In an Invited Editorial in @JAMAOnc today, my colleagues & I call for health systems to develop “Comprehensive #Pandemic Support Programs” for their most vulnerable patients.

These are our Top 10 Tips!

THREAD 🧵
jamanetwork.com/journals/jamao… JAMA Oncology article, "Variability in COVID-19 Vaccine
Tip #1: Health systems should explain to all patients that #COVIDisAirborne and is best avoided through multi-layered mitigation. Swiss Cheese model of COVID mitigation
Tip #2: Health systems should prioritize getting the most vulnerable patients vaccinated & boosted.

Offer #vaccines on-site w/the SAFEST options.

Vulnerable patients want highly-ventilated or outdoor options & high-quality (e.g., N95) masks for safety. Make it happen. Vaccination given while clinician wears an N95 outdoors
Tip #3: Health systems should test whether vulnerable patients have a good #antibody response to #vaccines (cutoffs of 5,000 or 11,500 U/mL for anti-S antibodies) to inform risk.

Consider pre-exposure prophylactics, based on the patient & the variant(s) circulating. Figures from Lee et al., discussed in our editorial. Cut offFigures from Lee et al., discussed in our editorial. Cut off
Tip #4: Health systems should help patients to sample and correctly wear free high-quality #masks (N95, KN95, KF94, FFP3).

Community-based programs have proven successful. Health systems should step up to support their most vulnerable patients.

Tip #5: Health systems should help vulnerable patients to understand the benefits & limitations of COVID testing, when to time testing, precautions to take after exposures/symptoms, and how to access #RAT and #PCR testing.

Make getting #Paxlovid easier. Headline: Paxlovid is underused.   Especially in my part of
Tip #6: Health systems should help vulnerable patients understand indoor air quality (#IAQ).

#Ventilation & filtration remove viral-laden aerosols to reduce COVID risk.

Health systems should offer concrete help w/purchasing #HEPA filters for home.

cleanairstars.com/filters/ Clean Air Stars, website
Tip #7: Health systems should be leaders in explaining to vulnerable patients how to reduce in-home spread when someone tests positive for #COVID.

Too few health systems advise on reducing in-home transmission.

BUT we have the tools!
healthyheating.com/2021.COVID.Res… Example image of tactics for reducing in-home spread of COVI
Tip #8: Health systems should support vulnerable patients by developing #LongCOVID assessment & treatment programs.

Such programs exist: survivorcorps.com/pccc

They are both underutilized & overbooked. We need more programs & less medical #gaslighting about Long COVID.
Tip #9: Health systems should support vulnerable patients by keeping a list of local businesses offering remote & #COVIDsafe options.

Many of us are doing so on the #Discord app.

Vulnerable patients want health systems to use their credibility & resources to do this. Screen shot of a Discord list of local recommendations.   He
Tip #10: Health systems should support vulnerable patients in solving the problems they face living in a confrontational, too-often #ableist world.

We offer concrete tips, such as reminding ppl masking is a healthy choice, not a political one.

While our tips focus on how health systems can help patients, our rhetorical strategy was to create tension.

If health systems get vulnerable patients into well-fitting N95s, that should foster #CognitiveDissonance when clinicians poorly mask.

Foot-in-the-door technique. "Foot in the door technique." Please read our arti
People w/#cancer are more vulnerable to COVID & long COVID, even when (wisely) vaccinated, per our article & others.

Patients w/ #hematologic cancers, late-stage cancers, or on systemic therapy (e.g., chemo) are quite vulnerable.

Today, JAMA Oncology shows that patients w/#hemocologic #cancer are among the MOST vulnerable.

It is not "virtue signaling" to mask correctly to protect the most vulnerable individuals. Photo of a hematology conference.   Today, JAMA Oncology's l
Finally, in our Invited Editorial in JAMA Oncology today, we note that "vulnerability" to COVID too often remains uncertain.

#Vulnerability is also dynamic, as an initial infection can increase vulnerability. Universal precautions remain key.

jamanetwork.com/journals/jamao… Paragraph from the article. Link in Tweet.

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More from @michael_hoerger

Dec 17
THREAD: 19 Tips for a DIY mask fit test to reduce your risk of #COVID19.

H/t @amandalhu & @__philipn__

What did I miss? Assorted fit-testing pictures
Fit-testing Tip #1: Keep it Simple.

