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Pandemic

To Fix Healthcare After Covid-19, Doctors Must Have The Courage To Change

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Doctors showed great courage during the Covid-19 pandemic. Now you have to show the courage to change … [+] the job.

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Long before doctors battled the coronavirus, their professional ancestors risked their lives fighting the Black Death.

Throughout history, doctors have shown courage: the ability to act regardless of risk or fear.

Think sawing off a gangrenous limb or having brain surgery or treating a disease like Ebola which kills up to 90% of the people it infects. In these harrowing situations, courage alone is not enough. Doctors too, to a certain extent, have to deny objective reality. You need to suppress the existence of fear, detach yourself from its emotions, not admit weaknesses, deny any pain, show single-minded attention to the task at hand, and extinguish any feelings that are trying to escape in the process.

Until recently, no one questioned whether such extreme denial was mentally healthy. The doctors just thought it was necessary.

Courage and denial remain cultural imperatives in today’s profession. These properties are taught to every medical student and hardwired in every doctor.

And they have some unfortunate and tragic side effects.

I remember a talented doctor who returned to work the day after she received a final diagnosis herself. None of her colleagues, friends or patients knew about her illness until she died. In medical culture, this type of emotional distance is the rule, not the exception.

As a nation, we are indebted for the courage and refusal of our doctors. Without their courage and sacrifices over the past year and a half, Covid-19 would have killed many more of our friends and loved ones.

But now that our country has weathered the worst of the pandemic, it is time to address the American health care failures that harmed doctors and patients long before the coronavirus hit land. To do this, doctors need to play a leadership role both in transforming the health system and in challenging their own cultural assumptions.

These changes require more courage and less denial.

1. The courage to ask for help

In a recent article, I wrote about three critical care physicians who had recently gone through hell.

A doctor, a resident, had started his rotation in the intensive care unit with half a dozen Covid-19 patients under his care. All were dead by the end of the month. Another doctor, a die-hard ICU veteran, said she woke up in sweat every day before dawn. The third, a senior officer, watched four of his patients die in a single day.

Psychological defense mechanisms such as denial help doctors suppress fear and bypass grief over the loss of a patient. But as with any coping mechanism, denial is best used in moderation, not permanently. No level of denial, repression, harshness, or hardship could have prepared health care workers for the flood of death that Covid-19 wreaked. No amount of cultural conditioning could adequately prepare clinicians for the pain they have endured. As a result, many feel exhausted at work.

As the saying goes: “You can’t pour from an empty cup”. Too many cups are empty.

According to Medscape’s latest physician survey, 42% of all physicians are burned out. But only 7% of them say they see a therapist to improve their mental health.

It takes courage to challenge the medical profession’s culture of harshness and emotional repression. Doctors need a lot of strength to recognize their limits. And it takes courage to seek help when it is needed.

2. The courage to recognize one’s prejudices

It has become the standard in American culture to point your finger at others and blame others. Doctors are no different. On social media and at medical conferences, doctors are seldom willing to take responsibility for any of the many health care issues.

Take health differences, for example. Ask doctors why black patients have shorter lifespans and poorer health outcomes than whites, and they will blame socio-economic factors such as income, education, and the ills of American health insurance. They point to social determinants (where people were born and raised, work, play and socialize) and social dynamics (such as racial segregation, poverty and educational barriers). Of course, these external factors contribute to health inequalities, but they are not the only factors that play a role.

Research shows that two-thirds of doctors have an implicit black bias. This type of bias is different from open hatred or even conscious bias. But it is no less harmful.

At the start of the pandemic, when test kits were scarce, doctors tested white patients twice as often as black patients with identical symptoms. This makes no logical sense, as black patients were two to three times more likely to die than white patients.

Bias also helps explain why black patients receive 40% less pain medication than white patients after surgery. And it helps us understand why the average black patient receives $ 1,800 less in total medical care per year than a white person with the same health problems.

