I haven't said much about the possibility of a COVID vaccine in this blog. The main reason is that I don't know much about vaccine development. We learn the principles of immunology, how clinical trials are designed, and the ethics of vaccine development (since vaccines are given to healthy individuals, the risk-benefit analysis is different than, say, a chemotherapy given to someone with cancer). But among the panoply of things we learn in medical school, vaccine development is given little weight. The vast majority of practicing physicians do not participate in designing, developing, and trialing a vaccine.

That is not to say that I don't understand and believe in the vaccines we have. Vaccines work and we should trust them. I've never seen a case of polio or the measles, all because of vaccines. I have seen the devastating consequences of someone without a spleen who did not receive the appropriate vaccines (asplenic patients are highly susceptible to certain preventable infections). Edward Jenner's discovery led to the elimination of smallpox, which had a mortality rate of 40%. It's easy to forget or overlook the incredible public health benefits of vaccines. Those who do not believe in the science and medicine of vaccines pose a serious threat to both individual and public health.

So what will happen when we hopefully get a coronavirus vaccine? I think there must be several safeguards in place. The testing of the vaccine needs to be scientifically rigorous. We already have established safety thresholds for vaccine development, and we should not cut any corners. We are pushing the vaccine through a lightning fast timeline with tons of resources, but we cannot relax our standards. Similarly, we cannot let political, pharmaceutical, or other interests influence the science. They can debate how we produce it, how much it costs, how we distribute it, but I want scientific integrity free of bias when it comes to determining the efficacy and risks of the vaccine. In this world, nothing is completely free of bias, but we must resist using the vaccine as a political pawn. And if we get a vaccine that has been studied and endorsed by unbiased, independent, recognized scientists and physicians, then I will get in line. We wait to see how effective it will be, and what side effects it might pose, but having seen the individual health impact of COVID and the community impact of this infectious pathogen, I think a vaccine will be critical in getting us closer to normalcy.

We know how much coronavirus has changed our subconscious when, in our dreams, we find ourselves avoiding the unmasked.

What a challenging summer it has been. With heat waves, wildfires, power outages (including a brief outage at the hospital which required us to switch to generators and halt non-essential activities), and blanketing smoke, the Bay Area has felt a little fire and brimstone. I am ready for 2020 to be over. 

I don't generally like complaining. But as this pandemic grinds us down and crises keep coming, I feel that it is important to acknowledge what this is doing to our psychological health. It's a different type of exhaustion than we had at the beginning of the pandemic. In March and April I sensed a stress related to uncertainty, fear, and clinical overload. We didn't know enough about the disease, we didn't have enough personal protective equipment, we worried for ourselves, our families, and our patients. We saw what was happening in China, Europe, and the East Coast, and we braced ourselves.

This activates a type of stress that some of us actually thrive on. I would say most critical care physicians and anesthesiologists function well under pressure. We self-select into these specialties that encompass rapidly changing clinical situations, acute life-threatening illnesses, and complex problems requiring immediate responses. The nurses, respiratory therapists, and other providers I work with have that personality as well. 

Unfortunately, six months later, this pandemic generates a different type of stress. It's a chronic stress of one thing after another, slowly wearing us down with no end in sight. I am not the type of doctor that handles this kind of long-term impending doom. I have so much respect for those outpatient doctors who care for progressive dementia or metastatic cancer. Perhaps the analogy isn't great, but it's one I've been thinking about. For those of us who run on adrenaline, our glands are tapped, and we are struggling to cope. I am exhausted.

So we try to accept that this is the way the world is now and prepare ourselves for the long grind. I have never been that interested in self-help literature, but I admit I've been reading more articles on how to build resilience, develop self-awareness, accept that we are grieving for a lost world. I've also paid more attention to reaching out to friends, finding activities that fulfill me, and caring for myself. We must continue to support each other.