There’s another thunderstorm rolling into town with lighting on the horizon which is starting to flash through my bedroom window. It seems apropos at the start of a weekend which is likely to be defined as the one in which the state of Alabama finally woke up to the realities of the Delta variant. Those of us who have been paying attention for the last month have been watching the numbers and the trends with some alarm all month but the general population has been blithely conducting its usual business in a serene optimism that pandemic dangers are past. Over the last few days, the news has become too major to ignore and in both public and private spheres, folk have woken up to the fact that we’re in for a wild ride.

What’s happened? The rolling seven day average of Covid cases in Alabama, which were at about 200 a day at the first of the month is now ten times that with a positivity rate pushing 20%. (Per WHO pandemic guidelines – positivity rates (the percentage of positive tests for pandemic illness) should be under 5% to be able to lower mitigation measures and those over 10% should be treated as panic stations). The number of hospitalized in Alabama is also up ten fold over the course of the month with more rolling in every hour. The rate of new diagnoses is shooting up in a steeper curve than even during the worse of this past winter’s surge. Delta is playing around. It’s R0 (the number of people a carrier is able to infect) is much higher than original strains of Covid. Where that was between 2 and 3, Delta is somewhere between 5 and 10. That doesn’t seem like much difference until you realize we’re dealing with exponential math. A disease with an R0 of 2.5 will spread to about 100 people after six iterations. A disease with an R0 of 7.5 will spread to nearly 25,000 people in the same six iterations.

There are hysterical headlines appearing regularly ‘Vaccines not as effective as thought’. ‘Vaccinated can spread the virus as easily as the unvaccinated’. When you look closely at this material, much of which is from non-journalistic and science sources, you find that much of what is written is misrepresenting the actual data on which the sensationalism is based so I’m going to try and take a minute to parse out what we really know about the Delta variant at this time. Mind you, much of what we know is somewhat sketchy as it’s not been around that long. Some of this comes from studies done in India, where the mutation that caused the variant originally arose. Some of this comes from studies done in the UK which had the Delta variant earlier than most Western countries due to its cultural/travel links with India. Some of this comes from study of a cluster outbreak of Delta variant stemming from the traditional gathering of gay men in Provincetown, Massachusetts over the 4th of July weekend which led to a significant spreading among a crowd of healthy and fully vaccinated folk who likely spent a good deal of their time on the dance floor.

-The Delta variant is not a new disease. It is a mutation of the coronavirus which causes covid-19 into a form that is more easily transmissible. There is some evidence that it may also be more virulent and cause worse disease.

-The vaccines administered so far have been effective. They are not 100% proof against a breakthrough infection (somewhere around 10% of vaccinated people can develop disease if exposed). However, vaccinated people have had much milder diseases. In the Provincetown cluster mentioned above, more than 1,000 cases were identified. Fewer than 20 required hospitalization (usually short term) and no one to date has died.

-It is not known if a third booster vaccine would improve immunity against the Delta variant. There are no recommendations for this at this time and the federal system which pays for vaccines will not authorize administration of a third vaccine at this time. The original cohort of people who volunteered to be guinea pigs for the vaccine a year ago are being studied and we may know more about this from their data in a few months.

– It appears that some (but not all) people with breakthrough infections can transmit the virus to others. For this reason, the CDC is again recommending indoor masking for the vaccinated. This is a new finding which is why the CDC is changing its advice from a few months ago. Science constantly updates itself with new empirical evidence. When the CDC changes guidelines, it’s not because its being inconsistent, it’s because it’s learning new things about the virus and is trying to help us adapt.

-Unvaccinated people are highly vulnerable to the Delta variant. It takes roughly 6-8 weeks from initiation of vaccination to achieve full vaccination status with Pfizer or Moderna so the time to get vaccinated is now, not next week. The hospitalization rates are skyrocketing due to the large percentages of unvaccinated and therefore vulnerable people and the infectiousness of Delta.

-The best weapons we have against Delta are the ones we have always had. Wash your hands. Keep your distance when you can. Mask up (again) when indoors with those you don’t know. It’s a piece of cloth, not barbed wire or chainmail. Masks work, but only when we all wear masks.

-No, I don’t think we need to go into lockdown. The vaccines are effective, the majority of those most vulnerable to the virus have been vaccinated. We just need to exercise common sense. Those who have regular contact with vulnerable adults such as those working in health care need to be vaccinated if they have not been already. It’s not about you, it’s about the people you care for. Vaccine mandates are coming and will really increase once the FDA moves vaccines from emergency use to approved status.

-Studies of vaccination of children under 12 are ongoing. We may have results in a few months but not before the start of the school year. Universal masking in schools is a good idea, no matter what your political leanings. While there are lots of news stories about children’s hospitals filling up, children, as a whole do not remain at major risk for serious disease. If you have children too young for vaccination, the best thing to do to protect them is to ensure that all family members and close contacts 12 and over are vaccinated.

It still remains to be seen what’s going to happen to the mortality statistics. The health system has gotten much better at treating the disease than it was a year and a half ago and the people succumbing currently, in the unvaccinated population, tend to be younger and physiologically healthier. The mortality rate may not skyrocket the way the case rate is currently doing but we’re going to have to wait a few weeks to find out. I don’t wish ill on anyone but I also don’t understand those who have refused to take a few simple steps to protect themselves from a deadly disease.

My favorite story about exponential math is one I remember from an elementary school textbook, one I likely had in fifth or sixth grade. In it, they described a legend connected with the invention of chess. Apparently, the Sultan of some unnamed kingdom was so impressed with the game that he invited the inventor to his palace and asked him what he would like as a reward. The inventor replied that he asked for very little, just some grains of rice. One grain of wheat for the first square, two grains of wheat for the second square, four grains of wheat for the third square, eight grains of wheat for the fourth square and so on, doubling with each square. The Sultan took the inventor for a fool, cried ‘Done’ and asked for a bag of wheat to be brought. The Sultan, of course made the mistake of thinking that exponential math works like linear math when it does not. There are 64 squares on a chess board. Two to the 64th power is somewhere in the quintillions and would generate enough wheat to bury the entire state of California to a depth of five feet in wheat.

