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Craig Spencer MD MPH Profile picture
@Craig_A_Spencer
Oct 3, 2020 • 7 tweets • 2 min read • Read on X
I’m getting a lot of questions about how fast COVID19 progresses:

I’ve seen 90 year olds test + and not have a sniffle for days.

I’ve seen 40 year olds come in stable and VERY rapidly decompensate.

There’s a lot of speculation right now. But the realm of possibilities IS vast.
I don’t know the specifics of the President’s case - but the American public should.

Maybe it’s all an abundance of caution? Or not.

Point being he could be stable. Or not. This virus is always fickle & sometimes ferocious.

I wish him a speedy recovery. And we need more info.
This timely transmission just in!

Reportedly not on supplemental oxygen.

Remdesivir started.

‘Doing very well’.
The initial FDA EUA in May limited remdesivir use to patients receiving supplemental oxygen.

This changed in the updated Aug 28 EUA: Remdesivir "may be effective for the treatment of suspected or laboratory-confirmed COVID-19 in all hospitalized adult and pediatric patients."
fda.gov/news-events/pr…
Again, I don't know that this tells us much.

It may be the kitchen-sink approach. Remdesivir isn't innocuous, but it's pretty well tolerated.

And every ER doc knows that VIPs don't always receive 'better care' - but they often get MORE care. More tests, more treatments.
If steroids are started in the coming days, that's an indication of more concerning moderate-severe illness.

Otherwise, it's still speculation until we have more details.

Let us wish him and everyone else struggling with this disease all over the world a peaceful rest tonight.

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More from @Craig_A_Spencer

Craig Spencer MD MPH Profile picture
May 22
I teach a class on the history of humanitarian response.

We talk about how a field full of dead soldiers in 1859 in Solferino led to the ICRC, Geneva Conventions, & international humanitarian law.

Every year, my students always ask “the ICC seems useless, why do we need it?” 🧵
In the aftermath of World War II, the Nuremberg Trials was the first international war crimes tribunal.

I think we can all agree that prosecuting those responsible for the atrocities of the Holocaust was an important endeavor.

There were calls for a more permanent tribunal…

cfr.org/backgrounder/r…
But the ICC wasn’t established until 2002.

In the last 22 years, it has indicted 40 people and convicted only 10.

Given that it seems like bad guys get away with doing bad things with impunity all the time, many will question the ICC’s role and impact.

icc-cpi.int/about/the-court
Read 13 tweets
Craig Spencer MD MPH Profile picture
May 12
I can’t stop thinking of a baby girl I treated, just minutes after grenade shrapnel tore through her brain…🧵
I was in Burundi working as a trauma doctor in 2016.

Civil conflict enveloped the country. I was training local physicians to treat and stabilize life-threatening injuries.

Most of our patients had gunshot wounds

or had been pierced by grenade shrapnel

Sometimes both.
When violence erupted, we’d hear a furious bang at the hospital entrance

the large doors would open

then 60-70 people wound stream in, some walking, some carried.

Many bleeding. Some already dead.

We’d start to triage. We had trained for this. We had a system.
Read 12 tweets
Craig Spencer MD MPH Profile picture
Mar 31
Four years ago today, I walked into the apocalypse.

Crossing the line in the ER felt like entering a whole other world.

Frenetic alarms.

Patients strewn about, struggling to breathe.

Too few staff. Too many deaths.

Covid was everything.

It had completely taken over our ER
Covid inundated NYC a week prior.

And many of our staff fell ill.

Especially the nurses.

We had only a fraction of those we needed.

Too few to notice when the oxygen tanks under patients’ beds ran out.

So we did something kinda insane.

Actually unbelievable
We ran tubing from the oxygen outlets on the wall

up, up, up

then through the ceiling

and then dangled it down to the middle of the ER

All over the ER

So everyone could get a reliable oxygen supply

And not suffocate when their tank ran out

It saved lives.

A lot.

A lot.
Read 9 tweets
Craig Spencer MD MPH Profile picture
Mar 20
How much do you know about food and drug safety?

Where did our current regulations come from?

And what were some of the greatest scandals that forced change?

We covered everything from swill milk, patent medicines, and thalidomide in our class today.

Here's what we covered 🧵 Image
We started with smill milk.

This was a massive problem that few—including in public health—have ever heard of.

In New York (and elsewhere) in the mid-19th century, milk was a big part of the daily diet, especially for children.

But people didn't realize how deadly it was.
Image
Image
Usually marketed as 'pure milk' with depictions of happy cows and happy kids, the reality was WAY different.

A lot of milk—estimates are 60-80% of ALL milk at the time—was actually 'swill milk'.

Swill milk came from cows fed solely on a diet of distillery slop (aka 'swill').
Image
Image
Read 52 tweets
Craig Spencer MD MPH Profile picture
Mar 14
Hey my medicine and public health people!

How much do you know about eugenics?

Just old pseudoscience, you say?

Any idea how much it continues to influence us?

Answer: A LOT.

I taught a class on the history of eugenics and public health today. Here's what we covered: 🧵 Image
Eugenics is Greek for 'well-born'. But it wasn't coined by the Greeks. It's a late 19th century term made up by Francis Galton. He LOVED data. We will come back to that.

Eugenics had the biggest impact on the approach to mental illness, immigration, and reproductive justice. Image
We will dig into each.

But first, you gotta know the background and key players.

For background, eugenics arose in an environment obsessed with progress, but also frustrated with economic and social realities.
Read 44 tweets
Craig Spencer MD MPH Profile picture
Oct 21, 2023
Having worked in conflict zones, I want to share a bit on humanitarian response in Gaza, as aid starts to trickle in.

This isn’t a thread on how to end the war, or hostages, or any of the other very important things. Those are critical too. But they’re not at all my expertise 🧵
Over the past week, shortages in food, water, and electricity have exacerbated the humanitarian and health challenges.

This creates new problems, as well as worsening chronic issues.

Without gas, generators can’t run. Newborns on life support in intensive care can’t survive.
Without electricity, patients can’t receive dialysis. Insulin for diabetes can’t be kept refrigerated, as it should be. These chronic health issues worsen, quickly.

Without water, infectious diseases like cholera (and others) become increasingly likely.

cnn.com/2023/10/18/mid…
Read 12 tweets

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