One year. 366 days (2020 was a leap year). 527,040 minutes (sorry Jonathan Larson but you’re wrong every fourth year). It was initially assumed that the first US COVID death happened on February 29, 2020 in the Puget Sound area. But, when the pandemic began to take off in March, the medical examiner’s office went back to a couple of mysterious unexplained deaths in otherwise healthy people following a flu like illness and found the presence of the novel coronavirus in tissue samples of individuals who died on February 6th and February 17th. One year later, according to the Johns Hopkins Coronavirus counter, the US is at 460,311 deaths.

How big is that number? If it was a US city, it would be 44th in population, coming in between Virginia Beach and Long Beach, California. It’s 10% higher than US World War II casualties making the pandemic the third largest mass casualty event in US history, bested at this point only by the Civil War and the 1918 Flu pandemic. (And at the rate we’re going, I imagine we’ll top both of those by this summer as we’re more than 2/3 of the way there). It’s enough to fill the 101,821 seats at Bryant Denny stadium four and a half times. It’s enough to have killed one out of every 719 Americans who were alive a year ago. As the average American has a cirle of acquaintance of roughly 5,000 individuals, statistically each of us has lost seven people who were in our lives a year ago. For me, it’s a much larger number than that given the nature of my profession. I lost seven people of my acquaintance during the first week of January alone as the surge driven by holiday gatherings reached its peak.

Fortunately, things are beginning to calm down somewhat. Numbers of hospitalizations, at least locally, are beginning to dwindle. There is one outlier, Tuscaloosa. I was in a meeting at the VA this past week where there was much consternation about a rapid spike of COVID among veterans getting are at the Tuscaloosa VA compared to the rest of the state. All you have to do to explain it is look to the night of January 11th when UA clinched the national football title and the young people of Tuscaloosa poured into the streets to celebrate. Human behavior drives the patterns of viral outbreaks in predictable ways. Most of those young people did not become seriously ill and most elderly veterans in the area were not chugging beers on University Boulevard in the wee hours of the morning. The mass of assembled people, however, allowed for the virus to be passed along to a greater portion of the population at one time. With higher numbers infected and a greater reservoir of potential carriers, older people in the community were just more likely to come into contact with someone infectious, even with normal precautions.

WIth vaccines rolling out in fits and starts, there’s a sense of societal ennui in the air regarding the coronavirus. I can’t quite put my finger on it, but its sort of a ‘OK, that’s over let’s move on’ sensibility which fits in neatly with both our short attention spans and need for the new, especially within the infotainment journalism we’ve perfected over the last few decades. COVID is so 2020, let’s move on to the next big story. The problem is that the virus hasn’t gone anywhere and it’s just waiting for us to change our behaviors in ways it can exploit to do its one and only job, propogate. When we allow it to move through the population, we create two major issues. The first is the obvious costs of morbidity and mortality. The second is we give the virus a chance to encounter more types of humans and more environments and increase the chance of mutations. Viruses are relatively simple organisms. There aren’t a lot of pieces so the genetic code isn’t all that long. Errors in transcription of genetic code happen all the time – anything from 1/100 to 1/1000000000 depending on the organism and whether it’s DNA or RNA or mRNA. The more different environments the virus encounters, the more likely one of those mistakes is going to aturn out to be an evolutionary win in a new situation and give a new strain a little bit of an advantage. What is a win for the virus may very well be a lose for us. The novel coronavirus that causes COVID is very closely related to the virus that caused SARS in Asia a couple decades ago. If a mutation occurs which causes this one to develop the same lethality of SARS, we may be in a world of hurt. It’s mortality rate was about 14% compared to about 2% for COVID. With that morbidity, we’d be looking at between 3.5 and 4 million dead in this country to date.

I’m not pooh-poohing the vaccine at all. It’s an incredibly useful tool and it’s a tribute to human ingenuity that it got from identification of the virus to people’s arms in less than a year. But it’s not the be all and the end all and it cannot substitute for good public health practices. It’s going to take a while to get everyone at higher risk from COVID (somewhere between 1/3 and 1/2 the population) vaccinated. The other things that we’ve been working on such as masking, hand hygiene, and social distancing need to continue for a little while longer. It’s still a bit unclear as to what is safe and what is not once you’ve received your vaccines. I’m still not eating out or going to the movies, but I feel better getting together with a couple of people, especially if we’ve all been vaccinated. I need a weekend away for mental health in the near future. I figure as long as I pick somewhere where I can do outdoorsy things.

We’ve still got a huge political problem in this country when it comes to public health. The change in administration, while it did put people who will listen to and follow the science in charge of the pandemic response, did nothing to change the gap between red and blue America. I think the most dangerous thing that can happen over the next year is for the administration and blue America to dismiss the concerns and attitudes of the antimaskers and their ilk as insignificant noise coming from a bunch of uneducated yokels. The analysis of the composition of the mob at the Capitol shows that these are not uneducated or unsophisticated people. They have, for whatever reason, bought into an ideology that those on the opposite side of the political aisle must be destroyed by any means necessary and their ideas must be ridiculed and abrogated. This morning I read an article that the governor of Iowa is eliminating all social distancing/masking and other coronavirus mitigation measures. One does not get to be a governor of any state by being a stupid person. But one does make political calculations based on various competing agendas.

I’m afraid our political split is here to stay unless some significant social surgery is performed (reinstatement of the fairness doctrine, repeal of Citizens United). I am under no illusions that things are over, not by a long shot. The Republican party is in thrall to a radicalized base where any attempt at comity is seen as heresy. As that base pulls itself further and further into a world of ‘alternative facts’, I have no idea what the leadership is going to do or what the economic powers behind the leadership are going to do. My guess is, as radicalization becomes bad for business, the polticians attempting to use those impulses for their advantage will start to see funding sources dry up until they fall back into line but you never know. It always comes down to money in our culture; it’s the only common language. The later millennials and generation Z seem to have figured this out, witness a group of Florida high schoolers eviscerating the National Rifle Association and a bunch of tech bros using the Robin Hood App to bringa hedge fund to its knees.

I feel like I’m blathering on a bit now so I’ll sign off, but not without my usual litany. Washa yo hands. Wear yo mask. Stay yo distance. Get yo vaccine when yo can.

The holiday surge is officially over. Case rates have dropped back to where they were in mid November when the rise really began to take off, a couple of weeks after Halloween parties. Back then, we were at roughly 10 million total cases and 240,000 US deaths. Now we’re at 26.5 million cases and 450,000 US deaths. More than 15 million people sick and more than 200,000 dead because America wasn’t willing to stay home for the holidays. I’m being a bit unfair. If we had all stayed home, there would still have been some cases, maybe a quarter or third of those totals. We’re still looking at a lot of people that didn’t have to die who did because of our social hubris and lack of empathy.

