December 20, 2020

And here we are at the leadup to Christmas week. The fourth Advent candle, symbolizing Love has been lit, people should be getting their homes and families ready for sacred traditions, and instead, due to abject failures of national leadership, we’re facing more prolonged estrangement, surging cases of Covid overwhelming hospitals and medical staffs, and a brand new social battle about to break out over distribution oThisf vaccine. We finally have a bright spot in these ongoing tales of the United States in the age of the corona virus with the arrival of vaccines developed in record time, but, due to the same governmental trends that have botched every other response to the pandemic to date, we’re likely to see additional problems before we see solutions.

The Pfizer vaccine has now been out for a week. The Moderna vaccine received its Emergency Use Authorization this past Friday and is shipping over the weekend and will be available starting this next week. While hundreds of thousands of doses have shipped so far,there are hundreds of millions of people in this country and almost all of them, from a biologic perspective, are eligible for vaccination. This leads to a situation of scarce resource and high demand. There has been no question in anyone’s mind that the highest priority for vaccination has to be health care workers who work in direct patient care, especially with those who have Covid. Too many of them have already become sick and roughly 2,000 of them have died from occupational exposure to date. The Pfizer vaccine, with its need for super cold temperatures, has been distributed through a limited network of hospitals and the shots are being given as rapidly as they can be administered safely. They require a second shot in three weeks and part of the distribution plans must include availability of that second dose.

There have been issues with distribution from the get go. The super cold temperatures have been a logistical nightmare. Doses have remained at Pfizer’s plant due to a lack of instruction from federal authorities as to where it should go. There has been speculation that some of the delays are political in nature and have occurred to give Moderna’s product a chance to get to the market. There is an advantage to the Moderna vaccine. It does not require super cold temperatures and can be kept in a regular freezer. One way or another though, my social media feed of the last week has been full of pictures of happy doctors and nurses receiving their first dose at work before going off to continue the battle. i received mine as well.

I feel a little guilty about having gotten mine in this first wave. I don’t do inpatient work on Covid wards. I am exposed occasionally in my outpatient clinic work but we’re pretty good about identifying potentially positive people and handling them by phone and other means so they won’t come into the office and expose other patients and staff. I got mine through the VA system as they want me protected so that I can get back out in the field safely with my rural house calls. I can’t help but think, however, that I could continue to do that work telephonically and that dose should go to someone with more exposures than I and I hope that the VA is making sure that they are equitably distributing it not just to the doctors and nurses, but to everyone that comes face to face with patiens – therapists, techs, custodial, dietary. From what I could see of who was waiting for vaccines when I got mine on Friday, they are. I carry a certain weight of survivors guilt from not having succumbed to the previous global pandemic of HIV I was exposed to, having been a young gay man in the SF Bay area of the early 80s, I really don’t want to have to carry around an additive burden.

The problem comes once the health care community has been taken care of. What then? Various factions, all with perfectly valid claims, have been coming forward demanding their place at the head of the line. The elderly, who are most susceptible to serious disease and death. Workers in front line non-health care jobs such as food distribution, transportation, and essential retail. Teachers with their exposures to the little disease vectors we call children. Representaives of communities of color who want to redress historic inequities. Over the next couple of months, until supplies can grow to meet demand, it’s going to get ugly as each group and its advocates jockey for position. I do not forsee a nice orderly ‘women and children’ first loading of the lifeboats. There’s one group, of course, that will line jump with impunity and quietly have their needs met: the wealthy and well connected. As much as I have amused myself imagining a line of well heeled Beverly Hills matrons lined up outside of Cedars Sinai, wobbling in their Jimmy Choos and bashing each over their heads with their Jane Birkin bags to be first in the door, we all know that certain lots of vaccine will simply disappear from the supply to reappear in concierge practices and other exclusive care venues not available to the general public. A very telling example happened at my alma mater who decided to give their first shipment of vaccine to their senior executives rather than to the staff actually taking care of Covid patients leading to some very noisy, and well deserved protests and some PR headaches that will take a while to disappear.

The conservative noise machine now has a problem. On the one hand, they have spent most of the past year minimizing the dangers of Covid and ramping up resistance to basic public health measures that cause little inconvenience. For this reason, we now lead the world in active cases by a long shot and our curve shows no signs of trending downwards. On the other hand, those who are behind the propaganda are not stupid and recognize that it’s their constituency that is most threatened by rampant spread and they are certainly going to protect themselves but have to figure out how to do it without being called out as flagrant hypocrites by both sides. It just makes me angry when I see someone like Marco Rubio, 49 years of age and, to my knowledge, in good health, and who has spent the last year supporting the balderdash coming out of the White House and the even worse behavior of Florida’s governor, getting a dose that should go to someone who is in harms way due to his political stances. Rant over.

I suppose I should say a few things about the latest out of London where there is a new mutation in Covid-19. Viruses of this type mutate all the time and mutate quickly. The current new mutant strain is more infectious than the usual strain and passes more easily from person to person, increasing the R1, the number of new people each case can infect. It does not cause more virulent disease. It will not cause the vaccine to be ineffective. The authorities in the UK and EU are trying to lock down the areas where it is spreading to keep this strain contained because, if it becomes more widespread, the number of active cases , and therefore the number of seriously ill, will increase rapidly and overwhelm what the health system can care for. We may be seeing things like this for a while. Don’t panic. And carry a towel.

Today is December 20th. It would be my parents’ 64th wedding anniversary and it is the first time in nearly two thirds of century that my father does not have my mother in this world to help center and complete him so my thoughts are with him today. I wonder, sometimes, what my mother might have made of this pandemic? She would have taken it in stride. As a child of the Depression and World War II and the daughter of two physicians, she would have worn her mask, kept her distance, washed her hands, and come up with plenty of ways to pass the time when spending the holidays at home. Be like Alison.