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The Vaccine Cards Are the Wrong Size

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This spring, as New York City warmed up and the local vaccination rate surged, I met my best friend for our first restaurant meal together in months. As soon as we sat down, she began rifling through her purse. “I have something for you,” she told me. From her bag came a rectangle of clear, thick, double-layered plastic—the kind of display pocket that often dangles at the end of a lanyard. My friend had swiped a handful from her office’s supply closet. “It’s for your vaccine card,” she explained. But I already knew.

When I got my first shot, in late February, I sat in the mandatory waiting area, holding my new card in one hand and my wallet in the other, trying to understand why the two objects weren’t compatible. I contemplated where I should put this brand-new golden ticket, ultimately sliding the thin piece of too-large card stock into an envelope I found in my tote. I’m going to either lose this or destroy it, I thought to myself.

Indeed, I lost it—at least for a little while. Despite dutifully sliding the card into its new protective pocket after lunch with my friend, I eventually found myself tearing my apartment apart searching for it, for exactly the reasons I had feared: It was the wrong size for the one place where most people keep all their important everyday documents, and of too nebulous a purpose to sit safely in a drawer with my birth certificate and passport. Could it unlock some sort of privileges at the airport? Were restaurants going to check it? Did I need to take it to medical appointments? My card had gotten shuffled into a sandwich baggie filled with extra masks, not to be rediscovered for six weeks.

[Read: No one actually knows if you’re vaccinated]

With all due respect to our country’s overworked and undersupported public-health apparatus: This is dumb. The card is dumb, and it’s difficult to imagine a series of intentional decisions that could have reasonably led to it as the consensus best pick. Its strangeness had been a bit less important in the past seven months, when evidence of immunity was rarely necessary to do things within America. Now, as Delta-variant cases surge and more municipalities and private businesses begin to require proof of vaccination to patronize places such as restaurants and gyms, the rubber has met the road on this flimsy de facto verification apparatus. It’s not the highest-stakes question of this stage of the pandemic, but it’s one that’s become quite common: How did we end up with these cards?

The logical step here is to ask the CDC what the deal is, but the agency, which issues the cards, isn’t saying much about them. It did not respond to my request for comment, and little is known about how the cards came to be. Their mysterious origin is tied up in the country’s light approach to keeping tabs on vaccinations, which, as my colleague Ian Bogost wrote in May, amounts to something of an honor system. America has no national database that records shots, and the Department of Health and Human Services does not know who has or hasn’t been vaccinated; the federal government relies on reporting from the states, and state governments have highly variable attitudes and strategies about vaccination and reporting.

The persistent informality of these efforts is especially odd because Americans always were going to need a way to demonstrate their COVID-19 vaccination status to others. Nearly as soon as the pandemic began, experts and government leaders around the world began discussing how people might be asked to prove immunity in order to return to some elements of everyday life. The Atlantic ran its first story on the topic in April 2020. While other countries have implemented national verification systems during their vaccine rollouts, the United States’ verification efforts have varied wildly. Some states, such as California and New York, are now trying to retrofit digital vaccine verification into the country’s piecemeal system, whereas others, such as Texas and Florida, have passed laws to punish businesses that try to check patrons’ status or have outlawed the use of verification systems entirely.

So now the only consistent vaccine documentation in America is the too-big, too-little cards, and they are precisely the “bad outcome” that the Princeton professor Ed Felten predicted in December they would be: a document designed to be a personal record that ends up being used as an official license to breathe on strangers in sealed rooms.

[Read: A better solution than laminating your vaccine card]

Although the CDC isn’t talking, there is much to suggest that the vaccine cards were indeed never meant to be evidentiary. The card’s template was initially publicly accessible on a number of state-government websites, and is still available on Florida’s. An official in Missouri, where the template was taken down at law enforcement’s request, told NBC News that the state had originally posted it to make things easier for local vaccine providers. Try to imagine governments freely distributing their templates for driver’s licenses, passports, or other documents intended to certify a particular identity or status. The vaccination card is much closer, physically and aesthetically, to an appointment-reminder card you get from the dentist when you schedule your next teeth cleaning. (The FBI has since clarified that printing your own vaccine card is illegal.)

