Report from the COVID frontlines

Oftentimes when the subject of COVID comes up what one hears is, who are you to speak to that? You are not the one treating COVID patients, you can't possibly know. And in the case of yours truly, that is a true statement - I am not treating COVID patients as a medical professional, nor have I ever made a claim to being involved in that activity.

And a lot of people who actually are treating patients seem to be reluctant to speak of their experiences, possibly due to the fear of some sort of official sanctions should they stray from the accepted orthodoxy. And that makes those who are not afraid to openly discuss their experiences and perspectives all the more admirable - both for the work they do treating patients as medical professionals and for the courage they display as citizens.

One of these people is Tina Goloborodko, as Assistant Professor at the Albert Einstein College of Medicine and a practicing physician at a New York City area hospital. Here is what she wrote in a 22 January 2022 Facebook post:

I feel like I owe you guys this post from the trenches after taking care of covid patients for the past two weeks and contrasting what I see in the hospital to the headlines, podcasts, comments, and opinions of people not directly involved in patient care. First of all, neither our hospital nor our staff appears overwhelmed. Things are as usual on the wards. Covid positive patients occupy five out of ten of the medicine floors, which is a lot, but nothing close to what was happening in March 2020. There is another very important distinction from prior covid surges though. Almost half of the patients on my covid floor were not admitted for covid. They were admitted for all kinds of other health problems - cancer, alcoholic pancreatitis, back pain, urinary tract infection, heart failure exacerbation due to not taking their meds, etc. They just all happened to be asymptomatically positive for covid, because our emergency room tests for Covid every patient who gets admitted to the hospital regardless of the symptoms they came in with. As you can imagine, this dramatically affects the statistics of covid hospitalizations, as all these patients are counted as such.

In two weeks, we have only had one death from covid (patient who had pre-existing end stage lung fibrosis from another cause), not a single intubation or ICU transfer. We have discharged people as old as 97 years old. As for the covid admissions, the most common covid patient is an 80+ yo vaccinated, but not boosted patient who is admitted for dehydration due to poor appetite from covid. We hydrate them until their appetite improves in a few days and send them back home. I'm sure the fact that almost everyone here is vaccinated dramatically changes our experience compared to the places where this is not the case.

Over the two weeks I only saw four unvaccinated covid patients - one 65 yo, two in their 70's, and one in their 80's. The one in their 80's is here due to poor appetite and needs hydration. The first patient in their 70's has HIV, is on high flow oxygen and may die, the other one needs 4L of oxygen currently but feels overall well, so hopefully will make it. The 65 yo developed an irrational fear of eating from covid and we are treating her for this psychiatric abnormality and malnutrition. I have not seen a single boosted patient with covid symptoms of any age. I also saw only one young patient who was recently vaccinated - he got covid and came to us with a late autoimmune complication of it. That patient had morbid obesity and was discharged several days later. Our youngest patient otherwise is the 65 yo who was immunocompromised and unvaccinated, who I mentioned above.

All these observations come from a sample of about 50 patients in a heavily vaccinated city, which is a very small sample and is not representative of the rest of the US. But based on what I saw, it appears that Omicron poses basically zero threat to people under 60 who are not obese or debilitated. People who remain at risk for hospitalization are the elderly who are unvaccinated or vaccinated, but not boosted. Even among that group, most hospitalizations result in discharge. What I saw on the wards comes in stark contrast to the media coverage of a disaster of astronomical proportions, but the likely explanation is that the situation may be very different in less vaccinated and more obese states.

What do I think about all this? I think all restrictions should be lifted in heavily vaccinated states and people shouldn't need to quarantine for covid positivity. It is not a dangerous disease to the overwhelming majority of the working population. Those who are elderly, obese or immunocompromised should protect themselves with a KN95 or N95 and get boosted. Vaccines and boosters don't appear to protect much from getting omicron or from spreading omicron, they definitely protect from getting severe disease those who are at risk for severe disease (elderly, obese, immunocompromised). For those who are not at risk - it is hard to say if they do anything yet, they may make the disease even milder or prevent long covid - unclear so far. If I were to spend political capital on mandates, my only mandate would possibly be vaccinating the elderly, obese, and immunocompromised - just to preserve the integrity of the medical system in case that integrity starts being compromised by the volume of cases. This may also be the most effective way to prevent new variants from emerging.

I'm proud to say that after taking care of covid patients for almost two years I myself got it from a very fun party in Spain about a month ago. I had a headache for 2 hours and a runny nose for two days. Then everything was gone. I wouldn't have known I had it if I didn't have to get tested because of travel. I got a booster prior to traveling. Wishing everyone great health and a speedy return to a normal mask-free and restriction-free life!

It is pretty amazing how closely this matches the perception of the disease that I have at this point. Especially the part where Dr Goloborodko fully confirms my perception that "Vaccines and boosters don't appear to protect much from getting omicron or from spreading omicron" (to which I would add, other variants too, but that is largely irrelevant now as Omicron completely dominates most everywhere). So if that is the case - what case can there be for forced vaccinations if all it is is a personal decision you make regarding the risk your are willing to accept?

In conclusion, I would like to once again extend my gratitude and appreciation to Dr Goloborodko and call on all of us to do our best to look at facts do our best to be as rational as possible because irrationality and rejection of reason is a threat far greater than any disease out there can possibly be.

References

Tina Goloborodko's Facebook post
22 January 2022

Tina Goloborodko's Facebook page

The scary Omicron variant...
@borepstein , 30 December 2021

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