I set a new record today on my rural house calls run. 310 road miles and seven driving hours. Due to some staff issues, I ended up having to do all the driving myself to Guntersville, Fort Payne, Henegar and Section. I was a wee bit fried by the time I got back to Birmingham. Notes will need to be written tomorrow as I am in no shape to battle the VA computer system this evening. I suppose today explains why there aren’t more rural house call programs in place. The VA can afford to run a program at a loss as long as it helps the system as a whole. Veterans enrolled in our program have somewhere between 60 and 75 percent fewer hospital days per year than age/morbidity matched controls who are not. It doesn’t take too many non-existent ED visits or ICU stays to free up enough dollars to pay for house calls. It doesn’t happen a lot in other systems for two reasons. First, in most systems inpatient and outpatient sectors are siloed from each other financially so there’s no way to calculate cost savings between the two realms. Second, there are a dearth of providers out there who feel comfortable and really understand how to provide care in the home environment. One of today’s patients was just out of a community hospital in Northeast Alabama and, per the family, it went from being relatively quite last week to a zoo over the weekend due to the impact of Covid patients.

The local news regarding Covid keeps getting worse and worse. Yesterday, there were two ICU beds available statewide. Today, there are a couple dozen more ICU patients in hospitals than there are staff to man those beds and the numbers aren’t even beginning to slow down. UAB’s inpatient census ticked up another couple dozen overnight. There are more than double the number of hospitalized children than there were at the peak of the surge last winter. Local school districts have only been in session for a few days and already the notices of exposures at school are flying thick and fast. We’re not quite at the level of Florida where one Tampa Bay school district had over 5,000 students out on quarantine but I won’t be shocked if we get there. The death rates are still relatively low, but that’s a lagging indicator and won’t really start increasing for another week or two.

There’s been a lot of grumbling among physicians and other healthcare workers of my acquaintance about having to take care of the willfully unvaccinated as they have deliberately put themselves in harms way and are not only requiring intense resources, but are also drawing away resources from patients with other conditions. While I get the emotional impulses fueling this (those working in health care are all exhausted after eighteen months of this with no end in sight), I can’t agree with it. My ethical compass dictates that I help patients, no matter the cause of their discomfort or illness. If we start drawing those sorts of lines, where do we stop? Do we stop treating lung disease in smokers? Liver disease in alcoholics? Injuries in those at fault in motor vehicle accidents? Heart disease and diabetes in the overweight? You can make all of the ‘right’ choices and you’re still eventually going to have something go wrong in your body and I don’t think any of us has the moral authority to sit in judgement in that way. So the health system is really not empowered to make people get vaccinated. The government really isn’t either in a free society. We believe in letting autonomous adults choose for themselves rightly or wrongly about all sorts of things. There are some carve outs for public health purposes, but with the highly polarized politics of the moment, I don’t see much of anyone in the governmental arena demanding anything from the entire population.

So what will increase vaccination rates? The thing that has always changed American behavior over the years – capitalism. Free market forces have already figured out that letting individuals with a potentially deadly infectious disease into your place of business may not be the world’s best strategy for economic growth. In addition, if your employees become either chronically or terminally ill, given our peculiar employment based health insurance system, Wall Street is going to stop wanting to pay for things which are largely preventable. Private enterprise is going to put more and more rules in place. They will, of course, be challenged in court, but with the packing of the courts in recent years with judges siding with corporate interests over the interests of the individual, I figure the right wing may find itself hoist on its own petard.

I had a meeting this weekend to start thinking about a possible new version of The Politically Incorrect Cabaret for the fall. Some ideas were bandied about but we were left at the end with the understanding that we had no knowledge of where society would be in a few months, in terms of either attending or comprehending satirical entertainment so we ultimately decided to see how things develop over the next few weeks before making any firm decisions. If I were writing the show this week, in addition to Covid, I would also be writing about Afghanistan and the situation there. The end game is incredibly sad, but was also inevitable as any student of land wars in Central Asia will attest. The final withdrawal has been a botch (but the administration assumed they would have weeks to plan and execute it, not just a few days) and my heart goes out to the Westernized urban populations of Kabul and Kandahar and other cities, especially the young who grew up in a relatively liberal atmosphere who are going to be pushed into a repressive medieval society not of their devising. But I can’t really think of ways to make either of these topics funny, even with the cutting humor I usually bring to the PIC that makes people laugh somewhat uncomfortably. Ah well, a problem for another day.