When you hold one of the vax cards, you can see how people would immediately misunderstand it as something that’s meant to be kept on your person. Although too big for a wallet, they’re also too small to easily keep track of outside a wallet. “It’s absolutely the wrong size,” Alison Buttenheim, a professor at the University of Pennsylvania School of Nursing who has studied vaccine documentation, told me. She noted that the cards don’t match the dimensions of any other common vaccine documentation she knows of, including the yellow booklet that the World Health Organization uses for international travelers, which is bigger. As we were talking, Buttenheim briefly misplaced her own folded-over vaccination card; it slid a little too far into one of her wallet’s compartments. (At this point, I should admit that I again lost mine in my apartment for most of a day after getting it out to examine for this article.)

A better option, Buttenheim told me, might have involved two pieces: a larger document with information about follow-up appointments and side effects, for example, which would have cut down on the amount of stuff that needed to go on a more durable, wallet-size, and ideally harder-to-fake plastic card. Such a system would also avoid data-privacy concerns that can come with smartphone-app verification systems, as well as the accessibility issues inherent in requiring people to own a smartphone to prove their ability to work or access services. Those requirements are the hardest on the poor or elderly, for whom COVID-19 poses the greatest health risk. And the technology for some of those apps is, uh, still being refined. New York City’s smartphone verification app—not to be confused with New York State’s Excelsior Pass, or its new Excelsior Plus Pass—appears to accept photos of restaurant menus as proof of vaccination. A spokesperson for Mayor Bill de Blasio has said that’s because the city’s app doesn't verify anything; it simply gives users a place to store a photo of their vaccine card.

But let’s hold our focus on the most important point of inquiry: What’s the deal with the cards? When Bogost looked into them in May, a historian at the CDC guessed that their design was likely inherited, but no one seemed to know from what. “Like so much of our vaccine rollout, I'm guessing someone had to produce this in, like, eight hours,” Buttenheim said. “There was not time to workshop it and focus-group it and pressure-test it and rapid-cycle prototype it.” But she also noted that the card’s backside includes a date in tiny print in the lower left-hand corner, which likely indicates when the design was finalized or printed. Buttenheim’s and mine are both dated September 3, 2020—months before any vaccine received an emergency-use authorization from the FDA, and before the mass-vaccination effort had taken any real shape. Preparation well in advance is important, of course, but it’s even better if it retains some flexibility to respond to new needs (such as vaccine verification) as they arise.

[Read: The futility of vaccine passports]

What seems most likely is that maybe no one thought far enough forward to consider the cards’ eventual off-label usage. “While I don’t know for sure, the size of the COVID-19 vaccine card is likely a prime example of public health being a bit antiquated,” Jen Kates, the senior vice president and director of global health and HIV policy at the Kaiser Family Foundation, told me via email. “The large vaccine cards on paper are a relic from the past, and they’ve never been updated. No one thought to do so now.” She compared the low-tech cards to some jurisdictions’ use of fax machines to send data to the CDC at the height of the pandemic.

Everyone I talked with eventually landed on the same conclusion, more or less. “I don't think it’s that deep,” Chelsea Cirruzzo, a public-health reporter at U.S. News & World Report, whose tweet about the oversize vaccine cards recently went mega-viral, told me. “I think someone just printed out a bunch of cards that are easy to write your name and vaccine brand on, without thinking about wallets.” Maybe the dimensions were determined by the even subdivision of an existing inventory of card stock. I even called my mom, Pamela Mull, who has considerable professional expertise when it comes to federal agencies printing out flimsy and questionably useful cards—she worked for the Social Security Administration for decades before retiring in the mid-2000s. Her verdict? “Nobody thought about it.”

For weeks, I’ve been trying to figure out why I feel so antagonized by something as innocuous as the moderately suboptimal design of the vaccine cards. Sure, they’re unwieldy on a number of levels, and they’re being asked to serve a purpose for which the country should have—and certainly could have—provided a better, more secure answer. But so what, really? It’s just a typical story of American government inertia. Maybe hoping for more is naive.

