June 30, 2022

Omicron continues. The BA 4 and 5 variants of omicron are swiftly becoming the dominant strains in the US as they have elsewhere in the world. The good news is that they are not that different from the initial omicron strain which first appeared around last Thanksgiving and immunity from either natural infection or vaccination appears to be holding, at least for serious disease. It’s difficult to interpret the numbers these days due to so many tests not being reported to health authorities as they are done at home but we do still get reasonable data from hospitals and, at the moment, the number of patients requiring hospital care for Covid and its complications continues to remain mercifully low. Still, we’re at about 32,000 hospitalized nationwide (well below the hundreds of thousands during previous surges) and the numbers have been trending up by between five and ten percent a week over the last month ago. We’re also still having between three and four hundred deaths a day nationally, or the number of people killed on 9/11 every two weeks.

The vaccines seem to be working relatively well. You’re about forty times more likely to be hospitalized if you’re unvaccinated. Those with two boosters have about 1/4 the hospitalization rate of those with one booster. The biggest issue is that immunity from vaccines does not appear to be long lasting and starts to wane after six months or so. This is particularly important in older people and in those with immune compromise. There is, therefore, a lot of debate about what to do next. Should there be another round of boosters in the fall? Both Pfizer and Moderna have been retooling their vaccines to offer better omicron coverage and the preliminary results of studies on these new formulations look promising. The FDA is in the process of discussing whether another booster should be made available in the fall and if it should be changed for better omicron coverage. The final decisions aren’t out yet but it looks like the answers are yes and yes. It may be that we are going to be getting Covid boosters once or twice a year for a while. The flip side of this is modelling what is likely to happen should we not make new boosters available and the short answer to that is a few hundred thousand more people dead.

Locally, the issue continues to be rapid spread among small populations with close contact. At least three shows in local theaters had to shut down and cancel performances in recent weeks once it got into the cast and crew. Fortunately, all of my performances, since the original omicron wave, were Covid free. I’m also performance free for a while. Taking my usual rehearsal time to finish up Volume 2 of these Accidental Plague Diaries for publication and then trying to take stock of my theatrical life and see what I can do to simplify. I’m responsible for two quasi-defunct production companies, a storage space full of theatrical paraphernalia, presidency of the opera board, a couple of other theater boards, and helping with a few capital campaigns. It also seems to be spreading in the main VA hospital with about 3% of the workforce out on quarantine this week. My VA job is peripheral to the hospital so I rarely go in and haven’t come into contact with anyone sick to my knowledge. I thoroughly expect to get reinfected at some time… but not today.

I taught an undergraduate class on the biology of aging and aging research opportunities via zoom yesterday. I hate teaching on line. I guess it’s my stage performance heart. I need to connect with my audience and read them and know when and how to time my jokes and when to get serious and when they’re into what I’m saying and when they’re falling asleep and checking their phones they think they’re successfully hiding in their laps. When they’re all just in little tiles a la The Brady Bunch titles, none of that works. I just have to start talking and hope that at least one point will trigger each of them in some way. They were all rising juniors planning on pursuing medical school and health care careers. It got me thinking back on me at that age. I was at Stanford. Ronald Reagan was president (first term) and I was vaguely thinking of a bench science research career in some sort of toxicology. It’s not where I ended up but the longer I live, the more I learn that life’s about the journeys and not the destinations.

I don’t necessarily have the fondest memories of my classes my junior year of college. It was the year I battled p-chem, quantum physics, group theory, and vertebrate anatomy. My MCAT was in the middle of it. This was long before computer terminals and on line testing so I took mine with several hundred other premeds using pencil, paper and a fill in the bubble form. Due to inopportune scheduling, my MCAT was at the same time as the second tech of ‘Hello, Dolly!’ which I was assistant directing for the big student theater group. Fortunately, the testing classroom was in the building next door to the theater so I was able to run over during all the breaks, check in, and then run back and settled down to the next section of the test. I can’t say it was ideal test taking conditions, but it seems to have worked as I did reasonably well on my MCAT and managed to make it into medical school about eight months later.

Most of my friends and colleagues have been preoccupied with distressing political news this past week, be it heinous supreme court decisions, testimony in the January 6th hearings, or prognostications regarding the midterm elections coming up in the fall. I refuse to go into a funk. Don’t like what politics is doing? Go out there and get to work and change it. The current conservative surge has been fifty years in the making and has succeeding due to a fundamental understanding of how our system works. It’s a winner take all system with judiciary as the referees. Want a different result, get out there and do the dirty work in the trenches of precinct politics. Volunteer for candidates of choice. Help build institutions that will produce trained minds that are qualified for the judiciary that will view the world as you do. Sniping at each other, edging others out for not holding quite the same views or being as idealogically pure as you, ginning up division on identity lines are all recipes for ultimate failure in the zero sum game of American politics where with 50.001% of the vote, you take it all. If you lose, you mourn for a day or so, then you have to roll up your sleeves, get out there and get to work. It’s the only thing that has ever succeeded.

There’s left over Chinese in the fridge and I’m hungry. Gonna stop now and eat. But wash my hands first.

June 24, 2022

Another work week over. This one punctuated by the collapse of Roe vs. Wade in the official release of the Supreme Court’s vote and opinion in the Dobbs case. This is where we are: a political system in which the minority party is busy dismantling the election apparatus in plain sight and a judicial system where the supreme arbiters are hell bent on imposing the world views of a particular religious minority on the majority. I can’t fix any of it so I’m not going to let any of it ruin my life. It will be interesting, however, to see what happens when there is no longer the unifying force of ‘overturn Roe’ keeping all of the disparate groups and agendas on the conservative side of the political agenda pulling together. Will they now start turning on each other over finer points of theology and doctrine? Will the money behind them whip them into a frenzy over a new target? (If this is what’s next, I’m likely to have a large bullseye on my back). Time will tell.

My friends in the local emergency departments are reporting a sharp uptick in people with Covid related illness over the last week. Most are not ill enough to require hospital support and are sent home with comfort meds and prescriptions for antivirals if warranted but the number of inpatients are creeping back up again. The bigger issue for the health system currently isn’t the patients but the workforce. When one of us catches it, we’re out for five to ten days on quarantine and as the case numbers climb, the number of nurses and doctors and therapists and pharmacists and housekeepers and billing clerks going out climbs putting additional burdens on those who remain to close the gaps. It’s leading to more and more erosions of care. There isn’t a specialty service I’ve called with a referral this past month that doesn’t have a six to twelve week waiting list for appointments. If I pull in favors and it’s urgent, I can sometimes get that down to a couple of weeks but forget getting someone in the next day or by the end of the week. Anyone I think’s emergent generally has to go to the ER if I’m going to have a prayer of getting it looked at in a timely fashion. It’s not a great use of ER resources but my hands are tied and my first responsibility is to the needs of my patients.

