Share this page!

Michael L. Barnett Profile picture
Twitter logo
9 Dec, 4 tweets, 5 min read
New analysis in @NEJM today with coauthors @McGarryBE @ashdgandhi @DavidCGrabowski

Vaccine mandates continue to be controversial, including in nursing homes. What are the stakes exactly?

The results are sobering, to say the least ...

nejm.org/doi/full/10.10…
@NEJM @McGarryBE @ashdgandhi @DavidCGrabowski From June-Aug 2021, we compared resident and staff infection + mortality rates between 12,000 homes with the lowest staff vaccination rates (~30%) vs. highest (~80%).

In the least vaccinated homes:
+132% COVID cases in residents
+58% staff cases
+195% resident mortality

yikes
@NEJM @McGarryBE @ashdgandhi @DavidCGrabowski Over an 8 week period, if all nursing homes were magically raised to the highest staff vaccination levels nationally (~80%), we would have:

4,775 fewer resident cases
7,501 fewer staff cases
703 fewer resident deaths (nearly 50% of all deaths)
@NEJM @McGarryBE @ashdgandhi @DavidCGrabowski There was no difference in areas with low COVID-19 prevalence, underscoring that vaccination itself is probably the key difference here (rather than other confounding)

This should not be a controversial thing to say, but COVID-19 vaccination saves lives. Mandates = life saving.

• • •

Missing some Tweet in this thread? You can try to force a refresh
　

Keep Current with Michael L. Barnett

Michael L. Barnett Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @ml_barnett

Michael L. Barnett Profile picture
8 Nov
Extremely provocative French study out in @JAMAInternalMed this morning on persistent COVID symptoms.

What is the association between persistent symptoms and COVID-19 serology vs. patient belief that they had COVID?

jamanetwork.com/journals/jamai…
@JAMAInternalMed The authors took a cross sectional cohort of >26,000 French survey respondents and compared their reports of persistent symptoms in early 2021 with:

1) COVID-19 serology collected May-Nov 2020
2) Self-reported belief about prior COVID-19 infection

2x2 table of pt chars below
@JAMAInternalMed Their findings:
1) Positive serology associated with 10/18 persistent symptoms

2) Positive belief association with 15/18 persistent symptoms

3) Controlling for serology, belief, other characteristics, all symptoms were associated with +belief, but not +serology (except anosmia)
Read 6 tweets
Michael L. Barnett Profile picture
13 Mar
There was a totally overlooked trial in @NEJM this week with jaw-dropping results. The question: how should we diagnose diabetes in pregnancy?

23,792 pregnant women randomized to receive either 1-step or 2-step screening for gestational diabetes.

nejm.org/doi/full/10.10…

/1
@NEJM There's no consensus on how to diagnose diabetes in pregnancy, which is VERY common and, if treated, can reduce risk of infant + maternal complications.

So the authors compared the more sensitive, single visit "one step" approach to a "two step" approach that can take 2 visits.
@NEJM There was a HUGE difference in diabetes diagnosis between the two groups:

One-step: 16.5% of women diagnosed with diabetes

Two-step: 8.5% diagnosed

This diagnosis comes with a lot of emotional and clinical baggage!!

…pregnancychildbirth.biomedcentral.com/articles/10.11…
Read 9 tweets
Michael L. Barnett Profile picture
13 Jan
Brief primary care rant.

It's 2021. We have developed an effective vaccine for a novel virus in months and we can land a probe on a comet.

There is major cognitive dissonance with our potential as a society vs. the every day struggle to provide basic care for common conditions
Let me give a few examples.

Take hypertension. 1 in 3 Americans has it. It causes millions of years of life lost.

What is the process to diagnose and treat it? I have to beg my patient to buy a $40 cuff at a pharmacy, measure their BP, then call or send the numbers to me.
Alternative is coming to the office to get their BP measured. What a waste of resources. There are no cheap BP cuffs that can upload measurements to our EHR. Insurance doesn't cover them.

Without data I can't just randomly prescribe and titrate a BP med and hope for the best.
Read 12 tweets
Michael L. Barnett Profile picture
8 Dec 20
On Saturday, I went outside to clear the small hill of ice that snow plows helpfully deposit on our driveway when it snows.

I didn't see a slick patch of ice. My feet flew into the air and I went splat on my left shoulder.

I was in enormous pain and realized I needed help.
I went to a local ED with a shoulder dislocation. I had a totally normal experience - in fact, I think above average.

But this time, as a patient, I learned again how "totally normal" in our health system is frustrating, isolating and bewildering.
After I checked in and was sitting in the waiting room, the endorphins from my fall wore off and I realized that I was in terrible pain.

The triage nurse called me in. I told her I was in a lot of pain. She snapped at me: "Look, I'm doing my job and you have to wait your turn."
Read 19 tweets
Michael L. Barnett Profile picture
3 Dec 20
You have probably seen the record-breaking, terrible COVID-19 stats for Dec 2nd in the US

Daily cases: 195,695
Currently hospitalized: 100,226
Daily deaths: 2,733

You need to understand these numbers in context

It makes them even more frightening

covidtracking.com/data/charts/us…

🧵
Let's start with hospitalizations: 100,226 total on 12/2/20.

On the average day in 2018, there were 612,000 hospitalized patients. Assume this is 620,000 in 2020 without Covid

So roughly **16%** or ONE in SIX hospitalized patients in the US has Covid.

guide.prod.iam.aha.org/stats/historic…
This is WAY higher than ANY OTHER reason for hospitalization, including childbirth.

Top 3 reasons for admission in US, 2017 (36.5 million annual admissions):
Childbirth - 10.1%
Sepsis (infection) - 5.7%
Arthritis (elective surgery mostly) - 3.4%

hcup-us.ahrq.gov/faststats/Nati…
Read 8 tweets
Michael L. Barnett Profile picture
13 Nov 20
I spent the entire month of February 2020 in a state of silent panic.

Watching Europe + US outbreaks play out, I knew something terrible was coming. But few of my colleagues shared the depth of my fear.

It feels like this again. And I think the public still has no idea.

🧵
Just. look. at. this. graph.

Did late March feel terrible and apocalyptic? We are FAR past that point right now.

And guess what? We have not yet reached the BUSIEST HOLIDAY TRAVEL WEEK OF THE YEAR

My patients are asking me about travel plans. They have no idea what is coming
And how can I blame them? Even *I* am uncertain about how to best counsel them.

Honestly guys ... as a PCP my best source of COVID-19 guidance is #epitwitter and #medtwitter.

If this is how I feel, as a PCP and a professor at @HarvardChanSPH then I fear for our country.
Read 9 tweets

Did Thread Reader help you today?

Support us! We are indie developers!

This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal

Or Donate anonymously using crypto!

Ethereum

0xfe58350B80634f60Fa6Dc149a72b4DFbc17D341E copy

Bitcoin

3ATGMxNzCUFzxpMCHL5sWSt4DVtS8UqXpi copy

Thank you for your support!

Follow Us on Twitter!

Like this author's thread?

Get emails when @ml_barnett has new unrolls!

Check out other threads from @ml_barnett!

Read all threads by @ml_barnett

:(