Sawbones: A Marital Tour of Misguided Medicine - The Omicron Variant

Episode Date: January 11, 2022

After a week of working on the hospital floor, Dr. Sydnee discusses her personal experience with the current state of the health care system and what the experts say the omicron variant might mean for the future of the COVID-19 pandemic.Music: "Medicines" by The Taxpayers https://taxpayers.bandcamp.com/

Saw bones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, talk is about books. One, two, one, two, three, four. We came across a pharmacy with a toy and that's busted out. We were shot through the broken glass and had ourselves a look around.

Some medicines, some medicines that escalate my cop for the mouth. Hello everybody and welcome to Salbones, a marital tour of misguided medicine and I am your co-host, Justin McRoy. And I'm Sydney McRoy here in Justin's basement ice cave where he keeps things very cold. Honey, that- I have to wear a blanket. The heater is on. Like I turned the heat. It's cold. It things very cold. Honey, that. I have to wear a blanket. The heater is on.

Like I turned the heat. It's so cold. It's not cold. Just never cold. Basement ice cave where the recording studio lies. You need to just get a few layers of scrumptious padding like me and keep you warm all winter long. Well said, I hate to say it,

you sound a little bit tired to me. What's going on? I just, and I am not a little bit tired. Oh, okay, my mistakes. I am incredibly tired. I'm extremely tired. I just have finished a week of inpatient hospital service. I think I've explained with that,

because I take for granted that that means something. It's basically the week Sydney is in charge of her department and the people in the hospital that are checked into her department of the hospital. That's sort of yes. Department sounds more physical than it is. I was going to say it's not a location. We have patient because we're a family medicine service. We have patients all over the hospital of all ages with all sorts of things going on.

I'm in charge of a team of residents and students and we take care of all these people. We have a very, if you're familiar at all with the family medicine training process, if you're in the medical world, family medicine doesn't always have a very rigorous hospital service. Our program is unique in that way. We run a very very busy intense hospital service because a lot of our graduates go on to do hospital medicine. So it's an intense week. This is why I'm saying this. I'm not trying to break it. I'm just saying it's an intense it's a very busy nonstop week. A lot of times if we miss a solbona,

it is because Sydney has been a hospital service and it is literally up at 6 a.m. and going until, I mean, you get on the phone with the hospital after the girls are asleep. So you can imagine it's very much like. Yeah, I'm not physically there for seven days, 24 hours a day, but I am physically there for much of it and then mentally and emotionally there,

all of the other hours. It's hard, I can't even really sleep well, even when I'm not getting calls throughout the night. Like, I can't. That little tenth of your brain that like is keeping you. That's mulling over. Should we have up those fluids up a little bit more? I wonder how someone says doing right now. Maybe I should call and check in again and you know those kinds of things. Anyway, but the reason that I bring all

this up is to frame before the end of the year, we were doing some fun things, some light things, but a lot of people have been emailing in and asking for us to talk a little bit about COVID, specifically Omekron, and the most recent surge wave, whatever word you want to use, spike. Yeah. Yeah, tri- meme. Meme? Is it COVID trending again?

Just that's the way you want to look at it? hashtag I'm a cron this time. It's gone viral. No, no, no, no. Yeah, you're actually not allowed to say that anymore. We decided that on a previous episode. You know, I was saying things gone viral anymore. And I also wanted to talk about it because I think that and we even mentioned this sort of peripherally that there has been an idea that perhaps this variant

will cause for an individual who gets it a less severe disease process than the previous variant variants. And I'm choosing my words very carefully because that sentence is very different from saying, this surge will be milder. That has a lot more implicate. And I've heard a lot of people say that, well, this will be more mild. And I think that it's really important from a public health standpoint to tease out the difference between the individual experience of one person who contracts this Omicron variant of coronavirus and the overall societal experience of this surge. Do you know what I'm

saying? Sure, yeah. Because that is not mild and I can tell you that from very recent first-hand experience that from a public health standpoint, what is happening right now is not mild. Well, let's talk about how you want to get into it. Said, how do you want to start? First of all, this is anecdotal. This is not evidence. This is not, I did not do a study while I've been involved in, I can tell you that the people who have been admitted

with symptoms of COVID who have become ill enough to require hospitalization, to require intensive care, intubation, anything severe, have 100% of the ones that I have taken care of have been unvaccinated. That has been to repeat. That is anecdotal because it is just my personal experience from the last week, but 100% of the patients that were severely ill were unvaccinated.

