Thread by @EpsilonTheory

Please read and RT.

I’m going to relay this correspondence with an Alabama radiologist as a Twitter thread.

It’s a crowded field, but no state gov’t has handled CV-19 more pathetically than my home state of Alabama. It's been total #DontTestDontTell.

epsilontheory.com/tick-tock/

"Ben, XY here. Radiologist at [hospital] in [small AL town] and [medical center] between B'ham and Montgomery. I could write a tome but neither of us has time! Thought I would share a few anecdotes.”

“Monday March 9. 50 yo patient smoker, recent travel, copd, coughing, was intubated, classic ground glass and consolidation changes on CT. State (ADPH) came out the next day and told hospital administration, "No need to test, didn't meet criteria." WTF. Who the heck is then?”

“Weds March 11, 35 yo pt with preexisting condition, intubated, 2 wk history of coughing so much she had post-tussive emesis. CT classic changes for covid. called ICU to alert. Friday 13th I hear the patient tested negative. Possible, but has me wonder about FALSE NEGATIVES.”

“Midnight last night, another classic case.

It is here.”

Q: What protocols are you examining these patients under?

“Droplet spread from the ER, for those with pretest probability. CT Techs gown up etc and CT room is closed down for 1.5 hours for deep clean afterward. We then use our second scanner in another part of the hospital.“

“But I am certainly worried about someone asymptomatic being scanned. Then the scanner becomes the source of future infection like the Broad Street well in London causing the cholera epidemic. After all, the sickest patients in the hospital use the scanner on a daily basis.”

“A known inpatient case would be droplet spread. There are no negative pressure CT exam rooms that I am aware of if that is what you are asking.

Most covid patients don't get CT scanning and that is what I am pushing for. Just test and treat.”

“But even [small hospital] has decent protocol with environmental services cleaning the entire room and 24 hour infectious disease nurse having a playbook to identify all contacts and ensuring cleaning.”

What’s my takeaway from this?

The doctors get it. The hospitals get it. The people who do NOT get it are the politicians, and they have real power over the doctors and the hospitals through policy (what is allowed) and resources (what is possible).

This is not just an Alabama thing.

We must REQUIRE our politicians at every level – local, state and national – to change their policies and increase their resources for our hospitals and healthcare prof’ls.

If we do that, we win. If we don’t, we lose. It’s that simple.