November 29, 2021

Where omicron has been detected

Dateline – Seattle, Washington

And the media keeps beating the omicron drum, despite the fact we know very little about it as of yet. Things we do know. Cases are rising in South Africa in the area where the new variant originated, but hospitalizations and mortality have not. Whether this is because the population is well protected by vaccination, the virus is less virulent than other strains, or that it is still too early to have seen an increase as hospitalization as an indicator usually lags two to four weeks behind a rise in case load, is simply not known. Cases have been reported on nearly every continent so it appears to be spreading. Because of this, travel bans, while good political theater, are likely too late as the index cases have already arrived and the spread has started.

No cases are yet reported in the USA but that’s more likely because our surveillance testing system is nowhere near as good as other country’s, like South Africa’s. (Our system is ranked 20th world wide by WHO).There is some preliminary evidence that reinfection rates are higher than with other variants, e.g. your natural immunity if you have been previously infected is not enough to block reinfection with omicron. Vaccination acquired immunity appears to be better than infection acquired immunity so our best weapon against morbidity and spread is high vaccination rates. The CDC has recognized this and today stated that all adults 18 and over should have a booster shot, whether or not they are at high risk. They have not made any recommendations yet regarding those younger than 18 but those individuals are all within the initial six month window of their vaccinations.

Humans like certainty. We like to plan ahead. We hate it when faced with the unknown. Unfortunately, omicron, at the moment remains an unknown quantity. It’s too soon to know if holiday plans should be scrapped, travel should be rescheduled, theater should be cancelled or any of the other thousand and one other things that people are starting to ask. My best advice at the moment is to keep planning and moving forward but be flexible as things may change rapidly as we learn more about the variant and its morbidity and possible mortality. It remains a good idea to have plans that involve masking, well ventilated spaces, good hand hygiene, and vaccination.

Today was a day of reveling in the small world phenomenon. I got together with two old friends, neither of whom I had seen in decades. One, with whom I was in high school and whom I became reacquainted with in recent years as he is involved in the opera world, turns out to be cousins with my publisher, a fact I was previously unaware of. The other, who is the daughter of another resident in my father’s senior living facility, was someone who ran around in the same friend group as I back in my medical school days. Not only that, but years before, she was friends with Steve when they were both bohemians in Venice Beach in their 20s. It was fun to reminisce and look back over many decades at where the roads had converged and diverged.

I’ve put in more time on my monologue. It’s all in the brain. I now have to work on making it come out in the right order, without skipping paragraphs or completely jumbling the words around. I can do the whole thing with my cheat sheet (a sheet on which I have the first letter of each word but not the words themselves) and now I have to get it to the next level where that is no longer necessary. I have until the end of the week. I hope I get it, god I hope I get it… At least the next few shows I have lined up don’t have quite so much memorization involved. 9 to 5 happens in late January and I was just asked to do a dream role in late spring. I’m not sure I can talk about that one yet so I won’t. Here’s hoping omicron doesn’t shut us all down again.

I’ve been reading all sorts of essays on line from people, some famous in the theater world, some obscure like yours truly, talking about Sondheim, how he inspired them, coached them, chastised them, corresponded with them, and otherwise touched their lives. His willingness to engage with anyone and everyone to help move forward the art form that he loved and dedicated his life to was exemplary and I can only hope that I will touch a fraction of the number of lives he did for the better by the time I go. A lot of people have shared pictures of their typewritten notes and letters from him over the years (someone said that typewriter needs to go to the Smithsonian and I am in full agreement with that). I’ll look through mine when I get home and see if there are any I feel like sharing with the world. I had finally gotten around to watching Tick, Tick… BOOM just a couple of days before his death and spent last night thinking about it through Mrs. Norman Maine’s eyes and wrote her review. It should be out in a few days.

Tomorrow is a travel day. Hopefully the post Thanksgiving crowds will have died down some. I have my mask, I have my sanitizer, I’ve had my booster, I try not to crowd up on others. I should be OK.

November 28, 2021

Dateline – Seattle, Washington

Still more gray and dreary up here in the Pacific Northwest. It works out OK as it makes sure that I stay in and get the various things I have to get done this long weekend actually done. First and foremost is cramming all fine pages of Comet’s monologue from The Eight: The Reindeer monologues into my brain. I am no longer of an age where memorization comes easy. I’ve been working on the piece for a bout two weeks now and all of the bits are there but I can’t yet make them come out in anything approaching the right order without some sort of a prompt. I have three more days before my next rehearsal and two weeks before an audience so I should be OK but everyone, please remind me not to take a part requiring this amount of unprompted memorization in the future. I am no longer thirty, I am now twice that.

I also broke the back on the sermon I need to deliver on the 5th which is about the role of serendipity in my life and how it ended up leading me to write the book. Speaking of the book, very nice meeting with my editor/publisher this afternoon. We’re going to start prepping my 2021 writings as if there’s going to be a volume two but be ready to pivot based on what actually happens over the next few months, which again feels terribly unsettled. Those of you on my publisher’s email list may get a query asking what you would like to see me write next. If you’re not on that list and want to me, drop me your email in a DM and I’ll make sure you get added.

I did a Q and A talk for my father’s senior living facility residents this afternoon for an hour or so. A significant portion of the resident population turns out for these and they seem to enjoy them. I find them a good way to hone my improv skills as I don’t do a whole lot of preparation in advance. The questions I field are usually fairly basic as far as geriatric medicine goes and I’ve been answering their like for decades. The fact that I get so many similar questions so often shows how poorly the American health system educates both its practitioners and its patients in the basic realities of the aging process. Maybe I should put it on my theater resume. Improv training – Spolin technique with Jeanmarie Collins and Geriatric technique with senior living facility audiences.

I’m still trying to understand the Omicron variant and what we really know versus speculation and hype during a slow news cycle due to a long holiday weekend. The CDC has been very quiet other than a rather terse and generic statement issued on Friday. Anthony Fauci appeared for a lengthy interview this morning on Face The Nation and, in reading the transcript, while a wide range of subjects related to Covid were covered, the developments with omicron were pretty much omitted from the discussion. This leads us with a population, on edge after nearly two years of pandemic news, being fed sensationalistic headlines but with little in terms of real response from the government other than Biden’s South African travel ban which is only going to stoke fears. South Africa is feeling a bit miffed as their very careful monitoring of testing caught this variant early before it had spread significantly and now they think they’re being punished on the world stage symbolically and economically.

As I said yesterday, there is no objective evidence that in a fully globalized society, banning of commercial air traffic is a helpful containment mechanism. There are just too many other ways round those transportation routes. I guess it’s what happens when you try to solve the problems of a 21st century global society pandemic with the tools of 19th century nation states. The problems we are all currently facing: climate change, the pandemic, wealth inequalities, and the like are global challenges and really will require global solutions of some sort. Unfortunately, when our political systems are feeling threatened, rather than reach out in an expansive way to other societies, we tend to withdraw into our own selves and to seek solace in the traditions of our tribe, likely one of the root causes of right wing authoritarian impulses across the globe. These trends are going to make the pandemic more difficult to control over time, rather than less. Will omicron push more people towards vaccination? Will it prove to be a rapid spreader like Delta? Will it cause any differences in clinical presentation, seriousness of disease, or new sequelae? Inquiring minds want to know but it’s going to be a while before we find any of this out.

