Today is 100 days since the first recorded covid-19 death in the US. Now we’re at a shocking 88,890 deaths (that number has jumped 600 since I first started writing this morning). We’ll be over 100K in a week or two. I am sure. I used the adjective “shocking,” because I personally think this number is out-of-this-world-jaw-dropping. It terrifies me to my core that this is the death toll despite insanely interruptive lockdowns and limits on socialization- with virtually complete closure of all schools, innumerable business closures, millions working from home, cessation of sporting events, closures in places of worship and parks and barbershops and breweries and restaurants and dentists, with preventing families from celebrating graduations and birthdays and weddings. Eighty eight thousand, eight hundred and ninety. But it is a number that many just respond with a nonchalant shrug, a so-what attitude. I challenge you to imagine this already shocking number without ALL of these difficult disruptions. An unfortunately intelligent and efficient virus has crept into our communities and stolen loved ones from nearly 90K families, while millions of us sat at home with the sole purpose of interrupting its spread.
This pandemic has already taught us so many important and difficult lessons, many new and many old that persist and need reminders. Many lessons are worth highlighting.
* The disproportionate toll on people of color reveals how chronic and deeply pervasive injustices contribute to social determinants of health.
* The devastating numbers among Native American communities reveals the ignored systemic consequences of historical trauma.
* The rise in child abuse and domestic violence reminds us that home is not a safe haven for everyone, and allows us to value teachers for an often forgotten role they play as mandatory reporters.
* It is profoundly hurtful to blow off the virus just because it “only” kills those over 65- a whole generation of people with generations of people who love them dearly; a generation of people who may have another 30 years or more left to live; and a generation of people that we rely on as essential workers (New Mexico has the second oldest workforce of doctors), as caregivers to our children, as teachers of our history and language and culture, and as friendly faces in our neighborhood. “Sacrificing the old” is not only hurtful, but deeply disturbing.
* This virus reminds us that many are one checkup away from a chronic condition that would put you at risk. The health of our nation has never been sicker when it comes to chronic conditions. When was the last time you had your blood pressure and glucose level checked or calculated your BMI (many deaths in young people have been in individuals with obesity as their only risk factor)? Even if you are healthy and not at risk, you are not invincible. And if you were invincible to death this one time, you are not indestructible to the morbidity associated with this virus. There’s a phenomena called post intensive care syndrome where, simply put, people who recover are not whole. They suffer emotionally, their muscles have atrophied, the secondary infections and antibiotic exposures have long lasting consequences on the GI system and susceptibility to multi-drug resistant organisms, their cognition is slowed, they may have scars and aches from tracheotomies and feeding tubes and central lines. They may leave with a new opioid dependence, reliant on dialysis or with permanent neurological deficits like inability to speak or walk. We’re now learning that children may suffer from a debilitating inflammatory process that leads to organ failure in their tiny, healthy kidneys and hearts. We can only predict the long term consequences these little ones will endure, and my scientific guess is grim. Yes, these people are recovered, but they are scarred and weak and may never return to their pre-covid state. Morbidity is equally important to mortality and should not be ignored.
* The job security of many healthcare workers and the “heroic praises” we are awarded during a public health crisis, our type of war, is not without risk of exhaustion, threat to our own health, threat to our family’s health, and irreversible injury to mental health. Those healthcare workers on the front lines are suffering- they see patient after patient die alone, they are under-resourced and overworked, and they are isolating themselves in such a despairing moment when hugs and kisses would be majorly welcomed, just to protect you and your families. They may never recover from their time on this battlefield.
* This pandemic is not just teaching us a lot about a virus and injustices of society, but it has also taught us a lot about ourselves and how deeply divided we are as a nation. This lesson has been truly difficult for me to digest. Of course this divisiveness has been apparent in leaderships’ willingness to accept science and data, the media’s portrayal of the seriousness of the virus, and widely varied approaches local governments have when it comes to systematically flattening the curve. But something so small that for me demonstrates how heartbreakingly divided we are is the task of wearing a mask.
