Anything But Normal

Governor Kathy Hochul said she wants New Yorkers to feel like life is returning to normal. So to help, she lifted the requirement to wear masks on public transit.

But the reality is that the disruptions wrought by COVID-19 are broad, deep and very much continuing. Whether you decide to wear a mask on the subway or not, we are nowhere near knowing what normal will feel like – new normal or otherwise.

Medical providers say they are still trying to put care back on track three years into our long pandemic, while at the same time coping with a new surge of health worries.

Is that a cold coming on? Or the flu arriving fast and hard from Australia? Or, maybe, it is actually the latest variant of COVID-19?

“Now, in late 2022, that doesn’t necessarily bring on the same fear or anxiety as it did in 2021 and 2020, but there is still an ‘Oh my god, I’m coughing, let me call my doctor’,” said one of those physicians, Dr. Judy Tung, section chief of Adult Internal Medicine at NewYork-Presbyterian/Weill Cornell Medical Center. “Whereas, pre-pandemic, people probably lived with it, worked with it, went to school with it, without the same hullabaloo.”

This surge in reported symptoms probably has two causes, said Dr. Tung, both traceable to the pandemic.

“Part of it is definitely heightened awareness and that, I think, is a good thing. Right?”

Instead of suffering in silence, and silently spreading COVID-19, many more of us, Tung said, know to pay attention to cold and flu like symptoms, look after ourselves and get tested for COVID-19.

“It is important to get tested for COVID if you have cold symptoms — not because you are going to get gravely ill, but because you may inadvertently pass it along to someone who could get gravely ill,” Dr. Tung explained.

Other Ailments

But there is clearly more than heightened awareness at work. While vaccines and treatments and partial immunity from past infections have made COVID-19 less threatening (although still dangerous to some, as Tung points out), our efforts to isolate ourselves from the waves of COVID-19 seem to have left us more vulnerable to other ailments.

“Some of it is actual change in the way our immune systems are unaccustomed to perhaps seeing things that we were constantly exposed to before,” Dr. Tung said, “that does make the symptoms complex a little bit more severe and last a little bit longer.”

Tung, whose practice is on Williams Street, also sees patients on the Upper East Side at NewYork-Presbyterian/Weill Cornell Medical Center. She said she has observed these more severe symptoms among common cold sufferers this summer.

A major concern for the fall is flu season. Masks and social distancing have kept flu seasons mild through the pandemic and also unfamiliarly late. This past flu season got off to a slow and mild start compared to the pre-pandemic norm, but it lasted unusually far into spring.

Now, health officials here have watched with concern as flu spread fast and fiercely in post-lockdown Australia, which is often a harbinger of flu to come in the northern hemisphere a few months later.

So officials are firing up their reminders to get your flu vaccine (including a new strengthened version for seniors), even as they are also pushing new COVID-19 booster vaccines reformulated to deter Omicron.

Hochul took her jab of the revised COVID-19 vaccine even as she lifted the transit mask mandates.

Legacies of the Pandemic

These competing calls to action are one of the legacies of the pandemic that will be with us for some time, along with updating other vaccines and catching up with preventive measures like colonoscopies.

The feeling that both patients and their medical professionals are a bit overwhelmed by it all, is part of why federal health officials are now saying that from here on they expect to establish an annual schedule for COVID-19 vaccines. They hope this cycle, familiar for flu vaccines, will make it easier to keep everyone protected against COVID, too.

But even this annual cycle isn’t as simple as it may appear, Tung said, in a reminder that medicine is the art of deploying science effectively.

She noted that the flu vaccine begins to lose effectiveness within a few months. So in the last two years, with the flu season slow to start because of pandemic measures, she has counseled patients to wait until later in the fall to get their flu vaccine to increase the likelihood it will still be robust for a late flu surge in spring.

“Sometimes getting it too early doesn’t actually extend the protection for as long as we need it,” she said. “So for example the last two years where we saw the peak happening more in the springtime would lead me to advise people to try to get it closer to November to last all the way until May.

But this fall the advice will probably be different. “Because its hitting Australia a little earlier I think we will not ask people to wait until November and get it as soon as it’s available in September or October, especially if it looks like the season is going to start in November or December as opposed to February or March.”

Serious Challenges

The idea, offered by Hochul and others, that we are getting back to normal, is particularly hard on doctors and other health professionals who are trying both to keep up with the many changes the pandemic wrought in our health patterns while also rebuilding from all the damage it did to the health care system itself.

Burnout, Tung said, is still a serious challenge among her colleagues. Things were hard enough when, at least, we all went out and banged pots and pans to show our united support.

But the feeling is that support is fading even though the challenges are not.

There is a particularly acute shortage of social workers and mental health professionals and many doctors now find themselves doubling as informal therapists in cases of anxiety and depression.

In another example, Tung said she was working to get all 40 doctors in her internal medicine unit licensed to practice medicine in New Jersey, even though they are all based in New York.

Why?

Because telemedicine, a boon and a literal life saver during the pandemic, was possible because many states loosened their licensing restrictions to allow, say, a New York based doctor to treat a patient who used to come into the office in New York but now was sheltering at home in New Jersey.

But with the supposed return to normality, those restrictions are being re-imposed to the distress of Tung and others.

“As one of my doctors recently said to me, ‘it’s these small paper cuts.’ Right? It doesn’t feel like a big deal to get a New Jersey license. But it also doesn’t feel like a big deal to not have a social worker. These strains are cumulative. What I think contributes the most to burn out is the feeling you don’t have the resources to do the kind of care every patient deserves.”

That is the normal that Tung and her colleagues hope to see some day.