Thread by @ChecchiaPaul

1/48 Well, I’m back to writing about COVID. Long 🧵 As I stated in previous posts on COVID, writing is a form of self-therapy as I work through my anxieties, frustrations, anger, disappointment, and ignorance.

2/48 I took the past couple of months off of social media because the need for therapy was greater when I was on social media than when I was off.

3/48 However, as I see the media stoking the fires of coronanxiety and COVID click bait; I found that I was writing a narrative in my head for self-care. Thus, I thought I would share my ideas.

4/48 First, my narrative kept repeating quotes:
1. “We have two ears and one mouth, and we should use them proportionally.”
2. The part of the Catholic mass that asks: “Protect us from all anxiety…”

5/48 3. Rudyard Kipling’s IF: “If you can keep your head when all about you are losing theirs…”

Let me work through this.

6/48 “We have two ears and one mouth and we should use them proportionally.”
Fear, depression, and anxiety are all around us at the start of this year.

7/48 However, if we listen to the actual data around us, rather than the noise coming out of some mouths; we might see a different, more positive, picture.

8/48 First, the wave of Omicron in South Africa is already over. (sciencedirect.com/science/articl…) (nytimes.com/live/2021/12/3…) The severity IS lower than previous waves with far less hospitalizations and far less mortality. (bloomberg.com/news/articles/…) AND this has occurred in 4 WEEKS.

9/48 Four weeks from start to finish of the identifying wave in South Africa. The South African physicians caring for the patients in their hospitals had been saying that from the beginning.

10/48 However, some “medical experts”, those spending more time on TV and social media than in hospitals and clinics caring for patients, flipped the above-referenced proportion of ears to mouth and spoke about waves, tsunamis, and firestorms without listening first.

11/48 I want to be clear; we are in a case-demic. It is staggering just how many cases we are seeing around the world. It is stressing staffing in every aspect of healthcare. Nobody is left untouched. It’s not pleasant; but it is not the apocalypse.

12/48 We have been doing this for 2 solid years; even 2-year-olds learn a lot in that short time span…and so have we. We have learned how to treat. We have learned how to triage. We have learned when to be scared.

13/48 Unfortunately, we have also learned how to be resilient in ways we never imagined. Some have also learned how to leave healthcare as a profession. This is all terrible, difficult, and depressing. I am not minimizing any of it.

14/48 I feel it (why do you think I need to write.) But we must try to look for the good in life.

What we have learned is that the vaccines work!

15/48 The latest data from UK is extremely encouraging. (assets.publishing.service.gov.uk/government/upl… ) Look at how many cases of Omicron there are in England since it first was discovered there on November 23rd: 198,348! HUGE number. However, there have been 57 deaths. Look at page 6 again.

16/48 57 deaths in all of England from Omicron. (And it’s been over 6 weeks, so enough with the “lag time” discussion.)

17/48 As a pediatrician let me quote from the document directly: “Preliminary sub-analyses estimated a lower risk of hospitalisation among Omicron cases in
school-aged children (5 to 17 year olds) compared to Delta cases in the same age group (HR
0.42, 95% CI 0.28-0.63).”

18/48 That is a very positive quote since the UK has only opened vaccination for 12-17 year olds. Additionally, the risk of hospitalization was significantly lower for everyone if you are vaccinated.

19/48 Even if you are only vaccinated with 1 dose of something (including the known to be slightly less effective AstraZeneca shot) you have a greater than 50% reduced risk of hospitalization.

20/48 If you have had a 2nd dose anytime within the past 6 months, you have a 72% reduced risk. If you have had a booster, you are back to an 88% reduction of risk. Even better, that data doesn’t even account for differences in co-morbid conditions.
So…

21/48 If you are vaccinated, even with 2 doses; you will be fine. If you have any of the co-morbidities that we have learned from the past 2 years put you at higher risk (obesity, diabetes, old age) but you are boosted; you will be fine.

22/48 If you are young and healthy, including children, and are even partially vaccinated; you will be fine. If you remain willfully ignorant and unvaccinated; you are rolling the dice and risking more serious disease.

23/48 Remember, I am an ICU physician, so my concept of “fine” as a vaccinated individual is potentially twisted, but a couple of days of congestion, sore throat, and low-grade fever does not represent serious illness in anyone’s mind.

24/48 Remember the quote about listening more than talking? What more do we need to hear? South Africa. UK. Fine, what about the US?