Is the drop off due to human behavior or due to the vaccine finally starting to roll out in significant numbers? Probably a bit of both. About 5% of the eligible US population has been vaccinated at this point and the emphasis on the high risk populations of health care workers and elders in congragate living is likely to have a significant effect on mortality rates moving forward. While the numbers are still difficult to comprehend (roughly 1/730 Americans who was alive a year ago has died of Covid at this point) I’m finally starting to feel hopeful that we’re going to have a bit more normal life come summer. The local vaccination sites are working well, the only limiting issue is the supply of vaccine and my sources within the federal government state that there’s a huge effort within the new administration to get those bottlenecks ironed out as soon as possible. Many of my clinic patients are in the pipeline to get their shots and we are getting shots hand delivered to my housecall patients. I may be able to get back on the road to see them over something other than a computer screen in a couple of months.

I’ve been working steadily on editing all of these musings of the last year into something that may eventually resemble a book. The rough draft came in at about 115,000 words which is about 30% too long so now it’s time to edit, cut, combine, rewrite, polish, and drive myself generally crazy as I attempt to turn writing that;s generally late at night stream of consciousness into a coherent whole. Fortunately, I have an extremely talented editor in Steve Peha (a man I have known since elementary school) who is leading the way through the thickets of my sometime repetitive prose and we are on schedule to get a full polished draft done sometime in March. (I may ask a few of you to be early readers to see what you think). It’s interesting as I reread things that I wrote months ago to see how much of the book I was thinking about writing about the problems to come with the American health system under the pressure of the Baby Boom is there, only with a more literary quality than that book would have had and with a different thematic spine of the coronavirus and America’s failed response to it. In some ways, that makes the book much more me than the original concept would have been as it straddles the right brain world of literature and memoir and the left brain world of health problems and policies.

When I began these pieces last March, I had no intentions of them being anything other than what they were. My musings on life, the universe, and everything and trying to make sense of my place in it. But when the whole of society was upended and everyone was as uncertain as I, it became clear that I had a certain gift for putting those existential fears into words, finding the threads of hope, explaining the concepts we all needed to know in order to understand both the disease and the societal responses and the feedback I received kept me writing until I realized at first that I was accidentally writing a plague diary and eventually that it was a book about coronavirus, both the government and the health system’s response, and what that meant to one man both inside and outside of health care. If you’d told me a year ago I’d have the rough draft of a book finished and it was well on its way to being edited into readable form, I would have thought you were smoking something.

While I’m trying to not fall behind on the book project, I am taking time out for another zoom theater piece, Moliere’s Tartuffe. I think I first read it in high school and was amazed at how sharp the satire of religious hypocrisy was in something written centuries ago. It was one of those things that helped me understand that while culture and the trappings of society may change, humans remain fundamentally the same. I get the same feeling from Shakespeare and Sophocles. Le plus ce change, le plus c’est la meme chose. I’ve only seen Tartuffe staged once. Katherine Burgueño and I went off to a theater in Berkeley to see a friend of hers in it. When I picked it up to study it for this filming (I’m playing Orgon – the wealthy fool who takes in Tartuffe and is fleeced by him), I was struck by how absolutely relevant to this moment in time the play is. A certain segment of religious America has hitched their wagon to some very irreligious charlatans for the promise of wealth and political power and, as the church is pulled away from its principles for temporal ends, the hypocrisy gap widens and widens and diminishes both church and state. I think we’re learning the lesson that in a pluralistic society, both church and state are stronger when they leave each other alone.

I did some acting in elementary school. My first major role was as the title character in Rumplestiltskin as I was the smallest boy in the third grade. I was a tiny child and the Saunders genome is wired in such a way that the males don’t grow until relatively late. I was the smallest boy in my grade level all through elementary and middle school, remaining under five feet until I finished 8th grade (I shot up that summer). Being very small in middle school and having a reasonable intellect was socially problematic and I convinced myself that one of my best defense strategies was to be invisible and not make waves. (It didn’t keep me from being thrown in the dumpster because I was easy to pick up). Being invisible meant staying off stage so I entered high school not interested in performing but still enamored of the process of theater so I became a techie and moved from that to stage management and to directing. Sometimes I wonder what my life might have been like if I had been a different person and had started performing at a younger age. Would I still have gone to med school or would I have tried the NYC thing to see if I had what it takes? Who am I kidding, I would still have gone to med school. As much as I love the theater I made the decision around age 20 that I always wanted to have it as an avocation and a love and never feel like it was work. I also didn’t want to tie my life to a profession that’s more about being the right person in the right place at the right time than it is about actual ability. Of course, there has been a certain amount of the former in my medical career anyway. Sometimes it has worked in my favor. Sometimes it hasn’t.

I’m looking forward to getting back on stage. It’s not ego driven. Tommy always accused me of seeking the spotlight but I really don’t care if I have a lead or am third nobody from the left. I enjoy the process of creation with a team of people, each bringing their individual skills, both on stage and off, to create something ephemeral that none of us could have possibly done on our own. I choose the projects I get involved with based on the other people involved. There are people I like spending time with, people I want to learn from, people whose talent I admire. If there’s a critical mass of that going on, sign me up and stick me where you need me. I’m hoping there will be some outdoor distanced theater this summer and that we may be at a point where we can all gather again indoors in the fall. There are way too many shows on my bucket list that I want to be a part of before I become too infirm to run around backstage platforms in the dark changing clothes as I go.

Get Andy back on stage again. You know what to do to make it happen. Wash your hands. Wear your mask. Social distance. Stay out of crowds. Get your vaccine when you can.

It’s the last day of January, the end of the first month of this new year. And what a month it has been politically. I would like to think that things will start to settle down into the old patterns where the news out of DC simply drones on in the background of life, but I’m not so sanguine as all that these days. We’ve still got an impeachment trial, an ex-presdient who has spent all his time in politics shattering norms and is almost certainly going to continue to do so, and a major political party that seems unable to police itself against spokespeople minimizing sedition, nattering on about nonsense such as ‘Jewish space lasers’ , and certainly doing nothing to dispel the Big Lie that the recent election was somehow stolen. This suggests that all of the forces that have been rending the social fabric won’t be going away any time soon.

I’m no expert in politics, but I have studied my history and have had a career that’s brought me into contact with many different people from all walks of life. It’s one that’s required me to develop my sense of empathy far beyond where it once was and, once you have it, you can’t really turn it off. Emotions, especially negative ones like anger are still running high. There’s a lot of belief that government no longer works to support ordinary citizens. On the left, it takes the form of government is a rigged game benefiting the wealthy at the expense of others. (Currently playing out in the Game Stop short sell market where the tech bros have figured out how to leverage technology to beat Wall Street). On the right, it takes the form of government is taking my hard earned tax dollars and giving them to the lazy ‘other’ (playing out in nativist and white nationalist sentiments). It doesn’t really matter which side you’re on; if enough of the population loses faith in the government for any reason, the government will eventually collapse and we will be left to forge something different. These peiods of revolution and reformation are usually turbulent and violent and I really have no interest in living through one so let’s all put our faith in understanding that government, of any stripe, is the mechanism by which we can help each other beyond the circle of our immediate acquaintance. Big problems like pandemics require big solutions and they can only be provided through government. No other human institution is large enough.

