Thread by @Gas_Craic

Welcome to #COVIDMarathon from @ESICM - follow this thread for the content coming up over the next 7 hours. #FOAMed #FOAMcc #COVID19 #COVIDfoam

A general update #covidmarathon

Evolving insights into increasing cases over time, globally. Very few reported cases in Africa over time. #covidmarathon

Total tests performed per million people. UAE tops the charts. South Korea second. #covidmarathon

The amplification phase can be varied WRT the doubling time. Containment is therefore VERY important. Delay the upsurge of patients who would require ICU. Active case finding is paramount --> isolate these cases. #covidmarathon

#COVIDmarathon Resource requirements vs Severity of disease. What does this mean for countries preparing for the surge? These disease severities are best estimates.

#covidmarathon What does getting ready mean? Some countries are more used to ID outbreaks. Screening and triage at ALL access points of healthcare system. We need to use a standardised scoring system to get an idea of disease severity. The community also needs EDUCATED.

A delay in Public Health measures = higher serious case loads. Surge actions need to be at the right time. 3 S's --> Structure, Staff, Supply... #covidmarathon

We need to prioritise evidence based care, as best we can, during this period of great uncertainty... let's look at the clinical characteristics that we do know. Research is of course, underway. Pregnant women and children tend to have milder disease burden. #covidmarathon

We need to do the basics very well. #covidmarathon

No effective antivirals as of yet. But we need to look at this further. Unwarranted use could seriously impact global supply chains etc. #covidmarathon

There are over 300 trials registered about #COVID19 - #covidmarathon - much more ongoing @Lennie333 - we need to try and contribute.

How can we use innovation to improve supply chain models? We need to think of our equipment and resources. @WHO and @UN are looking at and working on this right now. Also thinking about LEDCs. #covidmarathon

Check out this resource from @WHO #FOAMed #FOAMcc #covidmarathon

Prof. Bin Du from Peking, China - updates us on #COVID19 in his region. #covidmarathon

How do we manage these patients? #covidmarathon China's perspective. #COVID19 #FOAMcc

Failure to prepare is preparing for failure... #covidmarathon

Italian population older than Chinese population. Case-Fatality-Rate is similar up to 70yo amongst both populations. Testing numbers (denominators) are also different. #COVIDmarathon

Pre-crisis bed capacity in Lombardy, Italy was 750 beds.... now it's 1650.. in this one region alone. #COVIDmarathon The network was completely reorganised.

These are the current numbers from Lombardy in Italy... #covidmarathon #COVID19

A clear message from Italy to the rest of the world - GET READY. #COVID19 #COVIDmarathon

What does the data from Italy say? Here are the presentation characteristic %s. We also have seen: 81% MILD disease, 14% SEVERE disease, 5% CRITICAL disease. #covidmarathon

Looking at typical CXR and CT Scans... #covidmarathon

Massive proportion of MEN vs women are affected. The greatest number of patients are >61 years of age - but it is definitely seen in younger cohorts too. #covid19 #covidmarathon

Data analysis of the Italian Networks. Comorbidities and Respiratory Support Characteristics #COVIDmarathon #COVID19

Outcomes as on the 25th March 2020. Italian Network Data. #COVID19 #covidmarathon

Hypertension was a big risk factor for disease severity. #COVIDmarathon #COVID19

In the retrospective study from the Italian ICU Network... #COVID19 #covidmarathon

Varied and evolving statistics since January 2020 - for ICU, Mortality and Death #covidmarathon

Quality of data is difficult in an evolving picture. Mortality does NOT describe the complexity of the clinical picture. Kaplan Meier Analysis may prove more useful. #covid19 #covidmarathon

"Anecdotally, in clinical practice >30% of patients are getting steroids" - the evolving clinical picture is very complex. It is likely that pharmacotherapy's role is limited at best. #COVID19 #COVIDmarathon

Learning from SARS and MERS. This our 3rd Coronavirus outbreak in the past 2 decades. The virus lineages are similar. SARS, MERS and COVID19 are related. #covidmarathon #covid19

Currently, there is inter-country variability in severity: #covidmarathon

Comparing #COVID19, MERS and SARS - all share ARDS as a main feature. The mortality is quite similar in MERS v COVID19 - but infectiousness is also different... Also the pathology.... #covidmarathon

A closer look at MERS... #covidmarathon

?ECMO for MERS/SARS? #covidmarathon #covid19

Evidence isn't looking good for steroid use in #COVID19 (but SSC has loose recommendations for their use) more evidence awaited. #covidmarathon

Confounding studies have looked at antivirals in older coronaviruses: #covid19 #covidmarathon

Median time from symptom onset to enrolment was late in this study. ?is there a role for antivirals at an earlier stage?

18% of MERS patients had bacterial co-infection and 5% viral co-infection. SARS was quite similar. Consider abx in your patients. #covid19 #covidmarathon

Can we learn from MERS? EARLY suspicion and high IPC precautions = major target for us. Take it seriously from the beginning. Proper triage, proper places for patients to be. STRICT infection control. Low thresholds of suspicion. Pre-test probability is VERY HIGH. #covidmarathon

@Lennie333 reminds us about why we need to #FlattenTheCurve #covidmarathon The basics haven't changed in >100 years! #COVID19

For every one person who has #COVID19 - they might infect 3 people... this gives an exponential spread. To stop this - we need to drive the R0 down as low as possible. @Lennie333