Note about covid test.
You can get tested on Monday.
Be exposed to covid on Tuesday.
Get a negative result on Wednesday.
Go out to meet people on Thursday.
Be mildly symptomatic on Friday (“But I was negative”) .
Then get tested on Saturday.
Only to be positive on Monday.
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Dr Eric Levi
@DrEricLevi
Specialist Otolaryngologist Head & Neck Surgeon | Educator | Speaker | Views mine | Wurundjeri Country | Podcast on Spotify. @drericlevi@mastodon.online
Dr Eric Levi’s Tweets
Humans of New York on Instagram hitting the spot where it hurts for many docs.
23 patients this morning! Can’t wait! Christmas suit? Yes / no ?
Happy 2022.
May you swab your nose anatomically correctly this year.
Let’s just stop saying “no beds”.
Let’s just say “no staff”. Because that’s the reality. The beds may be available but without the staff, there’s no hospital care.
I accidentally found this. This hurts so much. I hope your kids will never have to write anything like this.
I’ve been triple vaccinated and I still wear a mask and check in everywhere. I’m living my life freely with a mask on. I adjust my choice of destinations, preferring outdoors over indoors. Hope you do the same too to protect yourself & loved ones against this airborne virus.
What did Melbourne, Australia do to get our covid numbers down from 700+ a day to zero in the last 48h?
Here’s a list:
5km travelling limit
1 hour outside the home
Leave home only for essential work, essential activities, medical, care, health/exercise reasons.
Curfew 8pm-5am
I’m a surgeon.
But surgery is always the last thing I offer.
I start with:
Words, advice, education.
Lifestyle change.
Medical therapy.
Minimally invasive therapy.
Finally, the knife, laser, drills, burrs, etc.
Lots of patience in between.
The nasopharynx goes back, not up.
When you take a nasopharyngeal swab or insert nasogastric tube, NEVER aim upwards towards the brain.
Go LOW and go SLOW.
What makes up the ICU is not the machines. It’s the experienced staff (especially nursing staff) who intensively care for patients 1 on 1, minute by minute. It’s the “Intensive Care Unit” not the “Lots of Ventilators Unit”.
Note to self:
Never use wife or family or religion as an excuse for poor performance at work.
Burnout is not a mental illness.
Burnout is a chronic occupational psychological injury.
Burnout therefore is a workplace safety issue.
Unless we consider burnout an issue of workplace safety, we will never move from individual resilience focus to workplace solutions.
1391 kids tested. 12% positive for #COVID19. Average age 6.7. 48.5% had no fever. 15% no symptoms.
Kids can be carriers of the diseases, many without fever and some without cough or other symptoms.
nejm.org/doi/pdf/10.105
Whatever is your belief, let us accept that none of us have ever seen a cold bring down health care systems around the world simultaneously, increase excess death and reduce life expectancy. Never in 100 years. We are living in a very unusual time.
Being kind is not virtue signalling.
Being inclusive is not being woke.
Being kind, inclusive and respectful is simply just being a good human.
As a medical student, I wanted to change the world.
As a trainee surgeon, I wanted to change lives.
As a specialist consultant surgeon, I just want to go home.
If “living with COVID” means that the two biggest Australian states need to cancel all but urgent and emergency operative cases to meet the workload demands, then that’s not a good place to be, right?
There are only 43 COVID patients in ICU today in the whole of Australia.
You don’t have to call us heroes because we haven’t seen a real tsunami.
Call our Public Health Officials and Medical Leaders heroes. They have saved us from an unprecedented disaster. So far.
One thing we learned from the pandemic is that very few of us actually learned from the pandemic.
Treating a celebrity sportsperson differently to the common people does not make public health sense.
It reinforces the message that rules don’t apply to some people. And it unravels all the hard work of community sacrifice.
I know that opinions are cheap. So here’s mine (and you can disagree).
Victoria has done extremely well in containing this virus, but we no longer can reach our goal because others have decided that it’s not a goal worth having so our plans have been sabotaged.
