Plague Year

personal history by Frank Diamond

In September 2019, I got laid off from my job as an editor of a trade publication that covered the managed health care industry. (That publication, Managed Care, has since gone belly-up.) It’s a common story in publishing but fortunately, in November, I landed another job with another trade publication called Infection Control Today. ICT had recently been acquired by my new employer (who publishes about 60 medical trade publications) and had not seen much love in recent years. The editor who preceded me quit suddenly and there had not been a steady editor for about two months before I took over. At that point, ICT existed in pamphlet form; the junk mail you’d toss automatically. 

As a beat reporter assigned a new beat, I knew the deal: Learn to earn. The goal was to increase the quality and quantity of content (making it a real magazine with a spine big enough to fit volume and issue numbers), develop sources, get a handle on the subject matter, build an editorial advisory board and master technological stuff that proved especially daunting to a causally anti-tech scribbler like myself. I had only recently surrendered my flippy for a smart phone and, at that point, did not know how to do such rudimentary things as send a photo via text. Or even take a photo. (Photos are overrated.) 

Luckily, my supervisor guided with patience and I relied heavily on the skills I did possess—writing, reporting, editing, ducking, dodging, blaming and whining. 

I had landed in the backwaters no doubt, though. Both in terms of the subject matter I’d cover and within the company, which publishes brands about oncology and neurology and a slew of other diseases and conditions that expert readers devour. Those mags were sent through a crack copy editing department, but not ICT. It didn’t bring in enough revenue. It was on life support. I did the copy editing as bestest as I kin because, after all, I are an editor.

The core readership of ICT comprises infection preventionists—IPs. Who? These were, for the most part, people with nursing backgrounds who try to prevent infections among health care staff and patients in hospitals and contain infections when they erupt. Exactly what they do varies from state to state and even hospital to hospital. 

They’ve been called hall monitors (not endearingly) for making rounds and reminding about hand hygiene (a lesson that never quite took; hand hygiene compliance rates among health care professionals in hospitals have been dismal for decades). They’ll often oversee flu vaccination efforts among hospital staff, make sure that operating rooms and the instruments in them get disinfected, track infection data, and ensure that airflow does the whole in-with-the-good, out-with-the-contaminated thing.

In many hospitals, you can become an infection preventionist if someone above you decides that’s what you are. States don’t require IP certification—Certification in Infection Prevention and Control (CIC). The organization that represents IPs, the Association for Professionals in Infection Control and Epidemiology (APIC), lobbies for that and also pushes medical schools to offer infection prevention as part of the curriculum, and hospitals to create actual career paths for IPs. An IP on the job for 15 minutes can be thrown into situations that an IP on the job for 15 years has to handle and be expected to exhibit the same competency. APIC solicited New York and Illinois lawmakers to require IPs be certified, but without much success so far. 

Because of the ambiguous nature of exactly what makes an IP and the lack of certification mandates, getting a tally of the number of IPs in the U.S. remains elusive. Experts have told me anywhere from 6,000 to 9,000. APIC claims a membership of 15,000, but that’s worldwide and also subject to the uncertainty of exactly who counts as an IP.

Anyway, by December 2019, I’d corralled my editorial focus. ICT would become a platform for these undervalued and underappreciated professionals. It would be shop talk where infection prevention experts and working IPs (often the same) could discuss the latest in mask fitting, proper donning and doffing of personal protective equipment, overseeing environmental services teams (the folks who clean the hospital rooms between patients, and entire hospitals, as well), contact tracing, sterile processing, and dealing with healthcare-acquired infections. This last often means taking on Superbugs, mostly bacteriological pathogens building an immunity to antibiotics, like Candida Auris, which had only been identified in 2009. I’d be a beat reporter covering a health care niche and the mostly unknown people who practice it. 

Then came COVID-19. 

ICT went from the little engine who could to the little engine who’d better. No longer tucked away in the corner of the company, ICT became the focus. Instead of slowly developing my skills, I’d been put into a situation that IPs on the job for 15 minutes can relate to: I needed to project the confidence of someone who’d been doing this for a long time. Fake it until you make it, as they say. (Who is “they,” anyway?)

IPs became rock stars. When I’d first arrived, the ICT website got about 7,000 pageviews on a good night; a little over 100,000 views on a good month. In July of last year, in the midst of the second COVID-19 surge, we garnered nearly 730,000 pageviews.

Last March, ICT’s parent company launched a 24/7 news channel in which we editors were to conduct zoom interviews with experts. The channel would be built around ICT and its sister publication, Contagion. I was chosen to anchor the broadcast three times a week—presenting a five-minute news roundup that led to an approximately 20-minute interview with experts and frontline healthcare workers I’d managed to chase down. 

Did I mention that I had to do this three times a week? Did I mention that technology isn’t my bag? Did I mention that I can whine a lot?

I had never used zoom, had only interviewed an expert on camera once, and hadn’t a clue about cutting and editing video. I’d throw in the cliché about flying the plane while building it at this point, but the metaphor would have to include that I held neither a building permit nor pilot’s license.

As far as videoing interviews, everything that could possibly go wrong went wrong. Sound that wouldn’t work. Computer camera angles like something you might see hanging at MOMA. On at least three occasions, I conducted entire interviews without first hitting record. I once referred to the governor of New York as Mario. My screen presence, awkward to begin with, did not benefit from my homecooked lighting which ran the gamut from garish to ghoulish. Watching myself “perform” on video the first time made me bite my nails. The second time I started biting other people’s nails. What? Drink bleach? Sure! I didn’t think I was quite that … THAT.

