A VACCINE IS COMING BUT PREVENTION IS AT OUR FINGERTIPS NOW

We know the mantra by heart: Wear a mask. Keep social distance. Wash your hands. Repeat. I am a pulmonary and critical care doctor at a busy intensive care unit (ICU) of an academic medical center. The mantra pervades my life, inside the hospital and out. Here is why I never stop listening: I’ve had COVID-19.

Fortunately, my symptoms were mild. Exhaustion and headaches, but no fever or cough. Severe congestion until I abruptly lost my senses of taste and smell. I was tested: positive, but nothing that required hospitalization. Still, recovery was rough and the fear of infecting my family was paralyzing. Now I am on the other side of the experience. I speak as both a COVID-19 survivor and as a physician helping others to survive, too.

Now I am on the other side of the experience. I speak as both a COVID-19 survivor and as a physician helping others to survive, too.

Whether you believe you are at risk for COVID-19 or not, the virus will affect your life, if it hasn’t already. Since March, I have witnessed unpredictable and often heartbreaking hospital scenes caused by the coronavirus. I have watched Zoom calls with dozens of family members weeping and praying as they say goodbye to a loved one in isolation, remotely, as the medical team provides comfort at the bedside. I have cared for elderly patients who delayed hospital visits, resulting in unnecessary catastrophic outcomes, including amputation and death. I have seen extraordinary efforts made to save lives, only to later learn the patient would not have wanted resuscitation.

Among the strangest and saddest consequences of this pandemic is treating patients in denial about having COVID-19 until they suddenly find themselves in crisis. For most people, the ICU is a foreign territory, happily unvisited outside of TV dramas. It is a hard place to describe until you have spent time within its sterile walls and cacophony of alarms. Patients often hover between life and death, reliant upon unfamiliar technologies and the expertise of professionals they’ve never met before.

Surprising to patients is how quickly the coronavirus can overwhelm their respiratory system, requiring mechanical ventilation to take over the work of the lungs. You are sedated, lying passively in bed, unable to speak

Rose is a pulmonary and critical care physician at UC San Diego Health. She lives in Scripps Ranch.

or communicate. Without pre-existing, signed documentation, one of the biggest challenges for medical teams is identifying who speaks for the patient when the patient cannot speak for herself or himself. Who is the appropriate surrogate decision maker? Too often, multiple family members with conflicting points of view assert their opinions, sometimes resulting in profound stress or worse for families and the medical team.

I cannot overemphasize the importance of identifying someone to represent you as a surrogate health care decision maker. An ideal surrogate knows you well and helps guide medical decisions based upon your values and wishes, rather than her or his own. Our goal is always to honor the intent of our patients, but we have to know what is important to that patient. Please complete and notarize an advanced directive. Every person should have one, pandemic or not.

We are fortunate in San Diego that our local health systems have not yet been overwhelmed as we are seeing elsewhere. We are not caring for patients in parking lots or field hospitals. Let’s keep it that way: Wear a mask at all appropriate times.

Wearing a mask honors health care workers, especially nurses. They selflessly spend more time inside the rooms of patients with COVID-19 than anyone else. Wear a mask for their sake.

When the pandemic first emerged, it largely struck the East Coast. Many brave and compassionate doctors and nurses locally and on the West Coast ventured east to help. Now, the virus is everywhere, in every state. There is no reservoir of untapped medical staff to summon for help. Every health care worker is needed and will be needed, here and elsewhere. If you are a health care worker, don’t let down your guard: mask.

This is hopefully the first and last holiday season in which we are being asked to stay home, apart from family and friends. Next year will be better. We will have more treatments and presumably multiple approved vaccines that will dramatically disable this devastating virus.

Even when the vaccine is available, however, it will initially be under Emergency Use Authorization (EUA) and in limited supply relative to public need. It could take months beyond the EUA for public access. So while the vaccine is near, thankfully, there’s a prevention method at your fingertips now. Please continue to wear a mask. It’s a simple ask.