Litany in the meantime – In my best Ansager outrageous accent – Vash yer hends! Kip yer mesks ovuh yer nose unt yer mouth! Don’t git toooo close. Vaaahks!

The numbers keep soaring upwards and, six weeks into this new surge, we have case loads and hospital numbers we haven’t seen since last January when a new administration and distribution of vaccine finally began to bring numbers down. The pandemic during 2020 was, primarily, driven by systemic failures in our politics on a national level. The election of an administration that saw itself as a wrecking ball, bent on upending the entrenched ways in which the government does business, led to a situation where the federal agencies that keep us safe on a national level were simply unable to function as designed. The change in administration brought a new culture to Washington DC which, when combined with an efficacious vaccine, completely changed the equation and we were able to return to a more normal life.

The pandemic during 2021 is not due to a failure of our politics, it’s due to a failure in our society. We have, for whatever reason, decided it is no longer important to care for each other and selfish behavior has become the order of the day. This has given the Delta variant the perfect opportunity to seed itself in the unvaccinated population and travel far and wide in a very quick manner, bringing us right back where we were eight months ago. The federal government hasn’t brought this about. The Biden administration done everything it its power to get the word out on vaccines and to get the resources available to states and localities for both preventive and aggressive care. Some states have been working actively against this – Florida and Texas being the most obvious examples – but they wouldn’t be doing so if the majority of their citizens hadn’t decided to take a political stand based ignore they neighbor and love only thyself.

There’s nothing new about anti-vaccination and anti-science attitudes in North American culture. Mandatory small pox vaccination rules caused riots in the late nineteenth century. There’s always been a deep distrust regarding the ‘government’ and its role in regulating bodily autonomy. There’s also nothing new about selfishness as a political virtue. I suppose one of the reasons that all of the great religions focus so much on hospitality and welcoming the stranger and loving thy neighbor is as a counterbalance to the selfishness that politics and economics tend to engender. When churches loose that mission and natural pull against those forces, they tend to stultify which is why state churches very rarely succeed. They are two opposing forces and states of mind, a yin and yang of church and state that must figure out a way to coexist for society to be vibrant and move forward.

We’re in a moment when a significant number of those rejecting sound science and health principles are allied with certain religious denominations and many of those denominations, in chasing the prosperity gospel, have rejected the basic tenets of openness to the other, which is very hard for humans to do, in favor of closure and definition of themselves strictly by what they are not rather than what they are. I don’t think it’s a particularly good way for them to find continued long term success. I know how hard it is to accept that those different from oneself have full fledged, authentic lives. I don’t think I really got it until I started doing house calls routinely and was welcomed in to homes that were not white middle/upper middle class. I learned how to see the world in different ways than I was used to. It wasn’t easy. I still don’t get the life choices of some of my patients but I have gotten to the point where I will accept them as being theirs to make and not mine to gainsay or to change in any way

I’m wondering if what we’re seeing is the death of the religion of medicine. In the early 20th century, the majority of the population had little to do with organized medicine. Specialty and hospital care was for those few with money or who lived in cities. The majority of the population were doctored and nursed by grandma with some help from a neighborhood GP, if there was one to be found. Things got a little better between the wars, but the depression ensured there wasn’t a lot of expansion in the health sector and people, for the most part were born and died at home, many at young ages from what we would consider preventable causes these days. Things changed rapidly, however, in the years immediately following World War II.

The post war boom allowed for new hospitals to be built and for medical schools to upgrade their training facilities. The new wonder drugs, known as antibiotics, created medical miracles as those who would previously died at home were successfully treated and cured in these new temples of medical learning, filled with white coated acolytes. The idea of American exceptionalism in medicine took root in the culture and the people felt blessed and worshipped the stunning achievements that came along from CT scans to organ transplantation to robotic surgery. Doctors were granted incredible social authority and the idea of ‘Doctor knows best’ inculcated even the most modest of households and whatever the health system suggested, the people tended to obey without question.

