Nursing Homes and Covid-19- the state affairs- thank you @JonLemire for taking time to discuss this topic @MSNBC@WayTooEarly a long 🧵 that I start with a picture from a NH in rural Michigan: yep, thats right- 14 staff out with covid-19 infections.
2/ A series of Graphs with situation today: data from @CDCgov illustrating cases by vaccine status-
clear decoupling among those w/ boosters vs not boosted
cases of vax but not boosted quite close to unvax-this is unadj data but reflective of highest efficacy of 3rd dose in NH
3/Next up-cases-data lag by about a week, but state data which maps to experience in many states-note Michigan data below followed by national trend-note low case counts this past year=vaccine.vaccine.vaccine
4/ Nursing Home Hospitalizations- also on the rise-harder to get granular data on % of hospitalizations from Nursing Home residents, but it is a growing share. Equally growing-->pressure to ACCEPT covid+ pts to NH but lack of hosp capacity/staff has forced hands of many states
5/Nursing Home Deaths-always the last to rise, but trends are NOT good, appear to be rising above #s seen in delta surge. Controversy exists over deaths to date in nursing homes (largely undercounted): detroitnews.com/story/news/pol…
6/Now on to even more bad news- cases and deaths amongst staff- almost 2500 deaths- this is probably the most under-reported statistic- also a couple of weeks old so actual # is higher. Majority of staff are female, over 50 and black.
7/ More on Deaths amongst Staff from CDC: below are unadjusted rates, but useful to see the uptick in trends- again, after lower rates earlier in year as part of delta surge. Some of these deaths are still delta to be sure.
8/why are hcw esp in nursing homes refusing the vaccine? not for the reasons you might think-top reason is:
1⃣vaccine cynicism- initially vax were rolled out too quickly, not enough data but now that viewpoint has morphed to sentiment they dont work/e.g see breakthrough rates
9/ More disturbing news: according to a survey profiled in this excellent @19thnews article in JULY 2021, only 1 in 4 nursing homes thought they can survive in a year (which is in about 6 months): 19thnews.org/2021/07/nursin…
10/ but lets go beyond statistics and maps:
I used to work inside of nursing homes/stopped bc I got pretty frustrated/easier to feel I could make a difference in the hospital/clinic setting
here is a glimpse of what it is like to be a nursing home resident now from @Altarum :
11/ here is what women who work in nursing homes tell me:
1⃣ they are so short staffed, they are just trying to make sure residents can get to the bathroom/get 3 meals
2⃣ average pay $14.82/hr -->not enough to pay bills
3⃣ they lack infection control/fear getting sick
12/
and why so many nursing home residents still unboosted? majority of nursing homes have less than 50 beds, are small esp rural ones and lack pharmacy infrastructure to vax/ large retail pharm either not able to come in like they did earlier in pandemic or simply not enough
13/
America has always had a problem with how our we treat our elderly (average age of resident: 85 yrs). we dont want to think about:
who will help turn us in bed to avoid bedsores
clean us after we urinate or defecate
who will feed us when we cant feed ourselves
Fin/
so what can we do?
for starters, pass #BuildBackBetter which has significant funding for $1 billion in workforce/infection control improvements. So lets actually start there
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1/n Kate Cox was 20 weeks pregnant when she received the diagnosis of trisomy 18 for her pregnancy with only 5-10% chance of survival at 1 year- more info on what that is here: my.clevelandclinic.org/health/disease…
2/n carrying the pregnancy to term would jeopardize the mother's health and put future potential for pregnancy at risk- the Cox family has 2 other children and until receiving this diagnosis she was looking forward to adding to her family
It took this insane tweet and its falsehoods to put me back on twitter. There are so many things wrong with this and shame on any physician but especially someone with a platform on twitter for spreading this level of misinformation.A 🧵about what is REALLY happening tomorrow 1/n
Monkey Pox Public Health Emergency Declaration- much of it were familiar phrases but the GAME CHANGER- @US_FDA@DrCaliff_FDA announcing that 1 dose of Jynneos MIGHT be split into 5 doses by injecting intradermally (versus subcutaneous)- pic below for difference- BUT...(1/
-Monkeypox contd- important to see if the dose sparing technique suggested by @US_FDA allows for similar immune response. Generally vaccine administration route matters in order to achieve the desired immune response- currently only rabies and BCG vaccines are intradermal (2/
Injecting into the dermis (skin layer)activates a broad array of cells that might trigger a more efficient immune response (thus allowing for smaller dose of vaccine to be used) BUT could result in less efficacy than the original route.(3/
Real world: working parents who have a mild infection and must isolate for days usually without pay- a 34 year old woman begged me not to run a COVID test and instead just prescribe something so she could work
(1/) So much will be written as it should about guns and violence.
But let me tell you about Uvalde,TX a beautiful town w/beautiful people -home to friends whose lives will never be the same
2/Uvalde is about 80 miles west of San Antonio where I grew up- we used to joke it was the suburbs of San Antonio where tornadoes went since it was not infrequent to get tornado watches/warnings in Uvalde
3/Uvalde is a crown jewel in the Texas hill country with an active volcano nearby and the beautiful Frio River which in normal circumstances would be packed with locals this upcoming memorial weekend
#triggerwarning#RoeVWade
This is a very long 🧵from a MD colleague who wanted to share her whole story regarding what is at stake with the likely SCOTUS decision -I will use her words in this thread.
This is a story of what is at stake. Read all of it.
1/n
2/n
If you're on the fence about being an ally for those fighting for the span of women's reproductive options that American women deserve, here's her story
3/n In fellowship she got pregnant on Nuvaring. She wasn't upset and fully intended to stay pregnant. Wk 9, u/s showed a thickened nuchal fold and incr fluid (warrants a further workup for possible genetic problems). F/u bloodwork was not reassuring.