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I need to rant.

June 16, 2020

 

Humans,

I haven’t ranted in a bit. So please allow me to get something off my chest. 

I’ll come out and just say it… what we are doing as a country since Memorial Day is not sustainable. I keep hearing our leaders hedge by using words such as… “maybe”, “perhaps”, “suggests”, “concerns”. I’ll say it clearly without a hedge… based on the increased numbers (or this, or this) we have recently seen in a number of places, we need to practice better distancing. Period. 

We are moving into exponential growth in a number of places and we all know exponential growth is no bueno. Remember it will take 2 - 3 weeks before our actions from today are truly reflected in new cases and a few weeks longer before the death rate numbers are affected. Additionally recall, before you die from COVID, most people first go through a grueling 2-4 wk hospital stay. 

No, I’m not saying we need to lockdown nor am I saying we need to close the economy. I’m saying the pendulum has swung a little too far. We need to practice better discipline so we don’t need to lockdown again. Second lockdown... bad. A little more prudence now… good.  

The pandemic didn’t go away. It’s going to be here for a while. Washing hands, wearing masks, and being thoughtful about what you are doing and how you are going to do it isn’t asking too much. I have been so hopeful seeing the amazing innovations businesses are implementing to limit transmission. Let’s influence individuals to practice more thoughtful behavior by modeling and sharing the behaviors we want to see.

And, since you have read this far and are apparently indulging my rant, I’d also like to say... ‘Rona don’t care whether you are blue or red - let’s not confuse science with politics. It’s a recipe for disaster. 

OK, sorry about that, I certainly feel better. 

Stay emotionally connected and physically distant,

Greg 

PS: Some great news came out this morning about steroids. A group released a pre-print on their study using Dexamethasone (commonly used steroid). It’s not time to party. We need to see the published study with the underlying data but I predict that this will be replicated. It makes sense, I suspected this would be the case <pat on the back>, and it’s consistent with what we know about inflammatory diseases. If you know Adrienne and me well, then you know we think a short course of steroids fixes just about everything (this reminds me of put a bird on it). Obviously, the formal study with the data needs to still come out. 

Also, since we are touting a pre-print, here (5 min) is Jerry Hoffman MD, riffing on this new COVID-era pre-print phenomenon and his explanation of how dangerous it is. He is a legend in ER circles. His ability to tear apart an academic paper with elegance, finesse, and apparent lack of effort is second to none. I have listened to many papers reviewed by this man and it is always a pleasure. Please take a moment to listen to his wisdom on being leary of pre-prints. 

So, if this study does prove to really be positive, more studies will need to be done to replicate it, sort out the best timing of getting the medication, and which patient populations would benefit. But, I think this is going to be the next big medical story.

Btw - keep watching after the 5 mins. There is a great explanation of pneumonia vs ammonia.