May 29, 2020

I’m going to take a break from the accidental plague diaries this evening to tackle a different subject, one that’s certainly very much on the minds of those that live in the South, the question of the underlying issues of race and class that always simmer but that are currently exploding in Minneapolis. I posted a short message earlier today about not being able to truly understand the African-American experience, as I am obviously not a member of that group, but at the same time needing and wanting to listen rather than to speak. I did that because I am tired of reading inanities from white people about ‘how they don’t see color’ or how ‘they understand the feelings but they don’t understand the actions’ and I didn’t want to write about such a charged subject without some input from my friends of color with lived experience.

The message that I received was one of ‘please – speak’ that I, as a white male of a certain age and privilege associated with my educational background and title, and with a bit of a following for my writings needs to be the sort of person that identifies and calls out injustice for what it is. So this essay is my feeble attempt to speak up for fellow humans pushed past what humans should endure by systems that were created and continue to by silently enforced by powers out of their control. What is happening in Minneapolis is a perfectly understandable reaction to the continued abuse of black and brown male bodies by a system that considers them suspect at best and disposable at worst. This is then combined with a gaslighting by the media practicing ‘bothsidesism’ which tells the population that they aren’t really seeing what they’re actually seeing and with a disastrous and rapidly decaying economic system due to the pandemic which is hitting working class people of color harder than most other populations. I’ve studied enough history to know that revolutions are born when enough parents cannot feed their children and that the class that’s hoarded the wealth at that juncture usually ends up with their heads on pikes.

I’ve heard a lot of ‘tut tut’ about the riots and about how can they destroy their own community. Again, knowing a bit about history, I would suspect that the majority of businesses catering to that community are not owned locally and are not putting money and resources back into that community but rather are profiting individuals who wouldn’t be caught dead actually living in that neighborhood. Decades of redlining, bank restrictions, interstates plowing through African-American neighborhoods and bypassing White neighborhoods, and wholesale destruction of African-American economic success (Tulsa anyone?) have created pent up communities with pent up rage. And when African-Americans have the wherewithal to move on up they are often forced to endure the hundreds of slights, large and small that face them when they are seen in traditionally white social spaces. The birder in Central Park is only the latest story. Working some in the classical music world, I have heard so many tales of African-American musicians dissed in the audience for a symphony or opera as some privileged white person assumes they cannot understand or appreciate the art form.

About twenty years ago, I had spent the night in downtown Indianapolis. I left the hotel about 9 the next morning and was attempting to find the entrance to the interstate. I didn’t know the city. Half of downtown seemed to be a construction zone making things even more confusing and, on my way to the on ramp, I missed a stop sign and rolled through it while searching for my next turn. That’s when I was stopped by the police car that was tailing me and whom I had not noticed due to my intense search for something that would tell me I was going the right way. The cop came up to the window and demanded to know if I was drunk; I said no, just a lost tourist. Let me give you my license and registration and reached for the glove compartment. He immediately went into react mode (I guess he thought I might have a gun in there) but eventually he realized I really was just lost, he gave me directions, told me to be careful and waved me on. It occurred to me later, that if my skin color were anything other than white, he could quite likely have shot me but it didn’t cross my mind at the time that was a possibility. That was my white privilege – something that my friends of color just wouldn’t have in a similar situation.

Over the last forty years, I have learned a lot about white privilege and how real it is. The above is just one small example. As a white male with a professional degree, I receive a lot of deference socially that I don’r really think I deserve and which I try not to use or rely on too much. I’ve always tried to live in racially mixed neighborhoods and I’ve always tried to have a wide variety of friends with a vast array of life experiences from whom to learn. When Steve and I moved to Birmingham all those years ago, we refused to live over the mountain or in suburbia – we wanted a real urban neighborhood. I’ve seen a lot of my peers start out life this way but, as they marry and have children, they have closed themselves off to these experiences in the name of protecting or providing better opportunities for their kids. This keeps their social capital within a segmented community of people like themselves, rather than flowing out among other communities. Perhaps I’ve been able to keep my eyes and ears more open as I am childless.

I have my own minority status. I’m an openly gay man in an openly homophobic society. When I moved to Birmingham, I learned some things very quickly. Don’t walk to close to your partner. Don’t hold his hand. Don’t put anything identifiable like a rainbow sticker on the car. Don’t wear certain clothes other than in safe spaces. I wasn’t prepared for some of the nastier things that happened early on like the HVAC tech, who when he figured out he was on a call to a gay household, deliberately plugged the drain line in the condensation pan in the attic so that Niagara falls poured through the dining room ceiling a few weeks later, but I learned how to navigate and earn a modicum of respect from both UAB and Birmingham at large. I can hide my minority status if I need to and pass to the casual observer as something that I am not, another privilege. It’s funny, I’m now old enough that if I’m more flamboyant in public, it’s no longer seen as a threat but more as a harmless eccentricity of the rapidly aging. Probably the same social thing that gives elderly character actors like Ian Mackellan a pass in Hollywood but that prevents leading man types from coming out.

I’ve been doing house calls for thirty some years now. I started doing them in the early 90s when they were almost unheard of as it became clear to me early on in my career that there were certain geriatric patients where it made a lot more sense for the doctor to go to them than for them to come to the doctor. It didn’t take too many years of home care in California for me to spend a lot of time in homes of all ethnicities and classes of people. I’ve taken care of people in tar paper shacks without running water and in elegant family mansions that were built by great great gandparents more than a century ago. Spending a lot of time in other peoples homes teaches you a lot about respect for other people, their circumstances, how they rise to their challenges, and how they view the world. One thing I have learned is that White America can learn a lot from Black American about the meaning of family and kinship and care. The amount of love and pride in accomplishment present in Black homes and the care that is shown to their less able members is incredibly gratifying. Most White Americans don’t know this because they generally don’t enter Black personal spaces. It’s always interesting to take a med student or resident who is a Birmingham native, usually white from an upper class suburb, around on house calls. They have no idea what neighborhoods other than their own are like or how they operate or even that cultures other than their own exist.

So, in the words of my cousin Sojie, I am declaring that I am not an ally in the fight against institutional racism. I am an accomplice. I will call out racism where I see it. I will do my best to treat all of my patients equally no matter what race or class they may come from and how they may view the world. I will support arts that speak to communities of color. (I was given an amazing opportunity by Birmingham Black Repertory Theater this year to be part of their inaugural production of Choir Boy and am proud to support Encore Theater and Gallery). I will listen to my friends, neighbors and colleagues in the African American Community and try to help them get their messages through to people in power where and when I can (and they shouldn’t feel afraid to call on me if they think my voice will help). It’s the least I can do in these troubling times and even though our elected leaders cannot find it within themselves to see the problems, I don’t wish to be part of those problems, despite accidents of birth and genetics.

