A few weeks ago I tweeted about the rising cases due to #DeltaVariant. I was surprised by the number of people who replied saying essentially “they did this to themselves.”
A short 🧵about why we ought to look at this situation differently
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A short 🧵about why we ought to look at this situation differently
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https://twitter.com/nickmmark/status/1420522984804999170
Seeing the #DeltaSurge among the un-vaccinated, I'm reminded of an adage I learned in my residency: “The trauma ICU is filled by man’s cruelty to man & the medical ICU by man’s cruelty to himself.”
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It’s true.
Without tobacco, alcohol, & opioids, there would be less COPD, cirrhosis, & endocarditis.
Without dietary indiscretions & "noncompliance”, we would not see fewer complications of DM or exacerbations of chronic illness.
But it's also not so simple.
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Without tobacco, alcohol, & opioids, there would be less COPD, cirrhosis, & endocarditis.
Without dietary indiscretions & "noncompliance”, we would not see fewer complications of DM or exacerbations of chronic illness.
But it's also not so simple.
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The last year has been marked by a periodic deja vu: a bizarre groundhog day where we seem to be making progress, COVID recedes from our ICUs, then a few months later a new wave hits.
If so much about the delta surge is familiar, why does this wave *feel* so different?
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If so much about the delta surge is familiar, why does this wave *feel* so different?
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I can think of three reasons:
1. This time around the suffering is almost completely *preventable*.
Even against the delta variant, vaccines remain highly effective at preventing hospitalization & death.
Unlike prior waves, over 95% of the current deaths are preventable.
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1. This time around the suffering is almost completely *preventable*.
Even against the delta variant, vaccines remain highly effective at preventing hospitalization & death.
Unlike prior waves, over 95% of the current deaths are preventable.
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2. Unlike other diseases encountered in the MICU, preventing COVID morbidity & mortality is *easy*
What could be simpler than receiving a free vaccination?
Addiction - the root cause of most "self inflicted diseases" - is comparatively much harder to treat.
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What could be simpler than receiving a free vaccination?
Addiction - the root cause of most "self inflicted diseases" - is comparatively much harder to treat.
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3. The negative externalities around vaccine refusal are enormous.
Not only do the unvaccinated risk their own health, but they endanger the health of others in their community, and [importantly!] our society's "return to normalcy.”
This feels selfish!
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Not only do the unvaccinated risk their own health, but they endanger the health of others in their community, and [importantly!] our society's "return to normalcy.”
This feels selfish!
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In the early waves of the pandemic, it was easy to see people as “victims” of the coronavirus, but as the pandemic wears on, this feels less true.
Today, as we round in the MICU it's easy to succumb to the trap of thinking "they did this to themselves"
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Today, as we round in the MICU it's easy to succumb to the trap of thinking "they did this to themselves"
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"They did it to themselves" thinking leads to burnout & an exodus of HCWs from medicine.
Of all the scarcities we face (ventilators, ECMO machines, ICU RNs), empathy fatigue is the one I fear most.
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Of all the scarcities we face (ventilators, ECMO machines, ICU RNs), empathy fatigue is the one I fear most.
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https://twitter.com/EricTopol/status/1245526300938260480?s=20
Instead of "they did this to themselves" I like to frame the situation differently:
We need to remember that no one *chooses* to have COVID. Instead of seeing this wave as a choice, I see it as a consequence of a another deadly comorbidity: misinformation.
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We need to remember that no one *chooses* to have COVID. Instead of seeing this wave as a choice, I see it as a consequence of a another deadly comorbidity: misinformation.
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We are dealing with a cognitive virus on top of the coronavirus.
Just as addiction is a disease that leads to other disease, so too is misinformation.
The *syndemic* of coronavirus and misinformation has lead to vast & unnecessary suffering.
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Just as addiction is a disease that leads to other disease, so too is misinformation.
The *syndemic* of coronavirus and misinformation has lead to vast & unnecessary suffering.
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So what can we do about this?
First, lower the barriers to vaccination even further.
Every interaction with the healthcare system is an opportunity for someone to make a good decision.
They need only make a good decision once (or better yet twice, 21 days apart)
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First, lower the barriers to vaccination even further.
Every interaction with the healthcare system is an opportunity for someone to make a good decision.
They need only make a good decision once (or better yet twice, 21 days apart)
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Pharmacists should ask about vaccine status when filling prescriptions & offer immediate vaccination.
Patients admitted to the hospital for non-COVID reasons should be offered vaccination prior to discharge, as should their loved ones who are taking them home.
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Patients admitted to the hospital for non-COVID reasons should be offered vaccination prior to discharge, as should their loved ones who are taking them home.
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Every family meeting is an opportunity to offer vaccination. Facing the reality of a sick unvaxxed loved one, many people re-evaluate their decisions
We usually focus just on our patient. We should use these quintessential teachable moments to offer help to their family
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We usually focus just on our patient. We should use these quintessential teachable moments to offer help to their family
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The MICU is filled by self-inflicted cruelty, tragically more so today than before
But in confronting delta, we need to remember that the cure for self-inflicted cruelty isn’t more cruelty
If we view misinformation as an illness it’s easier to empathize with the afflicted
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But in confronting delta, we need to remember that the cure for self-inflicted cruelty isn’t more cruelty
If we view misinformation as an illness it’s easier to empathize with the afflicted
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You can read more in my Op-Ed for @medpagetoday. Thanks to @genevievefri for inviting me to write this piece.
16/16
medpagetoday.com/opinion/second…
16/16
medpagetoday.com/opinion/second…
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