We’re seeing this play out in another industry, travel. I’m very glad that I decided to forego booking a significant vacation this summer (a combination of needing new kitchen appliances and expenses around the 60th birthday bash took care of that). The news from the front lines of travel, especially by air, is shall we say, chaotic at least and its a world wide phenomenon. It’s driven by a couple of things. The first is an inadequate workforce and understaffing (this one sounds familiar). The rapid fall off in travel in 2020 due to the pandemic led to the airlines hemorrhaging money and, like any for profit business they did what they could to shore themselves up. They offered early retirements and buyouts to senior staff to save on salaries and trimmed their work force. Now, everyone wants to travel again and the airlines just don’t have the flight crews – and it’s not like they can create a pilot from a willing applicant with a couple of weekend seminars, an on line training course and a couple of YouTube videos. Then there’s the lifting of the universal masking mandate on transport. Masking only really works properly when everyone does it and, in the airline industry, it helped keep the chances of flight crew getting ill and out on quarantine lower. Without it, the pilots and cabin crew are more likely to get sick, go out on quarantine and there you have it, not enough on the duty roster for all the scheduled flights to take off. The same thing is happening in medicine, just replace flight with elective surgery or MRI scan with contrast or rheumatology appointment.

The piece of the health system that looks like it’s going to collapse the first is the long term care industry. By the latest numbers, 98% of nursing homes and long term care facilities are understaffed and 73% are in the red as they have to spend additional dollars on agency staff to make up for additional employees coupled with inflation in food and energy costs. The pandemic also has made families rethink when to use group living for elders and a lot of the patients who would have been relatively easy care as their needs are fewer are being kept at home making the per capita acuity of those that remain higher, and therefore more expensive. In the middle of the last century, long term care was mainly a not for profit sector with the nursing home generally reserved only for those who could not be cared for at home by family and often subsidized by either a governmental or religious entity. As the industry was transformed with advances in medicine into more of a step down hospital role, and with more certainty of payments with the introduction of Medicaid for the indigent, for profit corporate entities began to buy up nursing homes as revenue generators and put processes in place to allow for economies of scale. For profit operators aren’t going to want to carry chronically money losing businesses on their books and I foresee a rash of closures coming over the next few years.

Closing nursing homes are going to run into smack dab into several other trends which are pushing the opposite direction. The first is the continued aging of the Baby Boom generation, that huge cohort of individuals that’s just starting to age into the chronologic band where long term care becomes necessary for a portion of the population. The lead edge is 76 this year. They’ll be 80 in four short years and with that, the number who will not be able to care for themselves due to physical and or cognitive decline will start to increase exponentially. The second is the financial strain that Medicaid places on state budgets. Medicare, which is a federal program and solely consists of federal dollars, does not pay for long term care. It will pay for brief stints in a nursing home for rehabilitative purposes to recover from illness or injury if certain conditions are met. If you require a permanent stay, you are on your own (unless you have private long term care insurance – a product that as now near impossible to obtain as it’s actuarially unsound). If you have either exhausted or cleverly hidden your assets from the state, than Medicaid, a joint federal/state program steps in to pay the bill to maintain you.

We don’t tend to think much of nursing home residents as they are a hidden population from society. You don’t see them walking down the street or out to dinner or at the football game but there are about one and a half million nationwide. Roughly 40-50% of a state’s total Medicaid budget flows to nursing homes annually. Medicaid is about 20% of the average state’s general fund spending so nursing homes take about one dollar in ten of a state’s discretionary spending. If nursing homes start to close, there’s going to be an enormous financial pressure on states to try and get out of future nursing home payments as most state budgets are pretty cash strapped. There’s not going to be a lot of push for the public sector to step in with new beds. I think there’s going to be pressure instead to get families to step up and house and nurse their own elders as in times past. There will likely be promise for new pots of public money to provide assistive services to make that more successful but the reality is likely to mirror the deinstitutionalization of the mentally ill some years ago. The mental hospitals were closed but the promised community based programs and funds that were to replace them somehow never materialized.

If you’re in my peer group and contemplating retirement and the unknown country of age and infirmity, it’s a good idea to sit down and make some plans and talk to the kids now. The old models aren’t likely to last. It’s one of the reasons I made my decision a couple of years ago to downsize to this condo. It’s a space I can age in with minimal supports. Take it from the geriatrician. Your golden years are coming, like it or not. Unless, of course, you skip your vaccines, expose yourself to sick people and don’t wash your hands.

June 20, 2022

Today is Juneteenth. And all good wishes to my African American friends and colleagues who are celebrating today. Both UAB and the VA are observing the holiday so I have a three day weekend and I used the first part of mine to sleep in after the excitement of the show this past week. I would like to use the rest of today to laze around, but unwritten progress notes, a lecture to prepare, and the usual unending supply of household projects and performing arts organizations requiring assistance in terms of planning will keep me busy until sometime in the evening.

Covid has been on the back burner the last few weeks while other life areas have taken precedence but I was jolted back to reality after receiving an email this morning about a potential exposure. I’m not worried. I’ve had both shots, both boosters, and natural immunity to omicron following my bout six months ago. I was feeling a little blah yesterday so I stayed home from a planned outing and went to bed early. I’m fine this morning. Hopefully noting will sneak up on me over the course of the day. It’s just a reminder that as much as the culture at large is moving on to a post pandemic mindset, we’re not completely out of this thing. I hadn’t looked for a bit so I checked the numbers. On a national level, they’re still rising but not at the rate they were a month ago, having flattened a bit over the last two weeks. The current hotspots are in the Rocky Mountain states and in Appalachia. Why that should be is anybody’s guess. Perhaps the virus is hitching a ride as people are escaping the sweltering summer heat to the relative coolness of mountain towns. Alabama numbers are similar. A general slow increase, but without a significant rise in hospitalizations or deaths. But it’s hard to say what’s really going on locally – the reported cases are those from testing done in hospitals or pharmacies or public health departments. Home tests have no convenient way to be included in the totals in this state. And most of the people of my acquaintance who have gotten sick recently have all been diagnosed with home testing.

The other big development is the approval of Covid vaccinations for children under the age of 5. The number of parents planning on getting their children a vaccine is distressingly small, likely due to the collapse of trust in expertise that politics has engendered over the last half dozen years or so. Actually, it’s been brewing a lot longer than that but that’s a subject for discussion another day. Katelyn Jetelina, who goes by the moniker YLE (Your Local Epidemiologist) has put together a very nice one pager on the vaccine for young kids based solely on the science and I highly recommend searching that out if you have children in that age group and questions. Her writings on Covid, while occasionally over my head as I am not a trained epidemiologist, are a great way to keep up on the latest regarding the pandemic and the science driving the response at institutions such as the WHO and the CDC. I find her a much better source than many of the more usual mainstream media writings which tend to over simplify or try to find some sort of clickbait angle to use.