My head looked as if it was about the roll off my shoulders. I sweated, the droplets sometimes rolling into my eyes. And because you must never, ever, ever, EVER touch your face in this pandemic, I battled itches with tics that made me look like I was trying to pick my nose with no hands. And when not sweating, I blinked like I would when the guy who does my taxes whistles softly through his teeth. Friends asked just why the hell did I keep wearing a suit in my own kitchen, to which I responded with the universal symbol for point taken. 

Once, I leaned so far over to grab something that I upended my chair and crashed on the floor. I lay there for a moment wondering if I should file a complaint against myself with OSHA. Most of my editing consisted of cutting out my questions which, to put it charitably, were not crisp. Think of the whacky backward interlude in “I Am the Walrus.”

What helped get me through was that I’d managed to assemble an editorial advisory board both knowledgeable and incredibly generous with its time. Also, the people I reported on had to deal with life-or-death decisions every day and worked continuously. Who was I to complain? IPs became the experts that hospital personnel ran to to find out the latest guidelines from the Centers for Disease Control and Prevention (which seemed to change daily, and often were not the same as the guidelines from the World Health Organization, which also seemed to change daily), or ask exactly what were the risks of getting COVID and how might they be lessened, and just when were they going to get more of those damn N95s? 

I tried to give IPs what they could not find in the burgeoning tsunami of information—some of it good, some of it not so good—that exploded on the internet. Developments needed to be reported with an eye on just how this would affect my readers. SARS-CoV-2 can be aerosolized? Then proper mask fitting’s a must. Beware the breakrooms and cafeterias. Health care workers too often let their guard down while socializing among themselves and that’s when many were infected. Someone’s infected you say? The IPs conducted contact tracing, tracking down everyone the infected person had interacted with. The COVID-19 vaccines arrived? IPs needed to combat a surprising amount of vaccine hesitancy among staff. 

That state laws do not require that nursing homes employ a fulltime IP proved to be fatal to thousands. Usually, the person in charge of infection prevention at a nursing home or other long-term care facility gets that as an add-on to her core responsibilities. In their defense, nursing homes have nowhere near the financial wherewithal of acute care hospitals.

As of this writing, COVID-19 vaccinations ramp up and infection, hospitalization, and death rates plummet not only in the United States but around the world. As of this writing. By the time you read this, who knows? The vaccines have proven to be at least somewhat effective against the variants and drug makers are creating booster shots to make them more so. 

But there’s still too much we don’t know about COVID-19. How it affects children, for instance. (There’s still no vaccine for children under 16, by the way.) Children and young adults may not be as impervious to COVID-19 as we originally hoped. Children’s hospitals in February noticed a surge in multisystem inflammatory syndrome (MIS-C). It happens to some children who’ve gotten COVID-19. What with everything else COVID going on, it’s a serious matter that’s been somewhat overlooked. According to the CDC, MIS-C “is a condition where different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs.” And for some patients of all ages, COVID-19 triggers a response that makes the immune system go full-on Hulk-smash, and attacks the patients themselves. And then there are the long-haulers, those unfortunates who suffer from COVID-19 symptoms months after they’ve gotten the disease and supposedly have recovered. “Months” because we don’t yet know whether this can go on for years.

Still, even if a new surge happens, the general feeling among health care experts is that thanks to the vaccines we’re going get back some approximation of our old normal lives, except that a lot of us will be wearing masks. (Well, maybe not in Texas.) 

Where does that leave IPs? They might again find themselves undervalued and underappreciated. Or they might be in great demand. That’s because suddenly everybody wants to know about infection prevention and control: schools, local government agencies, businesses, regular folks. There’s some talk that IPs might migrate out of the health care system; that job opportunities will come their way. If that happens, there will probably not be enough IPs to go around. APIC claims a membership of 15,000, but that’s worldwide. No one seems to be able to pin down exactly how many working IPs at hospitals and other health care settings there are, a function of the fact that anyone with practically any background can be called an IP in any hospital. Experts have thrown numbers at me from 6,000 to 9,000 IPs. That’s not enough to meet immediate needs at hospitals and nursing homes, let alone a demand for IPs outside of hospitals that may come along. IP supply also faces a demographic challenge: about 40% of them will reach retirement age in the next 10 years. 

IPs have told me that they’re concerned that they will again be relegated to the sidelines. They remember how their stock rose in 2009 when the swine flu hit, but then receded, only to rise again when Ebola surfaced in 2014. And again, it receded. 

Of course, COVID-19 is like nothing we’ve ever experienced before. It proved that when it comes to defense and survival mechanisms produced by evolution, viruses and bacteria have billions of years of a head start on human beings. There’s also this. For decades now, when medical experts talked about the flu epidemic of 1918 and the possibility of another pandemic that could hold the entire world in its deadly grip, they would say that it’s not a question of if but when. COVID-19 proved them right and hovering over us now are the bacterial Superbugs that grow more and more immune to any antibiotic we may throw at them. (The above-mentioned deadly Candida Auris took advantage of all the attention and resources being thrown at COVID-19 and spiked in some hospitals when it thought no one was looking.) There will be another pandemic. 

There will be a next time. It’s not a question of if.

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