Unpopular personal opinion:
What Victoria did last year to lockdown and drive the virus down to zero transmission was protective to the rest of the country.
“Pre-existing condition” is a trigger to care. Not a trigger to say “too bad”. Having pre-existing condition is not an explanation of increased in death numbers. Can we please respect people & accept that every death is a tragedy? There is not 1 death more excusable than another.
Calling omicron “mild” was one of the biggest cognitive mistakes we made. We took of our seatbelts and let down our guards.
With high transmission and reinfection rate, the burden of disease is far from being mild.
The strain on the system is significant.
This is the blood pressure cuff for some of the patients I operate on. Precious. Precious little ones.
How to get the trolls coming at you. Say these magic sentences.
Lockdowns were effective.
Masks are safe.
COVID is not the flu.
I work at 2 major public hospital systems here in Melbourne. My nursing colleagues are utterly exhausted. The relentless waves of illnesses have been really hard on them. It may look fine on the outside but certainly a real struggle on the inside. Let’s be kind to each other.
Rule number 1 in all of Medicine and Surgery:
See your patients.
I mean, really SEE them. See their pain, their fears, their concerns, their past, their social context, their struggles. See how their situations have influenced their illness.
See their humanity.
What a lot of people call “the flu” is actually common cold.
We all get the common cold.
Influenza is different. Let’s all get our terminology right.
Hi,
Surgeon here.
I’ve been wearing masks daily for almost 20 years. Some of my surgical cases go up to 8-12 hours long in duration and I wear a mask continuously during that time (small breaks in between).
Masks are protective and are not harmful to the wearer.
Replying to
A negative test is negative at the time of testing. And there’s a known false negative rate (meaning you have the virus but it did not turn positive on the test).
Don’t be deluded that once you’re negative you’ll always be negative. You can still be exposed right after the test
So a carer of a child in a cancer ward at RCH tested positive and the cancer ward is now a Tier 1 exposure site.
Let’s stop there for a moment.
1/
Did you know that catching the flu this year does not make me immune to next year’s flu strain.
That’s why the flu vaccine is different each year to prepare for the current year’s strain.
Please don’t let these numbers ever numb you from the fact that they are people who love and are loved by someone.
“I haven’t taken the vaccine and I’m absolutely fine.”
That’s because the rest of the community have done the hard work to protect you. Every time someone masks, distances, gets vaccinated, ventilates indoors & keeps density limits, they protect other members of the community.
Replying to
To receive complaint hurts when you’re already trying your very best. No one records the 99 great things you do. They record the one time you are less then perfect in their eyes.
Things that should have never been said:
2020 - COVID is not airborne.
2021 - Kids won’t get bad disease.
2022 - The pandemic is over.
Burnout is not a mental illness diagnosis.
Burnout is an occupational health issue.
The solution is not “more resilience” or more medication.
In Australia, we have a wonderful children’s vaccination schedule. Here’s what my 6 year old has received so far to keep her safe.
Surgeons are scrutinised routinely because we’re responsible for the lives of others. Politicians should be too. #QandA
Don’t let noise distract you.
Victoria is 89% fully vaccinated (12+).
That’s the vast majority of the state population supporting science and Public Health recommendation.
This is the real news. The evidence of support.
Minister for Foreign Affairs Penny Wong sworn in.
First Foreign Affairs Minister born in a foreign country. ❤️❤️❤️
Hey Australia,
Can we start a petition to set up an Australian Centre for Disease Control and call it AC/DC?
It’s a Long Way to the Top but I think we don’t want to be Back in Black.
Replying to
So please be kind with your comments. I know that there are hundreds of people tonight working hard to contain this.
Don’t blame it on Dan or Brett either. I don’t think it’s fair on them.
Don’t blame anyone. Just help out if you can.
Get Vaccinated. Stop the chain.
7/end
Roadblocks to hospital due to riots.
Being abused and spat on while administering vaccinations.
Caring for a COVID positive patient who attended the riots.
Thank you to health care workers who turn up to work every single day. Respect.
COVID is not a flu and it’s certainly not mild.