May 25, 2020

It’s Memorial Day. The day we are supposed to reflect on those who have given their lives for our country over the generations. In reality, however, it’s the long weekend that kicks off the summer season of lightened schedules, better weather, family outdoor activities, pool parties, outdoor concerts, and all the other things that we associate with a more languorous time of year. But not this year. We’re all engaged in another sort of fight, one that doesn’t fall into the traditional conventions of armies clashing. The enemy is unseen, of completely unified purpose, and is part of the usual design of nature with no ability of understanding the rhythms and rituals of the human race.

I, like everyone else, saw the pictures and video of the enormous pool party somewhere at Lake of the Ozarks full of squealing and slightly inebriated twenty somethings doing their best to violate every rule of social distancing. I saw the vituperative comments from their elders bouncing around social media. It didn’t make me angry, it made me profoundly sad. They are young people doing what young people are supposed to do, acting goofy in a large group full of energy and hormones. I did it in my day. I’m sure my parents and my grandparents had their variations (although my grandparents probably involved a great deal more layers of clothing). I completely understand their wish to gather and let off steam after this horrible spring and I completely understand the revulsion that their engaging in what would be otherwise completely normal and unremarkable behavior engenders as well. The public health failures that have allowed Covid-19 to become entrenched and endemic in the community are putting us all in an impossible situation. The few weapons we have that we can bring to bear as a society – social distancing, masks in public – are completely contrary to every social impulse present in those under the age of thirty or so. And it’s a population who isn’t neurologically able to make the connection between actions and consequences. Those frontal lobes don’t finish developing until after the age of 25 which is why frat boys think it’s a great idea to light fire to the couch and throw it off the roof of the house. How do we balance the needs of the mature for safety with the needs of the young for socialization? I really don’t know unless we all decide to become Shakers or some such.

I can confine myself to work and home because, at the age of 58, I’ve had my youth and know it’s another generations turn. I will admit that I spent all of my 20s on the educational treadmill so I was never able to get too wild and crazy and I more or less got married to Steve about half way through them which also slowed me down some. I still had my share of group road trips, late night parties, slightly excessive alcohol intake, heart to hearts in corner booths of all night diners, solo travel to distant parts with groups of young people from all over the world bonding in hostels or sleeping on the floor of the train station. and it breaks my heart that we’re stuck in a world at the moment where the young will have a difficult time going through these rites of passage, if they’re even possible at all for a few years. Because of my theater work, I’m around a lot of young people in their twenties and have enjoyed settling into the wise/wicked uncle role with them. Telling the stories of what the world was like back before computers ruled our every move, of how things were the same and how they have radically changed. That’s what our job is, we of the grandparent generation (I’ve finally woken up to the fact that even though I never had children, i”m definitely paw-paw) to tell the stories and provide the cultural continuity. Those friendships have kept me young and without those people around, whom I mainly see at rehearsal or theater related activities, I feel like I’m aging at an accelerated rate.

These are my friends… See how they glisten…

Speaking of theater, some of the Birmingham musical theater performers got together to do one of those virtual musical theater numbers which is now complete and posted to YouTube and linked above. I think it’s worth three and a half minutes of your time. I have fond memories of moments on stage, backstage or just shooting the breeze with pretty much everyone in it so give them some love. I don’t know when we’ll all be able to be together again in person, but when we are it will be a marvelous moment. All of my upcoming theater gigs are either cancelled or postponed along with everyone elses and I have barely sung in three months. I need to find someone who will do some virtual voice lessons/coaching or I’ll barely be able to croak out a tune at the end of the summer.

What are we to do as a society? The death toll will break 100,000 in the US in the next day or two. It shows no signs of slowing down. Locally, we’re spiking again in the rural areas as Alabama’s underfunded health care system starts to buckle. The news on Friday was that rural cases were flooding into Montgomery which was essentially out of ICU beds. I’m assuming they’ll be heading up I-65 this week putting more strains on UAB. We’re in a damned if we do, damned if we don’t situation. We can continue opening up some and contribute to the spike or we can stay the course causing additional social damage. I don’t have the answers other than continuing to do my part to keep the infection rate down – stay home as much as I can, wear a mask in public, keep my hands clean, avoid enclosed spaces with lots of other people as much as possible. It’s what I have to do to fulfill my pledge to my patients. I’m not ready to write off the elderly or the chronically ill en masse unlike certain other societal forces. All of us are having to look within and ask ourselves very tough questions. I think I know my answers but it’s testing my fortitude to keep moving forward.

May 21, 2020

I should have written an accidental plague diary entry last night but it was another one of those nights when I got home from work and felt completely drained of all energy and limp as a dishrag so not much constructive was done. I know it’s just my body and brain reacting to being steeped in the toxic miasma of stress hormones we’re all having to contend with. I’m pretty sure the current era is busy taking time off of our collective life spans due to excess catecholamines bathing our systems but there’s not a whole lot I can do about that. Cat videos on the internet only go so far to rejuvenate the soul.

I am happy to report some good news on the move front. Most of the house is packed and ready to go. Progress is also being made on the painting of the new condo (and what I’ve seen of my color selections on the walls so far makes me think I’ve gotten those pretty right.). On the bad news front, the HVAC at the condo is busy giving up the ghost and my usual service guy has suggested just tossing it off the roof in favor of a new unit. There’s probably HOA rules against doing that. I’ll have to check. I may be able to temporize for a couple of years with a more inexpensive repair and there is a home purchase warranty included with the whole deal which may cover most of it so that’s a good thing. Something else to deal with. Part of the reason for moving was to get out of having to deal with such things. Ah well…

The local numbers for Corona Virus are not looking good. We’re still doing well here in Birmingham with its heavily medical population but it is, as I had feared, beginning to explode in the more rural areas as the state continues to open up rapidly (and likely ill advisedly). A number of the rural hospitals in the central state are overloaded, Montgomery is nearly out of room and the cases keep coming in and will soon be diverted here. As painful as social distancing and isolation may be for all of us, we really do need to stay the course for the foreseeable future. I don’t think anyone will be very happy if the health care system, already strained, starts to collapse around us. I figure I’m spending the summer putting my home and life back together in the new space and perfecting my Xbox skills. There isn’t likely to be a lot of theater for a while. At least I went out on top. There is a lovely virtual musical number featuring a lot of the Birmingham musical theater performers (including yours truly) in the final phases of editing. I’ll post it when it’s done. Hopefully sometime this weekend.

The big argument in the hinterlands continues to be over the use of masks. Masks are not about protecting you from catching the virus unless you’re wearing a properly fitted N-95 medical mask (and unless you’re working around ill people in a hospital setting, I would wonder why you were doing so if I saw you in one due to the shortage of such supplies). Masks are about preventing you from spreading the virus to others as a possible asymptomatic carrier. They don’t do a lot of good unless they’re worn relatively universally at the moment which is why all the ordinances and requests for their use in public. For general socially distanced interactions, the cloth ones folk have been running up on their sewing machines the last few months are fine. I have a number. i keep one in the car, one in my pocket, one on my face if I need to be indoors around others. Today’s features classic Mickey Mouse. As I move around my area of Birmingham, adherence to masks (required by local ordinance) is pretty good. I hear it’s not so good in the suburbs but I haven’t been venturing out there to check.