Then things began to go wrong. The health system was sold to corporate America as yet another industry that could be monetized. Doctors became beholden to administrators rather than their patients. New information technologies allowed untrained individuals to access vast arrays of medical information with little guidance about interpreting their findings and results of their researches. A fractured media landscape allowed even the most lunatic of beliefs to find a foothold and an audience in the marketplace of ideas and to be amplified in the name of ‘fairness’. There was concern that the temples of healing might cater too much to the wrong sort of people so funding was diverted from the public health system to more private enterprises where the wealthy might take a cut. It is on to this landscape that Covid, like so many other infectious diseases before it, does its one and only job, move from human host to human host and replicate itself without care for what damage that may accrue to the host along the way. The people ignored the cries of the priests in their white coats as if they were so many Cassandras. They were determined to follow their own personal paths to salvation using the philosophies of everyone for themselves that had become popular in the political and economic spheres. Then they began to fall sick, and came to the temple for healing but there were too many of them and the temple and the priests, having been neglected, were incapable of meeting their demands and, their language of science, being full of uncertainties, confused the people with their sense of certitude in themselves. And so we are where we are. I don’t yet know the end or the moral of the story. It’s still being told.

I’m tired. I’m going to have to go back on jeopardy inpatient call again as UAB has to recreate the Covid surge teams of last winter. I don’t want to have to keep thinking about all this. But it’s our reality and here to stay for now. You know the litany: Wash your hands, wear your mask indoors in public, keep your distance when you can. Get your vaccines. The life you save may be your own.

It’s Wednesday night, it’s raining (again) and so there go the plans for the first church choir rehearsal of the season. We’re rehearsing out of doors due to the rapid spread of the Delta variant throughout the state. We’re pretty much all fully vaccinated but we don’t want to become a case report on an infection cluster so we figure we’ll rehearse outside for now, although that does leave us a bit at the mercy of the weather gods. Being from Seattle, rain doesn’t particularly bother me and I’m perfectly happy to show up in a rain hat and galoshes but I so suppose the pages of our sheet music will start sticking together, especially as we’re having these intermittent rain cells where absolute torrents pour down over ten minutes or so before it returns back to its regularly scheduled ninety degrees. As the next hour or so is now unexpectedly off, I might as well write.

There were 3815 new Covid cases reported to the Alabama Department of Public Health yesterday and the seven day average of cases is 3355. At the peak of the winter surge, our case numbers topped out with a seven day average of just over 4000 cases so we’re more than 80% there and the numbers show no signs of slowing down. At this rate, we’re likely to have more cases in the state than at the peak of the winter surge by the end of next week. The memos are flying thick and fast at my hospital systems to get ready to batten down the hatches again. Transfer visits that don’t need to be in person back to telehealth, reduce scheduled and elective admissions, prepare to have staff and students be pulled away from their current rotations back to Covid duty, drive through testing sites to be opened up again. The inpatient numbers aren’t as dire as they were this past winter – yet. This is likely a function of the elder population having had their vaccines and therefore not falling ill in the numbers that they were this past year. But the numbers are steadily mounting and everyday I hear about another relatively young healthy person who intersects with my circle of acquaintance being hospitalized in an ICU grievously ill.

The Delta variant, which if we had had better vaccination rates this past spring when vaccine became readily available, wouldn’t have become such a concern continues to rip through the land at a rather spectacular speed. Enough data has come in to suggest that it has an R0 of roughly 7. One infected person infects seven others on average. The original alpha strain had an R0 of about 3. One infected person infected 3 people on average. I’ve always been intrigued by exponents so lets look at the difference between the powers of 3 and the powers of 7. Calculators out: 3, 9, 27, 81, 243, 729, 2187, 6561, 19683, 59049. That’s enough. Now the other 7, 49, 343, 2401, 16807, 117649, 823543, 5764801, 40353607, 282475249. After ten iterations, the powers of 7 are nearly 5,000 times larger than the powers of 3. Now there are only about 5 million people in the state so it only takes 7 or 8 iterations at an R0 of 7 to get a number that surpasses the number of people. This is the reason why it’s so potentially dangerous and why it’s gone from zero to sixty seemingly overnight.

The thing I don’t quite get is the political doubling down coming from certain quarters of the Republican party. They should be able to do (or hire someone to do) basic math which shows exactly what’s happening and why and that a whole lot of people are going to get sick faster than the health system, already weakened by the first year of the pandemic, can possibly cope. Rather than quietly abandoning their rhetoric (which they could get away with under the improving conditions of the alpha strain seen this past spring and early summer) for a real world assessment of rapidly changing conditions, they seem content to play toddlers standing on the playground screaming ‘Mine Mine Mine’ and ‘No No No’ over and over again. Part of adulthood is recognizing that the world is the way it is rather than the way you want it to be and that no amount of magical thinking can change it. Unfortunately, the Republican party has, since at least the time of Ronald Reagan, used a combination of money and naked force to reshape political reality, at least, to their choosing and they have now made the mistake of thinking that these tactics can achieve success in any endeavor. However, coronavirus is like honey badger. It don’t care.