The patients that I took care of who had COVID, who were vaccinated, all except for one came in for something else. They just happened to also have COVID. And the one that came in for COVID was again not severely ill. So, I think that I just say that to, because you hear a lot of information about, oh, but a lot of vaccinated people are getting this new variant. Yes, but getting the, well, first of all, they're not getting at the same rates as the unvaccinated. And secondly, they're not getting as severely ill. Your chances of being

hospitalized, going to the intensive care unit, being intubated and dying of COVID are much, much higher if you are unvaccinated. And while this was just my anecdotal experience, it's backed up by every piece of evidence we've collected so far. So just illustrative of that. Okay. Okay.

We should also mention, and I don't know, whatever we talk about your experiences, which are obviously not going to be patients specific. No, I won't go. No, I won't go. I won't go. Whatever we I won't go. Sure, like whatever we're talking about should not necessarily be or not be a judgment on your workplace.

Like this is not a... No, I mean, you can make a comment about the state we live in because you can look up our vaccination statistics if you feel so inclined. More like vaccination stink. It's the stink. It's a it's a shame because we live in a state that took a lead. What's your name?

Waxed waxenation. Took a lead early on in the pandemic. Yeah, remember that. When we were like the most vaccinated state for just a minute, but it was because we were just very efficient at vaccinating the small percentage of people who wanted it. Now, it's not small, but it's not enough. We just have, we have a high rate of people who have refused to take back. We literally went from being the number one most vaccinated in the nation

per capita to our governor throwing out guns and trucks while his dog begs me. People think it's actually making you do it. You want to get back for baby dog? Yeah, do it for baby dog. Do it for baby dog. He's still on that. He's still trying it. It's not working. I'm not catching on, although I would get a do it

for baby dog t-shirt. They're out there. Yeah, sure. There's plenty of stickers and yeah, you can get all those things if you want. So again, that is my experience. The vaccine continues to be protective against severe illness and death, no matter what the variant is, and it still does decrease your chances of getting it, even if it's less

so with the Omicron variant. The booster especially, I don't know if you've seen the recent estimates, it took us a minute to collect the data on Omicron, but there was this really concerning like, well, with two doses of one of the mRNA vaccines, I think Pfizer is the one they tested first, the estimate was that you're protected like only 35% from getting it. Again, this is not severe illness and disease

or in death, this is from getting it all, but with a booster that goes up to 75%, which is the underlines the importance of that booster, that you don't even get it. That helps you protect the people around you who maybe you have somebody in your life who can't get vaccinated or who did get vaccinated, but has some sort of immunosuppressive, some reason why they didn't respond to the vaccine the way you would hope they would. This is is the, this is what I would say about Omicron and you've probably read a lot of articles about this. Many, if not most, if not all, I don't know how big you want that number to go, of us are going to get this variant. That is sort of the thought process now. And we're seeing

that right, a lot of high profile like celebrities and political figures and all kinds of people that Would make a headline if they got COVID have gotten COVID, right? And these are people who have been vocally vaccinated and boosted and so we know that right So right now we it seems that it spreads two to three times faster than the Delta variant. The doubling time of cases is like two to four days.

So we talked a lot about early on in the pandemic, the idea of the R-NOT, like how many people you're likely to give it to when you're infected. The original COVID was like two and a half, and then Delta was like seven. And this could be as high as 10. So I mean, it's just, it's extremely contagious. And the contagiousness of it also makes contact tracing. Because like, what are you doing? Tell me about all the places you've been in the past.

And yeah. Well, it's not just that. It's, it's how fast. So before, you know how, that. It's, it's how fast. So before you know how, um, that was, I think a notable thing about COVID when it first started is we knew that after you were exposed, you may not show symptoms even up to 14 days. Now, as time has progressed, we've accepted that as probably sooner than that, even with the original

COVID for most people sooner, um, seven, 10 days, whatever. But now with Omicron, people are showing symptoms within two days of getting exposed, which means they are contagious, possibly within two days of getting it two to three, you know, somewhere between two and four is the popular painting, but up to two. And the point is, if you don't know, you've been exposed until you're already symptomatic and exposing other people, do you see what I'm saying? You don't have a, there's not enough lag time to get in there and do contact tracing and stop exposures.

People are going to get infected, have no idea they got infected, and by the time they're notified, oh, you were exposed to COVID, they'll have already infected other people. It's just because it's spreading so much faster. And I don't mean that to be like, scarier, hopeless. It just is. It is what it is. It is that variant. It is this variant. But what that just means is if a tool like contact tracing is starting to become a little less effective, that doesn't mean we shouldn't try to keep track of, oh, I have, you know, I have COVID who,

who have I been around. Of course, you always should so that you can warn people and, you know, people can get tested and isolate and all that. But it makes it more important that we use all the other tools we have, right? Right. Right. So if contact tracing isn't the main thing, one is getting vaccinated. Because as I said, it still helps to mitigate this variant. You know, it is not as protective as it was against delta or original flavor of.