It’s been interesting being in a blue state these last few days. The majority of people wear masks on the street (although this may not be necessary for public health given what we know about coronavirus spread in open air and well ventilated places). I have to show my vaccination card to enter a place where people congregate. No one takes off their mask indoors in public space unless seated and eating and drinking. None of that happens in Alabama. I follow those rules about masking there even though there is no governmental entity requiring it as it’s what makes the most sense given what we know about the spread. Alabama covid numbers, on my most recent check, continue to remain low. The Washington numbers are actually a bit higher. Is this because of climate differences? It’s warmer in Alabama so more outdoor activity and less gathering indoors. Is it the lower population density in Alabama? Is it slight differences in circulating strains? I have no idea. I can but observe. If indoor activity and gathering is still a major trigger, everyone’s numbers will start going up again in two to three weeks due to the behavior changes of Thanksgiving. I’ll be watching that with great interest. In the meantime, everyone knows the drill. Mask up, keep your hands washed. Get your vaccines. Don’t crowd up too much on those you don’t know.LikeCommentShare

November 27, 2021

Sondheim surrounded by his creations

Dateline – Seattle, Washington

It’s been a very Seattle day, grey and wet which has matched my mood. Some of that is, of course, coming from yesterday’s news of the death of Stephen Sondheim. Anyone who knows me knows I’ve been a Sondheim fanatic for nearly fifty years and that his music and lyrics have provided the soundtrack to my adult life. As a geriatrician who knows all too well just what the last acts of life can entail, the fact that he had a good Thanksgiving with friends on Thursday and then died suddenly on Friday morning in full possession of his faculties is about as good a way to go as there is and certainly what I hope happens to me when it’s my time to board my train for the next destination. I’m sad thinking that the world no longer has him in it. I’m happy that we had him and his prodigious output and his accessibility to the music theater artists of the world. As I scroll through social media, everyone with any connection to the performing arts as a story of some small kindness or encouragement, some sense of self discovery from a song or a show, or some life altering experience from working with him or on one of his pieces. Well done and rest well and give Oscar a big hug when you see him.

There has been no doubt in anyone’s mind for decades that Sondheim was the gold standard for music theater creativity and craft. With him gone, who takes the mantle? Lin-Manuel Miranda? Robert Lopez? Flaherty and Ahrens? Marc Shaiman? Can anyone? Sondheim always spoke of theater as a living, vital thing that constantly evolves and reflects new audiences and expectations so whomever it is will need to understand this and give us more to see. In the meanwhile, I’ll read the tributes, listen to the songs and, when I get home, get out my personal bundle of typewritten notes from over the years and reread them. I wish I was a better singer so that I could actually be cast in some of the better roles he wrote, but I just don’t have the vocal chops and know it

.I’m still trying to find decent information on the new Omicron variant so I could get a better sense of whether it is worth the Chicken Little reporting that’s appeared over the last forty-eight hours. What I have been able to discern is that there have been fewer than 150 confirmed cases world wide, the majority in South Africa. The robust testing and sequencing done there identified the variant very quickly before it had spread too far. There are cases in other countries without links to South Africa suggesting that it has seeded elsewhere thanks to international air travel. It’s likely here in the USA but it just hasn’t been identified yet. The mutations likely make it more transmissible, but not more virulent and it has yet to be seen if it will start to displace Delta as the major circulating variant. There is no evidence to suggest that banning flights from certain countries will have any effect at all on the virus or its circulation. That is a piece of political theater to make nervous populations feel like someone somewhere is doing something.

And that’s likely the biggest problem. After nearly two years of continuous pandemic news and privation, the world’s population is shell shocked and all of our lizard brains go on high alert the minute that we are given any hint that danger is returning. We’re going to continue to react in this way for the foreseeable future as our brains have been significantly rewired by our pandemic experiences. This goes for our leaders as well as for us common folk in the trenches. We’re losing our abilities to think rationally and objectively about the problems Covid poses because it’s become so significantly intertwined with our primitive emotional reactions to an uncontrollable danger. Britain is going back to mask mandates over two cases. The CDC has been completely silent so far on US plans. The current administration, well aware of the politicization of the virus, is doing its best not to make waves but I don[t think radio silence is their best option.

The siblings and I got together yesterday evening for bowling. It was my sister’s partner’s birthday. I was not thrilled. The last time I went bowling, my high score was 37. Imagine my shock when I emerged with a 136, the high score for the night. As I have definitely not improved in athleticism in recent years, the gods were taking pity on me and letting fewer of my balls escape into the left gutter, where they usually end up. All is well in sibling land, and with my father and the extended family. It’s nice to see them face to face rather than over zoom which is how most of our connections have been this past year. It’s late… to bed, to bed…LikeCommentShare

November 26, 2021

Dateline – Seattle, Washington

Whether we want them to or not, the times they are a changing. Five minutes before I sat down to write this, I found out the king is dead. Stephen Sondheim left us at the age of 91. I’ve been expecting to hear this news for a decade or so now and was recently idly wondering how I was going to feel when it finally happened. Now I get the chance to find out. Sad, tired, not especially emotional. He’s been a huge part of my life since I discovered him as a teenager in the late 70s but as an Olympian or at least a demigod – out there in the ether, occasionally interfering in the lives of us mere mortals, not as living, breathing human full of flaws and contradictions. I was lucky enough to meet him a couple of times, to have him compliment me on some of my work, both parody and original, to have intermittent correspondence with him over the years, and for him to have lived long enough to receive my book and appreciate the compliment in the chapter headings. One of the ways I have processed loss for decades comes from one of his early lyrics. And it’s a song someone better sing at my memorial service someday. ‘Crazy business this, this life we live in. Can’t complain about the time we’re given. With so little to be sure of in this world. We had a moment…’

Will there be another to take his place? Unlikely. His life story from teenage protege of Oscar Hammerstein to being part of the quartet of queer Jewish geniuses that created West Side Story to his redefinition of what musical theater could be with the Hal Prince shows of the 1970s to the brilliance of dramatizing the creative process with Sunday in the Park with George. No one is going to be able to ride that particular trajectory of music/theater again. Lin-Manuel Miranda, who is the closest thing currently in music/theater circles is an entirely different animal dealing with entirely different finances and power players and with three or four more decades of creative abilities, he may end up going in very different directions as he develops additional skills as a film maker.

Me with Patty McDonald

Not only did I lose a king this Thanksgiving weekend, I lost a queen. Patty McDonald was not internationally famous. She had no shelves full of awards for her creativity but, in her own way, she was just as important in my theatrical life as Sondheim. Patty who was married to a US naval commander, settled with her husband in Birmingham when he became a power company executive after his retirement from the navy. Widowed about the same time I entered the Birmingham arts scene, she spent the next two decades championing the performing arts in Birmingham, serving on the boards, leveraging the connections and the funding, dressing to the nines with her halo of platinum blond hair and her glamour canes and attending every performance of music and theater she could. Tommy and I adored her and loved being next to her at opera dinners, music fund raisers, and a hundred and one other events over the years. When Tommy died, she wrote me a lovely four page letter that I treasure. She was an original who lived to make Birmingham a better place through the arts. Being on stage behind her as she sang ‘Proud Mary’ is one of my performing highlights. (You had to be there).

