November 10, 2020

Hi, my name is Andrew and I have Covid fatigue. There, I said it. I’ve been writing these Accidental Plague Diaries for eight months now and I’m tired. I’m tired of otherwise intelligent people ignoring science for political purposes. I’m tired of a government allowing ordinary citizens to suffer and die from a predictable infectious disease that can be mitigated by tried and true public health methods. I’m tired of working in a health system that’s under incredible pressures between the needs of Covid patients and the needs of everyone else. I’m tired of giving up a much of what I find pleasurable in life for the greater good to see hordes of people out and about just not giving a damn about what their behavior means to others. Tired, tired, tired… I know it was all getting to me this past weekend when I kept falling asleep most of the time. I didn’t have much on my docket so any time I sat down on the couch with a book, I nodded off yet again. It reminded me of how I would feel when I would come home from college for vacations and sleep 12-14 hours a day for two weeks, recuperating from the quarter just past and resetting for the quarter to come.

So where are we now? We’ve passed 10 million cases in the USA and for the last week, have been averaging over 100,000 cases daily. At current trends, we’ll be up to 11 million before Thanksgiving week. Hospitalizations are up by about 75% over the last month with some of the smaller Midwest states completely out of hospital and ICU beds. The death rate is up 15% over last week. All of this has been pushed off the front pages by the political news of the last week in the aftermath of the election. The way things are going, I won’t be surprised if we end up with a presidency in the White House and a presidency in Avignon trading barbs at each other for the next four years. Actually, the whole saga is unfolding exactly as those who read the political currents closely predicted it would some months ago with a Democratic victory and a lot of Republican sound and fury without much substance behind it.

We’re now in the third wave of Covid cases in the US. The first wave having happened in March and April when the disease first began to spread and the second having happened around July. This one is bigger and more widespread than the first two. Fewer people seem to be dying as the health system has learned how to save lives but more and more people are getting sick with unknown future sequelae. My brothers and sisters in health care were running on nervous energy and adrenaline and on the combined fear and hope of the unknown for the first wave. They received the second wave with grace, having more or less learned what they needed to do. However, they’re tired. They’ve been doing this for eight months without respite and the numbers are climbing again and I’m really afraid we’re going to start seeing some of them crumble. Those older than I are researching their retirement options. Those younger are looking at career paths that aren’t quite so stressful. Those my age are plodding forward one day at a time. We have a healthcare provider shortage, especially of skilled RNs in this country. We’ve imported them in the past. The current administration has shut that down.

I’m really worried that we’re going to see some major fractures in the health system over the next few months, just in time for the holidays. Large University systems like UAB will be fine. They have all sorts of resources they can draw on. I’m worried about community hospitals in more out of the way locations and with much smaller systems behind them and much less of a talent pool from which to draw. These have already been heavily stressed by the general changes in health care over the last few decades, and greatly exacerbated by the political refusal of Medicaid expansion funds tied to Obamacare. I’ve spent a lot of my career serving patients in rural poverty, going into their homes, learning the way they think and how they relate to health care culturally and I hate to think of the richest nation ever failing some of its citizens in so basic a manner.

Speaking of Obamacare, the Trump administration, together with a coalition of a number of Republican state Attorneys General was before the Supreme Court today arguing in California v Texas that Obamacare should be completely invalidated for nothing says I care for my citizens like stripping 20 million of them of health insurance during a pandemic and stripping all 350 million of them of protection against discrimination for preexisting conditions when we’re facing a disease with unknown long standing repercussions. I wouldn’t count on the conservative majority throwing the whole thing out, though. There were some remarks from the bench from some surprising sources that suggest it won’t happen. But we will see what we will see.

Rant over. I’m still tired. I should move on to a constructive project but I think I’ll finish my package of Oreos and turn on Netflix instead.

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