April 16, 2022

I’m still battling fairly consistent fatigue. It’s not bad enough to keep me from meeting any of my usual obligations but, when I get to the weekend and some free time, all I want to do is sleep. It remains unclear to me if this is a stress response (work is particularly hellacious at the moment due to significant understaffing coupled with increased demands on clinical geriatrics), my version of ‘long Covid’, or the fact that I’m older than I ever intended to be by several decades and my body is simply starting to require more down time. It might be all of these together I suppose. Anyway, I slept for ten hours last night and am retiring early tonight as I have to get up for church in the morning in order to sing with the choir and those high Es won’t even begin to come out without rest, relaxation, and hydration.

The Unitarian church, having been founded in opposition to the Trinitarian belief of God the Father, God the Son and God the Holy Spirit, doesn’t celebrate Easter in the usual way. We have what is known as the flower communion created by Rev. Norbert Capek nearly a century ago. The congregation arrives with flowers which are gathered and then, during the service we choose and depart with a different blossom – the flowers symbolize spring and renewal and they are all different just as we all are different, coming with us and departing with another member of the beloved community. It, like other religious rituals, comes around every year and the older I get, the more I recognize the importance of ritual and tradition in all of our lives. The world changes fast. As we age, our abilities to absorb and reorder ourselves for those changes decreases. The part of culture and religion that is unchanging becomes more and more of a touchstone, an anchor point in a world that is more and more unfamiliar. If I feel like this at sixty, I can just imagine what I’ll feel like in another generation when I’m eighty, should I live so long.

Most of the planning is done for my sixtieth birthday bash, which I’m regarding as a party I’m giving as a thank you for all of my local friends who have helped me weather the last few years of loss and pain and pandemic. Invitations are going out this week. Should you be local and not receive one and you’re really interested in attending, message me privately and I’ll get you the particulars. I haven’t given a significant party since Tommy and my last open house at the end of 2017 and it feels strange to put one together without his input. I don’t have his culinary skills to fall back on so I’m going with professional catering and I hope he’ll forgive me. I’ve picked a venue with space to spread out and good air circulation and I’ll keep my fingers crossed that Covid keeps its head down for the next month.

FILE – Boxes of BinaxNow home COVID-19 tests made by Abbott are shown for sale on Nov. 15, 2021, at a CVS store in Lakewood, Wash. The Biden administration’s plan for health insurers to reimburse consumers for over-the-counter COVID-19 tests is recalling the model of a bygone era when the companies processed large volumes of claims from individuals _ with paper receipts. (AP Photo/Ted S. Warren, File)

I’ve heard through the grapevine of a number of friends catching Covid over the last week or so. No one has been particularly ill and it’s mainly been picked up on positive home tests without PCR confirmation so it’s hard to say what’s going on. At the moment, the US is flying blind. The federal government’s payment for Covid testing for the uninsured has lapsed keeping large segments of the population away from testing. The large testing centers have closed. Exhausted health departments aren’t doing the contact tracing or surveillance they have been doing in the past. We really can’t trust the data being reported into the central data banks regarding numbers of positive tests to accurately reflect what’s going on out there the way we could a few months ago. What do we know? Numbers are creeping up in New England thanks to omicron variants spreading in the major cities. It does not appear to be enough to have a serious impact on hospitalizations. As a heavily vaccinated region, it may not get much of a hold on the population as a whole following the major spike of the initial omicron wave.

The local numbers here in Alabama are quite low. UAB hospital is holding steady at roughly ten inpatients with no one on a ventilator, giving the ICU teams a much needed break and allowing the system to open up for long delayed elective procedures. Given the prevalence of home testing, with no good way to actually collect that data, we may need to look for other numbers to help us make sense of the world. The first is the percent positivity rate of the PCR tests that are collected in hospitals and clinics and testing centers. If fewer than 5% (1/20) of those tests is positive for Covid, than, per WHO definitions, the disease is under reasonable control and spread in the community is limited. That number isn’t generally reported but it’s out there. I’ll see what I can find. The other major marker is wastewater surveillance which I think I have mentioned before. As all our bodily wastes, which will include virus, go through the same sewer systems, testing at water treatment plants for the amount of virus coming down the pipes is a pretty good marker for how sick the community is. This methodology is inconsistent across the US and can’t really be counted on for national planning.

There are a few studies out of Europe that suggest that we are not the only ones having difficulty figuring out what’s going on in real time. Studies there are showing an uncoupling of the data curves of testing from the data curves of reported illness as not all tests are being done quickly and reported to the authorities the way that they were being as recently as January when omicron reached its peak. Our current valley and more than two years of battle has left us somewhat spent and taking advantage of the lull. However, one must always remember that the virus never takes a break and simply exploits changes in human behavior in its inexorable need to replicate. I shan’t be in the least bit surprised at another surge coming up and that it will surprise it when it does come as we simply haven’t been looking for it, now being distracted with domestic politics and the situation in Ukraine.

If I am reading the tea leaves right, we’re about five years away from a major collapse in the health care system. Now that Covid is improving to the point that older populations are getting out and about more, the aging lead edge of the baby boom, now in their mid 70s, is reevaluating its health needs and trying to turn to geriatrics to make sure they age with eternal youth. (It doesn’t work, but my newer patients seem to think that I am Miracle Max and I’m just hiding some perfect concoction of turmeric, mineral supplements, biotin, blood pressure medication, and memory enhancers somewhere in my files and that if they just keep pushing, I’ll give them the secret – sorry Ponce de Leon did not leave me the map). They are about to be joined by their younger brothers and sisters clamoring for help from an exhausted group of health care providers, many of whom have left the profession leaving more work for those left behind. On top of that, the commercial insurers, who took a bath on Covid, are looking for ways to replenish their coffers and are ratcheting down on payments and fighting against even basic testing and medications – denials and prior authorizations and calls to adenoidal individuals at call centers with no medical training other than a script are way up and that just adds more and more time and busy work to our day. It now takes me about 6-8 hours on the weekend to catch up from my average work week. It used to take about 2. It’s going to continue to drive people away from primary care disciplines. Just another gift of the pandemic to our post pandemic world.

Enough kvetching. Time to end this and put on an old episode of Supernatural as I fall asleep. Be careful out there. I’ve gone back to masking in crowded stores. It doesn’t hurt me and it may help. Have an appointment for my second booster coming up as well. I figure it won’t hurt and it might help.

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