I'm not going to pretend that I understand the complexities of molecular bioengineering. But here's a great summary that delivers great information on the vaccine.
Accessed: December 27, 2020 in https://www.bbc.com/news/health-55040635.
Thank you BBC news.
Day 11 of #100DaysToOffload. Find out more about it here.
Imagine you are a healthcare worker. Imagine further that we are in a pandemic.
What mindset should he or she have?
Wouldn't it or shouldn't it be the interest of all, the interest of the most?
I'd like to discuss on two commonly used principles in medical ethics. The principle of Beneficence and Non-Maleficence. All healthcare providers must strive to improve their patient’s health and avoid in every situation causing harm to their patients. In basic terms, it means to do good and do no harm. Simple to say but never easy to execute in health care because there can be gray areas.
Today, I learned that a medical practitioner who reported for duty, for work, not feeling too good and under the weather, was tested positive for SARS-COV2. Certainly, I can commiserate with his/her predicament. No one wants to be tested positive. There is not one health worker who wants to be positive.
And then, there's the rub.
A medical practitioner, deemed a front-liner, deemed the most knowledgeable and expert in the science of the transmission and infectiousness of SARS-COV2 decided to go to work. In doing so, inevitably exposing other members of the healthcare team and will be compounded when each member goes home to their family and love ones.
The end.
Some key lessons learned:
1. Protect yourself always. When you let your guard down, that's the time when you will be reminded of Murphy's law. 2. Trust no one. Even your family, loved ones and friends. It is your inner circle that has the highest probability of infecting you more than a random stranger in a grocery store. 3. Worrying over being infected is stressful.
Day 10 of #100DaysToOffload. Find out more about it here.
Day 2 of the 50th Philippine College of Physicians Virtual Annual Convention.
Today, I learned about the Declaration of Geneva. No, the declaration and the Geneva Conventions are not the same. The former document is not about the humane treatment of prisoners of war and the humanitarian conduct during armed conflicts. This is another document and it is a modern form of the Hippocratic Oath. The Declaration of Geneva is one of the World Medical Association’s (WMA) oldest policies adopted by the 2nd General Assembly in Geneva in 1947. Currently, it is on its 7th version and was amended last 2017.
There was a line that was purposely pointed out during the PCP Annual Convention. It states:
“I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard;”
People tend to forget that health practitioners and medical professionals are people that can get tired and stressed out. But what I realized more is that, it is also incumbent upon the health care worker to attend to his personal needs. This exact line was also missing from the previous iterations of the document. It most probably reflects on the attitude of the health professionals as well.
Don't quit. Rest if we must. For if we are in our best state, we are able to help treat and/or cure the patient.
Do you want to read the complete WMA Declaration of Geneva? You can find it here.
Day 9 of #100DaysToOffload. Find out more about it here.
A little over a year ago, while I was doing my usual rounds in the hospital, a surgical consultant approached me and asked why I was wearing a facemask while I was in the ward. He even remarked that I looked silly and that instead I looked like I was harboring a respiratory infection with my facemask on.
I smiled and answered, I wear these masks so that I protect myself and my patients from the possibility of respiratory infections. He laughed rather heartily. Like I was such a joke.
I remember this incident because I saw him a few days ago. He was with his facemask and heavy duty faceshield. I'm sure he does not recall me or that conversation with him. This time, I thought to myself, “Where is your machismo now? I thought we don't have to protect ourselves from possible infections.”
Day 8 of #100DaysToOffload. Find out more about it here.
How can a consultant (boss) bully a resident in training?
There are probably a number of ways to bully a resident in training. But I think the brilliant once disguised themselves in “learning atmospheres”. Ahh, yes, the ones were you (the resident) is asked to present a case with less than 24 hours to prepare. It makes you feel that the objective really is to deprive you of valuable resource – sleeping time. Time that is scarce in the profession of medicine. She was probably having her bad hair days.
If the objective is truly a learning experience, then ample preparation should be given to the learner.
But what can a resident do, but to shut up and do or comply with what she asked. This way the problem goes away and hopefully her mood improves. Every resident must cope up and survive. Hoping for better days then...
P.S.
I was able to comply with her “request”. But I just need to vent for sanity's sake.
Day 7 of #100DaysToOffload. Find out more about it here.
Yesterday, one of my consultants asked a question about sensitivity and specificity, “Mathematically, how can you illustrate or formulate and explain sensitivity and specificity?”.
This is also in principle connected with a previous post about diagnostic tests on covid. But in this write-up, we will delve more into how a clinician puts weight or value on diagnostic tests.
Day 6 of #100DaysToOffload. Find out more about it here.
Currently, no SARS-COV2 test gives a 100% accurate result. Ideally, these tests need to be evaluated to determine their sensitivity and specificity, by comparison with a “gold standard.” The absence of a gold standard for the disease makes the evaluation of test accuracy challenging.
