Dr. Greg Cohen has practiced medicine in Chariton since 1994 and is vice president of the American College of Osteopathic Family Physicians. He was named the Rural Health Champion by the Iowa Rural Health Association in 2014 and was awarded the Living Doc Hollywood Award for National Rural Health day in 2015. He was named a Distinguished Fellow by the American College of Osteopathic Family Physicians as well as Physician of the Year by the Iowa Osteopathic Medical Association in 2019.

Dr. Cohen’s first commentary about the COVID-19 pandemic is one of the most-viewed Bleeding Heartland posts in the sixteen-year history of this website.

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Three years ago, I wrote a letter to the editor about my experiences as a rural physician six months into the COVID-19 Pandemic. There was no vaccine, no Paxlovid, and only experimental treatments for patients sick enough to be hospitalized. About 180,000 Americans had died. I had not hugged my children or grandson in nearly six months, and in my recurring dreams, I was suffocating in an ICU bed. (I finally hugged my children seven months later, after we had all been vaccinated.)

I wrote of the disaster unfolding in our country. How the richest and most powerful country on earth was failing. Mistrust and misinformation were dividing us. I asked people to wash their hands, wear a mask when around people they were not living with and to get vaccinated when an FDA approved vaccine became available. I wrote about “loving thy neighbor” and “doing unto others,” and the need to get past our divisions and overcome the mistrust and misinformation to get the pandemic and our crisis under control. 

Three years have passed. The state of emergency has ended, and the divisions, hate, mistrust and misinformation have cost us all dearly. More than 1.1 million Americans have died. Tens of millions more have been hospitalized. Hundreds of millions more have been damaged physically, mentally, economically and spiritually. 

More than 90 percent of us have had COVID-19. Some of us have had it many times. Not only is the virus not gone, it is on the rise again. I have lost about 50 patients and cared for more than 1,000 cases. I have been called a liar hundreds of times for telling sick patients they had COVID. (I didn’t test people who had no symptoms.) I have lost patients, friends and nearly lost family, all while risking my health and my life to give people the best possible medical advice.

I have had to learn to live with the reality that many people I have taken care of for decades believed strangers on tv and social media more than their previously trusted family doctor. Nearly all of my family members have had COVID at least once, some as many as three times. At least three of us (including myself) have experienced some form of long COVID. 

I am currently recovering from my second bout with the virus. My first bout (17 months ago) was longer and attacked my knee, leading to the need for surgery seven months later. This illness was thankfully shorter and less severe, thanks to the miracle of Paxlovid.  

So, what have I learned?

1. COVID is not going away anytime soon. There is no herd immunity, and immunity is not lifelong. The virus mutates frequently and will attack us again and again.

2. COVID affects each of us differently. Nearly 40 percent have little or no symptoms. For the rest of us, it is a crap-shoot every time. 

3. The main vaccines used in this country were safe and effective (at least initially). Getting vaccinated and boosted decreased the risk of severe disease, hospitalization and death by more than 80 percent, but did not ultimately stop infection for most. Much like flu vaccines, COVID vaccines need to be updated and boosted regularly. I wouldn’t give you the flu vaccine from three years ago and expect it to work. Nevertheless, it is clear that COVID vaccines saved millions of lives. 

4. Getting COVID does not provide superior immunity compared to being vaccinated. But getting vaccinated after infection has been demonstrated to provide better immunity than either alone.

5. Hydroxychloroquine, ivermectin, and a host of other medications and supplements do not work and never did. Even worse, mistrust, misinformation, and in some cases deliberate lies about them, the vaccine, and the few medications that have been shown to work have led to untold suffering and hundreds of thousands of unnecessary deaths. Per capita death rates in Canada, Israel, and Norway, countries with comparable access to modern health care, were one half to one third that of the United States. 

Even in our country, death rates in rural America were double that of urban areas, after the vaccines became available. We could have and should have done so much better. 

6. Long COVID sucks! It is frustrating, poorly understood, and difficult to treat. We have no idea just what all this will become. Nearly 40 percent of people will have at least one symptom 30 days after infection. An estimated 19.9 percent will still have symptoms after 90 days. About 9.9 percent will still have symptoms after six months. 

As of late June 2023, an estimated 6 percent of all American adults, or more than 15 million of us, still had long COVID symptoms. More than 26 percent of those were “significantly limited in their ability to perform day to day tasks.” 

7. Kids can get long COVID too. One international study estimated that between 5 and 10 percent of children still have lingering symptoms 90 days after infection. A more recent review of international studies “found that over 16% of children and teenagers with COVID had problems such as sore throat, persistent fevers, fatigue and muscle weakness at least three months later.” This includes many children who had mild or minimal illness with their initial infection. 

8. Paxlovid and a small handful of medications can dramatically decrease severity of disease, risk of hospitalization, and death—if given within five days of the onset of symptoms. They even decrease the risk of developing long COVID by 25 to 30 percent. Initial worries about Paxlovid rebound (where mild to moderate symptoms and positive testing can recur two to ten days after recovery) have proven unfounded. Rebound does occur in 10 to 15 percent of patients treated with Paxlovid, but when untreated, COVID rebound occurs in 15 to 30 percent.

9. Some 20 to 30 percent of all health care workers are gone. Some got sick and died. Some got sick and never fully recovered. Some got sick of what they were seeing and doing and left health care altogether. As a result, most hospitals, nursing homes, home health services, and clinics struggle with staffing and employee retention and struggle to provide the care they had previously provided. 

In addition, people who got acute COVID have been shown to be more likely to seek care for non-COVID illnesses like diabetes, chronic pulmonary diseases, neurological illness mental health related diagnoses for at least six months after infection, compared to prior health care usage. That has placed a significant additional burden on the remaining health care workers. Our nation’s health care system has been badly damaged, and it will take years to fix. 

So what do I recommend now?

First: Please get vaccinated and updated when your health care provider recommends. Contrary to the misinformation out there, it is effective, safe, and will decrease your risk of hospitalization, death, and long COVID.

Second: If you develop COVID symptoms (e.g., sore throat, nasal congestion, nausea, vomiting, diarrhea, fever, change in smell or taste, or cough), get tested as soon as possible. Available medicines are very effective but must be started within five days.  

Third: If you think or know you have COVID, please be considerate of the people around you. Even if you are not severely ill, the people you may expose to this virus may get much sicker or even die. Try to self-isolate, even in your own home. It is not a foregone conclusion that everyone in your home will get sick. I have now had this disease twice, and my wife has had it once, and we never gave it to each other. 

Don’t go to work, school, church, the store or family gatherings for at least five days. When you are feeling better, wear a mask around others for five days. The people you spread this to may be people who get much sicker than you did or care for someone who will. 

Fourth: If you have COVID and experience chest pain, shortness of breath, or can’t keep anything down for more than 24 hours, call a doctor or hospital as soon as possible. Those symptoms may indicate much more serious illness.

Finally, regardless of where you stand, and what you have or have not done for the last 3-plus years, try to be a little kinder, a little more patient, and a little more accepting of our differences. The damage the pandemic has caused to our families, friends, communities and country has been devastating. No part of our way of life and none of us has been left untouched. 

We all need a whole lot of healing, and it starts with us. 

Top photo of Dr. Greg Cohen provided by the author and published with permission.