“No thanks,” my patient said to me. “Two is enough.”
I was caught off guard the first time I recommended a COVID booster shot and heard that response. “What do you mean, it’s enough? Do you toss out half of your cardiac meds? Do you say, ‘Eh, that seems like enough’ partway through your hernia operation?”
I’ve been receiving that response more and more these days. “Two is about right.” “I’ll stick with two.” These folks are not vaccine skeptics. I work at a public hospital in New York City and my patients come from communities that were pummeled by the coronavirus; most lined up for the shots as soon as they became available in early 2021, undeterred by logistical barriers or social-media rumors. A year later, despite cases rising sharply due to the BA.2 variant, they—like most Americans—seem to have moved on.
We health-care workers have watched with a darting unease as communities fling off public-health measures. We even feel a tinge of envy, wishing that we had the luxury of declaring ourselves “done” with COVID. It may not be the only thing we think about anymore, but COVID is still part of every staff meeting, every communication, every clinical day. Case counts in New York are on the rise again, and COVID is now the third leading cause of death in the United States. Our COVID-testing tent, hurriedly erected in our hospital courtyard in March 2020, is still on active duty. Keeping up with shifting viral trends and treatment protocols remains top of mind. Our meetings remain largely remote, and we’ve never stopped wearing masks.
Oddly enough, I feel safest now in my hospital, where everyone maintains a healthy respect for viral might. This irony is not lost on me. I remember how hospitals were seen as nuclear-meltdown zones at the start of the pandemic and health-care workers who strode into these conflagrations were treated as a cross between conquering hero and Typhoid Mary.
One of my kids competed recently in an athletic tournament, and the consent form warned me that “neither receipt of a COVID-19 vaccine nor proof of a negative COVID-19 test is required” and that I must accept “the risk of my child being exposed to COVID-19.”
I read the form, both bewildered and livid. Yes, of course I could accept a risk of COVID exposure—that’s life every day—but why were the tournament organizers not making the slightest effort to decrease that risk? After suffering so long without adequate testing, we are now awash in rapid COVID tests: Schools send them home in backpacks; hospitals give them out freely; testing vans are parked on every other street corner. If they were going to pack a hundred teenagers into a closed space for a full day of huffing, sweating, and jostling, why not hand everyone a test kit along with their Gatorade on their way in? Yank open the windows and distribute masks in school-spirit colors. Everyone’s safety would have improved. But instead they seemed to just throw in the towel.
This collective shrug baffles me. Why wouldn’t we take modest, noncoercive measures to make COVID infection less likely?
As we lurch into year three, we have no choice but to contend with waning public attention for all things COVID. It is sliding, however fitfully, into the ranks of diseases like tuberculosis, malaria, heart disease, and diabetes—epidemics that are hiding in plain sight; epidemics that rely on narrow interest groups to rally resources, fund research, and formulate policy. In my clinic, I have to grapple with the growing divide between my patients’ attention to COVID and my own. To some degree, this is not dissimilar to other divides we confront. I often hear “No thanks” in response to my recommendations for a colonoscopy, or insulin therapy, or eliminating processed meats from the diet.
But COVID feels like a volcano whose recent eruption is too fresh to render quotidian. For frontline clinicians involved in direct patient care, the inflection point from crisis to chronic can be painful to navigate. Patients cast far longer shadows in our professional lives than statistics, and seeing a disease recede into ordinariness feels almost like a betrayal of those we’ve cared for and lost.
The other day a longtime patient came for a checkup. He’s obese, which puts him at higher risk for severe COVID, but he’s declined even the first vaccine dose. “I’m not ready yet,” he told me, as he’s told me at every visit for the past 18 months. Part of me wants to leap onto the exam table, brandishing the front page of The New York Times with its headline marking 1 million deaths, and holler, “What exactly is it that you are waiting for? Two million?”
Protocol demands that I be a bit more measured in my approach. But I also know that easily a third of those 1 million deaths were preventable— people who declined vaccination even when vaccines were freely available, people like the patient sitting in front of me.
I listened to my reluctant patient’s concerns, answered his questions, reviewed the data, and described why I thought he would benefit from the shots. We spent more than half of our visit talking this through, but we ended at the same point. “I’m just not ready,” he said to me.
As I survey these past two years—the funerals of my patients, the exhaustion and burnout of my colleagues, the grief of hard-hit communities—and then watch the numbers tick up again, I suppose I could say the same thing about moving on from COVID. “I’m just not ready.”