Notices by McNadoMD (mcnado@mstdn.social)

If they really don’t make a good flu shot available this fall, expect to see a shortage of healthcare workers. Workers who survived COVID and are debating retirement or career change will just quit. I have to keep working, and already wear an N-95, but I’m going to be one unhappy doc. Also, I’ve seen a ton of sick young people this year. Gonna be worse without a flu shot. None of us want that.

When you partially treat tuberculosis (TB), the bacteria that survive “learn”. You killed off the easy ones, and the ones that are left are bacteria that have genetic changes that make them drug resistant.

The US just shut down a program that supplies tuberculosis treatment around the globe. People in the middle of treatment for dangerous strains are being left without complete treatment.

This will kill people, and may make more drug-resistant TB. This is bad for the US, and world.

@briankrebs still down when I try it. Super.

Awkward day for all the US special ops guys in Ukraine.

One thing that NOAA does for me professionally:

When snowstorms hit Colorado, we have to figure out how to keep our hospital staffed, our ambulances available, and get food and supplies to crews and hospital staff. If we don’t know that a bomb cyclone is going to bury the whole area in 3 feet of wet snow, we don’t make preparations. People get stuck working 72 hour shifts. Ambulances can’t move. Crews aren’t fed.

NOAA’s forecasts mean someone shows up when you call 911 in a blizzard.

RFK has ordered a review of Moderna’s bird flu vaccine. The company that made the vaccine that saved the lives of every geriatric senator, and was required by Fox to enter their buildings, is being investigated because Trump thought it would be funny to be a crazy man in charge of our health.

I got COVID while resuscitating a patient, one week before my appointment to get the newly available vaccine in 2020. I have strong feelings about shutting down pandemic vaccine preparedness.

FDA cancelled a vaccine meeting that, among other things, looks at what strains of influenza to include in the vaccine for fall 2025. I am personally going to be affected by this decision. Why? I work in a flu cesspool all winter. I get the shot. Most of my coworkers get the shot. If there is either no shot, or it is ineffective, I’m needlessly at risk while I care for patients.

In 2024-25, influenza has killed thousands in the US, including many young healthy people.

These rich white guys claiming to follow the teachings of a poor brown guy, while praying for success in taking food and medicine away from all of the less fortunate, is something.

Texas has 124 known measles cases, and one kid has now died. Every one of those cases, and that death, were 100% preventable. This will get worse.

When someone in the US gets old and can’t safely live at home anymore, they often end up at a hospital. Case managers try to find them a nursing home, but that is expensive. Most old folks here don’t have adequate insurance for long term care. So what happens? The person’s house is sold, their assets liquidated, and then they get enrolled in Medicaid. If you take away their Medicaid, the nursing home starts eviction proceedings. That elderly person ends up homeless in my ER. No joke.

Why do Medicaid cuts affect people with private insurance or Medicare?

Hospitals with ERs are required to see all patients regardless of ability to pay. We have to staff basic service lines for this patient volume, whether or not we get paid for it. When the uninsured rate goes up, we have to cut something to keep the doors open. That something is social workers, case managers, in-person interpreters, specialists, “extra” nurses and techs, formulary options, new equipment… things we all use.

The entire state of Utah is about to spend a decade learning that Children don’t get good dental coverage in the US, and that untreated dental infections KILL children.

See, fluoride isn’t present in many natural water supplies in the US, and when you don’t add it in, kids gave much higher rates of dental infections. There is zero serious debate about this in the medical and dental literature. Fluoride at levels used in residential water supplies in the US is also safe. Dental disease is not.

In case anyone is wondering: most ER docs in the US have never seen measles. We see viral rashes all the time. The ones we see are almost always not a problem. Measles is a big problem. This is not a setup for rapid recognition and containment.

Just to be clear — if private military contractors working for the local cop shop are ziptying protestors, that’s the point at which you aren’t a democracy. You and your community either oppose that quickly and overwhelmingly or you don’t have a voice.

Btw, for anyone who isn’t aware, Coeur d’Alene and Idaho in general, has been a hotbed of literal nazis for decades. The Aryan Nation compound near there was only broken up because nazis guarding it beat two people after firing on their car when they drove by on a public road, resulting in a lawsuit that went poorly for the nazis. This isn’t isolated fuckery. It is resurgent public activity of a longstanding nazi presence.

Per 9News in Denver, a Children’s museum in Boulder County had sponsors pull out of the annual “girls in science” event that helps introduce girls to STEM. In short, the unnamed sponsors were worried that they would lose federal contracts or funding because of anti-DEI.

So anyway, the Republican party is officially against letting girls learn about science.

Medicare may no longer cover telehealth services. Depending on how this change is implemented, it could be a disaster for emergency care. Did you know that at many stroke centers, the neurologist who evaluates a stroke patient does so via video conference? The same is true for many mental health services, and oodles of other subspecialist services. If it can’t be rembursed, hospitals will drop that care.

Every time I have ever posted about psychiatric treatment/medications, a pile of lunatics appears in my feed to tell me that I’m a terrible person and that if we could just solve society’s ills nobody would ever need treatment.

This is bullshit. It is also a really good way to dehumanize and erase people with serious mental health disorders. These folks have existed, and suffered, throughout history.

If you bring that energy to my threads, you’re gonna have a bad day.

There is no widespread threat to kids from SSRIs, antipsychotics, and weight loss drugs. Some kids are on them. Most of those kids need them.

You know what happens when you arbitrarily ban use of antipsychotics in minors? Minors with psychosis get tied down and given massive doses of sedatives. They get hurt. They get killed.

I treat minors with psychosis in the ER. Kids who need these drugs really need them, and the alternative is inhumane and cruel.

My understanding of much of this firing spree of “probationary” federal workers is this:

Imagine firing every single medical doctor resident, effective tonight.

How many years do you think you can go without those docs entering the job pool before it is a problem?

We just did that for nuclear safety, air traffic control, tax audits, forestry, education administration, foreign aid, medical research, and — guess what? — some types of medical doctor.

“Efficient”