August 14, 2021

The numbers keep soaring upwards and, six weeks into this new surge, we have case loads and hospital numbers we haven’t seen since last January when a new administration and distribution of vaccine finally began to bring numbers down. The pandemic during 2020 was, primarily, driven by systemic failures in our politics on a national level. The election of an administration that saw itself as a wrecking ball, bent on upending the entrenched ways in which the government does business, led to a situation where the federal agencies that keep us safe on a national level were simply unable to function as designed. The change in administration brought a new culture to Washington DC which, when combined with an efficacious vaccine, completely changed the equation and we were able to return to a more normal life.

The pandemic during 2021 is not due to a failure of our politics, it’s due to a failure in our society. We have, for whatever reason, decided it is no longer important to care for each other and selfish behavior has become the order of the day. This has given the Delta variant the perfect opportunity to seed itself in the unvaccinated population and travel far and wide in a very quick manner, bringing us right back where we were eight months ago. The federal government hasn’t brought this about. The Biden administration done everything it its power to get the word out on vaccines and to get the resources available to states and localities for both preventive and aggressive care. Some states have been working actively against this – Florida and Texas being the most obvious examples – but they wouldn’t be doing so if the majority of their citizens hadn’t decided to take a political stand based ignore they neighbor and love only thyself.

There’s nothing new about anti-vaccination and anti-science attitudes in North American culture. Mandatory small pox vaccination rules caused riots in the late nineteenth century. There’s always been a deep distrust regarding the ‘government’ and its role in regulating bodily autonomy. There’s also nothing new about selfishness as a political virtue. I suppose one of the reasons that all of the great religions focus so much on hospitality and welcoming the stranger and loving thy neighbor is as a counterbalance to the selfishness that politics and economics tend to engender. When churches loose that mission and natural pull against those forces, they tend to stultify which is why state churches very rarely succeed. They are two opposing forces and states of mind, a yin and yang of church and state that must figure out a way to coexist for society to be vibrant and move forward.

We’re in a moment when a significant number of those rejecting sound science and health principles are allied with certain religious denominations and many of those denominations, in chasing the prosperity gospel, have rejected the basic tenets of openness to the other, which is very hard for humans to do, in favor of closure and definition of themselves strictly by what they are not rather than what they are. I don’t think it’s a particularly good way for them to find continued long term success. I know how hard it is to accept that those different from oneself have full fledged, authentic lives. I don’t think I really got it until I started doing house calls routinely and was welcomed in to homes that were not white middle/upper middle class. I learned how to see the world in different ways than I was used to. It wasn’t easy. I still don’t get the life choices of some of my patients but I have gotten to the point where I will accept them as being theirs to make and not mine to gainsay or to change in any way

L0016950 Altar and statue of temple of Aesculapius at Epidaurus Credit: Wellcome Library, London. Wellcome Images images@wellcome.ac.uk http://wellcomeimages.org Reconstruction of the interior, altar and statue of temple of Aesculapius at Epidaurus. Watercolour after: Defrasse, Alphonse & Lechat, HenryEpidaure, restauration & description des principaux monuments du sanctuaire d’Asclépios Defrasse, Alphonse and Lechat, Henri Published: 1895 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/

I’m wondering if what we’re seeing is the death of the religion of medicine. In the early 20th century, the majority of the population had little to do with organized medicine. Specialty and hospital care was for those few with money or who lived in cities. The majority of the population were doctored and nursed by grandma with some help from a neighborhood GP, if there was one to be found. Things got a little better between the wars, but the depression ensured there wasn’t a lot of expansion in the health sector and people, for the most part were born and died at home, many at young ages from what we would consider preventable causes these days. Things changed rapidly, however, in the years immediately following World War II.

The post war boom allowed for new hospitals to be built and for medical schools to upgrade their training facilities. The new wonder drugs, known as antibiotics, created medical miracles as those who would previously died at home were successfully treated and cured in these new temples of medical learning, filled with white coated acolytes. The idea of American exceptionalism in medicine took root in the culture and the people felt blessed and worshipped the stunning achievements that came along from CT scans to organ transplantation to robotic surgery. Doctors were granted incredible social authority and the idea of ‘Doctor knows best’ inculcated even the most modest of households and whatever the health system suggested, the people tended to obey without question.

Then things began to go wrong. The health system was sold to corporate America as yet another industry that could be monetized. Doctors became beholden to administrators rather than their patients. New information technologies allowed untrained individuals to access vast arrays of medical information with little guidance about interpreting their findings and results of their researches. A fractured media landscape allowed even the most lunatic of beliefs to find a foothold and an audience in the marketplace of ideas and to be amplified in the name of ‘fairness’. There was concern that the temples of healing might cater too much to the wrong sort of people so funding was diverted from the public health system to more private enterprises where the wealthy might take a cut. It is on to this landscape that Covid, like so many other infectious diseases before it, does its one and only job, move from human host to human host and replicate itself without care for what damage that may accrue to the host along the way. The people ignored the cries of the priests in their white coats as if they were so many Cassandras. They were determined to follow their own personal paths to salvation using the philosophies of everyone for themselves that had become popular in the political and economic spheres. Then they began to fall sick, and came to the temple for healing but there were too many of them and the temple and the priests, having been neglected, were incapable of meeting their demands and, their language of science, being full of uncertainties, confused the people with their sense of certitude in themselves. And so we are where we are. I don’t yet know the end or the moral of the story. It’s still being told.

I’m tired. I’m going to have to go back on jeopardy inpatient call again as UAB has to recreate the Covid surge teams of last winter. I don’t want to have to keep thinking about all this. But it’s our reality and here to stay for now. You know the litany: Wash your hands, wear your mask indoors in public, keep your distance when you can. Get your vaccines. The life you save may be your own.

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