1/ Debating whether to dignify this ... but here goes
I think most of us endangered docs/nurses/respiratory therapists/social workers/hospital chaplains are also frustrated re clarity of the campaign &publicly voiced narrative re this administration’s &our nation’s response ->
The ‘it didn’t have to be this way’ - must remind the public, the on the fence voter, of the following:
Pandemic preparedness structures were pared down ¬ present 2help initial strategy
‘Leadership’ must b holistic/humble - it sits back &listens deeply to expertise ->
3/ if ‘leadership’ respected lifelong career pandemic preparedness experts, we would have:
accepted WHO tests for #COVID19 to apply at the outset
commissioned efforts 2create a new test 2multiple entities 4redundancy as an insurance policy, ie .... ->
4/ .. commercial labs, academic virology labs, the CDC and NIH, and NOT JUST to one entity (CDC). The delay in testing bc of contamination of first CDC test was crippling on both coasts. We had to ration tests to only symptomatic/diagnostic use. We could not map/trace
... ->
5/
‘Leadership’ would be deeply humble/citizen centered. If it were, it would have heard EARLY we must (step 1 in pandemic) mass test/use positives 2map/trace/quarantine 2take gasoline out of exponential rise; step 2 is mitigation and smart shutdowns - we half heartedly did ->
6/ .. step 2 first, and never did step 1
Therefore, our unknown asymptomatic/presymptomatic spread and exposure was wildly more intense than it needed to be
So many lives lost, #healthcareworkers in harms way, with #hero thrust upon them (implies agency ..)
->
7/
Then when we have testing, automated machines to do multiple w 1-2d turnaround, reagents, swabs, to some extent #PPE, what is ‘leadership’ supposed to do?
With each small tic upward in reported infections (ah, transparency) across country, supposed to send huge numbers ->
8/ .. of those automated machines, testing supplies, teams, PPE, facility building teams, and BLANKET those cities, surrounding areas w #ContactTracing .. an eighth of industry was needed 2mass produce said supplies, automated testing infrastructure, .. but no
The continued ->
9/ epicenters internally from the coasts were an even deeper insult to the health and welfare of the nation. The very value of life rejected ..
A dereliction of duty - only a national/federal coordination could have had the scope/financial heft/messaging power to effectuate ->
These were our patients, colleagues, team members, friends, mentees, mentors
I wish, in the plea for change that is being made in debates, interviews, campaign, that we’d get the events right. This was a narcissistic anti expertise crime
->
11/ .. and it continues w the ridicule of masks/governors/school districts that make decisions they see necessary/widened testing programs/discussion of economic malleability of response necessary
At the very least our ‘leaders’ & ‘institutions’ were supposed 2have our back
fin
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1/ This past Thurs, I was honored to ‘emcee’ a grand rounds @HofNorthwellDOM, presenting the Candee Award for Education Excellence in Medicine 2our beloved Ron Rosen of @NorthwellDGIM
Ron is a 50 yr general internist who has taught no less than 40 yrs worth of learners -> 🧵
2/ Ron had so much to tell us about his aunt and uncle, who were early family medicine practitioners in the Bronx/Manhattan. Ambulance drivers would take them to a patient’s home. A beautiful sepia tone showing his aunt going to a call, and another of his uncle in the office
3/ We heard about Dr. Rosen’s medical school yrs @nymedcollege in the early 60s &how he knew the civil rights movement, the movement for reproductive rights, the attempts to mitigate poverty and the birth of Medicaid and Medicare would affect all his future pts &his work ->
1/Many of my colleagues and I have not been redeployed to the hospital during the #COVID pandemic. We have been doing the ambulatory care of pre/non hospitalized patients, helped w admitted pts and starting to see post discharge pts.
Many thoughts/advice points:
A 🧵THREAD
2/ First our #primarycare triage function in this process is crucial.
Workflows/teamwork/infrastructure have to be worked out and optimized.
An updated list of daily follow up #telehealth covid pts must be kept. Day of illness, daily update notes and tracking has to happen
3/ Key points:
Age, comorbidities matter. And yet, there are those healthier patients that get sicker, hypoxemic/stormy as well
Don’t completely know (like so much in this illness) the grouped likelihood ratios for the following but these are things to ask to be complete ..
Wanted to share 2vignettes with you #medtwitter, w permission (identities, some details changed)
Both involve rapid thinking, stretched foci of attention, unanticipated clinical events->
2/ first vignette :
Seeing last pt in morning session, 45 mins back
Finishing up, see another pt’s e mail & message on desk phone
Need 2finish up w pt in front of me, but odd message left in both places
Call back - 72 yo man, remote preDM but got that BMI to 23 long ago, ->
3/ mild lipids on lo dose statin, chronic bronciectasis, reflux. Know him 15 yrs as pt.
Pt: Dr. C, I feel better now, but ..(uh oh) when I woke had a discomfort in my L neck, felt sweaty. That’s all gone for a few hours now, I think I’m fine. But I don’t have my appetite ->