January 7, 2022
Dear Interested Readers,
Thoughts on COVID, January 6th, And The Future of Healthcare In the Bleak Midwinter
If you remember my multiple previous comments about “In the Bleak Midwinter,” a poem by the English poet Christina Rossetti, I apologize for the redundancy. It is my favorite winter hymn and its melody and first lines pop into my head with regularity this time of year. “In the Bleak Midwinter” reaches far past the Christmas Holidays for me. The first words and the sad melody paint an accurate picture of my world in January and February.
According to Wikipedia Rosetti published the poem as a “Christmas Carol” in 1872. It was just a poem until 1906 when the composer Gustav Holst put it to music, and it appeared in The English Hymnal. I have no way to explain why despite thousand of hours of “pew” time I never heard the song during the first forty years of my life. Perhaps the explanation is rooted in geography. Why would people in Oklahoma, Texas, or the Carolinas, the states where I grew up and where I was taken to church by my parents at least three times a week, ever want to sing about a bleak midwinter?
I first heard “In the Bleak Midwinter” as a Christmas carol when my wife and I began to attend The Wellesley Hills Congregational Church in the early eighties. Prior to that return to religion, except for a brief flirtation with Unitarianism, I had taken almost two decades off from attending most religious gatherings. I was approaching forty when my wife and I began to attend church again with our young sons. We returned to provide them with the cultural experience, and we felt that they should have the choice that we had enjoyed of rejecting or accepting church from a position of experience when they grew up. I should add that what I did not expect was to discover that the return would provide deep meaning for me. For the last thirty-five or more years and despite many disappointments with organized religion, I have been more focused on the positives of the religious experience, and I am very grateful that I did return. I should add that these days I am the “moderator” of the First Baptist Church of New London, New Hampshire where we can look out the window on a postcard winter scene of the quaint New England village as we frequently sing “In the Bleak Midwinter.”
To my great delight, James Taylor included “In the Bleak Midwinter” in his 2006 Christmas album. His production is very full and rich. You should follow the link with his name and listen to the song if you are not familiar with it. If you have heard Taylor’s version, I am sure it will “do you good” to hear it again.
The song just feels like winter. The words of the first verse paint a picture for me that extends far beyond Christmas. In my mind, the description of winter in the first verse is a better match for January through February than for the Christmas season in our era of global warming when it often takes long after the “Holidays” and deep into January before winter becomes a serious persistent concern. What do you think?
In the bleak mid-winter
Frosty wind made moan
Earth stood hard as iron,
Water like a stone;
Snow had fallen, snow on snow,
Snow on snow,
In the bleak mid-winter
Long ago.
Today’s header is a picture from mid-December when “frosty wind made moan” only for a few days to be followed by days when the thermometer climbed to the high forties and low fifties before dipping again to numbers when the lake could resume its preparation for skaters and ice fishermen who want to drive their pickup trucks over the same place where a few months earlier they floated a boat hoping to catch a rainbow trout or a fighting largemouth bass. Waiting for the time which is coming when we can say “Earth stood hard as iron, Water like a stone; Snow had fallen, snow on snow, puts me into a melancholy and reflective mood. My mood is enhanced by the fact that there is a natural letdown after the holidays and rarely anything positive about early January. Going forward for many years, I am certain that the feeling of early January will always be “heavy” after the events of January 6th last year.
January 6th has been a depressing day for me since 2013 since it was the day my mother died two months short of her ninety-fourth birthday. You can imagine my distress when on the eighth anniversary of her death a mob of hooligans was driven to a frothy madness by a president turned traitor to democracy. His greatest lie of the more than thirty thousand lies he told over four years in office was that he did not lose the election, In his continuing narcissistic psychopathology, he incited one of the lowest points of our national history. It amazes me that a year later his is marking the time until the next election from the luxury of his Florida compound rather than passing his days behind bars. It is mind-boggling that he remains an active participant in our national dialog, and the embodiment of much that we should fear,
This January is especially depressing because there is so much illness, so much unmet need in communities across the land, so many who are homeless or are losing their homes, so much strife in our politics, so little progress in Washington, and the denial by so many Republican members of Congress of the disgraces that occurred last January. We are a riven land with extremely bimodal demographics characterized in the extreme by excessive wealth and opportunity for a privileged few and extreme need for too many who live in shadows that a complacent middle majority can too easily ignore. The “average” experience hides gross injustices and the substrate of future misery for all.
The debate about what happened last January 6th is yet to be resolved and the fact that tens of millions of Americans chose to act like nothing of significance happened means that it could occur again. “Likely to get worse” applies to almost every aspect of our lives. Even as my lake and the ground where I take my daily walk are just moving into the first moments of their midwinter hardness at this late date because the planet continues to warm, there is evidence on a daily basis that something worse could yet happen in the worlds of climate, politics, and viruses because of the reality that we seem collectively afflicted with militant self-interest.
