Thread by @vivianleemd

Given all the news, I thought I'd organize what I've learned #COVID19 in a tweet thread (bear w me)
1. Uncertainty: We don’t really know how many cases we have in the US because we haven’t tested people. The testing shortages and why: theatlantic.com/health/archive…

2. Based on the tests we have done, the curves that we are seeing for the US are following those of the worst-case scenarios—much more like Italy, China and Iran, than, say, Hong Kong or Singapore (see #5). ourworldindata.org/grapher/covid-…

3. This resource from @JohnsHopkins is providing real-time world-wide updates: coronavirus.jhu.edu/map.html

4. How much should we focus on testing? It’s complicated-the sensitivity of testing is POOR. One (non-peer-reviewed Chinese) study showed sputum = 75-89% sens, nasal swabs 54-73% sens, and multiple cases with positive chest CT scan but negative lab test. medrxiv.org/content/10.110…

4. cont The problem with a low sensitivity test is that people think they’re fine, stop social distancing, and end up spreading the disease more. Still, for public health planning, it's important to test. Here's the @CDCgov site on # of test sites. cdc.gov/coronavirus/20…

5. The main things that make a difference in curbing the epidemic? This @Lancet article (HK, Singapore, Japan) and @JAMA_current article (Taiwan) highlight how readiness makes a difference. What did they do right? They prepared.
thelancet.com/journals/lance…
jamanetwork.com/journals/jama/…

6. Why social distancing is considered the main strategy of prevention at this point? With no vaccine or approved drug treatment, this PNAS study on the 1918 Influenza pandemic (Figure 1) tells the story pnas.org/content/pnas/1…

6. Cont'd @AriadneLabs translates #SocialDistancing into practical tips @Atul_Gawande
medium.com/@ariadnelabs/s…

7. Who gets sick and how? New info daily. This site tracks world wide data.
Fever, dry cough, and fatigue are most common. Some also have muscle pain, headache, nausea/vomiting, and diarrhea. First 12 US cases described here.
ourworldindata.org/coronavirus
medrxiv.org/content/10.110…

8. What is the likelihood of dying of #covid19? Summary of 72,314 cases in China in @JAMA_current. Case fatality rate there 2.3% (14.8% of those 80 and over). Most cases *87%) were 30-79 yrs. In Wuhan 63% of health care personnel became infected. jamanetwork.com/journals/jama/…

9. The @GileadSciences drug in trials is remdesivir (originally developed for Ebola). Has been distributed on a “compassionate use” basis to a few hundred patients & is in multiple clinical trials. Earliest results? April. Available for patients? Unknown.
scientificamerican.com/article/a-prom…

10. Telemedicine can help manage people outside of the hospital and reduce transmission—especially if supported by remote monitoring. And Congress is supporting payment for telemedicine in this emergency situation. aafp.org/journals/fpm/b…
Here's more nejm.org/doi/full/10.10…

11. Health care systems do not have the capacity to manage the current projected # of cases. Not enough beds, equipment and staff. A national ICU strategy is needed and we have to protect our healthcare workers. Some lessons from Italy: jamanetwork.com/journals/jama/…

12. If you're still reading this.. When we emerge from this crisis, we need to plan for a different response next time, starting w a public health strategy. @KBDeSalvo Until then, do what you can
#SocialDistance #PublicHealthMatters ajph.aphapublications.org/doi/10.2105/AJ…