January 16, 2022

And the hits just keep coming. Omicron cases continue to mount both locally and nationally and we’re over 150,000 people hospitalized nationally with Covid. From what I can tell, that number includes incidental cases in people hospitalized with other things so it may not represent the true state of what is bedeviling the health system. All I know is that the numbers at UAB have gone up enough to send us back into surge emergency mode with housestaff being pulled from their regular rotations to manage Covid and the call going out for volunteers from the faculty to staff additional care teams. I volunteered last surge (and was fortunately never called up – I’m not sure how useful I would have been not having done acute inpatient care since the last millennium) and will likely volunteer again this surge. Again, I hope it doesn’t come down to me but if it does, I will cheerfully and willingly do what I can.

I still believe very strongly that a society is strongest when it is a society of ‘we’ rather than a society of ‘me’. And I think that’s the major issue underlying most of what’s causing our fractures in our various social institutions. For the last fifty or so years, the US has been on a course favoring the individual over the collective, the private over the public, the have over the have not. It’s metastasized into all of our social institutions. Politics has tilted in favor of money and corporate profit over public good. Religion has found the prosperity gospel which conflates economic success with piety (despite Balzac’s dictum ‘Behind every great fortune is a crime’.). The educational system has been tilted towards economic success for the individual and away from personal fulfillment or even societal needs. The result has been a hollow and brittle sphere, unable to meet the challenges the pandemic has forced upon us.

We are now two years into this thing and the richest society this globe has ever produced still cannot vaccinate its population, provide real time testing and tracking of cases, guarantee adequate health care for the sick, or provide clear and concise information to its population on how to stay well and what the individual can do to combat the pandemic. These problems are not unique to the US but they are a bit more pronounced here than they are in other countries and societies; and I don’t see any of them being solved at any time in the near future. The structural issues run too deep and many of the wounds have been left to fester far too long.

Why are we here? It’s easy to point the finger at the former president and his administration, but that’s a symptom of underlying disease and, while it might feel nice to use an easy scapegoat, his recent treatment by his followers for even suggesting that vaccination might be a good idea shows that our problems stretch far beyond what goes on at Mar a Lago. We have an entire political party that decided last year that vaccine denialism, and posturing against public health measures was good politics. And people died. These positions remain. And people are still dying. When there’s a change in administration form Democrat to Republican, it’s become political orthodoxy to undo public health measures, as we are witnessing in Virginia where the recently elected Republican governor, as his first acts, is issuing executive orders to undo mask and vaccination mandates. The judiciary has jumped into this as well with the Supreme Court using some rather peculiar logic to undo OSHA’s demand that all large workplaces have vaccine mandates (or a test/mask alternative for those who refuse vaccines). The irony of watching a set of masked and vaccinated judges whose workplace requires vaccination ruling that the coronavirus is not a workplace hazard as it exists outside the workplace was not lost on anyone with more than a few functional brain cells.

These politics, like all of our politics, are driven by money. There’s a lot of right wing dark money pouring into various groups keeping all of these sentiments ginned up. When the sources are traced, it runs back to all of the usual suspects, mainly extreme right wing billionaires who have been playing a very long game of trying to undo all of the regulatory progress of the 20th century which stands between them and maximum profits. I presume that the Scaifes and the Adelsons and the Kochs of the world have some sort of plan in place to protect their assets once society has devolved to the point when the population can no longer afford the goods and services that they sell. Or maybe they’re content with Louis XV’s philosophy of ‘Apres moi le deluge’. The professional classes have tacitly supported this agenda as it’s been good for their 401K balances but I’m not sure how much longer that’s going to last. Economists like Piketty, who is probably the most important thinker in the field of the last fifty years, have been sending up smoke signals for years that Western Civilization is built on an economic house of cards.

Cassandra of Troy

I have always identified with Cassandra, ever since I first learned the stories of the Trojan War. The prophetess with the ability to see the truth and the curse of never having anyone believe her predictions. As I look around at the world today, I feel like I am a member of the Divine Family of Cassandra Like Oracles. (I should be able to make that into a cute acronym, but I don’t have the energy). I went into Geriatrics in part because my reading of demographic charts prepared in the 1950s and 1960s, before I was even born, alerted me to the needs of the population and how I would never want for people who could use my skill set. For the last thirty years I have discussed demographic changes and the needs for medical care with several generations of healthcare administrators, generally getting nowhere. I’ve spoken about the likelihood of a viral pandemic and the changes that would need to be brought to bear in eldercare since the mid 1990s, mainly to yawns. There’s a part of me that’s getting tired of fighting the good fight and that wants to retire into a hole and say ‘You figure it out, I’m done’ but I know I’m not going to do that quite yet.

I figure I can muster up enough energy for a few more years of crazy town, at least if it can be done along with those things which renew my internal energy sources – theater and travel. But I really wish our society would understand just how much deep damage they are doing to their healthcare system and the people in it. The political refusal to expand the health care system so that the whole population is covered is both disgusting and hugely problematic in the face of a viral pandemic without seeming end. The emphasis on profit in health care rather than outcomes is going to continue to drive workers out of the sector, especially under high stress conditions. Nursing, in particular, is in bad trouble and it’s going to take some years to replace the skilled nurses who have retired or who have been lost to stress, illness, or death. The aging boom, with their demands for instant satisfaction from all things in life, are going to be in for a rude awakening over the next few years when they can’t get everything they want from healthcare when they want it as the system has been too damaged to deliver. Most of my older patients are very good at following basic public health measures, but their children… Perhaps I should suggest a few trips out to the woodshed…

In the meantime, you all know what to do. Get those vaccines and boosters. They work. Keep your hands clean. Wear your mask (N-95 or KN-95 if possible as long as omicron is rampant). Watch your distance when you can.

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