We Four Olsons: My smile is broken.

True story. Ben and I tried to take lots of pictures Thursday- but turns out, my smile is broken.

I'm losing sleep anticipating what our world looks like 20 days from now, when the consequences of people gathering for Thanksgiving catch up to us. We (public health) have been dreading the next 8 weeks since when we realized we were in for a fall/winter surge. The timing of holidays has scared us for months, and now we are here. While this initial fall surge happened over the course of weeks with a somewhat uneven distribution of exposures/infections, the enormity of so many people gathering on the same day will play out on a catastrophic timeline. We won't see the effect of it immediately- it will be insidiously lurking below the surface, while the 40% of people now infected who are completely asymptomatic continue to spread COVID at an exponential rate. And it will take us right up to Christmas. Where people will, despite the begging and pleading of public health officials, of the physicians and nurses who will have to care for them, gather again. And by the middle of January, we are going to see hospitals out of capacity, workforces in crisis because so many people are quarantined and sick, and death counts at least double what they are now.

And this breaks my heart. Because how dark our days are about to be is unimaginable. It breaks my heart because in the last three days I've learned of a teammate losing her father-in-law in Mankato to COVID, and of a significant increase in the number of people I know and love who are now exposed, anxiously waiting for results. It breaks my heart because the impact of the holidays goes so far beyond ones own household. The reason for our most recent Executive Order prohibiting social gatherings, holiday gatherings, was to maintain hospital capacity so that people don't die in hallways and parking garages and wherever else we might have to set up overflow when the number of people needing care exceeds the space available in our world class hospital systems in Minnesota. It is so that people who need hospital-level care can get it. And here is the biggest thing about that. Not everyone is created equal in the eyes of COVID- it isn't proportionately impacting populations. Black Minnesotans make up 6% of our state's population. But they comprise 9% of COVID cases, 13% of hospitalizations, and 14% of all ICU stays. Similarly those who identify as Hispanic make up 5% of Minnesota's overall population, but are 9% of overall COVID cases, 10% of hospitalizations, and 12% of ICU stays. And very close to my heart, the thing that keeps me up at night the most-- while only 6% of all COVID cases in Minnesota require hospitalization, 33% of COVID+ people experiencing homelessness will need to be hospitalized-- due to multiple factors like their higher prevalence of underlying conditions, inability to access early care, etc. And while only 1% of COVID positives cases statewide end up needing ICU-level care, 6% of people experiencing homelessness with COVID will need an ICU. There are communities of people who have been historically, and currently, made to be more vulnerable to COVID, those same people are more likely to need hospitals. And those same people are going to be hurt the most when hospitals are overrun because people felt like their family was somehow unique, their situation more safe than anyone else's who disregarded the Order and gathered.

Frontline staff show pictures of their bruised faces after wearing N95s for whole shifts (thank you front line workers!!!!). But there is a whole sector of workers who have also been getting their asses kicked for 10 months. We are the people putting to work our training in infectious disease epidemiology, our understanding of the complexities of systems and disaster response, our core belief that the health disparities that impact people every day are made a million times worse during a pandemic. We are trying to keep people from dying not by administering life saving treatments in the ER, but by asking people, collectively, as a community, to implement guidance that will prevent the flooding of hospitals from happening in the first place. And in doing so, we have had our jobs threatened, our integrity questioned- we've been called names and been screamed at. We've been accused of unthinkable things and in some cases, received actual threats of harm. And yet we get up every day and we do it again. But I have to tell you, it is really, really hard to have hope and to keep going to work every day when people are not listening to what needs to happen to protect the most vulnerable people in their communities. The day after Thanksgiving I started responding to the newest major outbreak in a homeless shelter. This time "only" 16 cases in one day after mass testing in this one particular shelter. As we walked through how to quarantine and when to test again, my heart sunk thinking about where we will be in three weeks. How this all impacts this incredible, resilient community who has made it until November 28th with only 3 deaths from COVID.

Pictures of us don't have have dents in our cheeks from PPE, but our smiles are long gone. We have dark circles under our eyes and a lot of new wrinkles. We aren't sleeping anymore.

The worst fake smile ever....