I was on a zoom call last night with a group of community leaders brainstorming ways to get vaccine rates up and how to communicate more effectively with various population subgroups. One of the leaders suggested that we all go to various political meetings with a message of vaccine positivity backed by science and our credentials. After seeing news footage of screaming mobs of anti maskers and anti vaxxers at school board meetings, city hall meetings, and town halls all over the country, I don’t think i want to subject myself to that kind of abuse. Doctors and nurses and public health workers of all kinds who are just trying to protect their neighbors from irreparable harm are being subject to assault, battery, doxxing, and general bad behavior of all sorts. I have absolutely no idea how you change people who are not living in a world of rationality, but in one of emotions and feelings and inflated egos. At least here, when people don’t agree with what I have to say, they have to leave it as a comment that I have the option of erasing should I so choose. (It’s very rare that I have to do that, but I have done it and will likely have to do it again.)

The advanced copies of the book are somewhere in transit. I’m hoping they get here by Friday so I can get them out over the weekend. It’s occurred to me that as my patients learn of it and start reading it, I’m going to lose a little of my mystique as ‘Dr. Duxbury’ as the book is very definitely written from the perspective of Andy. I’ve talked before about how I put on a somewhat different persona at work than I have in my private life and I guess that the book is going to level them out a bit. Do I regret it? No. I’m rather Edith Piaf about my life. Je ne regrette rien. I’ve never seen the point of dwelling too much on the past. It’s over. You can only move one direction through life and that’s forward. Sign up for updates on book availability by submitting your email here https://bit.ly/apd-sign-up.

The storms today were reminding me a bit of Tommy. He and I liked to sit in bed in the old house on the hill and watch the storms race up the Jones Valley. In 2004, when we had been together for about a year and a half and were just starting to dip our toes together into the Birmingham performing arts community, hurricane Ivan came ashore on the gulf coast and headed inland directly over the city. Everything was cancelled, the power was out and we were on the floor of the bedroom playing a prolonged game of monopoly. The winds were blowing, the house was rattling, but at 200 miles inland, we were unconcerned until we started to hear an odd noise from upstairs in the living room. We went up to investigate and found that the rotation of the winds, being the opposite of the usual prevailing weather, was pushing the rain up under the shingles and that water was pouring into the living room from several points (the only time we ever had serious leak issues). Of course, one of the major leaks was right over Tommy’s precious grand piano so we immediately had to move it and all the living room furniture into the dining area and fetch every bowl and bucket we could find. The piano survived (although we did have to get a few of the felt hammers replaced). The buckets were enough. We finished the monopoly game, and at seven o clock that evening, set out to see if there was power anywhere for dinner. Fortunately five points south was fully lit up so we went out to dinner, had several cocktails, and went to bed early. We decided dinner and cocktails was definitely the best way to end a hurricane and vowed to try and make that a tradition.

Rains a coming in again, both literal and metaphorical. Hold tight, put up the storm windows, wash your hands, wear your mask, and get your vaccine.

Houston, we have a problem. And Baton Rouge. And Mobile. And Jacksonville. And Little Rock. And And And… The news pouring in from all over on the rise of the Delta Variant (and doesn’t that sound like a bad Chuck Norris film?) remains grim. Hospitals and ICUs are full. There are reports of burnt out health care workers simply walking off the job at the end of a shift, unable to take more unnecessary death and suffering. We’re back over 100,000 new cases a day in the country. On the first go round in 2020, it took us nearly eight months to hit that milestone which was reached the first week of November. It only took about six weeks this time to go from a low of fewer than 7,000 cases a day in early June to where we are now.

A brief reminder on how the virus works. It has no sentinent decision making capacity. It simply quickly and efficiently transfers itself from host to host using the behavioral choices of humans to gather in groups to its advantage. What we are seeing today is the result of our behavioral choices of mid June when there was a definite feeling that the worst was over and we could start getting back to normal patterns. What we choose to do today will have no effect on what happens tomorrow. Our behaviors today won’t become apparent in the course of the pandemic until mid to late September. This lag between behavior and consequence of behavior is a bit of a problem. A lot of humans don’t understand cause and effect if there isn’t a clear temporal association between two things, they have difficulties understanding the relationship. Of course the opposite is also true. When two things happen in close proximity in time, we want to believe in a relationship even when one does not exist. Correlation is not causation. I suppose this is, at least in part, one of the reasons why so many are susceptible to irrational theories regarding phenomena over scientific fact. The combination of more normal behavioral patterns regarding group activities, relaxing of masking and social distancing standards, and a significant portion of the population rejecting the one thing we have that we know works to keep the virus at bay has led us to our present predicament.