The long and short of it is we’re in interesting times, as the old curse goes, and they’re going to stay interesting times for a while. On the public health front, things are a bit easier locally. The number of hospitalized Covid cases continues to slowly descend and the rate of increase is not what it was a month ago but it’s still a good deal higher than it should be. Vaccines are rolling out, and vaccination centers will start taking everyone over 65 as of February the 8th. A number of high risk occupations are also becoming eligible such as teaching and working in food service and retail. Our local metro area has a number of mass sites up and running, the only limiting factor being supply of vaccine. There are still some issues to be worked out such as the classism of relying on sign up systems that require on line registration.

Work continues apace on editing these musings into a coherent book manuscript. I’m up through last July and has I reread, cut and paste, and take my editors suggestions, it’s been interesting to see where we all were compared to where we are now. It’s only been six to nine months, but we’ve all had to become used to a radically different world bit by bit. I haven’t completely decided what the book is. Is it strictly a diary? Is it a memoir of a certain time? Is it a compendium of my philosophies of health care using the pandemic and our response (and lack thereof) as a structure? Is it a story? I am inclining towards the last. It’s the story of a journey – of an individual, of a society, and of a health care system as it faces down pandemic illness, bringing out its best and its worst.

I like writing stories, but I’ve never been good at writing sustained narrative fiction. Like all of us, I feel like I have the great American novel inside me somewhere but I’ve never been able to get out more than a chapter or two before running out of gas or being side tracked by some other project. Short form has always worked better for me. These pieces. The insane world of MNM and her movie reviews. The one place I have been able to write long form fiction has been in playwrighting, having a number of those under my belt, some of which have gone on to independent life.

I started playwrighting back in the 1980s when I was in medical school. Lauren Marshall, an old friend from Stanford, had also ended up in Seattle after completing both undergraduate and Stanford Law. We had collaborated before in college, most notably when she directed and I assistant directed Hello, Dolly! for the big spring mainstage musical her senior year. In the late 80s, she had this idea for an educational musical that could teach legal concepts to high schoolers. She got some grant funding, we sat down to write book and lyrics together, found a composer and Whadda ‘Bout My Legal Rights? was born. It had grant money attached so The Empty Space Theater picked it up for an Equity tour through Washington High Schools (it was about 50 minutes long, designed to fit in an assembly period) and it’s still available from Samuel French should any of you wish to produce it.
Our next collaboration was a farce, Terrorist in the Family Room, which we drafted out together character and plot wise, but then I was returned to California for residency while she stayed in Seattle so she moved on to other projects. I rewrote and finished Terrorist and send it out occasionally to see if anyone wants to do it. While everyone loves the script, it’s never been produced. I should get it out again and do another rewrite for the age of Trump as its themes that the terror we wreak on ourselves are far worse than what terrorists can do to us are resonating again. People think that the title refers to the central character, an international terrorist taken in by a suburban family by mistake. It actually refers to the TV set. Perhaps I need to change that to social media.

Ten years or so ago, Ellise Pruitt Mayor, then running The Seasoned Performers, the second oldest senior theater group in the country, asked me to write some touring scripts for elder actors to perform for elder audiences, predominantly in senior living facilities and senior centers. Being the good geriatrician that I am, I dutifly went to look up what there was on writing for senior audiences and didn’t find much. So I turned to what I knew from decades of working with older generations including how to communicate with those with hearing/sight impairments, how to work with those with mild cognitive issues, and generational concerns. The result was two scripts. The first was The Green Room, a fantasy in which the traditional fairy tale villains including the wicked witch, the big bad wolf, the troll, and the evil step mother are tossed out of their stories and made to wait together in the green room of the eternal theater while cultural forces beyond their control try to reshape the power of narrative. They escape with the help of the audience by breaking the fourth wall. The second, Nightcall Nurses, had older actresses from a radio drama of that name coming back to the studio as honored guests, recognizing that they’re being belittled for being older, and taking over the broadcast on their terms. I always thought I should write one more and then could publish them as three plays for senior theater.

In between, I’ve written more editions of Politically Incorrect Cabaret than I can shake a stick at. I’ve always wanted to write something serious and dramatic for the stage, but I always seem to veer off into snide humor. When I write comedy, I write it for me and for jokes that I find funny, even if no one else gets them. For instance, in the very first Politically Incorrect, we did a spoof of The Trojan Women as if they were survivors of the Iraq war. It was the midst of the Bush years so Andromache had a line ‘We’re getting our own No Child Left Behind program. They’re starting with my son Astynax.’ I thought it was hysterical but it probably went right over the heads of 99% of the audience.

These pieces to are written for me, to help me understand a changing and changed world through the power of narrative. I’m happy so many of you have jumped on for the ride. In the meantime, wash your hands, wear your masks, keep your distance, and tell the story.

It’s Wednesday again. Three weeks ago on Wednesday, the Capitol was attacked. Two weeks ago on Wednesday, the previous president was impeached for a second time. One week ago on Wednesday, the new president was inaugurated. I’m kind of disappointed something momentous didn’t occur today as well. There’s still a couple of hours left before midnight, unless you’re east of Nova Scotia, so I suppose it’s possible we’ll have something major before the end of the day but it may be that it’s just as well that the rule of three is holding and we’re all being given a chance to catch our collective breath. We’ve all been given a lot to absorb and process the last few months and I, for one, could use a little down time. I don’t know how the generation that made it through World War II was able to keep it up for six years.

The news is mixed from Covidland. It hasn’t gone away despite having been driven off the front pages recently by political news. On the good side, it looks like the surge fueled by holidays is definitely starting to recede. Numbers are down in general. Here at UAB, inpatients are down about 25% from the peak from about 300 to about 220. It’s still far too many and the numbers in general remain grim. World wide, the count has broken nine figures with over 100 million cases recorded. (Almost certainly an undercount by a significant margin). In the US, we’re at about 25.5 million. The speed with which we’re experiencing new cases and deaths has begun to slow. Whether that’s due to behavior change, vaccine distribution, or other reasons is not yet clear. On the bad side, the new UK variant that’s significantly more contagious is definitely spreading in the US and this may be enough to knock numbers back the wrong way again. Even here in Alabama, several cases of the new strain have been identified.

Vaccine is finally being more appropriately distributed and everyday I hear from a friend or a patient that they’ve received their first dose and are scheduled for their second. Systems are falling into place at both the federal and state levels to keep supplies up, the current limiting factor. My VA house call program has solved the logistical problems with transporting the vaccine during its safe post thaw window around the state to our bedbound house call patients and we are getting them slowly but steadily taken care of. Large sigh of relief. There’s still a lot of work to be done to reach and educate underserved communities and there’s still significant political stigma associated but that seems to be waning somewhat as the vaccine rolls out with minimal side effects.

