[conspire] Clocks, vaccines, boosters

Tue Nov 9 20:24:47 PST 2021

First off, a PSA: 80,000 Kaiser union workers in various capacities are going on strike on 11/15-11/22. The issue was they wanted to *reduce* base pay for most of the unions. That went over…not so well.

On Sun, Nov 7, 2021, at 4:03 PM, Rick Moen wrote:
> Deirdre (who may or may not choose to elaborate) spends some time 
> reading and (sometimes) contributing to several subReddits where 
> nurses and doctors pseudonymously tell horror stories about dealing with
> delusional antivaxers and their families, both before and after they get
> infected (and infect others) and die ignominiously, avoidably, slowly,
> and alone.  The collateral damage they do to the medical system is
> severe.

I'll get to that, but first I want to discuss the development of the modern anti-vax movement, which I'm convinced is tied to the ball dropping on the opioid and methamphetamine epidemics.

First, the neurotransmitter dopamine is not the "feel good" hormone it's made out to be. In fact, high levels of dopamine can feel pretty awful. For this, we're going to focus on one aspect of dopamine: motivation, particularly what's known as motivational salience:

https://en.wikipedia.org/wiki/Motivational_salience (this page also gets into the dysregulation of this aspect in addiction, fwiw)

The difference between "I want it now regardless" and the "I'm going to wait for a sale"…that's dopamine. Being able to make long-term plans…dopamine.

I've been reading up a lot on it because ADHD is about a dopamine deficiency on the far side of the synaptic cleft, and the frontline meds for ADHD, Ritalin or Adderall, are amphetamines. Amphetamines prevent reuptake of dopamine, so there's more in the synaptic cleft, meaning those signals are more likely to get through to the far side even with dysfunction in the chain. Thus, ritalin/adderall works for ADHD the way an SSRI (or SNRI) works for depression. That's why it works for ADHD and help with the motivational gap so many of us with ADHD have.

I mention this because another class of meds that affects dopamine is opioids. If you have listened to people talk about former addicts who were musicians or artists talk about how they felt more creative on heroin, it's not that they were more creative per se, it's that they were motivated to create, and more likely to finish things (up to a point, because getting more of the drug becomes the first priority).

So, fentanyl, and the fentanyl crisis happened, then the gov't clamped down on prescriptions for all opioids. A lot of people who'd been on fentanyl could not get pain meds that worked for them, or even doctors who'd take an appointment. At all. 7.4% [1] of American adults live with such intractable pain that it interferes with daily life. (I am one of them. Most pain meds are about as effective as tossing a piece of paper across the room. Opioids work for my pain. [2] for how that works.) 

So what did many of these patients then do?

They got on facebook groups and offered tips to each other. Which led to all kinds of crackpot treatments. But a lot of patients couldn't find a doctor, any doctor, so they had to rely on each other.

This is a recipe for disaster, because a lot of those groups have anti-vaxx crackpots in them. But if you've created a system where people *cannot* get a primary care doctor, but you can get medical tips from some random person on the Internet, that's not going to go well once a pandemic hits.

Another big group of them switched to street drugs, including street fentanyl and methamphetamines. Methamphetamine, like amphetamines generally, also have the same kind of dopamine action (in fact, meth is a second-line treatment for ADHD, though it's fallen out of favor.)

Which brings me to this Atlantic piece about the change in the meth market:

https://www.theatlantic.com/magazine/archive/2021/11/the-new-meth/620174/

Pull quote; the change in meth was from the ephedrine form to the P2P that's now far more common:

> But as the meth changed around 2009, so did Barrera’s life. His cravings for meth continued, but paranoia and delusions began to fill his days. “Those feelings of being chatty and wanting to talk go away,” he told me. “All of a sudden you’re stuck and you’re in your head and you’re there for hours.” He said strange things to people. He couldn’t hold a job. No one tolerated him for long. His girlfriend, then his mother, then his father kicked him out, followed by a string of friends who had welcomed him because he always had drugs. When he described his hallucinations, “my friends were like, ‘I don’t care how much dope you got, you can’t stay here.’ ”

…also…

> In the Southwest, the drug quickly became more prevalent than ever. And supply kept flowing east, covering the country in meth all the way to New England, which had almost none before the mid-2010s. Since late 2016, the Midwest and South have seen an especially dramatic shift. Mexican traffickers had never been able to get their hands on enough ephedrine to cover those regions, but now that was no longer an issue.

…also…

> Thus, as P2P meth spread nationwide, an unprecedented event took place in American drug use: Opioid addicts began to shift, en masse, to meth. Meth overdoses have risen rapidly in recent years, but they are much less common than opioid ODs—you don’t typically overdose and die on meth; you decay.

