January 3, 2021

And we’re off into the new year, ending up a holiday weekend with the slog of regular work weeks lined up for the next few months. The US celebrated New Year’s day by surpassing 20 million documented Covid-19 infections. We hit 10 million cases this past November 9th meaning it took us only 52 days or less than 8 weeks to double the case load. And it doesn’t look like things are going to slow down anytime soon. We have yet to see the full surge in cases related to Christmas. Those won’t peak for another week or so. I wrote a good deal about numbers in the last one of these posts so we’re going to skip those for now. They were mindnumbingly bad then and they remain that way now.

The most interesting trend to watch over the next few weeks (other than the not especially entertaining circus in Washington DC) is going to be how vaccine roll outs proceed with the holidays out of the way and a significant number of first responders and health workers having received their shots. The federal government, with the current administration’s laissez faire attitude towards matters of public health, has devolved responsibilities to states without a lot of guidance and the states are doing about as well as you might expect – from lines of octagenarians camped out overnight in Florida to officials sneaking their friends and family into vaccination sites in Tennessee. Alabama is actually doing a decent job from what I can tell. The only thing I can fault them on is not communicating clearly with the public as to when vaccine will be available for community dwelling people at risk, but I’m pretty sure that’s because they don’t know themselves about how many vaccines will be available on what schedule and they want to be sure that whatever system they put in place is going to work as advertised and not fail under the weight of poor planning.

There’s been a minor skirmish in the gay community over gay health care providers who received their vaccinations and then immediately took off for Puerto Vallarta for a circuit party full of bronzed bodies dancing on the beach with lots of unmasked/lack of social distancing selfies popping up on social media. It reached a height of surreal when, on New Year’s Eve, a party boat full of guys capsized off the coast leading to the need for a water rescue. No one was physically hurt from what I can tell (although some puffed up egos were likely badly bruised). No reports on if the guys on shore sang ‘There’s Got To Be A Morning After’ in four part harmony while this was taking place. The basic issues seem to be two: a flaunting of privilege and the possibility of adding to case loads in a poorer community/country whose health system is straining under the number of cases already present. While I absolutely understand the need for gay professionals working in the relatively homophobic environment of medicine to go let off steam with the tribe, and have done so myself, the timing of this event appears to be, how shall we put it, poor.

It would never have occured to me to try and book such a trip at this moment. I’ve been leery of even heading for Gulf Shores or Pensacola currently due to the wild spread of Covid in the area. I’m not sure that I would go for the next month or two, even though I will be fully vaccinated. I miss travelling, I really do. Long trips to new places or even weekends in New Orleans or Savannah or at the beach but I’m doing my best to be part of the solution and to set a good example. Full disclosure: I have put down a deposit for a trip to Europe next fall as I am very hopeful that with a new administration and new approaches to public health policy, we’re going to be in a much better position by summer. I am, however, setting it up in such a way that I can walk away from it up to the day before if things are not going well with Covid and making the trip would be irresponsible on my part.

A lot of people tell me that these essays are helping them understand Covid, our health system’s response and what’s going on in society. I’m glad to be of service and pleased that these writings, which I took on to help me understand all of this, have found an audience (and are in the process of being made into a book. I hope a few of you will consider a purchase when it is finished). Of course, this does make me a bit of a role model and that’s always a hard position to be in. I get it at work all the time. New patients and their families come in saying things like ‘we’ve heard so many good things about you’ and that leaves me with the sinking feeling that I have to live up to a reputation that I may or may not deserve. I’ve always been of the philosophy of do the best you can one patient at a time and let the chips fall where they may. Because so many of my patients have been ignored or over treated by the health system in general, I can usually make them feel better simply by listening and helping them unlock their own inner powers of wellness and I guess that’s what gets circulated in the community. There are days when I walk into work and I’m tired and cranky and would rather be anywhere else but I put on my physician role and after fifteen minutes or so, I’m Dr. D again and ready to heal what little bit I can.

This is what makes Covid so difficult for me. There’s very little I can do other than watch and wait and treat some symptoms. Viral illness is like that. I have been trying to push a little harder on good health habits as it appears that those with well balanced health, even of advanced age, are far less likely to develop complicated and serious disease. So I encourage more exercise and a well balanced diet and talk about supplements where there is some evidence that there might be benefit and help get people off excess medication which might harm them in the long run and go over the basic mantras of avoiding viral disease like hand hygiene, masking and social distancing. I’ve watched my loved ones die of disease processes I could do nothing about, despite all of my training and intellect. I do my best to keep myself from having to be in a similar position with my patients. I know how to have those ‘there’s nothing more that I or the health care system can do’ conversations with patients and families but it never gets any easier. At least with Steve and with Tommy, I was able to sit by their bedsides and hold hands. I can’t imagine the pain of having to say goodbye via a borrowed iPad and FaceTime. So please, all of you, be role models in your own right. You know what to do. The more people who do the correct things, the faster this all comes under control. It’s been studied. When the privileged are seen flouting rules, the public assumes the rules need not be kept and we end up in situations like the one we find ourselves in. It’s hard, but it’s the right thing to do.

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