It’s been gratifying for me to see the return of the house call to a more prominent place in medical practice in recent years. I have always believed that they are central to helping people maintain good health. Back in the day, before my time, most primary care medicine was done in the home. The doctor made the rounds in a mule cart or Model T and treated what he could, educated families in proper nursing, and always comforted when there wasn’t much else available. Following World War II, doctors migrated into offices, usually attached to hospitals in some way so they could care for both outpatients and inpatients at the same time. They still did occasional house calls. The introduction of the federal payment structures of Medicare and Medicaid and the rise of for profit insurance nearly killed them completely with growing emphasis on time efficiency and volume.

When I entered medicine in the 1980s, there were no opportunities to observe or learn about the art of the house call. I was never exposed to one, even with my wandering around rural communities as part of the University of Washington’s program to create primary care doctors with roots in small town Northwest US. Neither house calls nor geriatrics were part of my curriculum either in medical school or in residency. (I never met a geriatrician until I was nearly finished with my internal medicine training). When I opted for geriatrics, one of my first assignments was to UC Davis’s small outpatient geriatrics clinic. On one of my first weeks there, the ambulance pulled up and offloaded a poor lady on a stretcher. She couldn’t get out of bed at home. The process of transferring her from the bed to the ambulance and then into the clinic had aggravated her arthritis and she was crying from pain. She was demented and not able to tell me much of anyting about her condition. No member of her family had come with her. The ambulance drivers knew little about her other than the address from which they had picked her up. I called her home, got her daughter (she hadn’t been allowed in the ambulance and didn’t have access to a car to have come on her own) and learned a bit about the patient. When I asked where the family lived and figured out it wasn’t more than a few miles from my house, I told them that next time the patient needed medical care, I was going to come to them.

I had no idea how to do a house call. I went to the powers that be at UC Davis and told them I intended to do them on certain clinic patients like that one who would otherwise require ambulance transport. There was no objection. I located a group, the American Academy of Home Care Physicians and attended their annual meeting looking for ideas. (It fit in a classroom as there were fewer than fifty members nationwide). I learned that the reason there were so few housecalls was due to the Medicare reimbursement scale for physicians which at that time simply made it financially unfeasible to do them. As a fellow in an educational program, this wasn’t an issue. I learned by doing. I did more.

I started to realize how much I missed only seeing patients in the artificial environment of the clinic setting. I discovered the family where all the medications were poured into a candy dish and grandma picked out the ones she felt like that day. I learned to equate chronic GI issues with unsanitary kitchens and help teach patients food safety. I learned to carry a large bottle of Febreze and spray myself down after visiting certain homes so I wouldn’t smell like an ashtray the rest of the day. I learned how not to touch the furniture in some places. I put up with the occasional case of scabies from unwashed bed linens.

By the time I left Sacramento, I had built a thriving academic house call practice that taught house call medicine to residents and medical students and provided care to a uniquely vulnerable segment of the population. I became comfortable with people on ventilators at home, and families that more or less ran an ICU out of their kitchen. The program disappeared in the collapse of clinical geriatrics at UC Davis that forced me to leave California in search of alternate employment, but when I got to Birmingham, I brought that skill set with me. The Birmingham VA had a functional home care service that I became part of for a while. I’m back with it again after a decade hiatus for other projects. I introduced the UAB system to house calls and more or less did them on my own hook for years and years as they were the right thing to do. UAB eventually saw the wisdom in them and has built a robust house call service over the last few years but for the most part I haven’t been involved as I have simply had too much on my plate.

Going into someone’s home as a physician gives you a unique perspective on a patient. You start to learn about who they are as people. What’s important to them. You meet their families. You meet their pets. You see the photos on the walls and meet their ancestors and their family histories. You also meet them on their own turf. The power relationship is reversed. You are on their ground and they are the ones in charge of what will and will not happen. There are times when I wouldn’t have it any other way.

Sign up for your vaccine when you can. Even if you’ve gotten it, you know what to do: Wash your hands, wear your mask, social distance, don’t take random pills out of a candy dish.

It’s only been three days since the last one of these entries but it seems like several months have gone by in the interim. Something seems to have happened to my perception of time. It feels normal in the immediate here and now but once something slips into the past, it’s as if there’s a great acceleration. Perhaps its the dizzying pace of events as the country reels from political and public health upheavals. Perhaps this is what happens when you age. My patients have always talked about time moving so quickly in their later years. It’s just that if feels like the inauguration was three months ago rather than three days ago. Or maybe it’s the rapid proliferation of 10,000 Bernie Sanders mittens memes…

With a new administration in place. things are beginning to change for the better in terms of the federal response to the corona virus pandemic. The administration has released its plan for bringing the plague under control and its a common sense compendium of tried and true public health measures, most of which should have been in place last spring. It has taken the availability of vaccines into account and there are now federal plans to utilize the national guard and other elements of the government to get vaccine out as quickly as it can be manufactured.

Locally, we here in Alabama are stymied by shortages in vaccine supply. The Alabama Department of Public Health who controls all distribution in the state has gotten its act together and is getting vaccine out to various points to begin vaccinating those over age 75, however, the complete lack of federal coordination has kept vaccine from flowing into the state to meet demand. Vaccinators often don’t know when they are going to get a shipment until a few hours before it arrives which makes setting up schedules and notifying patients a wee bit difficult. There are plans for several mass vaccination sites in the greater Birmingham area and the logistics are in place but they can’t open them up until there is a supply that can be counted on for both first and second shots.

In the meantime, numbers continue to mushroom. There is some evidence that we have peaked and we may be on the downward side of the hump caused by holiday gatherings and travel from Halloween through New Years. Numbers in the hospital locally are down slightly. The percentage of positive tests is decreasing somewhat (but is still more than double the five percent which is thought to be the level at which we can consider the pandemic under control in a particular area). Anthony Fauci has finally been allowed to share his expertise with the public untrammelled and is now responsive only to science and not to politics and his expression of delight at being able to at long last speak unvarnished truth and swing the CDC and other health organizations toward protecting the public rather than protecting the optics of the White House has been rather refreshing. The next big issue is the spreading of the UK variant which is significantly more contagious than the original strains. If this isn’t slowed, we may barely get a rest from this peak before a whole other surge begins later this spring.

Tonight was the one year anniversary of the opening of the Virginia Samford Theater’s production of Cabaret, the last live stage show I was part of during the ‘before’ times. The cast gathered on zoom to toast each other and watch an archival video of a performance together. I don’t like watching myself in such things – stage perforrmances depend so much on the interaction of the actors with the audience that you always feel removed on both sides of the equation when it’s on screen. However, it was fun to see everyone and to reminisce and to comment on how appropriate that piece was to the political times we have been living in recently. When the local theater world opens back up, we’re going to lobby for the theater to revive that production. One year later and I’ve just started rehearsal on another theater project, a zoom theater version of Tartuffe in which I am playing Orgon. Now there’s another play that’s perfectly in synch with the current political times despite being four hundred years old. That’s what makes great art, something born out of turbulent times that helps a future generation understand the turbulent times in which it finds itself.