Diagnostic tests (typically involving a nasopharyngeal swab) can be inaccurate in two ways. A false positive result erroneously labels a person infected, with consequences including unnecessary quarantine and contact tracing. False negative results are more consequential, because infected persons — who might be asymptomatic — may not be isolated and can infect others. [1]
Previously, test availability has been a concern here in the Philippines especially on RT-PCR, but test accuracy may prove a larger long-term problem. Another concern is the high number of rapid IgM IgG test available in the market yet it's sensitivity and specificity of COVID-19 remains problematic.
Interpreting the result of a test for COVID-19 depends on two things: the accuracy of the test, and the pre-test probability or estimated risk of disease before testing. [2]
To understand accuracy of the exam, concepts on sensitivity and specificity must be first understood. Sensitivity is the proportion of patients with disease who have a positive test, or the true positive rate. Specificity is the proportion of patients without disease who have a negative test, or true negative rate. These terms describe the operating characteristics of a test and can be used to gauge the credibility of a test result.[2]
Two studies from Wuhan, China, arouse concern about false negative RT-PCR tests in patients with apparent Covid-19 illness. The studies suggest that 70% is probably a reasonable estimate for sensitivity of the nasal swab of RT-PCR. At this sensitivity level, with a pretest probability of 50%, the post-test probability with a negative test would be 23% — far too high to safely assume someone is uninfected. [2]
In summary, a positive RT-PCR test for covid-19 test has more weight than a negative test because of the test’s high specificity but moderate sensitivity. A single negative covid-19 test should not be used as a rule-out in patients with strongly suggestive symptoms. What this highlights is that we are still on our infancy stage in detecting SARS-COV2 and diagnosing COVID-19.
In a perfect world, designing a reference standard for measuring the sensitivity of SARS-CoV-2 tests in asymptomatic people is optimal. Simply following people for the subsequent development of symptoms may be inadequate, tiresome and dangerous as they may remain asymptomatic yet be infectious.
References:
Day 5 of #100DaysToOffload. Find out more about it here.
A came across an article in the New York Times and it was about updates on the development of a SAR-COV2 vaccine. I was thus inspired to share a thing or two about vaccine development.
For starters, vaccine development typically require years of research and testing before reaching the clinic or health centers. And even after that, market surveillance is also done to check for presence of adverse events or any unexpected effects of vaccines. And if need be, regulatory controls will withdraw the vaccine from the market.
The US CDC has general stages for the development cycle of a vaccine and these are:
According to the article mentioned, there are at least 135 vaccines in development in various stages. The vaccines in development are diverse and use different methods to invoke the immune response in our body.
Please do visit the article to learn more on the various potential vaccines in development.
One last note, although the US Government has endorsed and selected 5 vaccine trials to receive federal support. And it's aptly named, “Operation Warpspeed”. I'm sensing a Star Trek vibe. We can be hopeful in 2021 there's going to be an available vaccine out in the market. But maybe, I won't bet on it yet.
Reference:
Day 4 of #100daystooffload
Last night, I had a nightmare. I was doing my routine in the hospital and my daily activities in the hospital, when for now apparent reason I was given a copy of my chest xray result. The image was typical of a COVID-19 patient. At this point, my mind raced (I didn't know that it was a dream, it felt real).
“Was I ready to die?”, I thought to myself. Then I woke up.
I remember before I slept I had a discussion about COVID-19 with the family about the risk of getting it is high for healthcare workers, among other things.
I realized that going to the hospital every single day has a tax on your physical and mental health. And then we have an add-on. We hear numerous negative comments from people ranging from the uselessness of medical workers to government quack conspiracies. Personally, I think the medical workers mind can't process those information at this point in time when faced with a clear and present danger in front of them.
A simple thank you, a simple prayer will definitely go a long way. If you can't utter it, then do us a favor and just shut your mouth.
Day 3 of #100daystooffload
Today is a milestone as we breached the 10,000 cases of COVID-19. Certainly not a cause for celebration but rather a time for reflection on how far we are or how far we have gone forward. It's been 97 days since the first covid-19 case was detected in the Philippines. Let's see what the charts convey and probably think or opine on where we are right now.
Let's try to dissect this chart.
It seems that we have an average of 300 diagnosed cases per day and as the news of new testing centers opening up in the coming weeks. I think we can see more diagnosed cases. I am not privy or I am unable to locate the number of tests done on a daily basis in the laboratories. This information can elucidate new insights on our fight against covid-19.
Recoveries since last month have steadily increased and more recoveries are good news indeed.
The target is always zero deaths. And we hope and pray for that eventuality in the coming days or weeks.
Some few things that leave me pondering, are the recoveries and deaths of healthcare workers (doctors, nurses, midwives, medtechs, IWs and just anybody working in a hospital) tracked on a daily or weekly basis? I've seen reports that tell us we are experiencing deaths of HCW in high proportions. And this information just adds more stress in my daily rounds
Day 2 of #100DaysToOffload