🧵 I’m not sure what I’m about to say has been made clear to ppl w/o a science or #MedTwitter background. It may be a genuine source of confusion (ie good faith questions), so here goes. Many are saying “If #Omicron makes a given person less sick (which appears to be true)…” /1
“Shouldn’t we just go ahead & get it over with? You know, masks off & almost everyone gets infected & then we’ll be done with it?” I get why someone might think or ask that. It makes sense. But it’s not the right thing to do, & here’s why. /2
There are the things you have prob heard before: even a tiny % of infected ppl dying is a lot of dead if most of the 🇺🇸 (or the 🌍 ) gets #Omicron. And there are overwhelmed hospitals, which cause deaths for other reasons. But this 🧵 isn’t about any of that. /3
It’s about the fallacy that everyone getting infected with #Omicron is a guaranteed end to the #COVID19 #pandemic. Because there are people who might say “Let’s do whatever it takes to end this ASAP, even if there’s carnage along the way.” Well, here’s the thing. /4
There is absolutely no guarantee whatsoever—none—that getting #Omicron will keep you from ever getting #COVID19 again. In fact, it almost def won’t. In the short term, it reduces your risk to have been infected before, but long-term (meaning many months or more)? No. /5
But this 🧵 isn’t even about that either. It’s about how #CovidVariants come to be in the first place. Mutations occur when viruses replicate in hosts (ie, all of us). These mutations can make a virus spread more or less easily, make it more or less able to evade immunity… /6
that we have from prior infections or vaccinations, make it more or less responsive to treatments like monoclonal antibodies, or make it more or less likely to cause severe illness/death. The process is actually kind of random… /7
If the mutations happen to make a virus less good at spreading thru the population, that #COVIDvariant will peter out, or never even get a foothold to begin with. If the mutations confer an advantage, that variant will become the main one, sometimes very fast, as #Omicron did. /8
But the point is that these mutations &, with them, new #CovidVariants are generated when the virus replicates or reproduces itself. When we say “Masks off, let it rip!” w/ a virus that spreads as easily as #Omicron, we’re giving it MANY chances to mutate into a worse variant. /9
There’s nothing that prevents the next #CovidVariant from being just as contagious as #Omicron, but less susceptible to our vaccines or to prior infection. Nothing to keep the next variant from being just as contagious but ultimately more lethal. /10
Will that happen? I don’t know. No one does. I sure as hell hope not. But it could. We’ve had infectious diseases wipe out huge swaths of the population quickly (eg Black Death killed somewhere btwn 1/3-1/2 of all Europeans in 6 yrs). /11
We have a handful of meds authorized to reduce risk of dying of #COVID19. They are in such short supply that even our highest risk #immunocompromised patients in the US cannot reliably access them. We certainly don’t have enough for the whole world or even the whole US… /12
To get them. Their supply is being scaled up quickly but we are still SEVERAL months away from having enough even to treat all those at increased risk of death from #COVID19. We’ll get there, but we most definitely aren’t there now. /13
So we have to realize that when we choose to throw in the towel on #WearAMask & declare it’s time to “live with it,” we actually don’t know what “it” is. Nor whether we can live with it. Because we don’t know what the next #CovidVariant will look like. /14
What I can tell you I’ve learned as a doctor is that we aren’t as prepared for a #pandemic as we liked to believe. That’s we healthcare, we the USA, & we the world. We got lucky —if you can call it lucky when we’ve lost almost 900K Americans in <2y & continue to lose 3K/day— /15
But we got lucky that thus far #COVID19 has killed “only” 1 out of every 70 or so people with a confirmed infection. If the next #CovidVariant is equally contagious but kills a higher %, we’re in real trouble. What are the odds of that? Well… /16
If you want to take two other airborne viruses that have caused outbreaks in the lifetime of most of you reading this, SARS-CoV (ie the original “SARS”) killed 1 in 10 of those who tested positive. For MERS, 1 in 3 of those who tested positive died of it. /17
So when I tell you we are lucky that Mother Nature gave us a practice virus to learn on with all of the #CovidVariants to date, listen to me. We have to stay humble & recognize that if we abandon masks now, we are giving this virus a mindboggling # of chances to mutate. /18
This #pandemic has been bad & long enough. I don’t want to give this virus an unlimited # of shots on goal to become a #CovidVariant far worse than any prior. I definitely don’t want to restart the #pandemic clock because now we have a variant our vaccines DON’T work against. /19
If you’re thinking or tweeting, “Ok, so you’re saying we have to #WearAMask forever?” the answer is no. As I said earlier in the 🧵, we have highly effective therapeutics, incl some likely to remain effective even in face of future #CovidVariants, we just need more supply. /20
And we now have 10B doses of #COVID19 #vaccine administered worldwide (>60% of 🌍 population #vaccinated) in a little over a year. Not too far in the future, we will have enough people protected that the virus will have a tough time finding a susceptible person to infect. /21
Between these 2 things— a harder path for the virus to travel to propagate itself & an abundant supply of meds to serve as a safety net if we do get infected—it won’t be as likely that we’ll get infected or nearly as worrisome when it does happen. So this 😷 isn’t forever. /22
But deciding not to #WearAMask now, in the midst of both a 🇺🇸 & global surge of #Omicron, is shortsighted. If your goal is to end this #pandemic, #GetVaccinated, #GetBoosted, & #WearAMask while we get others there with us. Stay safe. Let’s finish this. I’m ready & then some. /End

