🧵 LOTS of folks with #COVID19 in my text messages this week for the first time in months, & many of my #MedTwitter friends are saying the same. This has happened before every recognized 🇺🇸 surge. Be careful, esp if you are higher risk. All, please 😷 & test if you feel sick. 1/ Some insurers (incl Medicaid) are still covering #COVID19 home rapid tests. If you have rapid tests at home that have expired, check this list before discarding them. Many have had their expiration dates extended: . /2 #MedTwitterfda.gov/medical-device…

In May 2019, Dr. @rschilsky & I co-chaired the #AAADV19 Workshop Plenary Session "Decentralized #ClinicalTrials: The Future is Now." An incredible group of panelists from academia, industry, govt, & patient #advocacy 👇discussed the rationale, challenges, & opportunities of DCTs. No one knew yet that the #COVID19 #pandemic was just around the corner. In Mar 2020, FDA released a guidance on conduct of #clinicaltrials during the pandemic: fda.gov/media/136238/d…, & colleagues wrote about the impact on #OncTwitter trials: ncbi.nlm.nih.gov/pmc/articles/P…. /2

Students from 🏠 with annual income <$50K were half as likely to be accepted to med school as students with 🏠 annual income >$200K. We all knew this was a problem, but the magnitude is shocking. We all have a role in addressing this, #MedTwitter… /1

https://twitter.com/MytienTNguyen/status/1656766277384302592

Students from lower income 🏠 are at an educational disadvantage that begins well before college. A concrete intervention: volunteer to tutor students. I did this multiple times per month the whole time all 3 of my kids were in elem school. files.eric.ed.gov/fulltext/EJ898… /2

A study from #Brazil finds 1 in 4 adults who had mild #COVID19 demonstrated cognitive deficits. The average age of study participants was 38. See what happened when they were asked to copy a diagram. We are not prepared for this. #MedTwitter #LongCovid brainfacts.org/diseases-and-d… Many people are replying “I wouldn’t have been able to copy that drawing accurately even before #COVID19.” This is true. On avg, 5-8% of population are unable to reproduce this. What concerned researchers was that in this study of ppl w/ mild COVID, 25% of them could not.

A survey of 20K people found the most productive people:
👉Set objectives & priorities before beginning to read, write, or plan day
👉Insist on short, focused mtgs & clear, efficient comms
👉Develop consistent strategy to handle 🌊 of msgs/tasks
hbr.org/2019/03/what-m… 2/ A couple interesting observations. Americans work more hours than much of the world but are not more productive. I suspect this is because 🇺🇸 culture values “workaholics,”
so we push through with diminishing returns.

🔥IMPORTANT! #MedTwitter & all workers: the @FTC is proposing to make noncompete clauses illegal. Employers would be prohibited from establishing them & forced to rescind existing ones, incl notifying past employees of the change! 👏👏 @MedicineForward nytimes.com/2023/01/05/bus… ~ 1/5 of US workers are currently under non-compete clauses. They harm workers in many sectors, incl #MedTwitter, e.g., by preventing them from taking a better position w/ another company unless they’re willing to move or travel a long way to work. 2/

🧵This is a VERY brief thread about #HCWvsHunger tonight because this week has been out of control, & I still have to pack to fly to Texas for #SABCS22 on 12/5, which is TOMORROW! A longer thread will follow because I know everyone comes to Twitter for long form, lol.

1/ The last few months worried me. The economy. The numerically & emotionally depleted #MedTwitter colleagues. The very fate of this platform, which has big problems, & also has been an undeniable source of reliable info to the public during this #pandemic & community for us all.

🧵 I did 10 parent teacher conferences yesterday where my kids have an A in the class & I had nothing to discuss. I used the time to tell #TeacherTwitter a few things:
👉I know you risked your own health & life, & your family’s, to come to work in a #pandemic. #ThankYou

/1 👉I know you spent 1.5 yrs teaching our kids virtually, navigating unfamiliar technology, staring at a little dot on your monitor instead of a class full of kids, not knowing if the kids with cameras off were there, wondering about the ones who never connect. #ThankYou

/2

Learned so much in this evening's @AACI_Cancer@ webinar on physician use of social media! Dr. @fumikochino highlighted sev successful research collaborations that began via #SoMe & said that Twitter has helped a lot with the "hustle" all #MedTwitter junior faculty face.

https://twitter.com/fumikochino/status/1592216627374067714

Dr. @SyedAAhmad5, who began tweeting during the #pandemic, highlighted opportunities to expand reach of #MedEd via #SoMe. For example, he taught this to #MedStudentTwitter, then realized there was no reason the learning needed to be confined to his operating room. cc @AACI_Cancer

#HoCoMd #Election2022 - I am supporting @DanNewberger & @JackyMcCoyBOE in the non-partisan race for @HCPSS Board of Ed. I have spent a lot of time reading about all of the candidates. McCoy & Newberger, endorsed by @MomsDemand, are committed to ending #GunViolence in our schools. .@JackyMcCoyBOE has been a teacher for decades & is endorsed by our local educators. She has dyslexia & achieved a graduate level-degree so understands what supports make it possible for students with learning differences to be academically successful.
/2

So the kids at our local high school are now referring to “Homecoming fever,” a cough/fever that is hitting tons of the student body since the dance on Saturday.

I’m so tired of perpetual sickness. I know you are too.

#GetBoosted & 😷 & #WashYourHands

#Pandemic #HoCoMD Update: hearing from LOTS more parents on another platform that their kids have fever & cough post #Hoco2022. Sev have tested + for #Influenza A. If your kids aged 6m & up haven’t had a #FluShot, get it done. We don’t need more home/school/work disruption. 😷 + #WashHands.