Most of this past week, when not at work, was spent on the fundraising cabaret show, Little Black Dresses and Bowties. It was a Broadway Backwards or Miscast type revue where we all got to sing songs we would never be allowed to in the context of a real production as we would be the wrong gender or type for the role. With that in mind, we were somewhat genderqueer in our costume choices. I was the MC so I did a bit of a riff on my traditional garb as the MC of Politically Incorrect Cabaret – tail coat, white tie and vest (but without a shirt) for the top and pleather hot pants, fish nets and pumps with three inch heels below. The show was a success. I’ve gotten more compliments on my legs this past week (thank you Peloton and enjoying a good walk) and it has helped with coming out of my omigod I’m sixty funk. I did a lot of age jokes in my MC patter for the show as I’m pretty good at poking fun at myself. One I didn’t make, and should of, was that if I fell off those damned heels, I would have to yell out ‘Is there another doctor in the house?’.

It was one of the fastest turn arounds I’ve had in stage performance. Half an hour with the pianist on Sunday to figure out tempi and style. Meet and greet with the rest of the cast Tuesday evening and first band rehearsal and figure out some basic staging. The band was a standard jazz combo of keyboards, bass and drums and Sebastian Black, Lee Wright and Joe Cooley worked amazingly well together. Tech/dress Wednesday to iron out light cues and any other bobbles. Run Thursday-Saturday. We all had a great time as did the audiences and have decided that it should perhaps become an annual event. If it does, I’ll get smart and wear those pumps around the house for a few days prior to rehearsals. I’ll just have to come up with women’s up tempo Broadway numbers that I can sing. ‘Don’t Tell Mama’ was a good choice. Perhaps ‘Dance Ten, Looks Three’ for next year.

I have noting booked on my performance calendar at this time. I’m not worried about it. Sumer is a slow season for music-theater and something will eventually turn up. It always does. The venue we did this last show in would be perfect for Politically Incorrect Cabaret so perhaps it’s time to come up with another edition of that. If so, I think it’s time for a bit of a reboot. After nearly 20 years, those of us who survive from the original crew are getting a bit long in the tooth and I think I need to find some thirty somethings with an interest in political satire and street theater and cabaret forms and let them run with it. So, if you’re one of my local theater friends and you have any interest in this, drop me a line. The bigger theaters in town have announced their line ups for next season. I, of course, immediately scan them looking for parts I might be appropriate for. Not a lot has turned up so far. Choices seem to be trending female and young. I suppose I could get out one of Tommy’s wigs and put my pumps back on and audition for Truvy in Steel Magnolias, but I doubt I’d fit in with the rest of the cast – unless we’re all men and I just don’t see this particular company doing that. Oh well, any time I don’t use on theater projects can be used getting the next volume of The Accidental Plague Diaries ready for publication. We’re still shooting for September.

June 15, 2022

It’s been a bit of a wild few days.  There’s a new charter school in town, The Magic City Acceptance Academy, targeted especially at LGBTQ kids who, in the homophobic culture of the Deep South, are psychologically brutalized by their peers in most of the local public schools.  It opened this past year and the inaugural classes have been blossoming in an educational atmosphere that allows the kids to be themselves resulting in improved learning and test scores.  It’s the only school of its kind in this region of the country and is attracting students from outside the city and I am very proud of my friends who have worked incessantly to make it a reality over the last few years.  It wasn’t an easy job.  And then it came into being in the midst of the pandemic… 

There has, inevitably, been a backlash as the right wing noise machine has been going after gender nonconforming individuals over the last six months or so.  It culminated here with one of the more homophobic, and less successful gubernatorial candidates taking photos of the kids at MCCA and using them, without permission, in attack ads claiming untruthfully that the school was using tax dollars to turn kids gay or some such.  That particular noise machine has been ratcheted up to eleven in recent months as we head into the midterm elections because, I assume, that some Republican research firm determined in focus groups that attacking LGBTQ folk plays well to the base and those that will be hurt by it aren’t likely to be voting Republican anyway so what do they matter. It matters because political movements based on dehumanization of the other have a long and sorry history and it rarely stops with name calling and political attack ads.

One of the local theater companies put together a genderqueer Broadway cabaret as a fundraiser for the school and I was asked to do a number and be the MC for the evening.  Now standup really isn’t my forte but nearly two decades of being the MC of Politically Incorrect Cabaret has given me a certain skill set in terms of telling jokes, reading an audience, and guiding a mishmash of musical entertainment from one end of an evening to another.  This show, which opened last night and continues through the weekend, is a Broadway Backwards evening with the men singing women’s numbers and vice versa.  I start things off with ‘Don’t Tell Mama’ from Cabaret. I have to do uptempo numbers for something like this because I’m not really a singer.  I’m an actor who sings a little so I need a song that I can sell to an audience rather than them having to endure me butchering some leading man ballad written for the typical Broadway bariten, which I am not, being just a step or two above basso profundo in my natural range.

In keeping with the gender fluidity of the evening, I’m doing the whole show in pumps with three inch heels.  I’ve worn women’s shoes and heels before, but never for a whole two hour show with multiple entrances and I’m getting a new level of respect for women and for drag queens.  How the heck do you manage to descend a staircase without literally breaking your neck at every step?  The show is fun.  Audiences are enjoying it, and are being encouraged to be slightly raucous at every innuendo.  We’ve managed to keep Covid out of the cast.  My projects this spring/early summer have been remarkably Covid free.  That’s not been true of some other productions in town.  The local production of Kinky Boots has had to shut down for ten days due to multiple cases in the cast, but it will be back next week.

The local patterns of Covid are fascinating.  It’s impossible to tell what’s going on from the official numbers as so many people are home testing and not bothering to take the steps to report to the local public health authorities. I have friends who are going out on quarantine on pretty much a daily basis but none of them has been sick for more than a day or two.  The numbers in the hospital remain extremely low.  I got a report from the VA Medical Center yesterday.  Two inpatients with Covid (they generally were running more than twenty or thirty during the surges) but forty employees out on quarantine.  Maybe we’re starting to reach the end of the road of Covid as a serious disease that causes hospital level sickness.  Maybe we’re not. Time will tell.