This thanksgiving weekend, I have to give thanks for both of them and for all of the other people in my life that sustain me and allow me to do what I do, in all three of my careers. I couldn’t do any of this in a vacuum. It takes the proverbial village. As time goes on, I will lose more and more of the people in my life until it’s finally time for my train to depart the station. I’m not worried. I’ve had sixty very good years. I’d like a couple more decades as I feel I have a lot more to do , but I won’t be able to complain that I’ve been shortchanged if I have to leave the party early for some reason. That’s one of the things I work on with my patients a lot. Helping them understand that one of the crucial tasks of aging is learning how to say goodbye. To people in your life, to your younger body, to a generation that understands the world in the same way you do due to your common experiences. But as for today, I am safely in Seattle with my family, playing catch up after a glorious meal last night which all of the Seattle based family were able to attend.

Time to return to the world of the coronavirus. The news this morning is full of doom and gloom headlines regarding the emergence of a new variant in South Africa. This one, in keeping with the Greek letter system that WHO has been advocating, is known as omicron. In plowing through the headlines, it appears that the actual knowledge regarding the variant is limited. It has a significant number of mutations in the spike protein which means that it could possibly evade current antibodies and vaccines but it hasn’t been proven to do so yet. It appears to be pretty much limited to central South Africa around Johannesburg with a couple of cases having popped up in Israel and Hong Kong in recent travelers. There’s been a huge reaction from the western world with air travel from South Africa being shut down. It’s a stark reminder that Covid is a global problem, not a national one. We live, given the developments of the last sixty or seventy years, in an interconnected world and what happens anywhere on the globe can affect anywhere else on the globe. Goods, services, and people go everywhere. Trying to use a sort of fortress mentality on a national level to keep variants at bay is likely to ultimately fail because of this. No locality can draw an absolute cordon sanitaire around itself and survive. Ultimately, we’re going to have to come to grips with the fact that planetary problems require planetary solutions and the 19th century model of the nation state is inadequate to the task. The rich countries may wish to ignore the developing nations of the world most of the time but those populations will require vaccination and other public health members just as much as the population at home to win the war.

I’m not sure what to make of Omicron yet. The information circulating out there is minimal and there’s not a lot of good science yet available to parse and determine what it may mean going forward. At this point, I think the best thing to do is apply the usual common sense. Get your shots and your booster, practice good hygiene, be aware of the health needs of others. The significant unvaccinated population in the US remains a more imminent danger to local public health than what may or may not be happening half the world away. But that could change depending on what the actual properties of the variant are. The one good thing that has emerged is that it does not appear to cause worse clinical disease than any other variant. While this is a relief, this doesn’t mean you still shouldn’t take Covid seriously – it remains a virus you don’t want in your body, no matter the variant. I am starting to see more and more post Covid syndromes in my patients where six months or a year later there’s still significant physiologic dysfunction and they simply cannot live the lives they could before falling ill.

I feel like I should be writing some big think pieces this weekend, but I’m still dealing with my own version of long Covid – not the physiologic (as I never had it to my knowledge) but rather the psychologic as I try to come to terms with my changed brain after having lived through the last two years. Not to mention the nine minute monologue I have to have memorized by Wednesday. It’s about two thirds there so I should make it. I believe in challenging myself. It helps keep me young. But sometimes I want to beat myself up and say ‘You idiot! You’re not twenty-five anymore!’

November 23, 2021

Three complex and intertwining factors

The pieces do not fit. The center does not hold. And I imagine I am not alone in this feeling of existential malaise. Over the last month or so, the spread of Covid in Alabama has greatly abated. Positive tests, transmission numbers, hospitalizations – all down at levels not see since last spring when vaccines had become plentiful and the Delta variant had not yet become established. Our case rate is less than 10 per 100,000 (a benchmark that WHO and the CDC uses in determining if a pandemic is under control). There are only about 400 people hospitalized state wide (way down from the thousands of a couple of months ago). But we are still losing about 13 Alabamians a day, which in my mind is 13 too many. Does this mean the pandemic is over? I doubt it. We’re likely to see another surge or two in the next six months but, with luck, we’ll see life continuing to normalize through 2022. The next big test is this coming holiday weekend and what that might mean for transmission chains as people gather. We’ll learn that in mid December as the inevitable changes in cases correspond to changes in behavior, only about two to three years later.

Where we go from here depends on three big and unknowable factors. The first is the behavior of host organisms, mainly us humans (but being joined by various felines and white tailed deer among others). Viruses do not book tickets for Thanksgiving or gather together in a crowded concert hall. People do and viruses come along for the ride. We’re seeing a widely uneven distribution of cases at the moment. Here in the Deep South, we’re in a bit of a breather, but Michigan and Minnesota are overrun with hospitals buckling under demand again. I strongly suspect colder temperatures and more time indoors among others may be the culprit but I have no absolute data to back that up. We’re having the first freeze of the season tonight and cold temperatures for the rest of the week. If that has a bearing, we’re going to see an increase based on both this and Thanksgiving in December. So human behavior – which is not universally distributed – is our first unknowable variable. Some subpopulations continue to be cautious and mask. Some do not. Some are vaccinating their children which will interrupt transmission in the reservoirs of the school yard and some are not.

The second is what happens with the virus itself. It’s constantly mutating. Some of those mutations are failures and some are wildly successful like Delta which became the dominant strain within weeks in every geographic area in which it was introduced. It was that much more efficient at transmission and it had the unfortunate effect of also making certain middle aged adults much more ill than the original strain, especially if they were unvaccinated. We could get a mutation that makes the virus more infectious, one that makes it more deadly, or we may get lucky and get one that makes it less pathogenic. I still remain very worried about the issues with long covid and the possibilities of significant pathology that won’t become apparent for years or even decades after infection, like post polio syndrome in healthy adults who had and recovered from polio as children. Unlike the Mickey Mouse Club, every day is Anything Can Happen Day.

The third is the success of our treatments that may effect the overall mortality curves going forward. We’re at 773,000 deaths so far and the death rate nationwide remains fairly constant at just over 1,000 a day so we’re on track to be well over 800,000 by the new year. The distribution of those deaths keeps changing depending on where the hot spots are and the physiologic condition of victims. (There’s no judge looking over my shoulder at my use of that word, I hope). In younger adults, where willful antivaccination ideas continue to run rampant, deaths are coming among healthy unvaccinated individuals. In the elderly, where vaccination is approaching universal (99% of Americans over 65 have at least one shot and over 85% are fully vaccinated), deaths are happening in vaccinated individuals, but mainly in those with significant immune or physiologic compromise at baseline, much as with influenza. The introduction of the new oral antivirals may also change a lot of the trajectory as they are easy to distribute and for individuals to take, unlike the previous monoclonal antibody which required infusions in a clinic or hospital equipped for that procedure. Of course, they work early in the course of the disease. Those who engage in extreme Covid denialism and stay home for weeks getting sicker and sicker and only end up in the hospital when dragged there by family at death’s door aren’t going to benefit much from them. Nor will they benefit much from ivermectin. Their bodies are too damaged at that point for easy repair.

