November 23, 2021

Three complex and intertwining factors

The pieces do not fit. The center does not hold. And I imagine I am not alone in this feeling of existential malaise. Over the last month or so, the spread of Covid in Alabama has greatly abated. Positive tests, transmission numbers, hospitalizations – all down at levels not see since last spring when vaccines had become plentiful and the Delta variant had not yet become established. Our case rate is less than 10 per 100,000 (a benchmark that WHO and the CDC uses in determining if a pandemic is under control). There are only about 400 people hospitalized state wide (way down from the thousands of a couple of months ago). But we are still losing about 13 Alabamians a day, which in my mind is 13 too many. Does this mean the pandemic is over? I doubt it. We’re likely to see another surge or two in the next six months but, with luck, we’ll see life continuing to normalize through 2022. The next big test is this coming holiday weekend and what that might mean for transmission chains as people gather. We’ll learn that in mid December as the inevitable changes in cases correspond to changes in behavior, only about two to three years later.

Where we go from here depends on three big and unknowable factors. The first is the behavior of host organisms, mainly us humans (but being joined by various felines and white tailed deer among others). Viruses do not book tickets for Thanksgiving or gather together in a crowded concert hall. People do and viruses come along for the ride. We’re seeing a widely uneven distribution of cases at the moment. Here in the Deep South, we’re in a bit of a breather, but Michigan and Minnesota are overrun with hospitals buckling under demand again. I strongly suspect colder temperatures and more time indoors among others may be the culprit but I have no absolute data to back that up. We’re having the first freeze of the season tonight and cold temperatures for the rest of the week. If that has a bearing, we’re going to see an increase based on both this and Thanksgiving in December. So human behavior – which is not universally distributed – is our first unknowable variable. Some subpopulations continue to be cautious and mask. Some do not. Some are vaccinating their children which will interrupt transmission in the reservoirs of the school yard and some are not.

The second is what happens with the virus itself. It’s constantly mutating. Some of those mutations are failures and some are wildly successful like Delta which became the dominant strain within weeks in every geographic area in which it was introduced. It was that much more efficient at transmission and it had the unfortunate effect of also making certain middle aged adults much more ill than the original strain, especially if they were unvaccinated. We could get a mutation that makes the virus more infectious, one that makes it more deadly, or we may get lucky and get one that makes it less pathogenic. I still remain very worried about the issues with long covid and the possibilities of significant pathology that won’t become apparent for years or even decades after infection, like post polio syndrome in healthy adults who had and recovered from polio as children. Unlike the Mickey Mouse Club, every day is Anything Can Happen Day.

The third is the success of our treatments that may effect the overall mortality curves going forward. We’re at 773,000 deaths so far and the death rate nationwide remains fairly constant at just over 1,000 a day so we’re on track to be well over 800,000 by the new year. The distribution of those deaths keeps changing depending on where the hot spots are and the physiologic condition of victims. (There’s no judge looking over my shoulder at my use of that word, I hope). In younger adults, where willful antivaccination ideas continue to run rampant, deaths are coming among healthy unvaccinated individuals. In the elderly, where vaccination is approaching universal (99% of Americans over 65 have at least one shot and over 85% are fully vaccinated), deaths are happening in vaccinated individuals, but mainly in those with significant immune or physiologic compromise at baseline, much as with influenza. The introduction of the new oral antivirals may also change a lot of the trajectory as they are easy to distribute and for individuals to take, unlike the previous monoclonal antibody which required infusions in a clinic or hospital equipped for that procedure. Of course, they work early in the course of the disease. Those who engage in extreme Covid denialism and stay home for weeks getting sicker and sicker and only end up in the hospital when dragged there by family at death’s door aren’t going to benefit much from them. Nor will they benefit much from ivermectin. Their bodies are too damaged at that point for easy repair.

The Overloaded Plate

Back to my angst. As things have been returning to normal locally, life patterns are also returning to normal and I, in my naivete, am attempting to return to the activity levels I had in the fall of 2019 and winter of 2020 prior to the great pause. I’ve been going to the theater (masked), I’ve been taking some classes in performance, I’m teaching Sunday school. I’ve had all of my usual work activities and I’ve accepted a role that requires me to learn a nine minute monologue (off book date is December 1). This was my usual load of activities not so long ago and I had no trouble keeping the balls in the air. Now, however, I feel like I’m failing. I always feel one step behind. Maybe it’s the fact that I added a third career over the course of the pandemic which has its own set of obligations and worries and there’s now too much on the plate, but I think it’s something deeper than this. I think I’m a fundamentally different person than I was the second week of March 2020. Too much has happened.

