Anyone else surprised to see debates still raging on which exclusive strategy will solve the worst PH crisis in 100 yrs? Dichotomizing this a big reason why we're here & why we risk prolonging unnecessary hardship. Short memory = #LongCovid 1/
Of course we are not going to "_____" our way out of this, whether it's (solely) vaccines/masking/ventilating spaces/therapeutics. I don't know of any credible science/evidence to support this oversimplified dogma. "All or none" was never the best plan. 2/
Polarizing messaging has been very damaging from a public trust POV from early days. While we may disagree on (relative) impacts of one risk mitigation tool vs another, dismissiveness of their value altogether only erodes trust. 3/
When this all started many experts questioned the impact of masking (full disclosure: so did I). Ditto for #COVIDIsAirborne (so did I). But evolving evidence made these factors not only compelling but vital to our containment efforts. #HumbleBeeStings 4/
No doubt that some measures are more "measurable" by evidence than others. Eg. Vaccines can be tested for neutralizing Ab performance in the lab & w/ randomized trials to correlate for "real world evidence". One informs the other. 5/
Masking impact (by study) is more difficult to measure. Nearly impossible to control for so many variables (length of use/material/type of exposure/ventilation, etc.). Sadly some have tried then failed bc of flawed methodology, l/t inaccurate conclusions. 6/
That's why it's so important to accept >1 form of "evidence". Yes to engineering/ventilation science. Yes to epidemiology/infection control too as long as reason transcends dogma & admitting none of us is 100% right 100% of the time. #OpenAirOpenMinds. 7/
We have to be careful here. Our biggest foe is still the virus not each other. Our words carry weight. Our intentions matter not as much as the impact to many who still struggle w/ trust, peer pressure, politics more than they should. #WeNotMe 8/
I do still think masking is super important. Ditto for vaccines, clean air & better meds. We've won a ton of battles but this war is far from over. Success means neither minimizing our containment measures nor each other in the process. /Fin
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Let's be real. Whether you invoke the "with" vs "for" #Covid19 debate is besides the point. Hospital ERs weren't closing with this kind of regularity pre-pandemic. The burden of care has changed. Denying it will make things far worse. 1/
When patients either present with or acquire it in hospital, outcomes are often worse. As an internist, I see frail, elderly patients admitted w/ dehydration or a serious fall. They didn't just "happen" to have Covid too. It has actual implications. 2/
Just having to isolate a patient for infection control protocol means additional limitations for space/cohorting; greater demands on nursing care, infection control staff, never mind heightened risk & anxiety re: transmission for everyone. 3/
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/
🧵on easing #Covid19 restrictions when Omicron appears to be exiting in many parts of Canada but the pandemic has not. Time to pool our efforts & invest honestly towards sustainable safety, minimal disruption/collateral damage. 1/
Ontario Sci Table data showing lots of positive trends right now. Wastewater signal, hospitalizations, ICU admission, deaths, all on the decline. But a trend is just that. Right direction. Not the finish line. Trends change & 5 waves are proof of that. 2/
Several reasons for caution before assuming the worst is behind us:
Unfinished winter + lifting indoor gathering limits + incomplete vaccine coverage = guaranteed spikes in transmission. Only ?s are how much & how soon. 3/
In simplest terms, we are counting our chickens before they hatch. Again. Difference is, this time, we may be at risk of losing the whole damn coop. You don't need an epi or immunology degree to figure it out. Just a little common sense. 1/
Variants have evolved more rapidly, w/ greater virulence, transmissibility since pandemic onset:
- Jan '20 D614G (⬆️spread, same virulence, very vax susceptible)
- we were lulled into complacency that mutations would be bested by vaccines. 2/
- Sept '20 B117 Alpha (⬆️spread, ⬆️virulence, slight ⬇️vax susceptible)
- became dominant global strain after originating in UK, spreading almost everywhere. Vaccine efficacy was reduced but not enough to create any alarm signals. 3/
Want to know something? Some of my dearest, trusted colleagues, the ones I confide in in my moments of greatest distress, the ones with whom I share the best camaraderie & have the most in common...are Jewish. They embody the essence of the word "mensch" 1/
When I trained many years ago at (what was) Mt Sinai Hospital as a medical resident, many patients thought I was Jewish. At first glance, I looked it. After a few of my silly jabs in Yiddish, even I wondered if I was Abdu or Avram? 😉 2/
I marvel at how many words in Arabic & Hebrew have such striking similarity. Some, like "Shabbath" for Saturday (Sabt) are less colorful in connotation than "meshuganah" (majnoonah) for crazy, intended in playful spirit of jest more than insult/offense 3/