That assumption is precisely the problem. When I was vaccinated, in late winter, my appointment was at one of the country’s first FEMA-run mass-vaccination sites, on its second day of operation. Even as the site was still getting its sea legs and the military personnel who ran it were learning their new duties, it was a marvel of efficiency at a grand scale; I went from freezing at the back of a block-long line to sitting in the mandated post-vaccination waiting area in less than 15 minutes. On my second visit, I didn’t wait a single second. At its peak, the site vaccinated 3,000 Brooklyn residents every day in the gymnasium of Medgar Evers College, all with an astonishingly effective government-funded vaccine that had been developed years faster than any other immunization in human history.

The American vaccination mobilization, at its best, is a clear testament to how untrue the country’s common assumption of government ineptness can be. When funding and resources and political will are concentrated, doing something that will make millions of people’s lives better—even something that sounds like a pipe dream—is possible, and it becomes possible extremely quickly. The inconvenient paper vestige that vaccinated Americans now carry of that experience is an exasperating reminder not of the shots themselves, but of all the other missed opportunities our government has had to ease the pandemic’s many predictable problems.

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111 days ago
Beaverton, OR
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The Pandemic Experts Are Not Okay

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Saskia Popescu’s phone buzzes throughout the night, waking her up. It had already buzzed 99 times before I interviewed her at 9:15 a.m. ET last Monday. It buzzed three times during the first 15 minutes of our call. Whenever a COVID-19 case is confirmed at her hospital system, Popescu gets an email, and her phone buzzes. She cannot silence it. An epidemiologist at the University of Arizona, Popescu works to prepare hospitals for outbreaks of emerging diseases. Her phone is now a miserable metronome, ticking out the rhythm of the pandemic ever more rapidly as Arizona’s cases climb. “It has almost become white noise,” she told me.

For many Americans, the coronavirus pandemic has become white noise—old news that has faded into the background of their lives. But the crisis is far from over. Arizona is one of the pandemic’s new hot spots, with 24,000 confirmed cases over the past week and rising hospitalizations and deaths. Popescu saw the surge coming, “but to actually see it play out is heartbreaking,” she said. “It didn’t have to be this way.”

Popescu is one of many public-health experts who have been preparing for and battling the pandemic since the start of the year. They’re not treating sick people, as doctors or nurses might be, but are instead advising policy makers, monitoring the pandemic’s movements, modeling its likely trajectory, and ensuring that hospitals are ready.

[Read: America’s patchwork pandemic is fraying even further]

By now they are used to sharing their knowledge with journalists, but they’re less accustomed to talking about themselves. Many of them told me that they feel duty-bound and grateful to be helping their country at a time when so many others are ill or unemployed. But they’re also very tired, and dispirited by America’s continued inability to control a virus that many other nations have brought to heel. As the pandemic once again intensifies, so too does their frustration and fatigue.

America isn’t just facing a shortfall of testing kits, masks, or health-care workers. It is also looking at a drought of expertise, as the very people whose skills are sorely needed to handle the pandemic are on the verge of burning out.

To work in preparedness, Nicolette Louissaint told me, is to constantly stare at society’s vulnerabilities and imagine the worst possible future. The nonprofit she runs, Healthcare Ready, works to steel communities for outbreaks and disasters by ensuring that they have access to medical supplies. She started revving up her operations in January. By March, when businesses and schools started closing and governors began issuing stay-at-home orders, “we were already running on fumes,” she said. Throughout March and April, she got two hours of sleep a night. Now she’s getting four. And yet “I always feel like I’m never doing enough,” she said. “Like one of my colleagues said, I could sleep for two weeks and still feel this tired. It’s embedded in us at this point.”

But the physical exhaustion is dwarfed by the emotional toll of seeing the imagined worst-case scenarios become reality. “One of the big misconceptions is that we enjoy being right,” Louissaint said. “We’d be very happy to be wrong, because it would mean lives are being saved.”

The field of public health demands a particular way of thinking. Unlike medicine, which is about saving individual patients, public health is about protecting the well-being of entire communities. Its problems, from malnutrition to addiction to epidemics, are broader in scope. Its successes come incrementally, slowly, and through the sustained efforts of large groups of people. As Natalie Dean, a biostatistician at the University of Florida, told me, “The pandemic is a huge problem, but I’m not afraid of huge problems.”

