Thread by @ChecchiaPaul

1/ Reflection, introspection, and frustration. I don’t know if anyone else has had enough, but I know I have. I’m done. I’m done with doom scrolling about COVID. I’m done with falling into the fear cycle which dictates that enough is never enough; the “what about?”-isms.

2/ (Boosters for the elderly and highest risk…but what about completely healthy 30 year olds. Vaccinations for 5-year-olds…but what about infants?) I’m done with unvaccinated adults dictating the path of this infection for children.

3/ I’m done pretending that the CDC didn’t make an enormous mistake in utilizing poor data to formulate the message that those that are vaccinated are just as responsible for spread as the unvaccinated.

4/ I’m done attempting to change the minds of those willfully ignorant adults who would rather be overtly manipulated by logging onto a money making “whistleblower” video rather than believe the census data of every hospital in the country.

5/ I’m done fighting against the old anti-vaxx playbook of using the fear of infertility as its preferred misinformation campaign despite there being no evidence or even biologic plausibility behind that claim.

6/ I’m done listening to healthcare experts and non-practicing MDs who sit at their computer screens and then move in front of TV cameras, choosing a tone of fear in the hopes that it will panic those unvaccinated into shots.

7/ I’m done listen to conversations about personal health choices, but not hearing conversations about personal health consequences. And I’m most certainly done with hypocrisy of fully vaccinated adults sewing doubt about the safety and effectiveness of vaccines.

8/ But I’m also done with people who post pride in the death of anti-vaxxer as a “told you so” moment. I assure you that hearing those stories will not suddenly turn a COVID denier into a vaccinated person.

9/ I’m done talking about masks because we will never mask our way out of this situation; we will only vaccinate our way out. I’m also done being compassionate toward caring for the willfully ignorant.

10/ I’m done with: “This wave is getting worse and even if it’s not, just wait until the flu this winter.” The wave is diminishing. As I pointed out earlier, this wave will slowly march out across the country, state by state, county by county.

11/ This is happening, but it is slowing, and the places left vulnerable due to low vaccination rates are becoming smaller. While there continue to be hotspots, the general number, everywhere, is decreasing.

12/ If twitter were a country, it would be the only country still experiencing a surge of cases. The opening of schools has not led to widespread death.

13/ The packing of colleges by fully vaccinated students and staff may have led to reimposing ridiculous restrictions (providencejournal.com/story/news/loc… ), but it has not led to college-town hospital ICUs filled with students. Labor Day did not fuel added cases.

14/ As far as coexistence with flu, we have seen this already with RSV. There is no evidence to suggest that combined infections make either outcome worse. What was worse was having both surges at the same time. You know what fixes that problem?

15/ Vaccines: get both the COVID and flu shots. You can get them together. You can get them right after each other. Just get them both.
I’m done with: “If you are vaccinated, you are still in danger and dangerous.”

16/ The results of the study conducted on the original participants in the Pfizer trial have been unblinded. (nejm.org/doi/pdf/10.105…) The results show an incredible 98.2% effectiveness in preventing severe disease and 100% in preventing death!

17/ Plus, and here is the kicker, its 63% effective in preventing ASYMPTOMATIC infection! Your risk of even testing positive is cut by 2/3rds. If you are asymptomatic, you will not infect others. Period! Every study with delta demonstrates this fact.

18/ It will not take it to zero. If you are sick with a fever and cough, you are a vector that will spread the virus; BUT LESS THAN if you weren’t
vaccinated. Plus, if you are breathing on a bunch of vaccinated people, they are not going to get severely ill.

19/ This is the message that the CDC screwed up with the stupidity of the Provincetown faulty data. (factcheck.org/2021/08/sciche…) It is my opinion that this represents one of the greatest mistakes made this year.

20/ This is by far the best thing I’ve read on this subject. (theatlantic.com/ideas/archive/…) I have been brought up to think the CDC is the pantheon of infectious disease research and public health policy.

21/ I still believe some incredibly smart and caring individuals work there and have dedicated their professional lives to helping all of us live better lives. However, we must be willing to put hero worship aside and look at the results of missteps and even blatant errors.

22/ While this piece is a bit too harsh and motivated by someone with a book to sell, it does raise important points that must be dealt with as we emerge from this pandemic. (reason.com/2021/09/23/the…)

23/ I’m done with: “Vaccines aren’t as effective against all these emerging variants, that’s why we need boosters.” Vaccines work. They all work, and they all work against every variant.

24/ If a variant mutates enough to evade vaccines, it will mutate out of existence. (thetimes.co.uk/article/covid-…)

25/ I’m fine with rolling out a booster for those who are proven to be at risk, but having 60% of the population get 3, 4, 10 boosters will not end this thing better than having 100% getting even 1 shot.
I’m done with the willfully ignorant.

26/ As this article points out, the central question is how do you help those that don’t want to be helped? (thebulwark.com/the-anti-vax-e…) When I was a 3 year medical student, I vividly remember seeing a patient with my family medicine resident supervisor.

