- Glenn Sonnenberg
Musings from the Bunker 1/5/21
Good morning! While all eyes are on Georgia today, I can’t stop thinking about whether and how this pandemic is ever going to end, how our COVID vaccination program is going and how long this is going to take… I share with many of you “COVID fatigue” and try to explore its various manifestations. Get your coffee and settle in; this is a longer one… COVID FATIGUE It’s been a long time and most of us have been dutifully following the sporadic mandates passed down to us by those in leadership. We were told the vaccine was nigh and here it is. But its implementation has been slow and fitful, with little transparency. There are new strains of the virus that are more contagious. There are rising numbers of patients at hospitals that are overcrowded. We are asked to further curtail our behaviors. Our fatigue and sense of endlessness is increased by poor messaging (or lack of messaging) regarding the vaccine. At this point many ask, “Why should we believe anyone?” Some are “throwing in the towel” and giving up on a few fairly simple rules that can reduce the spread of the disease (and, therefore, the strains on the healthcare system). There are reports of large parties and group gatherings. Mask wearing apparently remains optional. People are cheating around the edges with extended family. I understand the fatigue. It’s hard to do anything for a long period of time. It is even more difficult when the rules keep changing and there is little sense of what will be expected after the vaccination process is in full swing. But these actions make it worse. How do we “gut it out” in light of COVID fatigue? COVID ANXIETY There is something as insidious as COVID fatigue. We all now suffer from something a bit different, namely, COVID anxiety. I worry about how the vaccine is going to be distributed and administered. I worry about the lack of trust in science. I worry about the likelihood that some people will not agree to be vaccinated. I worry that people won’t get the second inoculation. I worry that people’s behaviors may revert to “normal” once they think the vaccine has solved all their problems. Mostly, I worry because our leadership—at all levels—doesn’t seem competent, isn’t being honest and isn’t sharing information. I worry about what I don’t know far more than what I already know... We human animals are motivated not only by fear but by hope. And we are offered far too little of that. For those who have seen read The Splendid and the Vile or are otherwise familiar with Churchill’s leadership, we know he was brutally honest, “we will bear any burden; pay any price.” But he also offered hope…that there would be a payoff and that it would come soon. We will need a lot more guidance, trust, transparency, honesty, and shared purpose to make it through the vaccination project, so we really know better what we’re up against and what a realistic timetable looks like. FEAR OF THE UNKNOWN COVID anxiety is also related to fear of unknown consequences. Fear of the known is quantifiable, while the unknown is not. I know that when I get behind the wheel of a car I am to some degree putting myself at risk. I know that smoking cigarettes would increase my risk of lung cancer. But I have a pretty good idea how to mitigate these risks, if I choose. Most of the risks that we take have known likelihoods and known consequences and we can act accordingly. One of the many things insidious about this disease is its randomness of infection and randomness of effect. And this produces anxiety. My mental image here is that of a hundred-chamber revolver and a game of Russian Roulette. I imagine that 35 of the chambers are empty. Another 50 contain a bad dose of a virus that may persist for weeks and could have longer-term minor effects. The next 10 will require a hospital visit, several of which will require a stay in ICU. The last two bullets will kill me (given my age and gender). This is a game I’m unwilling to play. I can’t know which of my behaviors will bring on the disease and I have no advance knowledge of the likelihood of these results—so I remain pretty careful (and, of course, because I have the luxury of working from home, I can stay safely at home). Another level of unknown is just where I can feel safe and whom I can trust. Of course I trust my friends. I’m just not sure how many other people they trust. And how many people their children trust. I’m pretty sure I shouldn’t be out in public too much—certainly not indoors. I’m careful to wear a mask on hikes and give people a wide berth. Andrea and I have curtailed our activities significantly. But while I can make choices that I know will have the desired result (e.g., not drinking and driving, not smoking cigarettes and not skydiving), I can’t really assume that my actions will ensure safety. The anxiety of this disease is that miniscule seemingly inconsequential decisions could have enormous consequences. And how stupid would I feel taking a small risk and finding myself in ICU because I had to have that cappuccino at Starbucks. Add to this anxiety that, as much as has been learned about the disease thus far, we really know little. WHO’S IN CHARGE I sometimes feel like we are in one of those train movies where the passengers sit comfortably waiting for arrival at their destination and the train picks up speed. Some concerned passengers head to the engine only to find that there is no one driving, all while the train continues to careen down the rails. We are like those passengers—taught all our lives to have faith in those who are in charge—because they are dedicated to our best interests and they are experts in their field. These two assumptions are very much in doubt. In our present circumstance, we have been given little direction from the federal government and not much more by the State and local governments. Our scientific experts serve at the pleasure of elected politicians, before whom they are careful to mind their tongues. Anthony Fauci and others experts, whose advice should have been heeded earlier and followed more stringently sooner, are indicating that the worst is in front of us. Certainly we can expect the surge from the holidays and new years to continue through January. In the meantime, we are WAY BEHIND on the administration of the vaccine. We were promised over 20 million vaccinated by the end of December and barely cleared 2 million. With a population of over 330 million, we have vaccinated approximately the same number of people as Israel, with a population of 9 million. Dr. Fauci was on TV this