Thread by @medicalaxioms

#COVID19 update 4/20/20. #covid4MDs
It’s a big country and a big world. Feel free to chime in with the situation in your area. This is how it looks from Colorado, USA:

1. A month ago we were headed directly in to a disaster of overwhelmed healthcare systems and massive unecessary deaths. We stopped most activities of daily living and mostly averted that tragedy.

2. The US planned poorly and we went short of PPE. We still don’t have enough and we are reusing masks inappropriately and shields and goggles from home.

Strangely this “works.” Nurses and doctors get sick but many don’t after daily exposure.

3. Slowly, we are getting more and better tests in hospitals and states. From this we are learning we didn’t know this virus very well. Many are asymptomatic despite infection.

So now we know the virus tries to kill some and leaves others unscathed. It is a monster and a kitten. 🤷🏼‍♂️🤷🏼‍♂️🤷🏼‍♂️

4. Everyone who knows anything knows the way we have lived for the last month is unsustainable. We don’t stay at home until the end of the world.

The people who know this are making stepwise plans to go back to life.

They are doing a terrible job of communicating this.

5. Many predictive models show an isolated mountain peak like Mt. Fuji in Japan. This is wrong. It’s an oversimplification from some simplistic equations using simplified variables.

The back side of the mountain will not be symmetric with the front.

This thing will be shaped like an airfoil with a blunt end and a tapered end.

7. We never had any good medicines for the common cold and we still don’t. #covid19 is a close cousin to the everyday coronaviruses that give you the sniffles every winter.

We still don’t have good medicines for coronaviruses.

8. In a time when we need good science and fast, we get shitty fast science.

5 years from now we will look at these next few months of journal articles and wonder how this garbage got published. There will be a few lotus flowers in the mud of the swamp. 🌸🌸🌸

9. Experience is a good teacher. People who care for a lot of these patients are getting incrementally better at it.

They are also taking a lot of damage. The primary emotions are: guilt, exhaustion, futility, learned helplessness, gratitude, camaraderie, fear, and more fear.

10. The human brain only stays in disaster mode for a month. Then it switches to “new normal mode.” This is where we are getting. This is where are patients are getting too.

We all forget it’s weird to do end-of-life via iPad. We just make it work.

This is good because your brain starts to abandon its longing for a nostalgic return to yestermonth. There are good days and bad days here. We strive for good ones and learn from bad ones.

Just like normal.

11. We are about to make some mistakes. Nothing catastrophic. We are going to rush. Then cases are going to pick up again. Some will say “forge forward!” They will day we should run into the fire and get it over with.

They are wrong.

On the other side of the fire is... more fire. You don’t win much by taking all your suffering at once. It only inches your herd immunity forward and wrecks your healthcare workers with PTSD.

After the peak, more cases. Another day. Another mask. Another ventilator.

12. Doctors as scientists are learning a valuable lesson in aequanimitas. Imperturbability. Calm in the storm.

Don’t chase new fads.

As Osler said: In seeking absolute truth we aim at the unattainable, and must be content with finding broken portions.

Lots of people like to try to make a buck on tragedy. Selling fake PPE and non-working ventilators. Selling medicines that don’t work and pre-selling them as “promising” and “encouraging.”

13. Lastly, testing. The US is already in last place in the world. We have no national plan and no leadership beyond the individual states. This is an abject failure.

I’m not sure if we will bother trying to catch up (which would take humility and apology) or if we will just sacrifice a chunk of the population to our laziness, ignorance and hubris and try to move on.

What it means either way is we are going to have sick people and a wounded economy for months or years longer than modern countries that have faith in science, medicine and technology.

I believe it’s a lesson that will teach itself. Even the most misguided Americans are going to start to get it after awhile.

When it affects them personally.

🤞🏻🤞🏻🤞🏻

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