I wish we'd go with a cool name for our background. Alpha and beta. What's the C1? I don't know. I did, I was in an opportunity of sorority. Well, I actually know that's not true. I was in the chemistry fraternity, but they didn't make you memorize the Greek alphabet and the chemistry fraternity.

You know, that seems weird of all the fraternities where they make you memorize the Greek alphabet. Don't you feel like the chemistry fraternity is the one where they should have? I think it's gamma, alpha beta gamma delta. Well, there have been other variants. They just maybe haven't risen to the level that, you know, we were that worried about. Here's the thing is 24 is omega. So if we get the, we get to omega things that go off the, off the B pin.

There was a lot of, by the way, I don't know if you read that. So when it first got named Omicron, did you hear all of the, everybody worried about like, why Omicron? What did we skip? Well, we skipped some letters, right? Yeah, it's 15.

15 is on. We're on. Well, I mean, part of it is again, there have some letters, right? Yeah, it's 15. 15 is on. We're on. Well, I mean, part of it is again, there have been variants that we haven't, like, we haven't talked about because they just didn't go anywhere. The next letter up for a micron was actually new, but they thought it would get confusing. You have, you have new COVID. Oh, yeah. Okay. Well, right, like, it's like, I want COVID classic. I mean, that's what they were worried about. New COVID just

takes like flat classic COVID. If we use new, everybody's going to say, like, why have new COVID? Do you mean the new variant? Or do you mean the new variant? You know, I mean, it was going to be a whole habit and cassela routine because there, because there will be other variants. And so then you're like, well, I have the new variant? I mean, it was gonna be a whole habit and cacella routine. Because there will be other variants. And so then you're like, well, I have the new variant. Like the new, new, like is a new, or, you know, anyway. I'm doing a routine with myself. This is going to be a new one.

I was confused because there was a video game called by Quantic Dream for, I think it was the Dreamcast back in 2000 called Omicron Menomad Soul. It started David Bowie and he did all the music for it. So I was very, I was very confused. I thought there was just some Bowie fans. So you thought this variant of coronavirus. It was the limited yet beloved Omakron Mino Madsoul for the second dreamcast.

There was another, there's another letter. They skipped, which is X, I, I don't know. Shh. G, G. And they skipped that one because it is a very common last name in China. And that seemed, you know, and I think it'd be a Ken to like in the US, it would be like naming it the Smith variant

or around here'd be the Atkins variant. Poor coronabere is like, well, that's nice. That must be nice to have people looking out for you like that. That's nice. They have a policy to try not to name, you know, diseases in a way that would be like, that would cause a discriminatory view of a place, a people location, whether it be, yeah. I mean, what we do, we do, right? And so like, there is this policy at now that we try to avoid that.

What's the one that has so many different, like, oh, that's the French disease, or the, I guess, that's more of a common thing, It's not one thing, but... Well, they did that with syphilis for a while. Syphilis got, yeah, tossed around. And then, I mean... You have Frenchitis. The influenza of 1918, which some people call the Spanish flu,

was by people in Spain, was not called that. I don't remember. We talked about in the episode, it was like the German flu or the English flu. I mean everybody blamed it on somebody but that's why we don't do that right because as we have learned all too well viruses in bacteria they don't know country of origin. They don't know where you're from. They don't know what you look like. They don't know what language you speak. They don't care. And this all sounds very dire,

but I do think there's some hope here. It doesn't sound good. No, I do think there's hope here. I'm trying to, I keep saying it as much for myself right now is for all of you, because it's been a long week. But before I get to the hope, first. You gotta pay. You gotta pay.

You're gonna pay. You want your hope, you got to pay your money. Oh, it's good to be willing to pay. Let's go. You're in a theater, the lights go down. You're about to get swept up by the characters and all their little details and interpersonal dramas. You look at them and think, that person is so obviously in love with their best friend.

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All right, I think you've earned, earned your hope. I was just before we were talking about, right before the Millenipartment, the best example, and I think I've said this in an episode in the past, the best example, and I think I've said this in an episode in the past, the best example of not being able to name a virus because of the various names you pick upsetting different people with interests,

and that kind of thing, like vested interest in whatever you tried to name it after, is the scene Nombrae virus, the name virus, the hands of virus, which almost was named the four corners virus for the four corners area of the United States where the four states. But that was, that is a popular tourist area. And if you name a virus after it, right?

