Six years ago this week, the world shut down. I had just come off a career high production of ‘Cabaret’ as Herr Schultz, was in the throes of rehearsing Cendrillon for Opera Birmingham and had a couple of other juicy roles lined up for the rest of the season, none of which happened. Like everyone else, I was disoriented by the rapid changes to my ‘normal’, was desperate for news based in science, and continued processing my emotional state with the open form journaling I had started with Tommy’s death some two years prior. I had no idea the musings I began that week would go anywhere and could not have conceived that they became the three volumes of ‘The Accidental Plague Diaries’ and a social history of the next two and a half years as American society reeled from the Covid pandemic and then recovered.
As a physician and someone relatively well educated and versed in history, I had long expected that American society would be visited by pandemic illness. It’s not possible to predict where and when a pandemic will arise but it’s pretty darn easy to understand that they are part of the natural rhythms of life on this planet and they have always been with us and always will be with us into the foreseeable future. We may like to think in our society, with all of our modern conveniences and technological wizardry and medical miracles that the rules of life don’t really apply to us in our privileged position but that’s never been true. Biologically, we remain Cro-Magnons. Our brains are wired the same way those of our distant ancestors were at the time of the last Ice Age. One thing forty years of medicine has taught me is that people are people are people and human nature doesn’t really change that much. You can change our clothes and styling and our cultural beliefs and give or take away the various trappings of wealth but deep down we’re all pretty much the same. We want security. We want love. We want the familiar. We want joy. We want to avoid pain and suffering. We want to protect those who are important to us.
The pandemic ripped away at the societal anchors which have allowed us to get what we want for the last four or five generations. We lost the sureties of work and income. The young lost educational opportunity. We lost trust in medicine, science, and expertise in general as a fragmented media landscape and the politics of the time prevented the public from understanding why there were uncertainties in a rapidly evolving public health environment. Various entities seized on these uncertainties and exploited them, many in bad faith, often for temporary gains in power and position. And so we are left with a rickety health system hollowed out by a loss of expertise and redirection of funding, a federal public health system in tatters controlled by individuals with minimal knowledge of how health and disease actually operate, and media full of misinformation and half truths which are preached as a new gospel by some rather loud voices with personal agendas.
Because I like to stay informed, I don’t remain in my professional class socially liberal media bubble. I read things written by people with diametrically opposed viewpoints. I don’t think my worldview is perfect and I can be persuaded by facts, reason and cogent arguments to change my position on any number of things and have over the years. Politically, I am left of center but I don’t subscribe to liberal orthodoxy on all social and political issues. It tends to deal with the world in sweeping generalizations about groups of people in the same way that the right wing does and I really detest smearing of groups through the use of cherry picked examples. The father you go either left or right and the more rigid and fossilized the views, the more likely you are to meet coming around the circle.
However, I am not keen to change most of my positions on the pandemic or society’s response. When I look at right wing sites, i see more and more subscribing to the idea that the pandemic was some sort of cabalistic plot, often referred to as ‘the plandemic’. For proof, they often refer to pre-pandemic documentation from federal and public health sources on how a response to a future pandemic should be handled. This is idiocy. Anyone with even a middling education and understanding of the world should get that a pandemic would eventually happen and that one of the roles of government is to help society weather catastrophe when it happens. Of course there were plans in place. Most of them were ignored by the administration in power in 2020 when the unthinkable began to warp our lives but that’s what happens when you let ideology take precedence over reason. Our current government seems determined to throw out the ideals of the Enlightenment from which our understanding of the world derives but I cannot and will not agree with this. There are some Enlightenment fundamentals that I think we should reconsider, especially Cartesian dualism which separates our understanding of the life of the body from the life of the mind which has led to our woefully inadequate system for mental health when compared to that for physical health, but most of the thinkers of the 17th and 18th centuries were pretty brilliant and I would rather not see all of that advancement demolished in favor of a new fossilized age of faith.
I was asked by a patient today if they should get a Covid booster this spring. The messaging on vaccines of any kind has become extremely muddled with the current leadership of the Department of Health Services and the CDC doing their best to cast suspicion and doubt on settled science that conflicts with their belief system. Fortunately, a successful lawsuit by the American Academy of Pediatrics (among others) has scuttled much of the vaccine denialism before it could be institutionalized. Currently, covid numbers are blessedly low but it is still out there, people still get it and people still die from it. It seems to be settling in in similar numbers to influenza in terms of its impact on the population, a far cry from the years when it was the third leading cause of death, killed well over 1.2 million (and recent research suggests this is a serious undercount) and became the largest mass casualty event in US history. My read of the data is that covid boosters, as long as they remain available, are useful for adults on an annual basis. They provide significant protection against death, hospitalization, complications, and long covid symptoms should you happen to become infected. There is some data that those at higher risk from covid (immunocompromised, over the age of 75 or 80) can get additional protection by upping their boosters to every six months. There are no sure things here. I leave it to everyone to make up their own minds about what they feel is best for themselves. Personally, I’m going to continue with an annual booster in the fall but don’t see a need for me to take one in the spring. I might calculate differently if I were twenty years older.
Are covid shots dangerous? There is very little science to suggest that this is true. Like any medication, there is probably a small percentage of the population whose personal genetic makeup will react badly but this does not appear to be widespread. Most of the evidence against the shots cited comes from VAERS (Vaccine Adverse Event Reporting System). This is an unmoderated database to whom anyone can report anything and it has been flooded with thousands of reports of dubious provenance placed there for political reasons. In terms of real risk, there is definitely a small risk of myocarditis (inflammation of the heart muscle) in healthy young men between 15-40. The rate is somewhere between one in ten thousand and one in a hundred thousand and nearly all affected recover without incident. Using my usual metric of risk of fatal automobile accident as a marker (about one in eight thousand annually in the US), a young man is much more likely to be killed on the highway than from a covid shot. As young men aren’t at particular risk from the disease, they may want to make different calculations regarding boosters than I do for myself.
No need to bore everyone with details of my health going forward. I’m at about 90% of my baseline stamina and I had my post-op check this morning and everything has healed up without incident and I was told to go away and only come back if I develop new symptoms. I’m not planning on doing so. My two week pause has put me a bit behind in terms of learning the opera score but I’ve got ten days before we begin staging rehearsals so I should be able to catch up. The maestro is going to be staying in my spare bedroom during production period so maybe I can get a coaching on anything with which I am having difficulties. Life should be routine from now until mid-May when I have a two week break planned for pleasurable activities.
What to say about the war with Iran? The administration continues to prove that it has no clear objectives, no exit strategies, and they keep provoking Iran into more and more retaliation that spills over into the other Gulf states which is likely to make any solution infinitely more complex. There’s likely diplomatic strategies to be pursued but the administration gutted the State Department in the name of efficiency during the DOGE era so there aren’t many left with deep understanding of what all is going on and how best to navigate treacherous waters. What does this mean for all of us? As petroleum (on which the world runs), fertilizer, helium (necessary for the manufacture of computer chips) are all blocked by the closure of the Strait of Hormuz, expect prices of pretty much everything to start skyrocketing in the coming months. I feel so bad for so many of my younger friends who are underemployed and who are about to get socked with all of this on limited incomes.
Last day of my first full week back at work tomorrow and I managed to meet all my obligations without falling out of my chair once. I consider that a win. Up tomorrow, getting dressed, going off to clinic, and working to make my patients’ lives just a bit better.
Life, The Universe, and Everything 