Night Shift: A Really Unusual Year

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The calendar year usually starts with January and ends in December. But March 2020 to March 2021 will be remembered “the year of COVID.” This time last year we were being told that we would be under a national quarantine for “15 days to flatten the curve.”

Now after a year of quarantine, over 500,000 COVID-related deaths, untold economic hardship, widespread depression and isolation, political upheaval and even the banning of some Dr. Seuss books. Wow!  What a year!

The whole nation got a fever and went into a long night of convulsions. And just when we thought it was going away, it came back and back. And now we are wringing wet with sweat and exhausted.


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Through the miracle of science and uncommon political will we got a vaccine in a year that would normally take five times that long. And now we just might be seeing the light at the end of the tunnel. And hopefully it not just the light on the front of another freight train.

But in many ways science also failed us. Experts initially told us that PPE for the public was medically unnecessary. Only later we found that those pronouncements were claimed to have been knowingly false, but were made to save PPE for us — the providers on the front lines.

Learned professionals in the field of epidemiology, and some everyday docs just trying anything that they thought might help, tried off label applications of drugs we had used for years and found themselves in the crosshairs of professional vitriol and legal action.


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Trusted medical journals published studies that were based on unreliable research only to later quietly walk back their previous conclusions. Even the AMA got into the action publicly denouncing some practitioners and their methods as dangerous before later quietly reversing their position after the political storm subsided. We even got it wrong on the use of ventilators. What are we going to do with all the unused ventilators that we thought were necessary to avoid an apocalypse?

While quarantine of the healthy is still under debate, the tried and true methods of quarantine of the sick seemed to be overlooked. Patients diagnosed in the ER with uncomplicated COVID were sent home to “self quarantine” almost insuring that they would infect other family members.

Nursing home patients with the highest risk of complications were sent back to facilities where they could infect other high-risk patients. Elderly patients were isolated from life-giving contact with their healthy PPE wearing family members while low level caregivers wearing the same PPE all day were free to cross-pollinate their patients with the virus like busy bees going from flower to flower. And for some reason, massive expansions of bed capacity, to handle isolated patients, went largely unused.

At every turn it seemed like the cures that looked good in retrospective studies didn’t seem to pan out in randomized control trials. Anti-virals that held out so much hope seemed to fizzle like Tamiflu. Even infusions of plasma from recovered patients — while offering benefit for sure —wasn’t the magic bullet we’d hoped. We seemed to be left with the fundamentals of blocking and tackling, high flow oxygen, anti-coagulation and the good old mainstay, steroids.


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Ventilators, instead of being lifesaving, became the last step before death for 50% of patients in distress. Everyone from the ER to ICU to the isolation floors were working really hard for extremely long periods with seemingly little to show for it.

The toll this year has taken on front line caregivers is immeasurable. Some ERs resembled the worst of front line battalion aid stations in war. ERs accustomed to saving lives were losing them on a daily basis despite all the usual lifesaving measures. Some hospitals had to resort to refrigeration trucks to accommodate the number of dead.

Free floating fear, personal isolation and loss resulted in real depression, even PTSD, in some front line caregivers. Add to that, when you did finally get home, your kids were still there. Parents who could previously depend on eight hours of calm at home while the kids were in school came home to unrelenting questions about algebra and history. Trying to keep a first-grader interested in a Zoom classroom made political activists of some of the most passive citizens.

And superimposed on all of this, the volume of patients, especially the “walking worried” that seem to support the ED financially, almost completely dried up. Some EDs experienced as much as a 40% to 60% drop in patient volume. Staffing levels had to be cut because there just wasn’t the revenue to support everyone at their previous pay levels.

Groups did their best to spread the pain evenly, but for the first time in my professional lifetime most EDs were not looking to hire any new staff. New graduates of EM residency programs were having trouble finding work, any work, something that was previously unheard of. The issue of the widespread use of advanced practice providers in place of board certified emergency physicians moved to the front burner.

A change in administration promised to take the bull by the horns and get control of the problem with 100 days of mask wearing. The only problem was that people had been wearing masks, for the most part, already. And some states with mask mandates were doing no better than the states without them.

Mask wearing and social distancing made intuitive sense. But mask fatigue was rampant. Mask police, whether they were airline flight attendants or shoppers in Bed Bath & Beyond, finally started to step on a lot of peoples’ last nerves.

As April finally arrives, is the year of COVID almost over? Can we get back to normal already?  I hope so. I recently saw where the largest nursing home association had reported a dramatic drop in new COVID cases. That’s really good news.

While we are still seeing COVID patients in the ER, they don’t seem to me to be quite as sick. I hope that isn’t just wishful thinking on my part. I, like most of you, have been vaccinated for a month or more. And yes, I still wear my mask like a good boy, even though I probably couldn’t infect anyone.

As the vaccinations finally reach herd immunity levels I look forward to children going back to school. And as I write this on St. Patrick’s Day, I look forward to the crowded, noisy bars opening back up to full drunken occupancy. That will assure us of full occupancy in the ER, plenty of work for everyone. And while that’s probably not the politically correct thing to say, it is the ‘normal’ that I have known my whole professional career. I’m ready for the Year of COVID to be over.

 

ABOUT THE AUTHOR

FOUNDER / EXECUTIVE EDITOR Dr. Plaster has been an emergency physician for more than thirty years, working exclusively night shifts for the past twenty years in emergency departments across the country. During that period he joined the U.S. Navy and served two tours in Iraq. Dr. Plaster is the founder and executive editor of Emergency Physicians Monthly and the founder of Plaster Publishing.

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