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COVID Fatigue

Anesthesia alert! This overhead call alerting pending intubation can be heard bellowing throughout the hallways of my medical center several times throughout the day and is seemingly the soundtrack of COVID-19. My typical routine is to pause, make sure it’s not sounding the alarm to my patient’s room, and then continue with my workday.

It has been 304 days since the WHO has declared COVID-19 a pandemic. COVID numbers at my medical center continue to rise, and although the vaccine is widely available to hospital staff, we are continuing to see some of our highest numbers since the beginning of the pandemic.

As a general cardiology fellow on the advanced heart failure service at a high volume mechanical circulatory support and transplant center, we really get to know our patients while taking care of them during their index hospitalizations. For the past two weeks, I’ve gotten to know one patient in particular. She presented in cardiogenic shock, was stabilized on inotropes and a balloon pump, with plans for upcoming destination therapy LVAD implantation.

Every day when we come to her bedside, she is on FaceTime with her partner. Today, the day before her LVAD implantation, we walked to her bedside, and once again she was on FaceTime with her devoted partner. She is obviously loved. Considering that she was going for LVAD the following day, we spent a bit more time explaining the procedure in-depth to the patient and her partner. After discussing all of the technical details, she timidly asked “Do you think my partner could come to spend the night with me tonight? I just need to see my love and it’s been so long.” You could see the tears begin to drop from her face and her partners.

Donning and doffing, wearing the N95, not knowing what anyone looks like without their mask; things have become routine. Health-care workers have adapted so well to the ever-demanding challenges of practicing medicine in the era of COVID-19. We’ve made guidelines, adjusted our practice, established routines, and found ways to provide quality medical care in the darkest of times. We’ve become oddly accustomed to these necessary rituals in order to protect ourselves, our loved ones, and the patients that we care for.

But none of this is normal.

At that moment, when we told our patient that the person who loved her the most in this world could not sit with her the night before a life-altering surgery, it became dramatically apparent to me that all of this is abnormal. The weight of 304 days of pandemic sat heavy in my heart and the sounds of endless anesthesia alerts echoed in my head.

Depression and burnout were prevalent in the healthcare field even before the pandemic. COVID-19 has undoubtedly placed an added burden on all healthcare providers. I implore people to take time off if you can, spend time with family if able, and be thoughtful of your mental well being because this past year has been anything but normal.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

 

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COVID-19 and Historical Distrust

As a member of the AHA FIT programming subcommittee, I could not have been more excited about the upcoming scientific sessions meeting. The planning for this meeting began many months in advance with lots of zoom sessions, emails, and organizing to help lay the groundwork for a successful event. As a new member of the committee, I was excited to facilitate the preventative cardiology fireside chat and the racism in medicine discussion.

However, two days prior to the session, I woke up with a terrible headache and I generally felt unwell. Considering the ongoing pandemic, I was concerned that I may be infected with COVID-19. Over the next twenty-four hours, my symptoms worsened and the following morning I tested positive for the virus.

As my illness progressed, I experienced all of the common reported symptoms: myalgias, headaches, cough, shortness of breath, and fevers. The fatigue persisted despite adequate rest. The barking cough was painful, and the constant fevers were so agonizing. The onslaught of symptoms persisted throughout my time in quarantine, and the experience was extremely debilitating. Moreover, Instead of conversing with amazing and thoughtful leaders in the field of cardiology as previously planned, the virus forced me to focus on my own physical well-being.

One of the more insidious, yet profound effects, of the COVID-19  infection, is the effect it has on your mental wellbeing. As a physician who manages COVID patients, I am uniquely sensitive to the dramatic and acute trajectory the disease may take. Being isolated in quarantine for 10-14 days, while intimately perceiving every symptom in fear, was a distinctly stressful symptom of COVID that I could have never predicted. I was confronted with my most crippling fear of progressing to critical condition and needing to be hospitalized. Regardless of the fact that I am a physician, I stared in the face of the reality that as a black man, I have a greater chance of worse outcomes.

The pandemic has further highlighted the disparity in care that exists in this country among different racial and ethnic groups. A recent publication reviewed the American Heart Association (AHA) COVID-19 registry of race and ethnicity data, which included 7,868 hospitalized patients across 88 registry sites from Jan 1 to July 22, 2020, revealed an over-representation of Non-Hispanic Black and Hispanic patients, which accounted for >50% of hospitalizations [1]. Further, these minority patients were significantly younger than patients of other ethnicities at the time of hospitalization [1]. The disproportionate rates of COVID-19 illness, hospitalizations, and death in Black and Hispanic communities are linked to several structural risk factors including living in crowded housing conditions, working in essential fields, Inconsistent access to health care, chronic health conditions, and chronic stress.

This specific health disparity is just one example of the striking effects of structural racism, years of distrust in healthcare, and lack of physical representation in the medical field on healthcare outcomes in this country. What is more alarming, is that even with the availability of a safe and effective vaccine, the historical pretext of racism in healthcare will delay and prohibit mass vaccination among many vulnerable minority populations. In a recent Kaiser Family Foundation poll, half of Non-Hispanic Black adults are not planning to take a coronavirus vaccine once one becomes available, even if scientists declare it safe and if it is available free of cost [2]. Among Non-Hispanic Black adults who say they are not planning to get a vaccine, nearly 40% cite safety concerns, including that it will be too new and assume insufficient testing [2]. Another 35% attributed their concerns to a general lack of trust or have doubts about the government or the health care system [2].

If we ever hope to get back to some sense of normalcy, herd immunity secondary to general vaccination needs to be the utmost priority among healthcare professionals. Overcoming the understandable barriers of distrust that exist in the minority community will not happen overnight. However, consistent efforts to understand, relate, and effectively communicate with patients of color can slowly help to assuage fears about vaccinations and create positive relationships between the healthcare system and the most vulnerable communities that are often ignored.

So I ask the question, what can you do as a healthcare provider to better understand and address these hurdles and to help encourage acceptance of the COVID-19 vaccination?

 

References

  1. Rodriguez F, Solomon N, de Lemos JA, Das SR, Morrow DA, Bradley Smet al. Racial and Ethnic Differences in Presentation and Outcomes for Patients Hospitalized with COVID-19: Findings from the American Heart Association’s COVID-19 Cardiovascular Disease Registry. Circulation. 2020 Nov 17. Doi: 10.1161/CIRCULATIONAHA.120.052278. Epub ahead of print.
  2. Hamel, L., Muñana, C., Artiga, S. and Brodie, M., 2020. KFF/The Undefeated Survey On Race And Health. [online] Kaiser Family Foundation. Available at: <https://www.kff.org/racial-equity-and-health-policy/report/kff-the-undefeated-survey-on-race-and-health/> [Accessed 16 December 2020].

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”