Thread by @SharkawyMD

It's March 790, 2020. TL; DR. I'm leaving the #Covid19 ward again wondering why, how & if we will look forward to a day when we can (confidently) say "it'll be better next year". A 🧵 on what a "new normal" is & when it might happen. 1/

First a look back on the history of major pandemics. Even w/ a fraction of our present day resources in medicine & health infrastructure, the flu pandemic of 1918 had its share of similarities to this one because, well - humans are humans. 2/

1918 Flu was due to an H1N1 variant w/ Avian gene influence but the origin was not known till well after infecting 500 M people (1/3 of global population) & killing at least 50 M too. Doubt of origin fueled doubts of existence & potential threat. 3/

Now factor an era of no vaccines, no antibiotics & medical therapy that was at best crudely desperate in its unsophistication - lack of confidence in science or medicine isn't surprising; denialism a product of hopelessness as much as distrust. 4/

But even w/ bare minimum resources, an awareness existed of viral transmission based on basic tenets of germ theory & intuitive limitation of disease spread by minimizing contacts, improving ventilation, even masking. Yes. 100 years ago! 5/

Masks were made of gauze & porous. Better suited to mending war wounds than filtering anything smaller than a beebee, never mind a 5 micron aerosol. Point is the principle was understood & effort should be applauded despite failure in its execution. 6/

Mask resistance in 1918 was more about political identity & perceived infringement on liberties than lack of faith in efficacy. Hyperpolarized narratives, tribalism, even violent debates raged. Sound familiar? Yesterday's saloon is today's Walmart. 7/

Advocates for caution were branded oppressors, authoritarians. Advocates for "freedom" were ridiculed, resented. Who was on the "right side of history"? Let's examine the tale of 2 cities St.Louis vs Philadelphia. Show me thy brotherly love. 8/

Philly's insistence on holding the infamous Liberty Loan Parade of more than 200 K strong while flu raged through military ranks filled every bed in every hospital (31) in the city in 72 hours. 2600 deaths in 1 week. 9/
history.com/news/spanish-f…

St. Louis wasted little time after military outbreaks were known. Schools, theaters, pool halls closed. Public gatherings banned. Sound Draconian? Maybe. But thousands treated at home by volunteer RNs lived to celebrate that. Aside: #NursesAreAwesome 10/

Philly took months to recover from ravages of uncontrolled transmission, including $$ collateral losses. St. Louis flattened their curve and kept it that way. Even 100 yrs ago, the precautionary principle cost nothing to implement but a ton to ignore. 11/

What's different now? Scientific principles for PH & safety have evolved via better understanding of pathogen, transmission & resources for containment strategies. Genomic sequencing, vaccines, N95, Hepa filters are proofs positive. Celebrate them. 12/

Resources? We now have an embarrassingly wide array of #Covid19 vaccines in multiple platforms (vector, mRNA, protein subunit, even plant-based). Trialed + real world evidence in the hundred of millions. Yet doubt & disinformation persist. 13/

We have masks that can reduce transmission of agents as infectious as TB, measles, shingles & aerosolized SARS-COV2. Engineering, physicist ventilation science compellingly has proven that #COVIDisAirborne. Yet doubt & disinformation persist. 14/

I have no doubt #Covid19 will be with us indefinitely. But the pandemic will not. Hasn't yet ended bc our evolution in resources & technology has not been matched by the same in our sense of awareness that PH is everyone's job to do. #WeNotME 15/

Today while some argue about how soon we can get our 2nd booster or 4th dose, only 15.8% of the population in low-income countries have received a FIRST dose. Look at Haiti. Nigeria. Ethiopia. Vaccine inequity is a huge issue. Still. 16/

A wise man once said "we're not going to vaccinate our way out of this..." It's so wise that every time I see it, it reinforces how multi-dimensional the task is, how much more complex the challenge is a century later. 17/

What does the future hold? Detractors argue that vaccines don't work. They do. The goal is preventing serious disease & death. They have done this in every wave w/ every variant. Need to boost is evidence of variation in host/virus not failure! 18/

Detractors argue masks don't work despite aerosol science & epidemiology & common sense saying otherwise. In medicine we talk about "source control". If the source is lungs to mouth & nose try covering them. If I see one more plexiglass or painted ⬆️...🤦‍♂️19/

Detractors say variants will go on to evolve indefinitely. They're right. As long as we pretend we are smarter than a virus that knows our weak points - impatience, dogmatism, falsification of dichotomies ($ vs health) & deciding it's not our problem. 20/

If we want to stop the sub-lineages of BA 4, BA 5 et. al others from gaining a foothold by the fall of 2022 in schools, nursing homes, essential workplaces, etc. it's time to figure out that Haiti's problem is everyone's problem. #WeNotMe 21/

If we want to avoid the generational impact of #LongCovid that will lead to cognitive, neurologic, respiratory & other serious functional impairments for so many, it's time to stop trivializing getting infected as no big deal. bit.ly/37tEOPF 22/

I don't know if it's my last stint on the #Covid19 ward. I'm as sick of it as anyone. My kids hate the word so much we can't say it at home anymore. I remember simpler times when what & who I treated wasn't so fraught w/ angst or uncertainty. 23/

Maybe we'll get to a point when a combination of survived infections & vaccination confers enough cross-immunity protection to Omicron subvariants which helps this finally fizzle out. Endemicity is managed w/ annual seasonal vaccines? Quite possible. 24/

Until then, let's learn from history rather than revise it. #Covid19 doesn't care about political stripes or theories on social responsibility. So if we're not fighting the virus TOGETHER and FOR each other, what are we doing? #WeNotMe 25/Fin