The Holiday Season is Flu Season

And it’s Back to Business as Usual

It’s been a busy few weeks at WFM.

All day long patients stream in with cough, sore throat, congestion, fever, chills, malaise, and sometimes vomiting and diarrhea. Usually, we will rule out Covid, Flu, and Strep Throat with rapid tests that are done in the office and can give us an answer right away. It’s useful to identify those pathogens early because they have specific treatments for which the window of opportunity is short.

And yes, we will check for Covid even if you checked at home – no offence, but if I had a nickel for every patient who tested negative at home and positive in the office I could retire. One thing I learned from Covid is that when it comes to getting a good nasal swab, technique matters.

If those tests are negative and we still need to know the culprit – the illness is prolonged, let’s say, or complicated – we will send out a viral respiratory panel, a highly accurate PCR test that covers over a dozen viruses and atypical bacteria that commonly cause respiratory infections.

Those have been coming back all over the map with a panoply of organisms: RSV, rhinovirus/enterovirus, parainfluenza virus, adenovirus, and yes, plenty of Flu and Covid, along with a handful of non-Covid coronavirus types that cause the common cold. There is no good way to predict, except that the worst symptoms seem to be caused by the Flu in unvaccinated patients.

So if you haven’t gotten your flu shot already, we still have some left.

The good news is that it feels like back to business as usual – despite the continued prevalence of Covid, which has been reduced to just one of the usual viral suspects. When I think back to the dark days of the pandemic, riding to work on an empty bus through deserted streets, sealed off from the driver by cellophane and tape, this was the dream scenario. Not that Covid would be eradicated per se, but that we would conquer it by taming it – turn it from a tiger into a housecat, so to speak.

For that, we have the vaccine to thank, along with, finally and effectively, herd resistance.

I recognise that Covid is still causing deaths nationwide and that to the unvaccinated it remains a serious threat. But if you want to know what we are seeing in the trenches, at our specific practice, in our specific city, it’s this: lots of people are getting sick, but no one is getting sicker than usual, vaccinated or unvaccinated, low risk or high risk, whatever the organism.

Let’s take a moment to be grateful for that.

Still, why get sick if you don’t have to?

So in the spirit of the holiday season, let me offer you a gift – two great ideas, one big and one small, to help keep you healthy through the winter and all year long.


One of my biggest take-home points from the Covid pandemic is that masks work well. Really well. Both to prevent transmission of respiratory illness and – less so but still significantly – to prevent contraction of illness.

As a primary care doctor who sees lots of colds and flus, I would typically get sick myself at least once every few months. Since I started wearing a mask in the office – so for almost three years now – I’ve hardly been sick at all.

So let’s resolve to take masks out of politics, and even out of Covid for that matter, and treat them as the cheap and simple hygienic tool that they are, much like Purell.

And let’s be pragmatic, not doctrinaire.

One of my favorite professors at Princeton was Louis Menand, who now writes for The New Yorker magazine (holiday gift number three: read anything he writes). He argues that pragmatism is the great American contribution to philosophy and in his honor, I have derived the following five pillars of mask pragmatism.

One, keep a mask handy so that you can whip it out at any time.

Two, wear your mask in high-risk situations when you are in close contact with large numbers of people – especially indoors – if you feel it is socially acceptable to do so. Examples would include subways, buses, elevators, and spectator events like movies and plays.

Three, choose to not wear your mask in high-risk situations if you feel that it is not socially acceptable to do so. Examples might include dinner with friends, cocktail parties, or any other situation that involves social interaction with other people where it matters to see a person’s face.

Might you get sick? Yes – let’s even assume that you will; just like you probably will from your kids, especially if you have little ones. But the truth is, genuine human interaction has always been a risk/reward endeavor, and it feels like time to get back to baseline in that regard.

Four, do not wear your mask in low-risk situations. There’s no point and it’s not super neighborly – one of the nice things about living in the city is seeing other people’s faces. Examples include walking outdoors in the street or in the park.

I heard a theory that the enforced social isolation of the pandemic – like working from home and wearing masks – has only served to fuel the current increase in extremism and antisemitism. I think there is something to this. Just being thrown together and rubbing shoulders with a diversity of other people in the real world – one of the reasons I love New York – can have a moderating influence on bias and prejudice.

Five, if you are sick, wear a mask around others. Just tell them that you have a cold and don’t want to expose them, which has the added benefit of being true. If we all were to follow this one piece of advice alone, it would cut down the transmission of respiratory viral illnesses by an order of magnitude.

So much for the big idea. Now for the small idea.

Birthday Candles

The other day we went out for dinner with my brothers for Rachel’s birthday. After the meal, it was time for cake and candles.

Of all the pre-Covid rituals that were upended by the pandemic, blowing out candles on the cake was the one I felt actually had a good chance of never coming back.

By contrast, I knew we would eventually return to shaking hands, and so we have. It’s too deeply rooted a custom, too much an expression of good intentions and goodwill, and just not objectionable enough to avoid forever. After all, we already touch all kinds vectors of transmission over the course of a typical day.

But blowing on a cake before serving it to others? And then blowing again with increasing gusto when the candles don’t go out the first time, little droplets of spit spraying all over the food? At least that disgusting relic, I thought to myself, must be gone for good.

How wrong I was. I’ve been to several birthday parties over the last few months where the old custom was back in full force, right in its sweet spot between Happy Birthday and skip around the room.

So imagine my delight when after a delicious meal (we ate at Hav & Mar, a great new restaurant in Chelsea from Marcus Samuelsson and Rose Noel, for anyone looking for a recommendation), the waitress brought out the cake – with the candles on a separate plate!

Like all great ideas, it seems so obvious when you see it that you can’t believe you didn’t think of it before. Rachel gets to make a wish and blow out the candles, and we all get to eat spittle-free dessert.


One birthday that I neglected to mark last month is that of this blog. When I started writing Full Stack Family Medicine a little over a year ago, the idea was to connect with more people than was possible in the office setting, and to pull back the curtain on the life of a doctor in New York City. Topic-wise it has admittedly grown to well beyond that but what can I do – I like to digress.

I believe that attention is our most precious and valuable resource, and for you to direct yours to my writing on a recurring basis is not just a big ask but a gift that I truly appreciate.

Many of you have told me in person or in comments, texts, and emails that you enjoy the blog; a special thanks for that – it definitely keeps me going!

So with your encouragement, I’ll continue to type away in 2023. And to all my patients and friends, not to mention readers whom I have never met, may the New Year be full of health, happiness, and authentic human connections for each of you.

Dr. Bertie Bregman
Dr. Bertie Bregman
Full Stack Family Medicine is a newsletter about what it’s really like to practice medicine and run a medical practice in New York City.
This blog will be a mix of stories, advice and discussion – topics will diverge widely, but they will all share a point of view!