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1/ @Lancet paper out yesterday examining patients from Wuhan admitted to the hospital who met endpoint of either making it to discharge or dying. Some thoughts.

For new followers, I like data. Opinions are cool too, but data is better.

2/ 191 patients met criteria for inclusion (they didn't include people who were still in the hospital being treated- only if you had died or survived to discharge).

137 survived (72%), 54 died (28%)

Remember- these are people sick enough to need a hospital, but still. Wow.
Median time from illness onset to discharge was 22 days; to death was 18.5 days.

32 of the 191 (17%) required a ventilator.

31 of the 32 on a ventilator died (97%).

ECMO used in 3 patients. None survived.

RRT used in 10. None survived.
-50 out of 191 were admitted to the ICU (26%)

-112/191 had sepsis (59%)

-38/191 had septic shock (20%)

-103/191 had respiratory failure (54%)

-59/191 had ARDS (31%)

The majority of these numbers are driven by those in the "died" group.
5/ I'm a global health physician before all else.

I've worked in wards in Sub-Saharan Africa, Asia, & Central America.

I've seen patients die on the floor w/o making it to a bed.

These numbers concern me.

It concerns me that 26% required an ICU.
In this @JAMA_current study from last month (138 patients), 26% required the ICU as well.

Still, rmr that needing the ICU is different depending on where you are.

@BrighamWomens needing the ICU likely more severe than needing it in the community.…
But needing a ventilator is usually not that different.

Any other disease in which 17% of the people you admit will end up on a ventilator is something that any doctor would take very seriously.
Still, these numbers are still quite small; n just in the 100s.
8/ The Chinese CDC data was not though. That was 72k pts.

Where the 15% severe/5% critical #s came from. Those were from TOTAL pts, not just hospitalized

If we guesstimated only the severe/critical were hospitalized, & only severe were ICU--> 5/20-->25%…
9/ I share these numbers w/ the same conclusion.

#Socialdistancing is our shot to #FlattenTheCurve

To buy ourselves more time.

To make sure we have hospital/ICU/ventilator capacity if we get pushed to that.

Become experts in it.
10/ If nothing else, we saw that China-- the first place hit with #COVID19-- was able to get this under control (thread).

They reorganized their entire society.

We have the benefit of learning from other countries.

We must unite, and do this right.

11/ And remember that if this actually works-- if we don't get hit hard w/ #COVID19 after we do implement hard-core #socialdistancing & personal hygiene measures, it's not because COVID19 wasn't real.

It's because prevention was real. #FlattenTheCurve

12/ Before I clicked tweet on this thread, I had to look at the numbers one more time.

This is my 14th straight hour of work and I actually thought maybe I imagined some of these.

But they are real. All of this shit is real.
13/ Lots of people asking about comorbidities/risk factors/ China+smoking/ fact that much sicker people end up in limited hospital beds later in epidemics; there are many other factors- why I’ve included link to the paper. Despite all of these, it still caught my eye! #Covid19
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