The Delta variant is moving much faster than the previous Alpha variant. It’s moving so fast that neither our systems of governance nor our understanding of the patterns of epidemic disease can really keep up with it in real time. The combination of transmissibility and huge unvaccinated population in the red states is leading to a perfect storm that’s going to get a whole lot worse very quickly thanks to the realities of exponential math. The full hospitals in the cities on the leading edge of this new wave will be replicated elsewhere and the pressures aren’t going to let up for some months, even if we decide to lockdown again (and I don’t see any governmental entity having the stomach to suggest that, especially when the class of individuals with political power is pretty much all vaccinated and relatively protected). If the numbers go up as rapidly as they could, we’re going to see some hospital systems simply unable to cope further – out of beds, out of staff, out of resources. The collateral damage will be everyone else who gets sick from all of the other usual issues that send people off to acute care. They won’t have much to help. My hospital is gearing up for another time like last Winter and is ratcheting down on elective surgeries and other things that might take up hospital beds, saving them for the crunch that has yet to come.

In the meantime, the governors of Texas and Florida continue their contest to see which one can kill a greater percentage of their population. Florida appears to be winning. Current statistics there show a rate of 132 cases per 100,000 population.  If Florida were an independent country, it’s rate would be the third highest in the world, behind Martinique and St Barts.  (Those two countries have such small populations that one or two more cases move them up the rankings quite quickly.)  For comparison, Alabama, which is quite high for states, has roughly 50 cases per 100,000 population at the moment.  Governor DeSantis, in Florida, to keep the crown, has forbidden school districts from mandating masking on campus or face severe financial penalties.  He has also had laws passed forbidding cruise lines from requiring vaccination prior to boarding a cruise ship, perhaps the most perfect environment for viral transmission yet invented.  Not to be outdone, Governor Abbott in Texas is busy forbidding contact tracing in public schools and allowing potentially infectious children to attend without a quarantine period.  I’m trying to figure out why this deliberate doubling down against the advice of every public health and health care provider group out there.  All I can come up with is that the Republican position on any issue is currently simply to be against whatever Democrats might be for and who cares how much collateral damage in the form of dead citizens.  But then, this is the party that refused to pass common sense gun legislation after a school full of dead kindergarteners a decade ago.  The lives of children don’t seem to mean much, likely because they aren’t major campaign donors.

The same things are playing out locally, with our own governor refusing to mandate any particular school safety measures and kicking it down to local school districts; things are going about as well as might be expected in this heavily red state.  Roughly 1/3 of Alabama schools will be opening with a mask mandate and 2/3 will not.  Locally, the city schools are requiring masks, the county schools are not, and the suburban school districts are all over the map.  This is really playing out in one of the wealthy suburban school districts where many of the University faculty live and send their kids and where the school board (three retailers and two attorneys with no education experience among them) have decided that masks are optional but encouraged.  This has enraged the portion of the parent base employed in health care and my Facebook feed has been full of screeds against the politics of the moment that would let this happen.

Vaccines continue to hold the line, for now.  As more and more data come in, it shows that vaccines aren’t the best at preventing infection, which is why we are all aware of a vaccinated person or two with a breakthrough case.  Vaccines also aren’t the best at preventing someone with a breakthrough infection from being a carrier and spreading it to others.  The numbers for both of these things are significantly lower in the vaccinated population but hardly zero.  However, multiple studies from around the world show that vaccinated people are not getting the complications that require hospitalization and aggressive therapy.  And the few people who do become that ill while vaccinated are nearly all individuals with serious underlying health concerns independent of Covid.  If you’re reasonably healthy and vaccinated, your chance of major hospitalization or death is very small. You can, however, still be part of the transmission chain which is why its important to keep those masks on indoors in public for now.

