Goodbye, masks!

 

 

It's been a LONG three (plus!) years in California!  

I don't really recall when the mask mandate in community settings expired in our state/locality, but our kids went mask-free as soon as they were able to in schools (sometime in 2021, I think) and we adults have been living our social lives mask-free for more than a year even in settings where, per public health, it may have been "suggested" or "recommended."  We still really don't want to get COVID, but we are not worrying about COVID anymore as we go about our daily lives, travel, attend events, socialize, etc.  Anticipatory anxiety was and has been a big harm, and (for us) COVID is unlikely to cause more severe symptoms than most colds, flus, and GI viruses that have run through our house in recent days and week. It's wearing on the psyche to constantly be assessing settings, and people, for infectious risk and we needed to let go. COVID continues to be a presence, but we feel the pandemic is over. 

However, the mask mandate was still in place in health care settings. We'd have to wear masks (in CA) when taking the dog to the vet (in Oregon, this was not the case!). We were allowed to un-mask in our private offices and pods but still mask in the presence of patients (as they were also required to do). The kids had to wear masks in the dental waiting room two weeks ago (which caused a lot of grumbling. I don't think they remember the early pandemic days very well when they took to mandatory masking quite well!), and I had to mask when going to my dentist's office last week (and had to be reminded to bring one!).

I'm thankful to have the freedom to unmask now in all settings, including and especially at work which seemed so strange to continue to do!  I'm sure that in many other localities and states, masks in healthcare settings is a thing of the distant past, but California has been more COVID-cautious than most (and, in the era of vaccines, boosters, and treatment, for too long in my opinion). 

I know a friend who states she'll host a mask-burning party ("What about the next pandemic?" I asked wryly).  It's going to be weird to decide not to have the added layer of distance and protection (now I'll have to make sure that spinach is out of my teeth for real!) but I think it will feel really, really good. I think patients' viewing doctors' faces actually is important for rapport-building and, while masks can be still used to avoid noxious smells as often can accompany birth-work, I think I am ready to show my full face. 

Face freedom!

(and a gift for "finishing the pandemic marathon" awarded to Kelvin by site medical directors!)

V-Day!!!!

It has been a looooong ~839 days (more than HALF of Niall's 1602-day-long life) of dodging COVID (Iver started his series in Nov 2021, once Kelvin and I were both vaxxed and boosted)! Niall was told he'd get a treat after his shot(s) and proceeded to tell us he preferred the three-shot pediatric Pfizer regimen (we got to choose, however! The pediatric COVID vaccine schedules are quite confusing depending on the preparation. He ended up with shot 1/2 of Moderna which is simpler so we are a split household). He was so brave (NO tears even during the injection!) and is so resilient (the after-shot popsicle certainly helped!)

Thank you, science (and NCC)! 

In Memoriam

1 million. 

This is the current estimate of the COVID-19 death count to date, in the U.S. alone (and may even be an underestimate).  

I have known many friends, family members, colleagues, and patients who have contracted COVID-19, and had a few patients die from the disease (while, thankfully, people close to me have had overwhelming mild cases).

That being said, we are in an age of widespread, safe vaccination (and boosters) for those who understand and believe in science over conspiracy theories, as well as therapeutics. I also have heard that up to 75% of American children (possibly even my own, although no one has actually tested positive), and 60% of adults nationally have contracted the virus and have some degree of immunity, which means we are in a far different and better place than we were in 2020. 

Kelvin hosted a "Service Awards" event last week (which was a farewell of sorts to virtual events) celebrating years of service of employees of our FQHC (it's been >10 years for us both!).  Being a religious Oscars watcher, he decided to do an "In Memoriam" piece, which was a section in jest (we are not trying to make light of the innumerous deaths and devastation that COVID-19 has wrought on our country or our world). 

Here were his entries:

Betty White

Kane Tanaka (the oldest person in the world who survived 2 world wars, the 1918 flu pandemic, and cancer. She died at 119.)

March - Dec 2020 (which really, really sucked!)

All of 2021 (which, with exception of a pre-Delta summer, was also pretty rough)

 

Social Distancing

Wearing Masks Outdoors (finally ditched by public schools in CA in January 2022; the indoor mask mandate was revoked in March of 2022)

Blowing Out Candles with Your Own Breath (my Godparents used a hair dryer at a recent birthday!)