Like then you're like, wait, in that were that one hemorrhagic fever? Bad news, I got a bad case of push gardens. I've come down with six flags over America. So eventually they just call it the known environment because nobody could agree on what to call it. It makes you feel bad. Like I don't know what the Ebola river looks like, but I'm sure not a lot of people visit it.

Not as much of a tourist lot of people visit a river. Not as much of a tourist spot. It's a river, that's where it's named from. But anyway, the thing about this is, like I said at the beginning, a lot of people have talked about the idea that Omokron is more mild. And I just want to preface with, first of all, there have been some statements made. And I have said openly that I think there have been a lot of public health, especially messaging just failures throughout the course of this, just absolute failures in public health messaging.

And recently there have been comments made that we should be comforted by the fact that the majority of people who are suffering, you know, severe illness or dying of Omicron, of this variant tend to be people who have four or more comorbidities. So which I don't know what the end of that sentence is like, so don't worry. Yeah, so don't have comorbidities. Right. And I mean, like the ableism in that is so overwhelmingly apparent and upsetting and disconcerting. Right. Because, I mean, that's what that statement would mean. So don't worry.

That doesn't, as if that makes it not so concerning or less important because these are lives that we do not as a society value as much is the implicit. No, but that's the... And I'm not saying that's what... Yeah, but what... Yeah, but what somebody means, but like, there are going to be people who hear that and feel that way from that statement.

And that's a problem. Yeah, but we also have to... That's absolutely true. And I think that it's... What's hard is that you have to kind of like split your mind into when you're talking about this stuff because two things can be true at the same time two things that one death is a tragedy and too much and heartbreaking and also

One death would be miraculous If we could get to that point like both of these things when you're talking in pandemic terms You do have to get down to that like craft calculus if you're going to that point. Like both of these things, when you're talking in pandemic terms, you do have to get down to that like craft calculus if you're going to get through it while still keeping in mind the macro as well, right? Like trying to solve for both of those, I think is one of the challenges that we've had in communication, right?

Like, well, my experience wasn't bad, so you're blowing it out of proportion, right? Like, well, my experience wasn't bad. So you're blowing it out of proportion, right? That's the invert. That's the flip of what you're talking about, right? Is it is conflating personal experience with the whole global perspective? Right. Right. Which is your personal experience with coronavirus may be mild, but that does not mean that this is a concept as mild. And a life is valuable period. I mean, like if someone has comorbidities or doesn't, or is it high risk or isn't their lives matter.

And I think the bigger point is that if that is your sort of way of thinking, then you're less likely to impose more, just anything, measures to try to control the spread. I think there is a feeling that we're telling people to get vaccinated and then letting it go. That's the vibe that I'm getting. I think that masking is still very important and it's an easy thing to do. I mean, that's the thing I've never understood about the battle over masks. It's easy. It's an easy thing. It's symbolic. It's symbolic of these denses that think it's like a personal liberty issue.

And it would, but if it would protect people, it's such a small thing. I mean, I understand that there are implications, there are consequences of shutting down an entire economy for a period of time. And I know that that is a conversation worthy of having before you take that measure and thinking about how that plays out. Just like shutting down schools, there are tons, I mean, we've seen all of the consequences of that. And so these are complicated nuance topics that deserve a lot of time and attention. For me, the masks are not. It's easy. For the vast majority of us wearing a mask is in no way a sacrifice.

And it could be pushed harder. That being said, there is good evidence that right now that the Omicron variant may well be milder for you, an individual than previous variants. We knew from the beginning as soon as, and that's why we are so much better responding to things. We know what the original COVID variants look like. COVID classic. COVID classic. We know what these newer variants look like.

We see the changes and we know what some of those different mutations and changes can mean. The initial concern was we immediately saw mutations that meant more contagious. We knew from previous variant changes like, oh, that change made this other one, more contagious. So I bet this one is even more contagious. That information's probably easier to tease out, isn't it? Like, I mean, you just run them like more than like severity of symptoms.

I'll guess, right? Yes, well, because that we got to see play out. Right. Yeah, you can look at the mutation and then look in a dish, a petri dish and see like how easily it spreads, how easily can it infect different things. You can do that all in a lab and how easily it evades antibodies. So how easily is it going to evade the antibodies that you get from having COVID or the antibodies you get from getting vaccinated?

