Ok guys, it’s time for me to tell you about something very enlightening that I read in a book recently:
75% of people would rather being knowingly wrong and blend in, than be right and stand out. And there’s a well known psychology experiment that proved it. 🧵
Engineers raised the entire city of Chicago in the 1850s so they could install a sewage system in response to repeated epidemics of typhoid and cholera, but please tell me again how you don’t believe engineers can retrofit buildings with proper ventilation and filtration in 2022.
Whenever I see someone ask if we’re expected to continue masking in healthcare settings forever, I immediately think of Semmelweis. The man who discovered that HCWs’ dirty hands were causing fever and death in patients.
While I appreciate people like Dr. Fauci being clear about it being time to put our masks back on now, the truth is it was never a good idea to stop masking in the first place. Persistently high transmission is the reason these waves are coming at us faster than ever.
“Omicron is so contagious that it can’t be stopped.”
“We’re all going to catch it. It’s inevitable.”
“Omicron is like a natural vaccine, catching it is a good thing.”
Meanwhile on the other side of the world…
This may be controversial, but what if a solution to the insanely high home prices in Canada is to stop letting wealthy people buy up multiple homes as investments? Homes should not be hoarded.
Maybe we could keep/reinstate mask mandates for a bit while we figure out this liver failure issue that’s mostly affecting infants and toddlers, our littlest littles, a group that has literally no way of personal responsibility-ing their way through this? Just a thought.
In the 2020s twin coronavirus and monkeypox pandemics, humans in Western countries decided that the best course of action was to focus on fighting the fear of the viruses instead of fighting the spread of the viruses (which they thought was way too hard and like, bad vibes).
Real talk. I’m so mad about the war on the reinfections study bc I recently learned that a neighbor died. Young and healthy. It was her 3rd infection. She leaves behind a baby that won’t remember her. So spare me the “over-caution is as dangerous as false reassurance” routine.
It’s absolutely wild to me that we’re pretending that the higher than average number of respiratory tract infections and the pandemic of adults with pneumonia this year is not a warning sign of immune impairment. This is literally how immunodeficiency would present.
Am I the only one that didn’t know schools in South Africa closed for over a month for summer break on Dec 9-15 & only reopened a few days ago?
Seems like a detail that should’ve been a key point in the “SA peaked very quickly” discussions but somehow western media missed it.🤔
LIVING WITH COVID, a 🧵
Since covid isn’t going away (thanks to a series of poor choices over the last 2 years), it’s time to brainstorm what a real exit strategy might look like because “living with covid means accepting more deaths” doesn’t work for me. We can do better.
The current clown show of MID FLIGHT unmasking is bonkers. Future generations will think this scene in the HBO mini series is fictional and was added in for dramatic effect. And we’ll have to sheepishly explain how we were actually that dysfunctional as a society.
The way I see it, if somehow all the data on the cumulative risk of death, hosp, disability, heart attacks, strokes, etc with repeat covid infections turns out to be wrong, I will have worn a mask for longer than I needed to and missed a few social events. I’m ok with that. 1/3
Wearing a mask at work, school or the grocery store is not a lockdown.
Wearing a mask at work, school, or the grocery store is not a restriction.
Wearing a mask at work, school, or the grocery store does not limit your freedom.
We’re in a pandemic. Mask mandates save lives.
I plan to continue to wear a mask in all public indoor spaces, not just because I care about others, but because I care about my own health too. Both my short and long term health. So I don’t want to catch covid. I certainly don’t want to catch it multiple times. No thank you.
Mask MANDATES are the only thing that will get the majority of the population masking again. We are not a “do the right thing of your own accord” type of society.
The result of his discovery wasnt the widespread implementation of hand hygiene though… Instead he was shunned, ostracized, lost his job and eventually institutionalized. It took ~50 years before the life saving value of hand washing was fully recognized in healthcare. 50 years.
We’re surging again. In the summer. 🥲 I wish PH could just explain that if everyone wears a mask indoors for the boring stuff (like work, school, errands and transit) that would reduce overall transmission, reducing the amount of covid at gatherings, parties and social events.
