Signing Off

Dear Members of the Baylor College of Medicine Community,

"The prerequisite for writing is having something to say." – Langston Hughes

I wrote my first weekly COVID-19 message to the Baylor community on June 10, 2020. Today is my 54th message and will be my last – at least related to the pandemic, at least for now. It is time for me – for all of us – to return our focus to regaining our normal rhythms of life.

I would not expect anyone to read all my collected communications, but if you did, it would give you a glimpse of our shared experience during a year like no other: Times of hope and of despair; of certainty and ambiguity; of solidarity and division.

As communities come closer and closer to opening up completely, and people start to return to social gatherings, vacations and family events, the national mood has palpably lightened. The data show cause for optimism. Nationwide, in virtually every region, new viral cases, admissions to hospitals and deaths have all reached lows we have not seen for months, and generally not since late March of 2020. The local Houston hospitalization rate has inched up over the past few days, but every indicator suggests this is a blip, not a trend. Stay tuned.

Even with our renewed sense of optimism, it would be wrong not to pause and reflect on a more sobering milestone. This week our cumulative national deaths from COVID-19 passed the 600,000 mark - 600,000 of our friends, relatives and colleagues.

To be clear, SARS-CoV-2 is not gone. It will certainly be with us for months, probably for years, perhaps forever. There will be recurrences. Booster vaccines are in our future. However, it is unlikely to become the sort of economy-crashing, hospital-threatening existential threat we have experienced for the past 16 months.

Before I turn off the lights on these messages, I want to summarize a collection of outstanding concerns – concerns that I expect will remain relatively constant over the coming weeks to months. As a disclaimer, this is my opinion as a dedicated coronavirus watcher, which I believe is supported by what we know today. Beware of anyone who expresses certainty in matters related to the virus. Trying to predict the twists and turns of the pandemic has been a humbling experience for us all.

For the sake of brevity, I will not mount a defense of all these positions here – you are welcome to look back at my recent posts for supporting arguments behind each of these:

• Children remain a challenge. If your child is 12 or older, they should be vaccinated. Under 12, their risk of infection is much lower, and children do not typically become very ill. However, there are exceptions, and a statistically very small number of children become critically ill. I believe we are clearly at the point where the social, developmental, and educational risk of isolating our children outweighs the risk of getting sick. This is one of the most difficult challenges we all face as parents. I would encourage you to read my prior guidance on this topic. The best course of action at this point – in my opinion, based on my personal risk-benefit analysis – is to deliberately return our children to a life that approximates our pre-pandemic world as closely as possible, while remaining cautious. I would still avoid large, tightly packed crowds with an unvaccinated child. I would hope (expect? demand?) my granddaughter's daycare staff be fully vaccinated. Be aware of new variants emerging around the world – there is some early suggestion that some of the variants may place children at increased risk. I wish this were easier.
• If you are unable to be vaccinated, you remain at risk. People with true contraindications to vaccination remain at risk, and need to maintain physical distancing and masking. Check with your physician to see if you really have a contraindication – there are many misperceptions out there, and you may actually be eligible.
• If you are vaccinated, you are relatively safe. Take off your mask, hug your grandmother, go on vacation. You are unlikely to contract the virus. If you do, you are unlikely to become critically ill. You are unlikely to spread it to others. I do have one caveat. If you live with, or are in close frequent contact with someone at risk – such as an immunosuppressed family member – it is prudent to remain cautious. Also, be aware that restrictions remain in place in certain settings (for example, health care facilities).
• If you are unvaccinated, but eligible, you are at risk. Get vaccinated. I will not relitigate the point here, as I and many others have written about this at some length. The available vaccines are safe, free, highly effective, and readily available. If you do not get vaccinated, at some point in the coming weeks to months there is a good chance you will become infected with the virus. Emerging, more virulent variants will only increase your risk. Your risk of a bad outcome from the infection far, far, far outweighs your risk of vaccination. This is still true for people in their 20s and 30s, even though they are less likely to become seriously ill than those more elderly.
• Baylor will make vaccination mandatory. The date has not yet been established, and there is much preparatory work to come, but leadership is committed to mandatory vaccination at the appropriate time – with exemptions for sincerely held religious beliefs and medical contraindications to vaccination. Some will not agree, but as a provider of health care services, it is our obligation to our patients to provide the safest environment possible. Furthermore, out explicit mission is to apply "science and discoveries to further education, healthcare and community service locally and globally." Strong advocacy for vaccination is necessary if we are to live our mission and to set an example for our community. If Baylor is not committed to vaccination, how can I expect my granddaughter's daycare to require, or at the very least strongly encourage, vaccination of staff? The community will look to Baylor's example.

Finally, I need to thank all of you. Thank you for reading and distributing my words. I am grateful for those who took the time to write. The encouraging messages meant a lot to me, the challenging ones helped me to keep perspective. Your personal stories helped keep me focused on why we all come to work every day.

I stand in awe of the Baylor community – physicians and scientists, resident physicians and fellows, students, administrative staff, security, housekeeping, food services. We will emerge from this experience a much stronger organization. You will reflect on your role in the great pandemic for decades to come, and do so with justifiable pride. I will reflect on the honor of working with all of you.

Stay well.

James T McDeavitt, M.D.
Executive Vice President and Dean of Clinical Affairs

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