As a doctor who performs c-sections sometimes lasting hours, I am no novice to the discomforts of wearing a mask- the shortness of breath that inevitably exists, the anxiety of confinement, the itches you can’t scratch, the uncomfortable warmth of your face baking in its sweat, the condensation that leaks onto your eye protection, and to top it off once I have sterile gloves on I cannot adjust my mask, pull it off for a quick breather, or swiftly place it in a more comfortable position. You can often take a break to pull your mask off, but I might have a briskly bleeding patient relying on my undivided attention to the task at hand, a task which doesn’t even allow a minute away to readjust my mask. Sure you can say I signed up for this, but that would be an unfair statement. I signed up to deliver healthcare, to care for families, to keep people healthy. I wear a mask because I have to for your safety. It is an uncomfortable duty that comes with the job, like being a citizen of this world comes with the duty to also do no harm to your fellow citizens.
Wearing a mask is not foolproof. It is not comfortable. And and it is certainly not convenient. And recent changes in societal norms and the outrage that has ensued is clear evidence how people react when they are uncomfortable and inconvenienced. Unfortunately we cannot always cater to the convenience and comfort of the general population at the expense of suffering and death to others.
Wearing a mask is not foolproof, comfortable or convenient, but wearing a mask is many many other things. Most importantly, It is compassion, safety, and compromise. While its use is not perfect, it does provide significant reduction in the risk of transmission. But it works best when all parties wear masks and they wear them consistently. How silly would it be if only some surgeons wore masks or some decided to only wear it when they felt like it? With a disease as unrelenting and ever evolving as covid-19, why not take any simple task to prioritize safety? Consider the hundreds of other laws and rules that exist to prioritize your health and the health of others, like wearing seatbelts and helmets, and requiring vaccines for school entry and babies to be buckled in carseats. Consider how smoking is prohibited in public places and in airplanes and how age restrictions exist for purchasing tobacco and alcohol products and there’s limits to how much you can drink and drive. Remind yourself that it is required by law to have insurance on your car and a medical license to perform surgery. We are all subject to these small inconveniences for the large health benefits of the general population.
If you think demanding mask usage is a threat to your civil liberties then you should shout your gratitude from the rooftops that you are not a woman, that you are not gay, that you are not an immigrant or black or disabled or incarcerated or non-English speaking or poor. Because if being required to wear a mask is so threatening to your existence and happiness then be thankful that your privilege has protected you from discrimination in applying for housing and jobs, being unable to vote, marry, patron any business of your choosing, access to healthcare and reproductive choice, access to a fair trial and a just sentence. There are real civil liberties that are threatened and curtailed on a daily basis and I assure you that mask usage doesn’t begin to compare to what many of your fellow American and human beings experience.
Like I said, wearing a mask is also compassion and compromise. If not for you, then why not for others? It is easy to tell people who are elderly or immunocompromised or simply scared to stay home, but let’s be honest with ourselves, these stay at home orders are affecting all of us, every single one of us independent of race, political affiliation or health status. Just because you are elderly or immunocompromised does not mean you also have the privilege of staying home without fear of economic devastation or mental health deterioration. It does not mean that you aren’t in need of the non-essential comforts of a Home Depot run or an ice cream cone. It does not mean you enjoy being home or even have the means and capabilities of staying home. We are all humans dying for connection. We are all humans suffering the consequences of the lockdown. And we are all human, more safe in the public when we all wear masks. It’s not as easy as stay home if you’re at risk or scared. And a so-what-if-I-get-sick mentality ignores the people who will have to care for you as your rehabilitate, the nurses who lose sleep over your tenuous recovery, not to mention the many people you infect along the way. Right now, it’s not just about you.
Please do not make wearing a mask partisan. I assure you that just like seatbelts protect Republicans and Democrats equally, a mask will too. Please do not mock this “threat to your freedom.” Real injustices exist and interfere with the true pursuit of life, liberty and happiness everyday. And please leaders of our great nation, do not say that wearing a mask sends the wrong message or shows fear, because I promise it is quite the opposite. It promotes compassion for your neighbor and compromise for a uniquely difficult situation we are in. There’s an incredibly lethal virus circulating and the only way to stop it is darkly grim with mass and complete closures and an economic devastation from which we would never recover, so let’s at least slow and control its spread with the simple task of mask usage along with the more complex tasks of testing, contact tracing, systematic quarantining, and therapeutic and vaccine development. Wearing your mask will not be foolproof. It will not be convenient or comfortable. As someone who has been wearing a mask for the last 10 years, I can guarantee you this. But please know that it is compromise for opening our communities, it is compassion for those around you, and it is some degree of safety and security that you can take into your own hands. And if all goes well and we continue to stick to the recommendations of our public health leaders, then this too shall pass. The uncomfortable task of wearing mask will be temporary.
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