Will Smith's Acting Career

... And, as of today, May 2nd, our youngest child (despite, sadly, not yet being vaccine-eligible) is allowed to take off his mask indoors at preschool ("Masks are OPTIONAL!" Niall reminded us).

                          July 2020 (age 2)

May 2, 2022  (age 4) 

We're so happy to be in this place when masks (and the constant worry about COVID) are starting to recede from day-to-day life. While we remember the millions (and counting) people who have lost their lives to COVID (and we understand that we all will likely get it at some point), we are ready to say goodbye to the things that have held us back these last two years.  In memoriam, masks (and here’s hoping that asymptomatic and pre-travel COVID testing especially for fully vaccinated individuals will get the axe in the near future).

Ridiculous, Resilient

Yesterday, Iver told me it was the first day since being in school he's been allowed to "touch" (masks were allowed to come off inside about a month ago). This is how our conversation went:

Me (frozen a bit after hearing his alarming statement): Touch?
Iver: Yeah, like touch. You know because of COVID?
Me: So like you are now able to hug your friends or high-five when you were previously discouraged from doing so?
Iver: I guess. Yeah. But I was most excited because we could touch eachother while playing "tag."
Me: What?! How did you play before?
Iver: We had to tag each other with a noodle.  Also, we can now push eachother on the swings.
Me: How did you swing before? Just have to pump your legs really hard?
Iver: No, there was like this stick with a pillow on it that you could use to push your friends with (but we often times just snuck in a regular old push [he said with a sly look]).
Me: Wow, I had no idea.
Iver: AND we can now hug our teacher!
Me: What did you have to do before?
Iver: We had to just hug a stuffie (stuffed animal) with her picture on it when we needed to. Or air hug. We weren't allowed to actually hug her.
Me: Hmm. That's really sad to me that kids have missed out on so much "normal kid stuff," but that you seem like you've adjusted as well as one could be expected to.
Iver: Yeah, I guess.

I've wondered often (see my previous posts about Niall and masked cartoon characters and Niall and the Playground) how this pandemic/responses to it will affect children psychologically for years to come (mostly fearing that they will have harmed them in negative ways. I also feel that many "safety" measures, including school closures and not allowing kids to hug, went way too far). However, the "matter of fact" way Iver explained these routine (and positive) changes to me made me feel a bit better-- that now he's just excited to have things go back to "normal."  Kids are so much more resilient than adults. I hope and pray they'll be all right. 

Child of the Pandemic

Psychologists will be studying "pandemic children" for years to come.  While I haven't seen any speech or language deficiencies in Niall, who's worn his mask faithfully since turning two and who talks more and articulates better than most four-year-olds I've ever met, some educators feel that mask-wearing in kids has hindered speech and emotional learning.

I often wonder how the pandemic has affected (my) kids in more subtle (or less easily studied) ways.  When we go to playgrounds, Niall seems to bristle when there are lots of (unfamiliar) kids around and often says things like, "I want the playground to myself!"  We're not sure if this reflects him being conditioned to social distance and being used to playing solo/far away from others (although we did have a short playdate indoors this weekend with Kellie's daughter, Ada), or just more simply that he's not a kid who wants to "share" any playground equipment...

... maybe time will tell. 

Unmasked & Uncertain

Two years after California (and most of the world) shut down in March of 2020, things are getting back to normal around here.

Our family got a taste of "post-pandemic life" while we were traveling to Arizona over presidents' week. Liberal California did an excellent job managing the pandemic early, but had some of the strictest COVID restrictions around, and has been slow to lift them (pre-vaccine availability, I largely agreed with the exception of school closures which should have never happened).  I know several very risk-averse people who still feel that lifting mask mandates in elementary schools, among other places, is premature and are quite angry and vocal about it (the NYT Daily had a good podcast episode back in January about the irrationality and non-evidence-based positions of some people on the left).  However, once vaccines were available to all kids five and up and it's been clear that COVID in kids younger than this is very mild in the vast majority (and either similar or less risky than influenza in vaccinated or under-five groups), I've been very in favor of lifting most COVID restrictions and moving back towards normalcy, as I blogged about early in January, when people were extremely anxious about the Omicron wave. I read somewhere that at this point, due to the sheer numbers of people infected in December and January, up to 90% of Americans probably have some degree of COVID immunity, whether natural or acquired! Masks are small potatoes to me and my kids and don't disrupt life much for us. However, the testing-before-travel (as travel is one of my main joys in life!) and the forced isolation/suggested quarantining is what I'm most thrilled to eliminate (I think the UK just did this), especially as I'm not sure my newly-four and still-not-vaccine-eligible kid will likely be vaccinated for a good while more (and it's hard to hold onto hope for this as the "end all" for the pandemic risk for our family. Perhaps we've even all had COVID and just didn't know it/test for it!).   

