Slip Knot and Tuck Mask Fit

I saw the video the CDC suggested for getting a closer fit using a surgical mask. I had a tough time following how to tie the knot in the loops. Either the demonstrator went too fast or I was too slow (probably the latter.) I found a couple of videos on slip knots and crochet knots (another name for slip knot, evidently). There are probably dozens of YouTubes on how to do the Knot and Tuck.

Since the toughest part of the Knot and Tuck method is tying and adjusting the knot to hug the edge of the mask as closely as possible, I practiced a little. See what you think of the slip knot and tuck in my YouTube video below. Using a slip knot allows you to easily move the knot closer to the side of the mask, allowing a tighter fit. Tucking also helps. It also helps prevent my glasses from fogging up. It’ll never be perfect but it’s better than letting the sides flop open.

UIHC Covid-19 Q&A: Omicron and Vaccines

Here’s a recently published YouTube by University of Iowa Health Care on the Covid-19 virus, the Omicron variant, and vaccines (actually there are two, see update below). Points that grabbed our attention were:

Omicron is more transmissible, but overall seems to cause less severe disease.

Current vaccines, especially with the booster, protect against getting severe disease, although may not protect against infection.

It’s not a great idea to just get it over with by getting infected with Omicron. Getting the disease can lead to severe medical complications (including myocarditis) leading to hospital admission. The vaccines rarely cause myocarditis as a side effect and it generally resolves without treatment.

Vaccines make getting Covid-19 long haul syndrome less likely.

Avoiding getting together in groups of 10 or larger decreases the risk of infection with Omicron. The Swiss Cheese method of protecting yourself against Covid-19 still works best:

Include a slice getting the vaccine with booster: image credit Univ Iowa Health Care

There are medical treatments for Covid-19 disease if you get infected and have to be hospitalized. The treatments are not without side effects. One of them is dexamethasone, a corticosteroid. It can be used to reduce the immune system reaction that Covid-19 infection can eventually cause. Corticosteroids can cause neuropsychiatric side effects that can range from anxiety to frank delirium marked by psychosis. Fortunately, the duration of steroid treatment is relatively short. Vaccines don’t cause side effects of this type. Over the course of my career before I retired, as a psychiatric consultant in the general hospital, I was not infrequently called to assist in the management of extreme psychiatric side effects from high dose steroids (reference: García CAC, Sánchez EBA, Huerta DH, Gómez-Arnau J. Covid-19 treatment-induced neuropsychiatric adverse effects. Gen Hosp Psychiatry. 2020;67:163-164. doi:10.1016/j.genhosppsych.2020.06.001: quote : “Short course high-dose corticosteroid treatment, as occurs in COVID-19, may cause delirium and changes in mood (with a frequency of up to 52% of patients treated with more than 20 mg a day of prednisone during 3 months) [5], being mania and hypomania more frequently observed than depression.”)

Wearing a mask is protective. Recently the CDC recommended preferring medical grade or surgical masks over cloth masks. The guidance has a link to a YouTube on how to make the 3 layer disposable surgical mask fit closer to the face to provide a more effective barrier (and tends to reduce fogging on eyeglasses). N95 masks may be more widely available soon.

It takes a little practice

The vaccines are very safe and effective. We had minimal side effects, mainly sore arms.

Update: We watched the UIHC Covid-19 Family Forum last night which ran from 6:30-7:30 PM. I just noticed that it was recorded. It’s similar to the presentation above. It also contains helpful slides with graphs. There were great questions from the audience, which the experts answered and which are helpful to all of us. Many thanks to Dr. Dan Diekema, MD and Dr. Patricia Winokur, MD for this outstanding forum.

Take a Cup of Kindness and Say Goodbye to 2021

It’s been a quiet day around here. It’s New Year’s Eve. I got a great message from a former resident who has started his own Psychiatry Consultation Fellowship training program in Bangkok, Thailand. Dr. Paul Thisayakorn and his wife are welcoming 2022 with their 2 lovely children and hoping 2022 will be a better year, as we are. The Covid pandemic has been hard around the world.

Paul also looks forward to establishing a C-L Psychiatry academic society in Thailand in the coming year. Paul did his psychiatry residency at University of Iowa and his C-L Psychiatry fellowship in Cleveland. Sena and I wish him and his family all the best in the new year.

Today was quiet, but tomorrow the big snowstorm will come. We’ll be digging out all day because the forecast is for 5-8 inches, high wind gusts, and ice. It’s Iowa, after all.

But for tonight we’ll take a cup of kindness and say goodbye to 2021.

And if you like MacLean’s version of Auld Lang Syne above, you might have a listen to another with the Scottish lyrics translated.

Covid-19 Omicron Variant Update

This is just a short message wishing a safe and happy holiday to all. I’m passing readers a couple of links to update information on the Covid-19 Omicron variant and how to stay as safe as possible this winter.

