1/🧵How do we overcome #vaccination hesitancy?
 
#COVID19 ICU pts & #LongCOVID survivors tell me they wanted to get #Vaccinated but had immense pressure from family/friends NOT to…All but 1 said, “I should have protected myself & stayed safe.”

What’s our best approach? Read👇
2/ A significant portion of Skilled Nursing Facility (SNF) Staff remain #unvaccinated. Early data: bit.ly/3gOdSLi. Reasons include mistrust of govt & big pharma, potential side effects, and racism. Staff’s close contact w pts makes it essential to study their reasoning.
3/ N=193 staff from 63 Skilled Nursing Facilities (SNFs) were studied. The best way to overcome misinformation on #Vaccination from social media is to model specific scenarios & prepare positive approaches, NOT guilt or shaming. Let’s look at specifics…

bit.ly/2UmoOYX
4/ This table that outlines staff concerns. This is the order of the things raised in these town meetings. Remember, to these caregivers, these are “real” concerns that need validation to be unpacked!
5/ Here are some brilliant responses to these #Vaccine concerns + more: my DNA, infertility, speed of development, causes #COVID, bell’s palsy, booster shot, ineffective on variants, already had the virus, microchip, abuse of blacks, Guillain barre, spiritual concerns.
6/ Example of MICROCHIP concern…

response: “That would be scary if it were true. The technology to put a microchip into a vaccine doesn’t exist. If drug companies included anything in the vaccine that was not on the label, they would be sued.”
7/ Example of abuse of #Blacks

response: “Due to systemic racism & alarming medical racism, many Black, indigenous & people of color (BIPOC) are worried about vaccine safety. #COVID19 is disproportionately harming BIPOC, so BIPOC should strongly consider getting vaccinated.”
8/ “God will protect me”…

response: “God gave us the technology to create a great vaccine. Pope Francis and other religious leaders have strongly encouraged #Vaccination. There is no “mark of the beast”  or tracer in the vaccine.”
9/fin
If we understand our staff, we will understand the larger population’s #Vaccine hesitancy, too. Misinformation about #COVID vaccines is widespread among HCWs. Town halls that validate & address staff concerns by sharing stories & positive emotions can work. Lets get savvy!

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More from @WesElyMD

21 Jun
1/ Imatinib for #COVID19: @TheLancet

This study of N=385 ICU pts tested a Tyrosine-Kinase Inhibitor vs. Plac for 9 days. It’s important because it did NOT decrease ventilator or oxygen needs BUT reduced death at 28 days. What does this mean?

bit.ly/3gFJELG

#MedTwitter
2/ This study is technically “negative” because it didn’t hit the primary endpoint scientists “guessed” ahead of time as best choice to see if the drug works in #COVID: time to stopping ventilation & O2. Importantly, we sometimes GUESS WRONG! Next let’s look at other endpoints!
3/ This drug stops lung & blood vessel membranes from going haywire. It did not have safety problems & decreased DEATHS by ~50%, TIME on VENT by 5 days, length of ICU stay a WEEK, #delirium by 5%. These are huge improvements that I would want if I had #COVID. ( Fig 2, Tab 2/3)
Read 6 tweets
16 Jun
1/ 🎥🧵 How do we test someone for #delirium in #COVID19 or any ICU? When someone won’t engage it can be a huge red-flag for “quiet” delirium, which predicts 3X ⬆️ #DEATH by 6 mo & acquired #dementia. Watch this movie of me testing pt #1 for delirium.

#MedTwitter #NurseTwitter
2/ What does this mean? He starts out OK but then can’t follow my command to squeeze only on the letter A. Instead, he squeezes when I say the word “squeeze” & doesn’t relax his grip or vary it on different letters. This is inattention & a cardinal feature of #Delirium.
3/ 🎥 Contrast Pt 1 with this Pt 2 video of me doing the same test. This person had delirium on earlier days & is now improving. He gets 8/10 correct responses, which means he’s attentive and not delirious any more. This day he walked & talked for the 1st time!

#Recovery #nurse
Read 7 tweets
14 Jun
1/🧵 🎥
This week I met an extraordinary #COVID19 survivor who lost both hands, both feet & the tip of her tongue. @ccquad was featured on BBC as WINNER of the Queen’s MBE (Member of British Empire) award. Listen to her #Wisdom & teaching point on #Vaccination.

#LongCOVID
2/ @ccquad reached out to my #COVID patient, Autumn, who is now also losing her hands + feet & keeps asking me to share her story so all can learn. She went completely deaf as part of her viral sepsis & blood clotting. Her hearing is back & she’s getting koala prosthetics…🎥
3/ Watching these 2 powerful women meet and share their drive & passion is a major gift to me. They define #resilience. Rebooting life & finding the best way forward regardless of obstacles. Here is what Autumn told @ccquad… “I live freely. I live one day at a time…” Image
Read 6 tweets
14 Jun
1/🧵 I’d like to think as a medical community that we have changed & no longer discharge people w/out appropriate follow-up, but just last week I met a #COVID19 survivor who was discharged from the ICU simply to follow up w his primary care physician.

#LongCOVID #PICS #A2FBundle
2/ He couldn’t return to his job, was fired & had no income for his family. That resulted in him not having enough money for medications, gas, or bills. He missed his doctor’s appointment, his electricity was turned off, so he is unable to apply online for disability. 😤
3/ The cycle continues. I usually see these pts when they get septic again & end up back in my ICU on life support.
Read 4 tweets
7 Jun
1/🧵#SEPSIS is URGENT. Here it was caught way too late! Sepsis is marked by WBCs (White Blood Cells) either too high OR too low. If someone’s WBC drops from 14k to 6k to 3k WITHOUT antibiotics, that’s a total catastrophe & usually means death is closing in.👇

#MedTwitter
2/ So hypothetically (& I’m changing details to make this situation unrecognizable to the real patient my comment is based on)…if a month after a knee replacement someone comes in complaining of NEW knee pain and no fever…

#COVID19 #nursetwitter #TipsForNewDocs #nurse
3/ …with a WBC count of 14,000, scans & xrays not showing an abscess, an infected prosthetic joint is still my #1 Dx unless there is a completely obvious other cause of infection. Said another way, this is sepsis due to an infected knee until proven otherwise.
Read 10 tweets
7 Jun
1/🧵An Epiphany: #delirium treated w touch & eye contact, day by day...his mom cried, “He won’t let us help him shake this damned disease.” Finally his mind cleared. “What matters to you? How can I help?” Slowly, surely, he asked, “Doc, can you help me stop drinking?”💔
#Recovery
2/ #GroundZero. What a privilege it is to witness someone enter a long-awaited epiphany that opens the door to so much recovery. Unfortunately, in my early years as a doc, I thought, “Well, this isn’t critical care, so I’ll move on & let someone else take over.”

#shame on me
3/ But what is a doctor for?

1. To reduce human suffering & heal people where they are.
2. Plus the Latin root is “docere,” teacher.

It’s a dual vocation: healer + teacher. Because of the “Law of the Gift,” I know that the more I give, the more I receive, so…

#TipsForNewDocs
Read 7 tweets

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