By Dr. Max Hammonds
“1 – 2 – 3 – lift!” Will called out as he and his nursing team lifted the draw sheet and turned Mr. Paxton face down. Amy, the respiratory therapist, guided his head simultaneously and placed the specially designed face pillow to support his head, then quickly reattached the breathing tube hoses. Will reassured himself that the team properly positioned the patient for ease of ventilation. Then he stepped out of the room and collapsed into the nearest chair, his yellow isolation gown billowing out, his hood covering his head, his filtered hose hanging down his back like a long Chinese queue. He sat very still with his head down, his eyes closed.
“How long have you been up?” Dr. Martin sat on the unit desk, facing Will.
“Seventeen hours.” The nurse team leader didn’t raise his head. “Eddie tested positive. Maggie and I broke his 12 hours in two. We each worked half his shift.” He looked up through his face shield. “I have to sleep soon. Be back in here in . . .” He looked up at the clock. “In seven hours.”
“I’m staying in the call room on third floor.” Dr. Martin rubbed the back of his own neck, donning his own mask and half-face shield. “Sleep up there and save yourself the drive home.” Will nodded his head, gave a weary, thankful “thumbs-up.”
“How long – I mean, why does this go on?” Will stared at Dr. Martin.
“Because we promised to care for them.”
“Yeah, I did,” Will shot a quick half-smile, then sat up straighter. “But – I mean, this Omicron variant – it’s more infectious, but usually less serious. Why are so many in here dying – again?”
Dr. Martin collected his thoughts, organizing what he had read into an easily understood explanation. “Omicron – the fifteenth letter of the Greek alphabet. That’s how many genetic mutational variants of COVID-19 have appeared so far. They continue to appear because we have so many people still unvaccinated. Gives the virus a place to grow and mutate. Had we vaccinated everyone in the world as quickly as possible, there wouldn’t have been any variants – no Delta – no Omicron.” Dr. Martin was standing now.
“Actually, we got lucky with Omicron. Because it is so easily caught, so infectious, it has
driven Delta almost out of existence. Ninety-five percent of our patients are infected with Omicron. And we’re lucky because Omicron only makes about 20% of those who catch it sick enough to be in the hospital.”
“Then why all of these?” Will spread his hands wide, gesturing to the full ICU beds.
“Because Omicron infects so many more people, even the smaller percentage of those who get hospitalized are greater in number than what we had with Delta. And if you get so sick you are in the ICU with Omicron, you have the same chances of weakening or destroying the body’s organs, the same chances of dying, the same chances of long-haul COVID as with the others. Thus, the new surge of cases.”
Will shook his head. “To make matters worse, two out of three of our monoclonal antibody treatments don’t work on Omicron.” Again, he looked to Dr. Martin for an explanation. “Why?”
“Because – like the common cold, when we catch one cold virus, the antibodies our bodies make against it won’t keep us from catching another cold virus later on.”
“Omicron is just enough different from the earlier variants.” Dr. Martin began to pace in his own frustration. “If you were infected with the Alpha variant, the antibodies you made in your body were specific to that variant. When you are exposed to a new variant, like Delta, your antibody response will not be as vigorous as it would be if you were exposed to the Alpha variant again.”
Will suddenly sat upright. “But the Omicron variant is enough different that people who were exposed to Alpha or Delta are not immune to Omicron hardly at all. Is that it?”
Dr. Martin nodded his head in resignation. “Exactly. Their antibodies don’t help. It’s like they’re starting over – like with the common cold. And because it’s so different, the monoclonal antibody treatments don’t work most of the time. And the new antivirals from Pfizer and Merck are in short supply – and have to be taken within 5 days of first getting sick.”
“With the shortage of testing kits, that’s not likely to happen.” Will leaned back in his chair, his face a study in frustration. “So, here we are with an ICU full of patients with a new variant and few means of treating them.” He held out his hands in supplication. “So, what do we do? How do we stop this?”
“First line of defense: vaccination.” Dr. Martin turned to face Will. “Our current vaccines produce a broad enough antibody response in our bodies that they are effective in protecting against Omicron – not quite as good, but very good.”
“But that won’t work if people won’t get vaccinated.” Tiredness dripped from Will’s body like sweat.
“Exactly,” Dr. Martin said, “Second line of defense is testing.” He turned to face Will. “And masking in public places and when with people not in one’s own bubble. And pray for those who can’t take the vaccines or for whom they don’t work very well.”
Will slowly stood up. “And pray for the patients in our ICU. Most of them were unvaccinated. Two out of the 15 were vaccinated and boosted, but one has emphysema, one has chronic renal failure – neither likely had good responses to the vaccines. Don’t think either of them will make it.” Will started for the next room to turn another patient.
“Better get some rest,” Dr. Martin called after him.
“In an hour,” Will responded.