November 1, 2022

It’s All Saints Day, following hard upon Halloween, with All Souls Day coming up the stretch and Guy Fawkes Day taking the pole position. There really are a few too many notable occasions crowded into this week. Perhaps a few could be shifted to August which is notable as being the month without any significant holidays of any type. To me, of course, this week marks the anniversary of my arrival in Birmingham with Steve, Patrick the cat, and a 1994 Acura Integra stuffed with boxes and baggage as the vanguard of our household relocation; the moving van was a day or two behind. We hadn’t quite closed on the house so after we dodged the crowds of trick or treaters driving up Clairmont Avenue (never knowing that years later we would own one of those houses), we checked into the Crestwood Holiday Inn which was our base of operations while we got the furniture into the new house, got the utilities transferred over, opened the bank accounts, and all of the other annoying little details a cross country move entails.

That was two dozen years ago. I was thirty-six, licking my wounds after the ignominious end of the clinical geriatrics program at UC Davis into which I had poured seven years of my life and energy, figuring I would be here in the deep south for maybe five years before moving on somewhere more propitious. Boy was I wrong and I had absolutely no idea the twists and turns that life was about to take. I feel like I’m at a somewhat similar crossroads now. I’m transitioning into the final arc of my professional career and I can’t yet see how that’s going to turn out or what it’s going to entail. Will it be mainly clinical? Will it be more creative than that and be more about programmatic development? Will factors outside my control force me to reduce my usual days of racing from pillar to post, trying to get all of the tasks completed and the deadlines met? I haven’t a clue.

Three years ago this week, I was recovering from the usual wild ride of putting together an edition of The Politically Incorrect Cabaret. I had additional performances on the books: The Messiah and The Mozart Requiem with the Alabama Symphony Orchestra and Chorus, Cendrillon with Opera Birmingham, Herr Schultz in Cabaret and a small part in 1776 with Virginia Samford Theater and talk of a production of The Gin Game. Only a few of those came to fruition because, four months later, the world as we knew it shut down. The writings that I had been doing to entertain myself and my friends morphed into these Accidental Plague Diaries documenting, from my own unique point of view what was happening, and continues to happen to our world.

I’m starting to think it’s about time to put these writings to rest. Not because the pandemic is over, but because we believe the pandemic is over and our choices and behaviors echo that belief, no matter what science and fact tells us. I’ve spent too much of my life in geriatric medicine, calling out like Cassandra about the weaknesses in the American health system as it has to deal with a rising and inexorable tide of aging Baby Boomers, to want to remain a lone voice in the wilderness, preaching to my audience of one. I’d like to write about other things. History, art, music, social science, but not necessarily seen through the lens of Covid.

I’ve spent a lot of time poring over numbers, trying to reduce some rather complicated epidemiologic concepts to easily digestible morsels, looking at mortality, morbidity, case rates, the exponential math of spread and the like. Where are we now? Deaths remain relatively flat and stubbornly in the range of 300-400 daily. This multiplies out to somewhere between 100,000 and 150,000 annually. This is far below the 375,000 deaths in 2020 (about 10% of all deaths) and 460,000 deaths in 2021 (about 14% of all deaths). But it’s still about five times the annual death rate for influenza and high enough that this disease, absolutely unknown three years ago, looks to be the third leading cause of death 2020-2022, behind heart disease and cancer, and will be fifth or sixth going forward assuming there are no further surges (and that’s not a great assumption to make).

Modern science and the new mRNA technology allowed us to develop effective vaccines in records time. The first shots were going into arms less than a year after the virus was first detected in Wuhan. Despite widespread availability, the most recent booster has been greeted by a collective yawn by the American population. Fewer than ten percent of eligible adults have received the bivalent booster engineered to be more effective against the omicron variant. Is this how the pandemic ends? Not with a bang but with a whimper of apathy? I’m planning on getting every new booster as it becomes available. The virus has proven itself to have way too many nasty effects with unknown and unknowable long term effects waiting to surprise us later on. Most people aren’t as most people, who have had a combination of original vaccines and boosters and natural infection have enough of an immune response that when they have gotten the disease recently, they aren’t all that sick. Unfortunately, it may not remain that way as both natural and artificial immunity wanes fairly rapidly with time.

The antiscience antivaccine crowd aren’t apathetic. They’re still out there trading their conspiracy theories in the darker corners of social media, popping to the surface occasionally. A large contingent descended on the Greenwich Village annual Halloween parade this past weekend. A week from today, we go to the polls. One political party has repudiated this type of thinking, one has embraced it. Whichever one wins is likely to determine our continued pandemic responses going forward. Like every election, we’ll get the result we deserve.

I went to a reception earlier this evening at the UAB President’s mansion. I hadn’t been there in twenty four years, the only other time I was invited was to the party welcoming new faculty the fall I arrived in Alabama. This was to celebrate the creation of an endowed chair in LGBTQ health equity in the School of Public Health. I warranted an invitation as I had contributed to the necessary fund raising. As I stood nursing my drink on the terrace, I thought back two dozen years. It wasn’t that long ago but celebrating such a post would have been inconceivable back then. We couldn’t even get an equal protection clause into UAB policy at that point. Time marches on, things change, and the arc of history slowly and painfully bends towards moral right.

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