A View from the Vaccine Front Lines

Note: The following essay was written by my husband, Gary Bakst, a physician in New York’s Capital Region. Thank you, Gary, for sharing your experience and insight.

It has been a miserable year for all of us dealing with COVID-19.  The virus has killed over 500,000 Americans and infected about 30 million of us.  Some are still dealing with “long haul” symptoms, ongoing effects of the virus.  Sadly, many have lost loved ones to this scourge.  By now, very few of us do not know someone who has had it. 

Beyond the illness itself, the precautions being taken to prevent infection have entirely changed the way most of us live.  We are mostly staying home, working remotely, and avoiding gatherings.  There are no concerts, no theater, no ballgames.  Many of us are not willing to go to restaurants, bars, health clubs or yoga studios. 

For those of us still working in person, teachers, grocery workers, and health care workers, etc., there is the real risk of infection.  And in our office, that concern has similarly been significant.  There are about 90 employees in our office.  We represent substantial diversity in all kinds of ways:  race, age, religion, rural vs. urban, health status, educational and economic status. 

And we have about 300 people who come into our office on a daily basis for doctor’s appointments, to see physician assistants, nurse practitioners, diabetes educators, podiatrists or our surgeon.  They come in for labs and ultrasounds and bone density measurements.  It is a lot of people and a lot of appointments.  Altogether, since the beginning of the pandemic, it represents about 80,000 visits. 

Given the prevalence that COVID has had in our community, it was inevitable that, at some point, people who work in our office would test positive for the virus.  Yet, through the end of November, we had not had one employee test positive.  Our precautions were working. After the Thanksgiving vacation, that started to change. We had first one and then several and then a substantial number of employees test positive.  By and large, it did not feel like transmission was happening within our office although there was quite a bit of worry over that possibility.  Mostly, it was people who presumably became infected outside of work, possibly via contact with asymptomatic people who did not know that they were carrying the virus.

We had at least one example of a physician acquiring infection from contact with a patient who did not know they had the virus.  Personally, I had two consecutive Fridays in which a patient called (or a family member of that patient) that they had tested positive the day after their visit.  Sometimes people just don’t really think they have COVID – maybe they had minor symptoms and got tested but they answered our prescreening questions indicating no such issues. Getting those Friday calls led me to quarantine apart from Linda and certainly raised my anxiety level. Fortunately, I didn’t get the virus and neither did Linda.

Unfortunately, some of my patients have been very seriously ill with COVID-19 and several have died from it.  Many of them were lovely, sweet people with wonderful families.

Most of the employees who tested positive had minor symptoms or were asymptomatic.  Several were more significantly ill.  Several had to miss work for weeks or even months.  Those who were sicker longer have had some issues in terms not feeling entirely themselves even after returning to work. One of the many frustrating things about this pandemic is the unpredictability of the disease.

By early January, I had reached the point where I was seriously thinking that we needed to shut down the office for 10 days.  Then, the vaccine took effect.  I got my first dose on December 28th. It was 2 weeks after we received the first dose that all of this stopped.  Not all of our employees chose to get vaccinated, but the overwhelming majority did. 

Up until that point, the tension, the fear, in the office was palpable among many of our staff. Everyone handled it in their own way.  Some were clearly less concerned, and a few had to be repeatedly reminded to keep their masks on. 

Albany Medical Center saw up to 38 employees test positive on a single day in that period.  After vaccination – just over 90% of their employees chose to receive the vaccine – that number fell to either zero or one positive test per day.  Most of the employees who tested positive were those who chose not to get vaccinated. 

In terms of side effects, many of our staff did have some side effects.  Half of us received the Pfizer vaccine and half Moderna.  I did not notice any difference between those two vaccines in terms of side effects.  I personally only experienced mild arm pain with both doses (of Moderna).  But many in the office had more side effects with the second dose.  Some had fever and chills, some were achy, some had nausea, some were exhausted.  These effects generally lasted typically 12 to 36 hours.  I do not know of anyone in the office who had anything worse or anything that lasted longer.