Bliss Hall – The Lakeside School

I’ve been trying to think of a good story to tell. Part of the bone weariness is a certain mind stasis that prevents me from thinking rapidly and in an entertaining way over my misspent younger years. Besides which, I’ve already written up most of my best stories for this blog over the last couple of years. This last week marked the 40th anniversary of the eruption of Mount St Helens in Washington, an event forever entwined with my memories of high school graduation. As most of you know, I grew up in Seattle and I went to the local college prep school, The Lakeside School – a sort of transplant from New England complete with brick, white paint, colonial architecture, and maple trees that looked like it could have been helicoptered in from Andover in the early 20th century. I was the academic of the family and Lakeside was a good match for my needs. I started to realize just how good my education was when I arrived at Stanford and was handed the same Western Civ textbook I had used in 9th grade and a reading list for that course and Freshman English full of titles I had already dissected. Needless to say, i didn’t have a lot of difficulties adjusting to even an elite university. I was class of 1980. This makes me technically a baby boomer but my peer cohort has very little in common with those ten or fifteen years older than us. We came of age in the disco years of the late 70s, not the cataclysmic upheavals of the mid to late 60s.

Mount St. Helens in Washington spews smoke, soot and ash into the sky in April, 1980. The eruption is the first for the volcano since 1857. (AP Photo/Jack Smith)

I had my 18th birthday on May 11th of 1980, which was Mothers Day Sunday that year. I can’t remember if we did anything terribly special as a family although I do remember quite well what my present was from my parents – a suitcase. They were ready for the fledgling to leave the nest. (We all grew up knowing that once we graduated high school, we would be welcome back home as long as we continued our educations but, if we decided we were done with that phase of our lives, we had to figure it out for ourselves.). I had a mild case of senioritis that year and I wasn’t spending a lot of time paying attention to classes. AP exams were over, the diploma was in the bag and it was just a countdown to summer and then on to new adventures in September. The following Sunday, the 18th, the family had a duty call to pay on my paternal grandmother who lived in a retirement apartment outside of Olympia in a large senior life care community called Panorama City. My grandparents were among the first residents there and had bought in on life care contracts so they received whatever services they needed to support them until their deaths at no additional expense. You can’t find those deals anymore, they’re not actuarially sound but the modern senior care industry was in its infancy at the time they moved in in the late 60s.

We were up fairly early for a Sunday and all loaded into the car and heading south on I-5 when my father turned on the car radio and we got the news that St. Helens had blown the top 1500 feet or so off the mountain. it wasn’t a huge surprise as the volcano had been showing more and more signs of life over the previous year but we were a bit apprehensive as we were traveling down the highway towards an active eruption. Fortunately for us, the ash cloud was headed south and east rather than north and west where we were. We kept looking to see it, but it wasn’t visible from our vantage point. We spent a few hours with my grandmother, who was in a serenely foggy state at that time of her life, and then raced back to Seattle to indulge in the TV news with helicopter shots of roiling ash, flattened forests, and mud rivers carrying off stray automobiles.

Back at school the next day and comparing notes, we all found out something interesting. Whether you heard the explosion or not depended on your proximity to water. Those on the lake or on Puget Sound (even some off on a beach hike on the Pacific Coast) head an enormous explosion and raced out to see what had happened. Those more than a couple hundred yards from the water hear nothing. I’m assuming there was something about the physics of the sound waves echoing off flat surfaces involved. The mountain had several minor eruptions throughout that summer and I was lucky enough to be able to see the steam and ash clouds from those from Seattle. For one of them, I was on a boat on Lake Union (I cannot remember why – I think it had something to do with my job that summer working in the water chemistry lab for Seattle METRO – the sewer agency) and had a gorgeous view of this billowing white column towering over the city in the distance on a pristine blue sky day. For the children of the Pacific Northwest, May 18th 1980 will always be one of those ‘where were you days’. And I remember it far more vividly than my high school graduation ceremony which was a couple of weeks later where I marched into the gym between Jackie Durbin and Joanne Dwyer. I still have a bottle of ash collected from the roadside a couple of weeks later when I was down near Portland. My packers found it this week and were somewhat afraid it was somebody’s cremains. They have been reassured. Cremains at my house ride around in car trunks or live in an old shoe box.

Stay safe. Stay well. Wash your hands.

May 16, 2020

Relax, it’s a stock photo…

I’m just back from a four mile constitutional and I can tell you that indeed, Sumer is icumen in. It’s 86 degrees and this is the first day I’ve really started to feel the seasonal humidity. I’ll have to change my walks to evening or early morning (fat chance of that…) Time to open up the laptop, check the handy dandy Corona Virus counter that I keep open in my browser window, and launch into yet another edition of Andy’s accidental plague diaries. Anything to distract a bit from the fact that the house is now about 80% packed and I won’t be able to find much of anything for the next several weeks. If everything goes according to latest plan, the repairs finish up early next week and the painting should be the middle of next week. Give it a few days to dry and then things can start making the journey over. My out of work theatrical packing crew have done a stellar job. Shout outs to the lot of them.

While scrolling through some social media or other this morning (I woke up at usual alarm time despite it being a day I could sleep in if I desired), I ran across a quote from Albert Camus’ novel The Plague, that seminal study of human behavior under uncontrolled pandemic illness conditions. ‘stupidity has a knack of getting its way; as we should see if we were not always so much wrapped up in ourselves’. I could not think of anything more apropos to the historical moment in which we find ourselves. The idiotic notion that viral epidemiology can somehow be influenced be political ideology that’s running rampant at the moment leaves me entirely befuddled. I guess I’m too well trained in the sciences. I’ve tried to balance right and left brain over the course of my life but degrees in biology, chemistry, and medicine do leave a mark. Of course, Camus wrote his original words in French, but I’m too lazy at the moment to look them up.

Recent photo of Marie-Pierre Koban at age 87 with her friend Margaret Hardin age 102

Speaking of French, I heard through The Lakeside School grapevine that Marie-Pierre Koban died a few weeks ago. She was the long term middle school French teacher but she and I went back long before she came to Lakeside. My quasi-aristocratic grandfather decreed that all educated folk of European background should have a working knowledge of French, so a private tutor was sought for the Duxbury children. I don’t know where my mother found her, but from mid-elementary through middle school, off I went to Mme. Koban’s house in the University District for lessons. I was quick with the vocabulary and picked up reading skills without difficulty but I was, at best, an indifferent grammarian. Having learned it young, it’s still in my brain and, when I am around Francophones, it comes rushing back. I understand spoken French quite well (and rarely have to use the subtitles for a French language film), I can read it without too much difficulty as long as it’s not too technical or wordy. I can speak it back haltingly, but it gets more fluent with a little practice. Don’t ask me to write it. I know my verb tenses because of what sounds right in my head but I am incapable of translating that into the written word. I finished my tutorials about the same time she took the job at Lakeside. We would run into each other at school functions where I was always le petit Andre – not to be confused with le petit Nicolas to whom I was sometimes compared. When I hit high school, I switched to Latin with Lindsay Heather and Ken Van Dyke. But that’s another story. I will say my Latin studies gave me a much better knowledge of the way language actually works and the ability to sit here and tap out these essays with at least a modicum of clarity.