California lifted the indoor mask mandate for vaccinated people around February 16th and then, on March 1st, for all people. It's been hard to "change behavior" of what has been the norm for two years (with some brief gaps like summer 2021 pre-Delta)!  Arizona didn't have mask mandates when we were there, and we (even our unvaccinated kid) went maskless in grocery stores and malls, almost daring COVID to finally get us (note: we're all fine although I still held my breath for many days watching for symptoms in anyone; we don't believe in asymptomatic testing). Going maskless felt surprisingly normal when it was on "vacation," but more fraught when at home during our "regular lives." We saw some people in AZ masked, but they were in the minority (I can't even imagine what a different experience it would have been to pass this pandemic [and to reside now] in Florida or Texas or other "red states."). 

When I returned home here and attended church last weekend, 80% of people were unmasked, and I found myself trying to do the analysis of whether everyone was vaxxed (or recovered) or just unconcerned (as many religious people have been, even the elderly). I didn't wear my mask, but I sat in the back, away from singing spittle, and six feet away from my closest neighbor.  The library had lifted their mask sign when I visited last week, and I went maskless. But, when I went to the post office and felt like I was stuck in line in an enclosed space, I wore mine.  When Niall came with me this weekend to the library, worried about sending mixed messages to him due to his preschool's current policies, I wore my mask, as did he. But we went out to eat with friends and their kids at a pizza place on Saturday (the first time in forever!) and the kids were unmasked. It will be a while before I don't feel nervous (and naked!) to go about our town entirely mask free (Kelvin actually likes the anonymity of masks when shopping here); there will likely be a bit of intermittent (and fairly arbitrary) mask-wearing as we navigate these uncharted waters. (At work and per CDPH, Kelvin and I are still masking with patients, who are also masked, although we can unmask in our universally vaccinated work pods).

Kelvin says that the mask mandate for public school may be lifted around March 11th, while masks may still be "strongly recommended."  Each school (board) will have to decide (ours has a meeting this week) what their kids will be asked to do.  Daycare /preschool may have different guidelines. While I'm thrilled we're at this point in the pandemic, and Iver (who has been unmasked outside for a couple of months, which was met with a bit of trepidation but not a lot) is excited to attend school mask free, I still hesitate (as I know many parents will. I don't envy the principals having to deal with parental back-lash to unmasking in this liberal state as many had to deal with fervent anti-mask parents in others).  Kelvin thinks that the cloth masks that the kids have been wearing provide more of an "illusion" of protection given the contagiousness of more recent variants, and that Iver is not much more at risk of COVID or spread by going maskless even indoors; however, I feel there's probably a small layer of protection against testing positive by wearing one (along with, of course, his vaccine series. Obviously, all measures have helped him stay [we think] COVID-free to date. I don't know what percentage of the kids in his class are immune).  

Because we don't have flexible/workable-from-home jobs, until CDC lifts isolation guidelines, it might make sense to mask sometimes, at least before our planned international travel later this spring-summer!  I’m not worried about the actual health risks for COVID in our family but rather that we don’t have people to watch our  kids if they (or we) are sick with COVID. We could live with the flu risk in the past, and we have to be able to live with probable endemic COVID; it's just hard to scale back the hyper-caution we've practiced for two years and uncertainty is harder than certainty to navigate (while I would never want to go back to 2020, "just wear the mask and social distance!" was an easier path to know how to follow)!  And if, after all of our caution, any of us gets COVID right before long-awaited vacations (the lead-up anxiety will be very high for me), I will be extremely disappointed, despite how much COVID has taught us about being adaptable and flexible, and to not be too hopeful because things can change in an instant.  I am eager to read to read the book "Psychology of Pandemics" which should be on its way to me soon, as the psychology of risk calculation, risk tolerance, and risk budgets is extremely interesting to me, and such COVID calculations have consumed so much of my energy for the past two years. 