[Read: Why the coronavirus is so confusing]

The more successful public health is, however, the more people take it for granted. Funding has dwindled since the 2008 recession. Many jobs have disappeared. Now that the entire country needs public-health advice, there aren’t enough people qualified to offer it. The number of epidemiologists who specialize in pandemic-level infectious threats is small enough that “I think I know them all,” says Caitlin Rivers, who studies outbreaks at the Johns Hopkins Center for Health Security.

The people doing this work have had to recalibrate their lives. From March to May, Colin Carlson, a research professor at Georgetown University who specializes in infectious diseases, spent most of his time traversing the short gap between his bed and his desk. He worked relentlessly and knocked back coffee, even though it exacerbates his severe anxiety: The cost was worth it, he felt, when the United States still seemed to have a chance of controlling COVID-19.

The U.S. frittered away that chance. Through social distancing, the American public bought the country valuable time at substantial personal cost. The Trump administration should have used that time to roll out a coordinated plan to ramp up America’s ability to test and trace infected people. It didn’t. Instead, to the immense frustration of public-health advisers, leaders rushed to reopen while most states were still woefully unprepared.

[Read: The U.S. is repeating its deadliest pandemic mistake]

When Arizona Governor Doug Ducey began reviving businesses in early May, the intensive-care unit of Popescu’s hospital was still full of COVID-19 patients. “Within our public-health bubble, we were getting nervous, but then you walked outside and it was like Pleasantville,” she said. “People thought we had conquered it, and now it feels like we’re drowning.”

The COVID-19 unit has had to expand across an entire hospital wing and onto another floor. Beds have filled with younger patients. Long lines are snaking around the urgent-care building, and people are passing out in the 110-degree heat. At some hospitals, labs are so inundated that it takes several days to get test results back. “We thought we could have scaled down instead of scaling up,” Popescu said. “But because of poor political decisions that every public-health person I know disagreed with, everything that could go wrong did go wrong.”

“I feel like I’ve been making the same recommendations since January,” says Krutika Kuppalli of Stanford University. The last time she felt this tired was in 2014, after spending three months in West Africa helping with the region’s historic Ebola outbreak. Everyone who experienced that crisis, she told me, was deeply shaken; she herself suffered from post-traumatic stress upon returning home.

The same experts who warned of the coronavirus’s resurgence are now staring, with the same prophetic worry, at a health-care system that is straining just as hurricane season begins. And they’re demoralized about repeatedly shouting evidence-based advice into a political void. “It feels like writing ‘Bad things are about to happen’ on a napkin and then setting the napkin on fire,” Carlson says.

A pandemic would have always been a draining ordeal. But it is especially so because the U.S., instead of mounting a unified front, is disjointed, cavalier, and fatalistic. Every week brings fresh farce, from Donald Trump suggesting that the country should do less testing to massive indoor gatherings of unmasked people.

“One by one, people are seeing something so absurd that it takes them out of commission,” Carlson says.

Public health is not a calling for people who crave the limelight, and researchers like Rivers, the Johns Hopkins professor, have found their sudden prominence jarring. Almost all of the 2,000 Twitter followers she had in January were other scientists. Most of the 130,000 followers she now has are not. The slow, verbose world of academic communication has given way to the blistering, constrained world of tweets and news segments.

The pandemic is also bringing out academia’s darker sides—competition, hostility, sexism, and a lust for renown. Armchair experts from unrelated fields have successfully positioned themselves as trusted sources. Male scientists are publishing more than their female colleagues, who are disproportionately shouldering the burden of child care during lockdowns. Many researchers have suddenly pivoted to COVID-19, producing sloppy work with harmful results. That further dispirits more cautious researchers, who, on top of dealing with the virus and reticent politicians, are also forced to confront their own colleagues. “If I cannot reasonably convince people I’ve been friends with for years that their work is causing tangible harm, what possible future do I see on this career path?” Carlson asks.

