Contrasts

Dear Members of the Baylor College of Medicine Community,

It was almost exactly one year ago the Houston Livestock Show and Rodeo shut down, and our lives changed.  I am tempted to say “happy anniversary,” but clearly the one year mark of our COVID-19 experience is not a cause for celebration, and I sincerely hope is not an anniversary (from the Latin, literally to “return yearly”).

However, there is much cause for optimism, albeit balanced by concern. All the viral metrics in the Houston area have plateaued. A plateau is good, although obviously, we would rather see these numbers continue to drop. The more infectious UK viral variant is becoming widespread in the region and will likely become dominant. That will unfortunately put upward pressure on our R(t) value, which is now creeping above 1.0 again, and should reinforce our need for strong personal viral control practices. Although the UK variant is worrisome, it appears to have decent susceptibility to current vaccines.  We are entering the thirteenth week of our Greater Houston vaccination effort, and for the week have been allocated 232,610 doses. By way of contrast, from the first to the fifth week we averaged under sixty thousand doses. As anticipated, the vaccine trickle is now a steady stream, and will become a springtime flood. Vaccine eligibility has been expanded to include K-12 school and childcare teachers and workers. Availability is limited but improving. I suspect by the end of the month the state will further expand eligibility criteria, and I hope in the next 60 days if you want to be vaccinated, there will be opportunity. Nationally, we are vaccinating over two million people daily.

On this cautiously optimistic non-anniversary, I find myself contemplating contrasts.

First contrast – The wide-open expectations of 2020 versus the more modest hopes of 2021. Take ten minutes and do me a favor. Pull out your calendar. Scroll back to this week one year ago. Reflect on your life then and now. On March 3, 2020 we were celebrating the Baylor College of Medicine night at the rodeo. “Midland” was the post-rodeo band, and the Baylor chuckwagon won a hard-fought race.  In an uncanny act of marketing prescience, Baylor sponsored hand sanitizer stations throughout the stadium and grounds.  I left the following morning to fly to Orlando for my academic specialty society meeting. Shortly after I arrived, my colleagues started receiving calls from their home institutions – academic health systems and universities from across the country. The message? “We know you are already there, but we are instituting a travel ban.  Come home now.” I came home, the Houston Rodeo shut down, and almost everything else followed.  We set up Baylor’s Incident Command System, which is still up and running today.  This week, one year ago, our world changed.  Perhaps “our world changed” does not quite convey what happened.  Our old, comfortable rhythms of life were rapidly replaced by an emerging health risk, economic anxiety and widespread uncertainty. For many – for most – it has been a year of loss.

As you reflect on what you have lost over the past year, also pause to reflect on what has been good in your life.  In my case, one year ago I had an infant granddaughter who was just learning to smile responsively. One year later, she is toddling around non-stop, brimming with curiosity and personality. During the year I was blessed to add a second granddaughter (from a different daughter), who is perhaps the happiest infant I have ever known.  Both of our pandemic babies are blissfully ignorant of the difficult historic times into which they were born, and they are a source of joy to our family. A decade from now, I expect my memories will be more about them, and less about infectivity rates and herd immunity.

Given the news of the week, I cannot finish without highlighting a second contrast: Governor Abbot’s enthusiastic and sweeping announcement of his latest executive order (“It is now time to open Texas 100%”), versus CDC’s quiet and cautious guidance on how our behavior can change once we are vaccinated.  I would encourage you to read and understand both.  The contrast between the two could not be more distinct.  

I have already written my opinion of the governor’s order, eliminating occupancy restrictions on all businesses and lifting the state mask mandate. In brief, I understand and support the need to take deliberate steps to reopen the Texas economy. I would argue that some reasonable indoor occupancy limits are still necessary, but I primarily object the lifting of the mask mandate, which is not data driven and sends the wrong message to Texans at a critical time.

If the governor’s order was Texas-sized, the CDC announcement more like Rhode Island. As more people are vaccinated, individuals and businesses are hungry for information on how our vaccination will change our viral control practices. The answer? Very briefly summarized, for small private gatherings, you can take off your mask if everyone is vaccinated, or if you are vaccinated and visiting someone who is considered low risk. By my read – it is not well defined – a small private gathering is going to visit your Aunt Sally. It does not provide guidance related to businesses or public gatherings.

If you fully accept one of these announcements, you cannot accept the other – they are completely incompatible.  On the one hand, reopen without restraint.  On the other, take a small step to remove your mask in tightly defined situations.  How can they be so different?  I think it reflects a difference in mission and frame of reference.  Every political leader – liberal, conservative, progressive or populist – needs to balance multiple competing priorities.  Pragmatically, a successful politician must also consider the political consequences of decisions.  On the other hand, the CDC’s sole mission – the reason it exists – is “to promote health and quality of life by preventing and controlling disease, injury, and disability.” It does not have competing priorities, is deeply rooted in data and science and careful by culture and design.  As I write primarily for an academic health system audience, this is likely the view that will culturally resonate.  A group of small business owners might reasonably have a different view.

Given this and many other starkly contrasting messages from leaders, institutions, experts and media, how are we to know what to think? Is the pandemic over? No. Should we all stick our collective heads in the sand until someone signals it is safe to come out? No. We should listen well and deliberately.  We each have a responsibility to reach our own well-informed opinion.  This is perhaps the one of the largest frustrations of living in a democratic system, but clearly it is also the single biggest strength.  Be aware of your political leanings.  Take the time to seek out and listen to an opinion with which you violently disagree and make a sincere effort to understand an opposing point of view. Listen to understand, not to refute. You probably will not change your mind, but you will be better positioned to make a truly informed decision.

In the meantime, how should we approach the next several weeks?  Continue to follow good viral control practices – mask, maintain physical distance, stay out of crowded indoor spaces.  If you have symptoms of an illness – especially respiratory symptoms – do not go to work or school and take steps to keep from infecting others.  Support the economic recovery of our community by frequenting businesses that are open and have a visible commitment to keeping people safe.  Thank them for their efforts. Finally, vaccinate.  When you have an opportunity to receive a COVID-19 vaccine – any vaccine – take it.

It is not quite time to remove our face masks, but the day is coming soon – my guess in the summertime, perhaps in the fall.  When we finally celebrate our great unmasking it will be an act of unity, not division. Of cohesion, not contrast.

My mask comes off when all masks can come off.

Stay well.

James T McDeavitt, M.D.
Senior Vice President and Dean of Clinical Affairs

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