Opinion: As a doctor, I don’t fear Covid as I once did. But I carry its grave lessons forward

Medical staff inside a Covid-19 in 2020. Photo / Getty Images

OPINION

Covid is now a permanent part of our lives. Are we finally ready to accept that?

Walking through the intensive care unit is often a lesson in how much there is to fear.

Just a few years ago, I walked through these halls thinking constantly of Covid, afraid that I would contract the virus in a patient room or in a conversation with a colleague. The fear was distracting, sometimes all consuming. But now I am no longer afraid that the virus will leave me seriously ill, and the pandemic is a receding memory. Sometimes it is hard for me to believe that it even happened.

Nearly four years after the World Health Organisation’s declaration of a pandemic, the coronavirus is still with us. It likely always will be. And it is still resulting in 500 to 1,500 deaths (in the United States) every week as of the last month — higher than the mortality from influenza, though lower compared to previous years. There is also the persistent threat of long Covid, the debilitating symptoms that can persist after an initial infection.

But our response has changed. On March 1, the Centers for Disease Control and Prevention began recommending that Americans with Covid no longer need to remain isolated for five days after falling sick. Instead, people can return to their regular activities after they have not had a fever for 24 hours, which is the same recommendation for the flu and other respiratory illnesses.

When I pause to think about what happened in this intensive care unit, in the same patient rooms I walk through now, it is remarkable that most of us have managed to return to life as it was before. But that is what we do. We can remain in a state of heightened vigilance for only so long. There is no other choice.

And we are still adapting to a new reality: The virus is endemic. Covid is no longer so different from the seasonal flu and a host of other respiratory viruses, an inconvenience for most of us but a dangerous and potentially mortal threat for some. We have ricocheted in a few short years to acceptance from terror, which leaves us in a strange place: How do the majority of us move on when this virus still poses a threat to a relative few? Can we balance our desire to forget the past few years with the lessons that we, as a country, have learned?

Even having the chance to pose those questions is a step forward we could not have predicted just a few years ago. The threat of this virus was so great that in the early months of the pandemic, our lives stopped. We were afraid to breathe the air. Now, because of vaccinations and prior infections, our immunity is far greater than it was then, and infections are now typically milder. The devastating Covid cases that drove the earlier recommendations regarding longer periods of isolation are far less prevalent.

The nature of Covid infections is not all that has changed. There is also the simple human desire to move past the pandemic years. I know this feeling firsthand. While working in the intensive care unit, I was thrilled to take off my mask this summer when the hospital recommendations allowed me to do so. And more recently, I was irrationally disappointed when my hospital decided we should once again wear masks in patient rooms — even though that is clearly the right thing to do. The truth is that I just want it all to be over.

But as much as I desire everything to be as it once was, it is a challenge for some to get back to equilibrium. I used to imagine that at some point the virus would disappear, and then it would all be over. That isn’t how it happened.

While working in the hospital on a recent shift, I cared for a woman with cancer who had just undergone intensive chemotherapy and then was diagnosed with Covid. Her symptoms rapidly worsened and by the time I met her, she was intubated. As I examined her in my full personal protective equipment, I realized that she was in the same hospital room as the first Covid patient I ever cared for — another woman who had been completely healthy until the virus tore through her.

Back then, I held my breath during my daily physical exam, desperate to leave the room as soon as I could. But now, I took my time. We encouraged my patient’s family to visit. We treated her with steroids and antivirals, medications we now know can save the lives of those with severe Covid. The days of haphazard, fraught treatment of patients separated from those they love for weeks or even longer — they are all a murky memory. We know how to treat this virus. We know how to manage the ventilator. And we know that we can do so while keeping ourselves safe. Even if we get sick, chances are good that we will be OK.

Or so we sometimes think. Just a few doors down in that same unit, I cared for a young woman who had nearly died from a case of influenza. She was on lung bypass for a month. When I met her, she was profoundly delirious and so weak that she could barely move a finger. She was around my age and had been entirely healthy. There was little that separated her from me.

Did her story make me more afraid of the flu? Perhaps it should have, but it did not. This is the story of endemic respiratory illnesses that we see every year. They can be devastating for the immune suppressed, for older people or for the unlucky. That could be any one of us — a fact that before Covid, I was able to ignore.

But it is not so easy to ignore those realities any longer. We all know now what it is to feel vulnerable. Early in the pandemic, people with compromised immune systems noted that they finally felt as though they were not alone — that all of us now understood what it was to be afraid to walk into crowded spaces, least of all without masks. Even as we move into life with endemic Covid and, for most of us, stop masking except for when we are sick, we can remember what this virus taught us. As exhausted as we are by the pandemic and as much as we want to forget it ever happened, we know now that we are all connected. The decisions we make about our health impact those around us and even the smallest actions matter. We have the knowledge and simple tools needed to protect each other.

Just four days after she was intubated, my patient with Covid had improved and it was time to take out the breathing tube. We gathered around her as she coughed and caught her breath, still weak, still delirious, but breathing on her own. Standing at her bedside that day, I thought of that other extubation four years ago now. Back then we were afraid of the particles that could dissipate when we took out the tube, a fear that cast a shadow over even that joyful moment. Now, my patient smiled up at us and I felt myself return the smile under my mask. We are at once in the same place and somewhere entirely new.

Daniela Lamas is a contributing Opinion writer for The New York Times and a pulmonary and critical-care physician at Brigham and Women’s Hospital in Boston.

This article originally appeared in The New York Times.

Written by: Daniela J. Lamas

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