For decades, doctors have insisted that health inequalities are the fault of American society, existing policy, or other actors in the health system. While we must address these barriers to better health for all, doctors must also show the courage to hold up the mirror to the profession. After all, it is they who decide which patients will be tested and how much pain medication will be given.

Until doctors have the courage to face their prejudices, they will continue to violate the sacred oath of medicine to “do no harm first.”

3. The courage to treat patients like health partners

In the 21st century, the internet has flattened the gap between the experts and everyone else. In healthcare today, patients can explore diseases and treatments in unprecedented depth.

Many doctors believe that weeding out health information from the Internet is a recipe for “bad medicine.” May be. But doctors can’t expect patients to just stop looking for evidence on the internet. It’s not that people are suddenly asking for less information, less transparency, or less convenience from healthcare or other services.

American consumer culture is not going to go away. As a result, more and more Americans are demanding a new kind of doctor-patient relationship – one that looks far less paternalistic and more like a partnership. And this partnership must take into account the needs and wishes of the patient.

Telemedicine is a good place to start. Before the pandemic, only 8% of Americans had had a “virtual visit” to a doctor. Because most doctors had insisted that a good doctor’s practice can only take place in person. Covid-19 has proven that this perception is wrong. A recent survey found that 20% of consumers (55 million Americans) would trade their doctor for a doctor who offers telemedicine.

Historically, doctors have not valued or prioritized the patient’s time, convenience, or preferences. In the future, they won’t have a choice. A more equal doctor-patient partnership requires the courage to embrace alternative approaches to treatment and accept that patients have become (and will remain) savvy healthcare consumers.

4. The courage to uphold the true mission and purpose of medicine

For most of medical history, illnesses plagued doctors. Epidemics killed millions, including doctors who comforted the sick and dying. Entire civilizations died a gruesome death with doctors at their sick beds. And yet doctors never lost their nerve or the desire to help.

Many doctors today feel like victims of a broken system. They blame for-profit insurers, greedy pharmaceutical company executives, and hospital administrators for their professional dissatisfaction. And while they are right to call for sweeping health reforms that will free them from the administrative distractions that keep them from doing their jobs, they must also show the courage to change what they can control.

Doctors are the ones who write the prescriptions that contribute to 60,000 opioid deaths each year. They sign the surprising medical bills that have bankrupted millions of patients and their families. They contribute to the preventable medical errors that kill 200,000 people each year. They perform the 30% of all procedures that researchers at the Mayo Clinic have shown have no clinical value.

American doctors are at a crossroads. You are part of a wonderful and beautiful profession that is currently in crisis. Doctors must continue to uphold the righteous mission and purpose of medical culture. At the same time, they must have the courage to develop the most problematic parts of the culture. Not only does this benefit patients, but it also restores the appreciation the profession deserves.

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Pandemic

Here’s how to keep your kids safe from the Covid-19 Delta variant

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CNN

The more contagious Delta variant is spreading rapidly in the US, but children under the age of 12 can’t get the best protection there is – a vaccine.

That said, pediatricians say there are still simple things parents can do to help children protect themselves from Covid-19, especially when they return to school.

Serious cases are not common in children, but Covid-19 numbers have been higher than ever in the pandemic since November, said Dr. Yvonne Maldonado, director of infectious diseases in the Department of Pediatrics at Stanford Medicine and chair of the committee with the American Academy of Pediatrics.

Her association has been tracking cases and found that nearly 72,000 children and adolescents were infected with Covid-19 last week. That is a significant increase compared to the previous week, about five times as many sick children as at the end of June.

“It is clear that this variant can cause serious injuries in children. You’ve heard these stories from pediatric intensive care units in Louisiana where children are sick as young as a few months, “said Dr. Francis Collins, the director of the National Institutes of Health, John Berman of CNN on New Day Tuesday.

“Anyone who says that as a young healthy person you don’t have to worry, you have to think about it.”

The most important thing that parents need to think about, say pediatricians, is the vaccine.

If a parent or adult hasn’t been vaccinated in a child’s life, get one now, they guess. The same applies to siblings who are old enough.