There have been several concerns that people have raised regarding getting vaccinated.  I want to briefly comment about them:

  1. “They were developed too quickly – something must not be up to standards.”  Actually, they were subjected to exactly as much testing as all of the other vaccines that are produced, it was just that certain steps were done in parallel rather than sequentially.  While all kinds of factors allowed it to be brought to the public more quickly including the promise that our government would pay for many doses, no vaccine went to market until all of the usual safety and efficacy studies involving tens of thousands of people were completed. All three vaccines have been authorized by the FDA.
  2. “Since political pressure was brought to the process it must be tainted.”  While there has been all too much politics involved in so many aspects of our response to the pandemic, those in charge of the vaccine process, thankfully, resisted pressures to short cut the steps we take to ensure that these vaccines work and that they are safe.
  3. “The new technique of using RNA to make a vaccine means that my DNA will be altered or somehow there will be long term effects of the vaccine”.  The messenger RNA does not get into the cell nucleus and does not ever do anything to our DNA.  It is degraded fairly quickly and does not persist in our bodies.  mRNA vaccines have been used before and have been safe and effective.  However, never before has an RNA vaccine been used on this scale so it is absolutely reasonable to continue to monitor for potential adverse effects. 

We are now many months since the first volunteers received the vaccines and their safety record has been very impressive.  Their efficacy has similarly been very impressive as seen in our office.  And the disease that we are combating is dangerous.  We will not overcome it without vaccine.  More than 500,000 Americans have died from it.  With over 50 million Americans vaccinated, not one person has died from vaccine.  The risk of vaccine is so clearly low and the risk of being unvaccinated so very clearly intolerable, even tragic. 

Personally, I am so very grateful to be vaccinated.  I feel less vulnerable and less likely to infect other people.  Being vaccinated has not yet had much effect on the things I choose to do or not to do.  I am still quite careful at work and reluctant to go to places where people gather.  But I am hopeful that much of this will change as more of the people I know receive vaccines and I am encouraged that the availability of those lifesaving shots is increasing week by week.  I hope you are able to access a vaccine soon or have already had one and that it makes your life better and safer. 

Wandering Through the Pandemic

NOTE: I wanted to include additional (better) photographs to this post, but the platform wasn’t accepting the format of some. It is a mystery to me. I tried editing them in different ways, accessing them in different ways….I gave up. Oh well. Hopefully you will get my intention.

We are six months into the pandemic. It simultaneously feels like it has been a lifetime and hard to believe that it has been that long. I was looking through photos on my phone and thinking about the journey.

The experience has been both isolating and connecting. I have spent long hours alone. I have also spent hours talking to friends and family.

It is filled with contradictions – an opportunity to commune with nature, but also to feel powerless in the face of nature’s mysteries.

For me it began with my last foray out to dinner with friends in Beacon, New York, on March 7th.  We went to Dia that day and took in the abstract art and pondered its meaning (which I wrote about here).

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The pandemic has continued through today, August 20th, when I took a car ride up the Northway and explored Round Lake, partly driving, partly walking. I was hoping to hike through the nature preserve there but didn’t find a trail. I did find a dock where you could put in a kayak. Unfortunately, I don’t have one. I did find lovely views, brightened by purple loosestrife.

I got back in my car and found a promising bike path. Next time I will have to hook up the carrier to the trunk and bring my bike. I also found a charming shop named Leah’s Cakery. How could I not stop in given that it was apparently named after my daughter? I was rewarded with wonderful iced coffee and a delicious blueberry muffin.

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In these six months I have travelled around the Capital Region visiting previously unseen nature preserves and found many lovely spots, but I have also gone only as far as my backyard for respite.

Some examples of enjoying our back yard:

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Had family come by to swim, while keeping social distance – not easy when delicious babies are involved!

Evidence of some of my hikes throughout the region:

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a moment to appreciate the delicate white flowers

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surprised to find a sculpture on a tree – Montgomery, NY

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Scrambling over rocks in Massachusetts

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Walk through Five Rivers – photo by Barb Bradley

I have observed the arc of the seasons: from the gray skies and barren trees of the end of winter to the deep azure and lush green of middle of summer.

I am probably tanner than I have ever been, though that isn’t saying much.  The sun and I have a complicated relationship. I love it; it doesn’t love me. When I was young, the summer sun would cause a rash. Now with careful use of sunscreen with an spf over 30, I can handle the northern sun (a tropical sun is another story), mostly I freckle, at least I don’t burn. Each time I head out to walk, hike, jog or bike, I slather it on.

In that time, Gary planted a garden and reaped its harvest. He fought off critters that threatened to eat everything, but he won the war. He had a record-breaking tomato crop that we have been happy to share.

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Just some of the bounty from the garden – except the peaches, they came from the supermarket

We had a lot of zucchini, too. I made it every which way, from bread to soup. Luckily Gary and I like both (and they go quite well together, too).