I spent yesterday at the Magic City Clarinet Festival.  (The Birmingham Music Club asked me to sponsor it and, as clarinet was my elementary/middle/high school instrument, I was happy to do so).  Performances of everything from classical pieces to avant garde to Dixieland jazz.  Master classes from professional clarinetists from around the region.  It was well attended for a niche festival and the venue at the Birmingham Museum of Art, which has great air circulation, was the right place for wind instruments.  I dusted off my instrument case, brought it with me, and joined in the grand finale of Somewhere Over the Rainbow.  I can still play but it’s been a long time since I’ve played for an audience for anything other than comic effect.  (The last time was when I was in Gypsy – I dubbed Clarence and his Clarinet from the opening scene behind the curtain complete with squeaks.  I also played it once in Politically Incorrect after a set up where no one in the audience thought I could actually play it.)  I started playing in fourth grade.  At that time, in the Seattle Public Schools, you were allowed to pick an orchestral instrument and, for a modest fee, the music teacher would teach you to play.  My original choice was flute, but after playing around with it for a week, I had a hard time with the emboucher, and couldn’t get much sound out of it so I switched to clarinet which I could at least make squawk right away.  Our music teacher was Norma Durst.  She played viola in the Seattle Symphony and was an institution, having joined the group in her 20s and playing with them until fading eyesight forced her to retire in her 80s.  When she taught me the rudiments of clarinet, she was probably about fifty and in her prime.  And she actually had us formed into a school orchestra after only six months or so.  Eat your heart out Harold Hill.

It’s time for the litany.  You should all know it by heart.  Wash your hands.  Get your shot.  Keep your mask on indoors in public, unless you’re playing the clarinet.

Well, where are we? A quick summation of some recent news stories: Louisiana’s largest hospital is completely out of beds. The number of people hospitalized with Covid in Florida is roughly the same as it was back at the peak of this past winter’s surge (roughly 1/1,900 Floridians is in a hospital bed with the diagnosis). The total number of cases diagnosed in the US so far is something over 35 million (or roughly 10% of the total population) and is going up currently by 100,000 a day. Closer to home, the number of hospitalizations in Alabama has doubled from two weeks ago but there’s an odd geographic predilection. The huge increases are in the Gulf Coast and Mobile Bay areas and not so much in the cities further inland. I put that down to cavorting at the beach over the Fourth of July Weekend and geographic proximity to Louisiana. It’s coming our way. Druid City hospital in Tuscaloosa which was down to 7 Covid patients at the first of July, now has over 100.

The good news among all these bleak statistics is that if you are fully vaccinated, you need not worry too much. 99% of the hospitalizations in Alabama between January and July with Covid were in unvaccinated individuals. Those with breakthrough cases generally recover at home without much incident. I am adhering to indoor masking recommendations personally. I’m not afraid for myself, I care enough about my fellow citizens to try and keep from being an asymptomatic carrier. Besides, I have quite the collection of high fashion masks these days and I go to great pains to match them with my shirt of the day. I also try to get my socks to match but that’s sometimes a more difficult task.

The big debate going on at the moment, as we are approaching the first day of school, is school policies regarding masking, social distancing and safety in the classroom. The Delta variant appears to be somewhat more infectious in children than the Alpha variant of last year. (I don’t have hard numbers on this but it’s alluded to by several trusted sources). No one wants to go back to virtual school as it wasn’t terribly good for either kids or education so the consensus is that schools will open on their usual schedule. The state of Alabama, kowtowing to political pressure from the right wing of the Republican party, has passed legislation forbidding any use of ‘vaccine passports’, whatever that’s supposed to mean (although the legislation has no penalties attached for violations) and the governor has made it quite clear that she will not impose any sort of state mask mandate. At least she hasn’t expressly forbidden the use of masks in schools unlike Florida, Texas and Arkansas (where the governor is very sorry he signed the legislation). She’s simply kicked the can down to local governance and school boards. Locally, city schools have announced a mask mandate. The wealthy suburbs are being torn by competing groups of vocal parents – those calling for a mask mandate to protect their kids and those calling for no mask mandates to encourage their kids to have some normalcy in childhood.

I have a couple of thoughts. First, kids are infinitely adaptable. They’ll do whatever the culture tells them is proper in regards to dress and behavior. Tell them they have to wear masks, they will – it’s what happens in all those cultures where face veiling is considered a proper standard. It won’t hurt them negatively in any way. They’ll only rebel against masks if they’re getting the information that they should from a trusted adult. Masks aren’t going to damage them or their educational experience. Second, if the first job of governance is to protect the citizenry (something that has been in short supply these last few years), the second job is to make sure that the next generation can grow and develop into functional and competent adults. This means adults have to be adult and put the needs of kids before their own wants sometimes. Kids need to be around their peers and educated and so the steps we take should ensure that happens. Masks are a very small price to pay for that to happen safely. People often forget the purpose of the mask. It’s not about you. They don’t keep you from getting Covid, but if everyone wears them, they prevent Covid from propagating in the group and that’s ultimately more important. They need to be universal in areas of high transmission. They can come off again when transmission rates fall. I don’t have children so I don’t have a dog in this fight, but if I did, I’d send them to school with masks for in the building time and tell them to take them off and run around and yell, scream and sing outside at recess.