There was another mass shooting last night.  They seem to be taking place pretty much on a daily basis.  This one was uncomfortably close to home, in a local church during a senior citizen’s potluck supper.  There are three dead, a suspect in custody, and a reeling community as Birmingham is a city that revolves around church membership.  Everyone with a wide circle of acquaintance knows a congregant at pretty much any church in town so I know parishioners, choir members and staff from this church.  There’s been no official statements yet on motives but a lot of rampant water cooler speculation.  My church has a whole active shooter safety plan.  We have to.  As Unitarian Universalists are not a conservative Christian denomination, we’re a target.  There was a mass shooting at the UU Church in Knoxville in 2008 during service which killed two and wounded six.  The motivation of the gunman?  Hatred of liberals, Democrats, homosexuals, and African Americans.  And this was before the poison of intolerance really started to metastasize in our society around 2015. I’m not particularly afraid of being taken out in a mass shooting event.  I figure if I’m in the wrong place at the wrong time, that’s just the luck of the draw.  The thing that scares me the most about guns is when they fall into the hands of the demented.  I do a lot of rural house calls and I am not trained or equipped to take away a firearm from a paranoid patient. If anyone on any of my teams runs across a demented person with an unsecured gun, we hightail it out of there and inform the family we aren’t coming back until something is done.

When you compare the number of innocents that have been harmed by guns over the years to the number harmed by drag queens, I think it’s pretty clear as to which needs more societal control.

June 11, 2022

Mutations, mutations…

I’m behind. I should have written an entry a couple of days ago. I do my best to write at least two of these musings a week, unless life is really intervening. I failed at it this week. I suppose I’m still in recovery mode from the last show plus I had to use a number of my evenings this week to run around and see all of my friends shows (most notably local productions of Kinky Boots and The Sound of Music). I’m also in that weird headspace where I’m still trying to sell Volume I, editing Volume II and realizing that what I’m writing now will be Volume III if I choose to keep this project moving forward.

At least current Covid numbers are suggestive that there will not be a Volume IV. I will be able to take my imagination and my thoughts and apply them elsewhere. Maybe a novel, maybe a play. Maybe I’ll just get drunk on apple wine. In the meantime, however, I still don’t think we’re completely out of the woods. Coronaviruses in general become less active in the summer months and more active in the winter. (This is why you’re more likely to get a bad cold in the winter.) Some of our respite may be due to this natural cycling. If this is the case, things may start shifting again around football system when fall nips the air. The Covid coronavirus mutates about four times faster than the common influenza viruses and we are all familiar with how we have to get vaccines for flu every year based on the best educated guess as to the circulating strains. Sometimes we get it right, and the season is mild. Sometimes we don’t and it’s a heavy flu season. Is this where we’re headed with Covid? Annual shots and some good and some not so good years? There’s so much that’s unknown. Mutations, population behavior, politics, the ingenuity of vaccine manufacturers – it all adds in.

The official Covid numbers locally remain relatively low (and the number of people in the hospital with Covid also remains low and well within manageable limits). However, I hear of new cases among friends on nearly a daily basis. I think that some of that comes from these writings and the erroneous presumption that I must be some sort of Covid guru or Covid whisperer and so I get calls and texts and messages from everyone if they get sick and likely hear about it more than most. Most of my friends, long vaccinated and boosted, aren’t getting terribly ill and generally have been tested with home tests so I don’t think they’re being well counted by the public health authorities. And I think that’s likely happening most places as the pandemic slides into endemic mode – outside of some relatively narrow areas of study, it’s slipping from our daily consciousness, replaced by new worries about inflation, and gun violence, and war in Eastern Europe. I’ll take it, and the lessened burdens on health care and society, even if it’s going out with a whimper rather than a bang. I’m still not completely convinced, however, that there’s not at least one more very nasty surprise coming our way before it all runs its course.

I don’t think we’ve even begun to come to grips with what the pandemic has done to society over the last couple of years. We’re all too busy trying to restore ‘normality’ and making up for lost time to have the ability to sit down and take a sober accounting of how different things are from early 2020. I think some of the changes are too wrenching to fully comprehend. That’s certainly true of what’s going on within the health care system. The combination of loss of seasoned workers to early retirements or different ways of using their skill sets combined with the financial pressures placed on health care institutions is only just now starting to cause significant changes in the way business is done. What am I seeing? An acceleration of the system’s view of health care providers solely as revenue generating cogs in a large machine and significant pushes to increase and maximize that revenue at the expense of providers abilities – which basically translates into do more with lots less. Needs of patients and society are, at best, a secondary consideration as armies of administrators try to shore up the bulwarks of systems financially battered over the last few years.

The federal support that allowed health care to fight Covid has more or less come to an end. There’s not going to be more public funding of vaccines, reimbursement for indigent care, or extra payments to hospitals for their increased expenses going forward. And if there’s no money, there won’t be a lot of motivation to provide services. If another surge starts to take hold, response may be more sluggish than in the past. Congress could, of course, put additional dollars into public health but congress doesn’t seem to be able to do much these days other than conduct a cold civil war inside the capitol.

At the age of sixty, I’m getting a bit tired at being asked to do more with less yet again (this sort of thing happens every time there’s a downturn in the economy). I love my work. I love my patients. I don’t even mind tilting at the healthcare windmills out there but eventually it starts to all feel a bit much. I’m seeing a landscape where many of the support services I rely on – senior housing and health care facilities, home health agencies, meals on wheels etc. – buckling under a combination of inflationary pressures and the inability to hire and retain competent staff. This is combined with a rapidly aging population and the enormous boom generation right on the cusp of needing these services. It’s going to get really ugly over the next decade or so as more and more start competing for fewer and fewer available resources in a country with a fraying social contract and no political will to provide money for social programs for fear that someone unlike you might tangibly benefit.

Is the healthcare sector broken? It’s still intact but it’s frayed and needs some TLC in order to repair itself. If we define our system as the way in which those in need of health services are matched and receive proper treatment in a timely fashion, then yes certain things aren’t working too well. The numbers of aging adults means that specialty services commonly required by them are full up. It’s not unusual for me to be quoted a three to six month wait time for an appointment when I make a referral. Insurance programs, trying to staunch losses, are more likely to fight about the need for a service than in the past and that puts extra hours of work on my office staff. We’re out of IV contrast for certain X-rays preventing timely diagnosis (a supply chain / manufacture issue). Administrators are constantly looking for ways to reduce costs – replacing staff with lower cost/lower knowledge base individuals ensuring that more questions come up the ladder to me and my partners or no longer allowing us to launder white coats through hospital laundry. The little time sucks and aggravations add up. But, without some serious rethinking by those in positions of control, there’s going to be continued decline in human capital in healthcare for the foreseeable future.

