hope I’m wrong.
• San Francisco just converted back to purple status, AKA widespread COVID, and we’ll be shutting down like we did in the spring. What a bummer, but I guess we too got complacent. Hopefully, things are opened back up now in February. I’m also hoping that you didn’t get fatter again and were able to find some way to exercise. I know when the gyms reopened, it was really clear how good exercise makes us feel.
• American travel was technically down for Thanksgiving, but not by any percentage or quantity that it will make a dent in COVID’s onslaught. I’m feeling betrayed by anyone who traveled during Thanksgiving, particularly friends and public officials. Thanksgiving travel is COVID’s transmission dream, and it seems insane to me that people couldn’t forego it for a year or celebrate differently to reduce its spread. Or to help health care workers. It would be one thing if we were at a case and death nadir or if we had flattened the curve, and collectively agreed to do Thanksgiving with precautions. But we’re literally breaking world records for COVID in our states and counties right now, and millions of Americans decided they needed dry turkey and gravy.
• Was Christmas as bad as I thought it would be? I’m assuming I didn’t visit my family because Thanksgiving was so awful. I think it’s my first Christmas without them. Did you get any good presents? Those comfy warm slippers you were hoping for?

The Ugly

You should take a look at your naughty list and see if any of the following have done anything to get off it. Right now, you’re particularly disappointed with:

• California Gov. Gavin Newsom, who went to the French Laundry and set an awful example for Californians about how to behave.
• Lobbyists from the California Medical Association, who were also at the French Laundry dinner with Newsom (absolutely disgusting behavior when California physicians are working hard to stop COVID and have put their lives on hold or lost their medical practices due to COVID).
• The mayor of Denver, who tweeted “essential travel only” before hopping on a flight to see his family just before Thanksgiving.
• All those travelling for Thanksgiving, as if none of the rest of us who stayed home actually wanted to see our families for Thanksgiving.

One last thing: Right now, there’s lots of discussion of COVID fatigue, that people are tired of staying indoors and foregoing their normal lives, and that this is an understandable excuse for people going out and spreading COVID. I hope they have stopped using this as a reason. How do these people think we health care workers feel? Do you people in 2021 have a term for COVID fatigue from caring for COVID patients? Does the vast majority of Americans actually care about COVID now, after months of full hospitals and deaths? Right now, we are seeing more than 2300 deaths a day and are well on our way to breaking our springtime record.

Dr. Walkeris an emergency physician at Kaiser San Francisco. He is the developer and co-creator of MDCalc (www.mdcalc.com), a medical calculator for clinical scores, equations, and risk stratifications, which also has an app (http://apps.mdcalc.com/), and The NNT (www.thennt.com), a number-needed-to-treat tool to communicate benefit and harm. Follow him on Twitter@grahamwalker, and read his past columns athttp://bit.ly/EMN-Emergentology.