LMS President’s Message, March 2021: “A Return to Normal?”
By James Borders, MD
A common question posed to the medical professional is, “When will things return to normal?” The motive behind the question is a desire to return to a state of no longer considering mask wearing and social distancing as necessary, when businesses and schools return to normal operations, and all of us can return to a more care-free attitude regarding the safety of pre-pandemic human interaction.
Early into the pandemic, from a governmental viewpoint, these public health measures were emphasized in the hopes of not eliminating the spread of the virus but, instead, to “flatten the curve”- to slow the rate of spread so that the number of those becoming ill enough to require intensive care and ventilator support would not suddenly increase to the point of overwhelming our national healthcare infrastructure. Given that such measures were unprecedented in modern times in America, the implied agreement with American society was that the measures would cease once we could become confident that our hospitals could meet the demands of the pandemic. Further, political conservatives have argued that the government efforts should have focused upon educating the public on the benefits of masking, socially distancing, and improving personal hygiene as the means of allowing schools and businesses to stay open.
As we have lived with these new measures, we have discovered that the incidence of influenza and a number of other upper respiratory infectious diseases has fallen sharply in recent months. Statistics have proven an abrupt and early halt to the 2019-2020 flu season in the northern hemisphere. Influenza test positivity rates in the US in April 2020 fell 98% despite only a 61% fall in influenza testing. In the southern hemisphere between the months of April and July 2020, influenza rates were markedly lower. During those months in Australia, Chile, and South Africa, only 51 influenza cases were confirmed in over 83,000 tests. Some of the credit is likely due to reduced international travel along with an increase in influenza vaccination rates. In the United States, influenza vaccination rates increased 2.6% during the 2019-2020 influenza season compared to the prior year such that just over 50% of American adults were vaccinated. Western Australia has seen an abrupt fall in respiratory syncytial virus (RSV) infection responsible for 5% of childhood deaths globally. In Western Australia, RSV rates have fallen 98% and influenza rates have reduced 99.4% despite schools remaining open.
We have yet to fully understand the effect -possibly adverse- on herd immunity rates for many of these endemic respiratory viruses, but early indications are favorable for many of them, likely credited to current public health measures.
All of us recall a noticeable increase in routine precautions in dental offices years ago when dentists and dental hygienists began donning facemasks. As an internist, I long ago cultivated the habit of not touching my face- especially my nose- with unwashed hands. This measure is a sensible and easy measure to maintain after the pandemic subsides. It is likely that healthcare workers in direct contact with patients will be expected to remain masked as a routine precaution from now on. Social etiquette will require an increased sensitivity to donning a mask when going out in public with respiratory infection symptoms, and there will be more pressure from the workplace to remain home if one is ill with a respiratory illness.
We all have realized opportunities afforded us by technology to remain productive. The pandemic has placed us years ahead in acceptance of telemedicine, and many businesses have discovered ways to operate without expensive and time-consuming personal meetings involving travel. It is certain that many routine operations will maintain a “virtual option” long after the pandemic subsides.
However, there are negative consequences to the “new normal”. The impact on hospitality, service, and restaurant industries has been devastating. Besides the financial impact, the human emotional toll of isolation may be comparable. The National EMS Information System (NEMSIS) that provides first responder data for 46 million respondents recorded a sharp increase in calls due to drug overdoses and deaths, mental and behavioral issues, the need for naloxone, and in refusals to go to the hospitals by overdose victims in 2020.
The more subtle effects of the pandemic on the social development of our youth remain to be seen. Traditional parenting has long taken a dim view of the impact of their children’s prolific use of texting and internet communication with others in place of personal interaction. Tech savvy young people take fewer opportunities to learn the subtleties of body language and facial expression so essential for fully effective communication and to build healthy relationships.
Customs of handshaking, hugging, and even kissing as a form of greeting are deeply ingrained in the world’s cultures, but are being re-evaluated in the current pandemic climate. Religious congregations are essential to the world’s faith traditions but customary meetings have been challenged as unsafe. The Bible admonishes Christians “not to neglect meeting together” and Islam encourages followers to “gather together to read the Quran”.
An overriding principle that must not be forgotten is that life, as with love, is messy and involves risk. We need each other and, without others, it is not worth living. With sensible precautions learned during the pandemic, we can return to a “new normal”-one that acknowledges lessons learned in how infectious diseases are spread but one that values the necessity of being together.
James Borders, M.D.