So they did all that in labs and went, oh, we don't like that. What we couldn't know initially is when people get it, how sick are they gonna get? Is it worse? Is it the same or is it not as bad? Now, with some time, what we've started to see is what a lot of people have talked about a decoupling, a decoupling of the line of the rate of new cases

and the rate of hospitalizations. We've started to see that while both are going up, because I mean, like, you know, more people get sick, more people are gonna get hospitalized. That's just gonna happen. It's a bigger sheer number. It's not going up at the same rate and what that suggests is that

for an individual person, their experience with Omicron is likely to be more mild than their experience with Delta or Alpha or Beta or whatever. We are starting to see evidence of that. I haven't looked at the... You said that and made me think I'm going to look at the West Virginia numbers real quick because I remember when that was like, I mean, it still is to a certain extent, but that was like a ritualistic thing for the first few months, like every day, it was like 5 p.m. or something, it would update. We'd go to see where it was when like every single case really mattered because we, we, we, well, we were counting them also in like ones and twos and fives.

And I mean, I remember St. Patrick's Day of 2020 when West Virginia got its first case. Yeah. Um, we, yeah, last in COVID. No. Uh, yeah, we've had a rough, but, but all of us say yesterday, which was the second the last day you're on service, West Virginia reported 2,916 new cases, which, if you're in a very popular state, probably doesn't sound like much, but you should know that our last peak in September was 1,970.

So it's like, to look at the chart, it's honestly like extremely jarring. But. And we have a high number of unvaccinated people here. And we also have a high number of people with a number of chronic diseases and comorbidities that will put them at higher risk for severe disease on top of the fact that they're more likely to be unvaccinated. So these are the concerns here. Now I will say outside of the fact that when we started to see like, okay, umacron seems

to be causing maybe not a severe disease on average and an individual, when they started asking why, part of it is because we're seeing it hit populations where people are vaccinated, right? And we know the vaccines mitigate the severity of the disease. So that's part of it. The previous variants were hitting unvaccinated populations. Well, Delta not completely, but you know what I mean. Now there are vaccinated people. But there is something different we think about the way Omicron infects cells. It seems to stick to the upper airways a little more and not head down to the lungs as readily. And so that would mean that while you do get symptoms, you are less likely to get the COVID pneumonia, the COVID, the COVID, the complete inflammation of all of the lung tissue that can lead to respiratory collapse, intubation, death, all of the more severe things that the previous

variants have caused. Omicron doesn't seem as adept at causing. That doesn't mean it can't. It just means it's not as good at it as previous variants. And that is good for us. And what a lot of people from this early data have begun to wander is, is this how we get out of it? Is this the, is this the way that COVID becomes something that is endemic? Meaning we will continue to get it probably seasonally. At some point, what we will expect is all of us will get it. But it will be more like,

I mean, everybody try to compare it to the flu in the beginning. I mean, maybe it will be more like the flu where you get a vaccine. It will not be severe illness or death, but you will get sick. And we will have, unfortunately, some people,, you know, maybe just for, I don't know how long every year who do die of COVID, but it won't be the, the mass infections in illness that we see now. If memory serves, I feel like the co-host of some medical podcasts may have in a moment of ill-considered hubris announced that that was definitely, definitely happening exactly that way.

I think some different. It may be. Some of the medical podcasts, some xFUN may have done that, that what I just described. It may be. My thoughts are with them. That's got to be extremely embarrassing. In addition to having effective vaccines this time around with this surge, which, you know, more and more, we're recommending one of the mRNA vaccines. If you have access

to them, the Pfizer or the Moderna, we're recommending more than the J and J in addition. I feel like J and J never do anything about any more. Is that like people aren't using that much? Not as much. People, I do not think are recommending the J&J. As much as that doesn't mean you can't use it, but they're recommending the other two tend to be more effective. So they're recommending those. They're recommending if you got the J&J,

you would consider a booster of the Pfizer or the Moderna. So these are still your best tools. You should get them. We do have the medications now that we think help, we have the monoclonal antibodies now. There is the bad news that the Omicron variant is not susceptible to the first two monoclonal antibodies that were out there. The only ones that we've ever had at our hospital don't work on Omicron. There is one that does work on Omicron that is out there, so that is good.