I wonder how much (and when) hard-drive space in our brains will be freed by not having to perform so much risk analysis all day long!  I am looking forward to being confidently unmasked, being able to travel freely, and to actually look forward to vacations again, even if there's some degree of uncertainty involved!

A Taste of Normalcy

I've blogged recently about our approach to "common sense" COVID policies and feelings given the state and length of the pandemic in this country as well as the current science (the NYT Daily podcast today with Dr. Fauci was pretty maddening: [Michael Barbaro: "So you're saying that the vaccinated (and boosted, as well as kids) should still have to be extremely cautious, to protect the unvaccinated and uncautious (and likely inconvincible), who resent the caution in the first place?"]. If I were a childless adult with my current age and health, I don't think I'd be modifying  my activities, travel, or my day-to-day behavior much (I'd wear a mask without complaint if that was the law). Nevertheless, here we are with still one unvaccinated kid and CDC guidelines still recommending home isolation for even the mildest (/asymptomatic) COVID, while trying to go on with semi-"normal" lives. 

My friend Kellie asked if we wanted to celebrate Lunar New Year (which starts tomorrow) with her family in a small way this past weekend. I had to run it by Kelvin but he agreed that having them and their (similarly aged) kids over for lunch in our back deck was something we felt comfortable doing now (which is much different than six months or a year ago; we have been sooo socially cautious due to our kids that contemplating something like this felt like a jump for us! Kellie is also one of the safest, most responsible people I know). Despite somehow not taking any photos (Kelvin took the fruit pic above), we had a lovely time. Kellie and Mark brought cucumber salad, tangerines, and almond cookies, and we made noodles, meatballs, Vietnamese banh me chicken bowls with pickled veggies, and we chatted as the kids ran around and played in backyard, and even inside some (in Iver's fort area, and in the living room, where Ada and Niall had a blast with all of the toys in our living room).  It struck me as sad that something so normal, a Saturday afternoon playdate with two families and good friends, felt like such a treat and a gift.  However, I am trying to just appreciate it after its absence for so long.

Shannon, the director of our kids' trusty childcare and a good friend, has also been organizing some informal pick-up soccer games at one the parks in our local town on Sundays, and Iver has loved joining in (despite us not being a soccer family). The littler kids played at the nearby playground while the bigger kids (and adults, including Kelvin), played soccer in the nearby field.   The recent weather has been perfect for these outdoor games.

Niall and his bud Dylan (who attends his same preschool)

Seeing the kids (without masks) run, jump, and shout with joy at being able to be with their friends "like normal," on a weekend is just wonderful (“like there isn’t even a pandemic,” remarked one parent). While I know we are not out of the woods yet and we're still COVID-susceptible, it feels like we are getting closer to "normalcy" (or at least we're so fatigued that we've stopped caring about "testing positive” as it seems to be an uphill losing battle and we’re sort of surrendering). It feels (tastes) so good.

Dropping like flies: tough times in health care

 

Last week, one of the doctors who has been on maternity leave from our OB practice for four months, who was supposed to come back this week, informed us that, due to Omicron and exposure risks, she did not feel comfortable returning and postponed her return date until a few more weeks from now.  I support maternity leave fully and do think we could do much better for mothers (and fathers) in our country with leave (although California is quite generous with family leave).  However, I don't support people deciding, last minute, that a small group of OB providers who have been working tirelessly up to twice weekly for months on end and hanging on until her return (with one person retiring from birth work last week as planned in anticipation of the return), should have to scramble, rearranging our own lives and clinic schedules to do more work because of her anxiety and irrational low risk tolerance when it comes to occupational COVID exposure in a world with milder disease severity, vaccinations, and adequate PPE. I am actually shocked that, with two unvaccinated kids (until Iver recently got his two shots), we have not had COVID take down our family despite being at this for almost two years (maybe God knew that, due to short OB provider staffing, He better keep our family COVID-free lest there be no one to deliver babies here). I am sick of taking twice-weekly overnight call as my own emotional state and family have suffered, and tired of having my own boundaries infringed upon by others’ when we don’t have other human options. We'll see if she comes back or postpones her return further. As now the lead clinician for our prenatal clinic, it will be my problem to solve. 

