You know that moment when all the water pulls back from the beach until it’s completely & eerily empty right before a huge tsunami hits?

That was how it felt leaving the hospital today. Nearly every patient I took care of was #covid19 positive, up until the end of my shift.
2/ All kinds of stories here— stories that I’ve heard before; stories from April when we had our last surge. People infecting their parents, roommates infecting each other; nursing home/group home patients infecting each other.
3/ We tried to warn everyone to not travel unless it was an emergency & absolutely needed, not because we don’t want you to see your loved ones, but because we don’t want you to have to see them in a hospital bed as we see them. I am genuinely worried about what is coming next.
4/ We can still avoid some part of this. Anything we do- any decision we make; we have to believe it matters. If thousands of us begin thinking this way, & avoid unnecessary gatherings this coming week, we will prevent thousands of cases.

We have to believe in that.
5/ Many of my colleagues are making *immense* sacrifices. I had offered one of them to see his #covid19 patients for him as he has a family to go home to whereas I live alone- he thanked me, and he moved forward himself to care for his own patients

This is the heart of medicine
6/ I’ll be frank— we appreciate your support, but we aren’t here to be admired or to get credit— we signed up for this. This was our choice. We are here literally pleading with you to think and rethink your plans this holiday. Please.
That is all we ask.
Thank you! #covid19

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More from @AbraarKaran

22 Nov
1/ We usually call family members daily to update them on their loved ones. Some of the toughest calls are when the family is also infected. Many feel like it’s their fault for infecting mom or dad. Not being able to isolate safely at home *is not your fault*. #covid19
2/ Safe isolation is a fundamental part of epidemic response. This was a responsibility of our states & our government to provide this for people. As the virus surges, we will find ourselves in these situations again (we already are to be honest)
3/ I’m going to bring this back to the holiday before us. Please realize that spending days together at home with family you don’t usually see is a very bad idea. Testing helps & its necessary - but it won’t guarantee safety on its own.
Read 4 tweets
21 Nov
A traveler who tested neg 48 hrs prior to flight was infectious by day of flight, pre-symptomatic; using genomic analysis, traced to 4 cases of in-flight transmission

This doesn’t mean don’t get tested; it means *don’t travel unless an emergency* #covid19
washingtonpost.com/travel/2020/11…
2/ I don’t say that lightly. I know that this is a big sacrifice; but we were just shy of 200,000 new #covid19 cases yesterday. Hospitals will *not* be able to handle a holiday superspreading disaster happening simultaneously around the country.
3/ The problem with prevention is that it is hard to appreciate disasters that we avoided. This has been a challenge since the days of #stayHome - it can feel like a thankless task. But as a healthcare worker, I am thanking you right now. Please.

vox.com/platform/amp/2…
Read 8 tweets
20 Nov
1/ The single most important lesson I learned working on a state #covid19 response for 7 months: there is nothing worse you can do in an epidemic than waste time

We had over 187,000 new cases yesterday

What the hell are we doing?
2/ We have an intervention that we know works, that is of immense benefit w/ little to no cost. Yet we are still leaving that up to choice in so many parts of this country.

Don't ask me to say #MaskUp again- we need a national mask mandate for indoor spaces, now.
3/ We have thousands of Americans (maybe more) who are thinking about flying around the country for the holidays.

This is a true catastrophe waiting to happen. This is an epidemic slingshot being stretched, & will fire off more cases than we can handle.
Read 12 tweets
19 Nov
THREAD
1/ Have spent the last few weeks working on research examining early #covid19 spread globally. One of the articles needs to be re-shared again.

It looked at how Hong Kong, which had experience from SARS in 2003, kept its epidemic from getting out of control in March.
2/ They focused on intense surveillance not only in incoming travelers, but also in the community setting, testing 400 outpatients and 600 inpatients daily in *early March 2020*

If positive, patients remained isolated in hospitals until recovered/no longer shedding
3/ Close contacts were traced, from 2 days before illness onset.

They were quarantined in special facilities, so outside of the home.

By doing this well, they were able to avoid more intense lockdowns.

They also cite Singapore and Taiwan in this group of strong responders.
Read 6 tweets
15 Nov
1/ It is *problematic* how quick people are to judge how other people may have been infected by #covid19.

This judgment re-enforces stigma; this is a destructive force that makes viral spread even more hidden.

This is *not helping*. It dissuades testing and disclosure.
2/ I am not trying to defend carelessness. But I am also not trying to be the judge of it. As doctors, we hear deep and personal stories. As much as I have had patients who got sick on the job, so too have I had patients destroyed by social isolation--> depression, alcoholism etc
3/ In this CDC report, 1 in 4 respondents aged 18 to 24 had *seriously considered suicide in the last 30 days*

Along with viral spread, there have been significant mental health epidemics as well.

We are all struggling in different ways.

cdc.gov/mmwr/volumes/6…
Read 9 tweets
14 Nov
1/ Really appreciate @DrTomFrieden piece on more nuanced epidemic control based on local epidemiological data. @RanuDhillon & I wrote a similar piece back in August called “Smarter Lockdowns”— the problem is implementation. So many ideas, so little action

theatlantic.com/ideas/archive/…
2/ At a point, we recognize that there are so many ways to get R<1; the issue is that doing any of them well and consistently requires coordination, the right policies, & enforcement of those policies. We don’t have that. We needed that for 9 months.

hbr.org/2020/08/the-u-…
3/ We wrote a follow up piece @WBUR @NPR ⬇️— but admittedly, writing op eds generates ideas but if those ideas end up in a Twitter abyss, then they fail to influence what actually happens (hopefully @DrTomFrieden excellent piece gains traction/moves dial)
wbur.org/cognoscenti/20…
Read 5 tweets

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