Today has been an odd day. When awake, I feel like I’m about to explode out of my skin and take off like a rocket. And then I sit down for a minute and promptly enter torpor and fall asleep. Neither state is terribly conducive to getting things accomplished so I’m going to have to settle for having finished up my progress notes of the week for work, a self taping for a Halloween project, and several loads of laundry. Not the most exciting of Sundays but it will have to do.
I’m not good with emotions. I have a hard time differentiating between them and can’t always even tell positive from negative ones so when I have a day like today when they’re swirling around, my first instinct is to try and figure out how to tamp them down and wall them off somewhere so that I don’t have to feel uncomfortable and can get along with life and make a couple of further steps forward on my endless ‘To do’ list. The key to both of my relationships is that Steve and Tommy, each in their own way, were able to figure out how to block those natural impulses of mine to lock my emotional self away so that we could connect and build something together. It takes a particular kind of personality structure for that to happen with me which is one of the reasons why I’m not holding out a lot of hope for a third husband. The numbers of eligible men in my age group with whom that would be possible is shrinking.
I went to Opera Shots this afternoon. It’s something that Opera Birmingham has been doing for the last few years – gather a bunch of singers together recital style in a bar or brewery and have them belt out their favorite songs and arias while the audience sits around and has a few beers and catches up on old times. Covid, of course has changed the game. Opera Shots is now taking place in parking lots and its bring your own lawn chair, BYOB, stay six feet apart and wear your mask. Still it was nice to see people. Part of today’s funk comes from some programming. The second half was musical theater songs and half way through, someone sang ‘Someone to Watch Over Me’. That was Tommy and my song. He serenaded me with it very publicly when we were courting and it was the last song on his recital for his music degree – a gesture of thank you to me for having helped him to achieve that long delayed dream of his. Sitting there in the parking lot, I could feel waves of feeling. I held it together but the follow up was my friend Drew singing ‘You’ll Never Walk Alone’ and that one two was a bit much so I had to close my eyes and try not to feel for a while or I was going to become a complete basket case. So, at least one of the things roiling around is sadness and grief, stirred up by the great American song book. When I got home, I put on the original Broadway cast recording of Mack and Mable. Jerry Herman is always good for restoring happy thoughts. Sondheim for intellect and introspection, Herman for dancing around and singing along.
I think the other major emotion is a feeling of righteous anger over this morning’s headlines about the usual subject of these Accidental Plague Diaries. I have desperately tried to keep politics to a minimum in these writings and to be as even handed as possible but I just can’t after two things came to my attention.The first were remarks that the president made at one of his rallies last night which more or less accused physicians of over diagnosing Covid-19 so that they could be paid more. I have worked with thousands of physicians over the course of my career and the vast majority of them set much of themselves aside in order to do the best work that they can do in caring for the health of others and the number of times I have seen credible evidence of gaming the system for payment is very very small. Besides which, there is no system which would increase payments for a Covid-19 diagnosis over other diagnoses. The very suggestion that those of us who are getting up and going to work daily under very trying circumstances and putting ourselves in harms way for the good of our patients, our profession, and our country is somehow only in it for the profit motive just makes steam come out of my ears. 1700 US health care workers have died so far from Covid-19 caught on the job. Many thousands more have been sickened and may have permanent health effects. How dare you! Have you no decency sir? (Yes, I know the answer to that question…)
The second was Chief of Staff Mark Meadow’s remarks to CNN this morning where the administration finally made full admission to what has been apparent for months to anyone who has been paying attention. The administration more or less has no plans to bring the power and resources of the most powerful and richest society the world has ever known to bear on the worst public health crisis in a century and more or less is just going to let it infect the population and good luck to you. This complete abandonment of the foremost responsibility of a government, protection of the citizenry, also has me internally enraged. Even though I have known this is what they have been doing for quite some time, to hear it finally articulated in an official way just makes me want to punch a wall.
What does not fighting Covid-19 with good public health measures mean? It means the virus will continue to spread, because that’s what viruses do. To date, it’s infected somewhere around 7 or 8% of the US population so it’s got huge inroads still to make. Without any mitigation, it’s likely to infect somewhere between 70 and 90% of the population before it’s done. To make the math easy, we’ll say the population is 320 million and it will infect 75% or 240 million. Currently, it appears that about 40% of those who become infected, mainly children and young adults, never know that they are sick. Another 40% become ill enough to recognize that they are sick and get tested but do not become so sick that they require hospital care. About 20% are sick enough for the hospital. So, of our 240 million cases, about 100 million are well, 100 million get sick at home and 40 million are sick enough to require advanced care.
Of those requiring advanced care and support, about 20% require ICU care with about half of those needing a ventilator. That’s 8 million ICU patients and 4 million ventilator patients. We only have about a million hospital beds in the country and only about 130,000 ICU beds. We’ve developed a model of just in time medical care without excess capacity in order to maximize profit and there’s no easy way to get the system to accept millions of cases at once. That was what the whole ‘flattening the curve’ thing was about. Slowing the rate of spread so as to not overwhelm the health system’s ability to handle it. The overall mortality for the disease is about 0.6%. Six in a thousand. That doesn’t seem very high until you consider that’s about one and a half million deaths for the population. That’s nearly 500 9/11s, 25 Vietnams, or more than two Civil Wars. As the average American as a circle of acquaintance of roughly 5,000, that means every one of us will lose roughly 30 people we know before this is all over. I’ve lost friends, patients, close relatives of friends – colleagues or family is likely coming and I’m steeled for it. Smaller cities are out of ICU beds. (I read a news report earlier this weekend that the state of North Dakota was down to one ICU bed). We’re getting close to the medical system becoming overwhelmed in some areas. And there’s the downstream issues – me and my colleagues are getting burnt out. Disruptions in the health care industry are leading the more experienced among us to move up their retirement plans. Our complete inability to react to a thoroughly predictable pandemic as a modern nation will continue to make us a pariah state when it comes to such things as travel. Institutions which require us to congregate indoors in social groups will continue to suffer.
I don’t know how to fix any of this. All I can do is report on it and on how it impacts me and how I see it impacting health care and society at large from my vantage point of a little bit of knowledge.