Shift notes: This small tweak in the ER and clinics could save many lives.

Just a quick dispatch from the ER.

Today, we had dozens of patients, with the usual wide spectrum of diseases and concerns. We’re certainly still seeing some Covid-19, but what’s striking is how much more influenza (type A in particular) and RSV we now have to handle as well.

I handed out a lot of masks today to patients to take home. Like…a lot.

Without quantifying anything, between my colleagues and me, we made an impressive number of influenza diagnoses today, right here in this very ER. For some patients, the antiviral medication oseltamivir (“tamiflu”) was indicated and offered. (Side note: while that medication helps some, its benefits are often overplayed, and the side effects get downplayed. But that’s a story for another day.)

I personally tried to hand every single one of my respiratory virus patients who I could send home—whether caused by influenza, Covid, or RSV—a bag full of good masks.

Many of my colleagues do this too. But I think we sometimes forget to do it, as a matter of course. Particularly when it comes to influenza, we focus so much on the oseltamivir (which, again, probably does something for some patients, and very little for most who get it), that we forget to advise patients to do those all-important NPIs; that is, the non-pharmacologic interventions we know work. NPIs—like mask wearing and keeping the windows open, especially when around vulnerable people—probably do more to help stave off the spread of viruses than most of our antiviral medications.

Clinicians often refer to “UpToDate.com,” a website with best practices for a just about every medical condition out there. I just looked at a few of the influenza articles. Mask use and ventilation get mentioned in there at some point, but they really get short shrift. It’s time for that to change.

If the Covid-19 pandemic taught me anything, it’s that in the past, we have underutilized simple tools like masks, ventilation, and other interventions that slow down the spread of contagious pathogens (including paid sick leave). We can do a much better job of controlling colds and flu during the high season, which is now underway. I’m hoping we’ll keep getting better at this. In some ways, just by testing for many viruses more often, I think we’re starting to make some progress.

For me, today was a day where I made sure that all of my patients benefited from everything that I have learned these last few years. Those were lessons that I (and we all) learned the hard way. But they’re important ones going forward, as we try to keep our communities healthier.