December 31, 2021
Dear Interested Readers,
Reflections On 2021, A Very Unusual And Unpleasant Year, And Hopes For A Better 2022.
If you are reading this letter, you have survived a tough year. Well, maybe, there are a few hours before that is certain. On December 31, 2020, I was delighted to hope that the suffering and vulnerability of 2020 would be quickly fading from memory because soon we would all be vaccinated. Silly me, I thought that almost every American was as eager as I was to get vaccinated so that we all could get back to the life we had always taken for granted. Despite over fifty years with M.D. after my name, I was also naive enough to hope that just as we had virtually irradicated polio and smallpox from the planet, we would soon rid ourselves of our COVID concerns. The realities of 2021 have been a series of incredible disappointments punctuated with a few moments of hope. The emergence of the Omicron variant has just been the latest, and probably not the last in a rolling series of COVID surprises and disappointments. My biggest surprise and disappointment of the year was that millions of Americans elected to not get vaccinated.
I can’t argue with confidence that “vaccine reluctance” has contributed to the fact that there have been more deaths from COVID in 2021 than in 2020 when we had no vaccine. It feels tragic that so many deaths have occurred when there has been an opportunity for everyone to get vaccinated. In my perpetual naivete, I had hoped that a vaccine would save us all and end the pandemic.
In the midst of an evolving disaster, it is hard to see the big picture. Your attitude is largely developed from what is happening in your immediate vicinity. It takes a little while to get the statistics that describe the universal experience so you can be easily startled when you read a fact like life expectancy in America fell almost two years in 2020. Since there were more deaths from COVID in 2021 than in 2020, we can only expect that life expectancy will be worse yet when the final score for 2021 is known. The numbers have been even more of a concern for Black and Hispanic Americans. COVID is now credited as the cause of more than 800,000 deaths from COVID since February 1, 2020, but the CDC reports that there have been 937,372 more deaths in America between February 1, 2020, and December 18, 2021, than would normally be expected. People have died with COVID and many probably died of other causes because so many patients with COVID blocked access to the resources that were critical to their survival from non-COVID causes. Our resources for care have been pushed to the limit, and many care providers are deciding they can no longer tolerate the strain. One in five healthcare workers has left the field since COVID began. It is disturbing to realize that more than half of the deaths from COVID have occurred since we have had effective vaccines. On December 17 the CDC reported:
The United States recently surpassed 50 million COVID-19 cases and 800,000 deaths since the start of the pandemic. This week also marks the first anniversary of the first COVID-19 vaccination in the United States. In recent weeks, COVID-19 cases and hospitalizations have increased, with many parts of the country experiencing substantial or high levels of community transmission. These increases and the recent emergence of the Omicron variant highlight the importance of prevention strategies to help people stay safe and reduce the spread of the virus that causes COVID-19.
In the face of such a dramatic and economically crippling collective experience, it is a staggering reality that millions of Americans have chosen to remain unvaccinated. According to a CDC report as of December 14, about 85% of adults ages 18 and over in the United States have had at least one dose of some vaccine. It sounds good that only 15% of Americans remain completely unvaccinated. That 85% may be better than it sounds since many people, including some members of my family, got the Johnson and Johnson vaccine that initially required only one injection. It was also a surprise for me to read that the Johnson and Johnson vaccine with a booster may be particularly effective against the Omicron variant.
Of the 15% who have had no level of vaccination, the reasons deserve review. The graphic below from a recent article from the U.S. Census Bureau identifies the explanations that the 15% offer.
What is a disappointing reality is that the Omicron variant has infected many people who are vaccinated. Vaccination may protect many of us from severe illness, but in no way does it prevent the spread of the virus which seems to lead us to the conclusion that COVID will be with us for a long time, and Omicron may not be the last variant to challenge us. It is frightening to imagine that future COVID variants may be even more resistant to our current vaccines. It is easy to imagine us moving into a new reality that requires a new vaccine every year or even more often as we currently need for the flu.
Suffice it to say that the ability of new forms of the virus to emerge places us in a continuing position of uncertainty. An article from December 29 in “The Independent,” a British online newspaper, sums up the current situation in Britain and reviews what the British have found to be true so far about infections in people who have been vaccinated. The article emphasizes the uncertainty that we face about vaccine effectiveness (I find it “quaint” that they use “jab” to describe vaccination injections) :
The most up-to-date analysis by the UK government’s Health Security Agency indicates that two Covid jabs do not offer strong protection against symptomatic infection from the new variant, with the current suite of vaccines less effective than they were against Delta.
However, those who have received a booster jab remain up to 70 percent protected, the agency found, underlining the importance of getting a third shot as soon as possible.
Earlier results from studies conducted by the German Centre for Infection Research likewise found that there were significant reductions in antibody potency for the Pfizer/BioNTech, Moderna, and Oxford/AstraZeneca vaccines against Omicron.
Seventy percent effective means thirty percent ineffective. A little further on the article again references the uncertainty that has plagued us for the last year:
A small study has suggested that Omicron may be able to better evade the protection offered by the Pfizer/BioNTech vaccine than the initial Covid virus type.
