A post-pandemic journey

CLINICAL MATTERS

I’m writing this column on the Wilderness Express, a train going from Anchorage, Alaska to Denali National Park. This is the first family vacation I have taken since the start of the pandemic, and it feels surreal. After two years of death and grief, things are finally starting to go back to normal. While there is already a semblance of normalcy in our movements and activities, the scars in the hearts and minds of many, especially healthcare workers like me, still run deep.

All of us have stories of life interrupted as a result of Covid-19. Most people had to stay at home and contend with financial difficulties and the mental anguish of isolation. Healthcare workers and their families had to experience this on top of their duties in the hospital. Our family was hit by the pandemic life due to the nature of our professions. My wife and I and my parents-in-law are healthcare workers, three of us continuing to work during the pandemic. 

As an infectious diseases doctor, I was asked to see patients, run a Covid-19 research laboratory, and advise the national government on the Covid-19 response. My multiple roles exacted a deep and lasting mental exhaustion. I had to attend over 500 meetings as a member of the Technical Advisory Group (TAG), see up to 60 Covid-19 patients admitted to the hospital each day, and fulfill my duties at the National Institutes of Health (NIH). My wife is a gastroenterologist/hepatologist at the Philippine General Hospital (PGH) where she was the training officer of the GI fellowship program. She was asked to supervise trainees more intensely and do procedures on Covid-19 infected patients well before the vaccines arrived. We both put life and limb on the line every single day.

This is my second trip abroad since the start of the pandemic. The first was back in April 2022 to attend TED in Vancouver as a senior TED fellow. That trip to Canada was a lot of fun but it was also very busy and did not feel like a vacation at all. Before the pandemic, we took yearly trips as a family to the US for nature tripping at national parks like Yosemite and Yellowstone National Park. During the pandemic, we were supposed to attend my brother’s wedding in Hawaii in May 2020 but we had to cancel. Many other trips, mostly business and academic meetings abroad, were canceled as a result of the widespread lockdowns. The trips I missed the most were still the ones with my family, particularly those that involved nature and wilderness, which are the most calming to my frazzled brain each year of working in the high-pressure worlds of medicine and academic research. After the most challenging two years of my life made worse without a break, I was looking forward to time away to heal.

My kids, like most Filipino children, had to stay home and do online classes throughout the pandemic. Aside from the psychological impact of not being able to attend physical classes and interact with their classmates, they also had to contend with their parents being in harm’s way. My daughter would slip drawings under my bedroom door when I was in quarantine, while my son constantly worried about our wellbeing whenever my wife and I went off to work. 

In the days leading up to this trip, my kids were excited and kept asking how much longer we left. They worried about Covid-19 and whether this trip would end up getting canceled like the one to my brother’s wedding. We explained to them that we were all fully vaccinated and that the chances of getting very sick were low. Wearing a mask on the plane would further decrease the risk of getting infected. They were aghast once we got to the US when people weren’t wearing masks on the planes or in the airport. I explained that people had different belief systems as to what was important to them. In the US, people put a premium on their freedoms and did not necessarily use masks or access vaccines as a matter of choice. Unfortunately, this meant accepting the highest number of deaths from confirmed Covid-19 in the world–over one million deaths in a country of 330 million people. In contrast, the willingness of Filipinos to accept masks, vaccines, and mobility restrictions meant we had a relatively small number of deaths–about 60,000. These cultural differences are why I am grateful I have the means to take my kids on international travel. We make our choices as a country different from others around the world and we have to learn to respect diversity.

Reflecting on the last two years, it feels like a dream. Or more appropriately a nightmare. We lost many people dear to us. I took care of friends and family. I took care of some of my medical school professors, losing some of them. I fielded calls left and right, even when I was quarantining myself. I had to dig deep and keep my eye on the ball to guide the Philippines’ pandemic response, even as I was scared to death for myself and my family. There were times I would feel deep frustration as political and personal attacks came thick and fast despite the ultimate mission being to save lives. Some of the lowest blows came from my own colleagues and students who questioned our motives as we did our best to serve the Filipino people.

As we slowly emerge from the pandemic, the specter of further waves is always on the horizon. BA.5 is driving hundreds of thousands of cases worldwide. We remain open, however, with minimal restrictions and the deaths are low, thanks to vaccines. Updated vaccines are on the way and the low healthcare utilization despite rising cases means we are finally learning to live with this virus. It is not a license to be careless and we always need to be mindful of the more vulnerable members of society. My roaming cellphone signal has disappeared since we flew into Anchorage. It feels like a forced disconnect from my healthcare responsibilities. But it also feels like I am finally coming to terms with the trauma of the last two years. Humans are meant to be out and about. Seeing nature and accepting our roles in the grand scheme of things helps me move on and be at peace.