There aren’t that many people in the state of Alabama so, if the disease is that contagious, it will spread very, very rapidly through the susceptible population and likely burn itself out relatively quickly. This is more or less what happened in India. I just hope it manages to do so without crushing the health system and with a minimum of mortality and severe morbidity but we shall see what we shall see. In the meantime, you all know the drill. Get those masks back out and put them on indoors in public. Keep your distance. Wash your hands. Convince your loved ones to go get a vaccine NOW.

Covid’s bustin’ out all over. All over the ICU and morgue… I wish I didn’t have to say that but the numbers are soaring locally with Alabama having gone from a couple of hundred daily diagnoses at the beginning on the month to about 1,000 cases a day midmonth to about 32000 cases a day at the end of last week to nearly 3,000 cases a day this week. It’s the power of exponential numbers being manifest in real time. We’re back over 1,000 hospitalized patients statewide, a place we haven’t been at since February, just as the vaccinations were really beginning to gear up and things show no signs of letting up. I haven’t seen the numbers for UAB yet but all the pieces are moving to get the hospital ready for full scale inundation. Elective procedures are beginning to be postponed, drive through testing sites are being ramped back up, and the medicine services are limiting transfers in.

We remain behind the curve as the Delta variant didn’t really start spreading in Alabama until this month. Given the well known delays between diagnoses, hospitalization rates, and death rates, we won’t start to see a major crush on the hospitals for another week or two and the death rates will start going up beginning mid-August. To see where we’re going we just need to look at the Ozark area of Southern Missouri and Northern Arkansas. Delta arrived early via Memorial Day Weekend in Branson. Now, roughly eight weeks later, every hospital in the region is full. I have seen reports from physicians in the area that there are no ICU beds to be had in any of the surrounding states for desperately ill people, and they are significantly short staffed. The current surge is very different from the surges of 2020. Those were based in dense urban environments with large numbers of international travelers – New York, San Francisco, Los Angeles, Seattle. The current surge is hitting small town and rural areas where the infrastructure is nowhere near as robust.

When the numbers really begin to increase in Alabama next month, UAB and Birmingham will be OK. We have a strong medical infrastructure with a number of excellent hospitals. Rural Alabama, with its health care systems already weakened to the point of collapse by the political refusal of successive Republican administrations to take the Medicaid expansion, will not fare so well. I’m not sure that the smaller hospitals that serve a huge portion of the population are going to be able to survive the coming crisis. When they shut their doors due to lack of funds, lack of staff, a crush of patients they are ill equipped to handle, what comes next? When every ICU bed for a hundred miles is occupied by a Covid patient on a ventilator, what happens to the usual parade of heart attacks, strokes, traffic accidents, gunshot victims and all of the other things that arrive seeking acute care on a daily basis?

This is what infuriates me about the coordinated political push to undermine vaccines which has been conducted through certain media outlets since the change in administration. It’s not just about you and your personal choice. It’s about a health care system that was just beginning to recover from crisis that’s slipping back into it. It’s about the callous disregard for the toll that a preventable illness is going to exact not just on you but on the people who care for you, physically and emotionally. It’s about the denial of a more open life to the part of society that stepped up, washed their hands, masked up, social distanced, and got their vaccines – all tried and true public health measures – and whose hard work is being undone by people who somehow believe that viral illness works along partisan lines. Given the infectiousness of the Delta variant and the way exponential math works, it’s entirely possible that the vast majority of the 100 million or so American adults without vaccines will be exposed to it in the next two or three months. That’s another 500,000-1,500,000 unnecessary deaths that could be coming by the end of the year.

I’m tired of writing about Covid. I really am. It’s been over sixteen months now since the first entry in what became the Accidental Plague Diaries. I would love to write more about theater and travel and interesting people and reminiscences and art but every time I think I’m out, I get pulled back in again by a story that, as of yet, has no end. It seems to have become my place in life to chronicle all of this so that I and those of you who didn’t give up three paragraphs ago can continue to process the ongoing saga. So, I will continue to write. For those interested, I have seen the final page proofs of the book. It looks great. It goes to the publisher tonight for a test printing and, if that looks good, advance copies will follow shortly. A high proportion of Covidiots in my part of the world pretty much guarantees there will be enough material for a second book if I want to go through the agonies of putting it together – but that’s a decision for another day.

In the meantime – back to the litany. Wash your hands. Wear your mask indoors around people you don’t know. Social distance when you can. UAB is going back to indoor masking in all buildings unless in your own office. Get your vaccine. It’s not too late. A pharmacist friend told me that community demand is going back up (three vaccines a day last week, twenty vaccines a day this week) but there’s still plenty to be had.

I finished the fully edited manuscript of ‘The Accidental Plague Diaries’ at the end of May. The material covers the time from when I first started to write about Covid-19 and its societal impacts in March 2020 until January 2021 when a new administration came into power and shifted the calculus of our public health response. I had to cut the material somewhere and that seemed as good a choice as any. The last thing I wrote, over Memorial Day weekend, was an epilogue. At the time, thanks to a truly miraculous vaccine, case loads were plummeting and it looked like the pandemic would recede into the background of our lives. Less than two months later, we’re backsliding like crazy due to the spread of the Delta variant and resurgent political forces against public health precepts. Unfortunately, book publishing timelines are not well suited to rapidly developing current events so I’ve done the one thing I could do; I wrote a brief afterword which I will update routinely. I should have the proof copy end of this week, advance copies end of the month and then publication date will follow.

I keep hoping that I’m going to run out of things to write about that are at least tangential to Covid, but that hasn’t happened yet. The way things are going, I’ll have enough material for a full Volume Two by late fall. Whether I will go through the relatively maddening process of turning them into book form will depend entirely on what happens over the next couple of months. If the population of the US will start behaving rationally and doing a few basic common sense things, there will be no need. I am, however, not overly hopeful. The poison of misinformation has permeated the body politic too deeply to be gotten rid of easily. The end result is now 611,000 dead Americans with the numbers steadily climbing again.

