January 15, 2021

I haven’t been able to write for a few days. I don’t often get writers block but every time I sat down to compose something this week I would stare at the keyboard for a while and then find an excuse to do something else. I’m not sure if it’s delayed shock and a need to process last week, a creeping sense of hopeless futility when looking at public health statistics around Covid-19, or just a feeling that I’ve run out of things to say about this peculiar moment in time that we all occupy, when the political and the medical are interlaced in such a unique way. I finally decided this evening that I’m just going to start typing and see what comes out. Sometimes the result is a relatively good piece, sometimes it’s a hopeless jumble massively in need of a rewrite. We shall see.


On the political front, we are just a few days from a change in administration. I, like most of my fellow countrymen, am waiting with bated breath to see if another shoe is going to drop in Washington DC. The most perfunctory look at the rhetoric spewing forth from the extreme right wing suggests that the contretemps at the Capitol last week was not the end and that there are forces out there spoiling for a fight. Will there be more violence in DC this weekend or around next week’s inaugural? I can’t even begin to predict. If you’d told me at Christmas I’d be writing about an invasion of the Capitol building with very real physical threats to Congress within a couple of weeks, I would have assumed you were telling a rather cruel joke. Will action spread from the nation’s capital to state capitals? There’s some suggestion that’s possible. Let’s just say I don’t think anyone will be caught unawares. The possibility of surprise is long gone.


The biggest problem to come out of all this is the continued embrace of the Big Lie – that the election was stolen and illegitimate – by a majority of the Republican Party. There isn’t a shred of evidence that this is true (and a great deal of evidence that it is not) but as long as this farcical notion remains in the air, it’s going to hang over the Biden administration and hamstring it. Politicians, who should know better but who have cynical reasons for continuing the lie for their personal short term political gain, look like they’re not willing to take down The Big Lie for the good of the country and that’s going to continue to be a huge problem going forward the next few years and will likely hamper public health responses and economic recovery. If the federal government is viewed as illegitimate in certain quarters, the motivation for cooperation for the betterment of society is lacking and that’s going to include the response to the corona virus.


We’re at 23.5 million cases of Covid-19 in the country today according to the Johns Hopkins Corona Virus counter. We will surpass 400,000 US deaths sometime between now and the inaugural. If that number were a city, it would be 48th in population in the US, between Tulsa and Tampa. The winter surge, fueled by holiday travel and gatherings, has shown no significant signs of slowing down either locally or nationally. The local hospitals are full. The staff are burnt out. I hear stories of horrible conditions from friends in California. Hospitalizations from Christmas should be starting to peak in another week, from New Years a week after that. Maybe by mid February we’ll start to see better trends.


The vaccines, while off to an encouraging start last month, are bogged down in the same lack of competent federal leadership morass that has taken down pretty much every step of our public health response to the corona virus pandemic every step of the way over the past year. Distribution remains problematic. Some of that is the logistics of transporting and storing a product that requires sepcialized temperature regulation and which has a very limited shelf life. (It must be administrered within six hours of being drawn out of the stored vial). This has led to a lot of head into wall banging in my VA house call program as so many of those patients live in remote rural areas and are not easily transported to a vaccination center. We’re going to have to figure out how to courier doses off to any number of rural homes from Birmingham under a hard time gun. And we can’t just go house to house. Each recipient is going to have to be monitored for a minimum of fifteen minutes after administration and, given the frailty of the population, thirty minutes is a better idea. Draw up in pharmacy + get to nurse + nurse driving to far far away + nurse administering and monitoring adds up to a number of hours and we won’t realistically be able to guarantee more than two or three in a day to fit it in that six hour window. Then we have to account for weather, road delays, the occasional flat tire, and chattering families, starved for company, who don’t want to let the nurse head off to the next stop.

US numbers


I am deluged daily with calls, texts, DMs, emails, and taps on my shoulder in the grocery store asking about when so and so can get a Covid-19 vaccine. I have only one answer. I don’t know. All Covid-19 vaccine in Alabama is under the purview of the state department of public health. They have broken the population down into a number of groups. The first, called 1a, included health care providers and residents in congregate senior facilities. They’ve made significant progress in getting those vaccines out there. Group 1b, which includes first responders like police and those with significant chronic health conditions and those over age 75 will be eligible as of this coming week. The state and counties have set up hotlines for people to call to set up vaccination appointments. Those hotlines fielded over a million calls in a week and haven’t been easy to get through on. The last thing I saw was that all appointment slots were full and they were working on a waiting list.


The lack of coherent federal leadership means that pretty much every state is doing their own thing at the moment. Some are prioritizing community dwelling elderly, some are prioritizing those in occupations with more potential exposure such as store clerks and teachers. The CDC has issues guidelines, but not mandates and, from what I can tell, no one is paying a lot of attention to them. There was agreement that health care providers and congregate living seniors needed to go first but, after that, it’s devolving into a free for all. Add to that the so called ‘warp speed’ program of the executive branch that seems incapable of accounting for vaccine, where it is and how best to get it out there and we get announcements like the one this afternoon where they admitted their highly touted reserve supply which was going to be released to make up for shortages doesn’t actually exist.

How the adenovirus vaccine delivers DNA to a cell


There is one encouraging bit of news on the vaccine front. A vaccine candidate from Johnson and Johnson is starting to show some encouraging preliminary results. It is not an mRNA vaccine like the currently circulaing Pfizer and Moderna products. It uses a modified virus, one which cannot make humans ill, to transport DNA that encodes for the spike proteins of the corona virus into human cells. The cell then makes and expresses these proteins. The immune system recognizes these as foreign and gears up against them, protecting the person if and when the corona virus shows up later as the immune system already knows to knock anything expressing those proteins out. The adenovirus that carries the DNA is much hardier than the mRNA transport system of the current vaccines so it can be stored in a standard refrigerator and, best of all, it’s a single shot regimen. Data from trials is expected to be presented to the FDA in late January or early Februray.


It’s a long weekend. I have writing projects I need to get going on, legal cases that need reviewing, and I need to take down Christmas so I can reinstall my primitive green screen studio in the dining room. Next up: Tartuffe from the same people that brought you The Importance of Being Earnest in December. It’ll be your chance to see me in a 17th century wig.


The vaccine is getting out there, albeit slowly. There promises to be a more robust federal response on the public health front starting in less than a week. The weather will begin to warm so people won’t be as tempted to gather inside. It will get better. I have to keep telling myself that. In the meantime, vaccinated or not, you all know what to do: Wash your hands, wear your mask, social distance, and stay out of crowded indoor spaces. This is particularly important these next few weeks as the pesky British strain that’s more contagious appears to be starting to spread in this country and your local health care provider really doesn’t need the pace of people falling ill to accelerate.

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