July 25, 2022

Onward and upward. That’s the name of the game as we continue to head into the BA 5 omicron surge that has drawn a collective shrug and a yawn from American society. Unless your livelihood depends upon a functioning health care system or involves public health planning, you too are likely to be spending most of your time worrying about the economic shocks caused by the pandemic which have led to spiking prices for basic necessities such as food and fuel and the disruptions in supply chains which made everything take much longer for delivery than we are used to waiting. I and my colleagues are all waiting on tenterhooks waiting to see where this one is going to end up. We know how rickety the system has become over the last six months and it won’t take all that much stress for significant collapses to start manifesting themselves.

I see the little ones every day. Short staffing of delivery drivers so that medical equipment or home oxygen doesn’t show up when it’s supposed to. Not enough nursing aids in skilled nursing facilities so patients aren’t changed as often and start getting diaper rashes and skin breakdown they hadn’t had in the past. Delays of weeks to months in getting specialty appointments, even for urgent conditions. Empty bins in the house call supply room where the things we use routinely like phlebotomy equipment remains on perpetual backorder. Insurance policies redoing their terms and refusing to cover routine lab work or adding multiple convoluted steps of prior authorization. Agencies desperate for cash flow stooping to ethically questionable methods of recruiting new patients . Patients and their families, frustrated with a system that isn’t serving their needs turning to patient advocates and other mediators who reach out with reasonable requests but whom you can’t satisfy with your resources at hand.

If we look at the worldwide statistics for the pandemic since the spread of the BA 4 and BA 5 omicron variants (BA 5 has vastly outcompeted BA 4 which is now a mere blip on the radar screen), case numbers and hospitalizations have increased about 40% since the end of June. Hospitalizations have doubled in Europe. Japan is having one of its most rapid rates of increase since the pandemic began. Domestically, we’ve got about 45,000 people in the hospital and we’re losing something over 400 a day. On the good news front, the number of people requiring ICU care in the hospital is not going up rapidly, even though this variant is highly infectious and the case report data is totally inadequate due to the prevalence of unreported home testing. But, given the lag time between case spread, hospitalization, ICU care, and death, it’s going to be another month or so before we really know what the current wave is going to look like.

From Katelyn Jetelina’s excellent Your Local Epidemiologist Substack Newsletter

The majority of hospitalizations at this point are in older adults (age 70+). Vaccination remains highly protective against BA 5 and every other strain to date. If you’re over 70 and unvaccinated, make your will; you’re the demographic most likely to leave the hospital as a celestial discharge. Fortunately, nationwide, 92% of adults in this age group have had their shots and 65% have had at least one booster. My recommendation at this point is that, if you’re over fifty, you go get that second booster now. Those under fifty aren’t yet eligible for a second booster unless they have an immunocompromising condition. The feds are waiting on the in process development of a rejiggered booster with specific omicron protection which is expected to be cleared for production and administration in the fall, opening that up to everyone. I have a feeling that this will be the new normal. A covid booster once or twice a year along with our annual flu shots. Some enterprising big pharma corporation is, I’m sure, working out away to do both shots from the same vial. New Flovid! Just a little jab’ll do ya! I can see the commercials now.

I didn’t sleep well last night so I’m having more difficulties than usual maintaining a train of thought. I’m pretty sure that’s most of the covid news I needed to cover. I’m trying to ignore the political news at the moment as it just makes me nauseous. I’m sure there’s some new pop culture social trend story out there but the last thing I noticed was J Lo and Ben Affleck getting married and I had to wonder if we’d gone back to the 1990s. Cue Peter Allen singing Everything Old is New Again. That song conjures up three very specific things for me. One is the Bob Fosse film All That Jazz where Ann Reinking and Erzsebet Foldi do a dance number in the living room to it to the amusement of Roy Scheider. All That Jazz came out my senior year of high school and I remember that I saw it at the Broadway theater on Capitol Hill in Seattle (now a drug store although they did preserve the neon marquee). I was at that impressionable seventeen year old stage of deep feelings and quests for meaning and I found the film brilliant but also shocking in the rather blunt nihilism of its final act. I knew who Fosse was, of course, but I hadn’t quite morphed into the theater kid I was to become over the next few years so I was able to distance myself a bit from some of the negativity. If I had seen it about three years later, I would have been devastated. The second is Hugh Jackman playing Peter Allen in The Boy From Oz on Broadway. The Bio musical which used his song catalogue to tell his story wasn’t an especially good show. Shoehorning existing songs into a book never works as well as the creators hope. But Hugh Jackman gave one of the most amazing performances I have ever seen on a stage. He wasn’t yet ‘Hugh Jackman’. The first X-men movie had just come out and Wolverine wasn’t yet the pop culture icon he would become. I went with Tommy and my cousin Jenny and all three of us were entranced by Jackman’s effortless charm and ability to hold an audience in the palm of his hand for two and a half hours.

Blue Bay Los Angeles Locos – North of Manzanillo – Site of many shenanigans with Atlantis Events

The third involves a piano bar. Back in the 1990s, Steve and I began to travel with a gay travel group, Atlantis Events, which basically rented out Club Med type properties for a week for a LGBTQ clientele. Since those days, they have grown and now are best known for their huge cruises, but those hadn’t yet begun when the two of us would go off to what amounted to Summer Camp for gay men on the beaches of Mexico. Instead of arts and crafts, it was lazy days in the ocean and pool with an open bar. There were horses to ride (I’m a pretty good rider. Steve was not. I still remember him screaming as his mount decided half way down the beach that he preferred his paddock and took off at a lope the wrong way and Steve had no idea how to rein him in). And, instead of songs around the campfire, we had piano bar. Our pianist and song leader, Wayne Moore remains one of my favorite people and amongst the Broadway standards and medleys, he would do a killer version of Everything Old is New Again. One night at piano bar, Wayne launched into ‘One’ from A Chorus Line and a half dozen campers, all of whom had danced at one time or another with the original production on Broadway or on tour, got up and did the original choreography on the patio. I did not join them. (Although I did a fabulous lip synch Evita on that same trip…).

As we’re deep in musical theater land, I suppose I better sign off with so long, farewell, auf wiedersehen, adieu – go wash your hands and vaccinate un peu.

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