In the last day or so, I have seen seen news reports from the UK on an anti-mask/anti-vaccine/anti-everything rally where one of the speakers was calling for the execution of physicians and nurses for advocating public health measures, from Israel on an anti-vaccine crowd laying siege to the new prime minister’s home, and Brazil where the president was threatening a military coup to keep his beliefs about the ‘harmlessness’ of Covid-19 firmly in place. It’s all a wakeup call to remind me that the pandemic is not a domestic, but a global problem and that the reactionary forces I see locally are not limited to Red States. Any place that allows the coronavirus to spread unchecked is going to serve as a reservoir for additional mutations and reinfections into the population as a whole. The vaccines seem to be holding the line. There are studies that suggest that they are not necessarily fully effective at keeping a vaccinated person from contracting a Delta infection, but the data available all suggests that a vaccinated person will not progress to the frightening complications that lead to hospitalization and death. Those, at this point, seem to be limited to the unvaccinated among us. (The few vaccinated who have succumbed to Delta infection all seem to have had serious underlying illnesses of various stripes – there have been almost no cases of healthy vaccinated people catching Delta and then becoming critically ill). I’m waiting for the data to come in as to whether a booster shot will be helpful. If it is suggested, I’ll be among the first in line.

I went to a fundraiser for a local theater company last night. Drinks, edible tidbits, some singing, and an art auction (I bought a lovely metal piece which will go on one of my terrace walls). The theater folk of Birmingham, starved for gatherings of the type, turned out en masse and several hundred folk were there. I wore a mask when not eating and drinking through most of the evening. I trust that most of the people there use good judgement but if we continue to mask indoors in crowded situations, even for a little while, we’ll be able to help break transmission chains while the authorities start figuring out the messaging necessary to get vaccination rates up.

It’s been very interesting to see what’s happening in Republican political circles over the last two weeks. During the spring when vaccinations were quickly reaching arms and case rates began to plummet, it became fashionable for them to decry public health measures as an over reaction or unnecessary burden on people. These ideas, amplified through their media machine, became loud enough and widespread enough to more or less level off the vaccination rates nationally over the last month, coinciding with the rise of Delta. That’s why we’re in the current fix we’re in. As it’s become increasingly clear that this attitude is directly harming the Republican base, a certain amount of internecine warfare has broken out in the party between the Republicans who understand that there’s a time when political rhetoric is destructive and Republicans who have lost the ability to stand for anything and can only stand against the prevailing attitudes of the day. I’m wondering what happens when the Republican base starts to figure out that they were put in harms way and allowed to sicken and die as so much collateral damage to allow their leaders to deny the Democratic administration ‘a win’ on vaccine delivery and ending the pandemic?

This afternoon I have a Spolin improvisation class with some of my favorite theater buddies. Small group of people who know that vaccines are their way back to doing what they love so I won’t mask for that. I’m trying to use good judgement without going overboard. I wash my hands, don’t squeeze up on other people if I don’t need to, where my mask where warranted, and I have my shots. That’s what we can all do as individuals for the good of society at present.

Fasten your seatbelts, it’s going to be a bumpy night goes the famous line. I have a feeling the bumps are going to be lasting a lot longer than tonight, or this week, or the next month. Humans changed their behavior again and the virus has been doing quietly what the virus does in the shadows the last few weeks and now we’re all waking up to the fact that it’s everywhere again. You all remember the pattern from last year. Behavior change leads to a rise in cases in two to three weeks and a spike in the death rates two to three weeks after that. Two weeks ago was a holiday weekend. Lots of opportunities for humans to gather so they did. Cases were relatively low, the Delta Variant was out there but rare, and so the Delta variant with its increased transmissibility took advantage of closer human contact to spread and then exponential math took over.

The Delta Variant is now 83% of total Covid cases in the US. Case numbers are rising in every state. The absolute numbers are still below where we were six or seven months ago but all the trends are wrong. Case positivity is back over 5% but a lot of testing sites have shut down so we don’t know if we’re getting an accurate read or not. State health departments are all over the map in getting their data to federal sources so it’s kind of hard to know what’s going on in real time but we’re back to adding nearly 100,000 cases a week. The death toll continues to mount slowly and we’ll have no problems surpassing the Civil War casualty figures in a couple of months at this rate. And half the adult population is either unvaccinated or under vaccinated – make that nearly three quarters of the adult population here in Alabama. It’s not like it’s difficult to find a vaccine these days. The times of searching on line every night and driving four counties over are long gone. Vials are going begging for willing arms. And it’s not like they haven’t been tried out in hundreds of millions of people. They may still be under emergency use authorization and ‘experimental’ but the safety record has been excellent and data is being submitted to the FDA and they are likely to receive full formal approval shortly.

I am beginning to lose my patience with those who are foregoing vaccines for political reasons or based on obviously disprovable misinformation. The message I am getting is that you have a fundamental lack of respect for others in society, most particularly those who go out on a limb routinely to see to your health and safety. The doctors, nurses and other carers are exhausted after this past year and a half and they’re gearing up to go back into hell again. A friend was involved in a traffic accident today and went to the UAB emergency room to be checked out. They were practically chased out as the whole place was swamped with new onset Covid patients. It’s no wonder that every doctor and nurse and therapist in my age group I speak to is considering their exit strategy and retirement. No human should be asked to bear this, especially when it’s completely unnecessary.

Rant over. Well, maybe not… I’m going to be on more than just a rant if I have to cancel my vacation plans again this year due to virus resurgence and a need to lock down and work towards flattening curves again. Grump. Grump. I’m also trying to figure out what to do about masking in the face of the rise of Delta. (Now doesn’t that sound like a really bad action movie with Jean-Claude Van Damme?) I mask at work when in clinical space as do all employees and patients as we may be around people who cannot be vaccinated for various medical reasons or whose immune systems cannot mount proper responses. I don’t mask when gathered with a small group of vaccinated friends. I don’t mask outdoors. Where I am stuck is going in to stores or other places where the general public gathers. Masking isn’t so much about yourself as it is to protect others. (People forget that). It works and works well when it is universal. If you’re the only person wearing one, it’s not so protective. With no further mandates in place, few are wearing them locally. Do I slip one on when heading into the Piggly Wiggly (I don’t mind) or do I just trust in my vaccinated status and my relatively good health to keep me from becoming too ill and isolate should I become symptomatic?

