July 7, 2020

Thunderstorms over Birmingham

I came home from work this evening about 5:30, sat down on the couch, and found myself incapable of moving for about two hours. That’s become a fairly common pattern. About twice a week I get in from the day, feeling pretty normal, and then like someone stuck a pin into my balloon, I feel drained of all energy and can’t do much besides stare out the window (thunderstorms and rain today) and wait for my faculties to return. I assume it’s my personal physiologic reaction to the never ending Covid stress that we’re all living in. At least those of us who work in health care and are paying attention are living in. A significant portion of the population seems to be running around as if nothing has changed and that we aren’t living in a very different world than we were living in last year.

The local counts continue to rise. My hospital has over 90 inpatients with Covid (we were running 60-70 at the height of the early pandemic in March/April) and we’ve increased by over 50% in a week and a half. The numbers in surrounding Southern states are absolutely appalling with more than 10,000 cases a day becoming the norm in Florida and Texas with their large populations and relatively dense cities. The stories are spreading among medical professionals of overfull ICUs, patients being sent to other cities or even out of state for treatment, absolute exhaustion on the part of medical personnel, shortages of protective equipment and all the other logistical nightmares that have been reported in New York and elsewhere in the world. There hasn’t been much reportage on this – the powers that be (and the media that decides what we will hear and what we will not hear is very much part of that) has decided that a narrative of economic recovery is more important than one of personal safety. People have lost out to profits in our late stage capitalism enterprise.

There’s a lot of speculation as to why the death toll has not spiked in the same way as case numbers. Some may be due to changes in testing, some may be due to a shift in infections away from older populations who are taking greater precautions to younger populations who are not and that those younger populations are less likely to become seriously ill. (It is true that younger people in general, as they have healthier bodies with less chronic disease burden are less likely to be seriously affected but this malevolent disease that we do not yet fully understand makes a certain percentage of young and healthy people with no appreciable health problems deathly ill and appears to leave those that survive with chronic issues that may take months or years to resolve, if ever). But no matter what, every single infection is conceivably preventable with proper public health measures that we as a society are completely unwilling to take.

This spring’s lockdown was never about eradicating the virus and returning to normalcy. It was about buying time for the government and the public health system to put appropriate programs in place that would curb the spread over time so that we would eventually all be able to return to a semblance of normal. Most of the developed Asian countries and soon, the European Union, have done this and are heading back to normal economies and societal function. Our dysfunctional federal government has adopted a strategy of ‘live with it’ and pushed public health measures back to the states. The states, already cash strapped and unable to mount national responses are dealing in myriad different ways, most of which are unsuccessful and pushing down to the county and city level. The population, which needs strong leadership in an emergency and which will be able to pull together if clearly shown what the problem is and a road towards a solution, gets multiple conflicting messages and tunes out and goes to the mall with dinner at Applebees to follow. The end result in my life is a constant low level of exhaustion with no end in sight and no ability to take part in the activities I’ve always used to rejuvenate myself and I end up staring out the window for hours.

We’ve got some huge societal dilemmas coming up over the next year or so which are independent of current partisan politics or who occupies the White House. The first is the question of education. The vast majority of American families depend economically on two incomes which requires both parents to work. This means schools must be open and in loco parentis during usual business hours. Children gathered together in groups are highly unlikely to keep social distancing, proper hygiene or masks in place. The majority of veteran teachers are of an age to be in a higher risk group. If we send kids to school, how do we keep them safe? How do we keep teachers and staff safe? If Covid starts to spread in a school do we shut it down? What to do with everyone for quarantine periods? When veteran teachers decide to put their health ahead of their careers and take early retirement, how do we replace that lost experience? How do we deal with the extracurriculars which are sometimes the only things that will keep at risk kids in school? In higher education, where on line education is a little more feasible in certain subjects, what do you do with practicums like chemistry labs? What do we do about federal policies about students on visas not allowing them to remain in the country if their classes are on line? (A move that is going to decimate graduate and research programs nationwide – the US University system is one of the shining jewels in our culture and I can’t think of anything that could be done to destroy it more quickly than this particular piece of idiocy. Destroy the universities because of their perceived ‘liberalism’ and we will rapidly fall behind the rest of the world in science and innovation. It’s happened before. Look what happened to the research institutions of central Europe after the Nazis rose to power. They never fully recovered.)

I’ve certainly considered early retirement myself as it’s become clear that neither my state or federal government cares much about the safety of me and my colleagues or the stress that we’re being put through at the moment. If they did, they’d be paying more attention to the public health system (as underfunded as it is) and a little less attention to the chamber of commerce. If I were a few years older, I likely would, but in looking at all my options, I plan to keep soldiering on for a few years more. I’ll continue to hold up my little corner of the health care system and hope that things get better and maybe, just maybe the cavalry will eventually show up and give me and mine a little respite. I’m being a little unfair. Part of my job is with the Birmingham VA and they are bending over backwards to protect clinical staff as much as they can. I’m not high enough up the food chain to know what really happens in the C suite but they really are trying their best in a crazy and ever changing situation. Not every experienced health care provider is going to want to continue to work under these conditions. How do we replace them? We’ve been importing doctors to the US for years as US medical schools haven’t been able to produce enough to meet demand. If we become more cut off from the rest of the world and unfriendly to immigrants, where are we going to get people to replace them?

The right wing has been sending us down a path of isolationism for the last few years with their chants of build a wall etc. etc. The business community understands that, in this day of global economies and multinational corporations, that this has been relatively silly rhetoric that keeps the masses distracted while their pockets are picked. However, our complete failure to respond appropriately to the pandemic may lead the rest of the world to wall us off anyway, at least until we’re no longer seen as dangerous. Be careful for what you wish, for you may get it. I see advertisements for inexpensive international travel cropping up for late fall or winter and I can’t help but think that will never happen. We think it’s bad now. What happens when the usual flu season coincides with the pandemic with no adequate responses in place? I wouldn’t plan that trip to Paris quite yet.

Usually I’m relatively optimistic in these, my accidental plague diaries. I’m feeling pessimistic this evening. Maybe it was that two hours of staring out the window at the rain. Maybe it’s the life circumstance to have to go through this alone. Maybe the Smoothie King lunch I drank isn’t agreeing.

Wash your hands. Wear your mask. Use common sense.

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