August 11, 2021

This is a week old. You can continue that right hand side in your head…

It’s Wednesday night, it’s raining (again) and so there go the plans for the first church choir rehearsal of the season. We’re rehearsing out of doors due to the rapid spread of the Delta variant throughout the state. We’re pretty much all fully vaccinated but we don’t want to become a case report on an infection cluster so we figure we’ll rehearse outside for now, although that does leave us a bit at the mercy of the weather gods. Being from Seattle, rain doesn’t particularly bother me and I’m perfectly happy to show up in a rain hat and galoshes but I so suppose the pages of our sheet music will start sticking together, especially as we’re having these intermittent rain cells where absolute torrents pour down over ten minutes or so before it returns back to its regularly scheduled ninety degrees. As the next hour or so is now unexpectedly off, I might as well write.

There were 3815 new Covid cases reported to the Alabama Department of Public Health yesterday and the seven day average of cases is 3355. At the peak of the winter surge, our case numbers topped out with a seven day average of just over 4000 cases so we’re more than 80% there and the numbers show no signs of slowing down. At this rate, we’re likely to have more cases in the state than at the peak of the winter surge by the end of next week. The memos are flying thick and fast at my hospital systems to get ready to batten down the hatches again. Transfer visits that don’t need to be in person back to telehealth, reduce scheduled and elective admissions, prepare to have staff and students be pulled away from their current rotations back to Covid duty, drive through testing sites to be opened up again. The inpatient numbers aren’t as dire as they were this past winter – yet. This is likely a function of the elder population having had their vaccines and therefore not falling ill in the numbers that they were this past year. But the numbers are steadily mounting and everyday I hear about another relatively young healthy person who intersects with my circle of acquaintance being hospitalized in an ICU grievously ill.

The Delta variant, which if we had had better vaccination rates this past spring when vaccine became readily available, wouldn’t have become such a concern continues to rip through the land at a rather spectacular speed. Enough data has come in to suggest that it has an R0 of roughly 7. One infected person infects seven others on average. The original alpha strain had an R0 of about 3. One infected person infected 3 people on average. I’ve always been intrigued by exponents so lets look at the difference between the powers of 3 and the powers of 7. Calculators out: 3, 9, 27, 81, 243, 729, 2187, 6561, 19683, 59049. That’s enough. Now the other 7, 49, 343, 2401, 16807, 117649, 823543, 5764801, 40353607, 282475249. After ten iterations, the powers of 7 are nearly 5,000 times larger than the powers of 3. Now there are only about 5 million people in the state so it only takes 7 or 8 iterations at an R0 of 7 to get a number that surpasses the number of people. This is the reason why it’s so potentially dangerous and why it’s gone from zero to sixty seemingly overnight.

The thing I don’t quite get is the political doubling down coming from certain quarters of the Republican party. They should be able to do (or hire someone to do) basic math which shows exactly what’s happening and why and that a whole lot of people are going to get sick faster than the health system, already weakened by the first year of the pandemic, can possibly cope. Rather than quietly abandoning their rhetoric (which they could get away with under the improving conditions of the alpha strain seen this past spring and early summer) for a real world assessment of rapidly changing conditions, they seem content to play toddlers standing on the playground screaming ‘Mine Mine Mine’ and ‘No No No’ over and over again. Part of adulthood is recognizing that the world is the way it is rather than the way you want it to be and that no amount of magical thinking can change it. Unfortunately, the Republican party has, since at least the time of Ronald Reagan, used a combination of money and naked force to reshape political reality, at least, to their choosing and they have now made the mistake of thinking that these tactics can achieve success in any endeavor. However, coronavirus is like honey badger. It don’t care.

I was on a zoom call last night with a group of community leaders brainstorming ways to get vaccine rates up and how to communicate more effectively with various population subgroups. One of the leaders suggested that we all go to various political meetings with a message of vaccine positivity backed by science and our credentials. After seeing news footage of screaming mobs of anti maskers and anti vaxxers at school board meetings, city hall meetings, and town halls all over the country, I don’t think i want to subject myself to that kind of abuse. Doctors and nurses and public health workers of all kinds who are just trying to protect their neighbors from irreparable harm are being subject to assault, battery, doxxing, and general bad behavior of all sorts. I have absolutely no idea how you change people who are not living in a world of rationality, but in one of emotions and feelings and inflated egos. At least here, when people don’t agree with what I have to say, they have to leave it as a comment that I have the option of erasing should I so choose. (It’s very rare that I have to do that, but I have done it and will likely have to do it again.)

The advanced copies of the book are somewhere in transit. I’m hoping they get here by Friday so I can get them out over the weekend. It’s occurred to me that as my patients learn of it and start reading it, I’m going to lose a little of my mystique as ‘Dr. Duxbury’ as the book is very definitely written from the perspective of Andy. I’ve talked before about how I put on a somewhat different persona at work than I have in my private life and I guess that the book is going to level them out a bit. Do I regret it? No. I’m rather Edith Piaf about my life. Je ne regrette rien. I’ve never seen the point of dwelling too much on the past. It’s over. You can only move one direction through life and that’s forward. Sign up for updates on book availability by submitting your email here https://bit.ly/apd-sign-up.

The storms today were reminding me a bit of Tommy. He and I liked to sit in bed in the old house on the hill and watch the storms race up the Jones Valley. In 2004, when we had been together for about a year and a half and were just starting to dip our toes together into the Birmingham performing arts community, hurricane Ivan came ashore on the gulf coast and headed inland directly over the city. Everything was cancelled, the power was out and we were on the floor of the bedroom playing a prolonged game of monopoly. The winds were blowing, the house was rattling, but at 200 miles inland, we were unconcerned until we started to hear an odd noise from upstairs in the living room. We went up to investigate and found that the rotation of the winds, being the opposite of the usual prevailing weather, was pushing the rain up under the shingles and that water was pouring into the living room from several points (the only time we ever had serious leak issues). Of course, one of the major leaks was right over Tommy’s precious grand piano so we immediately had to move it and all the living room furniture into the dining area and fetch every bowl and bucket we could find. The piano survived (although we did have to get a few of the felt hammers replaced). The buckets were enough. We finished the monopoly game, and at seven o clock that evening, set out to see if there was power anywhere for dinner. Fortunately five points south was fully lit up so we went out to dinner, had several cocktails, and went to bed early. We decided dinner and cocktails was definitely the best way to end a hurricane and vowed to try and make that a tradition.

Rains a coming in again, both literal and metaphorical. Hold tight, put up the storm windows, wash your hands, wear your mask, and get your vaccine.

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