Fortunately, I had stopped coloring my hair long before the pandemic, but I didn’t get it cut until yesterday. It had gotten out of control – frizzy and wild. Over the six months, it has also gotten a good deal grayer, with silver sprinkled in, and white around my face. I don’t mind. I kind of like it, but each time I catch a glimpse of myself in the rearview mirror I’m startled by what I see. Hmmm, is that me? After taking a beat, I nod and decide again that I’m good with it. It is a badge of honor – I’ve lived 60 years and it’s okay that people know that.

On some of my hikes I have been accompanied by Gary or a friend, but at least as often I am alone. I am not comfortable going too far afield by myself, but I will walk a well-traveled path. Mostly I go to the U of Albany campus and walk around the pond there. I watched a family of Canadian geese grow from furry goslings to almost full-size. I learned from my daughter-in-law that the black bird I photographed perched on a branch hovering over that pond is a cormorant.  I have also learned that I like being able to put a name to a bird, tree or flower that I see.

For a number of months part of the ring road of the SUNY campus was closed off because they had set up COVID drive-thru testing. Just recently, they reorganized the test site and the full loop is open again. Now that it is late August, I look for signs of students. I have noticed more cars and more people using the tennis courts, but not much evidence of students. The gate to the basketball court is still chained shut. Tennis has been deemed safe to play, basketball is not. The judgments about what is safe and what isn’t keep evolving. Early on the tennis courts were off limits, too.

I am trying to make the best of the situation, trying to internalize that I am blessed. My husband and children are gainfully employed. My mother and in-laws have had health issues made more difficult to address because of COVID, but they have been managing; they have survived thus far. I even got to visit Mom once.

Despite the cooperation of the weather which has allowed us to get outside (though sometimes it has been beastly hot and humid), I feel sad. Hard to shake it, the melancholy that comes from knowing how many have died, how many have and continue to suffer and, while I have faith that a vaccine and treatment will be found, we don’t know how long this will go on.

I work at being positive, each day, finding humor, breathing deeply, looking at pictures of my kids and granddaughter, making my plan to vote and donating funds to candidates I support.  But, truth be told, the sadness remains.

The Dance of the Mask

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Masks ready for my next foray into a public space

As I understand the directive in New York State, you are supposed to be masked (nose and mouth covered) if you are in public when you can’t keep the appropriate physical distance (six feet). Seems simple, but it isn’t.

Some of the complexity I understand – I am confused by what it means in some circumstances (more on that in a bit). Most situations are crystal clear so when people aren’t masked inside stores then they are being defiant or selfish or both. I’m happy to report that the vast majority of folks I see when I go to the Price Chopper are doing it right.

I must confess that I don’t like wearing a mask. I am someone who, under ordinary circumstances, sweats a lot. If I walk around the block, I will be perspiring pretty much regardless of the weather. It is just a fact of my life. My forehead and face get damp easily. Wearing a mask makes it worse. I also wear glasses – contact lenses are not an option for a variety of reasons. The combination of these factors means that I am often looking at the world through fogged up lenses. I need a defroster. Someone should invent glasses that have that feature. Maybe windshield wipers?

Despite this inconvenience, I wear the mask. It isn’t comfortable, it isn’t pleasant, but I wear it. I don’t want to put others or myself at risk.

Now to the grey areas and questions I have…

Sometimes I see people driving in their car with their masks on. I wonder why. If they have passengers that would explain it. But many times, they are alone. I don’t wear my mask if I am alone in my car or if I am riding with my husband. Am I missing something?

The other day I stopped to put gas in my car. There were four other people getting gas at the other pumps. No one had their mask on. I did. Though we were outside, I didn’t think we were distant enough to go without. Again, am I missing something? Why weren’t others wearing their masks?

I wonder about the etiquette of mask wearing when outside in public. I don’t live in a densely populated area. When I go out to walk in the neighborhood, I am able to keep an appropriate distance even if I see someone else. Should I still be wearing my mask under those circumstances? Given that it makes me even warmer and that my glasses fog up, I prefer not to, but I also want to do the right thing. For all I know, my neighbors are grumbling, “why isn’t she masked?” Though, generally, when I see other walkers or bike riders on my street they aren’t masked either. Maybe I can stop fretting about this one.

If I walk in a more heavily trafficked area, I will have my mask on or at the ready so that I can mask up if I approach other people. I will give others a wide berth on the sidewalk and appreciate when others do that for me. Here is my question in this scenario: if all parties are wearing masks, do you need to still to be six feet apart? Can you just walk by each other without taking a detour into the street or onto the grass?

