December 3, 2021

Back in Birmingham. Back at work. Back to Covid insecurities. Back to Before… The return trip from Seattle was uneventful other than the entertainment consult at my seat on the Seattle to Atlanta flight not working so I had to read a book rather than snooze through some film I wasn’t overly interested in. Flying in the age of Covid isn’t a lot of fun between masks and limited service and feeling that entirely too many people who likely aren’t as careful as you are about their health are all up in your personal space. But it is what it is and I did make it home as scheduled without any major mishaps. Then up again seven hours later for a regular work day. Fortunately, I programmed this half week to be relatively light so I’m more or less caught up with the backlog already. I learned long ago that if you work in clinical medicine and you want your colleagues to take care of things in your absence, you have to be gone for a minimum of two weeks and preferably longer. They won’t leave things sitting that long. If you’re gone for a shorter time than that, they’ll just leave it until you get back and then you have to dig out from under the pile. People don’t stop getting sick just because you have a vacation scheduled.

My trip to London is still on as of today. I won’t be surprised if it still gets derailed by omicron sometime between now and scheduled departure. As it stands, to go I have to be covid tested before boarding the plane, again on landing in London, and again within 24 hours of catching a plane back to the US. If any of those turns up positive I am SOL. There may be more testing, more quarantining to come depending on what develops over the next couple of weeks and if the restrictions become too onerous, a weeks trip to London will become impractical at best. The same thing happened with my Portugal/Spain trip with the rise of Delta in August and it ended up working out fine in the end so fingers crossed.

Where are we with omicron? It’s spreading rapidly. Cases in South Africa have tripled over the last three days. One person in Norway inadvertently took it to a Christmas party and managed to infect a majority of the party goers despite them being vaccinated. Preliminary calculations suggest that it’s roughly twice as infectious as delta. It’s unclear if this means it is twice as transmissible or if it is only slightly more transmissible but its mutations make it less likely for recipients immune systems to be able to fight off the infection. Other things that are becoming clear include the fact that natural immunity does not hold the line very well. Reinfection rates in those with previous history of infection by other variants are higher than predicted. It’s unclear as to how serious these infections are going to be and whether they are going to differ for various age and other demographic groups. Vaccines seem to offer more protection than natural immunity but even they seem to be an imperfect wall. Again, the seriousness of an infection in a fully vaccinated person is incompletely understood. If the infections are mild and can be treated at home and don’t cause the crush on the health care system that other waves have caused, we can all breathe a little easier, so to speak. Hopefully, this will become clearer over the course of the next few weeks.

Reports of omicron are coming in from all over showing the relative uselessness of targeted travel bans. It’s definitely well seeded in the USA but ir remains to be seen how fast it’s going to spread and in what communities and whether holiday gatherings and travel will make a significant difference. We remain relatively low in terms of local cases here in Alabama with no significant uptick yet following the end of the delta wave this past month. Deaths are in the single digits statewide daily and hospitalizations remains quite low. The national picture isn’t so rosy. The national mortality rate continues to over around 1,000 daily. That’s a couple of jumbo jets crashing a day and, at an annualized death rate of 365,000 a year makes Covid the third leading cause of death behind only heart disease (660,000 a year) and cancer (595,000 a year) and well ahead of the next one on the list – accident (175,000 a year). Just who is currently dying is a bit uncertain as I haven’t been able to find a really good breakdown for the last few months. It seems to be mainly unvaccinated individuals with significant complicating health factors. I’d like to know what the mortality and morbidity rates for 59 year old men who are fully vaccinated, boosted, and in reasonable health, actually are.

The A number one predictor for vaccination status in the United States remains political party affiliation. Adults who declare themselves Democrats are over 90% fully vaccinated. Republicans are only about 60% vaccinated. Independents are in between at about 75% vaccinated. As omicron arrives, will it spread differently in red versus blue communities? Will there be another wave bringing pressures to bear again on our rickety health system? The health care system in rural areas is very fragile in baseline as the majority of physicians and other skilled practitioners in this country are urbanites with no interest in setting up shop in less settled parts of the country complicated by the financial challenges faced by rural health systems, especially in red states which did not take the Obamacare Medicaid expansion for political reasons. I wonder how many more surges those institutions can stand before they close their doors, finances and staff decimated by overwork and the unwillingness of their population cohort to do even the most basic things to protect themselves. Time will tell. We’ll eventually find out if refusing appropriate public health measures was a good idea socially, economically, or politically. The research that’s going to come out of this time looking at comparisons between red and blue communities and outcomes is going to be fascinating.

I have my monologue memorized. It still doesn’t want to all come out smoothly and in the right order, but it’s all up there. I had my first rehearsal off book today and for the most part it went well. Trying to get the words to come out when you’re also trying to learn new blocking and have stage lights in your eyes for the first time is a bit of a challenge. But I have four more rehearsals and a preview before a paying audience gets to pass judgement. The more I look at the play, the more intrigued I am by it. It was written in 1994, during the first term of the Clinton administration but the politics are very much of our immediate moment. Comet, my character is very much a MAGA type. I’m going to have to see if I can find a T-shirt that reads Make Crhistmas Great Again for him to wear under his black leather jacket. He’s an interesting guy to get to know. He’s not like me but I understand his righteous anger at the forces trying to destroy his idol St. Nick and undermine traditional Christmas as he’s known it. I’ve just got to figure out a way to be able to figure out where I am in the thing in case I go up in front of an audience so I can get back on track. Oh how I wish we had a teleprompter…

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