October 30, 2020

Hurricane Zeta ambled through town in the wee hours of the morning. We’re a few hundred miles from the coast so it did not have hurricane force winds by the time it passed through Birmingham but it was still enough to cause limbs and trees down all over town with massive power outages. I lost power briefly around 2:30 AM and would normally have slept through it but the restoration some minutes later caused things to go slightly haywire in my personal electrical grid. The smoke detector outside my bedroom began to speak to me in an overly chipper electronic voice demanding I get up and poke its reset button. While I was up, I noted that power was on in certain circuits but not in others. I had lights in the dining room, but no outlet power and no lights in the hall, refrigerator or wi-fi. Flipping the circuit breakers did nothing to rectify the situation and by now I was thoroughly awake and disgruntled so I went back to bed with a book to wait until morning when I could talk to building maintenance. I found out from them the whole building was a crazy quilt of circuitry that wasn’t quite right. For instance, the lights and doors of the elevators were operating, but the cable motors were not. There’s something odd about how the grid and the building interconnect that causes it to happen if there’s an incomplete interruption. I went off to work figuring it would work itself out while I was away and by the time I crawled back in about 7:30 PM after a very long day, it all seemed to be back to normal. It’s been 30 years since I’ve lived in a multi-unit building and I’ve never lived in one of this size so it’s something new everyday.

Returning to the Accidental Plague Diaries, today marks the day that the US surpassed 9 million cases of Covid-19. This got me interested in the mathematics of big numbers when it comes to Covid so I went back and looked up the other seven figure anniversaries that have happened so far this year and constructed this little table:

0 cases – 1/19/2020 (the first US case was reported 1/20/2020)

1 million cases – 4/28/2020 (99 days later)

2 million cases – 6/11/2020 (44 days later)

3 million cases – 7/8/2020 (28 days later)

4 million cases – 7/24/2020 (16 days later)

5 million cases – 8/10/2020 (17 days later)

6 million cases – 8/31/2020 (21 days later)

7 million cases – 9/25/2020 (25 days later)

8 million cases – 10/16/2020 (21 days later)

9 million cases – 10/30/2020 (14 days later)

The next data point will take us to 8 figures and a whole new order of magnitude and will probably happen sometime a week or so after the election given current trends.

South Korea, an early hot spot, had its first case of Covid-19 on the same date as the US. To date, they have had roughly 26,000 cases and about 450 deaths. They are, of course, a smaller country with roughly 1/7 of our population. If we multiply these numbers by seven, we get 182,000 cases and 3,150 deaths. Compare this to our 9,000.000 cases and 225,000 deaths to date. Our fate wasn’t inevitable. It’s the product of deliberate decision making on both the governmental and individual level.

As a society, we have all become conditioned to quick and convenient services and results. We have little patience for the slow pace and rhythms of the natural world. We want our needs met instantly with same day service, fast food, drive through convenience and all the other things we have constructed to allow us to live over scheduled busy lives. Given what I do for a living, I run into this all the time. When my patients become acutely ill in their 70s and 80s, we can usually get them over the hump and get their physiologic processes on track so that they can begin healing and restorative care. As the boom has begun to enter that age group, they expect their recoveries to take no more than a few days at best. That’s all they can allow for it in their lives. Nature doesn’t work that way. A body in that age group generally needs roughly 4-7 days of recuperation for every day of acute illness so four days in the hospital may equal a month before things are back to normal. Patients and their families get angry at me all the time as I gently explain that this is the way it works and no amount of money or social position or wanting it to be different is going to change that.

Why do we do this? Aside from our infatuation with instant results, I think it has to do with brain development. Our brains are growing and changing and maturing until our mid 20s. At that point, they’re done and we have our fully developed adult brain that will guide us the rest of our lives. When we’re younger than that and our brain is changing as our bodies change, we’re used to looking in the mirror and seeing someone different look back at us as our physical and cognitive/emotional selves mature together. Then that second one comes to a halt but the physical keeps on going and changing in ways that most of us would rather it not. So by the time you’re my age, you’re looking in the mirror and seeing an unfamiliar older person look back and you’re wondering ‘What happened?’

Those of us with a little education and access to health care can keep our bodies in pretty decent shape with minimal fuss until late 70s or early 80s these days and all the time, that same brain that still conceives of itself as 25, maybe 30, is rattling around inside and not really understanding that the physiology has changed. On an evolutionary scale, when most of us were dead by mid 40s at the latest, this wasn’t a big problem, but in the last few generations when aging has become equal opportunity, we’re creating huge numbers of people with a cognitive dissonance between mind and body. And as this is a new phenomenon, there isn’t a huge amount of accumulated common wisdom to have been passed down generation to generation about what it means and how to cope with being a healthy eighty year old and what you should worry about and what you shouldn’t The lead edge of the boom turns 80 in just five short years. It’s going to be awfully interesting in my professional world when that happens.

This lack of understanding of natural processes is, of course, playing out in our response to Covid-19. We want everything to stay the same, the way we’re used to it being. We want a quick fix. Slow methodical fixes that require significant behavior change and long periods of time just aren’t in our cultural DNA. Therefore, we want to get back to our restaurants and our parties and our football games and our school events. I’m human. I do too but I also know that the virus exploits our inability to maintain good habits and uses that to spread and every time it spreads, there’s a good chance that someone is going to become seriously ill or die.

It keeps hitting close to home. There hasn’t been a day in the last week or so where someone hasn’t reached out to me with a story about an ill friend or family member, looking for advice or support. I do what I can but there remain no magic bullet treatments. The one thing that seems to be happening is that there are fewer catastrophic cases, probably as more and more cases are happening among younger, hardier populations. I’m getting tired. I have a lot of energy to help but I’m not an infinite well and my usual restoratives have fallen victim to the pandemic. I am counting the days until I get some time off. This isn’t the flu. It’s much deadlier and the chronic health issues of those who are seriously ill but survive remain unknown. It takes out perfectly healthy young people.

We can all help bring it under control with a few relatively easy behavior changes:

-hand washing

-mask wearing

-social distancing

-staying out of crowds

and then on the societal level

-ventilating public spaces

-contact tracing

-testing

None of these is perfect, but when used together, you get South Korea.

There’s a lovely metaphorical model based on Swiss Cheese which shows why this works. If we don’t do these things, the virus is going to exploit our behaviors and behavior leads to rise in infections (going on now) leads to rise in hospitalizations (happening in many states – there are no hospital beds available in many Midwest communities) leads to a rise in deaths with a few week lag between each step. 10 million will become 20 million will become 30 million. Wearing your mask today ensures that someone else will be here for Christmas.

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