#LongCovid exists. Clinicians have to use the power we have to ensure workers get what is coming to them.

An honor to collaborate with @DorfmanDoron on this piece in @NEJM.

cc @bermaninstitute
@HopkinsMedicine

nejm.org/doi/full/10.10… A 54-year-old who works as a warehouse packer comes to your community practice for an exam. Six months ago, she was diagnosed with Covid-19. Since then, her usual 9-hour shifts exhaust her; she has trouble breathing & leg pain she describes as a sharp, hot knife cutting her. /1

Fun times this morning in the frum doctors WhatsApp group, which I left when people started fondly reminiscing about conversion therapy and calling transgender people mentally ill. Of course, I am mid-career, going up for tenure. I have some seniority. I'm able to walk away without any penalty. Imagine the providers and trainees have to put up with this, some of whom are queer themselves, imagine the patients who have to deal with these doctors

A thread about long Covid.

1. Long Covid exists, it is a disease (also, an illness). Like all chronic diseases, it is both an individual and a social phenomenon.
2. Like other chronic diseases, Long Covid is not necessarily caused by a single entity. /1 3. Since Long Covid is both an individual and social phenomena, calculating the average duration of symptoms in someone infected by the virus that causes Covid does not equate to an estimate of the total burden of long Covid.
4. Regarding disability, there are many kinds, and/2

@OlufemiOTaiwo and @LesterSpence at @redemmas ask, "Why philosophy for radical change?" and discuss what Taiwo calls the constructive view: Our planetary structure was built by the slave trade. The scale of #reparations should match that They compare the incremental vision of Conyers to the broader one of Detroit's Reparations Ray.

Excited to be watching this #WeSupport #CovidSafeWork Teach-In by @MarkedByCovid. @MarkedByCovid Great point by @gregggonsalves: it's not about a microbe, it's about the environments we live and work in, and it's about which people are considered disposable. It's also how we want to end the pandemic, who we want to include/exclude in the response.

I really admire all those on the front lines of this surge (ED, ICU, etc etc). I'm on the primary care middle-lines and I've aged a decade in the past six months. This pandemic *has* made me think a lot about a joke people tell, ruefully, in medicine, especially primary care, after doing something trivial (filling a Rx for a statin, or taping someone's toe): "another life saved."

Primary care saves lives, ideally, in a lot of ways....

Emily Oster is still making categorical judgments about how we should approach age differences in Covid risk -- even as we lack information about case transmission from schools to communities. And all the Osterites saying "Covid risk is the same order of magnitude as other respiratory viruses, but we're treating it SO DIFFERENTLY" are the same people who go gaga over contextless p-values. Stats means nothing without a brain and a heart. Use them.

Food manufacturing workers are striking.

Media workers are negotiating better contracts.

And health care workers?

Told to live off resilience. Part of the reason has to be doctors.

For too long now we've thought the world of ourselves. We're a guild!! We're autonomous!! We're independent!!

Except we haven't been that for a while. (Nor should we be.) We're health care workers getting a bit less shaft.

"I encourage everyone to continue to live the healthiest life they can. A balanced diet, fresh air, and vitamins really are vital to keep our bodies healthy" -- so about this/1

https://twitter.com/FLOTUS/status/1316467655860199425

encouraging a "healthy lifestyle" is really a moral directive unless ppl in power address the things that make healthy living possible. a "balanced diet"-- for those without $ to shop?; "fresh air" except when people put incinerators in ppl's back yards?; "vitamins" -- are BS/2

I have nothing against #PlasmaTherapy for Covid. I've looked at the data. It might be helpful. We need a trial.

Now, imagine if the attention paid to this *one potentially marginally helpful therapy*....

...was devoted, as well (not even "instead") to those sick with Covid. /1 What I mean is this. I'm a believer in biomedical interventions. Heck, I'm a board certified internist. Biomedicine is part of what I do.

But only a part.

So much of the help I try to give patients is not available./2

Someone asked how I could go to a protest today. Wouldn't Rona be there? Thread:

In general -- in my practice as a physician and in my educational/research/books -- I have tried to be as comprehensive in my understanding the possible reasons that lead people to weigh risks. /1 Because the tricky part about epidemiology and public health is this. Risks are population-based. Decisions are individual. In time of Covid, I have tried not to wax snarky about people seeking haircuts. People have reasons, they always do, even if they are not your type./2

Something I wrote last night:

I should go to bed -- my wife and children are snug in their beds, our house is safe in a way that so many living places in the US are not. No one is coming to get us, right now. I should luxuriate in that. But I want to write about the day I had. It was, of course, first of all, thanks to @baltimorebooks, who made dinner, drove the kids to school, worked a full day, put the youngest (who might be a little pissy on occasion!) to bed after supervising her homework, and welcomed me home. And thanks to my covering colleagues.

My institution has a dashboard to compare my opioid Rxs to colleagues. It shows me the # of pills and the # of Rx I write per X days compared to colleagues. We were asked to provide feedback. I pointed out the following was NOT on the dashboard:/thread 1. How many are diagnosed with chronic pain
2. With how many has tapering been discussed in clinic
3. How many have agreed to tapering
4. How many have cancer, sickle cell disease, or terminal illness diagnoses

Why at 4:30a am I in a Lyft to BWI airport, fleeing the Baltimore humidity on #July4 for the greater heat of El Paso?

Full statement is attached. Basically, #CitizenPresence is the reason. Making sure moral outrages of the camps are before our consciousness. Follow my day here. If they make a movie Davening [praying] in Airports I'll be in line. White privilege: no one looks at me. Today is #July4& also #RoshChodesh, the start of a new month.

I say Hallel, the collection of Psalms celebrating special days. "You freed my bonds." "I called from depths."

"Dr. Berger," said my patient 'Bettie L", a grandmother with chronic pain, "Hopkins cleared out my bank account. Their lawyer told me they're suing me."

Read this to find out why. It's shocking. And thank you to @NationalNurses for doing this work.

nationalnursesunited.org/press/new-repo… What's going on? Hopkins is suing people for medical debt. Poor people.

Oh boy if I finish doing dishes in time your boy is gonna open a can of whupass on this overmedicalization Saturday night special.

nytimes.com/2018/12/05/mag… First of all, I know that authors don't write their headlines, but c'mon "it's time to study [diet]"? Dietary epidemiology has been a robust literature for DECADES. And the reasons ppl are properly skeptical of it are legion.

This is a thread where the nice internist gets mad.

It starts with my patient, living in Baltimore, an immigrant from El Salvador. /1 A sweet man. On dialysis. He said (in Spanish), "I asked them to stop dialysis because I felt an emptiness inside, in my soul."/2