I got an estimate for some work to be done on our deck. The guy came to the house, he rang the doorbell and he backed away to keep an appropriate distance. I opened the door and asked him to go around back so we could talk by the deck. He was wearing a mask when he rang the bell, but it only covered his mouth. I wore my mask when I went outside to meet him in the backyard. I saw him adjust his to cover his nose and it stayed that way for about two minutes before it slid down. He didn’t fix it. I was wondering if I should say something to him. This is another etiquette question. I don’t feel comfortable correcting people on their mask usage. In this case, we were outside, and I could back away when his mask slipped, so I let it go.

To be honest, though, I have never asked someone to adjust their mask, even when I have been in a store. It is all so fraught. I don’t want to be in a viral video where someone goes nuts in response to being called out for not abiding by the rules. I don’t envy store employees who have to enforce the policy. What a thankless, and possibly dangerous, job. It is hard to believe we have come to a point where someone would actually pull a gun (this happened in a Walmart, of course) when admonished to put on a mask. It’s craziness!

I find it very stressful thinking about it all the time and trying to figure out the right way to handle each situation. As I said before, sometimes it is totally clear – other than when I am in my own house, if I am indoors, I am masked. But there are all these other situations where I do this dance. I worry whether I am doing it right and then I worry whether others are. I don’t want to think about it anymore! Maybe it would be simpler to just wear it all the time.

 

Observations and Questions in the Time of COVID-19

Is there more birdsong these days or have I just slowed down enough to hear it?

Same question about critters in general – my yard is filled with bunnies, chipmunks, squirrels, deer, woodchucks. Were they always there and I didn’t notice? As I was writing this, a fawn came out of the woods and strolled across our yard!

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one of two fawns in our yard this morning

I’m thinking of taking up bird watching as a new hobby.

Why do people bother wearing a mask if they don’t cover their nose with it? Are there any medical conditions that are truly worsened by wearing a mask? And, if they are that compromised, why are they walking through the supermarket in the first place? Though I have been tempted, I have never said anything to anyone who was wearing their mask incorrectly. Should I? I don’t want to police other people’s behavior. I also don’t want to get into an argument. At this point, what is the chance that they don’t know better?

It is hard to ignore the fact that poor people of color have been disproportionately harmed by coronavirus – in the incidence of illness, number of deaths, job loss. Perhaps our awareness of how inequitable our society is will be the one good thing that comes out of this catastrophe. The question remains, how will we respond? Will that awareness translate into structural change?

The number of deaths is mind-numbing. It feels like we have stopped noticing. I guess we have to do that, or we would be paralyzed. Will we ever deal with the enormity of it? Will the New York Times run another front page story listing the names of the next 100,000?

How do you decide how much vigilance in keeping physically distant and washing or sanitizing your hands is enough? Our daughter and son-in-law-to-be visited from Somerville, MA this past weekend. The reason for the trip was to order her wedding dress! A bright spot in an otherwise dreary time – even if we don’t know if the party can go on as planned.

The agreement about the arrangements for the visit (per my husband who is a doctor) was that we would keep physically distant. We didn’t hug. We did most of our visiting either outside or at least six feet apart in the house. We didn’t share serving utensils. They stayed in a bedroom in the basement. Any time he handed something to them, Gary ‘purelled’ before and after. I was not quite as careful, though I did my best. I’m thinking that if any one of us has COVID, we exposed the others just by being in the same house for an extended period. Did it make sense to take all of those precautions? I am thankful they visited, regardless of what happens. Unless all four of us get sick, we won’t know that we got it from each other anyway. All it takes is one virus-laden sneeze from a person on the one occasion you go out to put gas in your car… You can go round and round thinking about this, ultimately you make your best guess after weighing the risks and the benefits. The risks of their visit, given that Gary, the most vigilant among us, is the only one out in the work world on a day-to-day basis, and none of us had symptoms, seemed low. The benefit, especially to my emotional well-being, was huge. How are you dealing with making these calculations? Is it making you as crazy as it is making me?

As this drags on, will we get more lax about it?

My mom called asking my thoughts about getting picked up by her brother, taken to his house, visiting for an hour (so she can participate in our family movie club which is done online), and then getting driven back to her place. Her I-pad is too outdated to support the software for her to join in from her own place. She wanted to go. I thought about how hard the isolation has been on her, how much she enjoys movie club, weighed the risks and the benefits, and told her she had my support.

I hope with all my heart that these are the correct calculations.