Citrova Mab. No. But that's, it's hard because it's in short supply. Like we have none at our local facility, as far as I know. I don't, they are not telling me, I guess. But there are other meds, again, they're still in short supply, but they're coming out. Things like Pax, Lovid, Mollenupirovir. So there are meds that can help mitigate the severity of the disease should you get COVID now. And this was not true in the beginning of the pandemic. Plus, we're much better at managing it because we've seen it. Experiences taught us the things that work, the things that don't. We have protocols. Those of us who work in hospitals now know, you know, just like we know all the other things we were taught in med school, COVID has now become second nature in terms of the stuff we know to do. That doesn't mean we can cure it, but we know the things

that help. And that is all good news. The thing though, not to ignore, and this is why I say it's different your individual experience to what it does to a society at whole. Our numbers are going up up up up right now and while most people who get M.a.cron maybe won't get hospitalized. If enough people get it, there will be enough people who do require hospitalization that our healthcare facilities have already and will continue to become completely overwhelmed. And we said this has been the refrain of the pandemic, right? Well it's happening. I'm living it.

We are living it. All of us who work in healthcare, our hospitals are overwhelmed, not just physically full, like every bed is full, but you have to remember that healthcare workers are also getting this. So there are facilities that are already just letting, you know, sending out emails predicting, like 30 to 40% staff shortages in a couple of weeks, depending on where you live in the country and where you are on your curve. Is it possible for you to, and I don't actually know the answer to this,

but like to give, you know, we hear a lot of those numbers, but like to give like practical examples of like what that means since we're experiencing it now. It could mean things like, let's say that on, okay, in a busy community hospital, you have a lot of people who would need labs drawn. And so you would have, you know, I mean, depending on the size of your hospital, 8, 10,

I don't know, it a really big hospital, 20 flabotumus. I don't know. Lots of people drawing blood wandering the halls to collect all those labs. Because sometimes you need a lab immediately, sometimes you need a lab, you know, in the next hour, some of them can wait to the next morning, but you need a lot of people because that information can help you make life, you know, life determining medical decisions. We will be in situations where hospitals, and I've heard of these, have one person for the entire hospital And that includes the emergency room where labs are often stat, meaning right away.

And the ICU where labs are often needed right away. And what that will do is cause delays in everybody's care. Same thing for like a respiratory therapist, whose job it is to come and check like, is the oxygen support you're on working? Is it appropriate? Do you need more? Do we need to change you to something different to deliver oxygen?

Because what you're on is not working properly for you. Do you need a breathing treatment? Do you need, I mean, all of these things, if you don't have enough of that staff, so it's not just people who have COVID, it is those people. It's everybody. So everybody who needs hospitalization for anything,

whether it was something planned, a routine surgery that you had scheduled, or something you can't plan for, like, you know, a motor vehicle accident or a heart attack or, you know, a stroke. All of those patients are going to be getting less attention because our resources are spread to them. It may have been to a point where Sydney was telling me like, I'm not a lot of do woodworking. And we had a huge snow storm here about a week ago. Just a few days ago. A few days ago, my God.

The huge snow storm here and we wouldn't let the girls slid. Oh my God. It's not a good time to break your leg. It's not a good time to break your leg. It's never a good time to break your leg. But I mean, I just, I mean, when you know that you are wait times at different facilities could approach 16, 18, a whole day, I mean, know, I mean like that one, be more careful. Two, this is a, and these are things you can actively do other than getting

vaccinated and wearing a mask. Other things you can do are utilize healthcare resources as appropriately as you possibly can. The emergency room is like the great catch allall for anything you don't know what to do, you go to the emergency room. Well, I can tell you probably no matter where you live in the United States of America, your emergency room is overwhelmed. Maybe there's somewhere it isn't, but for the most part, the emergency rooms are overwhelmed and if you have something that isn't an emergency that you can go to your primary care doctor's office or a walking clinic or an immediate care or if you have

access to like an after hours call, a lot of practices have like an after hours call line where you call a line they connect you with like at our office it'll be one of our doctors is on call every night and they call you and they can help talk you through something. So like, oh, actually, you know what? Yes, I am concerned, but you don't have to go to the ER right now. We can wait in the morning. We'll get you in and just come here. Like, there are other ways if it is not truly an emergency that you can see, healthcare. And if it is one of those situations, I mean, if you don't know, of course, always go get help, but, but those are things to consider.