There seems to be a “very large drop” in immunity against the new variant among those given Pfizer’s vaccine, said Professor Sigal after his laboratory studied the blood samples of 12 people who had been vaccinated with the jab.
Moderna is yet to publish any official results on the efficacy of its jab against Omicron but president of the company, Dr Stephen Hoge, said there is a good chance current vaccines will not hold up as well against the variant.
Speaking to ABC News on 5 December, Dr Hoge said: “I think that there’s a real risk that we’re going to see a decrease in the effectiveness of the vaccines. What I don’t know is how substantial that is.”
COVID reminds me of that scene from the end of the popular 1987 movie “Fatal Attraction” with Michael Douglas and Glen Close. Each time Douglas’ character thinks he is finished with Close’s character she comes back again with another attack. Will COVID come back again and again with a vengeance that eventually exhausts us? I hope not. I would like to think that we will make great progress in 2022, but nothing seems certain except the need to get maximally vaccinated as recommended and continue to mask up each time we go out in the world. I feel that as the winter progresses we may well need to reinstate some of the restrictions that we used in 2020. Can you imagine the Super Bowl as a super spreader event for COVID?
It is hard for me to separate the infectious disease disappointments this year from my disappointments with the way the year has unfolded politically. The events in Washington on January 6 demonstrated with no uncertainty that COVID is not the only national malady that needs more effective management. I am a strong advocate for all of the human infrastructure improvements that we would experience collectively with the passage of the Build Back Better bill as originally drafted. With each cut made in deference to the conservatism of Joe Manchin, I winched a little, now he says that he wants none of it. There have been a lot of mistakes along the way to where we are, and Manchin’s behavior seems like “deja vu all over again.” It is usually the Republicans that gut a bill by implying that if the cuts they want are made they will be supportive. In the end, after the bill is a slim shadow of the originally drafted legislation they withdraw their support. Manchin seems to be taking a page right out of the Republican playbook.
Over the last fifty-plus years, we have been on a social services diet. I can easily remember the years before Lyndon Johnson lost his way on the road to Vietnam. Then came Nixon. Then poor Jimmy Carter’s feeble attempt to use government to improve the lives of millions got shanghaied by the mess that the Ayatollah made for us in Iran which set the stage for Ronald Reagan who picked up a chant from the seventies when in 1986 he famously said: The nine most feared words in the English language are, “I’m from the government; I’m here to help you.” It has been a long slide from the heady days of Johnson’s “Great Society” to where we are now.
In 1964, we briefly enjoyed the optimism of expanded medical and educational resources and the potential benefit of the full enfranchisement of all Americans. We could almost taste the benefits of allowing ourselves a more generous social services safety net in the form of the War on Poverty and the Great Society that unfortunately were largely derailed by the War in Vietnam.
I was a beneficiary of the country’s late sixties willingness to support education without financially crippling students with a burden of debt. My college education was covered by a full athletic “scholarship.” My medical education was financed entirely by a combination of gifted money from Harvard Medical School, my wife’s work as a teacher, and very generous federal loans in the last year after we had our second son. I am fond of saying that when I graduated from medical school in June 1971 I had a debt burden not much greater than would be associated with the purchase of a nice car. I owed $10,000. The terms were incredible. The loan was at 5.25%. The first payment was due five years after I completed all my residency and specialty training, and no interest was charged until then. In 1981 after I had purchased a very nice home in a desirable Boston suburb, owned two new cars, and was enjoying the good life on a generous paycheck, I received a booklet with 120 payment slips of $100.99 each. By that time interest rates from commercial lenders were about 18%. For the next ten years, I was happy to send Harvard University a check each month for $100.99. How easy was that? We spent more on Saturday night entertainment than my medical education at a leading medical school cost me.
I feel guilty now and know that something is very wrong when I hear that many medical students enter practice with hundreds of thousands of dollars of debt. I know from personal experience that as a nation we can do much better than we have done over the years since Vietnam. We could choose to eliminate poverty and give every child the education and healthcare that would guarantee them an equitable opportunity to earn an adequate living and enjoy a rewarding life.
In 1966 we chose spending lives and national resources on a distant war over continued collective investment in social progress at home. In 2022 we will have many choices to make collectively as a nation. What will we choose? This rambling note is a long run-up to a very short conclusion: I expect that the challenges we face from COVID and the challenges that we have brought on ourselves by an intense focus on “self” rather than community will continue in 2022. The prospects that we might Build Back Better seem to dim toward a faint flicker with each passing day.
I pray for a resurgence of commitment to the collective that will require some cost from those of us who have extracted privilege from our successes of the past fifty, forty, or thirty years. My hope for 2022 is that 2021 was a nadir from which we will begin to climb in 2022 toward a future with better health and greater opportunity for everyone. When I was in practice I used to think about the “acute presentation of a chronic process.” COVID and the misery and instability in our society that has culminated in the cult of Trumpism feel acute, but I fear it is part of a chronic process that needs our collective attention because we have a long road ahead that needs repaving and extension if our children and grandchildren are to enjoy the privileges and stability that we so hope will characterize their future.