Not catching a common virus for a year or 2, or 5, does not make you respond to it like an immunosuppressed person the next time you catch it. Avoiding pathogens doesn’t damage your immune system.
The war on masks is actually a war on public health. The objective seems to be to handicap our ability to effectively respond to public health emergencies that require collective action. Masks have become the public battleground but the battle is bigger than just masks. 1/3
There’s a weird thing happening recently where people that have had covid try to convince those that haven’t that we should give up and let ourselves catch it too. “You’ll be fine!”
Is it just me or do these interactions give you zombie movie vibes? 🧟♀️
Oh look, the wealthy and powerful are using all the SARS2 protections the ‘doomers’ have advocated for for 3 years while being aggressively characterized as a fringe group and increasingly marginalized by the decider class. Sure doesn’t look like they think covid is just a cold.
The world's elite at the Davos forum are enjoying every possible protection from Covid, including PCR testing, air filtration, UVGI light.
Why isn't this being offered to everyone else?
Every school, every workplace should have the same protections as the rich and powerful.
The “hygiene hypothesis” is the misnomer that just won’t die. We don’t need to get sick to be well. A better name is the “biodiversity hypothesis” since the rise in allergic/immune diseases is thought to be related to the loss of contact with biodiverse environments (nature!).
Never in my wildest dreams could I have predicted a future where a new virus would become the
#1
infectious disease killer of children and that medical leadership would decide the vaccine for this virus is NOT important for kids, and NOT promote it. 🤯
“You’re contagious for 10 days but we’re not backtracking on the 5 day isolation period so please be responsible and wear a mask around your friends and colleagues” is possibly the most irresponsible decision of the pandemic.
A friend today seemed to be under the impression that we still live in a time when you can call for an ambulance and one will arrive quickly. I explained that these days, it can take hours for an ambulance to arrive. She honestly had no idea and seemed confused and distraught.
What’s fascinating to me about those who ask “how long do you plan to wear a mask indoors?” is that it hasn’t occurred to them that many people are comfortable not knowing the answer to that question. We can cope with the uncertainty of not knowing when this actually ends.
A patient of mine was recently hospitalized for covid pneumonia. When asked about it, she told me that actually no, she was hospitalized for lung problems and the positive covid test was incidental. In case anyone was wondering how well the with/for disinformation is working.
If you’re arguing against mask mandates when pediatric ICUs are at or near 200% capacity across the country, you are prioritizing your own need to maintain the illusion of normal over the safety of babies and children. Let’s not sugarcoat it.
Wearing a mask doesn’t prevent you from smiling, nor does it prevent others from seeing that you’re smiling. “Smiles are back” is a stupid slogan. Smiles never left.
Starting to have patients ask whether they should keep masking after the mandates end. My answer is pretty simple: “if you catch covid, it should be while doing something worthwhile like spending time with loved ones, not at work or while doing your groceries at Costco”
We’re almost 3 years in. Those who continue to claim “masks are harmful for the development/mental health of children” owe us concrete evidence. Enough is enough.
The resistance to the idea that the air we exhale while caring for patients can be unhygienic and a source of illness and death for some feels exactly the same to me. Despite the evidence, the denial is strong. Many prefer to cling to the status quo they knew before the pandemic.
Business consultant in China: Stay the course. Keep covid out. Within 10 years, the West will fall because of long covid.
Consultants in the West: Gut public health and tell everyone the pandemic is over. If they notice that people seem sicker, say it’s because of the LoCkDoWnS.
A Chinese business consultant in a Ted-style talk justified zero-Covid policy by saying that in 10 years the West will be brought to its knees b/c long-Covid, which will decimate most of its labor force.
BA2 is looking more pathogenic than omicron. And more intrinsically contagious. But still no talk in the West on how to make our countries resilient to the constant threat of new VOCs as we open up. Endemic delusion continues.
It turns out that doctors didn’t take kindly to the idea that their own hands were unhygienic and the source of disease and death for some of their patients. Despite the evidence, the denial was rampant and it was strong. The majority consensus was that Semmelweis was a crank…
Yesterday someone confronted me about my social media content, saying that while I’m not wrong, I’m too radical? They asked me “ok what happens once everyone agrees [that covid infections are problematic], then what?”