Another colleague put in her notice at our FP clinic with her last day three months away with the other doctor retiring in March. That will leave me as the only doctor at my clinic site, among several APCs (NPs and PAs).  I hope we'll see another physician join us soon, but people are burned out, especially in primary care. We’re tired of trying to prevent disease when patients often don’t seem to listen, or care. 

Today. I had a patient (COVID-unvaccinated, by the way) spend a good portion of his office visit (until I tried to tactfully cut him off) complaining to me about how our broken health care system and preoccupation with COVID has prevented him from getting outpatient imaging and call-backs in a timely manner from the hospital. I could only shake my head and try to empathize with how frustrating it is to be a patient in a low-resource area with staffing challenges that are only getting worse, during a pandemic. However, I simultaneously wondered, "Does he have any idea what it's like to be an overworked doctor in primary care trying to care of increasingly sick patients who disregard our advice, with fewer staff members and less support, amidst a COVID surge?” (Note: He still refused the vaccine).

These are certainly tough times to be a health care worker.

I may be the next one to put in my notice, or to not show up to work next week...

Common Sense COVID policies

We are now close to entering the third year of this COVID-19 pandemic. While I don't know too many people who aren't completely COVID-beleaguered/exhausted, I think that parents of young kids, health care workers (and those, like us, who are both) are truly close to the end of what we can reasonably handle.  My sister-in-law Katherine recently sent me this article which nails it. 

We have been shielding our kids from "normal" childhood things for almost two years now, avoiding socializing outside of school/work, travel (with few domestic exceptions), activities, birthday parties, and more. Iver had asked me, after he got vaccinated in November, whether he'd be able to attend a friend's future January birthday party, and I was so thrilled to say "Yes, that sounds great!" (all the while, still thinking, "but we'll just have to see..."

And now, almost predictably, there's Omicron. 

We really are at a point where we feel that someone in our family contracting COVID in the near future is probably inevitable, despite our best precautions and luck in having dodged it so far. We are trying to walk a very fine line between freaking out too much, and not enough, "letting go" and still being "safe" (which is obviously relative).  (Note: regarding the birthday party this week, we’re letting him go. It’s outdoors and he’ll mask when inside with other kids).

Many people (some of my health care worker friends included) have questioned the evidence behind the recent CDC guideline change to shortening isolation/quarantine periods for COVID (to five days with subsequently mask-wearing five more/quarantine to 10 days from 14 ideally with testing on day 5 after exposure if possible). Some people fear it will lead to irresponsible behavior and unnecessary exposure risks for others (some very vulnerable) in the community and was changed just to benefit corporations at the expense of workers.  However, in this house, we rejoiced.  In our three-quarters vaccinated household, we are not scared of the health risks of COVID, but we are terrified of the implications and threats of missed school/work, and we feel like we are missing out a lot on normal life because of it (while I, the introvert, don't miss large gatherings at all and am super comfortable with being socially restrictive, I grieve for my kids). We follow the news and are NYT subscribers (and I am about as liberal as they come, politically), but we do feel that the media is currently over-representing the absolute risk of COVID morbidity to individuals like ourselves and to most Americans. 

I am hopeful that some day in the not-too-distant future with the tools of widespread immunity (acquired or natural), masks, and therapeutics, the period of isolation or quarantine will be eliminated altogether and that people in the world can and will accept the small (but real) risks of COVID like we have done for influenza, pneumonia, and other respiratory pathogens which, while they can cause severe illness and death, do not for the vast majority of the population. Lest you peg me for a COVID dismisser or minimizer (which, I assure you, I am not), there are common sense things that, in our opinion, would well balance the emotional risks of living with prolonged pandemic restrictions (which I have seen in my own patients and family) while still still avoiding excessive death/hospitalizations in this country (obviously, there's no way we can prevent them all). *Note: these our my personal views alone, and may differ from those of my organization or hospital system.*

I am FOR:

- Vaccination including boosters for all eligible, at the very first available opportunity (I’m also for vaccine mandates)

- Schools staying open (we still maintain that they should have never been closed even in 2020), even in light of variants (thankfully, Omicron seems to cause milder disease than previous COVID strains and COVID morbidity is rare, even in unvaccinated kids)