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More from @tmprowell

Jan 26
🧵My #UrgencyOfNormal includes:
👉People w/ #cancer needing urgent chemo getting a hosp bed without a wk+ wait & a desperate plea by their dr on Twitter
👉My #immunocompromised patients not wondering if kids brought home #COVID19 that can kill them (#vaccineswork less in them)
(P.S. You might think these are someone else's problems, but >1 in 3 Americans get #cancer in their lifetime, so reply w/ care...this could well become you or yours)
👉Timely medical care in our local ERs
👉The same teacher, not a parade of subs, because of #COVID19 illness

/2
👉#NurseTwitter, #MedTwitter, & drs in training not getting called in to cover repeatedly when they're finally off b/c yet another colleague has #COVID19
👉Thousands in US dying/d of a virus we'd never heard of a little over 2y ago
👉170K US kids not being orphaned by this virus
Read 4 tweets
Jan 23
Shout out to participants in #clinicaltrials. I’m enrolled in an NIH RADx-supported trial that requires me to do #COVID19 rapid tests & PCR every other day within a time window, & then drive a pkg to a FedEx every other day by 3p. This is the 4th study I’ve joined in my life…
The studies I’ve been in have ranged from pregnancy outcomes yrs ago to #COVID19 diagnostics. I keep joining them because I believe #ScienceWillWin, but also because it’s important to be reminded what a genuine hassle it is to be in a study. /2
In the very best of circumstances, it’s an inconvenience. It ALWAYS costs participants something, whether it’s missed work, lost wages, childcare, gas for a 🚗, discomfort, or more. And it’s always one more thing in a day that may already have way too many things already (🙋🏻‍♀️). /3
Read 6 tweets
Jan 10
This cannot possibly end well. As a doctor, especially one to people whose treatments are rarely optional, I hate to say this, but honesty compels me to: your goal of the next month is to do all you can to avoid health care settings. This is just not safe. #MedTwitter
Being treated by health care workers contagious with #Omicron is not safe. Being treated in clinics & hospitals so short-staffed that they’re allowing people actively infected with #COVID19 to provide patient care is not safe. None of this is normal. None of this is ok.
All of this leaves patients appropriately terrified. And remember that all of us—incl #MedTwitter & #NurseTwitter—are one diagnosis away from being on the other side of the stethoscope. This imperils ALL of us. At this point, choices have been made. #Omicron is out of control.
Read 8 tweets
Jan 8
🧵 Parents of teens looking for N95/KN95/KF94 masks that your teens will wear without complaint, I feel your pain. We are 2 drs w/ 3 teens. We obviously believe in high-quality masks, & we’ve struggled to find masks that fit well & are comfy enough for kids to wear all day. 1/x
Let me start by saying we have no relationship with any mask company, no one gave us any free masks, & no one asked us to review or recommend any mask. Our views don’t represent any employers. Tweeting here as parents & your kids may be different. 2/x
My teens (14, 16, 17) are both sexes & pretty average sizes, especially their faces (unlike their mom…I have a small face & can wear some kids’ eyeglass frames). We started trying the masks that we liked or had ourselves. 3/x
Read 23 tweets
Jan 2
In case no one has told you, the odds your kids will be at school in person in 2-3 wks in the US approach zero in most areas, no matter what your BOE or Governor decide about opening. There won’t be enough people well to run buses, lunches, clean, or teach. Plan now as a family.
I do think we’ll see a rapid peak of #omicron cases by some point in January & then a fall, but enough critical staff will be sick that it will be logistically impossible to keep most schools open during Jan. Our own county @hcpss had a 90 driver shortfall to start the school yr.
And our cases were low then. If it were that easy to just find more bus drivers, their efforts to hire all summer would’ve been successful. It isn’t going to be possible to hire a full cadre of replacement bus drivers in a wk or two. You don’t have enough people trained to do it.
Read 5 tweets
Jan 2
This is horrifying. I expected this to happen at some point in Jan or Feb with #Omicron. I didn't expect it happen on January 1. 💔

🙏 to all of of the volunteer #firefighters & #EMS. Friends, please go donate to your local depts to honor their service. #MedTwitter #Maryland
Listen, important. Most adults in #Maryland are #vaccinated. Fewer kids are. MANY haven't yet gotten a #boostershot (only 70M in entire US pop of 331M #boosted). A booster will ⬇️ risk of hospitalization by 88% & starts protecting you in 7d with major protection in 14d. GO DO IT!
If you're #boosted, THANK YOU. Your job is to call 3 people age 16+ NOW who are #vaccinated but not yet #boosted & tell them to #GetBoosted ASAP. This is time-critical, esp w/ #schools to reopen in 36 hrs. #Baltimore #Maryland, appts here as soon as 1/4: umms.org/coronavirus/co…
Read 4 tweets

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