Back to Covid 19. A friend of mine brought up a situation in her family where a cousin and his family had made the decision to go visit his elderly mother and traveled out of state to spend a week with her so she could have some grandchildren time and wanted to know what I thought of that decision. My response was that life is risk and that you always have to compare risk for reward. As mom lived alone, and not in a group setting where others could be endangered, if she thought the reward of family time was greater than the risk of possible contagion, it was her decision to make. Ditto the decision on the part of the cousin and his family. Every individual, family system, set of circumstances, beliefs, et al. are different for each such decision, and trying to impose arbitrary judgments usually fails. So what should we do as responsible individuals as things start to open up? I think we need to learn better risk stratification.

Americans are terrible at understanding risk. Culturally, we except incredibly risky things if we think we have some control over the risks involved and we are outraged by not so risky things where we have no control over the outcome. The classic example is how we think about cars. In 2018, the last year for which there are complete numbers, 39,404 people in the US were killed as the result of motor vehicle accidents. This means the chance of being killed in any given year is roughly 1/8,300 and the cumulative lifetime risk is about 1%. Most of us don’t think twice about getting in a car as we know we’re good drivers and we obey traffic laws and we can control unexpected situations. We worry much more about shark attacks at the beach (32 in 2018 with one death), plane crashes (393 fatalities in 2018, only one of whom was a commercial passenger), or salmonella contaminated food (420 deaths in the US in 2018). By the way, the leading cause of accidental death? poisoning – lifetime risk of 1/71 so don’t drink the bleach. I have long had a rule of thumb regarding choices. Is it riskier than getting in a car? The problem at the moment is, as this virus is so new, that we really don’t know what’s risky and what’s not. The federal agencies that usually would calculate and disseminate this information are in disarray. We’re essentially going to have fifty states going fifty different directions which should start to give us some data about which strategies work and which are disastrous. Until the data starts to make some sense, I’m continuing to stay in unless I have to go out for something. I’ll wear my mask in enclosed public spaces. To me, wearing a mask says to me ‘I see you and I care about you and all of us’ and not wearing one says to me ‘I’m a selfish Ayn Rand devotee’. As people are packing and moving for me, we’re keeping as much distance as possible, wearing masks, and sanitizing frequently. Risk mitigation until risks are better understood.

Be safe, be well, wash your hands.

May 12, 2020

And another year older. I completed my 58th orbit of the sun yesterday and today start into my 59th year. 58 is an odd age to be. There’s nothing terribly interesting about the number. You’re not yet on the cusp, it’s late in an undistinguished decade, it’s not even a prime. But that’s the way the world and our mathematical system works with its arbitrary divisions determined by the natural cycles of the seasons and the motion of celestial bodies. It wasn’t a terribly interesting day either. Monday is my double clinic day at UAB Geriatrics and so it was pretty much work work work followed by a zoom board meeting. There was carrot cake though, not once but twice. Once at lunch provided by my clinic staff and once again for dinner provided by the friends who are my packers and movers.

Yesterday was also the first big packing day in the slow process of relocating. Covid Corners has been rejected as an appropriate name for the new condo. I’m now leaning towards Clearview as it has a view of downtown from its perch on the side of Red Mountain and I purchased it in 2020. My other thought, and another ophthalmalogical pun, is Hindsight. Most of the stuff in the house will be packed by the end of the week and then it’s just a matter of getting the new space ready to receive it all. That’s going a bit slower than anyone would like due to issues with the supply chain delivering replacement items like sinks but, once it’s fixed and the paint is dry, I shall be ready to send the stuff over. Of course, I won’t be able to find anything for about the next six weeks. It’s a good thing theater is out of production and no one is looking for props or costume pieces.

I’m trying to decide where to go next with Andy’s accidental plague diaries (10,000 cases in Alabama now with over 1,000 in Jefferson County). I keep having brilliant ideas for tangential subjects to mull over but by the time I get home, get settled and start to write, I can’t remember what any of them were. I’ll have to start jotting them down during the day and sticking them in my back pocket for later reference. Some days, as I start writing, it just comes to me and flows. Other days, it’s the pulling of proverbial hens teeth and I’m quite certain what I’ve laid out is complete garbage and no one will be interested. And then I see a comment from someone about how much they liked it or that it helped clarify something that had been on their mind and I feel like maybe these musings are worth while after all and I decide I’ll go ahead and write another one or two after all.

I do ask for readers to make suggestions about what I should write and someone brought up the subject of depression in aging. How do older people, who recognize that their physical and cognitive faculties are going cope with that downhill slide? Do they get depressed by this? Does debility and dementia cause depression or does depression worsen debility and dementia? What does any of this have to do with Covid 19? (I think I have an idea about how it all ties together – let me keep writing and we’ll see if I get there.) I think the first thing we have to consider is that an older person and a younger person are not the same being.

I’ve brought up evolutionary theory before. I do it because one of my big aha moments when I got into geriatrics was an understanding that it applied enormously to aging. Niche theory is the idea that all species fill an ecological niche in a vast puzzle and that, as the environment and other species change, the species must change to always fit into its niche or head towards extinction. Older people are like a species, existing in equlibrium with their niche of a life they’ve spent decades building. It’s multidimensional and consists of family, physical environment, finances, social connections, and myriad other factors but it works for them and they hum along. Then, slowly, they start to change. Maybe it’s arthritis making the stairs more difficult. Maybe it’s increasing living expenses eating away at a fixed income. Maybe it’s memory lapses. Maybe it’s eyesight changes creating problems with night vision and driving. Some of these problems can be fixed, some can’t. If they can’t be fixed, the person can try to live an unaltered life but, as their physical reality no longer fits key in lock with their life niche, things start to go wrong and disease will result. Or, if they can’t change themselves, they can change their lives and adapt to new circumstance. Move to a home without stairs, do some sort of cohousing to reduce expenses, use Uber after dark. The person who recognizes life is change and accepts and embraces it and keeps themselves in balance with their individual aging process usually does well and rarely becomes seriously depressed. The person who tries to live in a fossilized reality created by their younger self often does become depressed by seeing the growing mismatch between who they are and who they want to be and having a life that no longer really supports who they are. Studies of those who have broken the century mark show that they all have only one thing in common, a sense of optimism and looking forward rather than a sense of regret and dwelling in the past.

