HIV and ID Observations

Dissonance: lack of agreement; inconsistency between the beliefs one holds or between one’s actions and one’s beliefs; a mingling of sounds that strike the ear harshly.

It started shortly after the chaotic, disruptive, and all together unpleasant Omicron wave of 2021–22.

It continued through the BA.2 and BA.5 surges, and now plays on through the swarm of Omicron variants that float all around us.

It’s the persistent background sound of an ominous minor chord signaling COVID cases to those of us who specialize in Infectious Diseases — never going away, waxing and waning in volume, all summer long and now into the fall.

That’s one of the two chords playing repeatedly and giving us information about test positivity rates, wastewater data, vaccine and treatment-evasive variants, and generating calls from patients, colleagues, friends, and family members about having COVID.

Undoubtedly this chord will be playing louder as winter arrives, along with variants BF.7, BA.2.75.2, BQ.1.1, and who knows what else is in store. Respiratory viruses, including SARS-CoV-2, are seasonal, after all.

Playing at the same time is a different chord, in a happy major key — probably C major, no less. People hearing this chord can all but ignore that there’s plenty of COVID out there. Sniffles again are allergies, sore throats and coughs no more ominous than what they were before the pandemic. Meaning, not very.

COVID test for that mild sore throat? You’ve got to be kidding. Mask up for crowded indoor spaces? C’mon, that’s so last year.

Schools, restaurants, bars, concerts, big weddings, places of worship, gyms, travel — as noted here previously, all back to normal.

Most people don’t experience these two chords, playing simultaneously. But we do, we ID doctors — a scary chord in one ear, a happy one in the other.

Where does that leave us ID doctors? With a whole lot of dissonance — the sound of those two chords, major and minor, playing together. Minor if we’re caring for the immunocompromised and/or older and frail, or leading the infection control team at the hospital, or managing tight clinical schedules with people dropping out for 7–10 days for COVID, or responding to queries about COVID — the volume of which correlates perfectly with local wastewater concentrations of SARS-CoV-2.

But it’s a major chord if we’re trying to be like most “regular” people, just wanting to get back to a pre-pandemic life.

It’s an appropriate time to bring up this conflict, because we’re on the eve of our big professional meeting, IDWeek — first in-person IDWeek since 2019, which was, of course, the Before Times.

You won’t be surprised that this meeting of ID specialists has strict masking policies, and a vaccine requirement to attend.

You also won’t be surprised to hear that, like the rest of our species, ID docs can’t socialize if it involves eating and drinking without taking off our masks. Figure that half the motivation to attend these meetings (at least) is for this kind of networking. Or that many of us, in our non-ID time, have gone to weddings, parties, gyms, restaurants, concerts …

Some might call this hypocrisy. The very definition of two-faced — yes, literally! Masked while indoors at the meeting, unmasked while sharing lunches, drinks and dinners with colleagues we haven’t seen in ages. Hey, what’s it going to be, ID docs?

Others could argue it’s still rational to require masking at the meeting. As Dr. Priya Nori noted to me during a recent discussion on this topic, we’ll be reducing our risk of viral respiratory infections at least half the day — and some risk mitigation is better than none. This was my view when I shared being invited to a group work meeting that, to my chagrin, appeared to take place in a crowded basement closet. Couldn’t we do better on ventilation than that?

There’s validity to both of these views (hypocrisy vs. risk mitigation), though certainly Dr Nori’s is the kinder and more generous one.

But I have another interpretation. I think we’re just confused. And nervous. And tired. And humbled. And, speaking for myself, we’re collectively suffering through a bit of PTSD, recalling the last two really awful winters, and for those of us from certain urban centers, the nightmarish March–April of 2020.

We can certainly hope those days are behind us, that our vaccine and infection-induced immunity continues to attenuate the severity of disease, that our ICUs and ECMO machines will remain unstressed, our elective surgeries not postponed.

But we don’t know that. Hence the dissonance.

And I hear it, and suspect everyone attending IDWeek in Washington DC this week will hear it too.