*THREAD*
1/ I think that information transparency is one of the most important things we can provide during the #COVID19 outbreak.
To help, I am going to share where "experts" are getting some of the big numbers/data so that people can go read it for themselves.
1/ I think that information transparency is one of the most important things we can provide during the #COVID19 outbreak.
To help, I am going to share where "experts" are getting some of the big numbers/data so that people can go read it for themselves.
2/ The first big numbers are the 81/14/5.
81% of cases are MILD
14% are SEVERE
5% are CRITICAL
The other big number: 2.3% case fatality rate
These numbers are from the Chinese CDC. They were published in @JAMA_current Feb 24th. They are available here: jamanetwork.com/journals/jama/…
81% of cases are MILD
14% are SEVERE
5% are CRITICAL
The other big number: 2.3% case fatality rate
These numbers are from the Chinese CDC. They were published in @JAMA_current Feb 24th. They are available here: jamanetwork.com/journals/jama/…
3/ Some of these %ages are likely OVERESTIMATES. This is because we are less likely to catch MILD or asymptomatic cases early in an epidemic. So, rather than 5/100 (5%) being critical, it may actually be 5/200 or 5/2000-- we just don't fully know yet.
4/ The same holds true for the Case Fatality Rate (CFR) of 2.3%. Rather than 2.3 deaths per 100 patients that contract #COVID19, it may be 2.3 per 200 or 2.3 per 2000-- we just don't know yet, but we have lots of reason to believe it is less than 2.3%.
5/ This study is also where the higher CFRs in the elderly & those w/ comorbidities comes from. Those who were:
-70-79 years of age had a CFR of 8%
-older than 80 had a CFR of 14.8%.
-diabetes, COPD, heart disease had CFR b/w 6-10%
Again, likely over-estimates for same reasons
-70-79 years of age had a CFR of 8%
-older than 80 had a CFR of 14.8%.
-diabetes, COPD, heart disease had CFR b/w 6-10%
Again, likely over-estimates for same reasons
6/ Important studies on ASYMPTOMATIC carriers-- you have #COVID19; you don't have symptoms.
This @NEJM study showed this in German travelers who screened negative by symptoms, but 2 had positive PCR tests by throat swab.
nejm.org/doi/full/10.10…
This @NEJM study showed this in German travelers who screened negative by symptoms, but 2 had positive PCR tests by throat swab.
nejm.org/doi/full/10.10…
7/ Expanding on this, these studies showed that you indeed can still *spread* it without any symptoms at all
- @JAMA_current study showed this in a family in China jamanetwork.com/journals/jama/…
-@NEJM paper showed this in a Chinese businesswoman visiting Germany nejm.org/doi/full/10.10…
- @JAMA_current study showed this in a family in China jamanetwork.com/journals/jama/…
-@NEJM paper showed this in a Chinese businesswoman visiting Germany nejm.org/doi/full/10.10…
8/ As doctors, concerning to us is the level of needs in hospitalized patients + rapid spread w/in the hospital
-This @JAMA_current study 138 hospitalized patients showed that 26% needed the ICU. They were older & had co-morbidities.
-Nearly half of ICU required ventilators.
-This @JAMA_current study 138 hospitalized patients showed that 26% needed the ICU. They were older & had co-morbidities.
-Nearly half of ICU required ventilators.
@JAMA_current 9/ 57 out of the 138 patients were already in hospital; 40 were healthcare workers.
Link: jamanetwork.com/journals/jama/…
This @NEJM study even larger- 1099 hospitalized patients. 5% required the ICU. The CFR= 1.4%. Surprisingly only 43% had fever on admission
nejm.org/doi/full/10.10…
Link: jamanetwork.com/journals/jama/…
This @NEJM study even larger- 1099 hospitalized patients. 5% required the ICU. The CFR= 1.4%. Surprisingly only 43% had fever on admission
nejm.org/doi/full/10.10…
10/ Also, questions of who is infectious, how infectious, and for how long? We know from this
@NEJM paper that asymptomatic patients can have quite high viral loads; & these are highest early on.
nejm.org/doi/full/10.10…
@NEJM paper that asymptomatic patients can have quite high viral loads; & these are highest early on.
nejm.org/doi/full/10.10…
11/ And this @JAMA_current paper showed that the rt-PCR can actually remain positive for quite a while afterwards- sometimes even after 2 negative rt-PCRs. This doesn't *necessarily* mean you have active infection or that you're still contagious to others
jamanetwork.com/journals/jama/…
jamanetwork.com/journals/jama/…
12/ Ah and one more-- the R0 (average # of people 1 infected person will spread the disease to). Early on, this came from
@NEJM
paper on transmission dynamics. -They estimated R0 = 2.2. -They estimated a doubling time of 7.4 days. The paper is here:
nejm.org/doi/10.1056/NE…
@NEJM
paper on transmission dynamics. -They estimated R0 = 2.2. -They estimated a doubling time of 7.4 days. The paper is here:
nejm.org/doi/10.1056/NE…
13/I share these to say: The data is out there. It is publicly available. You should go read it. If you don't understand it, there are many people happy to help you. We all have different interpretations of what is most important from these papers. Many more are coming out daily.
14/ There are a lot of "experts" claiming a lot of things. What I will say is *go to the data*. The data is what you can trust. Everything else is what people are interpreting/hoping/fearing. Even this thread is my interpretations of these studies. But the links are there for you
15/ Link to thoughts from yesterday on why young, healthy people w/ mild symptoms should avoid emergency rooms. This will help contain epidemic growth, and minimize spread to the elderly & vulnerable. Read thread-->
.@threadreaderapp unroll