Bad times, pandemic disease, political unrest, religious schism – no society is immune from such things. We like to think of ourselves as privileged individuals living in the finest civilization the world has produced, an apogee of comfort and enlightenment. I’m pretty sure the Ancient Sumerians, the Imperial Romans, Tudor British, 18th century French, and all the others felt the same way about themselves and their societies in their day. I think it’s part of the human condition to believe it can’t happen here until it does.

I have no idea how the new administration is going to go about solving the myriad problems in American society that our failed response to the corona virus has exposed. I don’t know what the opposition to President Biden and the Democratic party has planned in terms of response. All I can say is that there’s going to be no linking arms around the campfire and singing Kumbyah. We’re a long way from controlling this pandemic and we must all continue to be vigilant, vaccinated or not. Hundreds of thousands have died, hundreds of thousands more are likely to die but we can each do our own small part to protect each other. You all know what to do. Stay home, wash your hands, wear your masks and social distance.

Inauguration Day: The center holds, the Republic stands, and we can all go to bed this evening, no matter what our political leanings, knowing that there are stable individuals controlling the levers of power. What does this portend for the future, especially for those corona virus related public health issues in which I am most interested? I can’t say that I know. I am hoping that we will begin to see a unified national response, rather tha a piecemeal local one dependent on the whims of politics. I’m hoping those in charge bring the resources of the federal government to bear on the vaccination effort and that extant vaccines get into willing arms as quickly as possible. Most of all, I’m hopeful that policies will be crafted that will tilt the balance away from the side of profit back towards the side of people.

I have no idea how successful any of these shall be in either the short or the long term. particularly this last onel The economic powers that be which shield capital from the depradations of the people with needs are strong and entrenched and neither political party has really taken them on in some decades due to the great costs of maintaining the current apparatus of elective office, particulary the cost of campaigning in the media age. Lofty promises have been made, but results have been few and far between since the mid 1970s when the earnings of corporations began to outstrip the earnings of workers – and those curves have diverged further and further from each other over nearly five decades. That’s a lot of societal repair.

I’ve been talking a bit about the Big Lie regarding the truth of who won the election, the idea of it having been stolen by the Democrats from the Republicans still having currency in some circles despite essentially no evidence to corroberate this belief and plenty of evidence that the Democrats took both the popular and electoral voted fair and square. There is, however, an even bigger lie that’s been promulgated for decades. The one that the collapse of earning power by Blue Collar and rural Americans is due to a theft of resources by those below them on the social scale, whether by undercutting them in the job market or through governmental benefit, rather than to a redistribution of wealth to those above them on the social scale through corporate consolidation, multinationalism, and redistribution of economic resources outside of the US. This has fed the deep divisions in our country and they are likely beyond the ability of any one administration to repair.

There is one thing that gives me a great deal of hope and that was on display at the Inauguration in the person of Amanda Gorman with her brilliant reading of her poem ‘The Hill We Climb’. This young black woman, full of poise and meaningful words, captured our current moment perfectly and, to me, is emblamatic of the rise of the Millennials and Generation Z to power. She joins the Florida high school students whose work and commitment helped take down the untouchable NRA, the youthful climate change activists, and the committed young people I work with in medicine who are facing the challenges of Covid-19 head on. It’s a generation who clearly sees where the old forms and ways of doing things are broken and who are unafraid of speaking truth to power and moving forward.

The Baby Boom is not going to relinquish social, economic, and political power easily or gracefully but time is coming for them. Demographically, somewhere around 15% of the generation will have died by 2030. They will then die off rapidly over the next two decades, roughly 40% in the 2030s and another 40% in the 2040s. A few will linger on with the last American boomer passing away around 2080 at the ripe old age of 115. There will be a wholesale changing of the guard in society over the next twenty years and from what I have seen, the kids are alright and we’re in pretty good hands going forward.

We’re now at 400,000 deaths in the US from Covid-19, most of whom would not have needed to die had this virus arose at another point in modern US history but, as it coincided with an administration with minimal interest in the commonweal, an accidental plague it did become and we all have to live with the consequences of that and whatever part we played in allowing it to happen. Our fascination with infotainment over real news and analysis, our wish for quick solutions, our unwillingness to endure discomfort for the sake of others – all of these helped the virus establish itself here in ways that have cost real lives and untold suffering. Now we have the chance to make some different choices but it remains to be seen if we, as a society, will be willing to do that. I hope we can.

In the meantime, I’ll still be here. Watching, writing, trying to interpret the course of events in ways that help me make sense of this crazy world we find ourselves in. I’ll continue to follow my particular mantra, one which I have been imparting to medical students for decades: the world is saved one patient at a time. I have hope that the plague will recede enough that other things in my life will get back on track but I am content for the moment with my work, my thoughts, and a little recreation on the side.

Here’s to new beginnings, but in the meantime you know what to do. Wash your hands, wear your mask, social distance, and stay out of indoor crowds. May your vaccine arrive soon should you choose it.

It’s MLK day and things are relatively quiet. I’ve learned to steel myself in recent weeks before opening my news feeds to see what’s happened over the last day or so. I was quite relieved to read through my digests this morning to find that all of the threatened nonsense for the long weekend vowed by those responsible for the violation of the Capitol has not come to pass. There have been some rather desulatory state level demonstrations, but nothing to compare with what came before. Whether it’s because the riot at the Capitol has finally shocked American society out of its complaisance about extremism or because those forces are simply biding their time until we are all looking the other way to organize and strike again I do not know. I simply know, due to my study of historical patterns, that the Big Lie of a stolen election, Trumpism, and the bizzareness known as Q-Anon aren’t going away any time soon and will continue to influence our politics for a while to come.

Martin Luther King Jr. had a dream. I was a toddler when he gave that famous speech and I’ve heard it and its message my entire life. I’ve done my best to live up to the ideals of that dream and to see that my part of the world does as well. I’m human and imperfect so I haven’t always succeeded but I have kept slowly pushing to be a better accomplice for equality and justice and I know that’s going to be a life long challenge. I’m a white male of the professional class, one whose parents believed in education and in books, so I’ve had certain systemic advantages through life. Being openly gay has been a disadvantage but it’s also helped me see inherent biases and to recognize that correcting those biases aren’t any sort of personal attack on me and mine. I think a lot of the support for the toxic brew of white nationalism, evangelical christianity, and populist sloganeering that’s in vogue comes from people who haven’t been able to understand this, that changing society to allow broader anticipation isn’t about tearing down what is, but rather about adding to and strengthening to allow others to contribute their inherent gifts. It takes tesserae of all shapes, colors and sizes to create a moasic.

When it comes to history and the understanding of social structures and movements, I’ve always been of the opinion that the underpinnings are economic in nature. Who has the money? Where does it flow? Who gets to adjust those flows in terms of taxation and economic policy? We’re living in a time of extreme wealth. The amount of money our current titans of industry control would make the Roman Emperors blush. And the pandemic has hastened the concentration of wealth into fewer and fewer hands as the economic fallout has hit small business far harder than large. When I read about fortunes in the billions, I wonder how one even begins to spend that sort of money? For the most part, it isn’t spent, it’s simply concentrated and the various net worth lists become a sort of score card in the great game of amassing a fortune. Honore de Balzac once wrote ‘Behind every great fortune is a crime’. I wonder if that continues to hold true.

