December 23, 2020

It’s 3:30 AM. I woke up suddenly at 2:00 AM after crashing around 9:30 (early for me) so it’s going to be one of those first sleep/second sleep nights or I’m going to have a lot of empty hours before I have to get up and make my way to work in the morning. Fortunately, it’s my last work day before the holiday so I have a long weekend to try and get my sleep cycle recalibrated. For the most part, I sleep relatively well but about every two weeks or so, I have a night or two where all bets are off. I don’t worry about it a lot. It’s part of being an aging adult. So many of my younger (think 70s) patients are convinced that idiosyncratic sleep patterns are pathologic and get put on sleeping pills or anxieolytics, not understanding what havoc those are going to cause as they head towards their 80s. I avoid them.

I was having complicated REM state dreams involving my mother, a journey on foot through the woods which took us and a few friends through houses I have owned and houses of strangers, a couple of quick costume changes, and stairs – lots of stairs. I have no idea what it all means but as it made me wake up in the middle of the night, I assume I’m processing some sort of anxieties about life, the universe, and everything. It’s not like there’s nothing to be anxious about these days between public health issues, politics, and the general state of Western Civilization.

On the Accidental Plague Diaries front, newly diagnosed cases are running somewhere between 200,000 and 250,000 per day and we’re adding a million new cases every five days or so. The mortality rate at three weeks after diagnosis is holding steady aroun .16% so 16 of every thousand people diagnosed today will not be here on inauguration day. The bloodiest day ever for the United States in terms of battle deaths was the Battle of Antietam on September 17, 1862 with 3,600 deaths. Every day we have more than 225,000 diagnoses, we are ensuring a greater number of lives lost to Covid than casualties from that battle over the following 21 days. 331,000 so far and the numbers are continuing to accelerate upwards.

On the vaccine front, I am fielding a dozen calls a day from patients and families wanting to know when they will be available to older individuals or those with chronic illness. To all of them, I have the same answer, ‘I don’t know’. There has, of yet, been little in the way of guidance from either federal or local levels as to how vaccine will be allocated or distributed outside of the acute care health system. I will let everyone know when I know. My social media feed, filled with doctors and nurses has had two kinds of posts over the last week. Posts of relief and joy from those who have received the vaccine and posts of angst and frustration from those who are routinely exposed in their work and who have not yet been vaccinated or informed by their health systems when or how they will be. There’s not been much in the way of transparency in the system. It’s easy to understand the righteous anger at young and healthy political figures who are getting vaccinated before front line health workers, especially those who have been downplaying the pandemic for political reasons for months and months.

The abject moral and social failure of the highest levels of the federal government are becoming clearer and clearer during this time of transition as more and more energy and media coverage are spent on quixotic attempts to delegitamize and undo an election that was well conducted under trying circumstances. This, coupled by the cynical playing with peoples’ economic livelihoods for partisan advantage is nauseating. I understand the game. One side of the aisle is trying to spike the ability of the other side to govern effectively so they can blame them for failures and take back power later. The ultimate end game appears to be undoing the entire 20th century and, the way things are going both here and in the United Kingdom, most of the 19th as well, consolidating social, economic, and political power back in the hands of a small aristocracy with one set of rules keeping control of the rest through an iron fist of another set of rules. Of course, there aren’t enough of the aristocracy to make this happen without a set of enforcers, mainly the professional classes – those with enough money and assets to think they belong in the club but who are still dependent on salaries and other earnings for economic survival. They will do the bidding of those on top to protect themselves and their interests. Corporate America’s destruction of the pension system for IRAs and 401Ks dependent on the success of the stock market ensured that. This is my peer group but I saw through this charade years ago and recognize that I still work for money, rather than have my money work for me and that means that my true economic and political interests are with those lower on the ladder than myself rather than those higher up. My friends tend to be interesting people with something of value to offer society – artists, musicians, healers, free thinkers, not those who gather solely in the confines of suburban gated communities and churches of prosperity who think that everyone different than them must somehow be flawed.

I am really worried about what may happen to the health system over the next several months. Those of us who provide care will get our vaccines eventually so our chances of falling seriously ill and missing work will diminish. However, there are only so many of us to go round. The smaller regional hospitals have ICUs running at 150% capacity now. What’s it going to be like in a few more weeks? Alabama is a relatively low population state with a well trained workforce so we’ve got some capacity but I see the numbers coming in from Southern California or the Upper Midwest and I can’t even imagine how they’re going to begin to deal, especially with no hope of significant federal backup over the next month. That may change somewhat after January 20th but that’s still four weeks away and if 2020 has taught us anything, it’s that a lot can happen in a month. What happens when a new administration can’t get federal agencies to be more responsive quickly due to deep damage caused by the current administration? If we go a year or two into a Democratic administration with the same levels of dysfunction and lack of response to the needs of the citizenry that we’ve had over the last few years, the trust of the people in federalism will likely be irretriveably broken. What then? Devolution of power to states and localities? Civil War? Revoloution? We’d love to think that it can’t happen here but I bet the people of Sarajevo, when they put on the 84 Winter Olympics, never dreamed of what would come to them in a decade.

Now it’s 4:30 AM and I’m no closer to sleep than I was. Going to get up and have something to eat, disturb the cats, and watch some bad television. It may be holiday season but that doesn’t mean you don’t need to wash your hands, wear your mask, social distance, and avoid indoor crowds.

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