For those in the United States, wishing you a safe, healthy Thanksgiving. This year is unlike any other, and most of us are feeling upset, pain, sorrow, anger, and disappointment. I can certainly commiserate with that. But I also hope that we can identify a few things to be grateful for. 

I am thankful for the hard work, dedication, sacrifice, and persistence of the health care community that has stepped up during this pandemic. The team I work with in the intensive care unit is incredible. I could not ask for better nurses, respiratory therapists, consultants, and colleagues. Day and night we work shoulder-to-shoulder (figuratively - we distance when we can) taking care of the sickest patients, talking to their families, and performing high-risk procedures. Our infectious disease specialists have been a great boon, sifting through literature and helping us navigate this new illness. Our department and hospital leaders are aware of the mental, emotional, and physical toll this prolonged pandemic has taken, and are doing the best they can to alleviate the burnout. Our care of COVID patients also depends on an army of seldom-recognized co-workers, from those who source the PPE to those who dispose of it when we are done using it. We have so many people behind the scenes helping us in a myriad of ways so that we clinicians can focus on bedside patient care. Thank you.

In our larger communities, I am grateful for those tireless scientists who make my work possible, who give us hope, and who equip us with the knowledge and tools to tackle this disease. I appreciate those leaders in our communities and governments that have taken this threat seriously and done what they can to enact policies to protect public health. I am grateful for those in our community that have changed their lives and made sacrifices in order to social distance, avoid gatherings, and reduce transmission.

Most importantly, I appreciate my family, friends, and support network during this difficult and trying year. I think back to the beginning of 2020 and can't believe things have changed so much, but my friends and family have held steadfast through all these months. We will get through this together. Thank you.

As the holidays near, we try to navigate the complex interplay of risk and reward. On the one hand, we crave our families, miss our traditions, want to "live our life," feel that we can take precautions, and believe holidays can be an exception. But on the other hand, the virus is spreading exponentially, hospitals are at or beyond capacity, mass travel during this time compounds risk, and holiday get-togethers gather multiple households.

To me, the math is clear. Unfortunately, these should not and cannot be the holidays you remember from last year. They will probably not be the holidays you want. Frighteningly, the case trend even before Thanksgiving travel has gotten out of control. Our community prevalence is so high everywhere that you cannot eliminate risk even with a negative test and appropriate precautions. And without seeing signs of a peak or plateau, I think holiday gatherings will dig us into a deeper hole, something we cannot afford.

All that said, I do think it's a complex and hard call. Most public health recommendations say that we should only get together with those of our household. For traditional nuclear families, that might work pretty easily. But our country has a diverse mix of households. What about those living alone, those sharing custody of a child, a college student who has to go home for the end of the semester to a household with grandparents, or families with a newborn that need childcare assistance from relatives?

Ultimately, our country thrives on self-determination. We make our decisions, trying to weigh not only the risks and benefits to ourselves but also the risks and benefits to our communities. I really believe that if we have a well-informed citizenship that acts deliberately and with integrity, we can make it through together. The holidays have different types of significance for each of us, and a one-size-fits-all strategy isn't appropriate. But we cannot ignore that in this pandemic, our decisions will translate into life and death. Part of this blog is trying to arm ourselves with the information we need to do the right thing.

Scientists, public health officials, doctors, and news outlets are sounding the alarm. Each day this pandemic hits new records. Our health care system is facing incredible strain, and the death toll is rising. I have written in recent blogs about the responsibilities of our government and of individuals. But looking at this crisis, I think we need to be creative about who can help and how.

Should large, wealthy companies help? They have - at the beginning of the crisis, we received generous donations of N95 masks from local tech companies who stockpiled them for wildfire season. Other companies pivoted to learn to make ventilators. Many businesses offered discounts to front-line workers and first responders. Most companies transitioned to remote work. These actions make a difference.

But there is room for more. Companies have a lot of expertise and resources to contribute. For example, once the vaccine is available, distribution will not be easy. We can and should tap into companies that have figured out how to deliver nearly anything anywhere within a couple days. Vaccine storage may be a challenge because it requires incredibly cold temperatures; we should start identifying who can provide appropriate storage in our communities. Early in the pandemic, we faced serious PPE and ventilator shortages; manufacturing companies should consider if they can help maintain that supply. There are numerous roles for motivated volunteers to help with contact tracing, food banks, meal delivery to seniors. Companies should encourage their employees to help the community. I heard some companies paid volunteers to be poll workers; how incredible it would be if they decided to include pandemic volunteering.

Nobody wants a widespread shutdown. The economy is already teetering. One way to ameliorate the need for a complete lockdown is for wealthy businesses to give the health care system more buffer, more resources. I'm not calling on the small businesses that are struggling - they need all the help they can get, and I am advocating for another economic stimulus package - but on the companies that have the means. It may take a little creativity to figure out whether and how different industries can contribute, but since it looks like the federal and local governments and individual behaviors are insufficient to curb this crisis, we need to think outside the box.

Winter is coming. I think this may be one of the hardest winters this nation will face in recent history. The pandemic is out of control, and it will get worse. Tens of thousands of people will die. Hundreds of thousands will be infected. Many will have long-lasting health effects from the virus. Some of this death and disability will result from suboptimal care due to overwhelmed health facilities and health care providers. Some hospitals may even talk of rationing care. Non-coronavirus illnesses may be undertreated or neglected. The next few months will substantially change the health of our population. It is a terrible thing.

Unfortunately, this is on top of economic fallout, political divisiveness, social isolation, and industry upheaval. It occurs when we are fatigued and afraid and angry. Our mental, physical, social, and societal resources are being depleted. We have little reserve left. Our ability to meet outdoors is diminishing, and riskier indoor activities will rise. We face challenges in deciding how to celebrate the holidays; without doubt, they will cause a surge in cases, hospitalizations, and deaths.

There is some hope. Vaccine trial data is coming out and is promising. We may be able to begin developing a national immune system. A change in the White House may mean stronger leadership, closer adherence to expert recommendations, and more support to those who need it. Scientists are learning more about the virus, the disease, and the epidemiology. And our clinical experience in the last nine months have helped those of us on the ground take care of patients a little more effectively and efficiently.

I suppose I write posts like this every few months, and each time it feels just as pressing. Acting immediately and acting drastically will change the course of winter. We need to reduce viral spread now. Individuals need to take responsibility of masking and distancing, and governments need to take responsibility of educating, mandating, and enforcing. Health care systems need to look ahead, and governments need to provide resources to mitigate the oncoming deluge. We need to rethink our holiday and travel plans. We need to reimagine businesses. We need to reach out to each other in support. The more we do now and the fewer risks we take, the quicker we can make it through this pandemic.