OVER THE LONG HAUL
A COVID patient recovers and we all reflect
“I was like, ‘Oh my God I’m going to die alone in this hospital . ... I remember crying.” Christine Surel of Milford, on her five days last spring at Yale New Haven Hospital suffering from COVID
To begin to understand the knife-edge of life, the way we’ve changed in the last 12 months of coronavirus and the disorder that COVID-19 vaccines just might soften, let’s go back one year to see Christine Surel, a lifetime Milford resident and state employee who was then 53.
“I used to work out every single day and run a couple of miles five times a week,” Surel said this past Wednesday. She had no chronic medical conditions, ate “clean” food and most certainly didn’t fit the mold of a grandmother of two.
On Thursday, March 26, the last day her state Department of Children and Families office was open, she left early — sick. “By Saturday morning every system I had was failing.” she said, with a fever that spiked to 105 degrees.
Surel spent five days at Yale New Haven Hospital, where she thought she had a heart attack, was told she had pneumonia. “I was like, ‘Oh my God I’m going to die alone in this hospital . ... I remember crying.”
The illness didn’t go away. She has endured a hellish year, lost a lot of hair and memory function, and still suffers with fatigue, rashes, what she calls “brain fog,” on-and-off pain, tinitus and occasional panic attacks, like when she took a warm bath to relax — only to have it bring back memories of her fevers.
And yet it’s strangely uplifting to talk with this long-hauler, a sometime foster parent who, with her husband, has four adopted children ages 10 to 28. On Wednesday, she had her first workout since an ill-advised attempt in May.
“It just made me feel like I can beat this thing,” she declared, as she prepared to step out for trivia night at a local brewery. We talked about how her friendships and family life had changed.
“I definitely try to live more in the moment,” Surel said, “trying to spend more time with my kids just doing random things.”
‘Closer to my friends’
We’ve all pulled back on the number of people we see, mostly not by choice. It’s hard to know how the out-there aspects of our lives, in crowds and social situations, will shake out in the long run.
The vaccine, of course, will shape how we return to normal life. But even before the Pfizer, Moderna, Johnson & Johnson and other inoculations course their way through the global bloodstream, a lot of relationships — intimate, commercial and in-between — have changed in the one year since coronavirus hit the nation, hard in Connecticut in the early wave.
Surel’s experience made that rethinking more intense, but not necessarily more unusual.
“I definitely feel closer to my friends, even the friends that I don’t see that often,” she said. “The outpouring of support that I got when I was sick, I was like, ‘Wow, I really do have a great city and an incredible network of co-workers and friends.’”
‘Crisis unifies us’
On reflection, we see examples of that kind of rethinking all over the place.
At Amato’s Toy & Hobby on Main Street in Middletown, owner Diane Gervais didn’t relish the pandemic that kept her physically apart from most of her shopping families. But she, her daughter Caroline and their employees developed FaceTime shopping, “toy store takeout” and offered a lot of phone consultations.
“What last year oddly did was bring us even closer to customers,” Amato said.
I’ve heard that from a few doctors, too, who cite the dramatic rise in telehealth visits and, clearly, their role in a health crisis. “It did bring the patients closer to their doctors,” said Dr. Robert Russo, a Fairfield radiologist who’s executive director of the Connecticut State Medical Society.
“We usually move forward in the relationship between the patients and the physicians over time. I think COVID kind of bumped us, so that we flew forward,” he said.
State Rep. Caroline Simmons,
D-Stamford, sees it, for now at least, in politics at the General Assembly, where in-person sessions remain rare.
“In many ways the relationships between me and other legislators have been strengthened,” Simmons said. “People have kids running around in the background and dogs barking, we’re all sort of in this together.”
As co-chair of the Commerce Committee, Simmons cited bipartisan support for a bill to back businesses run by women and racial minority owners. “In the past I’ve gotten pushback on advocating for that,” she said.
“There seems to be not as much partisanship at least in Commerce and some of my other committees,” said Simmons, whose husband, Art Linares, was a Republican state senator when they married.
“Crisis unifies us in shared mission,” Simmons said, referring to public life, but she added, “I’m sure the politics will certainly come into play as we progress in the session.”
Chaos and dark humor
We’ve been talking about this whole shared-mission concept for a year now and it’s squishy but it also does seem real — along with the equally real friction over who gets the vaccinations and how much longer the travel, dining and events economy must remain shut down.
As with everything else in Coronavirusworld, the winding down of the pandemic as the vaccine reaches more people and as the virus runs its course is anything but predictable and orderly.
Gov. Ned Lamont’s top aides debated among themselves Wednesday and Thursday before announcing sweeping reopening plans. “It’s very difficult to make sense of what’s going on right now with the virus,” Lamont spokesman Max Reiss said.
All of this creates chaos and dark humor. Late night comic Stephen Colbert had fun with the reopening this past week, comparing the 100 percent business return in Texas to “removing all the stop signs from a four-way intersection,” then making fun of cautious public health officials. “Our scientists are starting to sound like parents on a long road trip.”
Stepping out of the fog
Out of the chaos, strife and for many, pain, come moments of uplift, determination, revelation.
Simmons has a 2-year-old toddler and a baby born last August, both of whom are growing up knowing only the postCOVID world. Teddy, the toddler, thinks of the mask as part of normal life. “He’s starting to say these words, like mask and COVID,” she said.
No, he hasn’t said “vaccine” yet.
Normalization is the opposite of what Christine Surel wants to see. She remembers heading to the hospital by ambulance. “We were like the only car on the highway,” she said, and with the crew in full hazmat suits, “I felt like ET.”