Now, what about, and this is interesting, because you mentioned this to me earlier, but like that applies to you, and I'm not sure if I realize this, but like even if you are positive for COVID, like your first option, not necessarily be the hospital. We've seen a lot of people who have that misconception that if you get diagnosed with COVID,

you should immediately come to the hospital. It feels like the kind of thing where it's like everyone, everyone listen. I have the novel coronavirus and I need the finest medical care immediately. Now, and that might be some people's risk. And there are caveats to this, of course, if you are high risk, there may be antibodies, monoclonal antibodies that you do qualify for. So the recommendation is that if you test positive for coronavirus, you should contact your primary care physician, your provider, your family doctor, your internist, whoever,

contact your primary care provider, and so they can tell you if you are someone who would qualify or would need the monoclonal antibodies. For most people, you don't. Most people will not have a risk factor that qualifies you. So if you are, you know, someone who, let's say you're a vaccinated person, you get diagnosed, you do a home test, or you go get swabbed, and then you get a call, you got COVID. Yeah. You got some, maybe some cold symptoms. Yeah. No shortness of breath, no difficulty breathing, you feel fine, you feel like you feel like you're a cold, you're okay, but you got a cold.

You do not, you do need to inform your primary care provider, you do not need to run to the emergency room for that. Certainly if you have shortness of breath, if you at all feel the breathing or chest pain, you know, then absolutely you should go to the emergency room. But generally, if you feel like you have a cold and you normally wouldn't go to the hospital for it, you just found out you had coronavirus. Let everybody, you've been around now so that they can get tested as well.

But you don't need to go immediately to the ER for some sort of treatment. And I think that's been a misconception. I've had a lot of people who've just come in because they thought that's what they were supposed to do. And some of them have been asymptomatic. And that there's really not much for us to do at that point for most people. Things you can do is if you have the means to buy a pulse oximeter, it's the little plastic thing that goes on your finger.

You've probably seen it at a hospital or doctor's office. And it tells you how fast your heart is beating and why your oxygen saturation is. It's not a bad thing to have at home right now. Yeah, you can find those. I think they're like most drug stores. Yeah, most drug stores sell them. You can buy them on the internet. I've talked about multiple places and given them to people. 40 bucks, something like that. So they're not the cheapest thing in the world Certainly, and I I don't think for the average person without a qualifying condition your insurance would necessarily cover this piece of medical equipment Unfortunately If you have the means this is a good idea to have

Um, and offer it to a friend. I know we've had once we've handed off to people periodically I always replace it. I know we've had once we've handed off to people periodically. We may not have a few years. Uh, I, I always replace it. I was, I, I carry one with me. Um, to your key chain. It is, it is on a chain. Uh, it's on a wallet chain. I did. And he keeps it like a, like a, like a scoff fan.

Cindy keeps her, her, with the kind, with the kinds of medicine I practice in coronavirus, having a pulse oximeter in my pocket is essential. I think as I said, like one of the cherry poppinatis, they have wallet chains, right? See who's right, guys. I don't know that much about scaw wallet chains. I mean, this is a correlation there. Having one of those at home, if you can.

Wallet chain? No, a pulse oximeter is a nice thing to have because if you are concerned, it can give you peace of mind. Obviously, if you're having shortness of breath, you shouldn't just sit at home and look at your pulse oximeter, you should go get help. But if you're just nervous and looking at that and seeing that your numbers are okay,

generally speaking, if you have healthy sort of functioning lungs, you might sit around 97 99 99 percent when your sick it can drop a little bit Honestly anything under 94 I Would at least go get checked out that doesn't mean you need to be in the hospital We don't admit people because they're under 94 Necessarily, but that you know you should go get checked out But that can bring you some peace of mind.

Other things, there's not a lot you can do at home, other than stock up on what makes you feel better during a cold. Archeese, slum, and then. Yeah, whatever, chicken soup, and fluids stay hydrated. It doesn't hurt to have over-the-counter pain relievers like Tylenol or Ibuprofen as is appropriate for you if you can take them. Or again, like cough and cold medicines, you would take for any sort of thing.

Those are okay. You'll read a lot about different supplements that people will tell you, vitamin D or zinc or C or whatever. If you want to, okay. There's not a ton of evidence to support that any one of those things is gonna make the difference for you, much like elderberry in the flu, you know.

But it's, you know, you can. The main thing is to isolate, try not to infect anybody else, stay home, take care of yourself, drink fluids, and I mean, that's the best you can do. Before you wrap up, I can tell, I know that how this week has been for you, and I just, I would like to give you a space to sort of like talk about it personally, like how just to give people a more human side of like, what your experience has been like. Don't make me cry. I cry really easily when I sleep.

I just, I think. Just basically just said, how you doing? I think just basically just said, I do. I think that I know that there have been a lot of healthcare workers who have spoken out about this. And if you, if you look at the right tech talks, you'll just see streams of them about how it makes you feel to be a healthcare worker right now. And I think, I think be a healthcare worker right now. And I think what I would say first of all is I have taken care of a lot of people who are unvaccinated. I feel, I personally, I'm speaking for me.