It’s Not Getting Easier

I thought this would get easier. When the quarantine started, I thought I would settle into the new routine without too much difficulty. After all, it wasn’t all that different from my life before coronavirus. In the beginning I didn’t feel particularly anxious – I had moments where I worried about my husband’s and our children’s health, but I wasn’t terribly fearful of getting ill myself. I was doing what I needed to do, spending more time cleaning and cooking, streaming more movies and t.v. shows, getting out to exercise. I thought, as time wore on, I would get used to it. I am surprised to be finding it harder and harder, even as restrictions are easing.

I’m thinking about why and I don’t have an answer. I have some possible explanations. Though we saw our daughter on Monday, which was wonderful, the ache of missing our kids gets deeper. Not seeing our two-year old granddaughter for three months is beyond painful. Though we FaceTime, I worry that she won’t be comfortable with us when we finally do see each other in person. When I think about it rationally, I don’t believe there will be long term damage to her or our relationship. But, that doesn’t ease the heaviness I feel.

I haven’t seen my mom in months either. On Tuesday the independent living community where she resides began a phased reopening, which is great news. Other than getting outside on her own porch, she has been confined to her one-bedroom apartment for the duration. I can’t imagine how I would have coped with that! Now she will be allowed to walk the grounds in accordance with a schedule (to maintain social distancing). I worry about the toll this has taken on her physical strength and mental acuity. It saddens me that I haven’t been to visit. Now that she can go outside, it is more practical for me to take the 3.5 hour drive to see her. I feel some relief knowing that, but again, we don’t fully understand the damage done or what the future holds. We aren’t out of the woods yet.

Before this happened, we were in the midst of planning our daughter’s wedding in December (2020) – a joyous occasion; an event I take great pleasure in helping to plan. We have not changed the date or arrangements, yet. I so want things to go off without a hitch, she deserves a great, festive celebration. Even if we didn’t have to deal with coronavirus, I would be worried about it all falling into place. Now with the specter of postponing or making major adjustments, all the unknowns weigh on me.

Perhaps more than anything, though, I am troubled by the news; I can’t tune it out. Whether it is the recent reminders that racism is alive and well or the latest effort by Trump to distract from the pandemic, I am sincerely worried about the fate of our country. I know there are good people – many of them. They may, in fact, outnumber the ignorant, ugly ones. But it seems that the latter have more power than their numbers should allow. Our president represents that ignorant, ugly strain of America. While it might be wrong to assume all of Trump’s supporters are of the same ilk, it hard for me to not think the worst. I am aware of Republicans who are ‘never Trumpers,’ but they aren’t in office and wield little power.

If all a Republican can say is that they wish Trump would ‘tone it down,’ as one person I know said recently, then they are blind to the damage being done. Toning it down doesn’t begin to undo the harm. They are unwilling to acknowledge the erosion of the rule of law, ethics and honesty. People may have been cynical about politics before his election, but after 3.5 years of Trump, the idea of virtue in public service appears to be almost dead. Can faith in public institutions be reclaimed?

I want to believe in the potential of our country, in the bedrock values that I thought were at the heart of our founding. Though we may not have fully realized those values – liberty and justice for all – I thought that the vast majority believed in those principles. I find myself asking if ethics, honesty and integrity aren’t part of the foundation of liberty and justice, then how do we achieve those ends?  We seem to have forgotten that the ends do not justify the means.

Just a couple of weeks ago, as I was walking with a friend, keeping an appropriate social distance, I was offering her optimism. She was feeling doubtful. I told her that science will triumph. A vaccine and/or treatment would be found, and we would emerge from the darkness. I still believe that scientists will find a solution to Covid-19, but I now fear that will not be enough. We are at a point where we seem to live in different realities, depending on where you get your news and your own predispositions. If a vaccine is found, will people believe in it and consent to take it? Will it be viewed as a hoax? Will it be made available to everyone?

The inequality, the inadequacy of our health care system, the vulnerability of our economy has been laid bare by coronavirus. Do we have the will to face these deeper issues? Do enough of us even see those issues? I never thought I would come to a point where I would ask these fundamental questions.

I need to reclaim my optimism. I’m not sure how to do that, other than to wait for election day and hope for a blue wave. The only thing to do is to keep on keeping on – writing, looking for constructive, productive activities, and caring for family and friends. Hopefully the gloom will lift long before November.

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I took this photo on my walk yesterday. Though I appreciated the beauty, it didn’t lift my spirits. That’s how I know I’m not in a good place.