June 5, 2022

The Merry Widow – Act II Finale

The Merry Widow has been put to bed. Scratch that. That has the wrong connotations. The Merry Widow has been struck. That’s not a lot better. Suffice it to say, the show is over and the Birmingham Music Club operetta has been put away for another year. I was asked what I would like to see programmed next year in the operetta genre. I had two ideas. The first was The Mikado, but do a conceptual production that gets rid of the problematic orientalism. As Gilbert and Sullivan were satirizing their own society, why not do a production that satirized our own and set it in Japan County, Alabama in the county seat of Titipu. My second thought was The Threepenny Opera, a work I dearly love but which needs to have a scabrous production for our current political climate and I don’t think Birmingham Music Club is willing to get quite that political. As long as it’s not Rose Marie…

The show was a good experience. Cast, orchestra, and staff all got along well without much in the way of backstage drama and, to my knowledge, no one has gotten Covid from participating. Alabama numbers are inching up again. We’re up about 75% over the last two weeks and hospitalizations are running slightly higher than they were, but nothing like previous surge numbers. Is that due to the new omicron variants? Behavioral change? The start of the summer heat pushing people indoors into air conditioning? The waning of vaccine immunity and natural immunity from the omicron surge of this past winter? No one really knows. I’m keeping an eye on the statistics and on what’s happening in both the UAB and the VA hospital systems so I can make good decisions and offer tempered advice. A lot of people I know have had a case in the last month, but none of them has been off their feet for more than two or three days with bad cold symptoms, but then they are all vaccinated and boostered.

Garth Brooks had an outdoor concert at the new football stadium in downtown Birmingham last night. 52,000 attendees. It will be interesting to see if that has any effect on local numbers. At least it was an outdoor venue which should help keep spread down. The only major thing on my social calendar this next week is the annual Pride Parade which is also out of doors so I’m not worried about that. In two weeks, I am the emcee for a fund raising pride concert, which will be indoors. If I don’t like what the numbers are doing, I’ll put a mask on. I’ll just draw a ridiculous face on it first with colored sharpies. It’ll save on stage makeup.

I, like many gay men of my generation, have a somewhat ambivalent relationship with Pride Parades. I’ve been around them a long time and have attended a number of them on several continents over the decades. They were incredibly important back in the day as they were one of the few ways in which the community had any visibility in the eyes of the larger straight world. Of course the straight world were always given a distorted view of the proceedings as the TV cameras would always focus on the more visual outre elements such as the leather guys, and the go go boys. A group of gay accountants in business suits just doesn’t make for great television. By the 90s, when corporate America realized that the gay community had disposable income, the proceedings became bigger and more monetized. Now they are increasingly falling prey to the fractious politics of the left where groups that don’t meet the ideological purity test de jour are pushed out and then push back leading to the usual circular firing squad that liberals are so good at enacting.

The politics of the gay world has changed so much since I started making my first timid steps out of the closet forty years ago. Back then, the gay community was invisible unless you knew where and how to look for it. The one place it was visible was in the HIV epidemic which brought its own set of cultural issues into play. Over time, as more and more people came out, and social attitudes began to change, it became more visible to more people, leading to quiet acceptance in some quarters of society and backlash in others. This is still going on. On the one hand, my church was full of rainbow streamers this morning. On the other hand, a gay bar in Dallas was attacked today by a group of conservative activists yelling that the patrons were ‘groomers’ and a threat to children. I don’t know how many times I have to say this but no gay people of my acquaintance has ever been a pedophile. We don’t go looking for children. Certain young people, when they reach an age of understanding of themselves, come looking for us.

June, as Pride month, leads to a flurry of LGBTQ focused advertising and rainbows in store displays as if it were just the next in our cycle of secular holidays, slotting in between Easter and The Fourth of July. I suppose ultimately, we’re going to have Pride mattress sales. I had to make a run to Target his evening and there were Pride T-shirts and greeting cards near the registers, next to the special on Pop-Tarts and Marvel movies. This would have been completely unthinkable a generation ago. So, on the one hand, I’m grateful that at least in my urban oasis here in Alabama that it’s treated in such a blase manner and that the young folk today coming up won’t have to fight the battles I had to. On the other, it’s sort of sad to see something that was emblematic of a long and painful struggle reduced in such a way.

There’s always been a battle in the gay community between the assimilationists – those who believe that LGBTQ people are like everyone else and should just be different colored tiles in the mosaic of American society – and the separationists – those who believe that LGBTQ people are fundamentally different and should therefore not subscribe to usual societal norms but instead create their own society and rules in which they can feel safe and protected. Outside of the big cities with a heavy LGBTQ population such as New York or San Francisco, a separationist life isn’t really possible so those looking for it tend to gravitate to one of those meccas and ghettoize themselves on arrival. I can understand the impulse, but it doesn’t speak to me. I am an assimilationist and always will be as the LGBTQ part of my identity is only a small fraction of who I am as a total person and I need to be part of a full society in order to feed all of my different parts.

I’ve lived long enough to become an eldergay, one of those older guys who is past his prime and is therefore no longer seen as any sort of sexual threat by straight society. These men are allowed to be out, as flamboyant as they want to be, and are, to a certain extent indulged in their eccentricities. Me, Ian McKellen, George Takei, Leslie Jordan… I don’t mind being an eldergay. It allows me to fulfill my natural role as mentor and storyteller. When I meet college kids now, just beginning to establish their identities as gay men, I have my stories from the 80s and beyond, and I can still share Steve’s stories of the 60s and 70s and provide them with a link as to who they are and where they fit in the rich cultural history of American society. They will have choices regarding marriage and children that weren’t open to me. I don’t begrudge them things I was denied. I’m just happy I was able to do some of the work necessary so that those doors are now open. And I have a feeling there is a lot of work still to be done to keep those doors open as there are some heavy hitting cultural forces who feel like they are on a roll who would like to see those doors slammed shut and some more extreme elements who would not just like us back in the shadows, but eliminated entirely. I don’t think it’s going to come to anything like that but the events of the last decade have taught me that anything is possible in our current times.

June 1, 2022

It’s late. It’s been a sixteen hour day so far beginning with a 7 am breakfast meeting, extending through a relatively average UAB clinic day, a voice lesson, a doctor’s appointment (yes, even physicians of a certain age need to take care of their health), some household chores, and second dress of The Merry Widow. I have now returned home from the Paris of 1905 and its embassy balls, garden parties, and hoopla nights at Maxims (where all of Parisian society seems to wear the same clothes evening after evening). The cat is demanding attention and keeps crawling over my keyboard much to my consternation. Please forgive me if there are more typos than usual. I guess I’m pretty much back in prepandemic mode in regards to life patterns, at least this week. I have one more theatrical venture after this before my season ends for the summer – a Broadway Backwards fund raising concert for which I am acting as MC which happens in mid June. Then, there’s nothing until after Labor Day allowing me time to make all the final edits and decisions for volume II of these Accidental Plague Diaries.

