I started this blog two years ago, in March of 2020. What a journey it has been. Two years is a long time; I can't remember exactly what the world was like pre-COVID, and I don't think it will ever be quite the same. I've been reflecting on the past two years, and a lot of adjectives spring to mind: unprecedented, humbling, motivating, exhausting, inspiring, demoralizing, beautiful, ugly, challenging. I have learned so much about myself, patient care, our health care system, societal priorities, death and suffering, the scientific enterprise, and this imperfect, fragile, frightening and wholly worthwhile world we live in. I hope that I have shared some of that in this blog.

This is my last post, at least for a while. This is not to say that the problem of COVID is gone; in fact, a new subvariant is sweeping the world, and doctors, researchers, and public health experts are hard at work. There are lessons to learn, questions to ask, stories to tell, lives to mourn, and victories to celebrate. There are many blogs I have not written, but I think it is time for me to set this aside and focus my attention on other writing and COVID-adjacent projects. I wish I had time to explore more. I wanted to talk about death, a fascination of mine since my undergraduate years, and what it is like to see someone die in the ICU with COVID, a prolonged process that can span months; on service this month I witnessed the passing of a patient with Omicron admitted in January. I wanted to talk about how conflicts can arise between health care workers and health care institutions in the context of return-to-work policies for those infected with COVID; were isolation periods curtailed in order to maintain a functioning workforce? I wanted to talk about survivor's guilt and our emotional states as we process the devastation and loss of the last two years; many of us are moving on with our lives, reclaiming lost time and a lost world, but how do we reconcile this with sadness for those who have died from this disease? What emotional scars do we carry from this pandemic? What violations and transgressions do we commit? There are many other stories, reflections, ideas, and questions I have considered blogging, and it is with sadness that I'm setting those aside.

I have been doing a lot of pandemic writing, and it's time for me to focus on different projects. Two years is a long time to perseverate on a topic, and this is a good stopping point for me. In many ways, the pandemic has taught us the value of time, energy, and focus. I will keep writing, but in different mediums, with different tools, for different goals. As I recalibrate my life to a new equilibrium, I am mindful of COVID, but also excited to broaden the scope of my physical, mental, and emotional worlds. 

One of most insightful things I've heard this pandemic was from a friend at the very beginning: Nothing has prepared me for this more than literature.

I agree. I enjoy my share of dystopian post-apocalyptic science fiction, and at the beginning of this, I felt as if I were in one of those stories. The world has shifted. It will not be the same again. But we are a hardy people, and like the characters in every single dystopian post-apocalyptic book I've read, we will find our way.

Please, stay safe, and stay connected. Thank you for reading.

With regard to COVID, what should we be doing now? I recently rewatched a TED talk by Bill Gates in 2015 where he presciently predicted the global impact, threat, and consequences of a viral pandemic. He also outlined how underprepared we were and recommended steps to bolster our public health. Unfortunately, his recommendations were unheeded, and COVID confirmed his predictions about our vulnerabilities. Retrospect is 20/20, but we can mitigate future surges and epidemics by preparing now.

One thing that worries me is how little we know. Although a wealth of research has been done on the virus, basic questions remain elusive. For example, we don't even have a test for infectiousness. Neither antigen testing or PCR accurately captures whether someone who had COVID remains infectious. We need to support research tackling basic and practical questions like this.

We also need to improve education and health literacy. I see a lot of misunderstanding around how to use tests. Although antigen tests are freely available, knowing when to use them and how to interpret them are nuanced topics. They're being used in ways that aren't intended such as screening asymptomatic people or keeping a gathering safe. But even more fundamental education is necessary; I still meet patients and families who don't believe in COVID or don't believe in the vaccine. These conversations are mindboggling, and they're also very challenging for me emotionally and intellectually. We need more tools and ways of communication to fix this problem.

But perhaps what we need most is money and expertise. Although we're in a lull after Omicron, we are already detecting worrisome signs in Europe and Asia of coming variants. We must maintain funding for our public health departments to research, track, understand, and prepare for future surges. Public health is one of these fields where the spotlight fades quickly, but the importance does not. It's also a field which requires time to develop leaders and experts. We need to be preparing tomorrow's public health leaders now. I have no doubt that the next variant and surge is coming - it may already be here - our government and institutions need to lean in and ready ourselves against it.

The war in Ukraine reminds me that a lot of grief and suffering in this world is ultimately caused by human action and inaction. This blog is only intended to be my account of the coronavirus pandemic, but in the last eleven days, COVID has taken a backseat to the war unfolding in Ukraine and the resultant humanitarian crisis. I don't know that much about Ukraine, and I certainly don't have any expertise in this area, but I notice a few parallels between these two disasters. Control of information and misinformation has enormous downstream effects. Governments and authorities can distort facts into a narrative as a potent weapon to sow confusion, distrust, and harm. Secondly, we live in an interconnected global community, and events halfway around the world can have profound effects on our lives. Finally, with any disaster, natural or human-made, those who suffer the most are minorities and the poor.

The war has devastating implications on health care and the pandemic as well. Aside from injuries directly sustained from military operations and damaged infrastructure, there are many other unfolding crises. Disruption of electricity means that cold-chain pharmaceuticals like insulin have become scarce. With the refugee crisis and bombardment of cities, coronavirus will spread more quickly, and the country is less than 40% vaccinated. Oxygen supplies are limited. Prior public health campaigns for tuberculosis, HIV/AIDS, and a 2021 outbreak of polio will be stymied. Damage to gas and power infrastructure will increase the risk of cold temperature-related illness. There has been and will continue to be needless harm, suffering, and loss of life as a result of this war.