We’re living in a time, not unlike that of the Industrial Revolution, when a small number of wealthy set national economic policies for their benefit to the detriment of those who actually generated the wealth. In the battle of people vs profits, profits were coming out ahead until about 1848 when various revolutionary reform movements began both in Europe and in the Americas. The pushback, which continued over the next eighty some years eventually led to fair working hours, the abolition of child labor, the idea of the pension, workplace safety laws, the existence of the weekend, and a thousand and one other things that we take for granted. People were finally valued over profits and the resulting policies led to the post World War II world with which we’re all familiar. However, capital and profit always fight back and, since the 1950s, bit by bit, profit has been renegotiating the social contract in its favor. Pensions became 401Ks forcing the middle classes to favor economic policies that were pro-capital and market economy. Recepients of social largesse were recast as moochers and thieves. Public investment in infrastructure was curtailed (compare public buildings and spaces in this country with those in any other developed nation to see where that’s left us).

When a stress such as the corona virus hits a society where the balance is tilted towards profit and away from people, you get what we have seen over the last year. An unwillingness to do the sorts of hard shutdowns necessary to control spread. A lack of response of the government to the people regarding the economic pain and anxiety of even partial shut downs. A public infrastructure eroded by neglect that cannot deliver tools such as PPE or vaccine efficiently. A general sense that 400,000 deaths to date is some sort of bearable collateral damage. A general message of we’re all on our own and good luck to you. Will that start to change this next week with a change of administration? I don’t know. The politics may change but the underlying economics will remain the same without some significant heavy lifting in all three branches of government and I’m uncertain that they’re prepared to do that.

In late January, 2020, a resident of San Jose by the name of Patricia Dowd, a woman the same age as I, developed flu like symptoms. Like most of us, she thought it was no big deal and stayed home treating herself. She died suddenly in her home on February 6, 2020. She was the first known US vicitim of Covid-19. 400,000 more have followed her since then. It only took us five weeks to go from 300,000 to 400,000 and thanks to holiday gatherings, the pace continues to accelerate. We will be at nearly 500,000 deaths on the first anniversary of her passing, more than we lost in four years of World War II and approaching the number lost in four years of the Civil War. We’re well on track for Covid-19 to become the worst mass casualty event in American history. I have hope that we will turn the corner this spring. Vaccines should become more available. They don’t necessarily prevent spread but they definitely prevent the serious forms of the disease that require hospitalization. There is an opportunity, with a new administration, to change the type and tone of public discourse. Better weather will allow more socialization outdoors which is considerably safer.

In the meantime, you all know what to do, vaccinated or not: Wear your mask, wash your hands, social distance, and avoid crowded indoor spaces.

I haven’t been able to write for a few days. I don’t often get writers block but every time I sat down to compose something this week I would stare at the keyboard for a while and then find an excuse to do something else. I’m not sure if it’s delayed shock and a need to process last week, a creeping sense of hopeless futility when looking at public health statistics around Covid-19, or just a feeling that I’ve run out of things to say about this peculiar moment in time that we all occupy, when the political and the medical are interlaced in such a unique way. I finally decided this evening that I’m just going to start typing and see what comes out. Sometimes the result is a relatively good piece, sometimes it’s a hopeless jumble massively in need of a rewrite. We shall see.

On the political front, we are just a few days from a change in administration. I, like most of my fellow countrymen, am waiting with bated breath to see if another shoe is going to drop in Washington DC. The most perfunctory look at the rhetoric spewing forth from the extreme right wing suggests that the contretemps at the Capitol last week was not the end and that there are forces out there spoiling for a fight. Will there be more violence in DC this weekend or around next week’s inaugural? I can’t even begin to predict. If you’d told me at Christmas I’d be writing about an invasion of the Capitol building with very real physical threats to Congress within a couple of weeks, I would have assumed you were telling a rather cruel joke. Will action spread from the nation’s capital to state capitals? There’s some suggestion that’s possible. Let’s just say I don’t think anyone will be caught unawares. The possibility of surprise is long gone.

The biggest problem to come out of all this is the continued embrace of the Big Lie – that the election was stolen and illegitimate – by a majority of the Republican Party. There isn’t a shred of evidence that this is true (and a great deal of evidence that it is not) but as long as this farcical notion remains in the air, it’s going to hang over the Biden administration and hamstring it. Politicians, who should know better but who have cynical reasons for continuing the lie for their personal short term political gain, look like they’re not willing to take down The Big Lie for the good of the country and that’s going to continue to be a huge problem going forward the next few years and will likely hamper public health responses and economic recovery. If the federal government is viewed as illegitimate in certain quarters, the motivation for cooperation for the betterment of society is lacking and that’s going to include the response to the corona virus.

We’re at 23.5 million cases of Covid-19 in the country today according to the Johns Hopkins Corona Virus counter. We will surpass 400,000 US deaths sometime between now and the inaugural. If that number were a city, it would be 48th in population in the US, between Tulsa and Tampa. The winter surge, fueled by holiday travel and gatherings, has shown no significant signs of slowing down either locally or nationally. The local hospitals are full. The staff are burnt out. I hear stories of horrible conditions from friends in California. Hospitalizations from Christmas should be starting to peak in another week, from New Years a week after that. Maybe by mid February we’ll start to see better trends.

The vaccines, while off to an encouraging start last month, are bogged down in the same lack of competent federal leadership morass that has taken down pretty much every step of our public health response to the corona virus pandemic every step of the way over the past year. Distribution remains problematic. Some of that is the logistics of transporting and storing a product that requires sepcialized temperature regulation and which has a very limited shelf life. (It must be administrered within six hours of being drawn out of the stored vial). This has led to a lot of head into wall banging in my VA house call program as so many of those patients live in remote rural areas and are not easily transported to a vaccination center. We’re going to have to figure out how to courier doses off to any number of rural homes from Birmingham under a hard time gun. And we can’t just go house to house. Each recipient is going to have to be monitored for a minimum of fifteen minutes after administration and, given the frailty of the population, thirty minutes is a better idea. Draw up in pharmacy + get to nurse + nurse driving to far far away + nurse administering and monitoring adds up to a number of hours and we won’t realistically be able to guarantee more than two or three in a day to fit it in that six hour window. Then we have to account for weather, road delays, the occasional flat tire, and chattering families, starved for company, who don’t want to let the nurse head off to the next stop.

I am deluged daily with calls, texts, DMs, emails, and taps on my shoulder in the grocery store asking about when so and so can get a Covid-19 vaccine. I have only one answer. I don’t know. All Covid-19 vaccine in Alabama is under the purview of the state department of public health. They have broken the population down into a number of groups. The first, called 1a, included health care providers and residents in congregate senior facilities. They’ve made significant progress in getting those vaccines out there. Group 1b, which includes first responders like police and those with significant chronic health conditions and those over age 75 will be eligible as of this coming week. The state and counties have set up hotlines for people to call to set up vaccination appointments. Those hotlines fielded over a million calls in a week and haven’t been easy to get through on. The last thing I saw was that all appointment slots were full and they were working on a waiting list.