My patterns may be prepandemic this week, but I have a feeling it’s a bit of a case of gather ye rosebuds while ye may. There’s another surge abrewing – it just remains to be seen how quickly it will spread and what it might mean for our beleaguered public health and hospital systems. The culprits are new variants of omicron, dubbed BA 4 and 5 by WHO which, like the original omicron originated in South Africa over the past month. South Africa was so hard hit by the original omicron that something like 97% of the population has Covid immunity either from vaccine or prior infection. Despite that, these new variants are causing a surge there, which has spread to several other countries, notably Portugal which has one of the highest vaccine rates in the world. It’s believed that these new variants are quite good at evading antibodies and the immune system and at causing reinfection in those who had the original omicron strain back during the holidays and those who have been vaxxed and boosted. It’s definitely in the US and the numbers have been rising. How fast and where are a bit debatable as so many localities have wound down their public health surveillance programs due to lack of manpower and funding and because so much of the testing is now home based without good abilities to collect and follow up on that data.

Alabama, which has been at a low point with Covid over the last month, is rapidly going back up with the number of cases doubling over the last ten days or so. Double of a very low number is still a low number but if it continues to do this, exponential math will start to work its magic and it will go from nowhere to everywhere in a few short weeks similar to the original omicron wave of December and January. I just know that a number of friends have had Covid infections in the last few weeks, caught in the community. All of them have been vaccinated and had at least one booster. None has become ill enough to require hospital treatment but their need to quarantine has disrupted plans. My advice at this point? The usual litany. Hand washing, avoid crowds of unvaccinated people in tightly enclosed spaces. Mask up if in doubt. Not a bad idea to get that second booster, especially if you’re over fifty or have either a disease or medication that can affect your underlying immune system.

Merry Widow rehearsals have been giving me a backache. This is not usual for me and the show is not particularly strenuous so I’ve been trying to figure out why this should be going on. I’ve finally decided that the flooring of the stage deck, which contains a large revolve, is just springy enough to cause me to have to tighten and loosen my low back muscles constantly to keep myself in good balance and my low back muscles are complaining. It’s not keeping me from doing everything I need to do onstage but when I come off, I claim seniority and make sure I get one of the chairs in the wings. Pretty much every show I’ve ever done has left some sort of mark on me and I guess this one will go down in personal history as the lumbago show.

Technical and dress rehearsals on this production have gone smoothly. The set is uncomplicated, I’m wearing my own personal formal wear so everything fits more or less, and the most complicated thing I have to do is some ballroom waltzing which I’ve been able to do since Ed Long’s ballroom classes for 7th-9th grade at St. Stephen’s Church in Laurelhurst. With a 6 PM call, we’re out of the theater, even with notes, by 10 PM and I can handle that, even at my advanced age. I am reminded of some other shows I spent time on in my misbegotten youth, perhaps most infamously, a production of Three Penny Opera put on by the Drama Department at Stanford my sophomore year. It was on the mainstage of Memorial Auditorium, featured a four level set, a raked stage, a flying carousel horse, a cast of fifty, and a design based on George Grosz. I was one of three stage managers and the production was so huge that tech week, I had to be there by five and we weren’t out until after midnight, on top of all my regular schoolwork. I had at least two nervous breakdowns that week trying to fit everything in on top of sleep deprivation. It was good training for internship that would hit me a half dozen years later.

The only picture I could find off hand of that Stanford Three Penny Opera

At one point in the show, Mack the Knife’s gang, who have stolen a bunch of valuable furniture, are supposed to ‘saw’ the legs off of a harpsichord to turn it into a bench. I’m not exactly sure what Brecht meant by that piece of business, but it did mean the props department had to build a fake harpsichord and fit it with breakaway legs that could be sawed off on cue. At one performance, the breakaway legs broke away a few minutes too early and the harpsichord came crashing down shortly after being carried on stage to the mortification of the actors. I seem to remember being blamed for that one as the harpsichord was one of my presets. I also remember having to climb up to the top level with an ailing actor with a basin just in case he had to throw up before he made his entrance. I was also on the fly crew for the carousel horse which had to ascend fifty feet up into the wings before making a graceful descent onto an upper platform. That always went correctly which was just as well or the actor playing Tiger Brown could have been seriously hurt. Audiences have no idea how dangerous stages can be what with running around in the dark with all sorts of not to code platforms and staircases. I’ve been very fortunate. I’ve had a couple of noninjury falls on platforms, fell off the stage apron once into the first row, and had the Anatevka train station flown onto my head during a performance of Fiddler on the Roof. None caused any major disruptions.

Midnight, not a sound from the pavement. Time to roll over onto the cat and get some sleep.

May 28, 2022

Monkeypox

It’s magic hour out on my terrace; that time beloved of all cinematographers when the golden pink light of sunset gives everyone a magic glow. And what am I doing, sitting on my bed with my laptop, watching the sunset through the open patio door while an old episode of CSI keeps me company whilst writing this. There’s probably some metaphor to be made out of that, something along the lines of watching life through the window while finishing the hat.

I’ve been editing the writings that are becoming Volume II of The Accidental Plague Diaries (this itself will be in a tentative Volume III). I’m still on schedule to complete the editing by the end of June and have the book available around Labor Day. While reading through my experiences of 2021 and my musings on the roll out of vaccines and the Delta wave, while it was only a year ago, it almost seems like a decade, so rapidly has the pandemic upended and changed everything about our society and how we relate to each other. Volume I continues to sell modestly well for a book with no publicity budget from a micro-press and picked up yet another award this week (I believe that makes five). None of this was written to make money or set the publishing world on fire, but I am hoping that fifty or a hundred years ago, some historian studying the effect of Covid on the US, finds it useful as primary source material. And I hope my current readers continue to gain a modicum of amusement from my reflections of the pandemic and all of its tangents as they occur today.

Covid has, of course, been retired from the headlines recently despite the numbers continuing to slowly increase due to societal fatigue with the subject – twenty six months is enough after all combined with the very human need for novelty, in news reporting as in all other things. The infectious disease beat, always looking for some new disease that can scare us, is chasing after monkey pox. Yes, it’s spreading slowly in Western countries, no you don’t need to be majorly concerned about it. Monkey pox is a close relative of smallpox, once a major human scourge which has, in recent years, been eliminated due to vaccination programs worldwide. Small pox had upwards of 30% mortality rate. Monkey pox is rarely fatal. It is not easy to catch. The R0 (number of people an index case can infect on the average) is somewhere around 1.2. Compare this to the R0 of 7-10 of the currently circulating subvariants of omicron. In general, you have to be in fairly close and prolonged contact with an infected individual to be at risk. As it spreads so slowly, the usual public health measures of containment and contact tracing are quite effective. There is also a vaccine.

