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Darren Markland

2 Sep, 9 tweets, 2 min read

Understanding why many of us are unvaccinated is crucial. The undermining of family docs and health networks has destroyed trusted leadership in many communities, a situation amplified by weak provincial leadership & worsened by targeted misinformation . theglobeandmail.com/canada/article…

Which then begs the question, how do we fix it? Trust takes time to build, it requires investment in social capital; education and teaching in critical thinking. It needs long term commitment to civility and compromise of absolute personal freedom. It requires public service.

Of course I’m of two minds. It’s hard not to grab at any life preserver when your drowning. I’m pretty desperate for short term mitigation strategies as well. One of the proven motivators of the undecided is a job requirement for vaccination. Yes #VaccinePassports work.

Convenience is also an under appreciated motivator. Keep going to the places of lowest uptake, hopefully with local municipal and cultural leadership leading the way.

What doesn’t work. Bribery. There is very good data out there that however popular incentives are publicly, they do little to sway the uncertain, and in often raise suspicion. That money and resource is far better spent in other domains.

Trust me on this one, after helping to raise two fantastic young adults, compromising my values, crossing boundaries without consequences and trying to pay them off, though tempting, was never the right way to go about it. I have my wife to credit for that wisdom.

Which leads me to my personal revelation. I’ve avoided using parenting metaphors throughout the pandemic because I did not want to appear to infantilize my audience, but really I think that was a disservice to good care givers.

We all crave good and consistent leadership. Inconsistent messaging and self serving goals are psychologically harmful. Picking favourites, being divisive, creating factions causes damage. I can’t help but wonder if this medium doesn’t amplify these divisions.

In summary, short term solutions require vaccine passports & mobile, multimodal vaccine delivery systems supported by local leadership. Long term solutions: education, community service, addressing social disparities and governance. Yes. Huge picture issues. I know.

Be safe 🙏

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More from @drdagly

Darren Markland

@drdagly

15 Sep

An open letter to my kidney patients….

First, let me thank you for all of your support. You never once complained that I was late, or a little disheveled. You asked how I was doing even though you were the one in need.

Let me assure you it was because I was running my clinics overtime to catch up with you after we had lost touch during the previous three waves. And I thank all of you for listening to me when I talked about vaccination despite the fact you had already done the right thing.

I thank you for the cards, the cookies, and even the gifts from your garden, not just for me, but for my staff, who were always rearranging my schedule and feeding me lunch. (Cuz apparently I get “hangry”)

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Darren Markland

@drdagly

15 Sep

She was a single mother of three girls.

Between the school closures and night shifts she hadn’t found the time to get one shot, let alone two. She did make her daughters lunches that day. They were on the kitchen table.

Her eldest called 911 when she slumped over the sink and couldn’t get up. That’s where the paramedics told me they found her, with one of her children trying to give her a glass of water.

Read 9 tweets

Darren Markland

@drdagly

14 Sep

We are clearly on a dangerous path, especially considering we are moving into fall which will further exacerbate COVID and influenza spread. We are looking at further expansion and different staffing models but at the cost of downgrading care. edmontonjournal.com/news/local-new…

We are looking at transferring patients to Calgary, and potentially to other provinces. The only surgeries that are being done are emergent, and that will bring us another wave of severe illness in a few months.

Triage will not be enacted until we use up all ICU resources, but there is differing opinions between what the province says we can staff and what we really can provide. This means that on some level or another physicians will have to make hard choices.

Read 9 tweets

Darren Markland

@drdagly

7 Aug

I am amazed by how much and how quickly we have learned about this perfect parasite. This article gives us insight into the nuts and bolts of how mutational refinements have made delta so infectious. #covid nature.com/articles/d4158…

First: It’s spike proteins are far more dexterous and literally able to probe the surface of our cells for the ACE2 receptor to unlock the door and gain entry.

Second, the virus as perfected a method that literally catapults in into its host cell at high velocity smooshing it into a coalescent hybrid.

Read 14 tweets

Darren Markland

@drdagly

6 Aug

She was a vibrant whirlwind in class, wise beyond her 8 years with a penchant for puns. She knew all of the countries & their capitals, & took special pride in knowing the ones that had changed after her parents had put away their atlases years ago. At least that’s how she was.

Her dad couldn’t put her finger on it. So many tribulations over the last year had left their family shaken, and the death of his mother had been so prolonged and draining that the entire family had aged along with her. His wife had kept them all going when he was laid off.

Little Sophie remained “resilient”. That was the word so easily bandied about by the doctors. The pandemic had be defeated by vaccines and the schools reopened. He felt relief to see how excited she had been to go back and see her friends again. She brightened again.

Read 15 tweets

Darren Markland

@drdagly

27 Jul

So. I’ve been pretty mute on the COVID front lately. It’s a topic that’s become pretty harsh as of late. We all want it done, especially our provincial government, hence the relabeling to endemic. Those who follow me know that I’m a big picture person, so here’s my take.

Our rising numbers are real, and predictable. We speak of how infection rates are decoupled from hospitalizations. That’s not true. It’s a numbers game, though the proportion of infections that require hospital admission is far less, without mitigation it is still significant.

Tertiary hospitals, the ones with advanced services, accept patients from all over the province. Our heterogeneous rural vaccination rate is a problem. Local outbreaks cause morbidity and high resource use. They require advanced transport and use ICU beds.

Read 13 tweets

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