The Overloaded Plate

Back to my angst. As things have been returning to normal locally, life patterns are also returning to normal and I, in my naivete, am attempting to return to the activity levels I had in the fall of 2019 and winter of 2020 prior to the great pause. I’ve been going to the theater (masked), I’ve been taking some classes in performance, I’m teaching Sunday school. I’ve had all of my usual work activities and I’ve accepted a role that requires me to learn a nine minute monologue (off book date is December 1). This was my usual load of activities not so long ago and I had no trouble keeping the balls in the air. Now, however, I feel like I’m failing. I always feel one step behind. Maybe it’s the fact that I added a third career over the course of the pandemic which has its own set of obligations and worries and there’s now too much on the plate, but I think it’s something deeper than this. I think I’m a fundamentally different person than I was the second week of March 2020. Too much has happened.

My brain has been rewired by living in an environment of constant danger, a new one for most of us and, as we emerge from, our pandemic lives, we’re all going to find that certain things just feel wrong and the pieces just don’t fit the way we think they should. I think we’re all going to have to be gentle with each other the next couple of years and we’re going to have to encourage our society, our workplaces, our schools, and all of our other institutions to understand this. It’s going to be tough. The business of America is business and the purpose of business is to make as much money as possible. Trying to steer away from this to something that puts human capital ahead of financial capital is going to be very difficult but I think it’s going to be necessary. If we don’t we’re going to see a number of sectors of our economy crater.

The service sector is in trouble due to people having resigned from low level jobs after figuring out new ways of living. The health care system is headed for a major crash due to the confluence of experienced employees leaving their jobs due to burnout due to the incredible stresses of the last few years and the enormous increase in demand that is just beginning to happen with the aging of the Baby Boom. Education is in trouble. The ill preparedness of the American education system for pandemic education has left children behind developmentally and with more and more significant behavior problems cropping up in schools. Their parents’ behavior isn’t much better and a raft of experienced teachers are rapidly heading for the exits due to the stresses of the last two years and the rising levels of abuse that administrators seem reluctant to quell.

All of this uncertainty is, of course, fanning the flames of authoritarianism in the political system as people, feeling unmoored and abnormal, turn to those who promise certainties and rules and a return to a past that never actually existed. None of this is unique to the United States. Eastern European states such as Poland and Hungary have redone their political systems in full authoritarian and illiberal patterns. In Western Europe, just as here, there are right wing authoritarian movements piggy backing on mistakes in coronavirus response. The Dutch police were out on the streets of Rotterdam with water cannons routing antivax protestors and in Austria, the government is cracking down on their sizable antivax minority by locking society down again and making it practically impossible to function without vaccine documentation.

Will be go the way of Orban in Hungary or Bolsonaro in Brazil or Erdogan in Turkey? It’s hard to say. The conservative wing of the Republican party has gone all in for this thinking (CPAC is even scheduled for Budapest next year rather than Washington DC) and, as the party continues to purge moderates or more independent thinkers, we will continue heading there if we elect a Republican congress and executive in the next few years. The Democrats are countering by trying to show the American people that big government and big ideas can help individual Americans. We have the infrastructure bill. We’ll find out shortly if we get the Build Back Better bill. The problem with the Democrats is that they have a very poor track record at messaging in terms the American public can easily understand. The Republicans use Fox and all of their websites and pundits to deliver a clear and unified message that is easily digested by their followers. The Democrats do not. And the main stream media is so involved in making sure there’s an exciting horse race between red and blue that we’re lucky we get any real news out of them at all.

I couldn’t sleep tonight so I spent my time writing all of this, that’s been brewing in my mind, down. Fortunately, due to the short week with the holiday, I don’t have that much to do at work tomorrow so if I am dragging around a bit, I’ll likely be forgiven. I’ll have several large cups of coffee and that should keep me going. Now I’m going to flip on Netflix, not Tick Tick Boom yet as I need to have full mental faculties for that, but to finish up Midnight Mass, Mike Flanagan’s latest supernatural/horror limited series. I started watching them with The Haunting of Hill House (which I tuned into initially as I had friends on the production crew and I try to support my friends and their artistic endeavors). The first few episodes of Midnight Mass felt like a moody psychological drama and then, about a third of the way in, there was an abrupt shift in plot and tone to Steven King land with more than a few echoes of ‘Salems Lot. I was going to give up on it at that point, but kept watching and, as it went on, I realized that the point of the series was not the monster movie or the horror drama. The series is a very clever allegory on the function of religion and how, when religion becomes fundamentalist and overly structured regarding creed and belief, it becomes easy for the followers to become seduced,in the name of religion, away from good to evil without understanding that their hard lines of us versus them are creating monstrous outcomes. It doesn’t take too long to think of dozens of examples of conservative sects of all faiths where this is currently happening. And it’s getting worse, dovetailing with the political issues I noted above.

I can’t fix politics. i can’t fix religion. I can’t fix coronavirus. I’m not even sure I can fix my own life. What I can do is keep abreast of local transmission. Wear my mask indoors in crowds, keep my hands washed, not get in other people’s personal space that I don’t know, and try to maintain good health habits. I think that will do for now.

November 17, 2021

I’m a bit on edge tonight as the last day or so has been seesawing between minor wins and little lows. I don’t know if it’s pandemic coping exhaustion or something else but the little things just tip me towards a state of lassitude. I’ve spent the last few hours feeling like I could fall asleep on my feet even though it’s not been a particularly arduous day. The way I put it together is as follows. We’ve all been stewing in a toxic environment of danger signals for some years now. Turn on the TV? Some pundit with excess jowls, too much foundation, and an inability to remain in the least bit calm begins to deliver a highly opinionated tale of doom and gloom. Browse social media? Dozens of click bait headlines announcing imminent disaster of various kinds. Phone a friend? You’ll eventually get around to some story of a mutual acquaintance who became seriously ill with Covid or with post infection long Covid symptoms. A constant mental diet of this is revving up our limbic systems and primitive brain functions into a high state of alertness. Our brains, evolved for a hunter-gatherer savannah life, don’t understand that the sabre-tooth tiger isn’t about to come over the hill and are forcing us into a certain level of paralysis in order to conserve energy to fight or flee the physical danger they assume will arrive at any moment. Must stay still. Must conserve energy resources. Must hold on to extra energy in case we have to walk great distances to greener pastures. (That’s why we’ve all gained weight and are having difficulty shedding the extra pounds. To our primitive brains, that fat is energy storage for when the ever promised danger arrives and we need extra strength and stamina to survive.)

Mental health is deteriorating everywhere due to all of this and I assume we’re going to have enormous amounts of depression, anxiety disorders, and post traumatic stress issues to deal with as a society for some years going forward. Add this to the physical toll of long Covid which is likely to render a significant number of people unable to function as independent adults due to physical issues without assistance. And where are the nurturers and the caregivers and the mental health professionals supposed to come from? These fields have always been poorly paid and low on the social totem pole in our society due to their identification with a traditionally female workforce and feminine characteristics. Job categories that require traditionally male attributes such as aggression, autonomy, and precision and which have been generally reserved for males prior to the social changes of fifty to sixty years ago have always been considered more important than those that require traditionally female attributes such as cooperation, and caring. You see this dichotomy immediately in health care where doctors were traditionally male and nurses traditionally female. Of course this has been changing rapidly over the last few decades and the number of women in medical school in this country now outnumber the number of men although women are still unconsciously directed toward the more nurturing specialties such as primary care and psychiatry and not towards the more technical surgical specialties.