[Read: A dire warning from COVID-19 test providers]

Other scientists and health officials are facing the wrath of a nation on edge. Unsettled by months of stay-at-home orders, confused by rampant misinformation, distraught over the country’s blunders, and embroiled in yet more culture wars over masks and lockdowns, Americans are lashing out. Public-health experts—and women in particular—have become targets. Several have resigned because of threats and harassment. Others face streams of invective in their inboxes and on their Twitter feeds. “I can say something and get horrendously attacked, but a man who doesn’t even work in this field can go on national TV and be revered for saying the exact same thing,” Popescu said.

Some critics have caricatured public-health experts as finger-wagging alarmists ensconced in an ivory tower, far away from the everyday people who are suffering the restrictive consequences of their advice. But this dichotomy is false. The experts I spoke with are also scared. They’re also feeling trapped at home. They also miss their loved ones. Louissaint, who lives in Baltimore, hasn’t seen her New York–based parents this year.

“I feel like I’m living in at least three realities at the same time,” Louissaint told me. She’s responding directly to the pandemic, trying to ensure that patients and hospitals get the supplies they need. She’s running an organization, trying to make sure that her employees keep their jobs. She’s a Black woman, living through a pandemic that has disproportionately killed Black people and the historic protests that have followed the killings of George Floyd, Breonna Taylor, and Ahmaud Arbery. During the ensuing reckonings about race, “I’ve been pulled into so many conversations about equity that people weren’t having months ago,” Louissant said.

“Someone said to me, ‘I hope you’re getting tons of support,’” she added. “But there’s no feasible thing that anyone could do to make this better, no matter how much they love you. The mental toll isn’t something you can easily share.”

These laments feel familiar to people who lived through the AIDS crisis in the ’80s, says Gregg Gonsalves, a Yale epidemiologist who has been working on HIV for 30 years and who has the virus himself. “I have friends who survived the virus but didn’t survive the toll it took on their lives,” Gonsalves told me. “I’m incredulous that I’m seeing this twice in my lifetime. The idea that I’m going to have to fend off another virus … like, really, can I have just one?”

But Gonsalves added that HIV veterans have a deep well of emotional reserves to draw from, and a sense of shared purpose to mobilize. His advice to the younger generation is twofold. First, don’t ignore your feelings: “Your anxiety, fear, and anger are all real,” he said. Then, find your people. “They may not be your colleagues,” he said, and they might not be scientists. But they’ll share the same values, and be united in recognizing that “public health is not a career, but a mission and a calling.”

Despite the toll of the work and the pressure from all sides, the public-health experts I talked with are determined to continue. “I’m glad I have a way in which I can be useful,” Rivers said. “I feel like it’s my duty to do what I can."

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508 days ago
Beaverton, OR
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we say, when someone’s
sensitive. So touchy. So
dangerous and delicate and
ready to tip. Touching,
though, is sweet. And we
are touched by the gift,
the thought. Moved
into knowledge of care
if not love. Touched, too,
means crazy. God-kissed.
The brain lit otherwise. I hope
we’ve all known someone
who has got the touch, able
to ease a knot, make any machine
hum true, tune a string. And
Touch me, says Kunitz
in the poem that always chokes
me up. As if the hand of a wife
would bring me back
to myself or to the selves
we both once were. Don’t
touch: first warning.
The stove, the open socket’s
shock, the body unknown
to you and all the bodies
it, in turn, has, willfully
or not, allowed such
intimacy. When I first
felt yearning for the skin
I always kept hidden
to touch another’s
hidden skin, it was
the early decade of a different
terrible virus. The danger
was known and unknown
both, and in some small
way, the risk of infection
was not unlike the risk
of intimacy. In touch, when
we know how someone
is faring. Touch and go,
when we’re not sure
how things will turn out.

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523 days ago
Beaverton, OR
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The Pandemic Is a Perfect Storm for ICU Delirium

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Barry Jones spent nearly a month in the ICU with COVID-19—including 15 days on a ventilator—but for part of that time, he thought he was somewhere else entirely.

“One day I was in D.C., the next I was in Chicago, riding motorcycles with friends of mine I hadn’t seen in years,” he told me last week, from his home in Boynton Beach, Florida. “I was putting my shoes on, walking out of the hospital to have barbecue and a beer,” Jones recalled. “I was all over the place. I was on a boat. I was going back to work. I was vividly, in my mind, doing things.”