Then we clean the air. HEPA filters are not radical.
It’s interesting to see people treat the statement “catching covid repeatedly until it kills you” as hyperbole. Covid is a leading cause of death across all ages. If nothing changes, then losing people we care about to covid will be as common as cancer, heart disease or dementia.
So if the air we breathe can be unhygienic and cause illness and death in our patients and we know there’s a simple, effective solution — filtering it through a mask — then it seems logical that this would become the new standard in our clinics, hospitals and LTCs. Permanently.
Something my skin cancer patients say to me all the time is “you know, my parents’ generation didn’t protect us from the sun when we were kids...” and it of course gets me wondering what today’s kids will one day tell their doctors about what our generation didn’t do for them…
But as with Semmelweis’ experience, I expect that suggestion to get a lot of pushback and for it to take a very long time for the medical field to accept that the old status quo is gone and that masking in healthcare is the new normal. I just hope it won’t take another 50 years.
I was today years old when I realized that the reason email is so painful for ADHDers, other than executive dysfunction, is bc it requires a buttload of masking to figure out how to say what you need to say in the semiformal, roundabout, fake polite way that neurotypicals expect.
Covid infections can cause strokes, heart attacks and pulmonary embolisms in the post-acute phase. Even if the acute infection is mild. Even if you’re vaccinated/boosted. Even if you’re healthy. Even if you’re young. Even if you already caught it before and have “hybrid immunity”
I’m so pro-mask and anti-infection that I started masking in 2019. Why? Because I was pregnant and working in healthcare. And in the beforetimes, it was normal to try your best to avoid contracting pathogens in pregnancy. We didn’t worry about “generational immunity debt.” 🤡
How is anyone that chose to be a healer fine with spreading an airborne SARS virus in healthcare? SARS2 is the
#1
infectious disease killer of Canadians of all ages. By a wide margin. Universal masking in healthcare is common sense and basic human decency.
#KeepMasksInHealthCare
On monkeypox: I really think we’re missing the point. Eliminating it isn’t about how severe it is or not. Or if it transmits easily or not. It’s about not having a viral illness that resembles a known bioweapon circulating endemically which risks delaying recognition of smallpox.
But that status quo was when we didn’t know better, and when we didn’t have such a virulent and dangerous new airborne pathogen in permanent circulation. Now that we do and now that we know better, we should be willing to do better.
They’re really planning to just let the pediatric healthcare emergency play out without intervening… the preventable deaths of *children* are on the line and we’re really okay accepting a do-nothing approach? I really can’t process this level of apathy.
We’re in our *3rd* post-lockdown viral respiratory season and admissions for viral resp illness+pneumonia are 6 standard deviations above the historical average. I do not understand how so many reasonable people haven’t figured out that the “immunity debt” scapegoat is disinfo.🧵
Across all ages, admissions are 6 standard deviations above the seasonal average. But we've grown accustomed to disease, to living our lives with complete disregard for reality and for what living in society means, at the most rudimentary level.
If you’re an MD that spends time counseling patients to exercise + quit smoking in order to reduce their risk of a heart attack or stroke, and you haven’t yet added “avoid covid” to your ‘cardiovascular risk factors’ counseling speech — you may want to re-evaluate that oversight.
I think many of us are wondering what in the world went wrong in Austria? Don’t they have free rapid tests and N95 (FFP2) level masks? What explains the skyrocketing cases? Follow along for some answers from an Austrian.
TLDR: 8 of 9 states dropped their mask mandates. 🤦🏻♀️
Did you know that if Bill 96 passes (and it looks like it will), BY LAW I won’t be allowed to speak to English-speaking patients in English anymore or Italian-speaking patients in Italian for that matter. BY LAW. For real.
Are people even aware that this is happening in Quebec?
So the children’s hospitals is full, to the point of turning patients away, there are more children in hospital or needing care than expected for this time of year, but then they make sure to emphasize that it’s not covid. Ok well then what is it? Why are kids sicker than normal?