The lack of social worth given to caregiving type jobs is now making itself fully felt in this period of The Great Resignation with large numbers of the previously employed not returning to jobs that did not value them. Every elder care facility and company I’m aware of is short staffed. Wages are beginning to come up as employers desperately try to find and retain good employees but it takes more than a decent paycheck to hold people in careers. It requires that their other social needs be met and that they feel that what they do is of value. When everything about their field of endeavor is demeaned, why should they remain. Someone once asked me what I thought the most important job category was in society that should be compensated on the highest salary scale. I thought about it a moment and decided it was first grade teachers. Those individuals, have the ability to instill a love of learning and inquiry that will ultimately lead to the absolute success of society in the long run. They determine literacy, the building blocks of math and science, and the basics of interpersonal relations with those who were previously strangers. We all know, however, that elementary teachers aren’t especially valued these days, when teach to the test is the mantra and they have the additional issues of political culture wars entering their classrooms. I’m glad Mr. Rogers is dead. If he were still alive, I’m sure some conservative pundit would be decrying him from a spittle flecked mouth for daring to embrace critical race theory as he shares a wading pool with a man of another race.

This is one of those days when I wonder if our society is rapidly becoming irretrievably broken, just like one of my dining room chairs which splintered when I sat down in it this evening. (One of the minor annoyances of the day). At least I have eleven others. I don’t know that I’ll ever have a sit down dinner party for twelve again and, if I do, I guess one of the chairs won’t match. Another annoyance was having left my phone on the bed when I went off to work this morning. All sorts of things now run through my phone. It functions as my beeper. It’s necessary for me to be able to sign prescriptions for controlled substances as the law dictates two separate authentications for the electronic health record. It’s how I stay in touch with the VA when I’m at UAB and vice versa. Funny how something that simply didn’t exist a couple of decades ago has become so integrated into every aspect of our lives. I can tell that it’s presence is rewiring my brain as I felt lost this morning without it.

On the positive side of the column, I sat at a table last night with fellow actors and had a table read of The Reindeer Monologues which I’m performing in a few weeks (presuming I can stuff a nine minute monologue into my rapidly aging brain). I hadn’t been able to do something so mundane and as necessary as that for nearly two years and it just felt good to be in that sort of space, making the sort of jokes theater people make when they’re getting together and feeling each other out. It’s an eclectic cast – a couple people I’ve worked with before, a couple people I’ve known for year but never had a chance to work with, and a couple people who are new to the game. It should be fun. It’s a small cast and crew and most of our rehearsing will be individual so I don’t feel at all concerned about Covid safety. It passes the car test. I feel the chances of being injured or hurt in a car accident are higher than getting sick from working on this project. Another positive is a reasonable raise at work. More money to donate to help keep theater in Birmingham afloat. I’ll take some of it for a trip next year but I haven’t figured out when and where that will be yet.

Most of the extra projects are out of the way so I can concentrate on learning my monologue and enjoy a few days off in Seattle. The one last thing on the to do list is to write a sermon for church which I am to deliver on Sunday the 5th. I have entitled it ‘Book Writing and other Happy Accidents’ and it’s going to cover some of the weird ways serendipity has impacted my life over the years. The last time I gave sermon (on issues surrounding gay marriage), it ended up getting published. Who knows what will happen with this one… must… write… first…. In the meantime, off to bed, then up in the morning for VA house calls – complete with mask, hand sanitizer, and appropriate distancing.

November 12, 2021

Current Hot Spots

I have the feeling that I better write this evening. I’m not sure what this is going to be about but there’s something stirring deep in my limbic system, banging on the thalamus and demanding to get out. I haven’t identified it yet. Perhaps it will make itself known as I continue to sit here and type. I don’t think it’s about work as the week was relatively quiet. My clinic patients were predominantly well, the VA had a Thursday federal holiday meaning I had yesterday off – a rare occurrence for me (I slept in and played catch up on a number of projects around the condo), and the deposition I had been prepping for all week was cancelled at the last minute. (I’m still owed for the prep time). If all my work weeks were like this, I could easily continue working into my 80s but this is the exception and not the rule. When my patients notice my aging (I’m now nearly 25 years older than I was when I started at UAB and I still have some of the same people – 70s then, 90s now), they look at me with an accusing glare, daring me to retire before they’re done with me.


The side effects of Covid on the health care system are driving a lot of my generation into earlier than originally planned retirement. In fact, some of the ‘great resignation’ that’s being talked about with workers not returning from the last year and a half of catastrophe is older workers deciding its just not worth it to go back to the stresses of jobs after a prolonged chance of figuring out other patterns of living. This is particularly true of health care given the inherent dangers of the field during a pandemic plus the precarious nature of a previously rickety system having been subjected to mind boggling stresses. It’s sort of like a beach cabin that’s been in the family for generations, much loved, but not necessarily kept up as well as it might have been – and then a category five hurricane hits. It may still be standing after the storm but it won’t necessarily be as sturdy or as functional as it once was. Most of the cadre of experienced nurses and therapists and other professionals over the age of sixty are mapping out their exit strategies and there just aren’t enough talented younger folk to replace them. I wonder if my clinical fiefdom at UAB could survive my retirement sometimes. Both nationally and locally there are a dearth of physicians with any interest in geriatric medicine and the economics of the system are such that it’s nigh on impossible to make geriatric ambulatory care pay for itself. Not to mention providing outpatient care in geriatrics is hard and the clinical schedules for outpatient work are rigid and punishing.


The local numbers continue to trend positively with fewer than 500 new diagnoses daily and few of those requiring hospitalization. The national trends are not as rosy. We’re still losing between 1100 and 1200 people a day (which may not sound like much until you multiply it out and realize that’s more than 400,000 people a year – more than have died in either 2020 or to date in 2021). The hot spots have shifted some in the last few weeks away from the Deep South and the Mississippi River Valley to the Mountain West, the Great Lakes Region, and Northern New England. For instance, case rates in Vermont, one of the most vaccinated states, are skyrocketing. It’s small size and population mean that the absolute numbers of sick or dead are quite small, but the percentages are concerning. If I had to make a guess, I’m thinking we are seeing the results of the change in seasons. All of the places where numbers are going up are places where the temperature drops and winter sets in relatively early. This forces people indoors and I’m thinking that more people indoors around other people more often may be the driver. This would also explain why case rates have been increasing in Northern Europe but not in Southern Europe. If this is true, we’re going to see a big spike following gathering for Thanksgiving – which will likely be very popular this year due to the inability to do so last year and general Covid fatigue among the population.


