I don’t like posting depressing posts but I think it’s time. When this all began, I would walk into the #COVID unit with the energy of a #hype man at a #hiphop show. I hate COVID19 but I love being an #ICU doctor & getting people better. Today I am mentally & physically exhausted
Other than my AM commute, I’ve seen daylight only once this week - today when I had a few minutes for a #coffee break. Today was also the first time I got home before 10 pm, but before I even had a chance to take my #decontamination shower...
I got called about yet another complex #COVID admission by my even more hard-working #PCCM fellows. The amount of face-to-face time required to take good care of these patients cannot be truly appreciated unless you’ve worked in an #ICU. The days are long & the work is relentless
I thought things were getting better, but our ICU census jumped considerably this week. I don’t have anything wise to say other than none of this is over.
I realize that I am very lucky. I have a job that provides me with purpose, gratification, human interaction, and an income, something #COVID19 has taken from a lot of people. I also get the desire to return to “normalcy,” whatever that was, because I crave the same thing.
But the beach crowds and protests and bar openings? It just seems like we are setting ourselves up to drag this all out for even longer. I haven’t been scared yet...I’m an #intensivist so not much phases me...but the thought of this continuing for months on end is horrifying.
I can probably tough out the unsustainable level of work & the persistent #N95-induced facial pain, but the suffering of my patients - many young & previously healthy - and their families is getting harder to watch. Even those who survive will have their lives rocked to the core.
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Very excited to share our most recent publication about #CovidVaccine effectiveness, just published today by the IVY network. Especially relevant in light of today’s news about #boosters (spoiler - I’m skeptical about the need for boosters for all). 🧵
Most young women I’ve admitted to the #ICU for #COVID19 have been #pregnant. Pregnancy is indeed a risk factor for more severe COVID illness, but the messaging about #pregnancy, COVID & #vaccines has led to a lot of confusion and preventable illness. Let’s break it down. 🤰🏽🧵
The reason I pretty much always hear from pregnant women for not getting vaccinated is, understandably, not wanting to put their pregnancy & their baby at any potential risk from taking a new & seemingly unfamiliar vaccine.
But forgoing vaccination exposes mom & baby to a much bigger risk - the known, real, significant risk of getting a severe #COVID19 infection. Both @acog & @MySMFM recommend that pregnant people get the #CovidVaccine in order to reduce that risk.
Thanks @CNN for sharing this story on @UCLAHealth's collaboration with @LAOpera! In this program, opera performers lead #COVID19 survivors through breathing and singing workshops - it's an innovative (and fun!) adjunct to pulmonary rehab.
What does #opera have to do with pulmonary rehab? Well, would it be surprising to know that some of the work we do in pulmonary rehab is quite similar to the #breathing exercises opera singers do? The opera stars just happen to be doing them on an elite level.
For example, diaphragmatic breathing, which we use as a technique to help increase tidal volume, is also used by singers to increase endurance and help them sing longer on a single breath.
Important questions about the type of ethical decision-making that needs to happen when resources become scarce - a situation no one wants to be in, but I worry may again become inevitable as #COVID19 cases continue to rise.
Should #vaccinated patients be prioritized over unvaccinated, all else being equal? I don’t think so, no matter how frustrating this is. Many unvaccinated are victims of misinformation. Also, if we did this, then where else do we draw lines related to personal health behaviors?
What about HCWs? When we were making our crisis standards of care document, there were discussions about the ethics of giving HCWs a tie breaker, all other things being equal. The rationale was that if they got better, they could go back to work & help others, maximizing benefit.
Honored to present at combined medicine & surgery grand rounds @UCLAHealth today & a privilege to highlight the incredible work done by the UCLA #COVID19 front line. Also packed in a review of the evidence basis for COVID therapeutics & discussed COVID recovery.
A lot to cover, and admittedly, I haven’t been that nervous about a presentation in a long time. I’ll share some slides here, starting with a summary of #COVID19 therapeutics.
Reviewing the body of evidence is always a task, even if the last time you did it was a week ago. You’ll get >100,000 results in PubMed if you search for #COVID19. In one year, there are about as many results for COVID as there are for influenza over 30 years 😳
Still getting the hang of Twitter chatting but...
A2 - start with brushing off your journal club #skillz! There are so many points to make here in terms of identifying confounders and bias, but I'll start w/ one I get asked about a lot - immortal time bias! #ATSChat
A2 - Immortal time = period of time during which, due to study design, the study outcome cannot occur. Occurs when there’s a difference between the timing of entrance into the study cohort & timing of the exposure. Exposure = the treatment being assessed. #ATSChat (2)
A2 - This can bias the results in favor of the exposure (ie treatment) group ➡️ immortal time BIAS. #atschat (3)