25/48 Data from Washington state from the past 28 days, thus accounting for Omicron, shows that hospitalization rates for unvaccinated people are anywhere from 12-18 times higher than vaccinated, depending on age group. (doh.wa.gov/Portals/1/Docu…)

26/48 While there is an increase in hospitalization amongst vaccinated individuals as well as unvaccinated, the overwhelming majority of seriously ill individuals remain unvaccinated…by a long shot.

27/48 Let me do a little sloppy math to attempt to demonstrate the impact of vaccination on our current situation.

28/48 Even if we took the worst case from above and had 100% of the people in this country receiving even 1 dose of something, the > 85,000 people with COVID in the hospital today according to the NY Times site, would actually be more like 40,000;

29/48 which would be about what they were on November 1st and we wouldn’t be talking about Omicron. (And that’s not even accounting for “with” vs “for” COVID, fully vaccinated, co-morbidities, etc.) My point, vaccines are and always will be the way out of this thing. Period.

30/48 “Protect us from all anxiety…” a Catholic prayer.
To that end, the way to protect us from anxiety and fear is to support vaccination of anyone, anytime, anyway, at any age. This will NOT be done by fear mongering.

31/48 This will also never be accomplished in some individuals; those willfully ignorant. They will not respond to the pleas that the sick unvaccinated are clogging up hospitals. They clearly don’t care about themselves, why would they care about random others in society?

32/48 I’m done trying to protect them. I understand that I will care for them. I also understand that public health officials feel the need to try. However, I will say again; I am done with them. You feel free to roll the dice with your own health.

33/48 Yes, Omicron is milder for the unvaccinated as well; but good luck going to Vegas. I prefer to stack the odds in my favor.

34/48 “If you can keep your head when all about you are losing theirs…”
Finally, please realize we are actually winning against the virus. This variant is an attempt by SARS-CoV-2 to survive by infecting more people, but at the expensive of severity.

35/48 I know that is hard to believe, but if you are vaccinated the odds are overwhelmingly in your favor that you will not get seriously ill or die. OVERWHELMINGLY IN YOUR FAVOR. Actually, even more than that; they are as close to zero as we are given in medicine.

36/48 The latest case fatality rate in the US is 1.5%, however, that accounts for the unvaccinated as well. Since all the vaccines retain a >90-95% effectiveness against death, we have effective therapies, and we have learned so much; I am very confident with my statements.

37/48 Stay calm. Try to enjoy life. Yes, it will be inconvenient to have flights cancelled because the pilots have a cold. Yes, you will likely catch COVID regardless of how diligent you are wearing your mask. That’s ok. This is not a shame cast on you and your family.

38/48 As a quote from this article states: “Instead of thinking they lost the race against the virus, Frenck encouraged people to redefine their concept of winning. "It's not that you failed," he said. "You actually succeeded.

39/48 You dodged the bullet … What are people trying to prevent? Are we trying to prevent the common cold? Nobody's going to do that.

40/48 You've gotten your booster, you've done everything, and you still get COVID, but how sick did you get?"” (inquirer.com/health/coronav…) If you are in contact with people who are vaccinated (even if they have co-morbidities and risk factors[if boosted]), they will be fine.

41/48 If you are in contact with a bunch of people who are unvaccinated and choosing to listen to conspiracy theorists on Fox News (who are themselves vaccinated); that’s unfortunately their choice.

42/48 If you are in contact with children who are vaccinated, even partially, they will be fine.

43/48 If you are in contact with children who are yet to be vaccinated, as the latest UK data show, the odds are they will also be ok just not with the certainty that vaccination would provide them.

44/48 Staying calm in this firestorm of noise is so difficult, but it is how we all really win.

One final comment on not losing our heads. We must stop making students bear the responsibility of the stupidity of adults. Students of all ages should return to in person classes.

45/48 We should not delay for any length of time. I am not alone in this recommendation. (policylab.chop.edu/press-releases…)

46/48 For my family, I must state that college students were at low risk to begin with and now with >95% vaccination uptake in that group at most campuses; it is utter insanity to have them start remotely.

47/48 Part of keeping our heads while others are losing theirs comes from learning from our past experiences.

48/48 I beg people to remember that we did this in the fall when there were less vaccines available and when Delta was actually more severe than Omicron…and it was fine! (theatlantic.com/ideas/archive/…)

We must stay calm and break the cycle of fear.