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Arghavan Salles, MD, PhD Profile picture
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18 Jan, 28 tweets, 13 min read
Quick thread about vaccine distribution—personal story

Mom is in a high-risk category and is eligible to receive a vaccine. I’ve been busy in the ICU and honestly assumed she was signing up to get vaccinated because she’s a responsible, conscientious person.

1/
After days of meaning to call, I finally remembered at a time of day when we're both awake and asked, just to confirm because of course she’s on it, right?

Nope. She’s not signed up.

2/
I’m in Arizona right now, she’s home in California. I haven’t kept close tabs on what’s going on with vaccines there (I've been busy), so I ask her why not. She says she doesn’t know what she’s supposed to do.

3/
Easy fix, I think! I'm a good daughter, I think. So I google “How to get COVID vaccine Santa Clara County”

This takes me to the County website. No big deal! I’ll get her the link in a sec, I think. I confirm she is eligible based on the current tier.

4/
Can’t schedule an appointment there. No problem—I’m sure they’ll tell us how to do it?

They say contact a healthcare provider. They then list several healthcare systems (not providers--I'm confused). Mom has Blue Cross Blue Shield. Maybe you’ve heard of it? Not on the list.

5/
Hmmmm….I’ll just go to the Blue Cross Blue Shield website. Surely, they’ll have information there, right? Wrong.

First of all, COVID is not even on their menu (on my mobile browser). So I tell Mom she should call her doctor.

6/
But I’m also thinking there’s no way this doctor is supposed to manage every single patient’s vaccine appointment, right? That makes no sense. And shouldn't someone have communicated something to the people who are eligible at this point??

So I keep digging.

7/
I scroll down on the BCBS website and find “COVID-19 Vaccines.” A-ha! This will be it. I mean, I’m on the website for her insurer, and this is the link for the vaccine. Done!

Nope.

8/
Their section on “When and where to get vaccinated” takes me to a site from which I can select the state. Remember that I started on the COUNTY website—the most local government resource available! Now I have to go to the state site. Fine.

9/
I click on the link, which takes me to the CDC. I select California from the menu. Maybe this will be helpful? I click on the “COVID-19 Vaccines” section. Wait for it…

Absolutely nothing about scheduling!

10/
I scroll down to the “Learn More” section because, well, I would like to learn more. Specifically, I would like to learn how to schedule my only mother, the one I worry about every day when I'm in the ICU caring for patients with COVID, FOR A VACCINE.

11/
Sadly, while the “Learn More” section has lots of information, it has nothing about scheduling a vaccine. I go back to the California Public Health website and see a link at the bottom to go to the California COVID-19 Updates page. I cross my fingers and click on that.

12/
I scroll down to “When, where, and how can I get a vaccine?” Soooo promising! I scroll through a bunch of generic information and get down to the “Questions and answers” section. I click on “How can I get the COVID-19 vaccination?”

13/
“Most Californians will be vaccinated at community vaccination sites, doctor’s offices, clinics, or pharmacies.”

🤦‍♀️

Seriously?

14/
I went back to BCBS, which has a link to check for in-network providers. Fortunately, some of the pharmacies in her town apparently have vaccines.

But who knows how one accesses those?

15/
That’s all I know for now. I gave up because I need to go to sleep so I can get up early and get back to the ICU.

I just wanted to share this because holy smokes how will we get 100 million vaccines delivered in 100 days if it’s this hard to figure it out??

16/
Btw Mom and I have 2 PhD’s and 1 MD between us (granted she hasn't put her cognitive power to the task yet, and I'm sleep deprived, but still!). And there may be a link on one of these sites I've missed, but really it SHOULD NOT BE THIS HARD.

17/17
cc @ASlavitt @JoyAnnReid @MollyJongFast @DoctorYasmin @drjessigold @RoxanaDaneshjou @FutureDocs @DoctorsForBiden @alikhan28 @GavinNewsom
Cc @hknightsf @sfchronicle @chrissyfarr @choo_ek @kavitapmd @FemiOke @iamsambee @AriMelber
Other people are clearly having similar struggles. I’ve learned a lot in the last 24 hours! Will share some resources here. First, here’s a link for people in SCC who are HCW or over 75 yo and don’t have Stanford or Sutter/PAMF:

forms.office.com/Pages/Response…
Second, multiple people have suggested following local news networks, health departments, etc and turning notifications on for their accounts. Seems reasonable to try.

Third, many have suggested this list put together by @patio11:

vaccinateca.com
Will add more tomorrow. Am reading through all the responses and RTs, but gotta get some sleep! Thanks to everyone for sharing their experiences and resources!
Ok, back at it for a minute! Sign ups for San Diego:

Contra Costa County:

Howard County, MD:

In Los Angeles:

Orange County:

Jefferson County in KY:

louisvilleky.gov/covid19

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More from @arghavan_salles

Arghavan Salles, MD, PhD Profile picture
2 Jan
Can we all stop playing the suffering Olympics? You know this game. It’s the one where everyone fights with their friends to prove they have it worse than everyone else.

In a world full of suffering, no one wins this competition.

Empathy, on the other hand, may help us heal.
It goes like this:

Person A: I can’t believe I lost my job. I don’t know how I’m going to pay my rent.

Person B: Well, at least you’re still healthy. With my arthritis I can’t even work.

Often Person B goes on to explain how their suffering is more extreme/sad/awful.
This leaves Person A feeling invalidated when what Person A actually needed was some emotional support.

Person B is also struggling and in need of support. Rather than competing about who has it worse, maybe it’s “yes, and”?

YES, you are suffering. AND so am I.
Read 7 tweets
Arghavan Salles, MD, PhD Profile picture
9 Dec 20
The other day, as I was walking into the hospital, I saw that when someone shared one of my tweets as evidence of how real COVID is, another person said mine was a parody account. What, exactly, I was supposedly parodying, I don’t know.

THREAD
Here’s what happened that day. We evaluated a new patient early in the morning. He’s in his 80s, and he’s breathing between 40 and 50 times a minute. Try doing that—it’s barely more than a second per breath for both the inhalation AND exhalation.

2/
He says he feels fine and has no problems with his breathing. But looking at him huff and puff, trying to get oxygen into his lungs and carbon dioxide out of them, we know he’s not fine. And at his age, he can’t exert that much effort for long.

3/
Read 15 tweets
Arghavan Salles, MD, PhD Profile picture
23 Nov 20
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/
Read 12 tweets
Arghavan Salles, MD, PhD Profile picture
12 Nov 20
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/
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/
8 months after sheltering in place, anecdotes like this one from @GretchenTG are supported by data.

3/
Read 14 tweets
Arghavan Salles, MD, PhD Profile picture
8 Oct 20
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 Profile picture
7 Oct 20
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/
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

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