Get a nebulizer (usually $30-40) & some 3M FT-32 Bitrex solution ($24). The FT-32 fit-test solution (right) goes in the nebulizer. J
Fit-testing Tip #2: Taste the Failure.

Use the nebulizer to spray the bitrex solution (barely visible). Breathe through your mouth. If you taste it, there’s a mask leak.

"It’s not rocket science," as @CorsIAQ likes to say.
Read 21 tweets
Dec 15
Our #pandemic global strategy:
"If I paint a rosy picture, will you promise not to cry?"

ascopubs.org/doi/full/10.12…
1/5 Image
Written a decade ago, the article was about how clinicians too often falsely reassured patients w/terminal #cancer that treatment was working just fine.

There are many parallels b/w cancer cancer, the pandemic, & climate change.

Mortality salience elicits #denial.
2/5 ImageImage
Don't believe me?

Look back at the 1960s. Only 12% of patients were even told they had #cancer.

Society will tolerate BS for a long time to avoid immediate discomfort. So too w/the pandemic. Hardly a mask in sight & reinfections mount.

jamanetwork.com/journals/jama/…
3/5 Image
Read 5 tweets
Dec 2
If you're advocating for more cautious and compassionate COVID policies or generally "doing the right thing," please keep pushing.

I've had three extremely validating interactions in the past week I wish to share (details disguised)....
#1 - A vulnerable family member had a cable guy come to her home. The cable guy refused to mask, so she refused to let him in and called to complain to the cable company. One of those big, hated cable companies.

Know what they did? Fired him on the spot. 🔥
#2 - Met with a ped's specialist (just a follow up, all is well). The hospital is anti-mask, "wash your hands," full droplet dogma.

BUT she was wearing an N95, says she's never going back. Asked thoughtful questions about the #PAPRbuggy. Shared how scary the pandemic onset was.
Read 4 tweets
Nov 15
I've yet to see a well-designed study showing that #COVID #RapidTests are no longer efficacious.

This one is no exception. Why?
5 reasons.

clinicalmicrobiologyandinfection.com/article/S1198-… Image
1. They compare same-day PCR against self-administered/interpreted rapid tests.

For most ppl, that's not reality. It's RAT today or PCR result in 1-3 days (or do both).

A fairer comparison would be a RAT today versus a PCR yesterday (since you'd have to wait for results).
2. They excluded 13% of the sample who were "confirmatory testers" (weird term) -- basically, people who had just tested RAT+ and were coming in for a PCR.

Basically, they excluded the people for whom the test easily worked. Drug trialists pull this stuff all the time.
Read 8 tweets
Nov 14
Cloth masks could be customized to look amazing. BUT they offered weak protection (poor filtration, many gaps).

What if you could safely customize an N95 or #BetterMask with a small logo, decal, or other decoration?

THREAD 🧵

1/ 3M N95 with monotone cancer ribbon (or interpret as another
H/T 🎩 to @amandalhu for recommending rub-on “dry transfers.”

Follow her & see her amazing thread of several examples. Very fun, especially for kids. Many pre-designed options.


2/
But can dry transfers be customized?

YES. I ordered a 6” x 6” sheet with >50 monotone #cancer ribbons from @stickermule. Cost about $20. Price goes waaaaay down the more you order. Comes with free hot sauce for some reason.

If you find other deals, please post.
3/ Sheet of dry transfers with >50 cancer ribbons.Randomly comes with hot sauce. Probably don't want to eat ri
Read 9 tweets
Nov 13
New article in @JAMANetworkOpen provides critical data on the long-term trajectory of COVID-19 symptoms.

Lots of bad news. 😕
Very bad news for ppl w/cancer or bad acute case of COVID. 😬
Also, a few rays of hope. 🌞
#LongCOVID #COVIDcancer

1/12
jamanetwork.com/journals/jaman… Title and graph, journal ar...
66% of adults had at least 1 symptom during the acute phase (first 2 months) of diagnosis of #COVID-19.

I’ve highlighted the symptoms experienced by at least 10%. Note that some of the less common symptoms are quite debilitating though (e.g., 9% w/lung pain).

2/12 Symptom table. Acute sympto...
If you had a #COVID symptom initially, what are the chances it persists beyond 2 months? See 2nd column, green highlights emphasize those enduring among >10%.

Many of the initial symptoms endure in about 20% of ppl. Russian-roulette like odds.

3/12 Table shows the percentage ...
Read 13 tweets

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