April 20, 2022

IT’S NOT OVER! If I had the budget, I’d like to hire a skywriter to write it in large letters in the sky over the capitol dome. Do we even have skywriting planes any more? I haven’t seen one in years and years. I suppose the chemicals they used to create the stable clouds are bad for us, like so much else in modern life, and they have gone the way of the dodo. I think small planes towing large banners remains a thing so I suppose I could do that but it doesn’t have quite the same impact. Then there’s the Goodyear Blimp. I’ve always wanted a blimp or a zeppelin ride but I was born in the wrong decade for that to be of high likelihood. I love the images of the elegance of between the wars travel with slim people in suits and hats sitting in elegant art deco lounges on ocean liners or the Orient Express. I’m sure the actual experience was nowhere near as refined and sophisticated as the image but wedging myself into a seat on a plane between two overweight people in faded T-shirts, cutoffs and flip flops is getting a bit old.

And why do I say it’s not over? Society is tired of pandemic life after two plus years and the political system as more or less abandoned all restrictions in the name of public health. One of the last bastions to fall, being the lifting of masking requirements on public transport by a judge in Florida earlier this week. If you actually read her opinion, that she was determined to find fault with the administration’s rule and just needed to come up with some specious legal reasoning to allow it. (Three guesses as to which president appointed her and what her family and social connections are…). Her opinion depends on a new reading of a 1940s public health law which permits the executive to exert necessary ‘sanitation’ measures by saying that the definition of sanitation refers only to something like a cleanser, and not to the much broader definition of sanitation in public health parlance, referring to any measure that prevents the spread of infectious disease which the drafters of that law were obviously referring to. Ah well, a few more people die due to preventable infection. What’s that to people who feel inconvenienced by a bit of cloth on their faces.

At the same time as this, over the last two weeks, new infections in the US are up about 40% from their low last month. These increases aren’t distributed evenly and are concentrated mainly in New England and the Northeast. There are a few other hot spots here and there but outside these areas things are pretty calm. They are being driven primarily by newer strains of omicron. It’s certainly not spreading at the astronomical rate it did this past winter (likely because it’s running into the walls of the vaccinated and the previously infected) and it hasn’t put huge strains on the health system yet, but it’s early days still. We shall see what we shall see.

We tend to be a bit myopic in this country and not pay much attention to what’s happening outside of our borders but, for those keeping score at home, Shanghai is in complete lockdown to try and contain omicron which has caused so much illness that their hospital and public health systems are basically non functional. This is likely due to China’s not pushing and prioritizing vaccination in their older population leaving a highly vulnerable group under protected and now dealing with heavy morbidity. Shanghai is the third largest city in the world. (By comparison, the largest US city, New York, is only about a third of the population and is ranked #45 in the world in population). If you look elsewhere, there are reports of new omicron sublineages emerging in South Africa, deaths in the United Kingdom are actually a bit higher than they were at the peak of omicron and cases in Canada are going up similar to what’s happening in New England, likely due to trans-border traffic. Keeping all of this in mind, I think it’s fine to enjoy the lull we’re currently having but we must all be mindful that our peace may be more fragile than we think.

I’ve been racking my brain to try and think of an amusing anecdote from my past to tell. People always seem to enjoy those. The problem is that over the last four years of writing these posts, I’ve told the majority of my really good cocktail chatter tales. But here’s a brief one involving Steve and the very beginnings of my professional career. It was brought to mind as I have been dealing with caterers this week. If you go into any sort of professional position, especially in academic life, one of the skills you must develop is negotiating a hotel ballroom full of people with a glass of wine in one hand and a plate full of nibbles in the other. When I finished my internal medicine residency and transitioned into my geriatric medicine fellowship, I was invited by my department chair to give a brief presentation at a gathering of the Northern California chapter of the American College of Physicians meeting that was taking place in Monterey. As I was speaking briefly, I would get an expenses paid weekend, some exposure, and a little notch in my anemic academic CV. At this point, Steve and I had never been to Monterey so he tagged along (he bought a copy of Steinbeck’s Cannery Row for company as he had no intention of sitting through the medical programs).

One thing that had to be understood about Steve is that he was the exact opposite of a foodie. If we went out to eat, he would always order the same thing and he had a huge aversion to seafood of any stripe. If he even smelled fish, he would grab my arm before we were seated and lead me out until we could find a dining establishment that smelled more like steak and potatoes. Finned fish, shellfish – it didn’t matter. If it lived in the water, he wouldn’t eat it. So anyway, here we are in Monterey, a town known for its seafood history, in a large downtown hotel and it’s the opening night reception. Plastic tumblers of wine (not for Steve who was sober in AA for thirty years when he died), chafing dishes with various hot hors d’oeuvres, people greeting colleagues they hadn’t seen for a while. I was chatting with a friend from residency when Steve came over, his little plastic plate piled high. ‘I’ve just discovered this stuff called calamari’ he said. ‘It’s delicious’ as he popped another piece in his mouth. Our mutual friend, who knew about his seafood aversion, looked at him and said ‘Do you know what calamari is?’ He admitted he didn’t and she made the mistake of telling him. He spat it out, let out a shriek and made a beeline for the door. I had the good taste not to refer to the incident the rest of the weekend.

It’s late and it’s bedtime. What should you do about masking in the light of what’s going on? It’s never wrong to wear one, no matter what others may say. I wear one at work when I’m in clinical areas and on house calls. I judge other indoor spaces by the number of people, the kind of people and the amount of ventilation. Study after study shows that one of the best ways we can control Covid is by adjusting ventilatory standards in public indoor space. It’s one of the reasons why I’m hosting my birthday party where I am. It’s a large open very high ceiling area with plenty of appropriate ventilation. And wash your hands. And have some calamari (it was always my and Tommy’s favorite starter when eating out).

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