- Masks in indoor public places or at large gatherings for as long as public health officials feel is prudent (masks are a very minor inconvenience that doesn't impact my life in any meaningful way; in fact, sometimes I like the anonymity of wearing masks indoors while out and about in our small town! My kids are also extremely used to them at this point and masks are a small price to pay for being able to do "normal things")

- Keeping kids (and adults) home when they're sick or febrile or feeling too ill to work and masking for the immediate and 10-day period after clinical illness and avoiding socializing during this period "in case" COVID is present

- Clinic-based COVID testing and evaluation for patients who are moderately ill, and appropriate testing/management for patients requiring hospital care (which is mostly the unvaccinated; it’s really hard to do this with grace, empathy, and without “I told you so”s)

- The option of at-home COVID testing for anyone with mild or no symptoms or who wants to be tested prior to gathering socially with vulnerable people, including people who obstinately refuse to get vaccinated or who are elderly or immunosuppressed (with hope and with help from the federal government, these tests become more available/affordable than they have been for people in the US, compared to Europe and other countries, and offloading the burden on our medical providers, who are sick of doing COVID testing all day long instead of other also important clinical work that creates its own downstream health problems)

- People at high risk for severe illness (like the elderly, immunocompromised) avoiding socializing unmasked during COVID surges whenever possible

- Tracking hospitalization and death rates (especially in relation to local, state, and national ICU capacity)

I am AGAINST:

- Tracking and sounding the alarm about rising COVID case counts (which, by in large, are like "bad colds" [or less] for the majority of the population, especially those who have responsibly been vaccinated and boosted)

- Routine and regular "surveillance" for asymptomatic COVID testing for "peace of mind" of employees or community members (especially those who have refused vaccination). I have always opted out of this testing when the clinic has offered it. Iver was required to have weekly testing in his school's after-care program (as they mix kids from different grades) until he was vaccinated and we've suggested he opt now now that he's had his shots.

- Wasting resources/time/manpower performing clinic-based COVID testing (especially multiple rounds) for patients who refuse to be immunized and who call with non-severe COVID symptoms but with panic about what this means for them and their lives

- Closing classrooms, schools, offices, stores, and businesses or lockdowns to "reduce the spread" of COVID, especially to the eligible-but-still-unvaccinated  (lack of staffing is it's own issue but I think you need to just make do the best you can, just as health care workers and other essential workers have done and continue to do throughout this whole pandemic)

- Isolation periods for employees and people who are well (yet incidentally COVID positive) and who faithfully wear well-fitting masks while at work and comply with avoiding socialization for the infectious period

- Barring masked birthing partners or restricting (by a capped/arbitrary number) doulas from supporting laboring patients or creating barriers to being present for one own child's birth (our hospital policy was currently changed just prior to the New Year to restrict visitors to only one [ideally vaccinated,] masked & presumably non-infectious partner to accompany the birthing patient; the operating room is sometimes even more strict). I have seen firsthand how negatively lack of emotional and labor support during pregnancy and around the time of birth affects birth routes, outcomes, and creates long-lasting trauma

- Mandatory masking outdoors 

I know not all educators/doctors/public health professionals/people agree with all of the above; however, as Kelvin is finding with all his COVID clinic research and work, the CDC and public health guidelines and messaging are adapting exceptionally slow given the state, length, and other social costs of the pandemic, and it really is time for some more common sense.  Something has to give, so life (for those of us, especially exhausted parents, who feel we've done all we can) can go on.

Almost Immune

Iver was due for his second COVID shot during the Thanksgiving holiday weekend. We figured we'd just get him in the following week once home; however, Mason and Sophia had their appointments lined up while we were visiting and Iver was able join in on the Kaiser vaccine fun, allowing even earlier "fully vaccinated" status!

While waiting in line, we saw all kinds of cute (and funny) kids' artwork about getting vaccinated.

He, again, was totally brave without a peep or a tear. 

In the post-vaccine 15-minute observation area, the kids were encouraged to take photos on the "red carpet," dance the funky chicken with their arms to help with the soreness, and to create their own art posters.

I think Mason is a budding immunologist (or professor)-- he was drawing pictures of killer T cells and complement!