This trend of #COVID19 followed soon after by #rhinovirus or #enterovirus (& we have it in our 🏠 , test-confirmed) is 👎👎. The 🫁 are taking a beating. Beware, especially folks w/ #asthma & other lung diseases. Masks on. 👀 recent CDC alert: emergency.cdc.gov/han/2022/han00…. #MedTwitter If you are age 12+, it’s been at least 2 mos since your last dose of #COVID19 #vaccine or any # of #booster dose, & you haven’t gotten your updated #Omicron bivalent #boostershot, get it! Likewise anyone 6m old & up who hasn’t had a #FluShot this fall, go get one. Same day is👌.

Part 2 of ACP-Medicine Forward series on solutions to #FixPriorAuth happening now w/ amazing lineup! @gabrieldane, co-founder w/ @EricTopol of @MedicineForward, kicks off the mtg w/ comments about urgency of #MedTwitter #advocacy & activism to protect dr-patient relationship.

https://twitter.com/ACPinternists/status/1576905413013946368

Dr. @ShikhaJainMD is orienting audience to the amt of time #MedTwitter spends doing prior auth & peer-to-peer calls, in many cases w/ insurance company "peers" w/ no training in the specialty. Some could not even pronounce the tumor type or drug name. #DenialOfCare #FixPriorAuth

FDA has extended emergency auth of Novavax #vaccine to age 12-17y. Given as 2 doses 3w apart, it was 78% effective in preventing confirmed symptomatic #COVID19 7d after dose 2. It is a protein-based vaccine like many familiar vaccines in use for decades, e.g. tetanus. #MedTwitter Those under 18 are much less likely to be fully #vaccinated against #COVID19 than adults in the US, even though we now have vaccines authorized & recommended for kids as young as 6 mos. We'll see fewer kids missing school this fall/winter the more we #GetVaccinated now.

I’m more cautious than @Bob_Wachter when it comes to #WearAMask indoors (basically always w/ ppl from outside my 🏡 except briefly when I have to eat). I share his🧵 because this approach is sound: choose deliberately knowing current trends & weighing risk vs benefits. I differ…

https://twitter.com/Bob_Wachter/status/1554702870213103619

On one point: I don’t agree that “the tools now exist” means everyone has the tools. We know that #COVID19 treatments are being underutilized in low-income & minoritized groups. We know that the high-quality N95 😷 that Dr. Wachter concedes are tough to wear all day every day…

Please reply with a few words or a story about an amazing nurse in your life. Patients, caregivers, #MedTwitter or #NurseTwitter, chime in. Our nurse colleagues are exhausted in this #pandemic & need to know how much they are appreciated. Bring it.

https://twitter.com/annemariebatten/status/1552082761674014721

I’ll start. I want to recognize Mary Evans at @HopkinsGynOb. With my firstborn, I had a difficult labor & then he was in the NICU for breathing problems. She held my hand for ages, long after her shift was over. Nearly 2 decades later, her presence still means everything to me.

I’m concerned that labeling #monkeypox a sexually transmitted infection (STI) will cause confusion & delay (🚂) in public response. It’s transmitted most often by direct skin-to-skin contact w/ the rash (see the whole list of ways it spreads from CDC 👇), and sex includes … 1/ plenty of direct skin-to-skin contact, but you certainly don’t need to have sex to get it. That means that we will identify cases regardless of sex/gender/age, & whether or not ppl are sexually active. We have to get this right in #SciComm headlines & opening paragraphs …/2

For the first time in nearly a decade, we have a case of #polio in an unvaccinated adult. Per CDC, ~1 in 14 US 2y olds are currently NOT fully vaxxed & thus at risk. The US polio vaccine is safe & effective. Please verify you & your kids are up to date.
washingtonpost.com/health/new-yor… #Polio most commonly spreads via the "fecal-oral" route which usually means not washing hands after using toilet then eating (or biting nails or, for kids, thumbsucking) but may also spread via airborne route. #WashYourHands #GetVaccinated #MedTwitter

history.com/news/vaccines-…

#OncTwitter
NCI Pooled analysis (N=6.9K) of antiPD1/PDL1:
👉0.6% incidence CPI-related major cardiac AEs, 77% grade 3+
👉Almost half were myocarditis
👉 Twice as common w/ combos vs monotherapy & w/ CPI + targeted agent vs CPI + antiCTLA4…
#ImmunoOnc
ascopubs.org/doi/full/10.12… #OncTwitter
👉Major cardiac AEs were mostly early events (1-2 months) occurring after median of 2 doses of CPI
👉1/4 of cases of myocarditis were fatal, all preceded by myositis 👀
👉Diverse clinical presentations so have high index of suspicion to diagnose & intervene early…

Hey, #HoCoMD friends, be careful out there. This rain is crazy. Just got flash flood warning. Those of us who have lived here awhile know the history of this town, including the last tragic flash flood just 4y ago: apps.npr.org/ellicott-city/. #ECstrong And now add a tornado warning to the flash flood warning, #HoCoMD. Done that before too in our own backyard (📸 2003). Careful out there, #EllicottCity neighbors.

🧵 A little vignette for #ASCO22 attendees & esp speakers/chairs. Today I spoke in an Ed session. E350 is small enough I could see faces. When we began, most were in 😷, but I counted 11 who weren’t. One had a drink. The rest didn’t appear to be eating/drinking. Importantly… 1/ a few people (not sure if in 😷 or not) were coughing. That’s something you always hear, but it takes on added significance in a #pandemic because #COVIDisAirborne & current #Covidvariants spread as easily as measles, the most contagious respiratory pathogen on earth. /2