Friday Reflection 58: COVID-19, Six Years On

Fear, Confusion, Carlinness, Anger, Irritation, and (maybe) Gratitude.

It’s about 6 years since the start of the COVID-19 pandemic. The years allow us to reflect on what the experience did to us and how we reacted. Personally, I realize I’ve gone through a version of Kübler-Ross stages — instead of denial, anger, bargaining, depression, and acceptance — fear, confusion, Carlinness, anger, irritation, and maybe now a measure of gratitude.

The first COVID emotion I remember, after detached interest in December 2019, was fear. I had spent some time at the medical school at Wuhan University and considered some of the doctors and educators there, those on the first front lines, as colleagues. I grew up in New York City and have friends, family, and medical colleagues there. Thus, I heard, in real time, how bad epidemic COVID could be. Although we were never truly crushed in Chicago, I experienced fear each day in March and April as I watched our occupancy numbers climb, 100’s of our beds filled with patients with COVID.

Confusion was another early symptom. As a generalist, rather than an intensivist or ID doc, where would I be most helpful? Add to that my middle age and iatrogenic immunosuppression, and I wondered if it would even be prudent to be clinically active. These concerns were allayed pretty quickly, which was fortunate, as being an active participant in the medicine felt a whole lot better than bystanding.¹

Carlinness was an emotion unknown to me, but it became familiar in 2020. There is probably a real word for it, but my term comes from the great George Carlin line:

Have you ever noticed that anyone driving slower than you is an idiot and anyone driving faster than you is a maniac?

I considered anyone being more cautious than me to be either misinformed or afflicted with an anxiety problem. Those who were more cavalier were idiots who put us all at risk. Even at the time, I recognized the absurdity and humor of this. I’m not proud of this intolerance.

Anger came early. Initially, my anger was aimed at the disease itself. I was angry about the lives being lost. I was angry at the hardship forced upon so many. I was angry at the disruption of my kids’ freshman and senior years of high school.

Later, I got angry at myself for accepting some absurd arguments. For a time, I believed that vaccination of 95% of the country would “end the pandemic”. I somehow forgot that COVID was a coronavirus that would continuously mutate and be with us forever.

Because being mad at a virus (or yourself) is not terribly satisfying (or productive), my anger settled to irritation at more concrete things. I was irritated by the decisions leaders were making that I considered irrational. I was irritated by the hospital visitation restrictions. I was irritated when our mayor closed the Chicago Lakefront. I was irritated that school closures dragged on and on and on. I was irritated that we were treating COVID as a threat that would turn the world into Wuhan, or Lombardy, or New York, rather than recognizing that those places were probably exceptional.

I knew that making the alternative decisions – allowing hospital visitors, opening the lakefront, opening schools – would mean more people would get sick, and some would die. Having to accept this trade-off was maddening.

Why was I irritated rather than angry at our leaders? I often think of this now-famous comment from Francis Collins.

If you’re a public health person, and you’re trying to make a decision, you have this very narrow view of what the right decision is, and that is something that will save a life. Doesn’t matter what else happens, so you attach infinite value to stopping the disease and saving a life. You attach zero value to whether this actually totally disrupts people’s lives, ruins the economy, and has many kids kept out of school in a way that they never might quite recover from.

I think this is an honest explanation for why those in power made the decisions they did. Though many disagree, I think they had our best interests in mind and were doing their best. I do remain angry that we let our leaders make tunnel-vision recommendations. We have lost the Weberian ideal of a society of experts and politicians. We have let our experts become advocates and let our politicians either defer to experts (“FOLLOW THE SCIENCE!”) or become beholden to their donors.²

My fear, Carlinness, anger, and irritation have abated. As you can tell from the discussion of my anger, some of my confusion persists. I mourn everything and everyone we lost. I mourn what the trauma has done to our country. I recognize my own luck and privilege. I did not lose anyone close to me to COVID-19. My work life was busier and more stressful, but otherwise not terribly different. I never had to work from home. I never feared being laid off.

Strangely enough, the emotion that I now feel regarding the pandemic is gratitude. I know this sounds unseemly, and I know it is probably just a bizarre coping strategy, so let me explain.

Pandemics are a part of the human experience. They have shaped our politics, art, culture, and genomes. I’m kind of grateful for having experienced one.

Today, when I look at art inspired by, or read histories of, the European plagues of the Middle Ages, I understand them better. Like everyone, I reread Camus’ The Plague in 2020 and found it riveting (more so than when I read it in high school).³ I recently listened to an episode of the podcast Short History of… on the Maori. I recognized that, however briefly, we were a native population being decimated by a newly introduced disease.

Becuase our reactions to COVID-19 were so similar to how our predecessors reacted to pandemics, I judge us less harshly. COVID-19 brought social division just as the Black Death did. Those 14^th-century Europeans were confused and prone to misinformation just as we were. We both turned to dubious remedies and protections. While Medieval Europeans embraced bloodletting and self-flagellation, we turned to cloth masks and ivermectin. And there was similar economic disruption. Sure, our labor shortages and inflation were more self-inflicted than those caused by the death of 30% of the population, but you get the idea.

I could probably rewrite this piece every February. The essay would evolve as my memory of the pandemic changes. I can now articulate the fear, confusion, Carlinness, anger, and irritation I experienced early in the pandemic. Hell, I can even think back on these early days without triggering all sorts of unpleasant sensations. Finally, I recognize some measure of gratitude for what the experience taught me.

Still, I’d be even more grateful if none of us had to experience any of what we did.

1. These early concerns stuck around as humor. In December of 2020, when we started to get vaccinated. Our medical center invited people by lottery. I was on the inpatient general medicine service at the time. My name was the last to come up among those on my team. I remember complaining that the healthy youth were being protected before the old bald immunosuppressed guy.

2. I have to thank Dr. Thomas Huddle for teaching me something about this. I will eventually get him to write about this on Sensible Medicine.

3. Yes, I know it’s an allegory. Don’t “at me”!

Photo Courtesy of Edwin Hooper