I’ve taken to writing my frustrations. Others in my family are much more visually inclined and create art. My sister, who has always been the artistic one, has made quite a career as an illustrator over the years, currently working predominantly in ink on human skin. (I’m referring to tattooing, not to some weird Ed Gein thing…) She did the cover art for the book which I will be revealing shortly. My father is a decent watercolorist and very clever with his hands having made many of our toys growing up. My nieces are both quite talented at drawing and graphic arts. My aunt became quite well known in the refined world of handmade papers and books after exploring Japanese woodblock techniques. The visual gene skipped me. When I pick up paint or colored pencils, the results tend to look like something a kindergartener left on the refrigerator. Tommy and Steve got the gay visual gene. They were both the kind of guys you could give some construction paper, a glue gun and some crepe streamers to and they’d emerge from the garage with a parade float after an hour. Not me. I did get the showtune gene and the brunch with too many mimosas gene though.

I did try my hand at visual arts once. In high school, we were required to have a year of visual arts to graduate. I took graphic arts my junior year. It encompassed basic drawing techniques, watercolor, various mixed media things, block printing, and the only thing that I was any good at, batik. (I still have a couple of my high school batik pieces hanging around). Our teacher was a wonderfully laid back guy with a droll sense of humor who was actually interested in what was going on in our adolescent heads. Teaching art was only one of his careers, on weekends, he was the minister for a Unitarian Universalist congregation in one of Seattle’s suburbs. He was my first introduction to UU (although he didn’t push it onto impressionable minds). I was raised Congregationalist, the most liberal of the Protestant Mainline denominations so UU wasn’t that far off from what I came from. I don’t think he thought much of my potential artistic talents (or lack thereof) although he was complimentary of my imagination and my liking to twist assignments in some interesting way. We got along quite well in general. I didn’t think that much about him or what he taught me for years after high school until a simple essay he wrote in his church job caught on in the 1990s and, all of a sudden was a poster on everyone’s wall. It was entitled ‘All I Needed to Know I Learned in Kindergarten’ and Robert Fulghum, my high school art teacher, became an international name. There’s a quote from that famous essay that I think we all need to remember at this particular moment in history while we forge our way ahead.

Share everything.

Play fair.

Don’t hit people.

Put things back where you found them.

Clean up your own mess.

Don’t take things that aren’t yours.

Say you’re sorry when you hurt somebody.

Wash your hands before you eat.

The news from Covidland is bleak. The numbers are trending up at rates not seen since the major surge last fall. The Ozarks are the canary in the coal mine, likely due to Memorial Day revelry in Branson, Missouri and environs and now, six or seven weeks later, the hospitals there are full, the death rates are spiking and they are as overwhelmed as they were six or eight months ago. There’s a difference this time around. Last year, there was a feeling of camaraderie and cooperation in health care and every one was running on adrenaline and a sense of mission and purpose. Then, this spring, through the miracle of vaccination, numbers came down, the pressure came off and exhausted health care workers took stock. Some retired, some transferred to less stressful jobs but the feeling was that the war, if not won, had at least moved into mop up operations. Then, antivaccine frenzy took hold and now, here we are.

We’re now no longer dealing with a race against time with a swiftly moving pandemic that’s gobsmacked us all upside the head. We’re now dealing with a totally preventable disease process that would be well on its way to control, at least on the domestic front had not a deliberate campaign of disinformation interrupted the flow of vaccine to the population, causing a lot of states to end up with less than half of their healthy adults protected. Add to this, a faster spreading Delta variant and we’re all off to the races again. Only this time, those falling ill are younger, have made a deliberate choice to set themselves up for infection and an exhausted health care system is running out of empathy.

I am not, at heart a conspiracy theorist. I know far too much about group dynamics to believe that evil cabals can secretly manipulate the world undetected. However, there must be some sort of political reason to explain why one of the two major political parties seems to be willing to tolerate the willful flaunting of the most basic public health precepts. All I can come up with is that a good deal of the current administration’s credibility rests on its proven ability to move rapidly to bring the pandemic under control. Therefore, if the pandemic surges again, with a little help from political rhetoric flouting the rather miraculous reduction of infection through vaccination, that serves to undercut the administration in power. I hate to think that one party is willing to sacrifice lives as so much collateral damage to one up the other party as I view that as ethically reprehensible, but our politics have become so screwy, I wouldn’t put it past the back room deal makers.

Locally, numbers are up about 50% over last week. Positivity rates of testing are surging. A number of acquaintances of my generation have fallen seriously ill despite being vaccinated (no one has died in that group yet but I know it’s coming eventually). Life goes on relatively normally. I’m not worried about myself but I am wondering what we’re going to have to do to keep us from going back to last winter. Full lockdowns are politically unpalatable. Do we go back to full mask mandate/social distancing rules? If the vaccines become fully approved (likely to happen within a month or two), do we start mandating them? Do we require vaccine passports for entry into public space? There are no easy answers. I’m being judicious with mask use, keeping my hands washed and staying somewhat distanced from populations of mixed vaccine status. What else can I do?

I went out on a limb last night. I was invited to be a storyteller at an event to benefit a local library system. It was a spoken word night with half a dozen storytellers and a few poets. I arrived, looked at the line up and my heart sank. I recognized more than a few names as folk with significant spoken word cred; the kind that I’ve heard on NPR and at poetry readings around town. What in the heck was I doing in that group? I’ve never been asked to do something like this before. I had rehearsed a couple of possible stories in my head but really had no idea what I was going to do. Fortunately, my slot was somewhat late on the bill and I had a chance to listen to some masters go first and got a sense of what was playing well to the audience. When it was my turn, I headed up front, grabbed the mic, thought to myself ‘well here goes nothing’ and entered the zone I go into when I do a public speech or am interviewed on television or the like. It’s hard to explain, but my usual brain gets tucked away in a little corner of my head and a whole different piece of my brain comes out and takes over and I just go along for the ride. I don’t know where it comes from or how it operates, but that piece of me is assured, rarely nervous, well spoken, and pretty nimble. Ten minutes later, I was done and then I fell apart inside and allowed myself to question every choice I had made and word I had spoken. I’ve never really been able to do stand up and I admire those who can because of the difficulty of balancing the humor, the audience expectation and the need to be honest to your material. I don’t get stage fright easily but I think I would in a comedy club. Tommy used to accuse me of always seeking a spotlight. I don’t think that’s true. I think when I let that piece of me come out (and I have to name him something. I just don’t know what…) he just knows how to communicate and the spotlight finds him.