I am left with the idea that the best strategy for 2022 is to expect that our challenges will be greater than dealing with iron-hard frozen turf, water that is like a stone, and tons of snow. Perhaps the best strategy is to expect and prepare for the fact that in 2022 COVID will mutate again into an even greater challenge, that our most recent ex-president will find a way to continue his efforts to regain power, or that someone younger and perhaps slicker than he is will continue his effort to turn us into an illiberal former democracy that appeals to the traditionally advantaged.
Usually, at this time of the year, we try to generate a positive outlook that will enable us to get through the certain challenges of midwinter. That strategy did not work last year and is likely only to foster disappointment this year. If we give credence to the possibility of growing rather than diminishing challenges then perhaps we will find the will and the way to turn the potential for a continuing decline into unrealized concerns that are “near misses.”
I would love to be able to say this time next year that collective wisdom prevailed and that somehow we had an unexpected awakening and change of attitude that allowed us to pass the legislation that improved our elections, addressed the challenges of tens of millions who live in need, and allowed us to find the collective wisdom to work together using our medical expertise in a unified effort to irradicate COVID and to avoid in the future the sort of fears, losses, and disruptions that we have endured since March 2020.
This is primarily a healthcare blog. COVID is an obvious subject for a healthcare blog. I frequently struggle with how much I should venture beyond the traditional boundaries of healthcare to discuss the societal issues that increasingly impact healthcare. Between the inauguration of President Trump in 2017 and the inauguration of President Biden in January 2021, I felt that healthcare was mostly treading water. The objective was not to make big improvements in the quality and availability of adequate care. The objective was to hang on to as much of the ACA as possible. The most significant event of the first three years of Trump’s presidency was the dramatic downturn of John McCain’s thumb. I disagreed with many of McCain’s political positions, but I see him as a great American who cared deeply about the integrity of our government and the maintenance of our 250-year experiment in democracy. The last year of Trump’s presidency was medical and political chaos that did not vanish when he reluctantly left the White House.
In the aftermath of Trump’s presidency, we have seen that his continuing reluctance to accept the results of the election has emboldened others to mimic his defiance and prepare for his return with attempts at skewing the voting process for 2022 and 2024. In some difficult to understand ways part of the strategy to regain control of the government seems to be non-compliance with common sense moves to combat COVID. It is bizarre to imagine that a risk factor for the acquisition of a COVID infection is your political party affiliation! A piece from NPR comments on this strange strategy and the price its devotees pay:
Since May 2021, people living in counties that voted heavily for Donald Trump during the last presidential election have been nearly three times as likely to die from COVID-19 as those who live in areas that went for now-President Biden. That’s according to a new analysis by NPR that examines how political polarization and misinformation are driving a significant share of the deaths in the pandemic.
NPR looked at deaths per 100,000 people in roughly 3,000 counties across the U.S. from May 2021, the point at which vaccinations widely became available. People living in counties that went 60% or higher for Trump in November 2020 had 2.73 times the death rates of those that went for Biden. Counties with an even higher share of the vote for Trump saw higher COVID-19 mortality rates.
It’s not the first time in the history of humanity that science and good sense were negated by a significant vested interest, but it does make the case for my assertion that over the past five years my “Healthcare Musings” have often become “Political Musings.” Political parties and politics, in general, have become a public health concern. I am using that observation as evidence that I should give up any residual qualms about the creeping expansion of the focus of this weekly letter into politics. I am absolutely convinced that former President Trump and those Republican supporters who continue to bend their knee to him are a public health threat. Their objectives are not compatible with the Triple Aim or any logical attempt to establish several of the primary objectives of progressive medical practice: equity, patient-centeredness, safety, efficiency, timeliness, and effectiveness, as described in Crossing The Quality Chasm. I will rest my case with the experience we have all witnessed with COVID. The current administration has been working against a very aggressive virus, but the challenge of its infectious disease problem has been exacerbated and enhanced by the concerted efforts of its political rivals.
I was delighted that yesterday the president used his speech on the first anniversary of the atrocities at the Capitol to finally present a defiant response to the disgraced ex-president and his fawning minions. If you did not hear the speech let me make it easy for you to “catch up” by either hearing or reading the contents. Just click here. During the speech, Biden never used the name Trump, but rather referred to his predecessor as “former president.”
My fellow Americans in life, there’s truth. And tragically, there are lies. Lies conceived and spread for profit and power. We must be absolutely clear about what is true and what is a lie. And here’s the truth: the former president of the United States of America has created and spread a web of lies about the 2020 election. He’s done so because he values power over principle.
The speech was a withering indictment of the former president’s crimes and the complicity of many powerful Republicans both in Washington and in the states. As speeches go it was inspiring if, like me, you have been waiting for someone to take off the gloves and vigorously defend the sacred part of our democracy that calls for leadership and power to be determined by the vote of the people.
