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I need you to do something for you

April 11, 2020

Humans, 

I’m going to ask you to do something that, unless you are involved in medicine, I bet no one has ever asked you to do before. But I’m going to ask you to do it anyway. I think you will be better for it. You will certainly be more educated. Without a doubt, you will have a better sense of what it is like to be an ER doc right now compared to watching another episode of Gray’s Anatomy. 

I'm asking you to watch an ER webinar.

The beauty of this webinar is that…

  • I don’t think you need to watch the entire thing unless you are simply interested. 

  • The further you go the more a medical degree will help. You certainly don’t need one at the beginning. I imagine you will follow 80-90% of the conversation at the start. By the end, I predict you will be at 10-20% understanding without the degree. 

  • I did a synopsis of the entire 1h45m for you so you can jump/skip if one topic is not interesting, but the next topic is.  

  • So, start watching it and then stop watching it whenever it no longer interests you as you will likely not miss anything once you are no longer interested. 

Here is the lecture. 

It’s the EM:RAP Live COVID-19 Update from April 7. EMRAP is an Emergency Medical education company run by a bunch of ER docs. Their stuff is excellent and usually by subscription. They have made all their COVID stuff freeAfter that endorsement, I feel compelled to tell you I have no financial ties to the company in any way. 

Here is the webinar again...

 

Below is a synopsis of the webinar. If you can’t tell, I think this is pretty fascinating stuff. 

Intro 

Update from NY 3:01

  • A doc working in a busy hospital in New Jersey gives an update on his hospital.

  • He talks about how the approach to treating the disease had changed so much from just two weeks ago. This is a great example of what I wrote about in prior emails. We need TIME. The longer you give the medical community the better treatment you will get if you get COVID and the closer you get to a vaccine.  

Modeling Pandemic 12:22

  • Great video I referenced in a prior email. 

  • I have zero recollection of getting any formal education throughout my medical training on pandemics. I’m not sure what that means because I also either don’t recall or never knew about this video

  • Andrea Bertozzi Ph.D. is a smart epidemiologist, she gives a short primer on pandemic modeling. It explains some of the basic science on how they are done and explains why there are such big variations in different models. 

Testing and Serology Updates 34:24

  • They discuss that not all COVID-19 tests have the same accuracy. Interesting. Maybe this is partly why we see such variation on the accuracy of the test 60-80%.  

  • Then they get into talking about the test that determines if you had COVID-19 in the past… convalescence testing, titer testing, serology testing. They mention the terms IgM & IgG. Just know that these are the antibodies that we make to develop immunity once we have had an infection. The fact that no one has ever been infected with this virus is why we call it “Novel.” It means no one ever made antibodies to this virus until recently. This type of testing will start becoming more and more important once we get past this peak.

Covered Study 45:16

  • This is a study that they are doing now that will attempt to determine the increased risk one is exposed to by working in an ER.

  • If that question is not interesting, skip to the next section. It is fascinating. 

Therapeutics Update 50:28

  • Ivermectin, Remdesivir, and Hydroxychloroquine updates.

  • Here is the take home. We have got to get real studies done in patients fast. An in vitro (lab) study that is then extrapolated to an in vivo (inside a body) conclusion is REALLY bad science. What are you talking about Greg? OK, let’s pick on hydroxychloroquine. Why do we think this drug may be helpful? They know that if you put this drug into a test tube with a lot of Coronavirus the virus will die. You have to make a big leap to then say well this will work in a human 100%. But what about the French paper? Not such a good quality paper they say. I have heard them dissect a bunch of papers and I believe them.

  • At 59:58 he goes into the bleach analogy. Bleach would do really well on this test. It kills the virus very well in a test tube. But, I’m not so sure I want to get a bag of bleach and infuse into my veins to treat a COVID infection. 

  • Convalescent Serum 1:01:46 - this is worth listening to. I have been very hopeful for this therapy since the beginning (I wrote about this in a prior email) and these really smart docs are also hopeful. It won't be a silver bullet but it could prove to be really useful.

Low Resource or No Resource locations (think Rural areas) 1:06:06

  • If you live in a rural community or a low resource area, or you work in the medical community in this environment, you will want to listen to this.

ICU Updates 1:15:01

  • This gets really medical. If you are non-medical and made it this far, then the take-home here is that we are learning really really fast and docs in CA and NY have taken a 180 in multiple different very fundamental therapies in just TWO weeks. 

  • She goes deep into splitting this disease up into two variants (one with good lungs and one with bad lungs) and perhaps a person can switch from one version to another. 

  • She is smart and verbose and so she goes on for a while. But, for the geeky ER and ICU docs, what she says is very interesting. 

 Cardiac Updates 1:41:30

  • Discussion of the cath lab in the COVID era.

 

I hope you find this even just ½ as interesting as I found it. 

Stay emotionally connected and physically distant,

Greg