To date, roughly 500 children have died of Covid in the US. That’s not a lot compared to the total of 615,000 or so deaths we’ve had so far but every one of those 500 families is broken, some beyond repair and 500 lives which were full of potential have been snuffed out at a young age. We’ll never know if there was a Gershwin or a Simone Biles amongst them. With vaccines, we can protect kids, not by vaccinating them directly (yet -but that may change) but by making sure that they are surrounded by adults who care enough about them to reduce their chances of exposure by being themselves vaccinated. That’s how herd immunity works. Any child death from now on is one too many as it’s not necessary as we have the tools to protect them.

I really don’t understand the politics of the right wing at the moment. The noise machine remains firmly antivaccination and continues to spew toxic misinformation to their base. I presume this is to be able to point to the Biden administration and say ‘see, they failed to protect you from the pandemic – vote for us’ in next year’s midterms. But the cynical calculations that have been made with innocent people’s lives, especially those of children and young adults, is unconscionable. It’s as if Governors Abbot and DeSantis and their ilk were standing in front of the altar of Moloch demanding the population push their children into the flames. In a decade or two, when this is all an unpleasant memory and today’s kids are young adults, those twenty and thirty somethings are going to look at their parents and ask ‘What did you do to keep me safe during the pandemic?’ and there may be some very uncomfortable conversations that follow.

It’s all so different from when I was in elementary school and we were lined up for polio, MMR and other vaccines in the auditorium. I don’t recall a single one of us having a parent that complained. They were just thankful that the dreaded diseases of their own childhoods had been beaten back. My earliest memory is of polio. I was not quite two but I vividly remember the little girl who lived next door who walked with braces on her legs as she had had polio several years before. It’s almost the only thing I remember from that very young age so it must have made a huge impression on me. We lived in a Connecticut suburb at the time (my father was on the faculty at Yale). I don’t remember much about it at all, but when Mad Men came out a few years ago with its depiction of suburban New England life in the early 60s, all of a sudden, memories of various conversations my parents had had about their neighbors and acquaintances from that time came rushing back. And I understood their decision to hightail it back to the West Coast in the summer of 1964.

The litany continues: mask indoors in public, wash your hands, get your shots, love your children.

Steve died twenty years ago today. It was an ordinary day, like so many of the days before. His lung disease had been a bit worse over the last week with some dropping in his oxygen saturation making him more confused, but we were over the worst of that and he was coming back to his usual baseline orneriness. Tameka, his caretaker when I was at work came at her usual time and she and I exchanged pleasantries while I finished my coffee and headed out the door to work. Steve was at his art table at the dining room window, working on a watercolor with pen and ink overlay of some flowers. The weather was sunny and he had a couple of visitors lined up for the morning. Jim Elrod, his hospice chaplain was due to stop by as was Peter Maynard to shoot the breeze for a while before lunch and then, if he felt up to it, an outing with Tameka to just get out of the house. The two of them were quite the pair rodding around town in his blue Mustang convertible.

About 11:30 that morning, after enjoying his visitors, he had been sitting on the couch in the living room. He stood up, turned to Tameka, said ‘I don’t feel so good’ and then dropped like a rock to the floor. His heart, which had been under incredible strain trying to pump blood through his increasingly fibrotic lungs simply gave up and stopped and he was dead pretty much as soon as he went down. Tameka called me in a panic. It was a Wednesday and I was on VA duty doing house calls for their home based primary care program. In those days, we piled the whole team into a van and did home invasion of all the disciplines at once. With Steve being so ill, I knew I might have to race home at any time so I had taken to following the van in my own car. I told Tameka to relax, call the hospice and I would get home as soon as I could. I excused myself from the home visit, got in my car and started to race across town. The phone rang again. It was the police who had somehow been summoned and gotten there before the hospice nurse informing me that Steve was most definitely dead.