Over FaceTime, Barry had told his longtime partner that a puppy was keeping him company, and that President Donald Trump had given him a tour of  Mar-a-Lago. A Kia commercial played when he closed his eyes. He tried to escape and join his family for Easter Sunday. When he was put on a ventilator, Jones hallucinated that doctors glued plastic tubes directly into his lungs.

Spending time in the ICU, especially for anyone with COVID-19, is a dangerous, physically taxing experience: Only the most seriously ill patients land in intensive care, where many undergo a number of complex medical treatments at once, making them even more vulnerable to life-threatening complications. Ten to 30 percent of the sickest, oldest patients who enter don’t make it out. But for survivors, the mental toll can be even more severe than the physical one. About one in three patients who spends more than five days in the ICU will experience some kind of psychotic reaction, which often takes the shape of delirium—an intense confusion that the patient can’t snap out of.

ICU doctors and nurses told me that delirious patients may believe their organs are being harvested, or that nurses are torturing them. A spike in fever might feel like being set on fire. An MRI exam might feel like being fed into an oven. Strange figures might appear on the floors, walls, and ceilings of their hospital room.

Delirium is a symptom of a brain strained by the extreme conditions of intensive care. In the ICU, patients often simultaneously experience sensory deprivation (from heavy sedation, immobility, isolation, and day after day spent in a hospital room) and sensory overload (from intense pain, bright lights, extended ventilator use, and constant prodding from a rotating cast of nurses and doctors). In response, they can become confused, paranoid, or completely lose touch with reality.

Doctors and nurses often struggle to spot delirium, but once they do, a proven playbook exists for treating it. Clinicians turn to low-tech methods such as preserving patients’ sleep cycles, allowing them to wear glasses and hearing aids, avoiding medical jargon, sedating minimally, and encouraging visitors—whatever keeps patients oriented in time and space.

But that was before the coronavirus pandemic. As ICUs across the country fill up with COVID-19 patients, doctors told me that the disease itself is undermining their tried-and-tested methods. Allowing visitors and keeping family at the bedside come at too high a risk of spreading infection, as does getting patients up for regular walks around the unit. And because of the severity of some COVID-19 cases, minimizing ventilation and sedation isn’t always possible. Altogether, critical-care specialists tell me, the pandemic has created a perfect storm for delirium.

“We treat critical illness for a living, but this is fairly extraordinary,” Bud O’Neal, a pulmonary and critical-care physician in Baton Rouge, Louisiana, told me. “This disease is going to test us.”

Ask a delirious patient what time or date it is and they’ll likely look around for a clock or calendar as expected. But ask “Does a stone float on water?” or “Can you use a hammer to cut wood?” or “What are the days of the week in reverse order?” and they may falter. “When you start questioning them, you realize they’re hallucinating,” Sharon O’Donoghue, a nurse in Boston, told me. Sometimes, patients’ delusions are downright chilling: whispering voices that won’t let them sleep, or assassins creeping into their rooms. “Delirium survivors fill in the blanks of a reality they can’t make sense of,” O’Donoghue said. “It’s something we take really seriously, and we try everything we can to keep it from happening.”

But in this moment, O’Donoghue and others told me, patients are unusually isolated, immobilized, and terrified. For one, COVID-19 patients are spending day after day on ventilators (often double or triple the normal duration for ICU patients with lung problems, according to doctors I spoke with), a known risk factor for delirium. Drug shortages are also leaving some hospitals no choice but to use sedatives linked to delirium. And clinicians are dressed in head-to-toe personal protective equipment, or PPE, a potentially scary image for many patients.

Not only are COVID-19 patients more vulnerable to delirium, but it’s harder for clinicians to provide the humanizing, intimate care required to stave off delirium when ICUs are filled beyond their capacity. Across the country, hospitals have converted regular wards into makeshift ICUs to keep up with surges in critically ill patients. Many have also moved doctors and nurses away from their specialties to help with COVID-19 care, who might not have the training or experience to recognize and treat delirium. “A lot of doctors are going into survival mode,” Chandan Khandai, a psychiatrist at the University of Illinois at Chicago, told me. “People are frustrated that they can’t be the doctor they signed up to be. There’s so much to do and so little time.”