StatCan just dropped a bombshell report on LC. This is the most important figure. It highlights that the risk of long term symptoms is cumulative, it increases with increasing number of infections. By 3+ infections, 38% report long term symptoms — that’s 1 in every 2.6 people. 🤯
So Fauci is skipping the WH shindig and Biden is skipping the eating portion. A world where we force people that don’t want to risk covid to exclude themselves from social events + other parts of society (while everyone else catches covid repeatedly) can’t be described as normal.
If you still think alarmism is a big issue at this point, in 2022 when we’re 5 waves in with a true global death toll estimated to be between 14 and 23 million, then I regret to inform you that you’re part of the problem.
I’m a little confused at the “making people feel bad about how their choices harm others is bad advocacy” takes. Didn’t we do that with smoking? Wasn’t the “secondhand smoke kills” education campaign exactly that? Isn’t “if you drive drunk you could kill someone” exactly that?
Ways to be smarter about this and restructure around an airborne pathogen starts with *clean air*. Cholera went away with clean water. We need to make the air in all our buildings as clean and safe as possible. Everywhere — schools, restaurants, work, apartment buildings etc
Influenza will never become endemic. It’s an epidemic virus. It comes back in waves every year.
SARS2 will never become endemic. It’s an epidemic virus. It comes back in waves every year (sometimes twice a year).
THIS is what epidemic covid looks like. This is it.
The thing about the people pressuring you to play disability roulette with them is that if you lose the game, they absolutely will not be there to take care of you. Illness is very lonely. We think our people will rally around us but that’s not what happens. Most just disappear.
We are at level 4 surge capacity. There is no level 5.
Instead of explaining very plainly to the population what that means*, politicians and certain media outlets are selling us “with covid” snake oil.
People making you feel bad for N95ing wherever you go and trying to catch covid the least amount of times possible is the 2022 equivalent of your “friends” making you feel bad for studying on the weekend and getting good grades in high school.
When a weird new health issue arises globally after the West’s coordinated decision to allow mass infection of their countries’ populations with a novel, extremely pathogenic virus, it’s the height of intellectual dishonesty not to consider that novel virus as the prime suspect.
It’s a well known phenomenon in medicine that the children with a stay-at-home parent that don’t get a dozen colds a year in infancy/toddlerhood accumulate an immunity debt and are at high risk of liver failure when they start school.
LOL no, that’s not a thing.
Hi, I’m Lisa! I live in Canada and I don’t think catching and spreading a deadly and disabling pandemic virus every ~6 months qualifies as “getting back to normal.” I didn’t do that in 2019 and I won’t do it now.
Hi, I’m Kate! I live in Canada and I too refuse to accept that infections and reinfections are inevitable- I will continue to wear a respirator to protect myself, my family, my students, and the older adults I work with and care for. Join me!
#MaskUp
It’s wild that so many people don’t consider covid a threat bc they aren’t disabled, when covid itself can disable you… Another covid induced autoimmune disease diagnosis today. Another difficult talk with a distraught patient on what it means to be immunocompromised in 2023.
Lots of people are rightly concerned about antivaxxers weaponizing the increase in premature sudden deaths to spread antivaxx disinfo. So am I. But at least antivaxxers actually *noticed* that young people keep dropping dead. Which is more than I can say for medicine/PH leaders.
I think the odds that monkeypox — a virus that causes ulcers on the face in >30% of cases, ulcers that are very painful and that take 2-4 weeks to heal and leave permanent scars, more than half the time with systemic symptoms — was circulating for years here unnoticed is 0%.
I see they’ve started up the “ebola is not airborne” and “asymptomatic or mildly symptomatic ebola cases don’t transmit” PR machine. Based on the last 3 years, these talking points start making the rounds when leaders realize they’ve lost control of the epidemic. 🚩🚩🚩
The “immunity debt” hypothesis was introduced into the literature (aka invented) in 2021 by the same doctor that previously said kids don’t spread covid to adults and hypothesized that it’s because they’re short so their coughs are too low to reach us. How did that one turn out?