They also tend to wind up in psych wards rather than mainstream hospitals…assuming they live that long.

But the point is: a lot of the paranoia and delusions became part of online culture, and we're seeing the downstream effects of that now.

ON TO THE ICU…

Some of you know I have a friend, writer Cassie Alexander, who wrote a book about her time in the ICU during the pandemic called Year of the Nurse. She wrote this largely while she was out on a much-needed mental health break.

https://www.amazon.com/Year-Nurse-Covid-19-Pandemic-Memoir-ebook/dp/B095PWYG3B/

Anyhow, I realized that I didn't really *know* what she was going through or why it was so bad for her. That's when I started reading r/Nursing. Whoo boy.

If I hadn't read all the science papers on Covid that I have, I probably wouldn't have been prepared for how gruesome the reality is. You can get a clue how bad it gets from articles like this one about Broadway actor Nick Cordero, who would have needed a double lung transplant and had to have a leg amputated:

https://www.cbsnews.com/news/nick-cordero-death-broadway-actor-age-41-coronavirus/

This guy's case was cited in the recent r/HermanCainAward thread where a guy is clearly headed for at least one amputation:

https://www.reddit.com/r/HermanCainAward/comments/qqekks/warning_medical_gore_blue_caught_covid_beat_it/

Which might seem odd for a respiratory disease, but Covid is not just a respiratory disease. SARS-CoV-2 spreads via respiration, sure, but the *advanced disease* is of the endothelium (the lining of the blood vessels):

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7470753/

In the HCA case above, the guy had thromboses, which leads to repair fibrins being strung through blood vessels, which leads to red blood cells under pressure being sliced in two on the fibrin strands like in a bad science fiction movie. That's what causes the huge bruising, typically.

But the real problem for the staff is the unrelenting hopelessness of it, especially as many of the people in the ICU these days *do not believe in Covid*. As one nurse said (paraphrase): to her, the current ICU situation is worse than the bombing of Lebanon she lived through as a child, because at least there, everyone agreed they were getting bombed.

Here's part of the body of one post from r/Nursing [3]:

I'm an ICU nurse...

And I can't do it anymore.

I can't walk into a pt's room with any semblance of patience, only for family to start bombarding me about bogus treatments and interventions and claims that I'm a moron and I don't know anything, and they Googled this, and Google says that, and my MDs are wrong. Then demanding to talk to an MD but they're busy triaging the 21 pts with covid that have slammed our ER in the last hour, and we have 12 boarding because there are no beds anywhere. So more shrieking at me "you need to do your job" and I can't even respond because I'm out the door to answer a call to a rapid four doors away.

I can't deal anymore arguing with my pt to please keep the bipap on because your lungs can't handle being without them, only to be screamed at because they want to eat; and coincidentally their husband was screaming at me earlier because the pt's O2 dipped below 89 earlier and how dare we let that happen, but she's sitting there at 62% now wanting a hamburger and I "am a complete monster" for taking it away from her.

I can't handle coding another pt, only to think the entire time I'm pumping their chest and sweat drips down my PAPR hood and between my shoulders under my isolation gown that this could have all been avoided had they just been vaccinated, while their wife screams at me from the hallway where my coworker has ushered them out in an effort to keep her from yanking at me hysterically while she's shrieking for me to do something. Do something?? I HAVE BEEN DOING SOMETHING. I'VE BEEN TELLING EVERYONE TO GET VACCINATED. YET HERE WE ARE!

I can't handle the guilt from being unable to change the mind of a wife who pulled her husband AMA from care because "ICU is not an option for us. I'm taking him home to do homeopathic care. Everything you're doing I can do at home. You are useless." So off they go, and I know he's going to his death.

I can't deal anymore with hitting my head mentally against a gigantic, unbreakable wall that this population has built up inside their heads between reality and their contrived worlds. This world where they yell at me because they had to wait 75 minutes for me to answer their call light and me saying "I'm sorry, I was in a code blue" is answered with "That's not my problem."

[...]

I can't deal with it.

We healthcare workers can't deal with it.

EVERYONE MUST DEAL WITH IT.

Instead, too many have turned their backs and plugged their ears. Refusing to believe that if you ignore it, downplay it, or  believe lies about the problem, it won't actually go away. It'll get worse.

(end excerpt)

I know a lot of the blame has been placed (fairly) at the feet of Facebook, but I see them as sort of the penutimate mile of the problem. If we hadn't pushed people into those disinformation channels, they might have had more of a chance.

[1]: https://www.cdc.gov/nchs/products/databriefs/db390.htm
[2]: https://www.ebmconsult.com/articles/opioid-agonist-pain-mechanism-CNS
[3]: https://www.reddit.com/r/nursing/comments/pbj0sl/cant_do_it_anymore/