My brain has been rewired by living in an environment of constant danger, a new one for most of us and, as we emerge from, our pandemic lives, we’re all going to find that certain things just feel wrong and the pieces just don’t fit the way we think they should. I think we’re all going to have to be gentle with each other the next couple of years and we’re going to have to encourage our society, our workplaces, our schools, and all of our other institutions to understand this. It’s going to be tough. The business of America is business and the purpose of business is to make as much money as possible. Trying to steer away from this to something that puts human capital ahead of financial capital is going to be very difficult but I think it’s going to be necessary. If we don’t we’re going to see a number of sectors of our economy crater.

The service sector is in trouble due to people having resigned from low level jobs after figuring out new ways of living. The health care system is headed for a major crash due to the confluence of experienced employees leaving their jobs due to burnout due to the incredible stresses of the last few years and the enormous increase in demand that is just beginning to happen with the aging of the Baby Boom. Education is in trouble. The ill preparedness of the American education system for pandemic education has left children behind developmentally and with more and more significant behavior problems cropping up in schools. Their parents’ behavior isn’t much better and a raft of experienced teachers are rapidly heading for the exits due to the stresses of the last two years and the rising levels of abuse that administrators seem reluctant to quell.

All of this uncertainty is, of course, fanning the flames of authoritarianism in the political system as people, feeling unmoored and abnormal, turn to those who promise certainties and rules and a return to a past that never actually existed. None of this is unique to the United States. Eastern European states such as Poland and Hungary have redone their political systems in full authoritarian and illiberal patterns. In Western Europe, just as here, there are right wing authoritarian movements piggy backing on mistakes in coronavirus response. The Dutch police were out on the streets of Rotterdam with water cannons routing antivax protestors and in Austria, the government is cracking down on their sizable antivax minority by locking society down again and making it practically impossible to function without vaccine documentation.

Will be go the way of Orban in Hungary or Bolsonaro in Brazil or Erdogan in Turkey? It’s hard to say. The conservative wing of the Republican party has gone all in for this thinking (CPAC is even scheduled for Budapest next year rather than Washington DC) and, as the party continues to purge moderates or more independent thinkers, we will continue heading there if we elect a Republican congress and executive in the next few years. The Democrats are countering by trying to show the American people that big government and big ideas can help individual Americans. We have the infrastructure bill. We’ll find out shortly if we get the Build Back Better bill. The problem with the Democrats is that they have a very poor track record at messaging in terms the American public can easily understand. The Republicans use Fox and all of their websites and pundits to deliver a clear and unified message that is easily digested by their followers. The Democrats do not. And the main stream media is so involved in making sure there’s an exciting horse race between red and blue that we’re lucky we get any real news out of them at all.

I couldn’t sleep tonight so I spent my time writing all of this, that’s been brewing in my mind, down. Fortunately, due to the short week with the holiday, I don’t have that much to do at work tomorrow so if I am dragging around a bit, I’ll likely be forgiven. I’ll have several large cups of coffee and that should keep me going. Now I’m going to flip on Netflix, not Tick Tick Boom yet as I need to have full mental faculties for that, but to finish up Midnight Mass, Mike Flanagan’s latest supernatural/horror limited series. I started watching them with The Haunting of Hill House (which I tuned into initially as I had friends on the production crew and I try to support my friends and their artistic endeavors). The first few episodes of Midnight Mass felt like a moody psychological drama and then, about a third of the way in, there was an abrupt shift in plot and tone to Steven King land with more than a few echoes of ‘Salems Lot. I was going to give up on it at that point, but kept watching and, as it went on, I realized that the point of the series was not the monster movie or the horror drama. The series is a very clever allegory on the function of religion and how, when religion becomes fundamentalist and overly structured regarding creed and belief, it becomes easy for the followers to become seduced,in the name of religion, away from good to evil without understanding that their hard lines of us versus them are creating monstrous outcomes. It doesn’t take too long to think of dozens of examples of conservative sects of all faiths where this is currently happening. And it’s getting worse, dovetailing with the political issues I noted above.

I can’t fix politics. i can’t fix religion. I can’t fix coronavirus. I’m not even sure I can fix my own life. What I can do is keep abreast of local transmission. Wear my mask indoors in crowds, keep my hands washed, not get in other people’s personal space that I don’t know, and try to maintain good health habits. I think that will do for now.

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