At the hospital, she was on oxygen but not a ventilator. They gave her the experimental drug remdisivir and other medications. She recalls little contact with the medical staff and long stretches of hopelessness.
Then one day a nurse approached her bed. “’I can’t tell you it’s gong to be all right but I’m here,’” she recalls him saying. “He put his hand on my wrist.”
Now almost a year later, the illness not gone, she’s grateful for that moment, grateful she survived, knowing a handful of people who didn’t.
“I’m doing everything I can to make the best of what COVID left me with,” Surel said. “It’s definitely gotten better. I know my Social Security number now.”
Like many grandparents, she said, “I didn’t see my grandchildren for almost six months and then I couldn’t take it anymore and said, ‘You’ve got to come over.’”
And this week, as the numbers led states to reopen, as normalcy finally appeared on the horizon, she took those strong steps out of the fog with a workout and a night out.
“I want to get back to living. I feel, like everyone else in the world, I’m tired of this.”
Let’s say you’ve gotten both doses of the vaccine and 20 days have gone by. Can you take off your mask and not feel guilty? Can you see your grandkids again? Can you go out on a date inside a restaurant?
The answer is, not surprisingly, not a very simple one.
The CDC has set some basic guidelines, such as “vaccinated persons with an exposure to someone with suspected or confirmed COVID-19 are not required to quarantine.” But, ultimately, it comes down to acceptable levels of risk, as Yale-New Haven Health’s director of infection prevention, Rick Martinello, explained.
“To a reasonable extent, having been fully vaccinated is a factor in how we make those personal decisions,” he said. “It doesn't impact the law. It doesn't impact public health guidance, but it is going to impact how we as individuals, and as families, make decisions about what's right for us.”
A question of risk
The available vaccines are, Martinello explained, approximately, 95 percent effective at preventing severe reactions to the coronavirus. Studies have shown that they are also somewhat effective at preventing an infected person from transmitting the virus to someone else.
But 95 percent is not 100 percent. There is still a measure of risk to yourself and to the community.
“One thing that's really important is, while it's 95 percent effective, it's still not perfect. So, yes, there is still some risk, but that risk is markedly less than what we had before,” Martinello said. “But beyond that risk to you as an individual is the risk to your family, if you were to bring it home.”
Your risk goes down after you’ve been vaccinated, but vaccinations are not the only such tool. Your risk goes down if you keep 6 feet of distance. Your risk goes down if you wear a mask. The risk of helping the virus spread through the community goes down, too.
There’s also the issue of what Martinello called
“risk compensation,” which he defined as an over-inflated sense of security.
“If you're doing something to decrease your risk with one action, such as getting vaccinated, it's going to alter your behaviors that may actually increase your risk,” he said.
Vaccines do offer a sense of security, Martinello said, but “there is no single action that keeps us perfectly safe, with the exception of totally isolating yourselves from others.”
What matters is not what we can do after you or I get vaccinated, but what we can do after everyone is vaccinated, according to Martinello.
“One thing that's different about vaccination is it’s going to provide us immunity, and that immunity will lead us to freedom,” he said.
Herd immunity
If, as Martinello said, herd immunity will mean freedom, the question then becomes, when might we see herd immunity in Connecticut?
According to Pedro Mendes, director of UConn’s Center for Cell Analysis and Modeling, herd immunity will be reached when 80 percent of the population is immune to the coronavirus.
His model estimates that, currently, “we have around 20 percent of the Connecticut population immune.”
That counts both people who have contracted the virus and survived, and people who have been fully inoculated. Mendes’ model only counts people who have been fully vaccinated.
Mendes’ baseline of 80 percent, though, could change depending on how widespread more transmissible variants become.
“Since the B.1.1.7 (also known as the U.K. variant) has about 50 percent higher infectivity, that raises the level of the herd immunity, from 70 percent to 85 percent,” he said. “It is unknown how prevalent it is (or will be), so I am assuming 80 percent for herd immunity.”
Depending on how fast everyone is vaccinated in the state, Mendes said hopefully the herd immunity threshold could be reached sometime late this summer.
Right now, Mendes said Connecticut is issuing about 5,500 second doses a day and, at that rate, “we would only get close to herd immunity by the end of the year.”
“However if we go up to 10,000 doses a day then we would reach herd immunity sometime in August,” he said. “I believe that with the increases in dose distribution promised by the feds, the state should be able to meet that 10,000 per day number,” Mendes said.
Years of waves
Martinello explained that viruses, specifically those that attack the respiratory system, come and go naturally in waves.
“What happens is, it literally takes years for this to work through the population and for that population to develop herd immunity,” he said. “And, of course, there's a great deal of tragedy along the way, with the millions who are dying as herd immunity develops in that population.”
“Then things get back to whatever that new normal is, but it takes a few years to get there,” he said.
Vaccines are, Martinello said, a bit of a shortcut to herd immunity, cutting those years down into smaller pieces. But that doesn’t mean other mitigation strategies can be abandoned.
“We're mitigating and, quote, flattening the curve with our public health interventions of masking, distancing, etcetera,” he said. “But it's still that long, painful road without vaccination. Vaccination allows us to accelerate the development of herd immunity, and get us to that point where we can decide what that new normal is going to be.”
Will grandparents be able to see their grandkids? Will people go out on dates and eat inside restaurants without fear? Probably. But that doesn’t mean the new normal is going to be the same as the old normal.
“That new normal, we’re going to be going back to school, with kids in school, but are you still going to be working from home?” Martinello asked. “Are health care workers going to always be wearing masks? That may be our new normal in the future.”