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Arghavan Salles, MD, PhD

23 Nov, 12 tweets, 5 min read

This thread is based on conversations with doctors at 3 large metropolitan hospitals, all in the position to know what’s happening with their ICUs. Here are some important points that endanger the public’s health NOW in these and many other hospitals across the country.

1/

Even if hospitals are relatively empty prior to a #COVID19 surge, it is very challenging to manage the surge because of how sick the patients can be, how quickly they come in, and the high volume of deaths.

2/

If hospitals are already full prior to a COVID surge, it is not hyperbolic to say that more people will die. And in all 3 of these hospitals, that is the exact problem.

3/

Patients come into hospitals in 3 main ways:

-acute illnesses, such as heart attacks or appendicitis
-trauma (eg car accidents, stabbings, etc)
-elective (planned) surgery

4/

We can’t limit the first category (acute illness), but we can limit the other two. Trauma volumes were down significantly when people were sheltering in place. Why? Most people who are in car accidents, stabbings, or shootings are outside their homes.

tsaco.bmj.com/content/5/1/e0…

Because now many people are moving around the world as they did pre-pandemic (with, hopefully, the addition of a mask), trauma volumes are now up. But they could go down again if people would #StayHome.

6/

Elective surgery could be stopped, and many hospitals are backing off elective surgery to some extent. However, in the spring hospitals lost an estimated $160 billion due to stopping elective surgery. Many hospitals can’t afford to do that again.

aha.org/system/files/m…

7/

So even though they know they need beds for COVID patients, they also can’t afford to stop all elective surgery. We need government subsidies to allow hospitals to stop elective surgery and make room for COVID patients.

8/

https://twitter.com/futuredocs/status/1330890786016268290?s=21

These are the reasons hospitals are now using beds in pediatrics hospitals and tents. It’s not purely due to the volume of COVID cases. It’s that there are many many other patients in hospitals right now.

https://twitter.com/futuredocs/status/1330890786016268290?s=21

And staff are exhausted. At many hospitals, staff have gotten COVID and are out due to that. So even if there are physical beds available, when there are no staff to care for patients in those beds, they might as well not exist.

abcnews.go.com/Health/900-may…

10/

Everything I’m hearing from colleagues around the country is DIRE.

Please consider staying home as much as you can.

#WearAMask if you need to go out.

Don’t travel for Thanksgiving.

We CAN limit the loss of life, but only by working together.

11/11

@MollyJongFast

Cc @MollyJongFast @ASlavitt @JoyAnnReid @ETSshow @rocketgirlmd @bethlinas @AriMelber @maddow @alexiszotos

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More from @arghavan_salles

Arghavan Salles, MD, PhD

@arghavan_salles

12 Nov

There were plenty of obstacles to women’s careers before the pandemic. When schools went remote in the spring, it was theoretically possible that childcare would be distributed among genders. It is 2020, after all.

THREAD

1/

@500womensci

It didn’t take long for womxn to share their struggle to work from home without the support of childcare. Pieces like this one, from @500womensci, sounded the alarm about the negative impact this all would have on womxn’s careers.

blogs.scientificamerican.com/voices/scienti…

2/

@GretchenTG

8 months after sheltering in place, anecdotes like this one from @GretchenTG are supported by data.

3/

https://twitter.com/GretchenTG/status/1306250106748968962?s=20

Read 14 tweets

Arghavan Salles, MD, PhD

@arghavan_salles

8 Oct

It’s become clear to me that Trump/Pence don’t believe in/understand social science. How can we move toward a more just nation with leaders who deny the existence of the very issues that are tearing us apart?

1/

In the #VPDebate, Pence said it was insulting to suggest that law enforcement has implicit bias. That’s like saying it’s insulting to say that law enforcement officers have two eyes and a nose. These are facts. Along with our facial features, we all have implicit bias.

2/

That’s why it’s so insidious and problematic. Indeed, the Executive Order on stereotyping also reveals a complete lack of understanding of these issues.

whitehouse.gov/presidential-a…

3/

Read 9 tweets

Arghavan Salles, MD, PhD

@arghavan_salles

7 Oct

Given all that is going on in the world these days, many of you may have ideas for writing. Great! We need to hear more from healthcare workers. But, especially if you haven't done it before, you may have some questions about where to send your work.

THREAD 1/

@drjessigold

In advance of my session with @drjessigold on writing (for @WIMSummit), I thought I'd address one of the most common questions I get asked. Usually it goes something like this: I've written about abc. Where can I publish it?

womeninmedicinesummit.org

2/

And the answer is: it depends. What is your intended audience? Is it a narrative? Is it academic? Is it making a persuasive argument?

3/

Read 16 tweets

Arghavan Salles, MD, PhD

@arghavan_salles

19 Aug

People are bustling around in the room, going from the computer to the counter to pick up supplies, to the patient or the IV pump to deliver meds. The ventilator is making the sounds of inhalation/exhalation, persistently pushing oxygen into the lungs & evacuating the CO2.

1/

There is a heart monitor that keeps alarming—a persistent ding, ding, ding--until one of the bustlers temporarily silences it. There is a continuous dialysis machine running, & blood fills up the tubing. The IV pole is overwhelmed due to the number of meds that are needed.

2/

The nurse brings in a second IV pole for additional meds. In the middle of all this activity is the patient. Everything we do in that room is to try to keep the patient alive. As the oxygen level goes low, the monitor alarms again.

3/

Read 13 tweets

Arghavan Salles, MD, PhD

@arghavan_salles

11 Aug

I’ve been in Arizona a week now. Maybe it’s because I already knew what to expect. Or maybe it’s because I’m not caring for the sickest of the ICU patients. Either way, when I first got here, I thought, “This is not as bad as I had expected.”

1/

Then I started to wonder if pandemic fatigue affected even this aspect of my perception. Was I so jaded about this virus that seeing sick people dying alone no longer affected me?

2/

Then I experienced something that could warm even the coldest of hearts. It happens every day in every hospital—a patient needing a breathing tube. What played out, though, could have been a scene in a movie, with a haunting melody from a cello in the background.

3/

Read 10 tweets

Arghavan Salles, MD, PhD

@arghavan_salles

7 Aug

On my third day I got the reminder. My first two days here, things seemed normal-ish. Yes, there were way more ICU patients than usual, and most of them had #COVID19. We still have to wear lots of PPE, and patients stay sick in the hospital a long time.

THREAD

1/

But we met in a workroom, not in a temporary ICU. We had some new patients who did not have COVID (at least not that we knew of). And there was a system in place for managing the additional strain on the hospital system.

2/

When I came in yesterday morning (day 3), 1 patient who had been stably critically ill had taken a sudden turn for the worse. And despite everything we could do, his life was ending. This is the COVID I remember from New York.

3/

Read 11 tweets

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