Iver and we are so thrilled to have him be just a couple weeks away from being "fully vaccinated." While we know he is not 100% immune to COVID, the risks of being seriously ill, spreading it to anyone in school or outside of school is so much lower that we, along with so many other parents out there, feel like our burdens are so much lighter.  We are so thankful for the miracle and privilege of these immunizations and do feel that the tide is turning with respect to the pandemic in this country (or at least our stress level at getting back out there into the world). Three people down, one in the house to go!

Hope on the Horizon

 Isola dei Pescatori (photo by V)

My parents are in Italy right now, and my sister and her husband, Marco, just returned from their overseas trip there, the first in close to two years. Looking at their pictures makes me long so much for a true soul-recharging exotic vacation and the opportunity to travel again. While I am jealous of the adults-only-all-fully-vaccinated-vacations (while we're still constantly on edge about childcare quarantines over here), I do recognize that we (I mean those in our family) are far closer than we were a year ago to returning to "normal life."  2021 is the only year in my recent memory (perhaps ever in my life?) that I haven't been to a foreign country (we miraculously got to Patagonia before the world shut down in 2020). I'm hoping that we can make it to Jamaica in 2022, a resort trip we've planned with my parents.

The great news: children's COVID vaccines seem to be on the horizon! 

While I believe that quarantines for kids are unnecessary even now, public health officials at least in our state disagree, and I am hopeful that when the under-twelves are vaccinated, school, activities, and life will not be significantly (or at all) disrupted by the threat of (or actual) "COVID contacts."  While I am having a hard time daring to hope, as I thought there was a chance kids might be COVID-vaccinated prior to returning to school this fall (and that the pandemic would be winding to a close--neither of which has happened yet), a possible Halloween "stick or treat" shot for our oldest (which Kelvin thinks is actually quite realistic in terms of timing from what the news is telling) would be a huge blessing (even though "a couple of months" still seems a looong way off for us parents, and Niall is still under five).

Another sign of hope: in a season and after years of drought, we locally had some much-needed rain this past weekend, and the smoky skies aren't nearly as bad as one year ago.

I and many healthcare workers are struggling every week with the exhaustion and long hours that come with working during a (now, eighteen months in, preventable) pandemic and chronically short-staffed.  We are tired of answering calls or MyChart e-mails from unvaccinated (despite counseling) COVID-positive patients at all hours. We are tired of trying to get unvaccinated people in for rapid testing or their monoclonal antibody treatment when ill.  We are tired of seeing babies die because of maternal COVID and our primary care patients die in the ICU. We are tired of having the "vaccine talk" so we could be past this.  I am tired of taking one-in-three three OB call and pulling all-nighters on a regular basis.  That being said, we have some prenatal/delivering provider candidates who I think will sign on in the next couple of months to help share the call burden. Our current providers' maternity leaves will not be indefinite. And, at some point (especially when young kids are vaxxed), the collective "we" will have some sort of herd immunity, whether acquired or natural (new variants permitting). 

"Hope is being able to see that there is light despite all of the darkness." -Desmond Tutu

It's hard, but I am trying to let myself feel that light through the crack, just a little bit...

Historical context and precedent

From a century ago...

 

And from the 50s, when more than 54% of the country believed in science and public health ...

Sound familiar? 

And for the libertarian hold-outs out there who don’t recognize that it’s time for vaccine mandates...

"Society based on the rule that each one is a law unto himself would soon be confronted with disorder and anarchy. Real liberty for all could not exist under the operation of a principle which recognizes the right of each individual person to use his own, whether in respect of his person or his property, regardless of the injury that may be done to others." - from the 1905 Supreme Court ruling in Jacobson vs. Massachusetts regarding Jacobson's refusal to get the smallpox vaccine.

Health care workers have to have some humor amidst the vaccine-refusing defiance we face every day from patients and parents:

All the deltas

 noun: delta; plural noun: deltas

1. 1.

   the fourth letter of the Greek alphabet ( Δ, δ ), transliterated as ‘d’.

   • the fourth in a series of items, categories, etc.

     modifier noun: delta
     ASTRONOMY

     the fourth (usually fourth brightest) star in a constellation.

     noun: Delta ("Delta Cephei")
2. 2.

   a code word representing the letter D, used in radio communication.
3. 3.

   a difference between two things or values.

