Disclaimer: The thoughts and ideas in this post are Dr. Tuchler’s alone and do not represent Kaiser Permanente’s positions, strategies, or opinions.


 

A tsunami is building.

Even as we prepare for a fourth wave, there really is cause for optimism. We are now vaccinating at an impressive rate of 3-4 million shots a day, and about 1 in 4 US residents are already fully vaccinated. I truly believe—like the trending hashtag says—that #ThisIsOurShot and that at this rate, we will see profound progress in case numbers by early summer. Of course, there will be flare-ups, hopefully of decreasing intensity, but COVID fatigue, inconsistent compliance with ongoing masking, and distancing recommendations coupled with the emergence of more aggressive variants make predictions tenuous as we await the elusive herd immunity.

I cringe when I hear “the pandemic is over.”

The “American Rescue Plan” is a good start, but it is just that. We are in desperate need of a reality check. One thing we can predict with confidence is the inevitable appearance of other types of surges. Some of these are less obvious than others, but have no doubt, they have been steadily building and will crest in rapid succession.

As we return to “open for business,” an avalanche of bills, including mortgages, rents, supplies, and credit, will come due. While PPP loans provided a critical lifeline, most other debts were merely delayed by forbearance and will not be forgiven. There will be numerous additional business closures, particularly small neighborhood businesses that simply could not survive the lockdown stress tests. Moratoriums will soon be lifted, triggering evictions and foreclosures, adding to our burgeoning homeless population. Joblessness and stress will likely contribute to an increase in crime, as prolonged unemployment leads to despondency, frustration, anger, and desperation. Patients are already presenting with more advanced stage cancers—a consequence of missed medical screenings including mammograms, pap smears, fecal occult blood tests, and colonoscopy and exacerbated due to canceled surgeries, and interrupted or delayed chemotherapy, infusion and radiation therapies.

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Pause of routine preventive and ongoing physician and dentist visits will have wreaked havoc on control of diabetes, hypertension, and other chronic conditions. Many people decreased their exercise or stopped meaningful activity completely, leading to dramatic weight gains and deconditioning. This will increase the incidence of complications and morbidity, including myocardial infarction and strokes. All of this will add strain to our already overburdened healthcare system, stretched to its seams.  And what of front-line workers and healthcare professionals?

Medical students and residents were necessarily pulled from their normal curriculum and rotations. Some will have knowledge and experience gaps that will deleteriously affect their training and readiness for practice. Physicians, nurses, and frontline healthcare workers of all types were in the throes of a burnout crisis that this will only serve to accelerate. Some will choose other professions and some lucky ones can afford to retire early. Many will not fare so well.

School closures were clearly essential but will result in educational gaps and special needs that will take many months, or even years, to correct. Academic challenges and delays in graduation will be seen at every level.

By some estimates, “Long COVID” is affecting one in three who were infected, and it is so much more than simple fatigue. The symptoms are legion and can include chronic shortness of breath, cognitive impairment, loss of smell & taste, pain, paresthesia, headaches, tinnitus, dizziness, heart and lung damage, and autoimmune and hypercoagulable pathologies. Many may be permanently disabled and never return to their prior level of function.  We don’t yet know the secondary illnesses that could potentially develop in these patients over the ensuing decades.

One of the biggest concerns is that everything I have enumerated will badly inflame this country’s mental health crisis. Depression, anxiety, addiction, PTSD, and suicide have already been on the rise from prolonged stress, isolation, and at times, the inconsolable, crushing loss of loved ones.

We need to be vaccinating, behaving safely, and simultaneously looking beyond infection control. Perhaps the most significant failure of our early pandemic response was, being so laser-focused on vaccine creation, we didn’t really look past that goal. “Post-pandemic” America will need federal, state, and local agencies to analyze, plan, fund, and execute our return to some semblance of a “new normal.” We also need to take these painful lessons and plan in earnest for the next pandemic, now. We must do better. We can’t make the same mistakes twice.

We can’t have our backs to these waves as they crash down upon us.