August 8, 2021

Houston, we have a problem. And Baton Rouge. And Mobile. And Jacksonville. And Little Rock. And And And… The news pouring in from all over on the rise of the Delta Variant (and doesn’t that sound like a bad Chuck Norris film?) remains grim. Hospitals and ICUs are full. There are reports of burnt out health care workers simply walking off the job at the end of a shift, unable to take more unnecessary death and suffering. We’re back over 100,000 new cases a day in the country. On the first go round in 2020, it took us nearly eight months to hit that milestone which was reached the first week of November. It only took about six weeks this time to go from a low of fewer than 7,000 cases a day in early June to where we are now.

A brief reminder on how the virus works. It has no sentinent decision making capacity. It simply quickly and efficiently transfers itself from host to host using the behavioral choices of humans to gather in groups to its advantage. What we are seeing today is the result of our behavioral choices of mid June when there was a definite feeling that the worst was over and we could start getting back to normal patterns. What we choose to do today will have no effect on what happens tomorrow. Our behaviors today won’t become apparent in the course of the pandemic until mid to late September. This lag between behavior and consequence of behavior is a bit of a problem. A lot of humans don’t understand cause and effect if there isn’t a clear temporal association between two things, they have difficulties understanding the relationship. Of course the opposite is also true. When two things happen in close proximity in time, we want to believe in a relationship even when one does not exist. Correlation is not causation. I suppose this is, at least in part, one of the reasons why so many are susceptible to irrational theories regarding phenomena over scientific fact. The combination of more normal behavioral patterns regarding group activities, relaxing of masking and social distancing standards, and a significant portion of the population rejecting the one thing we have that we know works to keep the virus at bay has led us to our present predicament.

The Delta variant is moving much faster than the previous Alpha variant. It’s moving so fast that neither our systems of governance nor our understanding of the patterns of epidemic disease can really keep up with it in real time. The combination of transmissibility and huge unvaccinated population in the red states is leading to a perfect storm that’s going to get a whole lot worse very quickly thanks to the realities of exponential math. The full hospitals in the cities on the leading edge of this new wave will be replicated elsewhere and the pressures aren’t going to let up for some months, even if we decide to lockdown again (and I don’t see any governmental entity having the stomach to suggest that, especially when the class of individuals with political power is pretty much all vaccinated and relatively protected). If the numbers go up as rapidly as they could, we’re going to see some hospital systems simply unable to cope further – out of beds, out of staff, out of resources. The collateral damage will be everyone else who gets sick from all of the other usual issues that send people off to acute care. They won’t have much to help. My hospital is gearing up for another time like last Winter and is ratcheting down on elective surgeries and other things that might take up hospital beds, saving them for the crunch that has yet to come.

In the meantime, the governors of Texas and Florida continue their contest to see which one can kill a greater percentage of their population. Florida appears to be winning. Current statistics there show a rate of 132 cases per 100,000 population.  If Florida were an independent country, it’s rate would be the third highest in the world, behind Martinique and St Barts.  (Those two countries have such small populations that one or two more cases move them up the rankings quite quickly.)  For comparison, Alabama, which is quite high for states, has roughly 50 cases per 100,000 population at the moment.  Governor DeSantis, in Florida, to keep the crown, has forbidden school districts from mandating masking on campus or face severe financial penalties.  He has also had laws passed forbidding cruise lines from requiring vaccination prior to boarding a cruise ship, perhaps the most perfect environment for viral transmission yet invented.  Not to be outdone, Governor Abbott in Texas is busy forbidding contact tracing in public schools and allowing potentially infectious children to attend without a quarantine period.  I’m trying to figure out why this deliberate doubling down against the advice of every public health and health care provider group out there.  All I can come up with is that the Republican position on any issue is currently simply to be against whatever Democrats might be for and who cares how much collateral damage in the form of dead citizens.  But then, this is the party that refused to pass common sense gun legislation after a school full of dead kindergarteners a decade ago.  The lives of children don’t seem to mean much, likely because they aren’t major campaign donors.

The same things are playing out locally, with our own governor refusing to mandate any particular school safety measures and kicking it down to local school districts; things are going about as well as might be expected in this heavily red state.  Roughly 1/3 of Alabama schools will be opening with a mask mandate and 2/3 will not.  Locally, the city schools are requiring masks, the county schools are not, and the suburban school districts are all over the map.  This is really playing out in one of the wealthy suburban school districts where many of the University faculty live and send their kids and where the school board (three retailers and two attorneys with no education experience among them) have decided that masks are optional but encouraged.  This has enraged the portion of the parent base employed in health care and my Facebook feed has been full of screeds against the politics of the moment that would let this happen.

Vaccines continue to hold the line, for now.  As more and more data come in, it shows that vaccines aren’t the best at preventing infection, which is why we are all aware of a vaccinated person or two with a breakthrough case.  Vaccines also aren’t the best at preventing someone with a breakthrough infection from being a carrier and spreading it to others.  The numbers for both of these things are significantly lower in the vaccinated population but hardly zero.  However, multiple studies from around the world show that vaccinated people are not getting the complications that require hospitalization and aggressive therapy.  And the few people who do become that ill while vaccinated are nearly all individuals with serious underlying health concerns independent of Covid.  If you’re reasonably healthy and vaccinated, your chance of major hospitalization or death is very small. You can, however, still be part of the transmission chain which is why its important to keep those masks on indoors in public for now.

I spent yesterday at the Magic City Clarinet Festival.  (The Birmingham Music Club asked me to sponsor it and, as clarinet was my elementary/middle/high school instrument, I was happy to do so).  Performances of everything from classical pieces to avant garde to Dixieland jazz.  Master classes from professional clarinetists from around the region.  It was well attended for a niche festival and the venue at the Birmingham Museum of Art, which has great air circulation, was the right place for wind instruments.  I dusted off my instrument case, brought it with me, and joined in the grand finale of Somewhere Over the Rainbow.  I can still play but it’s been a long time since I’ve played for an audience for anything other than comic effect.  (The last time was when I was in Gypsy – I dubbed Clarence and his Clarinet from the opening scene behind the curtain complete with squeaks.  I also played it once in Politically Incorrect after a set up where no one in the audience thought I could actually play it.)  I started playing in fourth grade.  At that time, in the Seattle Public Schools, you were allowed to pick an orchestral instrument and, for a modest fee, the music teacher would teach you to play.  My original choice was flute, but after playing around with it for a week, I had a hard time with the emboucher, and couldn’t get much sound out of it so I switched to clarinet which I could at least make squawk right away.  Our music teacher was Norma Durst.  She played viola in the Seattle Symphony and was an institution, having joined the group in her 20s and playing with them until fading eyesight forced her to retire in her 80s.  When she taught me the rudiments of clarinet, she was probably about fifty and in her prime.  And she actually had us formed into a school orchestra after only six months or so.  Eat your heart out Harold Hill.

It’s time for the litany.  You should all know it by heart.  Wash your hands.  Get your shot.  Keep your mask on indoors in public, unless you’re playing the clarinet.

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