weekend bragging that we have reached 500,000 vaccinations a day. At this pace, it will take two years to administer the vaccine (assuming only one dose is required; although the Pfizer and Moderna vaccines require two). How do we address the fatigue, not knowing when it can be expected to end? There are reports of people “cutting the line” for the vaccine. I worry less about “cheating” or favoritism around the edges—I care more that the States open up the distribution program and make it quick. There are reports of unused vaccinations sitting at pharmacies waiting for direction from the authorities. Hospitals apparently are being told they cannot administer excess vaccinations without further instruction, for fear of state-administered penalties—which instruction is slow in coming. The federal government says it’s the States that are responsible for implementation and the States blame the federal government for lack of guidelines. The local governments blame both. Who is in charge? FAILURE OF COMMUNICATION AND LEADERSHIP Worse than getting bad advice may be getting conflicting and ever-changing advice. It hasn’t just been the federal government. Our state initially seemed on top of this, creating several thoughtful levels of reopening that would be triggered by certain caseloads and hospitalization utilization levels. No sooner had these been publicized than they were completely ignored and “reopening” was accelerated. Restaurants were opened precipitously, only to be later closed. No distinctions were made for distancing and ventilation. And all this while, although you couldn’t eat indoors (and now not outdoors either), getting a tattoo was okay. Meanwhile our governor was caught with his napkin in his lap at the French Laundry [SIDE NOTE: Shocking as it may be to believe, I’ve never been to the aforementioned restaurant because (a) I don’t plan that far in advance, (b) I don’t like multiple course gorge-fests, (c) much of the preparation is overly precious, (d) there are no substitutions, and (e) the price can’t be justified…]. This is just one example of the elites ignoring the requirements they themselves encourage us to follow. Our President flagrantly dismisses the advice of our public health officials and stages super-spreader events. Messrs. Trump, Pence, Mnuchin and others have been vacationing this holiday season, away from Washington and in groups. It’s being played out again and again by celebrities and politicians who seem to believe the rules only apply to mere mortals. Our leaders are confirming to us that they aren’t subject to the same rules and their words have little value. I can’t imagine Churchill or FDR, or even Reagan and Clinton, ever behaving like this. During the London Blitz, Churchill and his family remained in London to show the people they were all in this together. Today, it feels like we are all alone. WHEN DOES THE VACCINE GET ADMINISTERED TO THE REST OF US? My COVID anxiety becomes COVID anger when I think of the ineptitude of the authorities creating the means of vaccine distribution and accurately conveying that information in a timely fashion. It originally was claimed that at least 100 million are supposed to be administered by the end of February (that seems unlikely). We have seen the first deliveries of vaccines and we have seen the highly publicized “celebrity inoculations.” After that, not much more. While some 11 million doses were reported delivered by late last week, somewhere over two million had been administered. Now that delivery is underway and administration to health care workers has begun, we are told residents and workers at nursing homes are next, followed by those over 75. I have two in-laws who are octogenarians. They have yet to hear anything about how this is going to work. So how is it going to work?
Will they receive an appointment date?
Will they instead receive a time block within which to get the shot?
Is there a place to log in one’s data to get on a list?
Do they do it at a local hospital or clinic?
Or will it be at the local CVS or Walgreens?
And will there be lines?
And what identification will be required?
And will there be a medical professional on staff to ask whether there are current other ailments that might interfere with the efficacy of the vaccination?
And how will they be tracked and reminded of the second required dose?
After the over 75 cohort, it’s the “essential workers” and those with pre-existing conditions. What’s the methodology for that? Proof of employment and job description? Doctors’ notes? Will we inoculate families together when one qualifies? Will there be a public service campaign on the airwaves and in the papers to inform people? And what about people for whom English is not their primary language? And after these groups, who next? And how will it be decided? Do we go down five-year age increments? What about teachers? Our public officials have had months and months to address these very same questions and yet we have shared few answers and have provided little direction. The anxiety level is high because the answers don’t seem forthcoming, and those messages to date have been anything but clear. This feeds on the fear of the unknown. As I’ve said, fear of the unknown is more anxiety inducing than fear of known risks. WHAT TO DO AND WHAT TO MAKE OF IT? I think about my control over the current situation not unlike getting into an airplane. I have no control over the flight and am relying upon the skills of the folks up front and their shared interest in a safe voyage. Since I have little control, I have to roll with the punches. That said, I can choose which airline to fly next time. And I have to say that the ineptitude of our federal, State and local governmental authorities makes me realize how important my vote is and that our elected representatives have failed more than they’ve succeeded. We have a right to demand better and a responsibility to ensure it happens. What I believe this pandemic, the economic calamity and the malicious and fraudulent claims of election fraud have laid bare is the inequities and the sheer unworkability of many of our systems. Our health care system, food preparation sites, mail delivery, elder care, educational systems, public messaging, emergency preparedness, and democratic institutions have failed us and remain in a sorry state. They need to be fixed. I hope the new administration is up to the challenge. As JFK said, “We do these things not because they are easy but because they are hard.” We will live through this. One day at a time. Stay safe and wear that mask! Glenn