When lecturing about basic aging theory, I have a five box model which lays out these ideas in graphic form – I can see students and residents have that same aha moment I had as they get this basic concept. I published it eons ago in a book chapter I did back in my UC Davis days but no one has ever picked it up and named it the Duxbury model of aging or anything. I suppose not enough people are reading obscure titles on health and wellness published in the mid 90s. Where did I learn it? From my mother. She taught junior college sciences from the time I was in middle school until her retirement and, amongst her many routine courses, was basic biology. I remember her grading papers at the kitchen table when I was in high school with Helene Curtis’s biology text at her elbow and talking to her about the ideas she was looking for in essay answers and niche theory was nearly always on the test. I guess I absorbed it and it came out again years later in a somewhat different way.

I’ll talk a lot more about dementia later; it’s much too complex a subject to dispense with in a paragraph or two but I want to dispense with a basic definition. Dementia is a syndrome, a collection of signs and symptoms, not a disease. It’s the syndrome that presents in an adult when a previously functional brain stops working in the way it used to when that individual was a younger adult. There are hundreds of possible causes of dementia, a whole panapoly of diseases. The most common is Alzheimer’s disease. It is a specific disease process that creates easily identifiable physical changes to the brain but these changes are microscopic and not easily observed in a living person, although newer scanning techniques are starting to change that. We tend to, in society, use Alzheimer’s and dementia interchangably but they are not. Alzheimer’s is a specific subset of the dementing illnesses. It’s probably not a single disease; it’s probably a number of different processes with common final pathways leading to similar pathologic brain changes. We’re just not smart enough yet to separate them all out from each other or understand them as different entities.

People with dementia do get depressed. Sometimes they have difficulty accpeting or adjusting to the inevitable change and regret lost funciton. This can be treated medically and, in early stages with psychotherapy. It’s not inevitable. I know plenty of very demented people who have been serenely unaware of their own declines and perfectly happy through the process. We don’t know why some people get depressed and some don’t. I have a feeling personality structure plays a role, as does heredity and individual neurochemistry. Some people develop change in the frontal lobe that keeps them from self initiating. They don’t do. They can take care of themselves and their body but they lose all interest in formerly pleasurable activities and just sit on the couch doing plenty of nothing. Families usually interpret this as depression, but it’s not and usually not amenable to antidepressant treatment. Adjustments usually have to be made but not by the patients as much as by their loved ones.

In general keeping people looking forward, keeping their sense of adult self and dignity intact as much as possible, and slowly helping them change their lives to keep them in line with their abilities does more to prevent and alleviate depression with dementia than anything in pill form. The pills are occasionally necessary. They can help prevent friction in family life as much as they help the individual and when a demented person is at home, you have to treat the family as a unit, not the individual in isolation. And this is where Covid 19 comes in and why I am both angered and saddened by the yahoos bound and determined to open society up before we have a good handle on the virus. It’s placing barriers between elders and their family members for fear of infecting a vulnerable person. Baby time with grandchildren and great granchildren (especially valuable for demented elderly women) is restricted. Family that would meet and eat together for Sunday dinner now drop off a bag of groceries on the front porch and go. Older people who fall ill and must be admitted to the hospital are forbidden visitors and become delirious with no recognized faces or comforting presence. Those whose needs are beyond what a family can provide and live in a facility don’t necessarily understand why no one comes to see them anymore or, if they do, realize that a FaceTime chat isn’t the same as a hug and a healing touch. Instead, they’re locked down with underpaid and overworked staff who love their charges but who simply don’t have the resources to help them maintain good mental health and those with a dementing process already in place are likely to sink deeper more quickly. So think about the men and women who won World War II who are still with us. They’re mainly over the age of 93 but they’re still around and weigh your wish for dinner at Applebee’s against what it may cost them.

I’m still staying in.

May 9, 2020

Maske-erade – every face a different shade

It’s mother’s day weekend, I’m two months into my socially isolated life, and still the number of cases of Covid 19 continue to grow. I use the Johns Hopikins Corona Virus Counter to keep track of the numbers and trends world wide. We’re at about 1.3 million cases in the US, Alabama is going to crack the 10,000 mark tomorrow and the national curves show little signs of flattening outside of the states hit badly early on that responded aggressively: New York, California, Washington. In most of the rest of the country, exponential growth continues on its merry way.

With things showing little signs of slacking off, our brilliant governor has jumped on the conservative Southern governor band wagon of ‘lets open everything up again’ starting this weekend. Friends of mine are describing ‘hooray we’re out of lockdown’ parties in suburban cul de sacs, traffic has picked up, there were lines outside of the mall waiting to get in right at the stroke of 9 am. I am personally in need of a washer and dryer for the new condo but when I went past Lowe’s and saw the crowd, I decided to wait for a midweek afternoon. I did do my every three week grocery shopping today but the local Piggly Wiggly is enforcing masks and is nowhere near as crowded as the Publix so it was a relatively quick and painless experience.

With the media full of propoganda about ‘it’s not so bad and everyone back to work’ that’s coming straight from the top, I’m just waiting to see what happens in two to three weeks. We’ve been very lucky locally to not overwhelm the health system and we’re just now developing some breathing room. That could all come crashing down again shortly. The amount of societal arrogance on display over the couse of the last few weeks from those who should know better would be tossed out of a Hollywood writers’ room as too far fetched. Perhaps we deserve every single thing we’re going to get. I had an imaginary conversation with Tommy and Steve over these issues as I had my dinner tonight. In my head, Tommy was arguing that what we’re seeing are simple extensions of the nastiness that has always existed in American culture. Steve was busy planning a counter demonstration to the next right wing ‘open up’ rally complete with a parade float, Earth Wind and Fire on the PA system, and a socially distanced kick line of aging Act Up members.

Out of curiosity, I downloaded all the entries in Andy’s accidental plague diaries and found they amount to roughly 30,000 words so far. That’s half a book. If I keep at this, I may have a book by the Fourth of July. It isn’t the one I started to write last year but sometimes life makes funny turns. A lot of the material I had been digesting for my book on Baby Boomer aging has made its way into these long posts, just with a somewhat different emphasis. I remain open to suggestions on topics related to aging, health policy, the interaction of the pandemic with the health system, and all the Ds of growing old: debility, depression, dementia, dissipation. I’m thinking I need to do a discussion of iatrogenic disease in the not too distant future (diseases caused by doctors and the health care system) as we’re likely to see a bunch more of these if Covid cases spike again and people start grasping at straws. (Hydroxychloroquine anyone? Multiple studies now suggesting it is not helpful at best, and dangerous at worst). I also really haven’t tackled dementia yet even though it’s sort of my specialty. (I am well known at UAB as being one of the few doctors that knows how to communicate effectively with the demented and the downright crazy. What that says about me, I don’t know.)

Not to change the subject or anything, but I have been a little productive. Still working on moving things. Slowly but surely the discards are being removed from the house. With the studio empty, I have somewhere to put them. My out of work actor packers are coming on Monday to pack things like the books and the art and the DVD collection – easy to box and won’t be needed for a while. I spent my Thursday evening on a video project involving most of the music-theater types in town, repetitively singing the Bass 2 part of an eight part arrangement to a prerecorded track and filming myself so that I can be mixed in with forty others by genius sound engineer Joe Zellner. Take after take ended up with my filming myself cursing my latest mistake but I eventually got a couple that would do and sent them in. It was a healthy reminder that I am strictly a character singer and that I should never be allowed to sing a cappella in public. Tomorrow I have to finish up my notes for the week. My volume of visits in clinic is nearly back to pre-Covid levels. Of course the visits are telephonic but they still require the same sort of documentation that takes hours of my fime.

