COVID Winter of Discontent

Sometimes the world becomes a Rorschach test for life’s challenges. Like this week’s family hike in Topanga State Park.

Last May a fire swept through the Park, just west of the landmark Eagle Rock. It devastated much of Santa Ynez Canyon, leaving a moonscape of barren gray and black hills. This weekend’s family hike along the fire road revealed faint green meadows and rain-washed hills now cleared of the black char and sporting patches of green new growth. Vistas of nature’s rebalancing and renewing abounded.

At the peak of the last weeks’ COVID conflagration it has been worth remembering that all pandemics eventually end. The very raging of COVID may herald, finally, its end. Then we will begin our own rebalancing and renewing. The ghostly, charred trees of Topanga offer a symbol of those left behind.

At the peak of the last weeks’ COVID conflagration it has been worth remembering that all pandemics eventually end. The very raging of COVID may herald, finally, its end.

What a month it has been. The contagiousness of the omicron strain and the holiday parties held by those weary of COVID restrictions generated staggering numbers of new infections. Not since the brief shutdown of our offices two years ago have such disruptions occurred. Our Urgent Care (UC) offices, crippled by the staff’s own COVID illnesses, struggled to cope with patient volume that spiked, virtually overnight, to more than twice normal. Primary care doctors like me worked UC shifts where we treated COVID case after COVID case. The unrelenting energy and positivity of the UC staff will remain one of the few bright spots of the pandemic years.

Despite déjà vu to the first disruptions of the pandemic, the winter omicron spike differs markedly from that experience. The once common symptoms of unremitting cough and insidiously progressive breathlessness seem strangely absent. Vaccinated individuals generally have flu and cold symptoms that improve rapidly. At the Medical Center, almost half of those with COVID were admitted for other reasons with COVID discovered only incidentally. Only ten percent of those admitted were fully vaccinated and boosted. Although the unvaccinated and immune suppressed patients continue to develop life-threatening disease, omicron illness has been largely milder. Hospital cases, lagging UC, have gradually risen to about two thirds of last winter’s peak.

Caring for the sick is a privilege even in such hectic times. But that awareness fails to alleviate the frustration and weariness of hours spent failing to convince skeptics of the potentially life-saving value of vaccination. Tragically, the magnitude of the current spike is largely a problem we brought upon ourselves. Were we all vaccinated this might resemble a somewhat worse version of a typical flu season. Instead, the 25% of the population that were unvaccinated provided the fuel for the surge that affects everyone. When questioned, many cite their lack of trust in the CDC or Dr. Fauci. Some prefer discredited treatments like hydroxychloroquine and ivermectin to a vaccine that now protects hundreds of millions of people worldwide. Science, I try to explain, is not a faith that one accepts or rejects. It’s simply the application of an unbiased search for truth. It’s the same process that brought us the internal combustion engine or indoor lighting. I freely admit that recommendations based on science are not infallible. Yet, when guided by informed expert opinion they offer the most sensible approach. When skeptics are hospitalized, they seem to regain respect for scientific procedure, sometimes tragically in the form of intubation and artificial respiration.

Science, I try to explain, is not a faith that one accepts or rejects. It’s simply the application of an unbiased search for truth.

The appropriate advice remains simple and relatively unchanged: vaccinate and get boosted after six months. As vaccinated individuals can develop and spread disease without symptoms, continue masking, distancing and avoiding crowds when possible.

The possibility of additional variants makes the future of the pandemic uncertain. However, the recent raging of omicron seems likely to leave most with either natural immunity from illness, immunity from vaccination, or both. With a less susceptible population, the virus may settle into a more stable endemic phase that allows a return to normal life. Periodic vaccinations may continue to be needed as they are for flu. Unvaccinated individuals may still end up needing hospital care. Those that attend to the public health recommendations and remain vigilant can anticipate, probably before too long, the regeneration of spring and the waning of the long COVID winter of our discontent.

Daniel Stone is Regional Medical Director of Cedars-Sinai Valley Network and a practicing internist and geriatrician with Cedars Sinai Medical Group. The views expressed in this column do not necessarily reflect those of Cedars-Sinai.