I went back to clinic after the February vacation 2020 still sick. It’s a reminder of how little we knew back then, because I wasn’t coughing, I didn’t have any symptoms besides the fever and fatigue, I thought everything would be fine using sanitizing wipes after every patient on the doorknobs and spraying Lysol in the waiting room when no one was there. Of course I’d stocked up on all of this stuff and with things that kept well but I never ate, like ramen, in early February. Following the Chinese, Iranian, and Italian experience with the novel coronavirus, it looked like a predictable consequence of hospitals overwhelmed, thousands dying, videos of people collapsing in the streets. It would be bad.
I never anticipated that little alcohol wipes would go from $1.50 a box on amazon to $65 or unavailable…we were flexible, bringing in cotton swabs and little bottles of isopropyl alcohol. I repurposed furnace filters and bandanas to make some very snazzy masks.
Six weeks later when we figured out (maybe) what the heck was going on with the kids’ COVID toes I had to tell all the patients I saw those week that they might have been exposed. As far as I know no one caught it from me in those weeks except perhaps one person who was not a patient. Everyone was really nice about it, considering. Again, I still don’t know if I had COVID and I never will.
I couldn’t call out sick, not really, not after a full week off and after all if I didn’t see patients no one else really had the bandwidth to cover, and not least…patients who weren’t seen didn’t bring in any revenue to our lean-run clinic. Self-employment means freedom and a lot of vulnerability.
There’s a narrative now that it was all a hysterical over-reaction and that everything would have been fine if we didn’t close schools or do any kind of lockdown (even the relatively mild lockdown we experienced in the United States). I’m part of a medical family of doctors and nurses, and we have friends all over…New York City locked down except for ambulances 24/7, they ran out of morgue space, and medical professionals were rounding trash bags as protective equipment and saving their precious N95 masks in paper bags to reuse them. In Massachusetts we just avoided overwhelming the hospitals by the skin of our teeth in April 2020. Locums were hired from everywhere, entire floors of regular hospital wards were converted to makeshift ICUs with rented travel ventilators, and outpatient family medicine docs and pediatricians were pulled in to round on the mass of terribly ill adult patients.
A lot of later stuff was ridiculous, like mask mandates in restaurants where you walk to your table with you mask and take it off once you sit down. But early on the brief total lockdowns really did spare the rest of the country from a New York City experience, at least for the few weeks everyone was on board. We really didn’t know anything then. We didn’t know about airborne spread, or when steroids were best, or any antivirals that worked and when to use them.
Even now that pervasive narrative that it was all a waste of time and fear and energy erases the over a million people who died of COVID in the US in the last 3 years. The first guy in my town who died was 54 years old and had teenage daughters. After the first 100,000 the NYT ran a full page front story with their names. But what do you do with a million gone? There are people who still think most of those were killed by a bunch of doctors who all the sudden freaked out all over the world and went rogue and madly ventilated thousands of patients who didn’t need it.
As always there’s a kernel of truth in the conspiracy, in that COVID patients tolerate lower oxygen sats than we are used to, so the paradigms for inducing ventilation could be held off for a little while longer…but it doesn’t mean that doctors ventilate people willy nilly. Do you know how much paperwork is required for an ICU patients on a vent? Conspiracy theorists ignore this.
I was so gloriously (yes, the lazy use of an adverb is worth it here) fortunate. Due to the sudden changes ordered by the Governor of Massachusetts in March 2020, we could close down our in person clinic and see everyone virtually without any break in care, and I didn’t risk a thing seeing them. I’m the youngest kid of the youngest kid by a lot, so I have a whole slew of elderly aunts and uncles and cousins. The advantage of being part of a massive nerd family is they wear masks and get vaccinated and the parents and aunts and uncles are all in their 80s and 90s and doing great.
One of my uncles worked at Los Alamos for many years. He carries uranium ore in his pockets (he always shows it to you without asking, juggling the rocks in his hand) because he thinks low level exposure to radiation is healthy. He’s 97 now and has 5 kids and I don’t even know how many grandkids.
Another way I was fortunate was in the age of my children when all this went down. They were old enough I didn’t have to babysit their online schooling (honestly the most stressed people in the early pandemic aside from the front line health care workers and the sick were the parents of babies, toddlers, and young school aged kids who were trying to work full time from home and watch their kids…they were even paying daycares to keep their spots!). My kids were young enough that they weren’t missing out on senior prom or even middle school graduation, but old enough that I didn’t need to memorize their logins. They learned pretty fast not to do anything they didn’t absolutely have to which meant they ignored a lot of the assigned school work…I guess that is a life lesson too.
That first year I only had the fevers for 3-4 weeks once every season. I still thought it was just maybe how my colds went now. No sniffles or coughs or sore throat, just a low grade fever and fatigue. It could be pushed through and I did push through it, and now I could go straight to my bed if I had a patient who was telephone only or if there was a break in the day.
Seeing patients online exclusively takes a lot of extra energy. It’s just harder to emote over video chat, plus the eye contact sucks. Once the vaccine came out I moved back to the office and said anyone could see me in person if they wanted to. We wore masks and I had plenty of extra air filters running. Hardly anyone took me up on the offer. Telehealth was just so much more convenient.
I grew to hate the office. Our gregarious secretary quit a month or two after the pandemic started because she was totally alone in the large office. Her replacement was an efficient mechanical engineering student who did not do small talk. Every time I got the fevers again we had to call everyone to be sure to see me virtually and not in person.
After a few hundred of these calls I figured it wasn’t my weird way of having a cold now but maybe something I should talk to my doctor about.
What is the general relationship between fevers and fatigue? Does a fever always cause fatigue? I assume you can be fatigued without having a fever. But is that true?
Was your fever outside the daily 24 hour variation in body temperature? Don’t our temps go down when we sleep?