So following my own advice, I canceled on anyone that had viral symptoms, which was… everyone 🙃.
Everyone is sick. At the same time. In mid April. After everyone was sick at the same time just 3-4 months ago. Super normal stuff.
It’s really painful to watch the group of virologists & friends that relentlessly mocked aerosol scientists over airborne transmission destroying what little credibility they have left by mocking a hepatologist that disagrees with them on the pediatric liver failure crisis.
Many ppl say that even if we do nothing, the waves will come down anyway. They’re right. But what they leave out is that we now have 4 waves a year instead 2, the troughs of the hospitalization waves are now higher than the crests of the 2020/2021 waves and more people are dying.
Everyone realizes that not being able to talk openly, honestly, casually about a pandemic virus that upended our lives, caused a global mass casualty event that then became persistently high excess mortality rates and a long tail of mass disability — is a trauma response right?
It’s not about the masks. It’s about the idea that we should all care how our choices affect the health and safety of other people. It’s a war on the idea that we all need each other. That a society that acts collectively is stronger than one that glorifies individualism. 2/3
Medical school lectures on respiratory pathogens in 2060:
“Interestingly in the 1900s and early 2000s, doctors thought respiratory viruses were transmitted by fomites, not aerosols. They spent a tremendous amount of energy cleaning hands/surfaces instead of cleaning indoor air.”
Good news, surgical site infections are way down so we’re loosening OR restrictions! ORs will now be “sterile glove friendly”. The use sterile gloves during surgery will be optional and based on each surgeon’s individual preference. High fives are back!! 🤗 /s
Everyone understands that insurance companies denying life insurance (not disability insurance, ~life~ insurance) to people with LC means they believe people w covid sequelae (10-20% of the pop and rising) are at increased risk of dying young, right? K, just so we’re all clear.
Denied life insurance due to
#longCOVID
. Pretty sure the insurance underwriters understand the risks of COVID better than public health and the general public.
So what happens when it turns out the government infecting >40% of the population — allowing thousands to die, paralyzing our healthcare system causing collateral morbidity/mortality, and causing an unknown amount of strokes, long covid, MIS-C… — doesn’t prevent a spring wave?
Got a message from one of the hospitals I work at saying that several outbreaks began with a symptomatic HCW coming in to work so if we so much as have a tickle in our throats, we must isolate and get a PCR test immediately and honestly that’s exactly the IPAC energy we need.
Dear people that are turning the need to vaccinate HCWs against monkeypox into a controversial take, you do remember that >100,000 HCWs died in the first year of the SARS2 pandemic right? Protecting healthcare workers is NOT a controversial position.
We need robust ventilation standards, use of UVGI, visible CO2 monitors (where above a certain threshold you would have to evacuate because the air is deemed unsafe). Call in the engineers! Yes it’s a huge project, yes it’s expensive but we can’t keep doing this yo-yo thing.
PSA I’ve now heard of several cases of a biphasic symptom and testing pattern for BA.2 from people that rapid test themselves liberally. They’re sick, they test positive, they feel better, they test negative, and a few days later symptoms come back and they’re positive again.
Yes the smoke smells like plastic. And the reason is horrifying:
“The VOC’s from the wildfire smoke interact with UV radiation to create benzene and formaldehyde compounds in the atmosphere. These are toxic air pollutants – and they happen to smell like burning plastic.”
Dear colleagues, I appreciate the attempts to drum up public outrage over the worsening pediatric health crisis, but outrage alone won’t slow viral transmission. Try yelling for:
-Mask mandates
-Air quality regulations
-Mandatory isolation for respiratory illnesses, with sick pay
I don’t know who needs to hear this, but vaccine-derived polioviruses are nearly indistinguishable from wild type polioviruses and are capable of causing paralysis. An American with no recent travel history catching a vaccine-derived paralytic poliovirus is *not* normal stuff.
Immunity debt making the rounds again. So here’s my reminder that while there are viruses that are more severe if caught as a teen/adult (polio, chickenpox), that isn’t the case for respiratory viruses. There’s a mortality *benefit* from 1st RSV and flu infections being delayed.