27/ He yelled at her saying “I know I smoked and drank my whole life, but now you have to fix me doc!” I decided to go into pediatrics that day. The innocence of the life and health of a child allows me opportunity to make the kind of impact I want to make.

28/ I think of that interaction often now since I know so many adult ICU colleagues are faced with the same situation: “COVID is a hoax. I don’t want the vaccine. I don’t even want your therapy. But you still better fix me and not let me die.” I’m done with all that.

29/ Mostly, however, I’m done with gloom. There really is so much good news!

Why won’t we listen to it? Maybe because good news STILL doesn’t sell. (sfchronicle.com/opinion/openfo…)

30/ Instead, I choose optimism, hope, and most importantly, data to balance each new flare of posts and tweets.
While I’m optimistic, anyone who has read any of my posts over the past 18 months knows that I’m also a realist. I seek to provide balance.

31/ Obviously, the opening of this post serves as a slap in the face; a bit of a wakeup call to knock ourselves more into balance against the overwhelming darkness that many of us (me specifically) has been feeling this late summer/early fall.

32/ Remember how hopeful and happy we were in the spring? We can get there again. In so many ways, we are already there. I really felt that emerging again this weekend. The problem is that we seem to have lost the central message.

33/ The message that vaccination is our way out of this. I’ve stayed relatively silent on masks and other forms of mitigation because we cannot mask our way out of this; we can only vaccinate our way out.

34/ Temperature checks, symptom surveys, and other forms of hygiene theater will not lead us to control; only vaccines can do that. Look at the successful areas of vaccination.

35/ We should be applauding that and leveraging that rather than undercutting it with mixed messages, delayed positive reinforcement, and irrational fear.

36/ While we can vaccinate ourselves out of risk of hospitalization, severe disease, and death; we cannot vaccinate ourselves against either ignorance or irrational fear. If you are healthy, vaccinated, and living in constant fear; 20 boosters will not fix that for you.

37/ The main message is that vaccines will bring us back to normal. However, remember that normal was far from perfect. I have thought often about my professional life as pediatric critical care physician prior to this pandemic.

38/ There was a special bond amongst healthcare providers who practice at the “sharp end” of medicine; whether that was ICU or emergency medicine. It was in our language, our dark sense of humor, and even our bar tabs.

39/ We knew what each other saw at work and we knew the reality of human suffering. The bond was knowing the fragility of the human existence. We saw past the façade of “health” to see the reality of “luck.”

40/ There was an even greater bond amongst those that deal with children in those settings. We have always known that bad things happen to children every day. It’s horrifying, frightening, soul-sucking, and exhausting.

41/ It’s why we hug our own children so tightly and why we find our own quiet places to cry at the end of a call night. We have always seen it. This was our reality even before this pandemic shined the bright light on our lives.

42/ However, I’ve also pondered what it would have been like to live-stream or live-tweet a day or week in any ICU (particularly a peds ICU) prior to 2020. It would not be something the world would want to see every day.

43/ In an odd way I am reminded of the quote from the movie A Few Good Men:
“You have the luxury of not knowing what I know…You don't want the truth because deep down in places you don't talk about at parties, you want me on that wall, you need me on that wall.”

44/ We must all accept that getting back to normal is still getting back to imperfection and risk. Of course, we must utilize every tool to minimize both the imperfection and the risk. This leads to vaccines…again.

45/ To reframe imperfection and risk, let me draw some parallels against other areas in medicine. First, we have made great progress in fighting cancer, but we are far from wiping it off the face of the earth. The therapies are sometimes harsh and dangerous.

46/ The outcomes are often measured in lengthening life rather than cures. Most of the benefit is found in prevention of disease rather than curative therapies. Yet, we still battle on. It’s still worth it.

47/ I use this example to dispel the silliness of thought that “well covid has a low mortality rate, so why bother getting vaccinated.”

48/ Most cancers have a less than 10% mortality rate when you look at entire populations (ourworldindata.org/cancer-death-r… ). Does that mean you don’t get screened? Does that mean you don’t avoid using household chemical carcinogens? Of course not.

49/ So why not try to prevent COVID with an insanely safe vaccine? While breakthrough, mild infections show just how imperfect vaccines might be, it is still worth a try. Wouldn’t you rather be told, “we caught the tumor early” rather than at stage 4?

50/ Yes, children have a low risk of the worst outcomes; but does that mean we should accept and allow their hospitalization when it is preventable?
For the second parallel, I am reminded of a significant point in Houston medical history.

51/ This week marked the 50th anniversary of the birth of David Vetter, the Bubble Boy. (click2houston.com/news/local/202… ) I bring this up to highlight the efforts that his parents and other members of society undertook to protect this one child.

52/ It is a wonderful example of why most of us love pediatrics. Yet, today, adult members of society won’t even make the effort to get a safe and effective shot.

53/ While people were willing to build a protective world for one child for years, we are unwilling to even consider wearing a mask while indoors.
Still, I want to get back to being optimistic.

54/ There really is good news around us, we just have to take control of the message, accept the imperfection of life and realize that even in its most imperfect form; it beats the alternative.