1/ As the senior-on-call @BrighamWomens (also known as “the Phys”) we are responsible for, among other things, going to all the code blues to help as “code whisperers” for the juniors & seniors running the code to help think through what’s going on + management.
2/ I’ve been in this role the past two weeks. As such, I’ve had the great privilege to be there to support some of my colleagues run their first ever codes. For all doctors, we know the feeling invoked by the alarm overhead (at BWH it sounds like a loud monotonous & ominous ping)
3/ They say to check your own pulse before you go to check the patient’s. It truly is an effort of multiple teams- nurses, respiratory therapy, pharmacy, docs, chaplains etc

It’s humbling both to show what we can accomplish as a team; and what the limits of modern medicine are
4/ These past two weeks have been among the best I have spent @BrighamWomens bc I got to work w/ my incredible colleagues @BrighamMedRes, be able to learn from them, to teach as well; but importantly, to care together & support each other.
5/ A special shout out to @LuisaParedesMD @LaurenMerzMD who both have been incredible code leaders over the past couple of weeks.

And to the many folks who make our hospital @BrighamWomens an amazing place to train & provide our patients w/ all we got

We work as a family.

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More from @AbraarKaran

23 Feb
Thread 🧵
1/ Have been thinking about this story all night (was working overnight at the hospital).

Japan appointed a Minister of Loneliness. So much of this year has been a deep well of isolation.

For some of my patients, this was worse than #covid19

insider.com/japan-minister…
2/ I have treated people who have suffered from #covid19 but said that actually losing their job, relapsing to substance abuse, being afflicted by depression/suicidality was even worse.

For some, it was not even a life worth living at all.
3/ I have also seen a ton of shaming around social activities on Twitter.

“Can’t believe this person did that” etc

We don’t know what other people are going through.

That doesn’t mean condoning all social activities- but it also doesn’t mean stigmatizing all of them either.
Read 6 tweets
22 Feb
1// “In seven clusters (A, B, C, D, E, F, and I), transmission among educators and students might have occurred during small group instruction sessions in which educators worked in close proximity to students”
#covid19
@CDCgov

cdc.gov/mmwr/volumes/7… Image
2// “However, information obtained during interviews indicated that specific instances involving lack of or inadequate mask use by students likely contributed to spread in five clusters (A, C, E, G, I). Students ate lunch in their classrooms, which might have facilitated spread”
3// “Although plastic dividers were placed on desks between students, students sat <3 ft apart. Physical distancing of >6 ft was not possible because of the high number of in-person students and classroom layouts.” #covid19
Read 4 tweets
21 Feb
A year ago, rhetoric was no mask

A few weeks after that, masks

Months later, finally started talking about #BetterMasks in mainstream #covid19 response

Then came double-masking as a backstop

Now- more pragmatic articles on how to get certified Hi-Fi masks ⬇️
2/ In @washingtonpost this week, we proposed how the Biden administration could actually operationalize a strategy to get #BetterMasks to the general public quickly. #covid19 washingtonpost.com/outlook/2021/0…
3/ As w/ most parts of the response, it’s not a lack of ideas but lack of actually doing them consistently, effectively, for long enough, with enough understanding of local public health & norms that determine the uptake of interventions. This isn’t new. It’s basic public health.
Read 4 tweets
19 Feb
🧵🧵🧵
1/ Just saying #BetterMasks isn’t good enough. How do we actually do this?

We already have supply across a number of certified options incl
•N95
•eN95
•KN95
•KF94
•surgical masks + mask fitters

Double masking can be good, but even here fit+filtration inconsistent
2/ Biden administration needs to have an Operation #BetterMasks.

People keep asking me where & how to get certified retail N95s or KF94– frankly, I’m not sure. Some are real, others are counterfeit.

Entire states are having issues with this at scale.

cbsnews.com/amp/news/n95-m…
3/ There would need to be some vetting by CDC/NIOSH & other private labs to quickly assess mask quality.

We need DPA/American manufacturing to help ensure a continuous supply of verified high filtration masks.

Priority for high risk &/or high exposure + unvaccinated folks
Read 8 tweets
17 Feb
Thanks @drsanjaygupta for the shoutout! Absolutely agree- high grade masks like N95s in all high risk settings can urgently curtail superspreading/ drastically slow spread- critical while we vaccinate. Hopeful @JoeBiden admin will operationalize #BetterMasks for #covid19 control
2/ @RanuDhillon @sri_srikrishna & I have a piece coming out shortly on this topic this week with more specific thoughts that raise the bar above double-masking, which is a backstop for the time being. #covid19 #BetterMasks
3/ not even clear that *supply* is the issue! Need to actually move existing supplies into healthcare and other high risk settings, & also continue to manufacture thereafter— but more than anything, need an organized strategy. #covid19 Image
Read 4 tweets
16 Feb
This is key

It’s been a long year, & I can sense hesitancy from the public health community about being too vocal on what is “safe”— but once you are fully vaccinated, you have excellent protection from severe disease!

When around those who aren’t yet vaccinated, wear a mask ⬇️
2/ I think part of the hesitancy is that “safe” and “unsafe” is a nonspecific framing.

Safe from what? From severe disease? Hospitalization? Death?

Yes, once vaccinated, the chance of this happening is extremely low. We have excellent trial data showing this.
3/ Is it possible to still get #covid19 after vaccinated? It’s possible- but it is much more likely to be *mild* disease

Can you transmit onwards? Yes, although vaccines likely ⬇️ this chance as well

This is why we say to wear a mask around those still waiting for their shots
Read 4 tweets

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