December 13, 2022

“My Covid test was positive”. I’ve been fielding that message multiple times a day over the last couple of weeks. As most of my patients are over the age of 75, their risk for complications and hospitalizations is higher but we’ve been pretty luck so far. Few have been sick enough to need the emergency department and no one has yet needed an ICU bed. It won’t last. I know I’ll lose one of my charges eventually. In the meantime, I and my staff run through our script of how to cope with the virus at home, when to call us, when to head for the emergency room, and we send in the Paxlovid prescription to their local pharmacy. A month or so ago we were getting about one call a week, now it’s ten to twenty so we can tell we’re in a surge even if the media isn’t really covering it.

If you look at the national numbers, the death rate is up about 50% over last month (from about 300 a day to about 450 a day), hospitalizations are up about about 30% from roughly 30,000 to 40,000, and test positivity has crept back up over the 10% mark to about 12%. There’s no particular hot spot when you look at the map, it’s going up pretty uniformly everywhere. If I had to guess why, it’s because it’s roughly three weeks after Thanksgiving and, if you’ll remember our usual pattern, hospitalizations rise two to four weeks after a behavior change. I imagine, going forward into the indefinite future, that the holidays with the travel and gatherings that accompany them, will translate into Covid season and we will tend to see peaks in December and early January for some time.

There is good news. Even though the numbers are up, they aren’t going up to the point that the health care system can’t handle them and we aren’t seeing gurneys parked in tents in the parking lot this year. And, with luck, we won’t be for some time as the pandemic continues to evolve into an endemic phase – a disease that remains part of our environmental landscape but which no longer seems to be ripping our social fabric apart. There have been issues with children’s hospitals and emergency rooms as the tridemic of Covid, influenza, and respiratory syncytial virus have been making the rounds among the younger set. Fortunately, as all students of pediatrics quickly learn, the vast majority of children are pretty indestructible and get better on their own so long term morbidity and mortality have been quite low in that population.

Those who are bearing the brunt currently are the elders, especially those over the age of 75, my population. The vast majority of deaths are within this group and are mainly in those with preexisting chronic illnesses of various stripes. If you’re vaccinated, in reasonable health and under 70, you need not be overly concerned by Covid infection, at least in its current evolutionary form. Mind you it could continue to mutate into something quite different over time, but you need not panic today. Of course, you may want to consider your potential place in an infection chain that could put your parents or grandparents at risk. This is why all my teams continue to mask for clinical encounters.

Personally, I have had two shots, three boosters, and two infections so I figure my immune system is about as primed as it’s ever going to get. I’ll test before getting on an airplane to fly to the British Isles in a couple of weeks. And I continue to keep a mask in my pocket for any situation where I feel things might be a bit dicey. Costco on Saturday afternoon comes to mind… Is the pandemic over? Not really, but we’ve moved out of the acute phase and are settling into a more chronic phase. And it’s not nearly as interesting to write about; although some of the usual suspects continue to provide bang head into the wall moments such as the governor of Florida’s recent announcement that he is calling a grand jury to investigate the CDC for providing ‘misinformation’ about Covid vaccines. Interesting that he feels a need to act there but not against those who were recommending injections of bleach, iodine gargles, or horse deworming paste…

As Covid continues to simmer in this more chronic phase, it’s becoming far less interesting to write about then it was in the past so I’m likely to leave the subject other than the occasional update. I will, of course, return to it with my usual zealotry if there are either major developments in its natural history such as new mutations or late complication syndromes with major implications for public health. It also means that the Accidental Plague Diaries is likely to end in book form after Volume III. And that’s just as well.

It’s giving me some time to actually participate in holiday stuff this year. This week is choral week. Multiple rehearsals for Handel’s Messiah cumulating in one glorious performance on Saturday evening with the Alabama Symphony Orchestra at Alys Stephens Center. I’m also adding to the bass section of Eastlake United Methodist Church choir for their Lessons in Carols and my usual Unitarian Universalist Church of Birmingham is using me for the basso profundo part of ‘You’re A Mean One, Mr. Grinch’ for this Sunday’s service. The UUCB repertoire of anthems is nothing, if not eclectic. Next week is relax week. Pretty much everything on my list with a deadline is done by the 20th. Perhaps I’ll finally get my tree decorated then. I did get it out of the box and up in its place but I haven’t gotten the ornaments on it yet. Part of that is deliberate. With the new cat in the house, I wanted to have it be part of the usual environment before covering it with shiny fragile things and having Binx decide he needs to take a swan dive into it from the piano.

Volume II of The Accidental Plague Diaries seems to be slowly but steadily selling. It and the first volume together make a lovely holiday gift to the readers in your life (hint hint…) I took a set to my dentist’s office last week for the staff. (Due to bad British teeth genes on both sides, I spend a lot of time at the dentist and I’m quite friendly with the staff there). I ended up having to go again this morning as my current temporary crown decided to pop off and go exploring the other side of my mouth a couple of days ago. The receptionist told me she read half of volume one while getting her oil changed and found it hard to put down. Another acquaintance later today told me she was trying to read it during a boring meeting and kept breaking into laughter at inappropriate moments and that she had no idea that the pandemic could be funny. And there you have it. TAPD – providing a little entertainment one reader at a time.

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