   "there's a delta between perception and reality"

It was definitely a summer of Delta around here.

There is of course Delta, the variant of the Coronavirus (which is raging locally. One of my FM patients died in the ICU this week and some vaccinated medical staff have tested positive). There is also the fact that the ongoing pandemic forced (for us; many are not acting this way) to scale back and still be cautious surrounding the things we looked forward to being fully open/available once we were vaccinated, which is our more meaningful delta (the stark difference between our expectations and reality).  We did have a brief glimpse of "normal summer"-- a vacation in SoCal and to New Mexico, and one birthday party with friends. It feels like a distant memory(/dream).

Iver just went back to school for the school year a week ago in first grade. He is given marks daily on (+) for "good job" on a skill (like respecting our and others' bodies, doing our best work, following directions, listening, etc.).  The less favorable "mark" is a "delta," which means "something that needs needs changing/improvement" (he's quite the rule-follower and has only gotten pluses so far). 

It's definitely feeling like fall around here-- cooler nights, foggier and cooler mornings, even though I still haven't seen rain.  I feel a change in the area. 

 Good bye, summer (of Delta and watermelon)... 

... and here's to fall Deltas (involving a change in a season... to, with hope, take us out of this Delta wave. A Delta from Delta?!).

First Day of First Grade!

 

More than ever in my life, I am trying to live in the present.  We can't change the past. We can't predict the future (as COVID has shown us the best of us planners over and over) and worrying about what it holds is not productive nor helpful.  You cannot fix all the world's problems or save all of its people. You can only be where you are, forgive and forget, and try to move forward (as hard as that is to do in practice). 

Today was Iver's first day of First Grade. He was one of ~ 340,000 American kindergartners and many more schoolchildren who, due to many public schools' decisions in 2020 to start the year doing "distance learning" (a phrase I try to avoid saying or hearing as it still makes me shudder), missed out on in-person school last year, which affected me deeply.  Here's a recap of the last school year for our young son which I am still trying to move past (even though he seems fine and well-adjusted, mainly because of our privilege and his access to high-quality childcare, which stayed open and very safe).  I know and understand that teachers, administrators, and many parents were scared about illness in themselves, their kids, and for their families last year; however, I still maintain that schools (at least locally) should have never been closed; it made for an incredibly stressful and traumatic experience for many working parents (and, more importantly kids) in an area with low disease prevalence (to put 2020 in context, infection rates of COVID locally at that time were a mere fraction of what they are now [over 100 cases and a few deaths per day, currently with our rural ICU beds full]). It is now obvious to more people that huge educational and social costs (some that may never be able to be regained) come from keeping kids out of school and using screens and "distance learning" as a (sorely suboptimal and downright harmful) substitute for actual face-to-face education (or just play). 

Iver has been excited to return to his small school and see the friends he made in two short months of in-person instruction last year. We still have to submit "symptom/exposure checklists" daily, and there unfortunately is no current before- or after-care due to teacher staff shortages (so he'll still have to be shuttled to his childcare in the afternoons), although we hope it will change sometime in the near future. Nevertheless, just having school open (and the choice to send him) still feels like a HUGE improvement from last year this time, especially because CDPH guidelines don't automatically quarantine a faithfully masked kid from school with a positive school COVID contact nor automatically shut down a classroom/school when there is a positive case (I will be so relieved when kids can get COVID-vaccinated but I personally do not think that asymptomatic or mild COVID cases in kids need to sound any panic alarms when all adults have had ample and free access to life-preserving vaccines and because kids.are.good.at.masking. They should not be hostages for irresponsible adults any longer).

Sunday before-bed reading

He made this sign all by himself.

Flashback to Kinder start in 2020 (when he had all of his teeth!)

We tried to "burn" this ZOOM SCHOOL sign, because we want it to flame out in the realm of our consciousness; however, it would not light (and it is probably better due to nearby California wildfires to not actually try to light anything on fire).

We maniacally ripped it up instead. 

School handwashing station.

Iver had a great first day at school (his favorite parts were apparently arte y recess). Here's to a do-over first day, a new year, a new start, and all the learning (including immersion Spanish!) that these kids expect and deserve (and that this parent could not adequately provide). Here's to this Año Nuevo. Bienvenidos a Primero Grado!