November 12, 2021

Current Hot Spots

I have the feeling that I better write this evening. I’m not sure what this is going to be about but there’s something stirring deep in my limbic system, banging on the thalamus and demanding to get out. I haven’t identified it yet. Perhaps it will make itself known as I continue to sit here and type. I don’t think it’s about work as the week was relatively quiet. My clinic patients were predominantly well, the VA had a Thursday federal holiday meaning I had yesterday off – a rare occurrence for me (I slept in and played catch up on a number of projects around the condo), and the deposition I had been prepping for all week was cancelled at the last minute. (I’m still owed for the prep time). If all my work weeks were like this, I could easily continue working into my 80s but this is the exception and not the rule. When my patients notice my aging (I’m now nearly 25 years older than I was when I started at UAB and I still have some of the same people – 70s then, 90s now), they look at me with an accusing glare, daring me to retire before they’re done with me.

The side effects of Covid on the health care system are driving a lot of my generation into earlier than originally planned retirement. In fact, some of the ‘great resignation’ that’s being talked about with workers not returning from the last year and a half of catastrophe is older workers deciding its just not worth it to go back to the stresses of jobs after a prolonged chance of figuring out other patterns of living. This is particularly true of health care given the inherent dangers of the field during a pandemic plus the precarious nature of a previously rickety system having been subjected to mind boggling stresses. It’s sort of like a beach cabin that’s been in the family for generations, much loved, but not necessarily kept up as well as it might have been – and then a category five hurricane hits. It may still be standing after the storm but it won’t necessarily be as sturdy or as functional as it once was. Most of the cadre of experienced nurses and therapists and other professionals over the age of sixty are mapping out their exit strategies and there just aren’t enough talented younger folk to replace them. I wonder if my clinical fiefdom at UAB could survive my retirement sometimes. Both nationally and locally there are a dearth of physicians with any interest in geriatric medicine and the economics of the system are such that it’s nigh on impossible to make geriatric ambulatory care pay for itself. Not to mention providing outpatient care in geriatrics is hard and the clinical schedules for outpatient work are rigid and punishing.

The local numbers continue to trend positively with fewer than 500 new diagnoses daily and few of those requiring hospitalization. The national trends are not as rosy. We’re still losing between 1100 and 1200 people a day (which may not sound like much until you multiply it out and realize that’s more than 400,000 people a year – more than have died in either 2020 or to date in 2021). The hot spots have shifted some in the last few weeks away from the Deep South and the Mississippi River Valley to the Mountain West, the Great Lakes Region, and Northern New England. For instance, case rates in Vermont, one of the most vaccinated states, are skyrocketing. It’s small size and population mean that the absolute numbers of sick or dead are quite small, but the percentages are concerning. If I had to make a guess, I’m thinking we are seeing the results of the change in seasons. All of the places where numbers are going up are places where the temperature drops and winter sets in relatively early. This forces people indoors and I’m thinking that more people indoors around other people more often may be the driver. This would also explain why case rates have been increasing in Northern Europe but not in Southern Europe. If this is true, we’re going to see a big spike following gathering for Thanksgiving – which will likely be very popular this year due to the inability to do so last year and general Covid fatigue among the population.

Fortunately, the vaccines seem to be doing their job. Covid breakthrough cases in the vaccinated are uncommon, but not rare but the vast majority seem to cause mild illness requiring minimal treatment unless the individual as other significant health conditions. Unvaccinated adults remain at relatively high risk of serious illness, hospitalization and death. More and more data is coming out showing that the disease burden is concentrating itself in unvaccinated communities and that these can be mapped with political belief. The latest piece of nonsense to appear is some quack advocating Covid detoxification baths with epsom salts, borax and other such things to kill the nanobots. (Someone watched the latest James Bond film a few too many times). Well, at least this one is relatively harmless unlike injecting bleach or gargling with betadine or eating horse deworming paste but it does show a complete misunderstanding of what the vaccines are, how they work and what they actually do in your system. I suppose it’s so that those who get the vaccine as it becomes more and more tied to employment can get it and then immerse themselves in a ritual mikvah to wash away the uncleanliness of it all and return purified to their tribe.

I’m still working out the risks I’m personally willing to take in my head. I wear my mask indoors around other people unless we’re all vaccinated or I’m actively eating and drinking. As this is a red state with minimal guidance from the top for political reasons, every venue and organization is more or less left to its own devices to try and determine best practices. The opera is requiring masking at indoor events unless eating or drinking. One theater company in town is requiring proof of vaccination or a negative test to enter. Another suggests masks but doesn’t enforce and I was one of the few audience members who remained masked the last time I attended a show. Fortunately, the sort of people that make up live theater/classical music audiences are the sort of people that are likely to have been vaccinated so I’m not overly worried. I’m applying what I call the car test. Is what I do riskier than getting in an automobile on a routine basis? The current chance of dying in an auto accident per year in the US is 12.4/100,000 population. The chance of a vaccinated individual dying of covid is 0.1/100,000 population so I’m not worried about keeling over. My biggest worry remains becoming an asymptomatic carrier to frail patients.

So, at this point I’m willing to return to theater life but with a dollop of common sense. I’m keeping my hands washed. I’m keeping my mask on unless actively performing. I’ve had my shots and my booster and most theaters are insisting that their performers all provide proof of vaccination. The first show I have booked is The Eight: The Reindeer Monologues as Comet. As it’s eight solo monologues, rehearsal contacts will be minimal and I can stay six feet away from the audience. Tommy and I went to see the show a number of years ago when Birmingham Festival Theater last did it. I wonder what he’d think of me being in it? He was always quietly encouraging of my stage career, just as long as it never interfered with his schedule or things he wanted to do.

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