First is the Rounding@Iowa link to the Omicron Variant update. It’s an interview with University of Iowa Hospitals & Clinics (UIHC) infectious disease expert, Dr. Patricia Winokur, MD. It’s about a 16 minute interview. Highlights are that it’s important to get the booster for solid protection against variants including Omicron and that the Covid-19 vaccine is, in general, likely to turn out to be a 3-shot vaccine similar to others, such as the Hepatitis and Shingles vaccines.

The other link is to UIHC infectious disease specialist Dr. Daniel Diekema, MD and his thoughts about the Omicron variant. They echo those of Dr. Winokur and the emphasis again is on the importance of getting vaccinated.

Lastly, there is some guidance by UIHC in a graphic below on how to stay safe from getting infected with Covid-19, (whatever the variant) during winter activities. Happy Holidays!

My Definitive Journey Revisited

A couple of days ago, I got my retirement gift from The University of Iowa. It’s a about a year and a half late because of the Covid-19 pandemic, but it’s welcome nonetheless. Normally there is an Annual Faculty Retirement Dinner, but it had to be cancelled. It’s a stunningly beautiful engraved crystal bowl with the University logo on it. It came with a wonderful letter of appreciation. It reminded me of my blog post in 2019, “My Definitive Journey.”

It’s a definitive symbol of the next part of my journey in life. For years I’d been a fireman of sorts, which is what a general hospital psychiatric consultant really is. The other symbols have been the fireman’s helmet and the little chair I carried around so that I could sit with my patients. I have changed a little.

I still have my work email access, which I’m ambivalent about, naturally. I check it every day, partly because of Fear of Missing Out (FOMO), but also to delete the junk mail. I still get a lot of it. I get a rare message from former trainees, one of whom said it “pained” her to learn I’m now Professor Emeritus.

I have not seriously considered returning to work. That doesn’t mean I have not been occasionally nostalgic for some aspects of my former life.

The poem, “El Viaje Definitivo” by Juan Ramon Jimenez evokes mixed feelings and thoughts now. I have gone away. But in looking back at the past, I now see now that the birds didn’t always sing. The tree was not always green.

I don’t miss my former home, the hospital, as keenly now, which is now a much harder place to work since the Covid-19 pandemic began.

And there is little that is definitive about my journey forward from where I now stand. I’m a little less afraid than I was over a year and a half ago. And the birds sing where I am now, sometimes more clearly than before.

El Viaje Definitivo (The Final Journey)

… and I will go away.

And the birds will stay, singing

And my garden will stay

With its green tree

And white water well.

And every afternoon the sky will be blue and peaceful

And the pealing of bells will be like this afternoon’s

Peal of the bell of the high campanile.

They will die, all those who loved me

And every year the town will be revived, again

And in my circle of green white-limed flowering garden

My spirit will dwell nostalgic from tree to well.

And I will go away

And I will be lonely without my home

And without my tree with its green foliage

Without my white water well

Without the blue peaceful sky

And the birds will stay


                                –Juan Ramon Jimenez

CDC Identifies Omicron as Covid-19 Variant of Concern

I’ve been seeing news items about the Omicron variant of Covid-19. The CDC only yesterday announced that it is now a Variant of Concern. Other CDC comments are here in a news release. There’s not a lot of solid information yet about how dangerous it is. Most of what I see on the internet are comments about the need for more information. Vaccine manufacturers don’t seem to agree on whether or not current vaccines would be effective against Omicron.

Interestingly, there seem to be about as many news articles about how to pronounce “Omicron” as there are about the variant itself.

When I compare the Omicron news to that of the recently identified Delta plus (AY.4.2) subvariant, I see very few references to the latter after late October. I never saw any CDC indications that the Delta plus was ever a Variant of Concern, although news items generally carried an alarming tone. As the CDC says, there will be variants. So far, as of yesterday, no U.S. cases have been found.

Great YouTube Q&A on Covid-19 Vaccine for Children Ages 5-11: It’s better than a stick in the nose!

There was a great live stream YouTube Q&A presentation today on the Covid-19 vaccine for kids ages 5-11 through the University of Iowa Stead Family Children’s Hospital this afternoon at 2:15 and it ran for about 30 minutes (scrub the play button forward to about a minute to start the recorded video). There were excellent questions and informative answers as well as helpful guidance for parents by Chief Medical Officer Dr. Theresa Brennan, MD and Pediatrician Dr. Rami Boutros, MD.

Parents have been eager to bring their kids in to the pediatric clinic to get the vaccine. Dr. Boutros shared a funny anecdote about his interaction with a child who had just got his shot yesterday. It’s about 34 minutes into the video. After the child received the shot, Dr. Boutros asked him, “How was it?” The child replied, “The vaccine is better than a stick in the nose!” Anybody who’s been tested for Covid-19 can relate to that.

How’s that for a meme? Get the vaccine; it’s better than a stick in the nose!

CDC Recommends COVID-19 Vaccine for Children Ages 5-11

Following the Advisory Committee for Immunization Practices (ACIP) vote yesterday recommending the Pfizer Covid-19 vaccine for children ages 5-11, CDC formally announced agreement with the committee’s decision after the meeting.