I feel no anger towards people who are unvaccinated. I feel frustrated because I hate to see somebody suffering if it could have been prevented, whatever the cause. I feel frustrated that we as a society didn't do a better job of answering the questions and quelling the fears and listening and responding compassionately. I feel frustrated. I feel very sad for the people I'm taking care of when I know things are about to get worse and there's nothing I can do. There's not a lot of things that you come across

with this regularity in modern medicine these days. I think that we take that for granted. Most of the time when I admit somebody, I know I can make them better. Or if it's something I can't make better, it's the big bad stuff that we all know, and it's not every day. Now we daily admit people that we know we can't make better

and we know we may lose. And it wasn't like that when I was training. That wasn't the expectation. A lot of the patients that we admit are so scared and it's really hard to see that. It's hard to see that fear and that realization that they made a mistake. I mean, some people are still mad and yell at you,

but that's the exception. The rule is that people are really scared and really regretful and realize that they made a big mistake. And I only have compassion for people who realize they made a big mistake, because I mean, we've all made big mistakes. It balances out me nicely. Yes.

Yes. As a me, okay. As a couple, Sydney and I are neutral. I have people in that situation. We all make bad decisions. I have devoted a lot of my medical career, my personal medical career to making sure that even if you've made some bad decisions, you get the care you deserve because I believe everybody deserves good quality health care and compassion and comfort when they are ill no matter what

happen to get them there. And I understand that it's different when you have people whose decisions maybe have also harmed others and I understand that I see that but when I am standing in a room taking care of someone it's just it's me and them and it's not I mean in that moment I am standing in a room taking care of someone, it's just me and them. And it's not, I mean, in that moment, I am their physician and they are my patient. And that is all that matters in that moment. And I feel really worried for all my fellow health care workers who are going through this every day. Because there are people who, you know, I work in the hospital sometimes, I don't work in there all the time,

for people who are doing this day in day out, for our ICU teams, I don't know, I don't know how they come out the other end of this okay, I know that many of them are not okay. And I don't know how much of that is is made worse by the fact that we already worked in a system where you often are prohibited from doing everything you want to do for your patients because of financial interest, because you have hospitals and insurance companies and pharmaceutical companies

who have NHMOs who have so much like who are trying to make so much money off of that interaction that they're getting in the way of trying to take care of that person. And there's already like in the American medical system, there's already that baseline frustration and anger. And I've talked about moral injury before on the show and that that is all that was all there. And people were already trying to figure out how they continue to do this job and not lose the part of themselves that made them want to do this job. And then you layer on top of it just watching this suffering. I'm really worried about our health care community. We're going to lose a lot of really caring doctors and nurses and therapists. We're going to lose a lot of people because they won't be able to go back to their job at some point.

At some point they'll say, I just can anymore. I'm not there. But. And when they do, I will be there ready to answer the call. Dr. Justin McCroy, the doogie house of the 41 year olds, sort of a 41 year old doogie house, stepping up to fill the gap. It needs, we can't count on 41 year old doogie house to fill the gap. It needs. We can't count on 41 year old doogie house are to fill the gap. We can't what we need is to

recognize that we had a system that was so dysfunctional in terms of what it was supposed to do, right? Like take care of people that that was so not made to do that and harmed so many people that when we at the first big test it has failed repeatedly and we need to destroy the whole system and rebuild it. Cool. Yeah, there we are. So we have universal health care, we need single-payer health care and we need a system that supports patients and the people who work in it so that when bad things happen like now,

it doesn't break, because the system is breaking. There's gonna be moments throughout, especially the next few weeks, depending on where you live or the next few months, where you can't get services you took for granted, where there isn't a nursing home to send patients to where there aren't home health services, where there isn't physical therapy,

where you can't go see that specialist. And I mean, a lot of people are gonna suffer for that. So we have to learn from it and do better. Thank you so much for listening. We hope you're hanging in there. This one is possible. Thanks to taxpayers for the use of their sound medicines as the intro and outro of our program.

And thanks to you, Sid, you're a hero, as far as I'm concerned. I look at that. I appreciate that. That's got to feel good. Does that make it okay? It does. I just see back. See, that's the thing.

A man has said you're a hero. Sydney. That's all it just give us some pizza. And if you guys could just bang the pots again. What happened to that? What happened to that? Yeah. Thank you so much for listening.

We'll be with you next week until then. My name is Justin McRoll. I'm Sydney McRoll. As always, don't drill a hole in your head. Alright!