COVID is a multi systems vascular disease that is spread in an airborne method through the respiratory transmission pathway.
This understanding may change with time.
My dear wife is an infectious diseases physician who’s been managing COVID. She’s on call for 2 hospitals. I am on call for 2 hospitals. Between our oncall schedules and weekend commitments to our spiritual community, this is the first weekend in 5 months we’ve had as a family.
Politicians who will never see a covid positive patient gets vaccinated before the junior doctor seeing suspected covid patients is how we prioritise things around here.
No one is going to say this out loud but I know Infectious Diseases Specialists and Emergency Medicine Specialists around Melbourne managing COVID cases today who are saying we are in a crisis situation.
There are no beds in several hospitals already.
Being kind to others is not virtue signalling.
Being inclusive is not being woke.
It’s simply being a respectful human.
Article from 20 years ago.
Prof Brett Sutton working in Afghanistan.
Quite a read.
mja.com.au/system/files/i
Unpopular personal opinion:
Year 12 students returning to face to face learning is not a higher priority than many other segments of society.
Redirecting vaccines (by cancelling bookings) so year 12 kids can return to school is an absurd strategy.
As an employee of one of the major hospitals in Melbourne, I need to declare any gifts above $50 I receive from any source. There is a form to fill to ensure that any gifts are recorded.
If I received a million dollar gift from anyone, my employer must know.
Dear Prof Sutton ,
How are you?
I’m thinking about you and the burden you carry for the health of Victorians.
Thank you for your kindness and expertise. You have been a picture of stability and integrity throughout this pandemic. Thank you.
This past month have been tense in our household.
Dear wife is an Infectious Diseases Specialist and myself an ENT surgeon. We have both been on call a lot recently. Our phones ring through the night. We take turns waking up. Weekends are spent in the hospital.
If you thought your voice was just one drop in the ocean, remember a young girl by the name of Greta who may have literally saved many lives of trafficked persons by speaking truth to darkness.
Rule number 1 in all of Medicine and Surgery:
See your patients.
I mean, really SEE them. See their pain, their fears, their concerns, their past, their social context, their struggles. See how their situations have created their illness.
See their humanity.
Me: Every surgery has to be done beautifully, gracefully, artistically.
Ortho: Hold my beer...
GIF
Dear Hospital,
Don't worry about reputation. Look after your staff. Your staff will look after patients. Patients will look after your reputation.
How do you do a Rapid Antigen Test on a child?
Here you go! (Quick vid due to time)
Wash hands, blow nose.
Kid’s head on arm/pillow.
Swab hand resting on chin or cheek in case sudden moves.
GO LOW, GO SLOW.
Gentle twirl 1-2cm for 10-15 seconds.
Do other side.
Take care!
Barbecued barramundi while the nation queues up for testing or is desperately looking for RAT is not the picture of everyday Australian. Like many others, I have not left my state or seen my family since 2019.
In our friendly local hospital today:
3 out of 4 doctors in training under me are down.
Cases are cancelled because not enough nurses to staff theatres and ward beds.
ICU is full capacity. Elective cases needing ICU bed cancelled.
Those who turn up are doing multiple jobs.
Things we know now that we didn’t know in 2020.
COVID is airborne.
The delineation of droplet vs airborne is faulty.
The definition of aerosol generating procedure is faulty.
Long COVID is debilitating.
Countries aiming for eradication have better economic outcomes. 1/2
Vaccination is not a silver bullet. Vaccination alone will not get us out of this.
Thank you Dr Chant. #COVID19nsw
I think some people misunderstand what freedom means.
Freedom means living safely in a community without fear of death, attacks or suffering.
Living by my own rules, I think, is childishness, selfishness or narcissism.
I have never been this concerned about the state of health care service in Australia and the wellbeing of my healthcare colleagues.
We are in a dangerous situation. Look and listen to what’s really happening in primary care, emergency, operating theatres and the wards.
It’s not the pandemic that has split this nation.
It’s the response to it.
Unfortunately COVID shone a light on the division & inequality.