Mom and Dad together

Tomorrow is Mother’s Day, the first without my mother. She ceased to understand or care about such things a number of years ago as her dementia advanced but she was still here and I could think about her when the weekend rolled around. My birthday usually coincides with Mother’s Day weekend (it’s the day after this year) so there were usually dual celebrations in mid May when I was growing up. In a different life, the clan would have gathered in Seattle a couple of weeks ago for her memorial service and we could have all been together and swapped stories of the remarkable woman that was Alison Beatrix Saunders Duxbury. Her keen intelligence, her love of language, her use of the cutting word that could put Dorothy Parker to shame, her affinity for the natural world. But it was not to be. We may be able to do something as a family later in the year but we’re getting too distant from her passing for a public memorial to have the same meaning. As international travel is out for the forseeable future and as I am in need of some time off, having not had a vacation since last Thanksgiving, I may work out a way to go to Seattle sometime this fall. I figure they’ll have gotten air travel figured out by then. Or I could drive… I’ll just have to allow an extra nine days for that round trip. But that is a challenge for another day.

Be safe, be well, be happy, call your mother…

May 6, 2020

Tiger King’s Joe Exotic

he hour grows later, I’m finally getting around to the sideshow of human comedy known as ‘Tiger King’ on Netflix (which is very definitely one of those ‘only in America ‘ subjects. I’ll have to admit this car crash of humanity is somewhat hard to turn away from but I can only stomach one episode at a time. There’s only so much human effluvia I can process at any one time). I spelled myself by binging the new series Hollywood this past weekend, which started out promisingly enough as a sort of dramatized Hollywood Babylon but was undone by some weak casting of pretty faces with minimal talent and a finale episode that just ended up making me mad as it basically discounted the years of pain endured by various minorities in the Hollywood Dream Factory for a pat happy ending that wasn’t earned by the story. MNM generally doesn’t review television, but I might have to make an exception for that one.

It can’t be all Covid 19 all the time even though sometimes it seems to become all consuming, not just to me but to all of us. There is still art and music and sunshine and small children at play and pets and good food. We can’t necessarily enjoy them in the way our culture has socialized us to believe is proper, but human society is infinitely malleable. People have thrived and lived and laughed and loved everywhere from the depths of the Sahara to the frozen tundra of Lapland. We’ve developed ways of being shaped by local environments – geographic, climatic, and microbial. We’ve made it through other plagues and we’ll make it through this one. People misunderstand the theory of evolution and the survival of the fittest. The fittest isn’t the strongest, the biggest, the richest, the smartest. The fittest is the most adaptable to the change that is inevitable in any living system. We like to think of our lives as static but they’re full of change all the time. I was born the year of the Cuban Missle Crisis and when I see dramatizations of that era, it looks as foreign as an 18th century costume drama. The changes just usually happen slowly enough for us to take them in stride. This one has been so fast and so wrenching, that we’re all still in a state of shock and trying to process just what has happened and where we are.

The numbers of cases of corona virus continue to climb steadily which, of course, means that the powers that be are working steadily to end the one weapon we have to combat a pandemic of this type, isolation. It’s pretty clear to me that those who run our society, nearly all of whom are unelected and not accountable to the public in any way, have come to the conclusion on their conference calls that the populations that will be hardest hit are expendable and the dead in more important (to them) populations, will be unfortunate collateral damage – the butcher’s bill that must be paid at the end of the day. The complete rolling over of government institutions to this philosophy is, to me, a betrayal of the most basic of reasons for government to exist, the protection of the citizenry and I am afraid that as time goes on and the death toll continues to mount (and every single one of us will lose someone at current trends), the strain between the will of the populace and the will of the power brokers may lead to some very unexpected effects. Add to that a society full of Veruca Salts who seem to have no concept of delayed gratification.

Rehearsal for Cabaret – January 2020 – four months and a lifetime ago

The Birmingham music theater types, knowing that performing live is out for a while, are all in communication with each other and working out alternate ways of being and sharing. We’re working on a group choral number each singing our own part at home and the combining the videos. There’s talk of remote readings, remote cabaret entertainments, remote drag tutorials. There was an extremely sobering webinar yesterday put on by the National Association of Teachers of Singing, the American Choral Directors Association, and other musical groups looking at what is known about viral spread and singing. The news isn’t good. There is no safe way to sing with other people without risking significant spread between performers and even to audience as the very act of singing creates the aerosolized droplets that the virus hitches a ride on . Wind and brass instruments do the same thing. A world without group singing – no opera, no musicals, no national anthem at the ball game, no marching band at half time, no hymns at church. It seems pretty bleak. I tend to be an Eyore by nature but in this particular case I’m going to trust to human ingenuity that someone, somewhere is going to solve these issues medically or artistically or stylistically in some way. In the meantime, I am so sorry for all of my friends who perform, especially the professionals. An opera singer is the equivalent of an Olympic athlete, stretching the abilities of the body to the nth degree in service of culture and humanity. What do we do to support them if they cannot practice the craft they have dedicated their lives to perfecting? How can we, as a society, support them – especially as we live in a society that tends to denigrate the artist in general as effete at best and parasitical and destructive at worst. I’m going to miss performing myself. It has become a huge piece of who I am these days, giving me a way to process my life experiences in service of a greater goal. Rehearsals are my social life. Without them, I’m just an aging queen home alone with equally aging cats and my thoughts. Well, if I never do perform again, at least I went out on top. My four roles in the 2019-20 season – Mr. Pendleton in Choir Boy, the Ansager in Politically Incorrecct Cabaret, Will Dearth in Dear Brutus, and Herr Schultz in Cabaret were among the best opportunities I have ever had and I will forever be grateful for this period in my life. I proved to myself that I’ve still got it and I think I surprised a few people who are only used to me in small character roles as well.

The move creeps on. Each step delayed and complicated by issues brought on by Covid 19. Progress is being made. Tommy’s wig studio was packed up by Red Mountain Theater Company and taken to storage where it will be kept until their new performance venue is ready for furnishing, and then it will be the basis of their wig department. This gives me an empty space so I can start getting the discards with useful life out of the house. I’ve pretty much decided which furniture is going and which is not. Now I’m going through closets. I have two major projects left in the sort – the kitchen and the basement which I saved for last as I’m not looking forward to that process in the least. In my more maudlin and dramatic moments here alone at night, I envision myself ensconced in the new place and, as the sun sets, closing all the windows and shutting myself in like Lavinia at the end of Mourning Becomes Electra, alone with my dead and waiting for the end. And then I think, no, life goes on. I’ll get the new place set up and, assuming I’m not terribly unlucky genetically, I’ll pass the test of Covid 19 eventually along with the rest of society and there will be music and laughter and parties and friends. You’ve got to hang on to something.

