Amy Cho, MD MBA Profile picture
Jan 26 13 tweets 7 min read
Just great.

I am certain that the jeering anti-everything COVID deniers will show up at the next school board meeting demanding that masking end "no later than February 15" with this toolkit in hand as evidence to support their demands.

This is so exhausting.
#NotNormal
I am certain there will be no nuanced discussion of the reality of outbreaks or healthcare capacity. Or of our ethical duties to those most vulnerable among us.

There will be no real world data on whether “focused protection” is feasible or effective.

I am certain that the title of these doctors will be used to justify and normalize leaving our most vulnerable behind. Unnecessarily.

I want to get back to normal too. I agree it is urgent and I’m working hard to get us “there.” But we aren’t there yet. Things are #NotNormal
Normal is my kids school being able to say open. It’s #NotNormal for so many student, teachers and staff to be ill that the school has to close.

Normal is a healthcare system with capacity to provide lifesaving emergency care, cancer surgeries and preventative care.
It's #NotNormal to have patients who can't get surgery for a brain bleed because there is no bed. Or who board in the ED for days or wait 18 hours to be seen.

It's #NotNormal to have test results delayed so long that therapeutics can't be started in time to work.
Normal is taking precautions to minimize short-term and long-term risks to our children.

Normal is not accepting unnecessary deaths of anyone.

Normal should be caring about everyone, whether they have a "preexisting condition" or not.

Ignoring reality - that a variant is surging at historic rates and overwhelming our healthcare system, schools & essential services - is #NotNormal.

Pretending like the pandemic will be over on an arbitrary date of our choosing is #NotReality and will lead to unnecessary death.
Deciding that we will leave behind our neighbors & vulnerable, because we got to the end of Spotify and we are “done” is #NotNormal. It is not leadership.

Arguing that COVID is just the flu* or masking doesn’t work is #NotCorrect.
*for unvaccinated

Arguing that healthy children are gravely harmed and cannot tolerate the harms of masks at school for the next few months but the solution is instead for vulnerable children to be singled out and wear an N95 respirator is #NotLogical and #Stigmatizing.
Justifying your theory of "focused protection" without demonstrating that it actually protects anyone and without putting in place the support systems to make it possible is #NotHelping to get back to normal. It's just justifying abandonment of our ethical duties to the minority.
I agree that we should maximize the ability of children to be in school.

I wrote about it in August of 2020.

“It is possible to make in-person school safe again, and we should neither deny the risks nor descend into nihilism.”
thehealthcareblog.com/blog/2020/09/1…
I agree that it's urgent to get back to normal. We should #DoTheWork to get "there."
1. Access to vaccines for all, including younger siblings.
2. Healthcare capacity to provide standard of care for COVID & non-COVID illness.
3. Access to therapeutics for the vulnerable.
The end is in sight but normal doesn't just happen "no later than Feb 15" all across the US. It happens when we #DoTheWork to make us all safe.

We are better than this. Let's not leave anyone behind. Let's keep at this a little longer to save lives.

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More from @amychomd

Feb 1, 2021
We need split flow for vaccination.

In the ER, we run to those with greatest need and triage by acuity. We also “split” off patients with low resource needs into a “fast track.”

It speeds things up for everyone.
We should invest more to vaccinate those at greatest risk due to medical vulnerability + social vulnerability.

Those with social vulnerability that puts them at ⬆️ risk for infection often have barriers to vaccination.
We should identify the barriers and invest in overcoming these barriers quickly. Some include:
👩‍💻MyChart account & tech savvy
⏱Time to search for appointment
🚨Timely alerts about open spots
⏲Time off during business hours to get vaccinated
🚙Transportation
❓Questions answered
Read 6 tweets
Dec 13, 2020
Congress has been working for years to solve “surprise billing.”

I’ve been trying to explain this issue - and EMTALA for years now.

Congress hasn’t been able build consensus or pass a bill for years.

On Friday a deal was announced. At 5:45p, a 300 page bill released.
It will be attached to a must-pass omnibus or COVId relief bill.
The 300 page bill was released on a Friday at 5:45p. The word from staffers is no changes will be entertained. Others say that and changes need to be done by EOD Monday. (So it can be included in a must-pass omnibus bill.)

No hearings. No public comment. No stakeholder review.
Read 30 tweets
Dec 12, 2020
Physicians are among the most resilient people I know.

We don’t need more resiliency training.

This is a system problem.

We need to fix the system.
The system is set up to maximize “efficiency” (ie profit), even as returns are diminishing. But cost (ie outcomes, complaints, burnout) is borne by individuals.

This is a system problem. This is why I’m thankful I work for an independent group with AGENCY to balance trade offs.
When you don’t work on the front line or pay the cost of your mandate, regulation, prior auth requirement or other directive, it’s easy and free to ask physicians to do just one more thing or make another compromise.

nytimes.com/2019/06/08/opi…
Read 4 tweets
Nov 15, 2020
A finish line is in sight. We can do this. Time to hunker down.

What I’m doing:
-keeping littles home from preschool
-pulled all kids from indoor sports
-no gyms
-continue online church
-takeout only
-no indoor gatherings without masks, even with our bubble
Our family is planning for #ChristmasInJuly. It’s not easy but I’ve worked Thanksgiving/New Years or Christmas holiday every single year since I’ve been an emergency physician (long time now 😬.)

Holiday traditions are important but they don’t make families. People do. Image
It’s really hard to tell my kids they can’t do sports or get together with anyone. But we can get through this. There is a finish line and the prize is worth the sacrifice.

But it *really* helps knowing that it’s not forever and the payoff is worth it.
Read 4 tweets
Oct 9, 2020
Apparently unpopular view:

A decrease in hospital stay from 15 days to 10 days from Remdesivir is a VERY meaningful outcome and benefit.
Hospital bed capacity (or more accurately nurse/RT capacity) is limited. A decrease in the LOS and recovery time translates directly into increased capacity.

100 nurse days/15 days per patient = capacity to care for 6.6 patients

100 nurse days/10 days = 10 patients

>50% ⬆️
We know that as hospital systems get overwhelmed, excess, unnecessary mortality increases: from COVID patients who can’t get admitted because they aren’t “sick enough,” inadequate care in the hospital and for all the other patients who can’t access care. scientificamerican.com/article/covid-…
Read 5 tweets
Oct 6, 2020
Lots of folks say “you must be brave” when they find out I work in the ER.

It’s true that I don’t (usually) get upset at the sight of blood. But there are plenty of things that scare me.

A non-exhaustive list of things this emergency physician is afraid of:
Choking

Because I’ve seen a child choke on a hot dog or grape that wasn’t cut lengthwise.
Door slamming

Because I’ve had to repair way too many fingertip amputations in little kids.
Read 20 tweets

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