A couple of people have suggested that I need to take some of my stories from work and my life and put them together in a Spalding Gray type monologue. I could probably write it but I’d have to find a director who could help make it into something besides my sitting there on a stool and talking into a mic for an hour and who would want to see that. Maybe someday. After the book is out. For various reasons, there has to be one more proof run on that and then we can get the advance copies run off and sent out. Hopefully before the end of the month. The general sale should begin in mid to late August. I’ll keep everyone apprised through my usual social media channels.

Right on schedule and completely unsurprisingly, the Delta variant of Covid is starting to spike in red states. There are now more cases of Covid in Arkansas than there were in July of 2020. New hot spots are emerging in Nevada, Louisiana, and Florida. The curve is shifting upward again at a steep pace. The relative numbers of cases remain low but it’s not going to stay that way with a more infectious strain and large unvaccinated populations in which it can easily run rampant. The number of deaths daily is back up in the 100s nationally, not on the scale of 2-3000 a day at the peak of the winter surge, but definitely going the wrong direction, especially as the individuals now heading to intensive care units and ultimately the morgue are tending to be in the 20-60 age group. (Those older have, for the most part, gotten their vaccines and are less likely to congregate in groups).

It’s become very clear from the data that we have separated into two distinct populations when it comes to public health – divided by politics into red and blue, for want of a better shorthand. Blue populations are much more likely to be vaccinated and in regions where they are dominant, the line against Covid is being held. Red populations are less likely to be vaccinated and are playing host to the vast majority (upwards of 95%) of new infections. Data out of Florida shows that case rates in red voting counties are double those in blue voting counties. We here in Alabama, currently in last place when it comes to percentage of the adult population who are fully vaccinated (not yet to 40%), can’t seem to get anyone out to vaccine centers so they have, for the most part shut down. There is plenty of vaccine to be had through commercial pharmacies and county health departments but no takers.

I’m just waiting for Delta to fully take hold. It’s here. It will happen. We could easily see local numbers similar to last year. I don’t know what to do about it and I think there’s very little I can do as an individual other than gentle encouragement on a one to one basis with patients (pretty much all my friends and acquaintances are vaccinated) and their families and patiently answer questions and try to dispel myths. But when a political party at its rallies and conventions has turned anti-vaccine rhetoric into applause lines, there’s not much else to do but hunker down and let them learn the hard way. If I was running a political party, I would not want to take positions that were likely to kill off my most ardent adherents, but that’s just me. What happens when numbers really start to take off in August? I don’t know, but I plan on being here continuing to observe and write and help us all muddle through this rather peculiar time in history. And if they do, a second volume of The Accidental Plague Diaries is pretty much a guarantee.

Do the completely different political realities of blue and red America devolve into civil war? I certainly hope not but I put nothing past the major mental health crisis the country seems to be going through. I think an actual shooting war would be difficult as the populations are so intermixed. There are blue and red states, but even in the red states, the cities and economic engines are blue and it would be very bad for business to round up all your educated city dwellers and run them out of town. The Khmer Rouge tried that in the 1970s and we all know how well that turned out. Perhaps we would go the way of 1980s Northern Ireland with blue and red neighborhoods with a sort of no mans land in between. I don’t think either side would stand for that as waste ground and barbed wire in the middle of your subdivision is bad for property values and likely against your HOA policies. I think we’re going to be stuck in a sort of mutual revulsion for a while longer until some sort of major existential threat forces us back together again. One would think a global pandemic would have done it, but obviously that’s not the case.

Today was definitely a Monday at work. No Covid, but a lot of significant mental health issues complicating family dynamics and patient care. Individuals have just reached their breaking point due to societal stress and brains awash in catecholamines and, when you add elder care responsibilities on top of all that, things are starting to go a bit haywire. The current elder generation, with their very long lives, don’t die rapidly. They decline slowly over years to decades and children, who take them in, thinking it’s going to be a year or two are feeling rundown after a decade or more with no end in site. Covid has made communal living for the elderly a less attractive option and hiring in home care, not a Medicare benefit, is prohibitively expensive for most. It’s going to get even worse over the next decade when you add in the denial of the realities of aging evidenced by the mind set of the aging baby boom. If I have day after work day like today marching into the future, I won’t be able to stick with it long term. I can absorb a lot with my empathic abilities but even I have my limits. My usual ten hour work day stretched to twelve and I arrived home with no energy to do much of anything other than feed the cats. The legal cases I am working on will have to wait.

I no longer think I have to end these posts with my litany of wash your hands, wear you mask, stay distant as only the first of these is really required if you’re fully vaccinated and moving among other vaccinated populations. That, however, may change as the variant spreads. There are more and more reported breakthrough cases of Covid infection in the fully vaccinated including some clusters. However, the vast majority are infections that can be treated at home and are not life threatening. Just use common sense out there. And if you have unvaccinated friends or family, gently urge them to begin the process now before things start to get hairy later this summer.

With ‘The Accidental Plague Diaries’ coming out in book form shortly, you’d think I could start writing about something other than Covid but the combinations of mother nature’s rules and human folly keep giving me more grist for the mill (and, the way things are going, a high likelihood of a volume 2 in another year). Here’s some statistics I’ve come across in the last few days. First, the number of global deaths has topped 4 million. The United States continues to tick up, not at the rate seen six months ago but still ever upwards: we’re at about 606,500. Second ,the cluster in Southern Missouri I alluded to earlier this week continues to explode with the local hospitals swamped and EMS runs happening frequently per local news sources. The deaths will spike in two to three more weeks per the usual patterns. Third, the percentage of Delta variant cases nationwide was running about 20% in mid June. It increased to 30% at the end of that month and now, just over a week later, it’s over 50%. Given it’s much more rapid transmissibility, it’ll be over 90% by the end of the month. Fourth, here in Jefferson county, the number of cases of Covid diagnosed doubled this week over last week. The number of people hospitalized at UAB with Covid has gone up five times from 5 to 25 in the past week. What do all of these cases have in common? Lack of vaccination. Somewhere between 94 and 99% of infections (depending on the study) now happen in the unvaccinated. If you’ve not been vaccinated yet, it’s not too late but remember it’s roughly six weeks from your first shot until you achieve full immunityand that may be a helluva gauntlet to have to run given what’s going on at the moment.