Stay safe, stay well, wash your hands, and remember social isolation isn’t about you, it’s about others and being a good citizen.

May 2, 2020

Michigan protestors showing Blue Lives matter

I’ve been looking at the photos of various protests of lockdown orders happening around the country, from waves of people looking like they’re about to storm the beaches of Orange County to angry yahoos overly armed marching on the Michigan capitol building and trying to figure out the various motivations behind these ‘spontaneous’ actions. It’s pretty clear that big money from the usual ‘conservative’ sources is ginning them up and providing logistical support and communications infrastructure. Most of these demonstrations aren’t terribly large when you consider the population as a whole and are being amplified by a media eager for something to provide content and sensationalism and ratings.

Personally, I stopped watching televised news and information programming years ago. Between the rise of Fox and the sale of CNN to Time Warner with it’s transformation from a legitimate journalistic enterprise to infotainment,there’s no cogent analysis or impartial drilling down to facts any more. It’s all dumbed down to some sort of hyperpartisan sports competition cast in terms of which side is winning and it’s not very helpful in understanding what’s going on. Not to mention the sensationalistic punditry that’s designed specifically to engage a viewers emotions. My first prescription for older people with high blood pressure for years is to limit themselves to one half hour newscast of choice daily. That’s enough to keep you up to date. Everything else if filler and is just going to raise your catecholamine levels. Those who actually listen to that advice, a distinct minority, often don’t need further pharmaceutical intervention.

The militia type folks parading around with their AK-47s aren’t especially scary to me, just sad. I see a lot of young men raised on a media image that a major societal transformation would resemble a combination of Mad Max, The Walking Dead, and Fallout Video Games. What did they get instead? People staying home, bonding with their families, working on their gardens, and learning home baking techniques. I think they’re having a major cognitive disconnect. If it ever comes down to shooting (which it probably will somewhere at some point), it’s going to go about as well for them as the second act of Les Miserables when they go up against trained military and law enforcement. I doubt any of the provocateurs has given much thought to such things as intel and logistics.

Ambulances lined up outside a Florida senior living community

The much scarier thought to me than untrained hobbyists with assault weapons is the quiet agenda that seems to be playing out at the highest levels of the government and business communiities, the one that seems to have decided that certain classes of people are expendable for the greater good. It’s the sort of thinking we’ve seen before in other societies and even our own (HIV anyone?), Moves are being put in place to hide what’s going on in senior living communities in Florida, in midwest agricultural plants staffed mainly by immigrants, in communities of color in large cities, in the homeless population. It’s a very slippery slope and very easy to begin casting that net wider and wider, especially if there’s positive reinforcement. What do I mean my that? Fewer nursing home residents means fewer Medicaid long term care dollars are needed relieving strained state budgets. A need to keep essential businesses open gives an opportunity to reduce ‘bureacracy’, in terms of worker safety protections, environmental regulations, and allows for union busting. A shrinking of ‘problem’ communities reduces a demand for social services. There’s a word for the merging of the needs of the state with the needs of the business elite, one that encompasses the use of symbols of patriotism, and holds up an idyllic and virtuous people as clean, while those that are ‘other’ are classified as diseased, and it’s not a pretty one.

No matter what the gestalt of the moment is, the virus isn’t beaten. It’s not going away, and it’s continuing to spread. Lockdowns have slowed things but until there’s widespread testing, an effective medical regimen, or a vaccine, there’s no other real weapon against it. We can give them up and try to return to a semblance of normal but doing so will kill a lot of people. What I suspect will happen is we will open up some, more people will die, but we’re just not going to hear much about it. The majority of those who do die will not be reported on by the media who, on a corporate level, have the same vested interest in opening things back up as every other big business. Personally, I’ll keep going to work – it’s my ethical and moral responsibility and I will follow the directives of my employers on staff and patient safety. They have made prudent decisions so far and I trust them to continue doing that. Other than that, even though I’m as ready to bust out of here as everyone else, I’ll continue to stay home. I have books to read, Netflix to binge, jigsaw puzzles to do, walks to take, food to eat, and I’m still trying to move over the course of the next month while using appropriate sanitation and social distancing.

Be safe, be well, wash y’alls hands

April 28, 2020

The Vietnam Memorial Wall – 58,220 dead – US Covid 19 Deaths through 4/28/20 – 58,335 dead

The accidental plague diaries need to go tangential tonight, not because Covid 19 has been beaten, or even been beaten back much (despite politicians hankering for everything to open up). The US cases broke one million today and the number of dead broke 58,000, essentially exactly the same as the number of Vietnam War casualties. It’s for selfish reasons. When my emotions go into turmoil, long term readers know I start writing stream of conciousness in order to process and those who are interested come along for the ride and those who aren’t stop reading and keep scrolling to the next cat video or political meme.

I know what the cause is this time around. It’s not work stress (although there’s plenty of that), It’s not isolation cabin fever (going to work regularly has helped keep that from settling in). It’s the date. Two years ago today, in the wee hours of the morning, I got one of those phone calls you don’t want to get. Tommy, who had been finally beginning to recover from serious heart problems after six weeks in the hospital, unexpectedly died in the night. I had steeled myself for the possibility of his death over the preceding weeks given the seriousness of his previously undiagnosed heart issues, but he fought back valiantly, full of plans for the future. The last time I saw him alive, he was making notes on wigs for Beauty and the Beast which was coming up that June. I hadn’t expected it that night, thinking that if he was going to die, that there would be a steady downhill course and time to prepare. It was not to be.

So, April 28th is now to me, a day of unrealness, of having to tell his family, of quickly having to make funeral and burial arrangements, and of having to begin contemplating aging alone, rather than with a loving, enthusiastic, exasperating and unconventional partner in crime. I know the date will lose it’s meaning eventually from experience. I always remember Steve’s birthday and our anniversary when they roll around every year, but I often don’t remember his death day until several days after it’s past. It’s lost its meaning with time as his illness and death recedes in my mind in favor of our years of heatlh and adventure. i know the same thing will happen with Tommy with time; it’s just a little too early.

I think this was my 7th weekend in isolation. It followed the same pattern as most of the others. Catching up on work undone from the week. Doing some writing. A couple of long walks through the neighborhood. A little more sorting of decades worth of accumulated possessions in preparation for the move. I did add a couple of constructive moments to the usual – getting together with Holly McClendon who’s acting as my moving coordinator (I can take no time off from work prior to June for various reasons so someone else has to deal with all the little niggling details) and having Debbie Wiatrak take a look at the new space together with her artistic daughter and giving me some ideas on colors. I think I’ve made final selections. Bolder than the pastels in this house, but not quite as wild as the range of colors Tommy chose for the old one. I have to come up with a name for the new place. I’ve named all my houses. The first thing that came to mind was Covid Corners but I’m not sure that’s the best idea.

