THREAD
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.
Read.
thelancet.com/action/showPdf…
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.
Read.
thelancet.com/action/showPdf…
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.
137 survived (72%), 54 died (28%)
Remember- these are people sick enough to need a hospital, but still. Wow.
3/
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.
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.
4/
-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.
-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.
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.
6/
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.
jamanetwork.com/journals/jama/…
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.
jamanetwork.com/journals/jama/…
7/
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.
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%
jamanetwork.com/journals/jama/…
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%
jamanetwork.com/journals/jama/…
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.
#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.
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
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.
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