Am I worried about the Delta Variant? Not especially. I’ve been fully vaccinated for some time, tend to hang out with people who work in health care or who have careers that depend on Covid risks being reduced and who therefore lined up for a jab as soon as they were able. I have a small chance of contracting a breakthrough infection and a very, very small chance of that infection making me seriously ill. It passes my test of being less risky than getting in a car routinely (1/8400 chance of death this year) so I’m not going to dwell on it. I am slightly concerned about the Delta variant mutating again in an unvaccinated population to become even more virulent but I’m not going to borrow trouble. There is good news as well. A study out of Yale that was published today computed that vaccines have so far saved about 300,000 US lives and promise to continue saving many more.

As bad as the pandemic has been, on individuals, on the health system, on the economy, on our collective psyches, it could have been a lot worse. The original SARS virus (Covid is officially classified as SARS-2) had a mortality rate of 14%. If Covid were similar, we’d have nearly five million US citizens dead over the last fifteen months (about one person in 75). Maybe the next pandemic will bring us that. There will be another one. Hopefully, not for some years, but they roll around as regular as the seasons and all we can do is try to prepare in advance and hope our leaders don’t take a wrecking ball to the public health system just prior to the occurrence.

I’m having new headshots taken this weekend. The last professional ones I had done are now more than fifteen years old and I must admit I no longer look like I did in my early 40s. And I just got my haircut short for summer which I hope will make me look distinguished rather than dorky. Hopefully they’ll turn out well and I’ll use it on the back book cover and for upcoming auditions. I’m itching to get back on stage in something. There usually isn’t a lot of theater around here in the late summer/fall because football so I’m holding out hope of booking something interesting for the holidays or early in the new year. There are a few projects coming up I’m interested in. We’ll see what happens. I’m trying to think of a good story. This one’s a short one and goes back to my senior year of high school – I’ll leave the names out of it but my high school friends will know who it’s about. It comes to mind because theater…

When I was in high school, our campus went through a significant expansion plan building several new buildings at once. One of these was an arts center to create new studio space for visual art and a new theater space. Prior to this, the theater program had used the chapel – which had, for instance, no way to access the stage left wings without climbing a ladder through a window. Teenage me wandered into the new building for the first time, walked on to the stage and looked up at the flies and was smitten. I wanted to know how to use these tools to create art so I immediately signed up for technical theater and found that my calling was in stage management. Some months later, I was stage managing a production of that old chestnut, You Can’t Take It With You. It was mid December. We were rehearsing up through the break, then coming back to tech and perform in January. The cast and crew were mainly over achievers of one kind or another and the guy playing Mr. DePinna had found out that day that he had been accepted into Harvard on their early decision program. In celebration, his parents had given him a bottle of champagne which he brought to rehearsal and everyone had a swallow in a dixie cup to toast his good fortune. The next day the whole cast and crew were called into the principal’s office. We were all to be suspended for drinking on campus. Pandemonium. We all went home for Christmas vacation two days early and that evening twenty sets of irate parents descended. They were reassured that the school realized the offense was somewhat ridiculous and that no names were being taken, no records were being kept, but they felt that they had to enforce the rule to keep something more problematic from occurring in the future. My parents laughed about the whole thing as they knew I was far from a troublemaker, besides which they’d allowed us kids small amounts of alcohol at family celebrations for years and knew that a sip of champagne wasn’t anything to me. It was the only ‘serious’ trouble I ever got into during my school years.

Usually Monday is my double clinic day at UAB, a slog through 14 or 15 patients with an emphasis on dementia, family dynamics, diabetes in poor control, the aftermath of strokes and heart attacks, and a few unsolvable social programs thrown in for good measure. Thanks to the timing of the calendar, this Monday has been spent sleeping in, playing with cats, and carefully going through the first proof of the book page by page to catch any errant typos or misprints that still remain. I’m about 40% through and have until next weekend to finish the job. Those corrections will go in next week, and then I can order and distribute advance copies while making plans for an official release date.

It’s felt very strange and a little humbling to hold an actual physical copy of ‘The Accidental Plague Diaries’ in my hands. I’ve always felt capable of writing a book but have never had the perseverance to take anything of this length to completion in the past. As I reread it, yet again, trying to catch every last misplaced comma and minor spelling error, I’m torn between thoughts of ‘this is pretty good’ and ‘this is three hundred and some pages of navel gazing’. I guess I’ll just have to throw it out there into the world and see what the world ends up making of it. I should have details on a signing event or two, Amazon links, and where it might be available locally for those, like me, who still like to patronize bookstores in the next week or two. Watch this space. Currently there are only two printed copies, the one I’m working from and the one in the hands of Steve Peha, my brilliant editor/publisher who is doing his own last minute scrutiny so no, you may not borrow it.

The theme of the long weekend was social gatherings, both in person and on line. A game night at a friends house. A zoom game of Apples to Apples with a bunch of old friends from college now scattered around the country, but with forty years of shared history. A 4th of July party that happens every year at an old friends house which is one of the usual markers on the social calendar of Bohemian Birmingham. She lives right below Vulcan on Red Mountain and has a terrific view of the fireworks display. As I stood there watching the explosions, my mind drifted back over various other fireworks I have attended over the years, some with family, some by myself, some with either Steve or Tommy at my side. Steve was a Southern California boy who was the right generation to have come of age with Disneyland (he was seven when it opened and his parents took him opening week). We went to Disneyland together a lot during our California years and he always insisted that we stay until the end of the day for the fireworks and took great joy in them, clapping and cheering. I’m sure they carried them back to his childhood for a moment or two. Tommy could take or leave fireworks, but would stop what he was doing if they were around to enjoy them. I remember standing on the back of a cruise ship with him, as it pulled out of Nassau on the last night of the cruise that was our first vacation together, enjoying a fireworks display over the harbor arranged by Atlantis Events and being able to hold each other at the rail as were in a safe gay space and could do that without fear of attack. The most memorable fireworks I viewed alone were at the Tivoli Gardens in Copenhagen. The rules seem to be a bit different in Denmark and they were shot off so low to the ground, that we could all feel the hot sparks drifting down on our scalps and cheeks. I found it a little unnerving.