Parents should also talk to children about why it is important.

“Make sure you have this conversation with them – about why it is important to be vaccinated and how it protects not just them but everyone around them,” said Dr. Dane Snyder, director of primary pediatrics at Nationwide Children’s Hospital in Columbus, Ohio.

Parents may also want to talk to anyone who interacts with the child about their vaccination status, Maldonado said. If the person isn’t vaccinated and the parents still feel good about having them around their unvaccinated child, at least ask them to wear a mask or even consider asking them to take a test before they do meet.

“You wouldn’t want your child in a car that someone drives without a seat belt or a driver’s license,” Maldonado said. “We shouldn’t be afraid to stand up for the health of our children.”

Snyder said parents should continue to reinforce the message about good hygiene.

For example, she said, parents should teach their children to cough into their elbows and wash their hands.

“Hand washing is really one of the most effective ways to prevent the spread of any type of disease, be it in your home or community,” said Snyder.

Three feet of physical distance can reduce the spread of the virus, good ventilation helps, and masks for indoor activities are key, public health experts say.

The American Academy of Pediatrics recommends that anyone over the age of 2, regardless of vaccination status, wear a mask when attending school.

“The data is very convincing that masking continues to be a very effective means of preventing infection,” said Dr. Larry Kociolek, attending infectious diseases physician at Ann & Robert H. Lurie Children’s Hospital in Chicago.

By some estimates, having a mask reduces the risk of contracting Covid-19 by about 50%, he said. “Masks are most effective in areas where there is a high risk of exposure and transmission,” said Kociolek.

Dr. Sarah Combs, an emergency doctor at Children’s National Hospital in Washington, DC, said parents can make wearing a mask fun.

“Go ahead and get them a mask of their favorite character and tell them it’s like Superman’s mask. Do whatever you can to get them involved, especially the younger who are less understanding, ”said Combs.

Snyder recommends that parents talk to their children about wearing a mask to school so they know what to expect, especially when a mask is not required. “Make sure you talk to children about accepting things about children who are either masked or not,” Snyder said.

As for parents and masks, Dr. Amy Edwards, assistant medical director of pediatric infection control at UH Rainbow Babies and Children’s Hospital in Cleveland, suggested that even vaccinated parents should wear a mask in public. “That way, they’ll be less likely to get Covid and bring it home,” Edwards said.

The risk of contracting Covid-19 is much lower if the child is playing outdoors.

Edwards said she restricted her own children to playing outdoors only with their friends. “It’s okay to play with the neighborhood kids, but only outside in the yard, not inside in the playroom or bedroom or the like where there is closer internal contact – which is a bigger problem,” she said.

For older children who enjoy video games, Edwards said a parent could set up time for streaming together even if they are in different rooms.

“Try to come up with creative ways kids can play together, but limit their exposure,” Edwards said.

Playing outdoors has an added benefit. “It’s not just safer from a Covid-19 standpoint – physical activity is a real health benefit,” Kociolek said, particularly given the rise in child obesity rates in the Chicago area since the pandemic began.

Talking to children about Covid-19 is essential, according to paediatricians. Children are like sponges, said Combs.

“Even at this very young age, they are aware of their surroundings, they are picking up your emotional cues. And when we try to keep things from the kids, they get more suspicious and fearful, ”said Combs.

This way even a toddler can understand the basics.

Edwards says she even talked to her kids ages 2 and 4 about the Delta variant. “I told them the virus kind of grew up and got a little bit stronger, so we have to fight a little bit harder,” said Edwards.

With teenagers, parents don’t want to make them more anxious, so be factual, Combs said. It can be helpful to acknowledge that it can be scary even for parents. “That’s fine because we know things and ways to reduce the risk and help each of us in the family,” said Combs.

Combs added that it is also good to encourage the children to be open, especially when they are unwell, so that the parents can keep them at home and remind the child that being home is not a punishment stay – it serves the security of the people.

