August 28, 2022

Round two. I suspected something was up last night when I woke up a couple of times feeling not my usual self. When I got up this morning with myalgias, a runny nose, and a mild sore throat, I suspected the worst and got out my handy dandy federally funded home Covid test and sure enough, the pink line appeared and I spent the next few hours getting hold of everyone who is depending on my over the next five days to let them know alternative arrangements would have to be made. I’m assuming this is locally acquired omicron. I flew last Tuesday and that’s sort of outside the window of getting sick on early Sunday morning. God knows I’m running around enough places these days trying to keep all the balls in the air that I could have picked it up practically anywhere. It’s a sharp reminder that we’re not out of this yet no matter how busy we may be or what responsibilities we may have.

I apologize to anyone I may have encountered in the last couple of days to whom I may have transferred virus. I’ll be keeping my mask on for the next couple of weeks just in case any stray critters are still lurking in my nasal passages. All I can say is that this bout doesn’t seem to be anywhere near as problematic as my last encounter with omicron eight months ago. That one felled me for a couple of days. This one just feels like a bad cold and, in normal times, I would be making plans to work normal hours this next week. I’m not allowed to go in to either UAB or the VA until I am cleared by their employee health departments so I’m switching all my clinical work to telehealth this next week and I’ll become a disembodied head on someone’s iPad in clinic. We’re too short staffed for me to loll around the house with bad television. I will go to bed relatively early tonight and try to get some decent sleep before the morrow.

We’re rapidly approaching the end of a fiscal year. Why fiscal years are based around October 1, I haven’t a clue but it does mean that a large number of tasks need to be completed in clinical medicine in order to close the books on fiscal 2022 and begin reeling in the numbers for fiscal 2023. Crossing this arbitrary boundary is going to change a number of things regarding the pandemic, mainly concerning federal funding. The federal dollars for immunizations, medications, testing, and other public health measures more or less run out with the new fiscal year and there’s been no motion in congress to continue these programs, likely due to pandemic fatigue and a general societal feeling that it’s over (even though it’s not – we’re still losing about 500 people a day nationwide and the numbers, while trending downward over the last month, are still way above what they were in the spring). In practical terms, what that’s going to mean is that if you want any additional boosters or test kits after the first of October, it’s going to cost you, or your health insurance which can set whatever coverage rules it chooses within federal guidelines.

Because that’s what we do in this late stage capitalistic society of ours. We monetize everything. If it can’t be harnessed in some way to create profit for some owner of industry, it must be worthless or, if it has obvious value as part of the commons, it must be brought down to size or destroyed through the manipulation of public opinion. (The current wars on public education and public libraries over idiotic ‘save the children’ issues come immediately to mind). What will a Covid booster cost on the marketplace? Hard to say. The federal government is playing Pfizer/Biontech and Moderna roughly twenty dollars a dose for huge bulk orders. The prognosticators are expecting the price to increase to about forty dollars a dose when the government is no longer the sole customer. By the time that goes through various middle men and administrative fees, I imagine boosters will have a cash price of about a hundred dollars. That may be reduced dramatically if we have another more virulent variant and insurance companies run the numbers as to what it will cost them to take care of an increased number of seriously ill patients and they may drop the price significantly in order to encourage more people to be boosted. But this is all pure speculation at this time.

Assuming we stay around five hundred deaths a day (and a certain percentage – somewhere between 15% and 40% depending on whose numbers you believe) of those are in individuals who have been vaccinated and boosted. Most of the vaccinated who die are either quite elderly or have serious underlying health conditions (in other words, my patient population). This is similar to what one finds with influenza. The difference is in the absolute numbers. Flu tends to kill about 20,000 Americans a year. In a really heavy flu year, it doubles. Covid is on track to kill nearly ten times as many if what we are starting to see now is the endemic pattern. If we as a society want to make the decision to bear that burden as part of living, just as we do at all of the other causes of death that we shrug our collective shoulders at, we can. But it doesn’t have to be.

I think we’re falling into our usual myth of control. Americans accept shockingly high risks regarding activities that we think we exert some sort of control and understanding over (driving, high fructose corn syrup, nicotine, alcohol) and are averse to risks we think are outside of our purview (alflatoxin in peanut butter, Alar on apples, cyanide in the Tylenol, shark attacks, lightning strikes). The early pandemic was clearly in the latter category. Anyone could get sick. We weren’t certain how it was being spread. Healthy people were rapidly becoming seriously ill and dying. Now with vaccines and a certain amount of natural immunity, especially after the huge omicron surge of last winter, it’s starting to feel more and more like the former. Yeah, I could get it but it’s not going to be that bad.

Perhaps the most serious issue with the turning of the fiscal year is going to be the drying up of US funding towards international efforts to get vaccines to poorer countries. We often forget, this isn’t a local disease, this is a world wide human disease and any population that is not granted immunity can become a pool in which the virus can grow and mutate. Perhaps our problem is that we’re trying to use the 19th century nation state as the model for solving 21st century problems. Pandemics, climate change, population migrations. All of these things are going to require transnational solutions.

If you’re over fifty and haven’t had a second booster, go get it before the end of the fiscal year.

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