The lack of coherent federal leadership means that pretty much every state is doing their own thing at the moment. Some are prioritizing community dwelling elderly, some are prioritizing those in occupations with more potential exposure such as store clerks and teachers. The CDC has issues guidelines, but not mandates and, from what I can tell, no one is paying a lot of attention to them. There was agreement that health care providers and congregate living seniors needed to go first but, after that, it’s devolving into a free for all. Add to that the so called ‘warp speed’ program of the executive branch that seems incapable of accounting for vaccine, where it is and how best to get it out there and we get announcements like the one this afternoon where they admitted their highly touted reserve supply which was going to be released to make up for shortages doesn’t actually exist.

There is one encouraging bit of news on the vaccine front. A vaccine candidate from Johnson and Johnson is starting to show some encouraging preliminary results. It is not an mRNA vaccine like the currently circulaing Pfizer and Moderna products. It uses a modified virus, one which cannot make humans ill, to transport DNA that encodes for the spike proteins of the corona virus into human cells. The cell then makes and expresses these proteins. The immune system recognizes these as foreign and gears up against them, protecting the person if and when the corona virus shows up later as the immune system already knows to knock anything expressing those proteins out. The adenovirus that carries the DNA is much hardier than the mRNA transport system of the current vaccines so it can be stored in a standard refrigerator and, best of all, it’s a single shot regimen. Data from trials is expected to be presented to the FDA in late January or early Februray.

It’s a long weekend. I have writing projects I need to get going on, legal cases that need reviewing, and I need to take down Christmas so I can reinstall my primitive green screen studio in the dining room. Next up: Tartuffe from the same people that brought you The Importance of Being Earnest in December. It’ll be your chance to see me in a 17th century wig.

The vaccine is getting out there, albeit slowly. There promises to be a more robust federal response on the public health front starting in less than a week. The weather will begin to warm so people won’t be as tempted to gather inside. It will get better. I have to keep telling myself that. In the meantime, vaccinated or not, you all know what to do: Wash your hands, wear your mask, social distance, and stay out of crowded indoor spaces. This is particularly important these next few weeks as the pesky British strain that’s more contagious appears to be starting to spread in this country and your local health care provider really doesn’t need the pace of people falling ill to accelerate.

And now it is Sunday afternoon. It’s cold in Birmingham, but the sun is out and it’s beckoning me to get outside and take a walk or do something else semi-outdoorsy. Yet here I sit, interior life roiling while I bang out another one of these essays that I have come to call the Accidental Plague Diaries. I’m still rattled by the surreal events of this past Wednesday and, as more and more information comes to light regarding just what happened on the grounds of the Capitol, I become more and more worried that this particular putsch was not the end of something, but rather the beginning of something.

For the most part, I’ve held my tongue on politics over the last ten months, other than the ways in which they intersect with health policy. I don’t especially believe in the vituperative name calling and attacking of personality that much of modern political discourse has devolved into. I believe in attacking misguided policies and problematic social trends. It’s never possible to truly understand the complexities, judgments, and motivations of an individual without knowing them intimately. It is, however, possible, to understand the actions of large groups of people through a study of sociology, economics, and political science. Le plus ce change, le plus c’est la meme chose. I’ve spent years writing political satire for The Politically Incorrect Cabaret. When doing that, I have a couple of rules I try to adhere to. Always punch up, never down. Punching down isn’t satire, it’s cruelty. Make fun of power and postions of power and the roles of power, not directly at the humans who inhabit them. It’s one of the reasons I have not ever been able to satirize the current president. It’s not possible to separate the person from the power and that’s one of the things that has made him so dangerous to our political norms.

There’s a lot swirling out there on the interwebs about the more violent elements behind Wednesday’s insurrection planning additional actions over the next week or so leading up to the inauguration. Whether there is any truth to these rumors, I do not know and will assume that the Secret Service, as a proud group of professionals, will do their duty to keep things safe for all involved and we will have no more paramilitaries stalking the halls of government buildings looking for politicians of opposing beliefs to capture and summarily execute. But do not color me shocked if violence rears up again next week.

The highest levels of government in this country have been lying perpetually for the last four years. Usually it’s been about little things that are easily disproven but, without shame, they shrug it off and move on to the next set of alternative facts. This has conditioned all of us, on both sides of the political spectrum to shrug off lies as par for the political discourse these days. Unfortunately, its also allowed a big lie, the lie that the 2020 election was stolen, to move forward unchecked. There is not one shred of evidence, other than the usual one or two vote errors that turn up when things are looked at with a microscope, that this is true but it became the underlying motivation for last week’s actions. The lie is still out there. It’s still motivating a substantial portion of the population. It’s still ascribed to by a significant number of national political figures for whatever cynical motives of money or power they may have. It no longer requires Trump for life and it’s going to hover over the Biden administration. The ironic thing, of course, is that there was a stolen presidential election in 2000 where everything hung on the state of Florida. All forensic recounts done show that Gore won the state and should have been awarded the electoral votes but the Supreme Court’s intervention tipped things the other way. The losers graciously accepted and there was some protest but no violence. One wonders where we would be today had we had a Gore vs a Bush presidency in the early part of this century. The current big lie about a stolen election is unlikely to slink off into the sunset in the same way and will probably motivate much of what is to come in both congress and the executive branch.

And this is my biggest fear. This is all happening in the middle of a worsening pandemic that has dropped right off the front pages. The numbers keep going up. Alabama is diagnosing roughly 5,000 new cases daily, the country is adding a million new cases every five days or so and the number of dead on a daily basis is now well over 4,000. This isn’t going away and, in order to start improving these numbers, its going to require an enormous amount of leadership from the incoming administration combined with logistics and resources to make sure vaccines are distributed, hospital pressures are relieved, and appropriate equipment and personnel are in the right place at the right time. If the Biden team has to spend all of its time shoring up political support and defending itself against the big lie, they aren’t going to have the energy and the resources to put into fighting the pandemic the way that they should. It means that the disease will keep on racing through the country, felling tens of thousands who don’t otherwise have to die. And it means that all of my brothers and sisters in health care who have been savaged physically and psychologically by the pandemic will have been written off by society as so much collateral damage, sacrifices on the altar of big lie politics.

