President’s Message

Posted on Aug 5, 2021 in President's Message | 0 comments

I was enjoying a blissfully peaceful day at the San Diego Zoo with the family. The sun was out, there was a nice breeze, and I had no mask on. Sure, we were outdoors, and the CDC had relaxed mask recommendations for the vaccinated indoors. But this was still a new thing to me, to be in public without a mask on. In fact, this was the first time that I had strayed from the Bay Area since the start of the pandemic, and it was liberating.  Vaccination rates in the state, while not approaching the magic 70-75% hurdle, were quite good in most counties. Overall disease incidence was still quite low.

Abroad however, reports came from Indonesia of a massive surge. Israel was reporting breakthrough infections among the vaccinated. The UK was in the midst of another wave.  News of the highly infectious delta variant became widespread, and I was cautiously hopeful that we would be able to resist this locally.  But as a global pandemic is indeed global, so were we to soon feel its effects.

Upon my return to work, I came to know that we were not going to be spared the latest COVID surge. CDC reports indicated that the delta variant, a more highly infectious strain, and one that seemingly caused more severe disease, was responsible for 80% of new infections in the US. We were once again wearing full PPE, N95’s and eye protection all day, PAPR’s were whirring constantly, and the arsenal of weapons we had to combat the virus were once again deployed. Moreover, as more data came out, we learned that even the fully vaccinated were not exempt from falling ill, though the severity of disease was lessened, the risk of hospitalization and death was substantially mitigated.

In some ways, we are better prepared for this. We know much more about COVID than at the outset, and we have better data on the efficacy of treatment regimens. Dexamethasone, remdesivir, casirivimab/imdevimab, tocilizumab, baricitinib: These tongue twisting names had become part of our daily lexicon and were dutifully employed on the sickest of patients.  But to hear a patient asking for the vaccine when they have already contracted the disease and to have to respond with “we can’t give it to you now, but when (or if) you get better, you should get it in a few months,” – is heart-rending.

In some ways, we are in a worse state. Our hospital is struggling financially, morale is low, there are constant staffing shortages (the causes of which are multifactorial) and patient volume is high. Most recently we are hearing about nationwide shortages of tocilizumab and baricitinib.

I am so thankful of the time that I had to see my dad in San Diego and have some (mostly) carefree moments, but I realize that now is not the time to let our guard down, for the enemy at the gates has returned with increased vigor and strength.

We will get through this, and the vigilance at work has to be met with equal seriousness outside of work. We know that even while fully immunized, we can be infected and transmit disease to others.  There are still vulnerable populations that either have not been vaccinated or cannot receive the vaccine. My kids, about to start school in person in two weeks, are not eligible for the vaccine yet.  So we are not out of the woods yet. Please, mask up when indoors and around large groups of others outdoors.

I can understand the frustration of taking care of patients who have not been vaccinated, but we have the golden opportunity to make a difference. Your patients trust your medical advice, and they are far more likely to be influenced by your counsel than a celebrity or a PSA. Take the time to understand the barriers and the causes of reluctance and address those with an open mind. Vaccination is not the only path forward, but the alternative is going to result in far more deaths, and far more difficult end of life decisions.

Jeff Chen MD, MPH, FACEP
Chief of Staff, ABSMC Summit Campus