The jet lag has come under control, things are relatively calm at work and I’m on the first day of a three day weekend, so I suppose things are right with the world. Of course, the prospect of A Midsummer Night’s Dream which must be analyzed, annotated, blocked, and led through a design process, is hanging over my head and there’s that pesky third volume of The Accidental Plague Diaries that must be finished up and unleashed upon the world later this summer. It should be enough to keep me out of trouble for the next few months. The rest of 2023 is coming into shape: Midsummer, book launch, trip to Europe, holidays. 2024 remains terra incognita. There’s a show in early 2024 for which I’m lobbying for a role and I want to do a trip to Asia or the Middle East later that year sometime but the rest, as they say, is silence.
We haven’t looked at the pandemic for a while. Part of that is because I’ve had other subjects about which to write (at long last) and part of that is because, with the end of the public health emergency, primary source information regarding morbidity, mortality, spread, hospital utilization and all of the other myriad details that the federal government collected and standardized so that we could try to understand what was happening in real time, have once again devolved to the hundreds upon hundreds of individual city, county, and state public health departments with no central collective authority. In fact, monies allocated for continued study of the pandemic for a better understanding and preparedness for the next one (and there will be a next one) were stripped out during the recent budget negotiations. I’ll bet you can guess at the insistence of which political party.
Some basic truths: The pandemic isn’t over. That’s wishful thinking. No one really knows how many people are getting sick and dying currently due to the ending of federally funded data collection, but when that came to an end, the number of new cases daily nationwide was holding relatively steady at somewhere between 15-20,000 and the number of daily deaths was running 200-250. Assuming that these are the new steady state, that’s about 6 million infections and 90,000 deaths annually, bringing Covid into 5th or 6th place in the annual causes of mortality race moving forward. There is going to be some reshuffling among the top ten over the next few decades due to the senescence of the enormous baby boom generation and due to Covid itself.
Somewhere around 12-15% of Covid survivors develop post Covid syndromes of various stripes. We’re still trying to figure it all out and come up with standardized diagnostic criteria, not to mention effective treatment. But pretty much every time you get a Covid infection, you have to make a d8 at best and d6 at worst saving throw and, if you roll a one, you’re in trouble. Post Covid more than doubles the risk of venous thrombosis and pulmonary embolism, diabetes, heart arrhythmias, chronic lung disease, and death. As Covid continues to circulate, we’ll all have a chance of being exposed over and over again through our lifetimes… and every time the fates roll the dice.
The one real weapon we have remains the vaccines. They continue to be in steady supply and any number of virologists world wide who understand these things far better than I do continue to look at the data regarding vaccine protection, genetic mutation, and all the rest and make the best recommendations they can regarding boosters. The last big push was for the bivalent booster that became available last fall and which had a better effectiveness against the various omicron strains. Fortunately, we are still in the age of omicron – or at least the WHO hasn’t found it necessary to reach into its bag of Greek letters for a new name since omicron wiped the field at the 2021 holidays. So, if you’ve had a booster at any time from September 2022 on, you’re pretty up to date.
Patients are asking me about future boosters. The messaging on this has been somewhat muddled and reports are not easy to ferret out since the end of the public health emergency. As I understand it, the FDA made a very weak recommendation for a spring booster for the elderly or those who were immunocompromised but didn’t really follow through with any sort of push. The data wasn’t great that it would improve things over the previous fall’s bivalent booster. However, there appears to be a push gearing up for a fall booster together with flu shot season. Full details aren’t available yet so I would just keep an eye on your favorite news source and see what they report. I’m planning on taking one.
The official CDC death toll for Covid remains a bit over 1.1 million to date. Assuming the numbers don’t change, it will take us a decade or so to finish up the second million. The first only took about two and a half years. These are just the pure Covid infection deaths. Deaths from disease processes developed due to prior Covid infection or from Long Covid aren’t included. The ancillary deaths from societal disruption – deaths in accidents, suicides among mental health patients, homicides – they’re all up substantially. The Reagan era wholesale attrition of the mental health system ensured that when we ended up with a society wide stressor, that the resources to assist the more fragile would not be available and we have all noticed the increase in anxiety, fear being channeled into anger, depression and dysthymia, and risk taking behaviors that have accompanied the wrenching changes of the last few years. And I think things are going to get worse before they get better. The federal government seems to be heading down a path of lets pretend the pandemic didn’t exist. All of the economic social supports that made the last few years bearable are being dismantled. Vulnerable sectors of the economy are going to have a very difficult time. As president of the board of Opera Birmingham, I am privy to the financials and the company did well through the pandemic given its eligibility for the payroll protection act. But all of those funds have been reappropriated and we’re faced with a traditional cultural event attending audience that still doesn’t feel fully comfortable gathering in theaters and public and private funding streams majorly reduced due to the number of competing needs. I think over the next five years or so a lot of arts producing organizations will be unable to continue. The ones that survive will get stronger with less competition for resources. But fewer producing companies means fewer opportunities for artists and fewer voices out there in the marketplace of ideas and the community as whole becomes poorer.
I can’t solve any of this so I’m going to bed early to fall asleep to reruns of ER on Hulu. I never saw it in its original run so I decided to finally give it a whirl. It’s a bit over the top, but the actual patient and staff interactions are fairly true to life. I do, however, wish they had employed a medical dialogue coach. There’s at least one major mispronunciation of a technical term per episode and every time it happens, it takes me right out of the story. And then there’s the weird mispronunciations in Medicalese which I’ve never been able to figure out. Why should centimeter be pronounced sawnameter by highly educated English speakers? I’m sure there’s a perfectly reasonable explanation but I haven’t a clue as to what it might be.
Life, The Universe, and Everything 