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Friday Night Update from the ER in Arlington, VA: “What happened in Uvalde, Texas this week is hard to process”; “After two years of wearing goggles, I tried out a face shield”

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Thanks as always to Dr. Mike Silverman, Chair of the Department of Emergency medicine at Virginia Hospital Center, for these helpful updates!

Friday Night Update from the ER in Arlington, VA

I’ve taken care of a lot of gunshot wounds through the years, and I’ve pronounced a lot of people dead. Probably hundreds in each category. Fortunately, we have almost no penetrating trauma in Northern Virginia and we actually don’t see a lot of cardiac arrests in our ER. While I remember the name of my first patient who died (3rd year of medical school, internal medicine rotation, at DePaul Hospital in Norfolk), I don’t remember a lot of specifics about most of the adults who have died through the years. However, I’m pretty sure I remember every kid who I cared for who died in the ER. I don’t really ever talk about the details of the pediatric patients I’ve had to pronounce, but whether it was SIDS, trauma, overdose, or some other cause, talking to the parents is always really hard. So much of what happened in Uvalde, Texas this week is hard to process. The families and community will never be the same. And being in a small town has its own challenges. One of the medics found out his daughter died when caring for another child. I suspect the ER staff will also be significantly impacted. And expect to see the national physician societies like the AMA speak out even more about ways to reduce deaths related to guns.

I’ve worked a lot over the past week. I’ve seen a lot of COVID. Old people, young people, people who got it a month ago and are still wrestling with symptoms. I had a couple of patients who came in for COVID symptoms (cough, fever, shortness of breath) but what got them admitted was that COVID exacerbated other pretty significant medical issues.

Although I wouldn’t know this from my clinical shifts, our data is a touch better than last week when we look at total numbers of new cases. The number of symptomatic people we diagnosed was up a bit, but thee percent positivity rate was down a smidge (0.4%). Our general screen/asymptomatic patient testing numbers was down compared to last week and a drop in the percent positivity. Overall, the total number of patients we diagnosed with COVID dropped a touch compared to the week before and our overall percent positivity went from 9.4% to 7.8% (6 week running average of 6.5%). We’re seeing about 1350 patients in the ER a week and about 45% are getting tested for one reason or another. We also saw a slight decline in the number of patients who required our “COVID isolation” protocol and/or were admitted from this group.

Pfizer released vaccine efficacy data on their pediatric patient group. For children 6 months to 5 years old, the three dose Pfizer vaccine was 80% effective at preventing illness during the Omicron wave. Recall that the 2 dose data released earlier this year was not nearly as effective. 80% is phenomenal. The 3rd dose led to a very strong immune response and the vaccine was well tolerated. Pfizer’s study group included 1678 kids under 5 who received a 3rd dose of vaccine at least two months after the second dose. The FDA has announced that they have a public meeting with their independent vaccine experts on June 15th to discuss both Pfizer and Moderna’s applications for this age group. I know a lot of parents are very anxious to get their kids vaccinated. And it sounds like it’s just around the corner. Finally!

The US Surgeon General released a report this week “highlighting the urgent need to address the health worker burnout crisis across the country.” In 2019, burnout among healthcare workers was already described as being at “crisis level,” but the pandemic and a significant shortage of healthcare workers has exacerbated the issue. Burnout obviously affects the individuals. We’ve seen several high profile reports of physician and nurse suicides over the past two years, including a nurse who shot himself halfway through his ER shift in a hospital supply closet on April 30th. But burnout also affects the overall health infrastructure. The Surgeon General did provide recommendations to address burnout. These are easier said than done but it certainly escalates the discussion among all the health entities, including hospitals, insurance companies, policymakers, etc…to address health worker burnout and “ensure their wellbeing.”

I was supposed to go to a large, outdoor neighborhood happy hour last Monday to celebrate a return to normal. Ironically, it was cancelled because of the increasing COVID numbers. Good call.

It’s also never too late to make adjustments to your routine. Two years into Zoom meetings, I finally loaded up a headshot to use when my camera is off. And clinically, after two years of wearing goggles, I tried out a face shield (see photo). This was actually great. I don’t know why it took me so long to switch from my goggles.

Have a happy and safe Memorial Day Weekend.

Coronavirus is not done with us yet.

Science matters. Get vaccinated (or your booster). Keep a mask handy.

Mike

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