2021 ends with many ongoing concerns. I will begin 2022 with the continuing hope that something will happen that allows reason to prevail and that during this year we will begin a long process of resurgence. As a nation, there is no reason but the collective effect of individual self-interest that prevents us from all enjoying better days. The New Year is always a good time to make our resolutions and begin once again to try to live up to our amazing potential. Here’s hoping that 2022 will be the start of something better.
My Wish For Us All Is That 2022 Is A Happy And Rewarding Year! It Is Possible.
For the first time in forty years, my wife and I did not put up a Christmas tree. Our usual Christmas preparations did not make sense in an age of COVID when visitors are infrequent, and we were planning to fly to California to spend the Christmas week with our West Coast son, his wife, and their two boys ages seven and four. We had missed Christmas together last year since travel, before everyone was vaccinated, seemed unwise. Now everyone but my youngest grandson is vaccinated, so it made sense that we go to them rather than having them come to us. As an added bonus our youngest son and his wife were joining us after spending a few days with her family in Colorado.
We picked up our youngest son and his wife at the San Franciso airport late Wednesday afternoon. They had flown in from Denver where they spent Christmas with her father and his wife’s family, and my daughter-in-law’s sisters. COVID canceled their earlier flight, so we were delighted that they finally arrived. We had planned to view the very special outdoor light show, The 23rd Annual Fantasy of Lights, in Los Gatos, so we went directly from the airport to Vasona Lake County Park. The display is a one-and-a-half-mile slow drive-through that sports an amazing outdoor holiday light show that is sponsored by Netflix and other Silicon Valley enterprises. My grandsons loved the ride. The adults also thought it was amazing. Today’s header is a scene near the end of this very colorful ride. I see this holiday tradition as nonsectarian advocacy for hope and positive expectations in the coming year.
Despite the pandemic, our family had much to be grateful for in 2021. We enjoyed two graduations, several promotions, and the resolution of some nagging problems. Everyone avoided COVID, and except for my four-year-old grandson, everyone has been fully vaccinated and boosted. My granddaughter has had a successful first semester at Bowdoin, and through her, I have enjoyed the successes of the Bowdoin Women’s Volleyball team which won the New England Small College Athletic Conference Championship. Her season was very exciting even though Bowdin did not advance very far in the Division III NCAA playoffs.
The youngest of my four daughters-in-law finished law school despite all the disruption of the pandemic which made much of the last two years into a Zoom experience. She passed the New York bar on her first try despite the disruption of COVID! She is a remarkable woman who is headed toward a career advocating for people in need. She decided to go to law school after working with refugees for the United Nations in the Middle East–Iraq, Tunesia, and Jordan–for several years. I now have one son and two daughters-in-law who are lawyers. One is an appeals court judge. The only other person with a healthcare connection besides my wife and me is my second son who uses his status as a LICSW to be a very effective therapist who works primarily with families and children who struggle in poverty in Albuquerque.
Any impression that I have of 2021 is enhanced by the positive way all four of my sons and daughters-in-law have managed the stress of the pandemic. My sons and their families are spread across the country. They live in New York, Miami, Albuquerque, and in Felton, California, a little town in the redwoods in the mountains above Santa Cruz. I enjoy the opportunity to get a great appreciation for the variety and diversity of the regional differences in the American experience by making “rounds” on them.
Despite all the troubles of 2021, Americans are collectively blessed with opportunities and resources that should give us great hope for a better future for everyone, if we can find some way to work more harmoniously to meet our common challenges. My prayer for 2022 is that there will be progress toward a majority coalition of Americans across all parties and philosophies who favor the choices that could ensure the opportunity for a healthier and more hopeful life for everyone.
2021 should stand as a warning that the challenges we face are collective threats that make everyone vulnerable. Alone, everyone is vulnerable, together everyone can have hope for a better future. It may sound mawkish, but the benefits of mutual tolerance and cooperation despite political differences have always been true. When we forget our foundational objective of creating a society that offers a good opportunity to everyone, everyone will always be vulnerable. When we work together after managing our political differences through the traditional ideals of good citizenship, we all benefit from the many elective cycles of a vigorous democracy.
I am sure that 2022 will offer us many challenges. Progress toward the goals I favor may stall if the Democrats lose control of the House and Senate. In truth, they may stall if even if they retain control. Democracy requires a lot of work, and a stable Democracy makes progress slowly. My greatest concern for the moment is that collapse can be much easier and faster than progress.
Each year is an adventure as well as a chance for victory in the midst of the risk that our long-running experiment in self-government is always vulnerable to failure through the abandonment of its principles. We may be able to anticipate some of the challenges we face, others will be fresh challenges and surprises. If we can try to extract the lesson of our mutual vulnerability from the experience of 2021, it is not unrealistic to hope that 2022 can be a happy and rewarding year for us all. That is my New Year wish for you and for all of us!
Happy New Year! May we all be well and committed to progress toward a more perfect world in 2022!
Gene
