March 30, 2022

The wind is howling outside the window as the stormfront from the west continues to march on Birmingham. It’s not here yet and, from my study of the weather map, it won’t hit for another hour or two but we’ve been under a tornado watch for the last few hours and I’m prepared to move into the master bath if anything starts to look too serious out there. The condo building is a large concrete fortress, but I’m not terribly worried as long as I’m away from any of the picture windows. I imagine there’s a metaphor to be drawn between such weather fronts and the coronavirus, but I’m much too tired to sit down and work it all out tonight. The general fatigue of the last few weeks continues. I did actually get my request in for time off in May and I’m hoping that, as the idea of respite sinks into my subconscious, it will alleviate somewhat – but I’m not holding my breath.

The news from covidland this week remains something of a mixed bag. The most important thing was yesterday’s announcement of the FDA approving a second booster shot for those fifty and over or those younger with immunocompromise. The FDA didn’t recommend it, they just approved it and so the messaging from both the government and the media has been somewhat confusing, at best. And this has been a constant bone of contention between me and the current administration – make your messaging about public health measures absolutely clear, consistent, and understandable by the general population. The Biden administration hasn’t done a whole lot better than the Trump administration in this regard. So what does the science say? It’s also somewhat unclear. The data that everyone is looking at is out of a very large study in Israel but there are some flaws with it. It wasn’t a randomized controlled trial, it was done in a self selected group of individuals concerned about their health and more likely to be proactive in various ways against Covid infection. Therefore, we are left with the question of whether the reduced risk of infection was actually due to a second booster shot or due to a set of improved health behaviors. The data doesn’t allow us to really distinguish.

Therefore, what we’re left with is a conclusion that a second booster shot may indeed be beneficial (although there is data from other smaller studies that show additional boosters give diminishing returns in terms of protection) but it’s not completely proven. The good news is there is no evidence that an additional booster is harmful in any way. I’m over fifty; I’ve had a case of omicron; I’m planning on getting a booster this weekend or next. Everyone is going to have to start doing their own risk/benefit calculations about what’s right for them. Ultimately, what’s going to be the most useful is rejiggering of the mRNA vaccines to make them more effective against new variants and, when that happens, we’ll probably all need an annual or biennial booster, something like a flu shot.

I ran into an interesting predicament today while dealing with some community elder health issues. There is only one population group guaranteed the right of health care by judicial fiat in American society. Prisoners. It’s usually not the best health care but it must be provided. One of the side effects of lock ’em up mentality is an aging prison population who must be provided with health care which gets more and more complex and expensive as they age. if they become bedridden or demented, they aren’t usually much of a threat to society but until they are released, they must receive health care from the Department of Corrections at public expense. Covid has caused some huge issues with this. Aging prisoners who developed Covid were hospitalized to protect other inmates and, those that recovered, were often too sick to return to hospital infirmary wards due to their acute needs for oxygen or wound care. They have been occupying hospital beds for months as the prisons can’t handle them, nursing homes don’t want them and hospitals have nowhere to send them.

This weekend, in one local town that shall remain nameless, the hospital decided enough was enough and discharged a number of long hospitalized prisoners back to the custody of the local prison, calling ambulances for transport. When they arrived at the prison, the staff refused to accept them and the ambulances returned to the hospital where the medical staff refused to admit them. A full third of the city’s ambulance fleet was tied up all day in the stalemate and unavailable for any other calls. What was the resolution? A judge was rousted out on the weekend to change their sentences to ‘time served’ to keep them from having to go back to prison and the social services staff was busy calling every nursing home in a fifty mile radius to see if they could be admitted anywhere so that the ambulances could go back in service. My source didn’t know the end of the story so I can’t relay it.

This is emblematic of the hidden problems that are currently shaking the American health system to the core. A large new chronically ill population combined with the normal aging issues of the huge Baby Boom generation combined with the great resignation combined with the grossly inefficient system we’ve allowed to continue for decade after decade is going to lead to more and more incidents of this kind. I have absolutely no solutions to any of this. All I can do is point a spotlight at some of the more ludicrous aspects. Why is it allowed to continue? Money. It’s always money. More and more private equity is moving into the health care center and they have one motive and one motive only. Profit. If a crazy quilt system that doesn’t serve the population’s needs allows the dollars to keep flowing, they will lobby congress long and hard to prevent any sort of reform.

I’ve been listening to the audiobook of Dune in the car this past week. I’ve read it several times before, but not since college. The politics of Arrakis, Giedi Prime, Caladan, Corrino and the rest, all culminating in ‘The Spice Must Flow’ seem eerily prescient and appropriate to our current moment. It’s just that we’re living in a system where the cash must flow. In the meantime, consider a booster, keep your hands washed, and remember we’re not exactly out of the woods quite yet.