Edwards said clear communication and reassurance are important in children.

“How many times have we told our parents it wasn’t fair and our parents told us life wasn’t fair?” Said Edwards. “For children, this pandemic is the ultimate ‘life is not fair’. We have to let them know that we are doing everything we can to help them. ”

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Australia records one of its youngest COVID-19 deaths as Sydney outbreak grows

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SYDNEY, Aug. 4 (Reuters) – Australia’s New South Wales on Wednesday reported one of the country’s recent deaths from COVID-19 as daily infections remained near a 16-month high despite 5 million people in the state capital, Sydney in the 6th week.

The nameless man in his twenties, who had no underlying health problems and was unvaccinated, died at his home in the city, authorities said. It was deteriorating rapidly after previously complaining of only mild symptoms, they added.

The death underscores the risk to Australia’s largest city, which is struggling to contain a highly contagious Delta variant outbreak when fewer than 20% of Sydney’s residents are vaccinated.

Last year, neighboring Victoria state said an unnamed man in his twenties died of COVID-19, although a coroner is still investigating the exact cause of death.

The young man was one of two COVID-19 deaths reported in New South Wales (NSW) in the past 24 hours. NSW also recorded 233 new cases, near a 16-month high reported last week, and Prime Minister Gladys Berejiklian said case numbers were likely to rise.

“I am not going to rule out that the number of cases will not worsen, I even believe that they will worsen,” Berejiklian told reporters in Sydney.

“If you look at the number of infected people in the community, it suggests that we may not have peaked yet.”

Berejiklian is under intense pressure to ease the restrictions on movement that are threatening Australia into its second recession in as many years. However, she said at least 50% of the state’s population would need to be vaccinated in order for the curbs to be loosened in late August. Continue reading

Still, many are wary of taking the AstraZeneca (AZN.L) vaccine, the most powerful of two vaccines approved in the country, due to a rare blood clotting problem.

In addition, government models released Tuesday showed that at least 70% of the state’s population would need to be vaccinated to slow the spread.

Authorities have warned people not to wait for an increase in Pfizer shipments (PFE.N) expected in the next month, as case numbers are proving difficult to cut and wastewater tests suggest that the coronavirus may be heading north has spread.

COUNTER-MEASURES

New South Wales has taken aggressive countermeasures to halt the spread of the coronavirus, including cordoning off high-risk suburbs and urging the military to help police enforce lockdown rules. Continue reading

A total of 17 people have died in Sydney during the current outbreak, which began on June 16. During that time, the surge has brought the total number of cases in NSW to more than 4,000.

Nationally, Australia has recorded 927 deaths since the pandemic began, with just over 35,000 cases affecting 22 million people.

Queensland reported 16 locally acquired cases on Wednesday, just like the day before, prompting authorities to declare it the state’s worst outbreak since the pandemic began and warn that a lockdown in the capital, Brisbane, could be extended beyond Sunday .

“If we don’t do anything really, really, really special in Queensland, we’ll be extending the lockdown,” Queensland chief health officer Jeannette Young told reporters in Brisbane.

Coverage of Byron Kaye and Renju Jose in Sydney and Colin Packham in Canberra; Editing by Gerry Doyle and Christian Schmollinger

Our Standards: The Thomson Reuters Trust Principles.

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US Covid-19 hospitalizations top 50,000 for first time since February

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According to new data from the US Department of Health, more than 50,000 Covid-19 patients were hospitalized on Monday for the first time since February 27.

The 50,625 Covid-related hospital admissions on the HHS dashboard are more than three times the number of people hospitalized for Covid-19 a month ago when 16,000 patients were hospitalized.

Florida leads the nation in Covid-19 hospital admissions, with 10,682 listed on the HHS dashboard. Texas reported 6,628 Covid-19 hospital admissions this week. California reported 4,682. And Louisiana reported 1,839 Covid-19 hospital admissions, nearing its record for that pandemic.

“You have people with chest pain sitting in an emergency room while their families sit in the waiting room wringing their hands and calling everyone they know,” said O’Neal.