An outbreak of monkey pox in Western Society has been predicted for decades. This is due to the overlap in immunity between smallpox and monkey pox. My generation and all those older and the older Gen Xers below me were all vaccinated for small pox. This practice ended in 1972 after the disease was eradicated in the US. However, as the vast majority of the population was vaccinated and immune, there was no way for monkey pox to ever gain a foothold. The cross immunity and herd immunity prevented it. Now, however, the majority of the population was born after 1972 and therefore unvaccinated against small pox and therefore vulnerable to monkey pox. With every year, more and more of the older generation that conferred herd immunity and were immune themselves dies off leaving the population more vulnerable for a pretty much inevitable outbreak. So, if you’re under fifty, you do have a bit of a risk as you don’t have vaccine immunity but the number of cases remain a handful and it’s the kind of slow moving disease that even our rickety public health infrastructure can deal with so don’t spend a lot of time worrying about it. I know that’s easier said then done. All of our nervous systems have been upregulated by our experiences of the last few years and we’re all on edge with much higher levels of anxiety than we usually have at baseline so we will tend to blow things a bit out of proportion, especially those thing we feel we cannot control in some fashion.

The other headline grabber is, of course, the tragedy in Uvalde with the latest massacre of children by a deranged individual with a weapon of war designed specifically for killing large numbers of humans in a very short time. Every time we have one of these incidents, which occur with great regularity in our society and nowhere else in the world, I wonder if we are finally going to come to our senses in regards to the second amendment and semi-automatic weaponry. We never do. There’s too much money to be made in creating a climate of fear that causes a certain segment of the population to purchase more and more weapons which in turn enriches the manufacturers of such weapons who then turn a portion of the profits over to lobbying organizations who use the money to purchase loyalty from lawmakers. Congress, as we have all seen over and over again in recent years, is beholden to those who fund their increasingly expensive campaigns, not to their constituents. The ‘world’s greatest deliberative body’, having divided itself into two armed camps, has entered a state of paralysis and is, once again, refusing to do the first job of government which is to protect the citizenry. We’re going to see more children offered up on the altar of the second amendment before things change. Perhaps if we publicized the photos of broken and bleeding bodies so we couldn’t safely tuck these events away in the abstract.

I was doing some reading on the science behind the study of mass shootings and the evidence suggests that we are looking at them in the wrong way. They are not really acts of mass homicide, but rather acts of violent suicidal rage in which the homicide victims are collateral damage. Perpetrators are generally created starting at an early age from childhood trauma and deprivation and, when they begin to show disturbed behavior in later childhood and adolescence, the sort of mental health services that could short circuit these problems simply don’t exist or are grossly underfunded. It’s not the least bit surprising to me that the segments of the population that wish children to be born, no matter what, and not that children be wanted and nurtured, thus ensuring a constant stream of neglected and abused children who will develop underlying psychiatric issues, are also against controlling access to firearms and against any sort of expansion of mental health or other social services as that might give ‘the other’ access to ‘free stuff’. I don’t know what it’s going to take to get the legislative and judicial branches to act. Thirty dead children? Forty? A hundred?

Uvalde, a town of 16,000 people, spent 40% of its town budget on its police department and, due to the militarization of the police over the last few decades, had its own SWAT team. The local police had been through active shooter training just two months ago. The first point brought up in that training was that time was of the essence and that police should move in immediately in such a situation. We all now know they did not. They were afraid for their own safety when confronted with a shooter with a semi automatic weapon (that should be a telling point). They dithered, performed crowd control, prevented frantic parents from entering the school, and the delay cost lives. I’m hoping this starts to put to rest the myth that the solution for bad guys with guns is good guys with guns. And maybe John Q. Public will start to think that letting anyone purchase a weapon that the police are afraid of may not be in the best societal interest.

I’m hoping the news is better tomorrow. If nothing else, I get to spend most of this next week in 1905 Paris with The Merry Widow on the stage of The Harrison Theater at Samford University. It’s good goofy fun and not too taxing for those of us in the Ensemble playing third nobodies from the left. Yes, we’re washing our hands and staying healthy.

May 24, 2022

Ten years… Ten years ago, a deeply disturbed adolescent entered Sandy Hook Elementary School in Newtown, Connecticut and killed twenty students, mainly kindergarteners, and six adults. Today, a deeply disturbed adolescent entered Robb Elementary School in Uvalde, Texas and, at last count, killed eighteen students and two adults. In the intervening decade, we have made our children do active shooter drills, discussed arming school personnel, subscribed to the myth that more good guys with more guns would stop mass shootings, watched while the teenagers of Marjory Stoneman Douglas high school did far more to curb the power of the National Rifle Association than any of the adults in our society, and, in general ignored the irrefutable evidence that more guns in more hands always leads to more gun deaths.

What will happen this time? There will be wailing and gnashing of teeth as the news cycle fills with stories of grieving parents and a shattered community until the next ratings grab distracts them and the TV vans pack up and race out of town, leaving a community with an empty center that won’t ever be completely healed. Ask the people of New Town if there lives are the same or if they would be better were there twenty additional teenagers at the local high school, young people who should be negotiating the craziness of adolescence and thinking about college plans, not buried as shattered corpses only a few short years out of toddlerhood. Let’s face it. Our society regards our guns as more valuable than our children. If we didn’t, we would elect representatives who would actually take prolife positions on sensible gun control laws. But we seem to be perfectly happy with our occasional sacrifices to the gods in the form of mass shootings, capital punishment, vigilantism, untreated mental illness, and all the other ways in which innocent individuals meet violent ends in our society.

I suppose the lack of empathy in our society which allows for us to collectively shrug off a school of dead children is the same lack of empathy that allows us to blithely ignore that we’re still in the midst of a world wide pandemic and that our numbers in regards to Covid infection are all trending the wrong way again. We’re over it and we don’t think it’s going to happen to us, so off to some other distraction such as the high cost of gasoline. The current omicron subvariant, BA 2.12.1 has come out of nowhere the last few weeks to now be the dominant strain in the US, moving from less than 30% of infections two weeks ago to nearly 60% this week. And we’re back up to roughly 100,000 infections a day. This subvariant is about 25% more infectious than the prior omicron strains which is why it’s spreading more rapidly. Fortunately, it doesn’t seem to be more virulent and hospitalization rates are remaining relatively low. But if this sort of infectiousness mutation happens in a strain that causes more serious clinical disease, we may rapidly get into trouble again.