I don’t remember a lot after that point. I know I got home. Steve was lying on the floor where he had fallen and was most definitely no longer among the living. I calmed Tameka down and sent her home. The hospice nurse showed up as did the funeral home transport. I kissed him goodbye on the forehead and made sure that Patrick, his cat, was able to sniff and recognize that he was gone. A few friends showed up. I needed to keep myself busy so I kept doing stupid things like unloading his pillboxes just to keep my hands and brain doing something other than thinking about what had just happened. I called our pastor, who was out of state awaiting the birth of her first grandchild. I decided on having the memorial quickly that coming Sunday afternoon.

What I remember most was just feeling. I’ve never been good at emotions or understanding them. To this day, I cannot always tell when an emotional response is positive or negative, much less what the emotion actually is. It’s odd. I’m very good at understanding and identifying emotions in others but not so good at doing it within my own brain. Even a few courses of psychotherapy have not been able to help me much with that one. I suppose that day it was truly a mixture of lots of things, both positive and negative. Love for Steve. I was 39 and we had been together since I was 26 so he had been my constant companion through my mature adulthood up to that point. Loss and regret that we had no more time together to build new memories. Relief that his suffering (and by extension, mine) was over. Fear at what would come next. I had no idea how to be alone as a mature functioning adult. At that time, I had no idea that Tommy was out there. (We had met each other when he had waited on me and Steve at the local Olive Garden but I have no recollection of this). I had not been prodded back into the world of performance, music and theater. I was thinking it might be time to return to the West Coast somewhere.

613,000 plus American families have gone through that shock and loss over the last 18 months. The current death toll from Covid is currently inching up, but isn’t accelerating at the rate it once did. This may not hold much true much longer. Both Louisiana and Florida are reporting numbers of new cases on a par with last winter at the worst of that surge. Other undervaccinated states are starting to accelerate in the same way. It will be a month before we know what that’s going to do to the death toll. I spent my last post trying to lay out the facts about what’s happening to us with the spread of the Delta variant which is significantly more transmissible than the Alpha variant which caused last winter’s surge. I’m not sure what I can add to that.

Breakthrough infections in the vaccinated are definitely increasing. Fortunately, the vaccine is doing its job and the majority remain relatively mild. The chance of a vaccinated person dying from Covid is somewhere between 1/100,000 and 1/1,000,000 which is roughly the same as being struck by lightning in any given year (1/500,000). If you’re vaccinated, don’t panic. You’re protected. The new recommendation to mask up again isn’t so much about you as it is about protection of society and the unvaccinated (especially kids). Masks are more about others than they are about protecting you and are a mark of social altruism. It comes from the recent data out of Provincetown around the Fourth of July weekend which showed that fully vaccinated people are capable of spreading Delta, even if they aren’t getting that sick themselves.

The Provincetown data are very good. The CDC has gone on record as to how well people cooperated and helped them trace contacts and they were able to map out infections with an accuracy and ease that they weren’t used to seeing. That’s because we’re dealing with gay men. This isn’t their first time at the pandemic rodeo. They know what to do and how to be good citizens, even though their country isn’t always great at repaying them. Now, as gay men, when they gather en masse, tend to crowd themselves into bars and onto dance floors, their may have been a bit more ease of transmission going on then you will find at your neighborhood Publix. Unless you’re living in West Hollywood..

.I’ve been getting a lot of questions about kids. I’m not a pediatrician or an elementary educator (except Sunday school) but I do try to keep up on the latest. The political forces that are trying to ban masking in schools are crazy, but laws have been passed. Very young children before school age may have issues with masks but once they get to Kindergarten, they’ll comply if it’s reinforced. And they can take them off outside at recess. Masks will not stunt their growth or lower their oxygen or any of those other things. There are cultures in which that part of the body is routinely covered and they don’t have any issues. We just believe in Western society that if you cover any part of your face, you have something to hide. At the moment, masking should be universal indoors in schools. The Delta variant appears to hit kids a bit harder than the Alpha variant. There have certainly been more hospitalizations. Whether it has increased mortality for children we don’t yet know. Things might change as more and more adults get vaccinated. Studies are ongoing as to whether it is safe to vaccinate kids. There should be at least some preliminary results this fall. In the meantime, how do you best protect your kids? If they are twelve or older, have them vaccinated. If they are under twelve, make sure all of the adults around them are vaccinated and that they mask when indoors at school or in other public places.

So what to do? Repeat after me. Wear your mask indoors in public (unless actively eating or drinking). Wash your hands. Keep a reasonable distance from those you don’t know. Get your shots. There’s no need to go back into lockdown if we just do a few simple things for our friends and neighbors.

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.