BC HEALTH
Saved by @Alex1Powell

As US hospitals make the necessary shuffle to accommodate the current wave, I would like to remind leadership about the study done on the psychological status of frontline hospital workers during NYC's spring Covid surge (thread).

 As expected, many participants reported stress, anxiety, and depression. But the study also looked into *what* exactly made participants feel distressed. https://t.co/ZHCbh10pBG
This graph is showing % of participants who found these factors "highly distressing." Note in the work environment section (blue) the number of things that rank higher than patient deaths.
These include:
- Perceptions of a lack of control and/or uncertainty
- Performing clinical work that is outside of your specialty
- The need/expectation for healthcare providers to provide social support to patients in lieu of their families (due to visitation restrictions)
- Difficult triage decisions or rationing of care (potential or actual) due to resource scarcity
- And also fears related to getting/transmitting Covid within the work environment - in particular, the uncertain Covid status of other healthcare providers
I bring this up because I think there are some good lessons here from Wave 1 for hospital leaders facing Wave 3.
First, if the #1 source of distress is loss of control and uncertainty, than people need as much control and certainty as possible. Transparency, minimal bullshit, problems stated clearly and promptly. More information is better.
Whenever possible, decisions should be made after engagement of multiple stakeholders, and with opportunity for feedback and changing course. We didn't always have time for that in Wave 1. But we had intervening months to learn better approaches in the period since.
Examples of pediatricians seeing adults, radiologists deployed to the ICU have been thrown out there as a signal for hospital system overload. I don't think we have really stopped to acknowledge how distressing it is to be asked to practice outside of your usual scope of work.
Hospital leadership needs to treat this like the very big deal it is, and provide concrete support for rapid skill development and psychological distress beyond "please watch these YouTube videos, phone a friend, you'll be fine."
HCWs at this point should know the range of resources they have to support patients who are isolated from their loved ones and also the processes and bodies that support triage / ethical decision-making in the setting of scarce resources.
But if they do not exist, if they are not sufficient, or if they are not sufficiently communicated, this needs to happen ASAP.
There are two other things I'd point out from the study. First, note how low the clinical hours worked was on the "highly distressed" chart. It's a concern, for sure, but not the main thing. I suspect it's more of an issue at this point in the pandemic...
...when people are exhausted in every sense. But I also think that this is something we amply talk about, because it's familiar and we know how to talk about it. I've gotten my share of "we know this sucks but it's what we gotta do for x reasons, here comes second back-up" ...
And I wonder if there's less severe distress because leadership tends to talk about it clearly and plainly and without the vagueness, avoidance, or insincerity that seems to be used around other topics (like PPE use, or practicing out of specialty, or triage decisions).
The other thing from the study is >60% of participants reported feeling a high level of purpose and meaning. I think of this a lot. Because that's something HCWs bring to the table, an asset that is in some ways hospitals' to keep or lose.
And I think the way you eff that up is actually related to all of the above. When employees are treated like children rather than trusted and respected partners in the work, when they are subjected to unsafe situations without a good faith effort to fix them...
Cheery declarations of "remember, we're all in this together" or wellness Zooms or downloadable apps have no hope to sustain morale.
Once again, I have spoken.

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Adam Wagner
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🚨New lockdown regulations just published, in force tomorrow

The Health Protection (Coronavirus, Restrictions) (No. 3) and (All Tiers) (England) (Amendment) Regulations 2021

https://t.co/L5jwlTDaIE

(Thread)


These are not a new set of regulations: they are amendments an old set of regulations

Which we thought were gone! But they are back

Welcome back No.3 regulations

A quick thing before we continue!

I have been analysing these laws for free for 9 months now - if you want to say thanks and have a few £ to spare please give to my @LawCentres fundraiser

They give free legal advice to people who need it

They also amend the All Tiers regulations

Oh god it's all amendments by paragraph references

Basically all of England now in Tier 4 and Tier 4 is amended but not by a huge amount

This really is a terrible way to make laws on the fly - who can possibly understand it?!


So, to explain, you need 2 documents open if you want to understand what is going on:

All Tiers regulations (Tiers 1-4, 2 December as amended) https://t.co/IraPQ112ak

And amendments https://t.co/L5jwlTDaIE

No sensible way of doing except by track changes, on it now, back soon
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All Women are at risk of getting Cervical Cancer. It often affect women over age 30.