You cannot do medicine alone.
Medical school trained you to be individually excellent. In practice, you need to be excellent as a team for the sake of your patients.
Learn to bring out excellence in others.
“You’ve had 18 months to prepare.”
This is being said to many health care workers by people in the community, as if we should be ready for whatever onslaught the community is about to throw our way.
Also said as if we had been doing nothing for 18 months.
Let me clarify. 1/
I don’t say this lightly, but it is my humble personal opinion that the Prime Minister has failed his most basic duty to protect the country.
He failed to implement a safe quarantine system and he failed to secure protection for his citizens in the form of good vaccine supply.
The Australian Medical Association represents doctors. They are not a peanut gallery, even if you disagree with some of their policies.
1. Here are 3 important videos on Rapid Antigen Tests
GO LOW. GO SLOW.
Going up is painful (narrow roof, deviated septum common).
Going fast is interpreted by the nose as pain.
Going low and slow reduces pain and allows time for swab to absorb samples. Rotate gently.
Self-swab
Quote
As a health care worker, I take a different flu vaccine every year. I don’t really know fully what’s in it but I trust the scientists & vaccinologists who have prepared & studied the flu vaccine. I do it not for me but for the people I interact with, especially for my patients.
Can’t believe we still have to say this out loud 2 years later.
COVID is real.
COVID is airborne.
Masks are effective.
Vaccination works.
Hydroxychloroquine (last year’s trend) & ivermectin (this year’s trend) have not been proven effective. Studies are false and retracted.
I have so many paediatric patients who wear their masks better than some adults. 😉😁😷
A politician asks people to stop testing so they can get back to work quicker.
That’s not how it works.
It’s like if you came to hospital & we stopped checking your vital signs & labs so we can discharge you earlier.
Knowing your status today matters to people you meet today.
Doctors & nurses are increasingly being asked to do more than doctoring or nursing. They’re asked to do data entry, clerical duties, advocacy, systems management, etc. Many of these are dictated by non-doctors. We’re becoming less efficient, prone to errors, increasing cost.
You want to change culture of Medicine? Don’t worry abt expensive programs or protocols.
Start with being kind. Start with being patient. Start with being a human being. Start w being humane to each other in this high pressure workplace. Unlearn microaggression. Relearn respect
Supposed to be on leave.
Heading back to hospital because the surgeon oncall has COVID.
This is not unusual. This is the story of healthcare workers around the world. We’ll all keep juggling to meet the demands.
Have you had to sacrifice something to fill gaps?
There are differences between
Stress
Exhaustion
Burnout
Moral distress
Compassion fatigue
&
Mental illness
1/
Underpaid. Overworked. Under-appreciated. Unprotected. No wonder many of them are leaving the profession.
The nose goes back, not up. Aim for the back, not for the brain. Take care, friends.
Replying to
And for those who have had family members died of covid, please assure them that their loved ones did not pass away this way. This can be triggering for them. Clinicians have a duty to relieve suffering and we would not allow this person to reach this point of breathlessness.
Humanity is full of underlying conditions.
We have chronic illnesses and prior conditions.
There are MORE people with chronic illnesses than those with perfect health.
67% of Australians are overweight or obese.
DO NOT ATTRIBUTE COVID DEATHS TO UNDERLYING CONDITIONS.
It’s exhausting.
While some are screaming “give us our freedom back!”
Those of us in health care are battening down the hatches, donning N95 and airborne PPE, preparing for the upcoming tsunami.
We’ve worked hard, and we’re going to work even harder in coming months.
It’s 2022 and let’s recap some major learning points as a planet.
COVID is definitely airborne.
COVID is not the flu.
COVID is a multi-systems disorder that happened to be transmitted through the respiratory mucosa.
Long COVID is a known long term complication of COVID.
1/
I can’t say to a patient with cancer “you’ll be fine.”
They might not be fine.
My duty is to tell the truth. I often say, “It will be rough. Hope for the best. Plan for the worst. I will journey with you.”
Same in a pandemic. You just cannot say “she’ll be right mate.” 1/