Not everyone in the liberal media was entirely pleased with the speech. Zach Beauchamp writing in Vox said:
The reviews were positive. “Biden hitting all the right notes here, and hitting them hard. A reminder of how powerful the Bully Pulpit can be,” Washington Post columnist Karen Tumulty tweeted. “Is anyone on the right listening?”
But it’s far from clear that the “bully pulpit” is powerful at all. Historically, there’s been little evidence that presidential speeches have advanced legislation or changed the opposing party’s or the public’s mind on major issues. More recently, we have had no shortage of speeches from Biden, Barack Obama, and other Democrats extolling democracy — yet Republicans, Senate moderates, and large swaths of the public remain unmoved.
If anything, Biden’s speech is a reminder of the hollowness, even futility, of his pro-democracy rhetoric. Facing a Republican opposition that’s closed ranks around Trump and a 50/50 Senate where pro-filibuster Democrats have veto power, there is only so much the president can do. Tellingly, the speech contained no new concrete policy proposals for protecting democracy from ongoing efforts to subvert it.
Beyond the criticism of the speech and the lack effective action over the last year, the piece ends with a sense of ultimate futility:
The question posed by Biden’s January 6 speech, then, is not whether it will persuade anyone important to think about these issues differently. The odds are that it won’t.
Instead, the question is whether it’s a signal of a course correction: that the Biden administration will live up to its own lofty rhetoric and start taking more concrete steps to combat the mounting threats to democracy. That, more than the speech itself, will determine the Biden administration’s role in the history of American democracy.
My spirits were lifted by the speech, but my own sense of reality confirms much of the sense of futility expressed in the Vox article. Perhaps it is understandable that across the land there was no great expression of regret for what did happen, no movement to defang Trump, and no evidence that any Republican leader was paying any attention or cared at all about the risk to democracy that the president addressed. I wondered what John McCain might have said. I am deeply grateful for the courage and patriotism of Adam Kinsinger and Liz Cheney, although I would find many of their policies to be short of my hopes, that is the way democracy should be.
So, 2022 begins with a continuing threat from the ability of COVID to evolve to match many of our defenses while on the political front there is a continuing faceoff between the parties that is unlikely to serve any of us well. I have no doubt that we will survive the bleak midwinter, but I remain very concerned that a lack of progress on the issues that divide us will continue to threaten the ultimate health and aspirations of all Americans and I am not sure that our democracy can survive much more stress. My concern encompasses the haves and the have-nots. We all are on a trajectory for even greater losses. My own limitation of one vote in a small state leaves me nothing to do but express my concerns to you and continue to look for ways in 2022 that I might be of some benefit to my neighbors who might not have shared the good fortune that has come my way.
Walking “In the Bleak Midwinter” With Care
Last July one of my sons and his wife surprised me with the gift of a Peloton for my birthday. They knew that with the foot drop that I had acquired when I fell on an icy road last winter I was riding my bicycle for exercise. They also knew that bicycle riding outdoors would be a challenge when our very hilly roads became icy. I have enjoyed the challenge of the “virtual road” that the Peloton has offered me when it was either too wet or too cold to be riding outdoors. I did not realize that there was an automatic “wind chill factor” when riding a bike on hilly roads. Forty degrees can feel like twenty-five degrees, and even with “double gloves” my hands (I have Raynaud’s) can be like concrete on the handlebars. When I use the Peloton I pass on the classes with the buff young men and women less than half my age who are willing to make me feel hopelessly inadequate. I prefer the scenic rides I am offered on the screen in places like The Big Sur or Costa Rica.
What neither my son nor I knew in July was that with the help of a foot drop device I would be able to walk on the roads at a reasonable speed by year-end. I am happy to report that I can now hobble along on our hilly roads at a respectful clip of under twenty minutes a mile for four miles! I am as delighted with that ability as I was a little over forty years ago when I could maintain a pace close to six minutes a mile for a whole marathon. My ability to dorsiflex my left foot is gradually improving! My neurologist is encouraging. Having people care about you is a great therapeutic benefit! I have high hope for 2022 for my own heath, if not for the continued health of the “body politic.”
I plan to be careful this winter when I do venture out. I have a plan to deal with the realities of the bleak midwinter. I have new hiking poles to go along with my microspikes, and more subtle “fit over” ice grips. I will use the Peloton with great gratitude when good sense precludes an outdoor adventure. I am more hopeful for my own success with exercise this winter than for the success of passing the Build Back Better bill or for the passage of meaningful voting reforms. What I have learned is that improvements in physical deficiencies can occur. I am not yet willing to give up the hope that whether or not COVID passes we will be able to find some way to overcome the political obstacles and move a little closer to the Triple Aim. Good luck to us all this year. It is going to be a challenge, but despite the fact that we are in a political “bleak mid-winter” it is not time to give up hope.
Be well,
Gene