Fortunately, the vaccines seem to be doing their job. Covid breakthrough cases in the vaccinated are uncommon, but not rare but the vast majority seem to cause mild illness requiring minimal treatment unless the individual as other significant health conditions. Unvaccinated adults remain at relatively high risk of serious illness, hospitalization and death. More and more data is coming out showing that the disease burden is concentrating itself in unvaccinated communities and that these can be mapped with political belief. The latest piece of nonsense to appear is some quack advocating Covid detoxification baths with epsom salts, borax and other such things to kill the nanobots. (Someone watched the latest James Bond film a few too many times). Well, at least this one is relatively harmless unlike injecting bleach or gargling with betadine or eating horse deworming paste but it does show a complete misunderstanding of what the vaccines are, how they work and what they actually do in your system. I suppose it’s so that those who get the vaccine as it becomes more and more tied to employment can get it and then immerse themselves in a ritual mikvah to wash away the uncleanliness of it all and return purified to their tribe.


I’m still working out the risks I’m personally willing to take in my head. I wear my mask indoors around other people unless we’re all vaccinated or I’m actively eating and drinking. As this is a red state with minimal guidance from the top for political reasons, every venue and organization is more or less left to its own devices to try and determine best practices. The opera is requiring masking at indoor events unless eating or drinking. One theater company in town is requiring proof of vaccination or a negative test to enter. Another suggests masks but doesn’t enforce and I was one of the few audience members who remained masked the last time I attended a show. Fortunately, the sort of people that make up live theater/classical music audiences are the sort of people that are likely to have been vaccinated so I’m not overly worried. I’m applying what I call the car test. Is what I do riskier than getting in an automobile on a routine basis? The current chance of dying in an auto accident per year in the US is 12.4/100,000 population. The chance of a vaccinated individual dying of covid is 0.1/100,000 population so I’m not worried about keeling over. My biggest worry remains becoming an asymptomatic carrier to frail patients.

So, at this point I’m willing to return to theater life but with a dollop of common sense. I’m keeping my hands washed. I’m keeping my mask on unless actively performing. I’ve had my shots and my booster and most theaters are insisting that their performers all provide proof of vaccination. The first show I have booked is The Eight: The Reindeer Monologues as Comet. As it’s eight solo monologues, rehearsal contacts will be minimal and I can stay six feet away from the audience. Tommy and I went to see the show a number of years ago when Birmingham Festival Theater last did it. I wonder what he’d think of me being in it? He was always quietly encouraging of my stage career, just as long as it never interfered with his schedule or things he wanted to do.

November 8, 2021

The cast of Encore Theater’s Skeleton Crew

The weekend was busy and the work week promises to be busier still. I thought that the change in time might fix my sense of chronic fatigue, but alas, that has not come to pass. I’m still feeling very drawn out. I have a new understanding of Bilbo Baggins’ line about feeling spread too thin like not enough butter on the toast in The Fellowship of the Ring. I better check my jewelry to see if any of them has a previously unknown power. I don’t wear a lot of jewelry. Cuff links with dressing up, the occasional ring. I took my wedding ring off a few months after Tommy died and put it away in the box in which I keep my other pieces. I look at it occasionally and remember but I don’t want to look at it all day every day as I did in the past. You keep moving on.

The night after seeing The Glass Menagerie, I went out to Encore Theater, the African American theater company run by my friend Marc Raby to see a production of Dominique Morisseau’s Skeleton Crew (shortly coming to Broadway in a production starring Phylicia Rashad). Like The Glass Menagerie, it’s an intimate four person drama served best by a small house connecting audience and actors but they could not be more different stylistically or in subject matter. Skeleton Crew is an unflinching look at four African American Detroit autoworkers at a manufacturing plant threatened by the economic downturn of 2008. I enjoyed it very much and thought that all four of the performers were exceptional in their roles. I hope more of the theater community will check out the Encore and its productions. Everything I’ve seen there has been top notch in terms of the performances and I’ve learned a great deal by turning up there regularly. If Marc ever needs an old white guy for something he’s mounting, he’ll know who he can ask…

It continued to be a theatrical weekend with my having to get up early Saturday morning and head out into the hinterlands to be a judge for the Alabama high school theater competition, known as Trumbauer (after a Walter Trumbauer whom I assume did something at some point to get the whole thing off the ground). This year, my category was musical theater duets – both dramatic and comedic. Some very good and some not so. They’re mainly 14-17 year old kids so one always gives them an A for effort and looks for constructive ways for them to improve. I’ve done this every year I can for a decade or so and I always enjoy it. And I’ve seen some of the better ones eventually join the cadre of performers in the greater Birmingham area, sharing their talents beyond school audiences. We have a very talented theater community around here. We have folk with extensive professional credits that have ended up in Birmingham for family or other personal reasons that still want to perform on some level. We have theater kids that have gone on to major careers in New York and elsewhere. Local folk I’ve worked with are currently playing the title role in Dear Even Hansen, Simba in the Lion King and are understudying Sutton Foster in the new production of The Music Man.

The next major theatrical moment of the weekend was trooping down to the Virginia Samford Theater for a callback for Larry in Sondheim’s Company. I don’t expect to get it for various reasons but being considered competitive for a role in a Sondheim show isa huge ego boost. One of my friends in New York was a member of the original cast as one of the vocal minority so I asked her to send me some long distance good mojo. I also shared that the sentence ‘I have been called back for the role of Larry in Company’ is not one I would ever expect to write. I am acutely aware of my limitations as a musician, singer, and performer in general. If I am cast, I will work like hell to rise to the demands of the piece, the character, and the production but it’s very much work for certain roles where I feel like I’m outside of my comfort zone. But I figure it’s good for me to stretch and maybe bite off a bit more than I can chew.

On stage at my CAT reading

Lastly, I spent ninety minutes on stage as myself doing a reading from the book and interview regarding it’s creation as a benefit for Central Alabama Theater. I generally don’t get stage fright. As long as I feel like I’m adequately rehearsed and prepared, I just go out there and do my thing. That was not true this time. I was very nervous about getting up there with no character and no one else’s words to hide behind. I’m told the whole thing went well but to me it was a bit of a blur. Several people have suggested that I put my three lives – doctor/performer/author – together and adapt The Accidental Plague Diaries into a one man monologue performance piece a la Spalding Gray. I’d be willing to do it, but it’s going to take someone much more savvy than I to figure out how to take those words and use them to create ninety minutes or so of something that has true theatrical energy and audience engagement. If you think you are that genius, give me a call. We’ll talk.

I’ve written five paragraphs and haven’t said much about Covid. It’s receding locally into the background. I am under no illusions that it’s going to stay there. This virus is hardy and sneaky and rapidly mutates so there’s still more to come. With international travel picking back up, variants will have lots of opportunities to jump borders and into new populations with relative ease. I wish I could predict what’s coming next, but I can’t. There are a lot of trends that are happening rapidly, all of which could significantly affect the next stage of the pandemic. These include the vaccination of children. Children 11 and under are one of the last great pools of unvaccinated individuals and, as the vaccine rolls out to them over the next few weeks, that may rapidly change how transmission chains work. We’re just about to enter the holiday season with the annual travel and gatherings of family and friends. With last year having been a bust, there may be redoubled efforts to get people together this year, especially in families that have been vaccinated. They’re unlikely to make each other sick but there’s always that chance of spread of subclinical disease which may then be carried to an unvaccinated population elsewhere. The weather is changing driving people indoors. A lot of social activity was redirected outside over the spring and summer as people recognized it was much safer but that trend may not last with colder weather. Numbers of cases are going up again in Northern Europe. The change in weather is thought to be one of the reasons why. Then there’s corporate America and policies tying vaccine status to employability which continue to spread. Trends so far suggest that only a small minority are willing to put their livelihood on the line to avoid the vaccine. Data continues to pour in on the safety and efficacy of the vaccine. The major risk factor currently in the US for being unvaccinated is political party affiliation. A recent analysis shows that those in predominantly red counties are three times as likely to die as those in predominantly blue counties. When you drill down on the data, that differential is almost all due to vaccine hesitancy among Republicans.

