Over the past nine months in the Bay Area, we've bounced back and forth between stricter and looser regulations, trying and unable to find an equilibrium. We locked everything down in the spring, watching the East Coast in trepidation. Then in the summer, we navigated changing restrictions when the Midwest became overwhelmed. Up until recently, the Bay Area has avoided disaster. Unfortunately now, disaster is here.

It might feel like the boy who cried wolf. Before this, whenever we got scared, we shut things down, and went more or less unscathed. Now, we cry alarm, but our communities are exhausted, our businesses flailing, and our holiday hopes dashed. We are reluctant to listen to these cries, and now the wolf is real.

I don't think the analogy reflects what exactly happened. We avoided a surge in the spring and summer because we cried wolf. Our shutdown measures made a difference. We weren't giving false alarm. But I worry that with time and repeated calls for caution, fewer take heed.

Now, like the rest of the nation, California and the Bay Area are in a crisis. We reinstituted severe lockdown measures, to criticism from small business owners and struggling communities. I can't imagine how hard it must be to try to run a restaurant, or to worry about when unemployment benefits expire, or to feel trapped in one's home for nine months. There are devastating hardships and consequences from shutting things down. And the benefits may not be immediately appreciated from afar.

This is how bad the health care system has and will become. We are seeing a steep rise in cases. Before Thanksgiving, our COVID patients occupied less than a third of the intensive care unit, nicely sequestered in our COVID-specific "pod." The following week, the numbers surged and we didn't have enough room in our COVID-designated areas. Our engineers scrambled to convert rooms to accommodate COVID patients. A few days ago they made up two thirds of our intensive care patients, and most recently, 80% of them. Our ICU still needs to care for strokes, heart attacks, sepsis, cardiac arrests, overdoses, and all the other life-threatening illnesses that come to our door. We have opened up additional intensive care availability in our post-anesthesia recovery area. We have boarded patients on ventilators in the emergency department as they wait for beds. Every day we are discussing mitigation strategies to make it through that day.

However, beyond beds, our biggest shortage will be staffing. Nearly every shift I have in the intensive care unit, I see the clerk calling nurses at home, seeing if anyone can come in on short notice. When that fails, we ask nurses that are working 12 hour shifts if they can extend to 16 hours. Our intensive care doctors are stretched thin. At the busiest, I am responsible for intensive care patients in three areas of the hospital on three different floors. 

We are experiencing burnout. The physical and emotional stresses of caring for these patients are enormous. Many of them are young. Many of them are dying. Many require heroic interventions and efforts to save them. And working longer hours, more shifts, with busier services, we don't have the bandwidth to process these emotions or even to eat or drink water. This is not sustainable, and yet, we anticipate this surge to last for weeks to months.

Does intensive care make a difference? I think this is an important question, else we are scrambling and stressing for little benefit. It does. We have patients who arrive in extremis, requiring complex coordinated intensive care and life-support who survive when we weren't sure they would. The hospital stays are long and they face an arduous recovery, but we can save lives. Each critically ill coronavirus patient requires weeks of intensive care, dozens of doctors, nurses, and therapists, and a lot of love, care, and support. We have love, care, and support in abundance, but hospital beds and providers will get scarce.

I don't think it is easy to weigh the benefits and consequences of a lockdown. In the spring, a lockdown made sense; businesses did not have the masks, sanitizer, gloves, barriers, guidelines, and education necessary to run safely. I know that a lockdown now, when there is no federal support for businesses, will have drastic and long-lasting consequences. Asking people to isolate during the holidays is not a small thing. Our communities are weary and battered. And a complete shutdown isn't ideal; it's a blunt instrument when perhaps selective restrictions may strike a better balance between protecting the health care system and preserving parts of our lives we can conduct safely. But here we are, and we need to do something.

Because from the ground, from the intensive care unit where I reside, we need all the help we can get, and I'm appreciative of all the sacrifices made to make that happen.