Dear America – We Are No Longer Great

The title “Greatest Generation” has been taken. History will not be easy on our current generation when a moniker is decided upon to describe our actions during this pandemic. I’m afraid that the description will be far from Great. In the early days of the pandemic, many of our leaders focused on the economy and the stock market, rather than the devastation that was being wrought on essential workers and those in healthcare. These were the people that couldn’t stay home and have their groceries delivered while they worked remotely. In the waning days of the pandemic, we see those who are vaccine resistant and want others to get the vaccine first while they enjoy the benefits of vaccines; elimination of mask mandates, opening of restaurants and bars, freedom to travel. I see this everyday in my office now that we are starting to see the end of the pandemic. Each patient I encounter I inquire about Covid vaccination status. If not vaccinated, I try to dispel any myths as well as encourage by using empathy to protect those around them. Time and again I hear the phrase, “I don’t want to expose myself to any risk if not getting the vaccine doesn’t affect my ability to live my life”.

The Greatest Generation saw life much differently. They were willing to make huge sacrifices – sending their sons and daughters off to wars, rationing food, growing Victory Gardens and initiating scrap drives. A vaccine that protects not only you but those around you seems minor in comparison to these sacrifices.

I recently finished Andy Slavitt’s book, “Preventable”, that provides an overview of the pandemic both from a scientific and political perspective. He highlights the concept of exponential math involving the spread of Covid. Early on, it was estimated that each person infected with Covid would spread their infection to 2.3 people. Two to three weeks later that original infection had spread to 4000+ people and approximately 10-20 people would die or be hospitalized. And this was before the Delta variant which is twice as infectious. The vaccine not only protects you from being hospitalized or death, but more importantly protects 4000 others around you that you may not even know.

The African proverb of “It takes a Village” to raise a child is something we as Americans need to embody in the future when it comes to how we treat not only our family but those around us that we may not know. It is not only vaccines, but how we should view climate change and the effect our actions have on those in far away countries that suffer the effects of rising sea waters. It is why we should make the minimum wage a livable wage so that parents can support their children.

This post was prompted by a recent visit from special friends. Twenty-nine years ago, I made a decision to help a friend create a family. Twenty years ago, we decided to add to our family by adoption. Four of the young adults that resulted from these decisions were together in the same place for a glorious few days. Despite a gap in ages and living in different parts of this country, they have become fast friends that reconnect within minutes of being together. A long ago decision to help a friend by egg donation coupled with a later decision to expand our family thru adoption is my living example of exponential math. With the vaccine, we may never know how many people we have benefitted from getting sick or dying of Covid, but the low level of infection in those states with high vaccination rates is evidence of the village mentality working. Now is the time to help our village of America so that we all can return to a pre-pandemic life.

The Steep Hill We Still Need to Climb with Covid

I live in Minnesota, where summers are short and highly valued. We Northeners spend our winter daydreaming and planning our summer activities, which was probably even more true during this Covid winter. My plans include backyard dinners, weekends at the lake with family and friends, enjoying the bounty of Twin City restaurants and biking along our extensive network of trails. Unfortunately, some of those plans may not be a reality due to the rising Covid cases in MN. And this predicament is what has brought me the most frustration over the past year; the failure of individuals to follow simple guidelines around masks and social distancing as well as the reluctance to get the vaccine.

My clinic is administering hundreds of vaccines each week and I ask every patient if they wish to be put on the waiting list. This includes pregnant patients, as the evidence is strongly supporting benefit to both mother and unborn child with no evidence of negative side effects. At the time of this writing, 50% of Minnesotans have received their first dose of a vaccine. We need 75-80% of the nation to be vaccinated in order to achieve herd immunity and put an end to this pandemic. Getting the last 25% of the population vaccinated is the steep hill that will take longer and require more encouragement than vaccinating the initial 50%.

I need all of those who have been vaccinated or are waiting for their chance at a vaccine to push our nation up that remaining steep hill. Talk to family and friends who may be reluctant to be vaccinated about your experience with the vaccine. Comment on falsehoods that you see on social media. Restrict your unmasked social interactions to only those adults who have been vaccinated. Continue to wear masks in public until we can achieve herd immunity and the prevalence in the the community is very low. I have included some facts below that address the most common falsehoods I hear from patients during my discussions.

