COVID comeback: A South Bay doctor’s reality check
There is no need for anyone to die in a hospital bed alone
An “overflow ICU” at Providence Little Company of Mary Medical Center during the height of the pandemic in January, when the hospital’s entire ICU was filled with COVID patients. The overflow ICU handled non-COVID patients. Photo by Alex D. Hakim MD
by Anita Sircar, MD, MPH
EDITOR’S NOTE: Dr. Sircar is an infectious disease specialist who spent the last two decades working internationally, including work with the Center for Disease Control fighting Ebola in Africa. The South Bay native works at three area hospitals — UCLA, Providence Little Company of Mary Medical Center in Torrance, and at a clinic. At one point during the pandemic, she worked 155 days straight.
For two agonizing weeks, our patient in the corner room of the COVID ICU struggled to breathe. It mattered little what we did, her lungs would not cooperate. Her final struggle was drawing near and what had gone from weeks to days of a possible survival was now down to hours. She was alone in that corner room, no loved ones to be with her, no familiar face to look upon her one last time before the end. Only strangers in masks and gowns who came and went, their voices barely loud enough to be heard over rumbling HEPA filters. This is what a COVID death looks like.
But in those closing moments, a dedicated nurse of the highest caliber reminded me what it means to be human. Bryan Kieffer, RN, BSN, stopped everything he was doing, went into the patient’s room, pulled up a stool and held her hand until she passed away. He was not going to let her die alone. This tender act of kindness that I have witnessed over and over again, in countless rooms in the ICU over the last 14 months, never loses its enormity on me, nor does the weight of each COVID death ever lessen.
The enduring compassion of our healthcare workers despite an arduous year of burdening this pandemic on their backs humbles me. They, along with my patients, teach me what it means to be fragile and brave every day. But these stories of the COVID ICU are not ones of days gone by, nor are they of the early days in this battle. No, these are stories that continue to happen in COVID ICUs every day, even while Disneyland opens its doors, even while sports arenas and concert halls begin to sell tickets. These are deaths that happen anonymously, quietly and alone.
As hospitals start to empty and restaurants start to fill, there is a palpable optimism that the end of the pandemic is drawing near. Where Los Angeles County once held the record for the highest number of COVID cases and deaths anywhere in the United States, California has now been declared the state with the lowest number of cases in the continental U.S. This remarkable turnaround is a comeback unlike anywhere else and an achievement California should be proud of. But beneath this swelling tide of hope runs a nagging current of unease that the risk of reversing our gains is all too real should we drop our guard too soon.
Where only a few months ago LA county reported 15,000 new cases per day and 250 daily deaths, there are now fewer than 400 new cases per day and less than 50 daily deaths. Looking back at those staggering early January numbers from where we sit now, in May, it is hard to believe there was ever a time when ICU beds were at maximum capacity (and then some) and freezer trucks stood at the ready in hospital loading docks awaiting more bodies than we could count.
How California was able to achieve such a remarkable comeback in such a short period of time was likely multifactorial with little to do with social distancing, masking or “playing by the rules” and much to do with the arrival of vaccines. The high number of people infected in each wave left a substantial portion of the population with some level of native immunity. This coupled with a widespread and relentless campaign to get as many of the state’s 16-and-over population vaccinated as quickly as possible inched us ever so slightly toward “herd immunity” status. But as sites such as Dodger’s Stadium begin to close because surplus COVID vaccines now outnumber demand, what will stall, or even dissolve our effortful gains will be due to vaccine hesitancy. Currently, only 30 percent of those eligible for vaccines in Los Angeles County have been fully vaccinated, where conservative estimates put the highly coveted herd immunity threshold at around 80 percent or higher. Pockets of the city with reduced access to vaccines or communities where a shared belief that vaccines are not useful, remain susceptible to future outbreaks. Where the once raging flames of widespread infection are now squashed, there still remains quietly smoldering patches of the city waiting to ignite again.
Dr. Anita Sircar receives a vaccination. Photo by Beka Mallow RN
Cautionary tales of what California and the U.S. could face should we let our guard down too soon surround us. Countries that have opened up too early before achieving significant levels of vaccine coverage have paid a heavy toll for it, India being the most heartbreaking example. Where once India lead as role model for the world on how to manage a pandemic in a densely populated country, it is now in the throes of a relentless tsunami that has lead to over 300,000 new cases in a single day, the highest ever reported in one day, in any country since the pandemic began. India’s nascent success was promptly thwarted by its eagerness to open up too early.
Despite California and LA County’s admirable progress in turning its tide, we are not out of the deep end yet. Those of us who still work daily in COVID units are ever reminded of this virus’s deadly toll. Those who die today still die alone. What makes the deaths of this year ever more tragic compared to the deaths a year ago is that this year anyone can walk into any CVS on any given day and get a free vaccine, whereas last year the possibility of a vaccine did not even exist yet. Every COVID death now is a preventable one. There is no need for anyone to die in a hospital bed alone, not now, not ever.
We are in a race, as a state, a country, a community, to vaccinate as many people as we can as quickly as we can before more lives are lost. As LA County begins to reopen and more public spaces are available for use, the opportunity for this virus to spread through a vulnerable (i.e. unvaccinated) population swiftly is a very real one. The group most often being admitted to COVID units now are younger patients in their 30s, 40s and 50s; those who were not eligible for vaccines at the start of the year. This shift in demographic highlights the vulnerability of those groups with little to no immunity among them.
So, if you are still trying to find a way to relevantly and meaningfully contribute to this pandemic, now is your chance. Go get vaccinated. Go get vaccinated for yourself, for those you love and for the world at large. Every fully vaccinated person gets us one step closer to the end of this pandemic and although vaccination is a uniquely personal decision, the consequences of a couple shots in your arm are more far reaching than you could ever imagine. Getting vaccinated saves lives. Not just yours, everyone’s. We are almost there. Let’s not stop now.
If you live in California and are 16 and older, you are now eligible for a free vaccine regardless of immigration status or insurance. If you’re still not vaccinated, start here to find out where you can get one: VaccinateLACounty.com. Let’s do this for ourselves, each other and for all those who could not say goodbye one last time. ER