Still, nurses and doctors tending to COVID-19 patients shared with me the countless ways that they’re attempting to overcome the obstacles to care imposed by the coronavirus. What many of them detailed were small and simple moments of compassion. Without family members at the bedside to hold a patient’s hand, caregivers are finding other ways to ensure that isolated patients are treated as human beings, not human bodies. Relatives are encouraged to “visit” loved ones through regular videochats. Megan Hosey, a rehabilitation psychologist who practices in the ICU at Johns Hopkins, printed out and hung family pictures on one patient’s wall, and got another a pair of reading glasses so he could video chat with loved ones. Clinicians are taping photos of themselves to their PPE, so patients can see what they actually look like. At Johns Hopkins, Hosey told me, the glass windows of patients’ rooms now feature handwritten notes about their occupation or the names of their grandkids. “The difference between someone who leans over and says, ‘Hi, Mr. Smith, your mom told me they’re praying for you and that you’ll be okay,’” Hosey explained, “and someone who comes in and out of the room without saying anything, is life and death.”

Others are focusing on keeping patients as comfortable and as mentally stimulated as possible. Pharmacists dispatched to ICUs are prescribing melatonin to help patients sleep at night, and physical therapists are providing physical contact. Some caregivers have encouraged the use of “ICU diaries” to help patients remember what has really happened to them, day by day. Heidi Lindroth, a doctoral researcher and ICU nurse at Indiana University, keeps music playing in COVID-19 patients’ rooms—soothing tunes paired with nature pictures for those who are sedated, and preferred artists for those lucky enough to be awake.

O’Donoghue told me that she’s taking extra care to provide patients with access to their individual interests—headphones for the opera aficionado, baseball-game reruns for the Red Sox fan, glasses and a pencil for the Sudoku enthusiast. “We’re figuring out, how can we make patients feel less alone when you can’t even smile at them?” O’Donoghue said. “You identify what makes a person unique, and use that to reach them. And you can see them, for a few seconds, be them.”

Jen Ludwin knows intimately that survivors of COVID-19 will likely face lingering trauma to their psyches, as well as to their bodies. In 2009, she spent three months in the ICU after falling gravely ill with the swine flu.“I remember waking up and wondering, What kind of nightmare is this?” she told me. “All the sounds from the machines, all the tubes coming out of your body, the people going in and out of the room constantly—it was overwhelming.” That confusion morphed into paranoia and hallucinations of psychedelic colors, an imaginary roommate, and knife-wielding hospital staffers. Her delirium eventually led to PTSD, which she’s still getting treatment for a decade later. “These things don’t go away when you leave the ICU,” she said. “You carry them with you for the rest of your life.”

Delirious patients are at a higher risk of developing dementia and needing ongoing treatment, such as nursing or rehabilitative care, after leaving the hospital. But despite the seriousness of the condition and the established ways to treat it, experts say that ICU delirium remains  “grossly underdiagnosed.” Specialists told me they’re hopeful the pandemic will offer a silver lining: a chance to teach health-care providers, as well as patients and their families, that delirium is a common part of intensive care. “There’s no question people are recognizing the importance of delirium right now, since it’s happening at an incredible rate,” Sharon Inouye, a Harvard Medical School professor, said. “I don’t think it’ll be easy, but I’m hoping we can use this as an opportunity to build awareness.”

Chris Thomas, a pulmonologist and critical-care specialist in Baton Rouge, told me he hopes doctors will emerge from the pandemic with an understanding that ICUs are a place where COVID-19 patients’ minds, and not just their lungs, were rescued from the brink of collapse. He imagines a future where doctors constantly check for delirium (using, for example, a simple confusion-assessment method developed by Inouye) as diligently as they already monitor a patient’s heart, lung, and kidney function.

But for now, lots of patients and their relatives enter the ICU with little understanding of the potential mental-health challenges ahead of them. Barry Jones is now free of COVID-19 and slowly recovering from his time in the ICU. The hallucinations and delusions are gone, but he remains astounded by how real those memories still feel. “No one said anything like that could happen,” he told me.

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573 days ago
This was today's article...there are so many layers of terror to this.
Beaverton, OR
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