March 30, 2021

Numbers from Detroit showing the uptick happening in recent weeks

The news from Covid land is decidedly mixed. I wish it wasn’t. I wish I could say that we are definitely on a downhill slide and that this was all going to be over soon, but it’s just not yet possible to do that. The big push for vaccinations is certainly helping. Most of my patients have been able to at least begin their series and there have been many heartwarming stories from them of finally being able to leave their homes unafraid, reunions with children and grandchildren, and the picking up of social activities for those who have been locked down in congregate living facilities. But it’s still a minority of the population that’s been able to access vaccines to date. It gets better all the time thanks to the efforts of the current administration but it’s going to be a while before everyone who could benefit receives the shot in their deltoid of choice.

On the negative side, the numbers are not looking good. The numbers of cases and the numbers of deaths have both been steadily rising over the last few weeks. I think it’s too soon to say we’re definitely in another surge but it cannot be completely ruled out. What;s driving it? Likely a combination of factors: spring break, a general feeling of that we’re getting towards the finish line so we can relax, governors in more conservative states relaxing mask mandates and other public health measures due to political pressure, the spread of the new variants. The problems with this initial rise over the last couple of weeks is that these might represent the early stages of exponential numbers and, within a month, if they continue to rise in that way, we may be right back where we were in January.

The scuttlebutt among those of us in health care that work the Covid wards is that there’s a bit of a sea change in whom they are seeing. As the elders get their vaccines, the people who are arriving sick as snot requiring ICU care are skewing younger and younger. People in their 30s and 40s who are otherwise healthy devolving from cold symptoms to nonfunctional respiratory systems in a matter of days. We still have a ways to go and it’s too soon to put away your masks and your good habits developed over this last year of pain and loneliness. It’s going to be some months yet before vaccine can really roll out to the younger adult population and, while the chances of any one individual in that group getting extremely ill isn’t great, the vast population means that the absolute number at risk remains high and all of those illnesses and deaths remain preventable.

I’m not sure what to make of the current dissection of the response to Covid by the previous administration that’s occupying the press. Anyone with some knowledge of epidemiology and infectious disease isn’t in the least surprised by the current spate of breathless revelations. Those basic facts were there to be seen by those that looked – from the deliberate hiding and downplaying of deaths in the state of Florida at the behest of the governor to the toadying at the highest levels of the CDC to the political whims of the previous president. I don’t feel any particular sympathy to any of the public figures currently being caught with their pants down over previous Covid responses. They all knew truth. They all chose not to speak it for whatever reason at the time.

One of the chief probllems at the moment remains the language we use to continue our framing and understanding of what is going on with Covid and public health. We use terms such as war and battle. This anthropomorphizes the virus and we then start to presume that it has feeling and thought and strategy. It doesn’t. It’s just a virus, doing exactly what nature designed it to do – spread. It’s spread doesn’t depend on it’s behavior. It has none. It’s spread depends entirely on our behavior. The current rise is likely caught up in our decisions and our choices as individuals and as a society.

This leaves me, of course, as an educated individual both in the ways of humans and the ways of viruses in something of a quandry. I too wish to be free of the proscriptions of the last year and I am fully vaccinated. I have allowed myself a bit more leeway in terms of socialization with other vaccinated folk and I’m not overly concerned about socially distanced outdoor activity (witness my participation in the covid compliant concert staging of highlights of Pirates of Penzance) but I’m not willing to doff my mask, yell ‘Whee’ and dive into a mosh pit. I want to be a good guardian of society and particularly my patients. At the same time, the subtle cues of society are all those of ‘get back to normal’ for both economic and social reasons. it’s not normal yet. It may be more normal than a year ago but it’s not two years ago and if we don’t keep vigilant, it isn’t going to be. I wish our governor, who is allowing our mask mandate to expire a week from Friday, would continue to push it for just a few more months but she won’t for political reasons and I get that. I’m going to keep mine at hand. I’ve gotten used to them. Besides, I have collected quite a few that are fashion accessories.

The second edit on the book edition of these ‘The Accidental Plague Diaries’ is nearly complete. Next stop proofing and then it will be a manuscript worthy of reading. I feel like Little Red Riding Hood – excited and scared that something written originally strictly for myself and friends will soon face a readership who doesn’t know me or how my mind works or where all these strange ideas come from. It will go out there and sink or swim on its own merits I suppose. I have these fantasies of it catching someone’s attention and being nominated for a Pulitzer and then I come back to reality and recognize that if I sell more than 20 copies outside of my immediate circle of acquaintance, it will be a success. My sister has come up with some wonderful concepts for cover art which might sell a few if it ever makes it into a bookstore.

I return to the field with my VA housecalls starting next week. It will be interesting to see what messages of the current administration and public health policy will have penetrated rural Alabama. Until then, keep the mask, keep the hand hygiene, keep the distance.

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