Long-lasting infection with certain types of human papillomavirus (HPV) are the main cause of cervical cancer.

HPV is a virus that is passed from one person to another during sex.

A Thread 🚺


More than half of sexually active people might have HPV at some point in their lives, but few women will get CERVICAL CANCER.

Early Screening tests & the HPV vaccine can help prevent cervical cancer.

When cervical cancer is diagnosed early, it is highly treatable &....

2/cont.

associated with long survival and good quality of life.

Most (almost all) cervical cancers are caused by HPV.

There are many types of HPV.
Some HPV types can cause changes on a woman’s CERVIX that can lead to cervical cancer as time goes on, WHILE other types can cause genital

or skin WARTS . HPV is so common that most people get it at some time in their lives.

HPV usually causes no symptoms so you can’t tell that you have it. For most women, HPV might be SELF LIMITING (ie it will go away on its own); However, if it doesn't, there are a chances that

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OTHER FACTORS CAN INCREASE YOUR RISK of CERVICAL CANCER —
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Advertisement
Alex Berenson
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@AlexBerenson
This one is for the real stats folks.

Let's deal with some objections to the deaths after flu vax/deaths after Covid vax comparison.

1) I agree Covid vaccine deaths are probably more likely to be reported than flu vaccine deaths. Are they 900 times more likely? Very doubtful...

2) Here's one good reason to think the gap may be small. The ratio of non-serious to serious Vaers reports is far HIGHER for the flu vax than for Covid. In other words, people have basically STOPPED filing non-serious event reports after Covid shots, because they are so common...

3) If people were clogging VAERS with Covid vaccine side effects reports because they are so sensitized to them, we'd see the opposite - tons of reports in every category. We aren't, though.

4) Children aside (and children do receive a lot of flu shots), the idea that the Covid vaccine is going to a meaningfully different population than the flu vaccine is nonsense. Flu campaigns are targeted at the elderly and healthcare workers, just like the Covid vaccine...

5) The correct area under the curve at risk post-Covid vaccinations is not 41 million doses x 8 weeks of followup. It's more like 41 million doses x 3 days. READ THE VAERS REPORTS YOURSELF. I have. The "he was hit by a bus a week after being vaccinated" isn't what's in there...
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Patrick Strudwick
Patrick Strudwick
@PatrickStrud
I’m deeply saddened to learn that Dr Joseph Sonnabend, one of the most important figures in the history of AIDS, died yesterday. I spent time with him in 2018 for one of the last interviews he ever gave. Let me tell you about this man and what he did:

Sonnabend was one of the first doctors to raise the alarm. In 1979, while running a sexual health clinic in Greenwich Village, he wrote to the NY Health Dept to warn them of the symptoms he was seeing: low white blood cell counts, enlarged lymph nodes. He didn’t get a reply. 2/

So he kept speaking out. When a patient of his developed a very rare cancer – Kaposi’s Sarcoma – he linked up with a dermatologist at NYU who said that over a dozen gay men had it. Sonnabend knew there was something very wrong. He started working at the lab at NYU — for free. 3/

It was soon after this in 1981 that the New York Times famously reported “Rare Cancer Found In 41 Homosexuals”. The next decade would kill most of Sonnabend’s patients and friends — and all of his lovers. What Sonnabend did was to fight for every single of them. 4/

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writer sam
writer sam
@writersamr
Some thoughts on this: Firstly, it might be personal preference, but I am not keen on this kind of campaign as I feel like it trivialises cancer. Sometimes the serious message gets lost because people are sharing pics of cats or whatever and the important context is gone.


More importantly, the statistic being used in the campaign is misleading. It says 57% of women put off cervical screening if they can't get waxed. But on further investigation, that's not accurate.

The page here goes on to say "57% of women who regularly have their pubic hair professionally removed would put off attending their cervical screening appointment if they hadn’t been able to visit a beauty salon."

So the 57% represents a concern not across the whole population of women, but only those who regularly get waxed. So how big of an issue is this across the whole population? And what else is stopping people getting smears?

I think campaigns for cancer screening are really tricky because there is so much nuance that often doesn't fit into a catchy headline or hashtag. It's certainly not easy and is part of a bigger conversation.
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