This weekend also marked the 40th anniversary of the first mention of what would come to be called the HIV epidemic in the press. It was a small article in the New York Times that appeared July 3, 1981 on page 20, taken from a mention in the weekly Morbidity and Mortality Weekly Report published by the CDC about a rare cancer (Kaposi’s sarcoma) having been diagnosed in a cluster of gay men. I didn’t read it. I was 19 at the time and not necessarily predisposed to reading the New York Times in a day before electronic accessibility, besides which I would have had a hard time accessing a copy. I spent the summer of 1981 in the Bering Sea working on the University of Washington’s oceanographic research vessel, the Thomas G. Thompson, running water sampling machinery on the graveyard shift and they weren’t delivering a whole lot of newspapers to our few land stops – Dutch Harbor in the Aleutians, the Pribilof Islands, Nunivak Island, Seward on the Kenai peninsula. I was busy punching buttons in the middle of the night, reading voraciously (I finished War and Peace in five days), and visiting the occasional elephant seal rookery while in the lower 48, natural and political forces were coming together that would end up shaping my life in ways I could not yet imagine.

I started to hear about the mysterious new disease when I got back to Stanford that fall (we were just down the peninsula from San Francisco) but I was still closeted and developing my dichotomous life between a double science major during the day, and a theater whiz in the evenings and weekends which didn’t leave me a lot of time to get into too much trouble. And it’s the pattern that likely saved my life when so many others of my generation were taken. As time went on and the negligence of the government condemned many in the gay community to death (shades of our current pandemic), I braced myself for a short life span and became determined to pack as much into it as I could, which is likely why I continue to overwork and overcommit. There’s a piece of me that has been conditioned since my late teens to believe that there will never be enough time to complete your goals.

The biggest thing it ended up doing to me was killing off a majority of the out professional gay men a decade or so older than I. This meant that as I moved through my education and into my career, I had almost no gay role models. No mentors. No one who could help me navigate through the inherent homophobia of academic medicine of the late 20th century. No one to help me open doors or smash glass ceilings. Consequently, I made more than a few mistakes over the years and my career took some unusual twists and turns. It all came out ok, I think, but I sometimes wonder what I might have accomplished if HIV hadn’t been a part of my times. But it did give me enough experience with how American society refuses to provide succor to marginalized populations in times of public health crisis to give me some decent tools for handling my job over the years and to see many of the socio-political themes behind the current pandemic more clearly and, if I couldn’t do that, there would be none of these essays and no book.

It’s another month and we’re half way through 2021. At times, the days fly by, and at other times each one seems to drip drip drip by at an interminable pace. I think pandemic thinking and experiences have screwed up my brain’s inner understanding of time. It no longer seems to be uniform with each hour identical, but more elastic stretching or compressing like Silly Putty depending on events or my inner moods. Society, at least around here, seems hell bent on restoring itself as if the pandemic were over and there’s a need to make up for lost time. The trouble is that it’s not. The number of cases and the death rate continue to inch up. We’re at something over 605,000 dead now, not that much further until it surpasses the Civil War and becomes the second largest mass casualty event in American history – the 1918-19 flu epidemic is likely to hold on to the number one spot, at least for a while.

The big problem area at the moment is Southwest Missouri, home of the Ozarks and Branson. I would venture to guess that the latter is why this region has become the first major cluster of the Delta variant. The type of person who vacations in Branson (and the usual tourist traps are booming as people come out of a year or so of restricted life and movement) is less likely to be vaccinated. They have come from all over, crowded into various theaters and attractions, and brought their viral hitchhikers with them passing them on to employees who then carry them into the surrounding communities. The local hospitals are inundated again and transferring patients to St Louis and Little Rock. I have a feeling that this is a canary in the coal mine moment and, as visitors to the area return to their homes, Delta will soon be popping up in a community near you where, given it’s increased transmissibility over the original strains and its predilection for young and unvaccinated people, numbers will start rising in hospital systems elsewhere. Given the usual timelines between seeding of virus, a significant population developing virus, and when that population starts getting seriously ill, I’m thinking we’ll start seeing a spike in casualties at the end of the month.

Of course, the vaccine will help, but the lack of enthusiasm for vaccination by a majority of the unvaccinated crowd means that even if it becomes clear that numbers are going up, the mass vaccination sites have been dismantled due to waning interest and there is roughly a month delay between first jab and full immunity so they would have to begin the process now to be protected by August when we’re likely to start seeing some more concerning numbers. I don’t have a lot of empathy for willful antivaxxers who are becoming ill at this point. Who I do have empathy for are the burnt out health care workers who are being called on to keep on keeping on in a preventable situation. This has very real consequences. People are quitting clinical health care positions in droves and there aren’t a lot of folk standing in line to take their place. Almost everyone I know of my generation and older is taking a fresh look at their retirement plans and the stories of docs having to not only do their work, but pitch in to change the sheets, administer the medications, and mop the floors due to a shortage of other clinical workers are legion. Most physicians I know will buckle down and do anything necessary in a crisis but it’s not a sustainable long term model for a functional health system.

I wish I had a better read at the moment on the business of health care. I knew I should have gotten that MBA when I seriously looked into it a couple of decades ago. From what I can tell, there’s a major acquisition spree going on in the C suites with small and medium size players being swallowed up for larger interstate players and this seems to be true in most sectors of the business. The AMA released a report this week that for the first time, a majority of physicians worked for a hospital or health system entity rather than for themselves in private practice. I don’t think that’s necessarily a bad thing. I have always worked for a large academic health system as faculty – it’s a model I grew up with, allows me a certain amount of freedom to feed my intellect and soul as well as make money, and I like knowing how much money is coming in each paycheck. I haven’t gotten rich doing it but I keep the bills paid and can afford to retire when I think the time is right. The problem is that most of the big players are not academic health systems, which are not for profit public goods but rather private companies whose only goal, ultimately is profit.