The US death toll topped 750,000 this week. It was roughly 375,000 at New Years so the 2021 death toll is now the same as the 2020 and we still have two months to go. This shouldn’t have happened as we’ve had a safe and effective vaccine all of 2021 – it wasn’t widely available early in the year but as of April or May it’s been pretty much everywhere. The social rules of belonging to one of two competing Americas, red or blue, has prevented its being used effectively. Today, a sitting US senator attacked Big Bird from Sesame Street for spreading propaganda for some mild statements regarding getting the vaccine. Big Bird has been a tool of American public health in explaining and demystifying vaccines for children since 1972 and has flown under the radar (so to speak) for nearly fifty years. Why the faux outrage now? Especially coming from a senator who has himself been vaccinated? Historians of the future, trying to parse the current times a century or two in the future are going to be very puzzled about all of this. The portion of the population that rejects education, expertise, science, health, and other sundry items in an attempt to define itself by being the antithesis of the other side is going to have a very difficult time creating policies allowing the US to function in the modern world next time they come to power. And they will come to power again – it’s the way the US political system works. It’s winner take all structure pretty much foreordains a two party system with power see sawing between the two at fairly regular intervals. If we want something different, we’re going to have to elect a different sort of congress. I don’t think the monied interests who pay for campaigns are going to be very interested in that.

This week, outside of the usual work stuff, I have two depositions to prepare for my medicolegal side gig. I’d rather not, but deadlines and court dates approach. More money to donate to help get the local arts community back on its feet following pandemic catastrophes. But I might just keep a little for myself for a new trip. Signing off for the night. You all know the drill. Wash your hands, wear your mask indoors unless everyone’s vaccinated, don’t go out if you’re sick with anything, and support your local arts community.

November 4, 2021

I went to see a production of The Glass Menagerie this evening. It was in the small black box space at the theater where I have done most of my work in musicals – nineteen shows over the seventeen years since I made my debut there in Jekyll and Hyde as the butler. For years the word was out – need a butler, a random aristocrat, or a drunk? Call Andy. I’m generally not a huge Tennessee Williams fan but the scaling down of the piece to fit the intimate space made me really listen to the language and at how beautiful the choice of words are. I’m a reasonable writer but then I see something like that and I realize how inadequate my little scribblings are. I was dwelling on the famous closing speech Tom gives in which he says nowadays the world is lit by lightning. Blow out your candles, Laura. And so, goodbye as I was coming up the hill back to my condo and I thought perhaps there’s something terribly prescient in that sentiment. We are living through a time of great change, a time that is indeed lit by lightning and those who attempt to sit back amid the candles of the past are doomed to a slow fade into oblivion.

The lightning strikes and peals of thunder are, to a certain extent, created by the monster of the twenty-four hour news cycle that’s come to dominate political and social discourse over the last few decades. In the past, you got your news in the form of the daily paper and it was formatted in such a way that you could take it in slowly and digest it with your breakfast or your before dinner cocktail and, if it was a bit assaultive, you could always turn to the comics or the sports section or the arts and entertainment pages. The only available visual news was pretty much limited to a half hour local and a half hour national newscast that stuck to facts and news rather than opinion due to the strictures of the fairness doctrine. Things have changed a bit with the invention of continuous cable news networks, the demise of the daily paper, and the availability of insta-news of dubious quality via various online sources distributed through social media.

There’s something in the American character that just loves competition. Not only just competition but brutal winner take all competition. It’s no wonder that football took off here and not in any other country. The idea of a sort of gladiatorial combat in which men maul at each other to capture territory and which is set up so that only one team can be the champion and get the accolades seems to fit in with the country built on manifest destiny and the rolling over and exploiting of the less fortunate and less powerful. I’ve never been a big football fan. That has not served me particularly well since moving to Alabama where football is a religion. I joke about the sportsball, but I do usually know who’s winning and losing. You can’t avoid it in this part of the country. I attended football games in the student section when I was in college. I brought a book. But it did give me my one and only football claim to fame. I was there in the stands in 1982 for the Stanford – Cal game that included the crazy finale with the infamous band play and saw the trombonist get tackled. It was wild.

We all know that the most interesting sports competitions are those which are the closest. It’s the suspense of not having a foregone conclusion, the last minute field goal, the impossible save, that grab and keep are attention and give us something to talk about for the next week until there’s a new highlight. These sort of edge of the seat moments are great in the sporting world, but in this brave new world of fleeting attention spans, these qualities are invading other areas of our lives in an attempt to capture our eyeballs, however briefly, driven by the news cycle and causing certain areas of our lives to become counterproductive. Take the movies, for instance. Reportage on film used to be about the quality of the product, written by critics of discernment. Now it’s all about who captured the box office and is number one or how many teenagers paid to see the latest MCU opus opening weekend. The language is full of sporting and military metaphor. The result has been a significant decline of lower budget films about adults for adults as they can’t possibly ‘beat’ the competition and ‘win’ the weekend.

Of course, it’s become most corrosive in our politics, especially on a national level. Politics and governance are not inherently exciting subjects. In the past, no one was terribly interested in what went on behind the closed doors of congressional meeting rooms as the sausage was made. People were much more interested in what was presented after the wheeling and dealing was over and policy was voted upon. Congress was there to do the people’s business and to get policies with popular support enacted into legislation. Now most congress people seem to be acting out of a sense of personal aggrandizement. As the old adage goes, politics is show business for the unattractive and draws the same personality types. The media, needing to create the news cycle and excitement to get the clicks and the eyeballs, spins as much as possible into a continuous horse race between R and D – red and blue – where they’re constantly neck and neck, calling first for one side, then the other. The result is a dishonest look at the business of governing and a continued push to pick a team and team colors and to be yelling for your team from your side of the stands.

It’s even spread to what should be apolitical topics such as public health. There have always been people opposed to public health measures for various reasons but they have generally not been given a megaphone to spread their ideas and they have generally gone dormant once the public at large has seen the benefits of vaccination/sanitation/industrial safety/smoking reduction or whatever other issue is at the forefront. With the recent introduction of coronavirus vaccines, the sentiment seems to be everywhere. If you go back through the various streams of information, most of the antivaccine rhetoric comes from a surprisingly few outlets, fewer than twenty in total. It just gets magnified by social media and then the news media as a whole picks up on it and the nature of the news cycle and the need for the close horse race takes over and a small minority opinion seems to have equal weight with a large majority opinion that has all the facts and the science on its side. This is, I suppose, why the media predicted that tens of thousands of NYPD officers would leave their jobs rather than take the vaccine when required. The actual number who have left so far is fewer than fifty. Tying vaccine status to job/salary, whether you agree with it or not, is working to bring the numbers of vaccinated up relatively rapidly and, concomittantly, the hospitalization rates are going down. We’re down to ten Covid inpatients at UAB as of today. To my knowledge, there aren’t any hospitalizations there due to vaccine side effects.

