HIV and ID Observations

Three works of art sit on my father’s desk in his office, gifts from his children from when we were in grade school.

From my brother Ben, there’s a little bear, or perhaps it’s some other burly quadruped — easily a B+ in his art class from the 1960s, likely an A- now with grade inflation.

A graceful ceramic bird represents my sister Anne’s contribution. It’s elegantly taking wing with the kind of naturalistic style one might have found from Bernini himself as a 6-year-old. I can just hear the teacher’s approval as it came out of the kiln — top-of-the-class kind of stuff.

My piece of “art” is a rock with three small shells stuck on awkwardly by Elmer’s glue. Ouch.

In short, in our family Anne got the bulk of the artistic skill (and I got the least — almost zero). Long-time readers may remember her cartoons from our ID caption contests, this figure of the Four States of Clinical Medicine (a particular favorite of mine, so clean), or this Fulyzaq, may it rest in peace.

I bring this up now because Anne kindly asked me what life is like for us ID doctors now 2 years into the pandemic.

I tried to explain it by saying that our usual distribution of work and non-work activities are constantly barraged by this big bully, COVID-19. If you picture your life as a pie chart, with each slice representing how you spend your time, along comes this scary, gigantic brute shoving everything else aside and making the rest of your life experiences and activities that much smaller.

Anne was kind enough to sketch it out for me — it looks something like this:

The compression of non-COVID stuff is a loss — it’s even more extreme during surges (now), with the COVID part occupying at least 80% of this pie chart. And 90% of our worries and disturbing dream content.

So what are the consequences for other work and life activities? Let’s consider a few, selected at random from my experience and that of my colleagues.

That friendly call to your patient who recently started HIV therapy to give them the good news about their first monitoring blood tests?

That research on molecular mechanisms of drug resistance in shigella?

That quality improvement project on optimal management of Staph aureus bacteremia?

That teaching module for medical students on the diagnostic approach to fever and rash?

And finally, that hike in the woods to the top of a nearby mountain with your family, fully disconnected from work?

All made that much smaller — or delayed or skipped — by this giant piece of pie insensitively hogging space in your life chart. There’s only so much time in a day.

Of course, this is understandable. We’re infectious diseases specialists, after all, and the pandemic is caused by an infection, a virus. And no doubt this is true for other clinicians in various specialties — emergency room doctors, primary care providers, pulmonologists.

But I can guarantee what another pie chart looks like. It’s shows the percentage of ID doctors for whom the pandemic has massively shrunk the time they have to spend on non-COVID activities.

It’s a big circle, completely filled in, 100%. All of us.

Even I can draw that one.