Yeah. Covid-19 is currently waning, but the emergency rooms are getting swamped. Why? Because lots of people stayed home to avoid Covid-19 and did not see their doctor for "little things". Like a colonoscopy. A mammogram. Routine care is kind of important, especially with chronic illness. Legs a little more swollen in heart failure. That chest pain. Turns out it was a myocardial infarction a month ago and now you are in heart failure with a cardiac output of 32% when it should be 55-70%. Ooops. You are very short of breath when you walk, and are worried that it is Covid-19. It isn't. BUT if you get Covid-19 or influenza with that cardiac output, well, dang. Might well die, honey. Sorry.

Yes, you are an emergency, but so is everyone else. And if you are a lesser emergency, you gotta wait in the hall. A new thing? No. In residency at OHSU our team of family medicine docs on the internal medicine ward would cheer when the hospital was "On divert". That meant the ER was full and the ambulances would go to the other hospitals in Portland. We were not on divert very often. We were on call as a team every fourth night. So maybe twice for us in the six weeks of the rotation. "On divert" did not mean the fire hose of patients would stop immediately. They might admit six or ten more to our team, from the full ER. But if it happened at say, 6 pm, we MIGHT get to sleep some that night. Maybe.

So "on divert" is nothing new. But if it is happening at multiple hospitals in a city three times a week, that is ominous. We are just entering winter. Influenza is just waking up, stretching and thinking, hmmm, might be time to wake up and move to the Northern Hemisphere. It is still pretty mild this year. But now we have Halloween, which is usually not so bad. The bad period, from a clinic doctor point of view, is January 2 and on. Most years we slow down from Thanksgiving to New Years, because even though people are sick, they do not want to come in. They are with family or doing all the school Christmas/Kwanza/Hanukkah/Pagan/Winter Break/whatever stuff. As soon as New Year's is past, the phone rings off the hook. New Year's resolutions, been sick for a month, I've been meaning to get the referral for the colonoscopy, I haven't seen a doctor since 1999, and so forth. For the last two years, there was not much slow down but we got very busy in January. We see bumps: the spreading of colds and flu and whatever at Thanksgiving and then even more so at Winter Break.

I do advise influenza vaccines, especially if you are going to travel. Oh, the airplanes are really clean? Yes, well, I am less sure about the airport and where ever else you go at your destination. I got my flu shot a week ago and am now teed up for my covid booster this weekend. Hoorah. Protect yourself, your family and others. The covid booster may make me feel crappy, but that will be a milder crappy than getting Covid-19. It's all relative. And then there is long Covid. I have a family member who keeps sending me ivermectin information. I am fine with using it appropriately for parasites, but not for Covid-19. I just don't find the studies convincing and in vitro is not the same as in vivo. It can look great in a lab but then it either works in humans or it doesn't.

Be careful out there.

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