A couple of personal stories that have come to my attention recently. In one, a good friend, whose family remains in Southern California, is worried about her grandmother. Grandma has had a fall and has some facial fractures and a subdural hematoma. She was taken to the ER and seen there. She needs neurosurgery to drain her subdural but the hospital is out of the supplies needed to treat her in the OR. Calls to every other hospital in the region reveal no space. She has been sent home to recover on her own the best she can. The family described the ER as a war zone with gurneys everywhere and tents over parking lots to accomodate the dying. She may become a victim of Covid without ever contracting the disease. In the second, a rising star of regional theater, who ran one of the most successful theaters in the Southeast known for its innovative productions, was exposed last year for a long history of racially insensitive and descriminatory actions. He was ostracized, the theater was shut down (more from pandemic related finanical issues than anything else), and he, despite being a gay man from a performing arts background, decided to begin marketing himself on social media as a radical right wing figure and quickly became a darling of Trump circles. There are unconfirmed reports that he was one of those in the Capitol last week. The morals of these stories? Don’t think it can’t happen here or that Americans are exceptional. Our health system is buckling due to years of neglect and moving of its goals away from health to the making of money and it can’t cope with the stresses of the pandemic. If you’re feeling alone and disenfranchised and helpless in life, it’s easy to be caught up in a different pattern if that one gives you positive reinforcement and validation.

I’m hoping the new work week gives me something more positive to write about. In the meantime you all know the drill, vaccinated or not: Wash your hands, wear your mask, social distance.

It’s another one of those sit bolt upright at 3:45 AM sort of nights with the head spinning full of half baked anxieties and bad dreams. When that happens, I never get back to sleep again so I might as well grab the laptop, start writing and see what comes of it. In my REM state just beofre I woke, I was having my cognitive faculties checked by some unidentifiable power with one of the standard mental status questions and I had just been asked to name as many words as I could that started with the letter ‘O’. Option, occidental, orthostasis, omicron… and then I was awake and aware.

I assume I’m processing all of the very bad news of the past few days in my own peculiar way. I deliberately did not watch the live news broadcasts of the Capitol takeover as I have come to the conclusion that televised news is in general bad for my underlying anxiety levels. Instead I read analysis, reportage and opinion later, all of which was accompanied by plenty of well composed still photos of what went on. I’m sure you’ve seen them to and for each of us, there is probably one that is the punch in the gut. For me, it was the one of a man flouting the Confederate flag through the rotunda, something that never happened during four years of Civil War. A close second was a trampled American flag replaced on a stand by a Trump 2020 flag. The semiotics of flags is interesting. How we put so much meaning into scraps of colored cloth and how they come to hold our most cherished dreams or deepest fears and even the briefest glimpse of a universally recognized one in visual media, such as the Nazi banner, can immediately change our whole worldview. The last show I did before the shut down, Cabaret, immediately shifts in the audience’s perceptions with the appearance of a small swastika near the end of the first act. One of these days I need to read a good book on vexillology if anyone has a reccomendation.

We may all be distracted by political theater but the corona virus is not going away and continues to pose an imminent threat to the stability of the health system. We’re now topping 4,000 deaths daily in this country (that’s 30% higher than 9/11 and 40% higher than Pearl Harbor on a daily basis). Our local hospital systems are inundated with beds going into waiting areas and some people, who require monitoring but are not in imminent danger, being shuffled into close by hotel rooms. There hasn’t been a day in the last two weeks when I haven’t heard of a friend being diagnosed. Fortunately the majority are young and healthy and seem to be recovering without major incident but I am also receiving daily calls from friends about grandparents, great aunts, and other cherished elders who are not doing well.

My major thought of the day is that the corona virus and our politics are fundamentally the same. Something invades the body or the body politic and quietly goes about its business unseen and ignored until all of a sudden it bursts forth in a reign of havoc. On the micro level, the virus enters the body, generally through the respiratory tract. It’s a simple organism, a protein capsule containing its basic genetic information that allow it to create the proteins of which it consists. It’s so simple that it uses RNA rather than the more involved DNA for its genetic code and doesn’t have the cellular machinery to even replicated itself. Instead, it’s spike proteins attach to host cells, it injects its RNA into those cells and uses the host’s own mechanisms for its replication. One successful viral attachment can lead to that cell releasing thousands of copies of that virus which then go on to attach to other cells and repeat the process many times over. Eventually, the hosts immune system is going to notice the rising tide of invaders and react and the symptoms of disease appear. The devestating consequences of Covid-19 are often the result of an over action of the immune system resulting in inflammatory changes which can lead to organ failure and death.

In the same way, one virally infected individual can enter a social group, appear to be healthy, have no signs or symptoms of disease but shed virus easily to others through close contact and respiratory droplets. If the asymptomatic period is prolonged, the contacts then go on about their business, never realizing they have been exposed and carry it on to others. This coronavirus is infectious but not as infectious as a lot of other common human viruses so it’s quite dependent on human behaviors of congregation to propagate. Transmissibility can be curbed through simple measures such as social distancing and mask wearing. When we refuse to adhere to these simple public health measures, the virus, having no brain or thought, simply takes advantage of our own conscious choices that benefit it. The result of the spread is more and more sick people and, with the traditional gatherings for holidays, the numbers have soared quickly. Our country’s immune system against disease, health care, is becoming overwhelmed and may start to react in ways due to the pressures put upon it that may ultimately end up being damaging, a sort of institutional auto immune process. We’re just very lucky that Covid-19 has a relatively low mortality rate. If the mortality rate were the same as its very close cousin SARS, we’d be counting the dead in the multi-millions currently.

On the political front, there have been inoculums of misinformation, disinformation, and fantasy injected into public discourse. They’ve bred in the darker corners of social media such as 4 chan and 8 chan and Free Republic and seem to be combinations of regurgitated talking points from the Protocols of the Elders of Zion, Mein Kampf, and The Camp of the Saints. They have, through widespread social media, entered the minds of those who understand on some basic level that the political system is no longer responsive to the people, but to wealthy donors who fund campaigns. Those ideas have churned quietly in the dark for years, fertilized by a media ecosystem who understood that they could be mobilized politically, amd have been used by political, economic and religious leaders as a base upon which to amass power and wealth without actually understanding or wanting to do much of anything about the conditions stoking the grievances. The body politic is now fully infected, the show down at the Capitol yesterday was just a symptom that cannot be ignored. The responses I see from many in power are like those of most American’s to disease. Let’s just go down to the urgent care clinic and get a pill and everything will be normal again. I don’t think that sort of magical thinking is going to help in the situation we find ourselves in. The latest polls show that half of rank and file Republicans are convinced that Wednesday’s events are some sort of false flag George Soros/antifa plot. The usual corners of the conservative media ecosphere are bubbling with ‘this is just the beginning’ rhetoric. We’re going to see more. And what of the immune response? Power protecting itself from those without? Will it be proportional or will we develop a severe civic autoimmune disease worse than the original infection? I don’t know. I couldn’t have imagined the events of this year a year ago so I have no idea where we’re headed.

What can I do? I can get my second Covid shot later today. I’ll take whatever after effects it may give. I feel it’s my civic and professional duty to do anything in my power to keep the disease from spreading and to set an example. The serious side effects such as anaphylaxis rates among the beta test group of health care professionals and long term care residents that have been vaccinated so far appears to be about 11 in one million and, as far as I know, no one has died. The current death toll from Covid in the US is about one in fifty. I’ll take my chances with the vaccine.

In the meantime, you all know the mantra. Even if you’re vaccinated: Wash your hands, wear your mask, social distance.