I don’t know what to do about any of this any more than anyone else does. All I can do is recognize the patterns and hopefully continue to read widely and deeply on current affairs from multiple perspectives, avoid television news and click bait, and not put too much stock into the results of any particular partisan race having a whole lot of meaning for the future of the country as a whole. I’ve also had my shots and my booster, keep my hands washed, and I wore my mast in the theater.

October 30, 2021

I’ve found my Halloween costume

It’s been a lugubrious couple of days, at least as far as the weather is concerned. Dreary, gray, with intermittent rain showers. Very Seattle. Such weather used to make me homesick but as I haven’t lived in Seattle for nearly thirty-five years, that phase has passed. Now it merely makes me sleepy. I came home from work yesterday, sat down on the bed with every intention of doing some writing and woke up four hours later. Of course this meant that when it was actually time to go to bed, I was bouncing off the walls and ended up staying awake most of the night binge watching old episodes of Supernatural. I’ll get myself back on track through the weekend. I don’t have much scheduled other than a Halloween party tonight. I have a feeling I will make an appearance but not stay too late.

We haven’t run the numbers for a bit. We’re at just over 745,000 deaths in the US and just about to hit five million deaths worldwide (the world figure is a major undercount as there are significant parts of the globe without access to appropriate testing to know whether deaths are related to coronavirus or not). The Delta Wave is pretty much on the downslide both locally and nationally, but we’re not out of the woods. Nationally we’re still losing somewhere between 1000 and 1500 people a day which is a good deal higher than the numbers late this past spring when the roll out of vaccine and better social behavior were driving spread way down. And then Delta… I’m waiting for another strain to start spreading as we still have a large unvaccinated reservoir in the US population. In Alabama, we’re up to about 2/3 of adults having at least once vaccine and 55% being fully vaccinated. It’s better than it was but there’s still a long way to go. The senior population is doing much better. In Alabama, nearly 90% of those over 65 have had at least one shot and more than three quarters are fully vaccinated. I can breathe a little easier about my patient population.

The senior generation has gotten themselves vaccinated. Nationwide, 97% of those over 65 have had at least one shot and nearly 90% are fully vaccinated. Despite being heavy consumers of Fox News and other propaganda outlets, they understood the very real risks to them and their health. The prevalence of vaccination in the age group means that the Delta wave did not really do much damage to older Americans. The death rate over the last six months for them is comparable to other respiratory viral illnesses such as influenza or respiratory synicitial virus. Delta killed and is still killing the middle aged who decided to put politics and tribal identity ahead of their own health concerns. Older adults have memories of prior pandemic disease such as polio and the miracle wrought by the public health vaccination campaigns of the 40s through the 70s. Those under sixty may recall getting their shots but would have no real adult memory of the rise and fall of epidemic disease. Never having experienced it, to them it’s not quite real – it’s a relic of a bygone time like the grainy black and white photographs of the two World Wars. So when pandemic disease showed its ugly head in the modern era, younger generations were not prepared to process what was happening to them and their society. In that liminal space between events and reactions, various forces took root, urged on by a political system that thrives on controversy, one up manship, and a sort of high stakes football game with each side trying to move the ball to their own end of the field and tackling the opposing side as they do so. And here we are.

I still haven’t figured out if these musings are going to become another volume of The Accidental Plague Diaries (relatively easy) or if they are going to transform themselves into something quite different with time. I don’t foresee us really being out of the pandemic until next spring (although many of my living patterns, as they happen in a segment of society with very high levels of vaccination, are returning to what they were pre Covid). Viruses are sneaky and, as they are such simple organisms, they are constantly mutating and sometimes those mutations are fortuitous for the virus to begin spreading anew or to create more serious illness in the host. I have a feeling we’ve got another wave or two to come. As the vaccination levels are going up, albeit slowly, with luck they will not be as serious as the Delta wave of this summer.

As I presumed, the government has not mandated vaccines on the population. They have, however, mandated them on federal employees and contractors as a condition of employment. The government doesn’t want sick employees and quarantines to interrupt its business any more than it has to. It doesn’t want sick or quarantined military troops. The troops that are fussing about the vaccine are being a little silly. They had to have all sorts of vaccines as part of their induction into service including things like anthrax to protect against biological warfare agents. Now they’re complaining? State and local governments in blue areas are also mandating public employees, especially first responders, health workers, and school employees., be vaccinated. In most areas, there is grumbling but when people realize their job is on the line, they get vaccinated and they are fine. The hospitals of Los Angeles are not overrun with school district employees suffering serious vaccine complications. In red states, they are busy passing laws preventing local governments from mandating vaccines for public employees and are searching for ways to nullify the federal mandates. They won’t have much luck. There is well over a century of precedent allowing such actions in public health emergencies and the few Covid related questions that have reached our conservative supreme court have been turned away in favor of vaccination.

The private world, with our ridiculous employment based health insurance system, has realized that they will be on the hook for many many expensive hospitalizations if vaccination is not widespread and is coming down firmly on the side of vaccination as a condition of employment. No, it’s not a violation of your rights for them to do this. They can mandate all sort of things regarding your job such as uniforms, dress code, safety policies etc. This is just one more thing in that long list. If you cannot abide by the employer’s rules, you are free to seek employment elsewhere or to become self employed and set your own rules. Some large companies are not allowing sick leave to be used for Covid quarantine if you are unvaccinated making it time off without pay. I suspect that the insurance plans offered in 2022 when people go through their annual open enrollment a year from now, will have a new rider denying coverage for Covid claims in the unvaccinated who cannot prove medical contraindication or long standing religious belief regrading vaccine use.

Where will all this leave us? I think it means that the next inevitable wave of Covid will be confined to rural and suburban areas in states which have not taken vaccination seriously for political reasons. Most city dwellers, whether in red or blue states are vaccinated and so even though the population density is higher in cities, the virus will have less purchase, especially if we keep up the new patterns we have developed of moving dining and other social activities outside as much as the weather permits. As more and more data becomes available, it’s becoming increasingly clear that the virus is not easily transmitted in outdoor environments (or indoor environments with high airflow). It’s also not particularly transmitted on surfaces. So you can let the kids trick or treat outside and you don’t have to Clorox the candy. The new normal should be for the adults to sit on the porch with the candy bowl to hand it out rather than inside the house.

The weather is changing (that’s where we came in on this essay). And with that, social behavior is going to start changing and we’re going to move more indoors. Then we have the holidays with the usual gatherings and travel patterns. Will this lead to a fresh wave this winter? I’m hoping that there’s enough vaccine out there that we’ll see a little blip up but not a steep curve as we had in July and August with Delta. Time will tell. If Halloween parties make an impact, we’ll be seeing rates of hospitalization increase again in mid November. Thanksgiving will become apparent in mid December, and Christmas/New Years in mid to late January. Assuming I haven’t gone completely barmy, I’ll report back on all that when the time comes.