The Sondheim 90th Birthday Virtual Celebration

I watched the on line Sondheim 90th birthday concert last evening. I had tried to watch it on Sunday but the technical glitches that led to the delay in broadcast meant that I fell asleep about the time it started so I had to wait until Monday after work. Such electronic gatherings may be the future of theater in the short term. I hope not because so much of theater depends on the connection between performer and audience and you just don’t get that in an electronic medium (and why I really don’t like watching theatrical performance on film – it always feels like something is missing.) It was worth the delay and I’m glad I was able to see it. Sondheim’s music has been so much the soundtrack of my entire adult life that any celebration, or new interpretation of the canon always brings me joy. But it was mixed with sorrow, especially Brandon Uranowitz’s performance of ‘With So Little To Be Sure Of’. It’s a song that’s always been dear to my heart and one that always come to mind when I think of my losses. To hear it performed so well when I was preparing myself emotionally for the anniversary of Tommy’s passing hit me and I must confess I cried for a couple of minutes. But the song also applies to this entire moment we’re all going through: “Crazy business this, this life we live in. Can’t complain about the time we’re given. With so little to be sure of in this world…”

I, of course, am not the only person to lose a loved one. There’s a lot of that going around at the moment. Each unique individual loss, whether its Covid or something more mundane, leaves a hole in the tapestry of life and the edges start to unravel. Only a combination of time and other people knit it back up. We all have time at the moment but there’s a dearth of other people. It took a small army of friends, family , and colleagues to get me through my losses with dinners, coffee dates, phone calls, post rehearsal chats, and all the rest of that and I feel so for those who lose someone at this moment of history who can’t draw on those resources in the same way. No gathering at a wake or funeral to share memories and tell outrageous stories, no losing oneself in a crowd reminding oneself that life goes on, no getting down and playing with groups of children as a reminder of the cycles and continuity of the process of life. If you have lost someone recently or know someone who has, my heart goes out.

I’ll try to go back to something a bit more health and science related in the next entry but I needed to get some of this off my brain. If anyone has a particular subject you’d like me to explore, let me know.

In the meantime, be well, be safe, wash your hands.

April 25, 2020

My handy Corona Virus counter shows we’re closing in on three million cases world wide (doubtless a huge undercount for both political and logistical reasons), one million cases in the USA and just over six thousand cases here in Alabama. The greater Birmingham area remains relatively virus free due to the local population continuing to adhere to social distancing requirements. The state hotspots are Mobile (likely due to proximity to New Orleans) and the Georgia/Alabama border area around Auburn. I have no need to travel to either of those places. I haven’t been much of anywere other than work in the last six and a half weeks. I’m still working on the same tank of gas I put in the car in early March.

There is still a population out there who want to believe, mainly for idealogical reasons, that Covid 19 is no worse than the flu and isn’t worth all the fuss. As a point of comparison, we are currently at just over 51,000 death in the US from the disease (again, likely an undercount due to inconsistent reporting methodologies and spotty testing) and, at current trends, will hit 60,000 by the middle of next week. This means the disease will have killed more Americans in eight weeks than were killed in eight years of misadventure in the Vietnam War. Every one of those deaths was someone’s child, someone’s parent, someone’s colleague, someone’s friend. The ripple effects are going to be enormous and long lasting as we’re still in an upward trajectory.

Some are advocating opening up and herd immunity. Herd immunity happens when enough of a susceptible population is immune to a disease process so that a communicable disease cannot get established and transmitted. It’s what protects the small portion of the population that cannot be vaccinated for medical reasons from common infectious diseases. Enough people are vaccinated to keep it from ever reaching those vulnerable ones. Herd immunity has been studied and is one of the more basic concepts in epidemiology. It is easy to calculate, based on a simple formula which depends on the transmissability of the disease. In simplest form, if an infected person is capable of transmitting the disease to two people, 1/2 or 50% of the population must be immune to achieve herd immunity. If it’s three people, 2/3 or 67%, four people, 3/4 or 75%. The more transmissable, the higher the percentage must be. The transmissability of Covid 19 is hotly debated and is somewhere between 2.2 and 5.7 meaning between 55% and 82% of the population must be immune to achieve herd immunity. In the US, with a population of roughly 320 million, that’s between 172 million and 256 million infections that need to happen. How many excess deaths would that cause? It’s unclear as there seem to be significant numbers of subclinical cases – people who have the disease but never know it. The percentage of asymptomatic cases is unknown and spot studies have shown everything from 5 to 80% which is too wide a spread to be of much use. What is clearer is the mortality rate for symptomatic cases which seems to be about 3.5%. This leaves us with a low of 35 million to a high of 243 million clinical cases to achieve herd immunity and 1,170,000 to 8,270,000 deaths.

It may or may not be possible to save those individuals but the longer we can delay their becoming ill through social distancing and flattening the curve, the greater the chance of developing a vaccine or coming up with medications which, if not cure, can at least lessen the damage the disease causes. Then there are the issues of the health system. It cannot cope with tens of millions of cases at once but it can begin to cope with lower numbers over a longer period of time. We’ve been relatively blessed in Alabama with not a lot of our health care workers becoming ill and stocks of PPE lasting. That’s not true for the country as a whole. I saw somewhere that it’s estimated that 10,000 US health care workers have caught the disease on the job to date. By contrast, in forty years of HIV care, fewer than fifty US health care workers have contracted that disease on the job.

Reopen Rally – Madison Wisconsin – April 24, 2020

I see the crowds rallying at statehouses, riled up by politicans and economic forces that do not have their best interests at heart and I don’t understand. We all want it to be like it was. I miss getting together with friends, having rehearsal, going out to dinner but I know that as a responsible citizen and member of society, not to mention a health professional caring for a very vulnerable population, that that has to be put on hold for a while. Even if lock down orders are lifted, it’s not going to go back to 2019 behavior patterns the next day. People have learned a lot these last few weeks and are going to be much more cautious in their choices. They’re going to have the freedom to not do things as well as to do things and the economy is going to remain in trouble, driven as it is by consumer spending. There is no way to get through this process without economic disruption whether that’s by shutting things down or by doing nothing and letting a significant portion of the population suffer and die all at once bringing down the health system with it (and the health system is nearing 18% of GDP). And, quite frankly, if those are the choices, I’m happy to take the former.

If no vaccine is found, ultimately we’re all going to be tested by fire and get Covid just as our ancestors all got small pox. The majority of us will survive, life, society and civilization will go on, just different. How different? I don’t know. There are tantalizing clues in studing the pandemics of the past and their effect on society (The plague of Justinian effectively ending the Roman Empire in the west and leading to the development of Byzantine society, the black death of Medieval Europe allowing for the Renaissance, Reformation and modern world, even the Spanish Flu effectively helping end World War I). Unfortunately, I left my crystal ball in an old handbag at the left luggage counter of Victoria Station some years ago so my prognostication abilities for the current pandemic are, shall we say, limited.

Be safe, be well, wash your hands.