The days fly by and summer is rapidly turning to fall in Maine. In our last update, we hoped to have the pandemic in the rearview mirror. Sadly, that has not happened in Maine, or across the country and world. With apologies for length, here is the current situation.
In April 2020, we noted that if we were to beat COVID-19, we would need to collectively mobilize in the same way we came together to win the Second World War. We locked down to protect our first responders and hospitals to make sure they would be there when a critically ill or injured patient needed them. We bought some time for science.
Through the last 18 months, we at LifeFlight have followed, contributed to, and engaged with a massive amount of science so we could understand an insidious disease filled with many unknowns. We have experienced peaks and valleys, learning to live with COVID-19 and managing the ongoing devastation as best we can.
As we first modeled what might happen with the pandemic, we expected surges, peaks, plateaus, and valleys as the virus waxed and waned. We are now in our fourth surge. All of the numbers are up in Maine—cases, ED visits, hospitalizations, patients in ICU and on ventilators, and deaths. LifeFlight is caring for multiple, critically ill COVID patients every day. Our hospitals are again struggling to absorb more critical patients with heart attacks, strokes, trauma, or the myriad conditions needing our operating rooms and ICUs. As with other states, we are moving patients far from home as we search for open hospital beds. Worse, with this surge, critically ill patients are much younger—in their 20’s, 30’s, 40’s, and 50’s. Over 20 percent are less than 20 years old and younger children are being hospitalized in much higher numbers.
Nationally, the numbers change every day but according to the Mailman School of Public Health, 1 in every 3 Americans has acquired COVID, and while most people have mild to moderate illness, approximately 1 in every 160 Americans have been hospitalized and 1 in every 496 Americans have died from COVID. In parts of the country, physicians are using crisis standards of care, having to triage those who get full medical care and those who can only be afforded comfort care, because there are more patients than resources. Nationally and worldwide, deaths now exceed the 1918 Spanish flu pandemic. These are staggering wartime numbers. We are at war with an insidious disease that evolves faster than we do. This is a worldwide war fought with science, not weapons, with safe practices and vaccines, not bomb shelters.
What is happening in other states is on the edge of happening in Maine. While cases are plateauing in the southern states, hospitalizations and deaths lag behind cases by 3-6 weeks. New cases are skyrocketing in the northern states as the weather gets colder, we head inside, and schools start the year. The good news of a surge quieting down must be tempered by the high likelihood of the next surge. This is a long game. Maine has one of the highest rates of vaccination in the country—nearly 1 million Mainers have started or completed vaccination for COVID. This has been a tremendous effort, but nearly 400,000 Mainers, over 30% of us, are not vaccinated, including all of our children younger than 12 years old.
In the news, people argue about new state and federal mandates that require all healthcare workers, the people who take care of you when you are sick, to be vaccinated. This is to keep you safe, as well as working towards more universal vaccination. We understand that many people have different comfort levels with mandates.
The mandates are driven by the game-changing impact of the Delta variant. New hospitalizations and deaths continue to rise at alarming rates. The increased transmission and virulence of the Delta variant means the virus is not held in check solely by our previous mitigation measures of lockdowns, masks, social distancing, or handwashing. We know that even some people who are vaccinated can acquire and transmit COVID-19, hence the return to masks indoors. All mitigation measures remain vitally important, but vaccination is the only true protection for the population as a whole.
We recognize that some people are hesitant about a “new” vaccine despite the hundreds of millions of doses safely delivered. We hear their concerns. We know from national data, there can be both adverse (health impacting) and unpleasant side effects (short-lived, not health impacting) from the vaccines. But the risk of an adverse effect is minuscule compared to the number of vaccines administered; the risk of unpleasant vaccine side effects is minimal compared to the risk of acquiring COVID-19. The vaccines have undergone the most intense monitoring program ever undertaken for any vaccine or medicine. You are far more likely to die from COVID-19, which we now know is possible to contract again. At this point, we absolutely know the vaccines are safe and effective.
We continue to struggle with getting as close as we can to universal vaccination.
Here is what we are watching:
On the good news front
- Viruses ‘proofread’ themselves in transmission to the next person. For the visible future, Delta will continue to predominate over new, potentially more problematic variants. We have time to get this under control.
- Vaccinations are increasing, albeit too slowly in the US, but significant worldwide progress is happening, although more needs to be done.
- The vaccines continue to be effective. While boosters and perhaps annual vaccinations are in the future, breakthrough infections remain low.
- While it is possible to acquire a breakthrough infection, if you are vaccinated you are more at risk of spreading COVID-19 for a short time than becoming seriously ill.
- The serious breakthrough infections seem to be isolated to our most at-risk populations with boosters on the way to hopefully mitigate the severity of the disease.
On the challenging news front
- We are in the fourth surge and the original modeling of a two-year horizon now stretches to as many as five years with surges, plateaus, and valleys in the months ahead. Hopefully, the surges will be lighter but there is still much unknown.
- The conflict over mandates, which has occurred with every vaccine mandate across the years, is fiercely partisan, and is tied up with all the other conflicts in society making this much more difficult to disentangle.
- Unfortunately, many people in the first responder community and some caregivers in hospitals are taking partisan stands against the mandates. This is incredibly sad and frustrating as these are the people who take care of our critically ill.
- Influenza season is upon us. (Please get your flu vaccination now)
- We are concerned with the increasing severity of illness in young people, especially children, as influenza and RSV season are upon us. The science is not robust. Hopefully, vaccinations are on the horizon for children.
- Our healthcare workforce is stretched to the limit, fatigued, and frustrated. Compassion and empathy are also stretched and tearing. We are working hard to address the burnout, but we are seeing caregivers leave the profession and we are expecting the PTSD already present across the healthcare workforce to become much more acute.
Here is what you can do to help us. This is very much a call to action.
We appreciate varying viewpoints on vaccine mandates, but the mandate is to protect our businesses, our communities, our schools, and our economy. As much as it may feel uncomfortable and “not right” to some, vaccinations are critical to making sure all of us are safe. Every new vaccine, for every terrible disease, has faced the mandate issue and in every case through history there has been resistance. This was absolutely the case with smallpox and over time we have nearly eradicated smallpox worldwide. We must continue to share this message and overcome the resistance.
We need everyone to speak up. Listen to the concerns of people who are hesitant or resistant to vaccines, but share good science and encourage change. The noise is extremely loud and very one-sided. We all must speak up, quietly, with compassion, with empathy but we must speak up, and publicly. Find the forums you are comfortable with and help us change the tide. We are all in this together and we need all of us to work together, to come together to defeat COVID. LifeFlight needs your help, our hospitals need your help, and the people you look to take care of you in a medical emergency need you more than ever, to save lives.
On behalf of the LifeFlight team,
Thomas Judge, Paramedic
Norm Dinerman, MD, FACEP