Spending this New Years Eve in my apartment getting ready for several days back on the medicine wards starting tomorrow morning. Grateful to have a roof overhead, to have health, to have received the vaccine. So many of the patients we care for don’t get any of these luxuries.
2/ The perspective that we get in caring for people who are sick & struggling is so important. In a year when we have been primed to judge others & fight w/ one another, the hospital reminds me what humanity & empathy look like. We need these values front & center, which is hard
3/ It’s hard bc lives are on the line- many of us have lost loved ones to the epidemic already, & many others will in the coming weeks. I understand this; there were times I have wanted to judge or shame people for making “selfish” decisions when I had to go work in a hospital
4/ But over time, it became so clear how much people were struggling from the other effects of the epidemic; patients coming in having relapsed alcoholism; suicide attempts; lost jobs, lost homes, off meds — the list goes on. And you would never guess it from the outside.
5/ There were times earlier this year that I tweeted “stay home”— but once I started caring for #covid19 patients, it again became clear that most of the people getting sick could never afford to stay home.

Yes, a few people perhaps were “reckless”; most were not that.
6/ And even those “reckless” few that could have avoided transmission were not evil, heartless people; most were extremely regretful, some were clearly misinformed; others ended up in situations they never intended to. I honestly can’t rmr caring for any strict “Covid deniers”
7/ I’m sure they are out there; maybe they are more densely congregated in different parts of the country; even so, I am willing to bet the majority of this country is filled w/ good people who are truly struggling during a terrible year.
8/ Every day in the hospital, as much as we see evil in the form of disease, so too do we see goodness in the form of people who care for each other.

You’ll find genuine love, often times family & friends, other times nursing & other frontline staff who go above and beyond

• • •

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More from @AbraarKaran

2 Jan
THREAD
1/ Important article by @skarlamangla

Some of the key factors with what went wrong in LA

Fundamentally, LA county was set up to do poorly- structural inequities (surprise) were almost a guarantee of this

But this is unacceptable

#covid19

latimes.com/california/sto…
2/ “But in L.A., it is common for a working-class family of four, five or even more to share a costly one-bedroom apartment.

Among the 25 biggest metropolitan areas in America, L.A. has the highest percentage of overcrowded homes”

*Need safer isolation options*
#covid19
3/ “L.A. County has a huge manufacturing sector and two of the biggest ports in the nation — industries staffed by people who work in the kind of close quarters that can facilitate spread of the virus”

Article notes big outbreaks here. Why weren’t these workers protected?
Read 4 tweets
31 Dec 20
As a healthcare worker, I think there is a big assumption here that all healthcare workers have familiarity with vaccines, vaccine research, virology, or even clinical trials & how to read or interpret them etc

That is frankly not the case, nor is that a reasonable expectation.
2/ The hospital is a complex place. There are healthcare workers of all different backgrounds w/ different levels of expertise & knowledge. The vast majority of us are not experts in mRNA vaccines. Blaming healthcare workers for hesitancy is uncalled for.
3/ We (public health experts) have warned for months & months that vaccine deployment would be extremely complicated. I have had numerous healthcare worker colleagues ask my opinion of the NEJM trials for Pfizer & Moderna, & I have shared my interpretations of the data.
Read 7 tweets
31 Dec 20
1/
mRNA1273 (Moderna) vaccine- Phase 3 trial

2 doses, 28 days apart (black arrows)

28,207 in per-protocol analysis

Primary end-point: preventing symptomatic infections w/ onset at least 14 days after 2nd dose

Overall: 94.1% vaccine efficacy

nejm.org/doi/full/10.10…
2/ Key secondary end-point: preventing severe #Covid19 disease

Vaccine group- 0 severe cases

Placebo group- 30 severe cases

Vaccine efficacy of 100% in preventing severe disease
3/ "In addition, although our trial showed that mRNA-1273 reduces the incidence of symptomatic SARS-CoV-2 infection, the data were not sufficient to assess asymptomatic infection" (cont)

#covid19
Read 7 tweets
29 Dec 20
First reported case of #COVID19 #B117 variant in the United States in a Colorado man with no relevant travel history to UK. What this suggests is community transmission of new variant.

latimes.com/world-nation/s… Image
2/ New variant is thought to be more transmissible but not more severe in terms of the disease it causes. BUT- more transmissible can very much be more problematic than more fatal (see thread/tweets below)

3/ Longer thread here linking to a number of articles as well as different responses by various countries in terms of travel restrictions (which ultimately make less sense/are less efficient for control when you already have community transmission) re #b117 #covid19 variant
Read 6 tweets
29 Dec 20
THREAD

1/ Read this. This is "global health"? This is our "solidarity"? This is extractive.

Vaccines produced in South Africa & tested on South Africans are then deemed safe, & first given to Americans, British, & others in wealthy countries.
nytimes.com/2020/12/28/wor…
2/ "Poor & middle-income nations, largely unable to compete in the open market, rely on a complex vaccine sharing scheme called Covax."

But as the article mentions, this 'aid' is conditional; some countries are not "poor enough" to qualify, but also can't afford enough vaccines
3/
Within South Africa (& many countries), the wealthy will buy vaccines to protect themselves.

The poor are in a gamble w/ their lives.

**“We’ll all be dead then,” said Prudence Nonzamedyantyi, 46, a housekeeper from the same township.** (quote from the article)
Read 10 tweets
29 Dec 20
Check out this new piece from Ed Yong in @TheAtlantic on pandemic year two

Thanks to Ed for having me share some of my thoughts here alongside a number of colleagues

We have an immense year ahead of us

#covid19
2/ “There will be a whole lot of pain in the first quarter” of 2021 --Anthony Fauci told Ed in this piece.

I agree. I am hopeful that summer 2021 will be our first major exhale in a while.
3/ One of the most consequential parts of reaching a better summer 2021 is going to be our vaccination strategy, which we aren't doing well right now. Read this thread below

Read 7 tweets

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