Just over two weeks ago, the hospital had 36 Covid-19 patients, O’Neal said. On Monday it was 155.

“No diagnosis should take up a quarter of your hospital,” said O’Neal. “We no longer believe we are adequately caring for anyone because these are the darkest days of the pandemic.”

The best way to slow the spread of Covid-19 is to get a vaccination, but it doesn’t go fast enough, O’Neal said. Even if people are vaccinated today, it will take weeks for the vaccines to fully work.

So people should wear masks, said O’Neal.

In many hospitals, patients are younger and sicker than they used to be, doctors say.

The seven-day average of daily new coronavirus cases is up more than 40% from the previous week, said Dr. Rochelle Walensky, director of the US Centers for Disease Control and Prevention on Monday.

“While we absolutely want to deal with this pandemic, Covid-19 is clearly not done with us yet. Therefore, our fight has to take a little longer,” said Walensky.

With vaccination rates rising but still below where they need to be to slow or stop the spread of the virus, many local leaders are turning to masks again to protect their populations.

The CDC updated its guidelines last week advising even fully vaccinated individuals to mask themselves in areas with significant or high transmission. CDC adds 16 travel destinations to its

These guidelines cover more than 90% of the US population – about 300 million people, according to a CNN data analysis released by the CDC on Monday.

Louisiana Governor John Bel Edwards has temporarily reinstated the state mask mandate for anyone aged 5 and over, both vaccinated and unvaccinated, while indoors and in public. The mandate comes into force on Wednesday.

“Nobody should suffer the misconception that this is just another climb. We’ve already had three of them, this is the worst we’ve had so far,” said Edwards.

The state health officer, Dr. Joseph Kanter said he anticipates that at any point in the pandemic, Louisiana will hit the highest number of hospitalized Covid-19 patients on Tuesday.

“If we intend to prioritize the things that are important to us, such as keeping our children back in school and in person, and keeping our growing economy open by keeping business open, masking is the best way to ensure that Masking order seriously, both in your personal life and in your professional life, “said Kanter.

Breakthrough infections aren’t as alarming as they seem, says Fauci

Reports of infections in vaccinated individuals known as breakthrough infections have caused some public concern. However, experts say they are not as alarming as they seem. About 99.999% of fully vaccinated Americans have not had a fatal breakthrough Covid-19 case, CDC data shows

“The vaccines do exactly what we ask them to do when it comes to keeping you out of the hospital, keeping you away from serious illness, and certainly preventing your death,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

Vaccines result in an eight-fold reduction in the number of people developing the disease and a 25-fold reduction in both hospital admissions and Covid-19-related deaths, Fauci said.

“An important point to make is that the absolute number of breakthrough infections might appear high in a larger percentage of people vaccinated, even with a high level of protection. That’s not the critical number. The critical number is the proportion “of those vaccinated, people who … get breakthrough infections, and that’s the critical one,” added Fauci.

This Texas city has a relatively high vaccination rate, but it is still struggling to get firearms in the face of rising casesWalensky gave some details on what that percentage looks like: Of the tens of thousands of people likely to have been exposed in an outbreak in Provincetown, Massachusetts, she found 346 confirmed breakthrough infections.

“During the summer, some Barnstable County towns can have up to 240,000 visitors a month,” Walensky noted.

Some of these people will even get infected if they are vaccinated, Fauci said.

“You can expect breakthrough infections,” he said. “Most of these infections will be asymptomatic or mild.”

“The bottom line of what we’re saying is … Get vaccinated. I say that every time,” said Fauci.

The CDC reported on Sunday that 816,203 additional doses were administered, and for the fifth straight day the agency recorded more than 700,000 firearms. The current 7-day average of administered doses is 662,529 per day, the highest average since July 7th.

CNN’s Matthew Hilk, Rebekah Riess, Deidre McPhillips, Maggie Fox, Ralph Ellis and Theresa Waldrop contributed to this report.

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