1. The vaccine is too “new” and I want to see how others do first before I get it myself. mRNA technology was first developed in the 1990’s and has been studied in flu, Zika, rabies and CMV. Widespread use of the technology did not become necessary until a worldwide pandemic occurred. Covid-19 is that event. Are we really that selfish as a nation that we won’t take a miniscule risk of getting a new vaccine in order to protect our friends and family?
2. I know lots of people who have had Covid and they weren’t that sick. This was especially true during the initial wave of Covid in 2020 but has become less true in 2021 as the Covid variants have become more common. Our hospital beds are now filled with much younger patients who are not succumbing to Covid but who are going home on oxygen for weeks to months. The existence of long haulers disease is a reality that we are seeing more frequently with chronic fatigue, shortness of breath and foggy memory months after initial recovery.
3. The vaccine can cause infertility by changing the DNA of my cells. mRNA never enters the nucleus of the cell where DNA is housed. Rather, it works as a “messenger” telling the cell to make a protein that is displayed on the outside of the cell and initiates an immune response. There is no live virus involved in the vaccine and the mRNA is broken down as soon as its message is received by the cell.
4. I have had Covid, or think I had Covid, so don’t need to be vaccinated. I have seen multiple patients who have had Covid twice. Natural immunity has been shown to only last 3 months while vaccine immunity has now been proven to still be effective at 6 months post vaccination and is probably closer to a year of immunity. If you have had Covid, the initial reaction to the vaccine is no different than if you have not had Covid.
5. People get “sick” after the vaccine. While many people develop a low grade fever and body aches within the first 24 hours after getting the vaccine, this is not a Covid illness but the immune system reacting to the messenger and gearing up for a fight against future infection. If you talk to anyone who has had a moderate case of Covid with days of high fever, fatigue and body aches they would greatly prefer the mild 24 hours of post vaccine reaction.

People want to hear from others they trust about their experiences getting the vaccine as well as the reasons they were vaccinated. Please help health care providers spread the word and get us to herd immunity in the next few months. A Minnesota summer is approaching and I am excited to enjoy all of what is has to offer.

Why getting a Covid vaccine can be a powerful Social Justice statement

I signed up for my chance to get the Covid vaccine within five minutes of being notified that I was eligible. I wanted to protect myself, my patients and my family as well as get back to a more normal lifestyle. I assumed that the majority of my colleagues in healthcare would do the same. We have all seen or heard of the devastating effects that this illness can have on our patients and their families. The science behind the vaccine is sound and the effectiveness impressive. For those reasons and others, I was extremely disappointed when I learned that just less than 50% of eligible healthcare providers at my hospital had taken the opportunity to get the vaccine. The most common reason cited for declining to be vaccinated was “I plan on waiting to see how the vaccine affects others”. We have seen how it affects others – that is the purpose of a large study size that both the Pfeizer and Moderna vaccines have published.

If the science behind the vaccine doesn’t convince you to get your shot, I’m willing to try a second argument. The recent increase in awareness around social inequities has lead many Americans to educate themselves about Social Justice initiatives. People of color (POC) have been inordinately affected by this virus in numerous ways. They are at higher risk of contracting the virus due to overcrowded and often multigenerational housing as well as occupying a large percentage of front line jobs. Risk factors for more severe Covid illness, such as hypertension, diabetes and obesity, are more prevalent in POC. Front line workers often don’t have health insurance and delay accessing a medical facility until they become very sick and further along in their illness. Historical injustices around experimentation with black bodies to further the advance of science has also increased their hesitancy to receive the vaccine.

If you are a white healthcare provider, the most vocal Social Justice statement you can make today is to get your vaccine. Actions speak louder than words. We need to prove to our patients and colleagues who are POC that we care enough about their health and the injustices that have been perpetuated against them to get a vaccine that will decrease the overall viral load in our communities. Getting a vaccine may cause most of us to feel a bit uncomfortable. Compare that to the uncomfortable feeling that POC encounter daily due to the lingering effects of racism that still exist in this country. For a change, let’s see white people leading the charge in this newest social justice initiative.