Being on the cusp between the Baby Boom and Generation X, I didn’t have anything like active shooter drills in elementary school. We didn’t even really have the famous ‘duck and cover’ drills of the older Boomers. (Someone in the educational hierarchy of the Seattle Public Schools must have figured out that if you’re being vaporized by a nuclear weapon, ducking under a desk wasn’t likely to be of much help). I’m trying to remember what my fears were in elementary school. I entered kindergarten right after the 1967 ‘Summer of Love’ and I do remember walking home from school with my best friend and seeing peace symbols spray painted on the trees in the park by a vandalizing teen and being convinced that they were airplanes and that it meant our neighborhood was going to be razed for a new airport. We kids warned each other of the dangers of eating unwrapped Halloween treats as they could be laced with ‘goof balls’. We didn’t know exactly what those were but we knew they were bad. I was vaguely aware of the civil unrest of 1968 and the Vietnam war news was always in the background but none of that made that much of an impression on elementary school me as that was far away from our placid faculty ghetto neighborhood.

We’re living in a time of high levels of anxiety. It’s a spiral. The politics of divisiveness, the media frenzy, the pandemic. All of these create anxiety which bathes our brain and our bodies in catecholamines and other hormones that ready us for fight or flight, heightening our receptiveness to danger signals which keep coming in. We can’t live with that amount of stress and angst without it coming out in some way. In me, it’s coming out as exhaustion, inattention, and disconnectedness. I notice in others, as a result of my professional work, that it comes out as hair trigger temper, rage at mild or imagined slights, and a need for a feeling of control, no matter the cost. No wonder gun violence, motor vehicle accidents, and other issues linked to anger or erratic behavior are seriously on the increase over the last few years.

I’ve never owned a gun. I’ve never wanted to. I was taught how to shoot and I’m a reasonable shot but anyone who works in health care knows that the number one risk factor for getting shot in life is the presence of a firearm in the home so I’m not planning on arming myself. When society collapses and the hordes are ascending the hill to plunder the condominiums overlooking the Jones Valley, I suppose I’m a sitting duck but I’m not sure I want to survive into the aftermath.

May 20, 2022

Freude schoner Gotterfunken and all that jazz. Tonight was the first night back performing with the Alabama Symphony Orchestra Chorus in twenty-six months. It seems somewhat fitting that my very last performance before the shut down in March of 2020 was Mozart’s Requiem and the return to choral singing of major works is Beethoven’s 9th symphony and The Ode to Joy. The house wasn’t packed, but decent and it was possible to feel the joy wafting off the audience from our perch in the choral balcony as the thundering chords of that 4th movement brought back one of the highlights of the choral cannon to public performance. Many cheers at the end, even though our numbers have been diminished by the prolonged toll of the pandemic and all of the changes in patterns that has brought forward. Usually there are 90-100 of us up there, tonight we were 65 but tried to bring the same fortissimo. One more performance tomorrow night. Now if only Carlos, our splendid Venezuelan conductor, would not take that last bit at quite the tempo di bat out of hell. I can’t turn the pages fast enough.

Tomorrow morning, it’s back to rehearsing The Merry Widow (from which I have been off for a few days due to the combination of symphony rehearsals and most of the rehearsal time being dedicated to principals). The ensemble doesn’t have all that much to do so I think I have most of it down other than the rather insipid English lyrics to the famous Merry Widow Waltz at the end of Act One. They aren’t quite as bad as the English lyrics to Die Fledermaus a few years back, but they run a close second. I find it very difficult to learn bad lyrics as the moon/June/spoon variety have so many possibilities, they don’t want to stick in your brain. Good lyrics, on the other hand, are easy for me to learn. They are so specific to the music that no other word could possibly come next.

Kimberly Kirklin, me, and Diane McNaron performing The Alabama Song

My other task tomorrow is more melancholy. I am MC for my friend Diane McNaron‘s memorial tomorrow afternoon. Diane was instrumental in the development of my performance career when she and I and Ellise Pruitt Mayor devised Politically Incorrect Cabaret back in the spring of 2004. I thought about doing it in my PIC Ansager character but have decided no, I need to just be me, although the Ansager may slip in around the edges a bit. Diane was my first voice teacher, my patient, my collaborator, my friend. We would bump heads bitterly when creating a PIC show as our political and satirical views did not always align but in the end, we were always able to meet in the middle somewhere and some of the pieces we did were inspired. Me dressed as Mrs. Anna from The King and I doing a kinky version of Getting To Know You. Singing The Alabama Song from The Rise and Fall of the City of Mahagonny together with her as a show opener. A salute to Capital Punishment in Alabama to Razzle Dazzle from Chicago. A commentary on the Deepwater Horizon oil spill as a ballet with a seabird trapped in the oil slick to Saint-Saens The Swan. Doing out of town shows in four other states in some of the strangest theatrical venues you could imagine. I owe her the send off.

Covid numbers are inching up again, not enough yet to call it a surge in the making, but enough to be concerning. Case positivity rate nationally has inched back up over 10% which is not good. Of course, with so many home tests now available, it’s hard to know what data is actually going into that number these days. The rates in the Northeast and the Upper Midwest are serious enough for the authorities to recommend universal indoor masking again. I have no idea if the populace is listening, not being in one of those regions (feel free to chime in if you are), but the barometer I follow – Broadway performances – have definitely suffered with more cancelled shows due to infections in the cast and an extension of mask mandates for theaters until at least July. The hospitalization and death rates are also inching back up with deaths having doubled from the 200 a day it had fallen to back to 400 a day this past week. The hospital rates are low enough to be absorbed by the system but I remain worried. It wouldn’t take much of a surge to put us back in overwhelm mode due to the changes in staffing the pandemic has wrought.

Here in Alabama, we are still relatively spared. My last look at the local numbers had us at less than 5% case positivity and with very small case loads both here in the Birmingham area and statewide. However, the trends are heading back up this past week. I’ve had a number of friends who have tested positive in recent weeks but none of them has been seriously ill and the biggest headache has been the inconvenience of quarantine. I’m still feeling relatively safe being maskless in public but I’m keeping a sharp eye on local numbers and trends and will be popping it back on if I don’t like what I see. Of course, I still wear one at work and will for the foreseeable future as I do work in health care with folk with immunocompromises of various stripes.

Why is Alabama still doing so well despite dismal vaccination rates? Isn’t that the sixty-four dollar question. Perhaps the overwhelming number of omicron infections of a few months back has left the population with a certain amount of lingering immunity. Perhaps it’s something climatological. The nice weather we’ve been having without the humidity having quite yet arrived has chased a lot of activities outdoors. I’m going to trust that the combination of my infection from a few months back and two boosters is going to keep me going without too much difficulty. Although, after the last couple of weeks of staycation without the usual work headaches in my life, I don’t think I would mind an additional week of quarantine while feeling relatively well, as long as I could time it so it doesn’t interfere with other life duties. But, knowing my luck, it would likely strike on a performance weekend and I have a few more of those coming up in June before I hit the summer lull. So I’ll keep those hands washed, watch the numbers, and have my mask handy. And I’ll take as many boosters as are proven to help.