COVID numbers are declining. This is a much-needed reprieve but does not mean the healthcare system is suddenly better. The long clinical course of COVID means that even though new infections are dropping, patients who became sick weeks ago may still remain hospitalized or fight lasting symptoms. "Long-haul" COVID means some subset of those infected in the "Delta wave" will not return to their pre-COVID health for a long time. And though the curve of infections is reassuring, spread is still happening, and we must remain cautious and vigilant.

The other impact of the "Delta wave" is that health care might have been deferred or delayed. Fortunately, for my hospital in the Bay Area, we did not have to suspend any scheduled surgeries. But certainly, other hospitals and communities that suffered a more precarious surge may not have been able to attend to some non-emergency care. Individual patients or doctors may have decided to put some things off until the surge passed. Now, our health care system needs to attend to these postponed medical issues, some of which may have worsened in the weeks or months of delay. Our hospital has been busy. The winter months usually are, but this is a reminder that there's not much buffer in our healthcare system. Perhaps this a problem we need to eventually fix, but for now, our margins for future surges remain thin.

Ultimately, as the holidays approach, just like last year, we need to do our part in mitigating spread. With vaccinations, the situation is much better than it was last year, and we are grateful for that. But we will navigate new challenges - how to deal with family gatherings with all but one person vaccinated or whether to take children on a plane or mourning family members lost in this past year or struggling with being unable to spend the holiday with relatives when everyone else is (I happen to be working Christmas weekend in the ICU). But ultimately, this will be a better winter than the one most of us faced last year.

I recently read The Great Influenza by John M. Barry. I was impressed how relevant and prescient this book was to our current situation, and I wish I had read it earlier. Written by a historian in 2004, it is a thoroughly researched treatise on the 1918 influenza, the worst pandemic in modern history. Its approach is multidisciplinary and multifaceted, and its scope is ambitious. It's a long book, and I skimmed over sections with which I was familiar - those on medicine and epidemiology. Its biographical lens was also not my primary interest. But I was enthralled by its detailed historical account of how the pandemic unfolded in the United States in the midst of World War I. The descriptions of local, state, and federal response, overwhelmed hospital capacity, measures to mitigate spread, impact of the media, concerns over the loss of individual rights, and the mobilization of public health, medical research, and organized medicine are relevant today. The pandemic touched every aspect of life: political, cultural, economic, familial, military, scientific, religious, educational, societal, and more. I was shocked to see many parallels and dismayed that despite having this resource, we were inadequately prepared for the challenges of a global pandemic a century later. It also gives insight on the lasting, possibly years-long impact with resurgent waves that may still come. Ultimately, I think the past provides a wealth of experience in many different lenses, and this book is a well-researched, worthwhile read for anyone.