Hello! Your friendly next-door ID physician here checking in! I haven’t submitted anything here in several years. I’ve been too caught up with my work and family to delve into my creative side. But the very recent news that we will have a new head of human and health services (an individual without formal health care training and who has expressed a rather strong anti-vaccine sentiment in the past) paired with the recent reports of rapidly spreading H5N1 (avian) influenza has driven me to extremes: Taking time out of my normal chaotic day to sit down and write.

The COVID-19 pandemic was bad for our family and me personally. When it hit the U.S. in the early spring of 2020, I had recently taken on a lease for a new office space for my solo ID practice. I had hired two new staff members to help run my clinic. I had just signed a contract for a rather pricey new EMR system (they are all rather pricey—I contracted with the least expensive company for my needs). I had hired someone to assist with marketing, invested in a medical fridge, new furnishings for my office, and an abundance of supplies (so my office would be well-stocked for everything from wound care to IV antibiotic infusions in-office, etc.). This was supposed to be my “dream practice.” Everything I imagined that would make a consummate patient-centered practice was poured into it. My entire heart and soul and everything I had worked so hard for during my career was in this practice.

I started hearing about some human cases of COVID-19 in January 2020 in China. No worries yet, though. We can prevent spread with the timely closing of the borders, right? Nope. Wrong. I saw Italy getting pummeled with cases. We started getting reports of U.S. cases of COVID-19. I’m not even sure of the order of these events anymore. I just remember I started getting worried. Then I began personally seeing the first U.S. cases in the hospital. The first case that I can remember was a very young woman in her 20s who became catastrophically ill in a rapidly progressive fashion. And I started to become terrified. Because I literally only had my prayers to rely on: They paid off, and she eventually survived. Barely.

This continued for the next two to three years, but in high volume. So we could no longer process the critical illnesses and losses of life slowly and carefully, as in the first case. But the experiences were all very traumatic nonetheless: The man in his 30s who suffered a massive MI post-COVID-19 and held on dearly to life for a couple more weeks before passing; the physicians and nurses and other medical staff we heard about passing; the people whose lungs sustained permanent damage, sometimes being referred for lung transplants. Luckily, researchers rapidly started studying the virus and finding out which medications were effective and which were not. I frequently scoured the regular reports by the CDC and NIH on transmission risk and treatment recommendations. They guided my management decisions every step of the way; they were my lifeline.

I screened patients regularly for receipt of treatments like remdesivir and convalescent plasma and monoclonal antibodies and tocilizumab, as they began receiving emergency FDA approval for COVID-19 management. Many patients accepted the treatments, and some declined. They were able to choose whether they received the still rather experimental but sometimes lifesaving treatments. After all, it was all that we had at the time.

Similarly, when research came out that drugs like ivermectin and hydroxychloroquine were not found to be effective, I stopped using them and discouraged inappropriate requests for them from patients. And lo and behold, we had vaccines available by December 2020. I was first in line for the vaccine after seeing the devastating effects of COVID-19. Even if it did not work, at least I would have tried to prevent it (I’m going to say it was likely effective for me; the first time I developed COVID-19 was a URI in September 2023, likely from my child’s school event). Once the vaccines were rolled out on a larger scale, I encouraged my family members to protect themselves as well. And of course, I encouraged my patients, especially high-risk ones, to obtain the vaccine. And mask up, of course. Quite simply, I rather like my patients and did not want them to die. That is it. Nothing complicated about it.

It was difficult to watch the plethora of misinformation and attempts at the use of inappropriate agents in the treatment of COVID-19 during the next few years. It was difficult to watch some people deliberately thwart public health measures or berate public health officials and places of business for implementing safety measures. It was extremely difficult to have people suggest that health professionals were somehow personally profiting off this utterly devastating pandemic that we would have given anything to prevent. But most of all, it was difficult to continue to keep both my family and medical practice from collapsing during all of this. In fact, at least one of them did not survive.

I attempted to keep my inpatient and office practice afloat for at least three years during the subsequent extremely turbulent professional and personal time. I retained my clinic staff for about six months into the pandemic, thinking it would be over soon (and very stupidly, never even attempting to apply for a PPE loan; I was too overwhelmed to think about it). I did not want to let anyone down (story of my life).

Eventually, one of my staff left due to concerns about her children’s remote schooling, risk of exposure, etc. All this time, I dealt with my own personal family problems.

The onset of COVID-19 coincided with an extremely difficult time period for one of my own children, who was going through mental health issues and a recent school change. Things were just starting to look up at the new school when COVID-19 enveloped our world. Remote schooling was not good for either of my children, who were traditionally very strong academically. Their mom (me) was gone most of the time, swimming in COVID-19 patients (with extremely thorough isolation precautions), and when I finally got home, my children were petrified to come near me.

Alas, my solo medical practice did not survive. A few years into the pandemic, I was given an offer that I could not refuse. Basically, I became an employed physician again, something I had never thought I would go back to. But it came at the right time, and it had many of the opportunities I was looking for as an infectious diseases physician. I am very grateful for it. I think it saved my family when I finally closed the very stressful solo private practice.

But I do not think my family can survive another pandemic. And the H5N1 influenza cases are starting to worry me. I am having some flashbacks to the very early COVID-19 days. Without regular reports, how will we know about and prevent further transmission, if it happens?

The author is an anonymous infectious disease physician.