April 7, 2022

And merrily we roll along as if the pandemic is definitely in the rear view mirror. I am not so sanguine. BA2 continues to spread in this country. It hasn’t caused a trend upward yet in cases or deaths (which still remain mercifully low) but the pace of decline has slowed over the last few weeks which could mean a new equilibrium or it could mean it’s just about to start back up again. Time will tell. I was reading today about yet another omicron variant that’s been identified and that’s spreading rapidly in the UK. This one, known as XE, has genetic material from both the original omicron and the BA2 or stealth strain. So far, there’s no reportage that morbidity or mortality is higher from it but there is some evidence that it is much more contagious and spreads even faster than the original omicron – and that one went from a few hundred cases in South Africa to the highest levels yet seen worldwide in a matter of weeks. Be prepared to fasten your seat belts, or at least put your masks back on.

What’s been preoccupying my mind this week as I march through my daily round of clinical geriatrics problems to be solved (this weeks include a man whose friends keep sneaking large quantities of vodka into his assisted living, a family who is majorly unhappy about surgical complications from five years ago with which I was not at all involved, a daughter demanding a letter certifying her mother, who is bed bound, is safe to be left alone all day so she can get Adult Protective Services off her back, and a schizophrenic who has destroyed all the appliances in his house) is what comes next. We may actually be at the point where Covid slides from pandemic into endemic mode, always there in the background like the flu but not enough to cause major social disruption.

I wish I knew. I don’t think we yet know exactly what social disruptions have been set in motion or where they’re going to end up. The flu pandemic of 1918 helped lead to a rapid closure of World War I and the disastrous Treaty of Versailles in Europe while, in the US, it helped create the social conditions that led to the demise of the Victorian way of thinking toward what we would consider a more modern way of viewing the world. The societies of the Titanic and The Great Gatsby were only about a decade apart but everything changed in that decade. I think we’re in the middle of a very similar social transformation but, because we’re all stuck in the middle of it, we can’t really see it or understand it in any sort of objective way. It may not be clear for years yet.

I’m toying in my head with this idea that there’s some sort of fundamental connections between various pieces of our social turmoil, kind of like the unified field theory of physics that explains the failures of our politics and social institutions and Eastern European unrest and horrible public health responses. I’m not quite smart enough to see them all or draw all of the parallels that need to be drawn, not being the Kwizatz Haderach, but there’s something there and I think the stressed of the pandemic are making it more and more visible. Perhaps the simplest way of thinking about it is the failure of the neoliberal globalization of capitalism which has been the grand design of the Western democracies over the last couple of generations. I think the pandemic has exposed the extreme inequalities that have been brought to bear, both domestically and internationally by our current economic system.

We’ve been able to paper things over with the traditional bread and circuses but over the last two years, it’s become very clear that when faced with an external threat which was equal opportunity, that that did not come with equal consequences and there wasn’t a lot of attempt to level the playing field. Wealthy populations were able to cocoon and isolate themselves with aid of modern technology until vaccines became widely available and still have managed to figure out a functional life with fewer social contacts. Poorer populations had to do go out and do the jobs that allowed wealthy populations to maintain this existence, and died. Meanwhile, the poorest populations internationally couldn’t even get vaccine for months and months and months. The system we’ve built which puts profit at the top of Maslow’s hierarchy of needs as created a totally dysfunctional society which no longer serves its denizens, only the profit motive. And this rapacious hunger is leading to climate change, conflicts over resources, tribalism, a lack of empathy and caring, and a steering of religion away from its ancient function of bringing people together to separating us from them through a myriad of rules. Perhaps this is how civilizations fall and its just time for Western Civilization to go the way of the Minoans, the Romans, and the Mayans.

Both Tommy and Steve had political views that were predicated on the flaws in modern society. Steve liked to agitate and always called himself a Gay Communist for the shock value. Shortly after I joined the faculty at UC Davis, I was invited to some sort of fancy cocktail party honoring some political figure (I’ve forgotten whom) and Steve marched up to the then Dean of the Med School and said ‘Hi, I’m Steve. I’m a Gay Communist. What are you going to do about it?’. It was not one of his finer moments. Steve, as a kid who had grown up near the studios in Hollywood, was very savvy about appearance and media. In the late 80s, when California was chafing under a Republican governor and considering a bunch of anti-gay legislation, pushed as a reaction to HIV, he would turn up at all the protests at the Capitol dressed in a three piece suit and looking quite dapper. He could be well spoken when he wanted and he usually ended up on the evening news as ‘Gay Activist’. Tommy, for the most part, absented himself from politics as he felt that the whole system was corrupt and, with his nursing work among the poorest of the poor, that it had nothing much to offer the have nots so he wasn’t going to engage until it did. Personally, I’m more hopeful than either of them. The system is flawed but is capable of responding to fixes if people are willing to put the work in. The current conservative ascendancy is the culmination of sixty years of movement conservatism and a lot of grunt work at the local level that showed little result for decades. The left generally doesn’t seem to have the patience to do what’s going to be necessary to right the ship.

Several people have asked me over the years if I would be interested in going into politics. My answer has always been not just no, but hell no. I have far too many skeletons in my closet and I’m not that interested in compromising my core beliefs for campaign donations. I’m also not a particularly good equivocator. Someone once said that politics is just show biz for the unattractive. I’m not especially good looking, but I’m OK for regional stage so I’ll continue to do my performing in the world of musical comedy and let others perform for the cameras of C-Span. Not that I’d mind being a political adviser of some sort. As the Baby Boom continues to age and demand more and more of society and the health system to help them cope, there may be a role for me in retirement for something of that stripe, but I’ll gladly remain an eminence grise.

It’s late. Time for bed. One more work day to get through this week, then four more weeks before I get some time off.

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