1/🧵COVAX was created to get #COVID19 #Vaccine to ALL countries. Hailed as a “heroic effort to transcend limits of human ingenuity,” it fell short globally because we “rich countries behaved worse than anyone’s worst nightmare.” @TheLancet
 
bit.ly/3yskwxJ
 
#MedTwitter
2/ At COVAX’s pledging summit, it finally secured US $8B ask for procurement & delivery of #vaccines for 92 eligible low-middle-income countries (LMICs) this year. But even with full financing, the COVAX roll-out is moving too slowly compared to high-income countries.
3/ “Today, ten countries have administered 75% of all COVID-19 vaccines, but, in poor countries, health workers and people with underlying conditions cannot access them. This is not only manifestly unjust, it is also self-defeating”, UN secretary general António Guterres said.
4/ The poorest of the 92 countries were to receive them at no cost. Team Europe (led by Germany) & USA have provided US $5B to COVAX AMC, Japan has given US $1B, and UK, US $735M. Most of these funds have been pledged only in the past few months. Some LMICs are self-financing.
5/ The grand idea of COVAX was that the combination of self-financed and aid-financed pieces would give COVAX a way to invest in R&D for promising vaccine candidates. COVAX would be a lifeline for self-financing countries that had not made bilateral deals w vaccine makers.
6/ But US, EU, and UK all made huge deals bypassing COVAX’s plan. “Everyone knew rich countries would enter into bilateral vaccine deals, but it was hoped that they would also buy into COVAX as insurance.” That didn’t happen, and luckily the vaccines worked. BUT…
7/fin
The process left the shelves empty at COVAX and the poorer countries without a safety net until major outbreaks had already occurred, leaving the #COVID19 virus happily spreading around the globe in the most vulnerable countries – LMICs.

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More from @WesElyMD

6 Jul
1/🧵Wake-Up to how #SLEEP flushes waste from your brain 🧠 @JAMA_current
 
I may get more done when I 💤 less, but I lose the long-game! #Evolution dictated that we gain an advantage by spending 1/3rd of our lives asleep.

I’ll tell you WHY? bit.ly/3qPgzAA

#MedTwitter
2/ Why do we sleep? Brain rest? To process bad decisions or incomplete conversations? Maybe. But the coolest reason is removal of #amyloid & #tau proteins that cause #dementia. Our #glymphatic system does this most efficiently during deep sleep.
 
3/ Have I mentioned that I’m fascinated by the glymphatic system? It’s the lymph system for our #brain & serves as the “garbage” removal program to keep our #neurons healthy. Wanna know more?
 
Read 12 tweets
5 Jul
1/🧵Human Error in Decision Making and Judgment:
 
For those who loved @NobelPrize Laureate’s book Thinking Fast & Slow, there is a new Kahneman book called Noise reviewed @TheLancet. It’s worthy of a bit of commentary…

bit.ly/3hzD7RR

#MedTwitter #ScienceTwitter
2/In statistics, #NOISE refers to random scatter, ie, variations in our judgment that are NOT caused by individual judgment. #BIAS on the other hand is systematic deviation in judgment.
 
@nataliexdean @EpiEllie @f2harrell – teach us more & did you read Kahneman’s book yet?
3/ Kahneman himself (see quote in @TheLancet review👆) acknowledges that this book is somewhat data-o-penic. We need much more knowledge about “noise”…it’s a limitation in science at this point. In Medicine, he claims #Psychiatry is an extreme noise factory…@APAPsychiatric
Read 5 tweets
1 Jul
1/ Serious End-of-Life 🧵

…He told her, “Never give up on me because I’ll keep fighting to live.” What does it mean when a person valiantly asks this of a spouse & then illness leads to #transplant, #infection, and eventually #life support that doesn’t help?
 
#medtwitter
2/ First I just listened to her heartache and saw their immense love. “I made a #promise, Doctor.” My personal commitment became to help this couple uphold that promise, yet medical options had long since run out & failed him. I asked her to come into the hall.
 
#nursetwitter
3/ Always go out outside a pt’s room to discuss anything you don’t want the patient to hear, even when he is in a dense coma. Assume dying pts hear everything said & respect their dignity as your number one goal in all interactions. Here is what I said…
 
#PalliativeCare
Read 10 tweets
30 Jun
1/🧵🎥 Hepato-Jugular Reflux (HJR)?
 
Neck Veins tell us a lot about how much fluid people have in their body. Look at this video & you’ll learn a trick doctors use that tips us off about blood volume! (Movie w perm)
 
#medtwitter #nursetwitter #TipsForNewDocs #TipsForNewInterns
2/ My patient had kidney failure & too much fluid, making him short of breath. I press down over his liver & watch his neck veins pop up (or not). When they do, it correlates w high pressures in the heart from too much blood volume.
 
bit.ly/2UDAVkl

#MedStudentTwitter
3/ Another way of seeing this is the CXR (see pic). This simple measurement from a vein to an artery called the Vascular Pedicle Width (VPW) also tells me the heart pressures are too high. His VPW is 84 mm and > 70 is way too much. So he needs to pee a LOT!
 
#LASIX #DIURETIC
Read 5 tweets
29 Jun
1/🧵What do CONDOMS have to do with the #COVID Vaccine?
 
The Pelzman Effect is currently threatening societal safety.

What is it & why is it important? Let’s unpack.
 
#MedTwitter #Pandemic
2/ The #vaccine, heralded as a panacea to the pandemic, risks further weakening adherence to other safety measures like social distancing & masks 😷. When people respond to safety measures with a compensatory ⬆️ in risky behavior, it’s called the “Peltzman Effect.”
3/ Example: medications allowing HIV preexposure prophylaxis (PrEP) dramatically lessened risk for HIV transmission AND were associated with decreased use of condoms, higher numbers of sexual partners, & more STDs. 😤
 
bit.ly/3xVTqPu
Read 11 tweets
28 Jun
1/ 🧵🎥 Chronic Pain

#Pain comes in all shapes & sizes. Let’s explore how we process pain. Watch & Listen to what Anderson Cooper tells Stephen Colbert about #grief and #suffering: “You can’t have happiness without having loss and suffering.”
2/ My lucid & kind patient (pic w written perm) uses scalding water as a coping mechanism for abdominal pain from pancreatitis. He wants to share his rationale.

#MedTwitter #ChronicPain #nurse
3/ Before I share what he told me, I first want to make my mindset as his #physician clear: My first job is to believe in him. Then to understand him. Then to devise a plan to help him.
Read 13 tweets

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