One reason that people should show more empathy towards unvaccinated people is that many, or most, of them believe — **incorrectly** — that safe and effective Covid vaccines will endanger their health, or that of their children.
Many are wrongly - yet truly - scared.
And likely that stems not just from usual misinfo (e.g. clowns like Alex Berenson), but innumerable heart-felt first-person testimonials/videos shared widely on social media, of individuals describing various horrible symptoms/illnesses they believe vaccine-related.
One problem we face, even putting aside issue of media disinformation, is that emotive testimonials/stories are more persuasive than facts & figures for many. Yelling "correlation is not causation!" does not carry the punch of a tic toc video of someone saying they were...
... perfectly healthy until vaccinated and then X, Y, Z dreadful thing happened. Yes, we can correctly retort, "The vaccines are safe and incredibly well studied, and there's zero medical data supporting a causal link between them and what that you heard," but it's uphill work.
I don't have a solution, but I mention this as one more reason to have sympathy/empathy for unvaccinated people, rather than scorn.
It doesn't mean we shouldn't have vaccine mandates in workplaces: I think we should, because saving lives is paramount.
It doesn't mean we stop trying to increase vaccine uptake — we should being offering vaccines door-to-door, in my opinion; there should be vaccine clinics in schools and workplaces; we should keep trying and informing and persuading and pushing.
But it's important to keep in mind, because we know anger at the unvaccinated is rising — and with it falling compassion, efforts at mitigation, and calls for ridiculous things like rationing care by vaccination status.
We need to stop patient blaming.
• • •
Missing some Tweet in this thread? You can try to
force a refresh
Somewhat surreptitiously (for me anyway — not my clinical arena), a new class of drug has emerged in recent years as paradigm-shifting for both heart and kidney disease: SGLT2 inhibitors, originally approved for diabetes control. There’s something … academic.oup.com/eurheartj/adva…
… that I learned in Eugene Braunwuld’s short history (linked above) that’s so important. Initially, these drugs were merely thought to be modestly successful at improving diabetes control — i.e. one more oral hypoglycemic. But FDA became concerned about cardiac impacts of …
…such agents and required big clinical trials to prove safety in hard outcomes. To everybody’s initial surprise, per Braunwald, in these recent trials, the drugs then showed surprising / dramatic life-saving efficacy in heart failure, and reducing progression of kidney disease…
A new study at @JAMAInternalMed finds that protracted symptoms are not independently associated with evidence of prior SARS-CoV-2 infection ascertained serologically (except loss of sense of smell), but is associated with belief in having had COVID.
Although that is the top line finding, as important to my mind was the finding that among those who believed they had COVID, there was no correlation between antibody positivity and any protracted symptom (except for loss of sense of smell).
In August, I wrote:
"The lack of difference in symptom prevalence between those with and without serological evidence of a prior SARS-CoV-2 infection in such studies suggests that for some, 'long COVID symptoms' could arise from processes other than a prior SARS-CoV-2 infection"
The mainstreaming of dubious quackery about Lyme is many years in the making, but it is seems to be reaching something of an apogee with Ross Douthat’s recent work, which I fear could lead many a suffering person to useless, even harmful treatments. nytimes.com/2021/11/06/opi…
How much does this matter? Arguably not much. Although, the nearly universal “deference to narrative” shown to his (and similar work) in recent years by nearly all commentators is not so innocuous. On social media you will find innumerable heartfelt stories of individuals…
… who believe they (or loved ones) have suffered any number of terrible maladies from COVID vaccination (linkages not based, to be clear, on medical knowledge about these vaccines). Should the etiological claims in such narratives receive the same deference as those of Douthat?
Clinically, one of the great unresolved questions of treating critically ill COVID patients is how long to push off intubation. Some deny the controversy, but it is real, & it is quandary. A question uniquely difficult, if not impossible, to address with randomized trials.
One of the first things for the critical care community to do is to acknowledge that it is a serious quandary, and to not pretend that our pre-existing orientation to the proper timing of intubation/MV in acute hypoxemic respiratory failure was right.
And I would add, that for such an important question, there has been a surprising paucity of observational studies — or even commentaries, editorials, debates — in CCM journals.
To the extent that healthcare access mattered for vaccination uptake (I believe it did substantially, although obviously many other factors at work), it will matter much more for a drug that requires, at a minimum, access to expedient testing with rapid results, and likely an Rx
If we had a universal primary-care-based health service, with geographically defined catchment areas where each of us was some clinicians'/practices' concern, and much greater public health — medical care integration, I would be much more optimistic.
Everyone of us should have a primary care clinician who spends at least some time each year thinking (and sometimes worrying) about us — and sometimes bugging us — even if we go year(s) without coming in for a visit.
For everyone wedded to the notion that group differences in lung function stem from genetic difference, this new & massively important study should shake you up: there was a *huge* secular shift in lung function over the past century+ in Europe. 1/2
We should *not* assume that racial differences in lung function are “innate”, whatever that means, considered in conjunction w/ our recent study confirming that Black-White differences in lung function are associated w/ worse mortality among Black people