As the profit motive has invaded sector after sector of our economy and lives, there’s been a certain level of degradation of our way of living. The wheels of capitalism grind on, lifting a few up and right over the backs of most of the rest. That’s because of when we are asked to choose profit or people, we currently choose profit and turn a blind eye to the people that creation of profit may harm. In medicine, the profit motive at upper levels leads to additional layers of byzantine bureaucracy as each tiny kingdom attempts to minimize its cost centers and buff up its balance sheet. It leads to clinicians being asked to do more and more with less support. (Support salaries are expensive). It leads to an obsession with data and numbers over the actual patient. I keep having to teach medical residents that lab numbers are not interchangeable with the patient and to go talk to him or her and get a decent history about how they’re feeling and symptoms before relying on what spits out of a lab computer.

The sucking of money out of systems for profit is leading to other problems as well. Compare our decayed public infrastructure with that in other wealthy countries and a political system that is having extreme difficulties coming up with solutions as it might require additional public spending. It’s seeping over into private spending as well. Would the Surfside condominium tower have collapsed if the squabbling residents in the HOA had been willing to fund the urgently needed repairs when they were identified several years ago? Now I know a few readers are busy calling me communist in their heads. I’m not. I’m just not a vulture capitalist that believes that everything should always be about profit all the time. The profit motive is a good one and keeps us industrious but I do think it has to be shaped and managed by good government and policy so that a handful of families control more wealth than half the country. My work on rural house calls routinely takes me into the homes and lives of those that capitalism has completely crushed through no fault of their own and I get a lot more of the downsides than most in the professional classes, who have minimal contact with others not like them, do.

I’ve been booked as a ‘celebrity’ story teller at a fund raising event in a few weeks. I’m trying to decide just which of the stories of my life I need to tell. I’m leaning towards the saga of Steve’s cremains as it’s a classic but I’m afraid it may be just a bit morbid so I should think of something a bit more uplifting. While perusing the internet this week, I found that a previous blog (written from 2005-12) is still on line and accessible. Maybe I should poke around that. I have had two other blog lives – one from 2001 started just after Steve died and kept off an on up through meeting Tommy in 2003 (which I cannot find a trace of on the internet although it may be archived somewhere I haven’t thought of looking yet) and a group blog called Eternity LTD from the late 1990s that covered the period where everything fell apart in California and Steve and I had to relocate to Alabama. (I think I know where that one may have an archive.) Do I dare read any of them? Will I even be able to read these posts in another decade without cringing? And what about the book? Am I going to look at it in a few years as a significant accomplishment or a slight embarrassment? I would like to think that practice is making my writing better with time but one never knows, does one…

I’ve been exhausted most of the weekend. There’s no reason for me to be particularly tired but I still slept ten hours Friday night, required a two hour nap Saturday afternoon, slept another eight hours last night and napped again today. It reminds me of coming home from college for vacation. I’d do little but sleep as my body unwound from the stress of the previous quarter and prepared for the stress of the upcoming quarter. I’m not sure if this is about the receding of Covid and political stressors or if my body knows on some level that there’s more to come and making me slow down and store energy for the next round. All I know is I’m not proceeding terribly quickly on my next few projects. Fortunately, they aren’t things with specific deadlines attached so if I keep losing time to naps, I’ll still be OK. If nothing else, the cats seem very taken with my predeliction for falling asleep and snuggle up to do the same.

Covidland is relatively quiet. The number of US deaths has dropped below 300 a day, despite the spread of the delta variant. Whether this is now the new normal or the calm before the storm of an exponential rise in cases in states with low rates of vaccination remains to be seen. The problem with exponential numbers is that everything seem placid and calm and then all of a sudden things are everywhere seemingly out of the blue so it’s entirely possible that there will be a relatively rapid rise in cases to be followed by increased mortality later this summer. We shall see what we shall see. In the meantime, I’m taking advantage of a more open social life as the theater folk are starting to get back together as we have all been vaccinated. There was a very nice backyard gathering last night where I saw many folk I have not seen for the last year and a half.

The book is essentially finished. After much consultation with my editor/publisher we’ll be running a couple of preliminary copies next week to go over with a fine tooth comb to make sure all the errors have been caught and that all of the art/titles are correct. Advance copies should come out the second week of July to send to people to try and garner some positive buzz and reviews and then it should go on general sale at the end of July. I’ll be working on setting up some readings/signings locally. It still seems very dreamlike, as if I’m discussing someone else’s work and I don’t know if it will seem real until I have actual physical copies in my hands. Even then, it might not seem real. I don’t know if it’s my impostor syndrome or my underlying Eyore personality that makes me feel like it’s always someone else’s story anytime I have a significant accomplishment.

As I don’t really have much to say this evening, I suppose it’s story time. This one is from many decades ago, back when Steve and I were first together. As I related in my last post, I have a bit of an odd GI tract that does weird things. One of the things that it does is react strangely to local water systems. I figured this out years and years ago when every time I would visit LA, I would have an upset stomach that would go away as soon as I returned to Seattle or Northern California. I don’t know what it is about LA but I assume it has something to do with the mineral content of the water or how it’s treated. Anyway, Steve was an LA boy who had only moved up to the Sacramento area about a year before we got together so most of his friends remained in LA. We therefore drove down a couple times a year to see some of his old friends and visit his old haunts. The run from Sacramento to LA down I-5 was about seven hours so we could even bop down for a long weekend, especially with two drivers.

One visit, early in our relationship, we decided to go to Universal Studios – neither of us had been for at least a decade and we thought it might be fun. We got up early to get to the gates before things opened so we wouldn’t have to wait in line. My upper GI tract was bothering me, as it usually did in LA, so I hadn’t had any breakfast and really wasn’t interested in eating anything. Steve was having none of it so he went over to the snack kiosk and bought me a banana and stood over me forcing me to eat it. Ten minutes later, my stomach rebelled and the banana was going to reappear. We were in the middle of the plaza in front of the gates with no convenient rest room so I did the only thing I could do and leaned over the rail at the edge of the plaza. There was a drop of some forty feet down to a flower bed which the regurgitated banana sailed down, to the consternation of the tourists marching up the drive. Steve was mortified. I felt much better and we ended up having a great time on the tour. Steve learned his lesson. Ever after, if I told him I wasn’t hungry or didn’t want to eat something, he took me at my word. And to this day, I do not eat bananas other than the occasional slice in a fruit salad. And don’t get me started on banana pudding which is constantly offered but always politely refused.