What You See is Not Always What You Get

A couple of days ago I thought of Gary Larson’s Far Side cartoon, the one with the toggle switch in a passenger airplane cabin seat with the message “Wings Stay On; Wings Fall Off.” I googled it just for fun and found that it spawned a lot of web articles obviously trying to reassure the flying public that airplane wings don’t just fall off.

What brought the “Wings Stay On; Wings Fall Off” cartoon to mind were a few events in the last two days. Day before yesterday, Sena took our lease car to one of the local dealership’s car wash. She does this all the time without incident but this time she noticed that the “soap” didn’t rinse off. She drove it home and still couldn’t get what appeared to be soap film off the car. She finally drove back to the dealership and discovered that the car wash attendant had accidentally pressed the hydraulic oil lubricant button instead of the detergent button. A number of other car wash customers also had been victims of the mishap and were complaining to dealership management.

So, what had looked like soap film actually turned out to be hydraulic lubricant meant for the car wash motors. It turns out that accidents like these can happen. Could the button for the lubricant have been situated so close to the detergent button that the attendant accidentally pressed the wrong one? By itself, that reminded me of the Larson cartoon. If the systems analysist for the car wash design was asleep at the desk on the day of manufacture, I guess all you can do is think before you act. And what you see is not always what you get.

The next day, Sena and I were at the dealership sitting in an agent’s office. We noticed a tipped over cup of coffee. I reached over to pick it up, mentioning that he must have had a little accident. Much to my surprise, both cup and mess came up as a spill prank, which I had never seen before, believe it or not. The joke capitalizes on our human tendency to sometimes act before we think.

Finally, a couple of on-line news items caught my eye this morning. They were both about white tail deer in Iowa, discovered by Iowa State University (ISU) researchers to have somehow picked up the Covid-19 virus. One story was much shorter than the other.

The longer story by the Des Moines Register had a lot more ISU research detail in it and didn’t stress certain facts that might reassure readers that there was low likelihood that humans might be vulnerable to catching the virus from deer.

The shorter story by the KCCI news network didn’t present as much of the ISU research details and basically said as long as you used gloves to dress the animal in the field and thoroughly cooked the meat, you were in no danger of infection. Both stories basically carried the same message that there was low likelihood of infection to humans. But there was a slight tendency to overemphasize the risk in one article and maybe a tendency to underemphasize it in the other. These might illustrate the “spin” phenomenon for which readers should just be on the alert.

By the way, the CDC web site carries a message saying the risk of catching Covid-19 from wild animals is generally low.

What you see is not always what you get, especially at first glance. And it pays to think before you act.

CDC Advisory Committee Meeting Today on COVID-19 Vaccine for Children Ages 5-11

Today the Advisory Committee on Immunization Practices (ACIP) had the meeting today to discuss the Pfizer Covid-19 vaccine for children aged 5-11 years of age. Presentation slides are here. The Policy Question to be voted on for today is:

“Should vaccination with Pfizer-BioNTech COVID-19 vaccine (2-doses, 10µg, IM) be recommended for children 5–11 years of age, under an Emergency Use Authorization?”

Dr. Kevin Chatham-Stevens’ presentation on implementation of the vaccination program for children in the age group was informative. Most children will likely be vaccinated in their regional doctors’ office. Dr. Woodworth presented very helpful, practical, and reassuring information about the practical aspects of vaccination, see slides from “Interim Clinical Considerations for COVID-19 Vaccine in Children Ages 5–11 Years.”

Dr. Oliver’s presentation “EtR Framework: Pfizer-BioNTech COVID-19 vaccine in children aged 5–11 years” as part of the evidence to framework details.

Ҥ Children are at least as likely to be infected with SARS-CoV-2 as adults

– Over 1.9 million reported cases; seroprevalence estimated ~38% among 5–11 years in Sept 2021

– Infections in children less likely to be reported as cases than infections in adults

§ Children 5-11 years of age are at risk of severe illness from COVID-19

– >8,300 COVID-19 related hospitalizations as of mid-October

– Cumulative hospitalization rate is similar to pre-pandemic influenza seasons

– Severity comparable among children hospitalized with influenza and COVID-19, with approximately 1/3 of children 5–11 years requiring ICU admission

– MIS-C most frequent among children 5–11 years

– Post-COVID conditions have been reported in children

§ Secondary transmission from young school-aged children occurs in household and school settings”

The negative impact on children is considerable, especially for those of color. Vaccine efficacy was 90.9% in the Pfizer randomized controlled trial. The bottom line was that the balance and risks is favorable for vaccinations of all children. Post authorization safety monitoring will continue. The Work Group proposed to recommend the intervention.

After discussion, the committee voted on the ACIP Interim Recommendation below:

“The Pfizer-BioNTech COVID-19 vaccine (2-doses, 10µg, IM) is recommended for children 5–11 years of age, in the U.S. population under the FDA’s Emergency Use Authorization.”

The vote on the interim recommendation passed unanimously (14 yes votes).

The meeting was adjourned at approximately 5:00 PM, ET.

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