I am a nonbinary physician of color. I actually worked for the state governmental COVID 19 response here in Oregon, as my first job in this state.

I felt tremendous responsibility and pride in doing the work I did when I did it, because  there was an acknowledgement of community stake, partnership and investment with the way  we did our work. Blue state vs. Red Federal policy clashes somewhat helped with the ability to  do the work, above and beyond what the CDC was publishing in those days. We were in a group  of about 18 physicians and scientists writing policy and guidance from a variety of lived  experiences. I contributed heavily as a physician of color and made some of my first few friends  in Oregon working in POC predominant teams as the scientific liaison to state based community  engagement work. I was publicly shamed and ridiculed on the internet by trolls and those at  odds with the state’s policies that emphasized community action and non- pharmacologic  interventions to keep everyone safe from a new, scary and unpredictable threat. Yet through all  this, I persisted.

I ended up leaving my position in early 2022 when after more than a year of conflicting  policies, shifting narratives, the politicized CDC influence on state-based policy making was too  great and overrun by individualistic public health policies to an airborne pathogen. For  something as contagious as COVID-19 and with ongoing high mortality and even higher  morbidity, an individualistic approach just serves to marginalize the few- the disabled, the  elderly, the chronically ill, and really a lot of female bodied people without any of the above  conditions with the disproportionate and increasing toll of long Covid in all these populations.

Out of concern for my own safety and to avoid new disability, I have continued to avoid  getting infected. These days it has been getting increasingly difficult. I spent the 6+ years of my  medical training suppressing and coping with a moderately disabling condition to know how  terrible it was to feel even moderately disanled compared to peers. A friend even casually  mentioned one day that I was a 27 year old in a 40 year old body. Ableism exists and even worse  so for people in the health professions. I also don’t have the luxury to assuming that my family  with chronic illness including immunosuppression will survive repeat COVID infections without  worsening of their chronic conditions, or loss of their transplant organ.

Since COVID-19 continues to kill 1.5 times as many people as seasonal influenza, and  maim even more even in the times of Omicron sublineages, I don’t have the choice to ignore it.  Ignoring it could potentially risk my livelihood, my intellectual ability, including the brain that  got me through years of medical school, and the physical ability that allows me to enjoy life  without pain and restriction.

As an extrovert, my life has changed dramatically. Negatively? Not necessarily. I’m  selective with my friendships, I have stopped seeing a lot of my friends who have moved on  mostly because of dismissive or slighting comments, and unwillingness to make  accommodations to see me. My life is full of outdoor patios, and masked brief indoor outings  here in the states. I have traveled and continue to travel with my partner- albeit in lower  frequency than pre 2020 – in fit tested n95 respirators. I got to go to Japan to experience life in a collectivist society, even if for a brief while, earlier this year. My respirator kept me safe, as did  community masking through all kinds of crowded venues.

The costs of my life are that I know more, and care more about chronic illness and the  dangers of reinfection. Much more than my immediate family, my partner and oftentimes some  healthcare providers. That’s been a side effect of always staying appraised and up-to-date on  this virus and its accompanying set of illnesses. It’s a burdensome role, shared by many other  new branded COVID experts, even larger of a burden for those studying long COVID, those  studying end organ system and immunologic impacts, who then have to share this data with the  public. It’s a tremendous moral injury to be a caregiver of people and of populations in these  times.

I returned to clinical practice for a short while between policy changes, for a half day per  week from the summer of 2021 to 2022. I had a mostly substance use reduction based practice  and felt uncomfortable in increasing workloads of COVID-19 positive patient care that I knew  were upcoming especially with increasing community transmission. However, with societal  reopening and the end of the mask mandate on transit, my commute on crowded max trains  got increasingly uncomfortable, and especially so during times of high community transmission.  I left in-person clinical practice, a year after I had re-entered it. I feel increasingly reluctant to  return especially with the loss of universal masking in healthcare settings even more recently.  Unfortunately, this virus is not at a virulence that I can tolerate workplace exposures without  reasonable mitigation. Despite some personal and group based advocacy I engaged along with  others, mostly disabled, suffering from long COVID, or other chronic illness that puts them at  risk, we failed to achieve a stay on healthcare masking. I have been lucky enough to not require  frequent healthcare services for myself during this period of sustained viral infectivity and  severity combined with falling mitigations. But these compounded losses as a healthcare  provider, I will grieve for longer, and more deeply than some of my other social and community  losses where I could rebuild and forge new connections from the small but still strong  community of people who care about community caring, love, support and wellness.

The only times I feel concerned for my wellbeing and mental health are in the gaslighting  and minimizing comments by healthcare providers, and colleagues both in public health and  healthcare who have “moved on” and make comments to indicate disapproval or worse,  incredulity.

I knew, years ago, when I entered Healthcare as a profession, that this was a place for  healthy people, who “worked out”, who experienced no chronic illness, both physical or  behavioral, or none that they could show transparently. This has been highlighted by the  Oregon Medical Board’s decision to remove stigmatizing language on the attestation forms for  physician licensure around mental health and substance use. But cosmetic fixes like this don’t  dismantle the very real systemic ableism in healthcare that continue to persist. Some of the  same reasons for physician suicide I see replicated in the gaslighting, marginalization and  repeated dismissal of physicians who desire and have very real physical needs to avoid and  minimize infections and reinfection with COVID as a reason to avoid or reduce the chance of  disability. If our healthcare workforce, agencies and systems can’t even care for our own, who  will care for our patients?