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#CoronaChronicles Week one: CDC recommends N95s, disposable gowns, AIIR for all pt care. NP swab = aerosol generating procedure, collect only in an AIIR (airborne infection isolation room) @CDCgov Thread
#CoronaChronicles Week #12 After mass panic has depleted supplies of N95s, surgical masks, gowns, CDC recommends - bandanas/scarf as PPE for healthcare workers @SHEA_Epi @nytimes @eliowa @JInterlandi @VP @SecAzar
Thread #3This would be funny, if it weren’t so tragic. HCWs deserve better. I fear for my friends in hospitals in the United States who are caring for COVID pts. @dr_dmorgan @CDCDirector @h_babcock @IDdocAdi @CarlosdelRio7
Meanwhile the airline industry is being “powerfully supported”. How about increasing production of gowns, gloves, masks? Remember when China built a 1000 bed hospital in 6 days?
People will die of COVID in the coming days, weeks and months. Some of them will be healthcare workers. @SHEA_Epi @Apic you are failing us. This could be your finest hour. Please act now!
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More from @PSampathkumarMD see all

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Priya Sampathkumar
@PSampathkumarMD
The @CDCgov advice on PPE was problematic during H1N1, but they did eventually provide decent advice. With #COVID19 the CDC has failed us. This has made the job of hospital epidemiologists very difficult. Let me explain. Thread
@SHEA_Epi @CarlosdelRio7 @ASlavitt @JInterlandi
Problems with US response
1) Failure to acknowledge the magnitude of this threat at the very highest levels of government.

2) Lack of availability of testing in the early stages when containment was possible.
3) Impeding private labs (including direct threats) from developing and using their own tests. @DrMattBinnicker

4) Political manipulation of epidemiology /numbers in the early stages to make things appear better than they were. This has caused the virus to spread to all states
Read 6 tweets

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Ashley & Brooke Barlow PharmD
@theABofPharmaC
🚨 New Guideline Published 🚨

Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with COVID19 🦠

Tweetorial on key clinical recommendations 👇🏻#CCM #ICM #COVID19 @ESICM @SCCM @CritCareMed
1️⃣COVID19 Testing in the ICU 🔬

➡️If pt is intubated, lower respiratory tract samples preferred > upper respiratory tract 🧫

➡️➡️Lower respiratory samples, prefer endotracheal aspirate >> bronchial wash or bronchoalveolar lavage 🧪
2️⃣Infection Control in the ICU

✅Recommend video-guided laryngoscopy for intubation

✅Aerosol-generating procedure➡️ require a negative pressure room & HCPs should wear fitted respirator masks + PPE

✅Non-ventilated OR non-aerosol-generating procedure➡️ med/surg masks + PPE
Read 8 tweets
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Depth of Anesthesia Podcast
@DepthAnesthesia
Starting a rolling thread reviewing some of the literature on risks of respiratory virus transmission in the health care setting.

We must take care of ourselves so that we can take care of others.

#COVID19 #PPE #medtwitter

1/
A fair amount of the literature is from the SARS and MERS outbreaks. I think some of the lessons, especially pertaining to the unique risks to healthcare workers and PPE management, continue to apply.

2/
Data from SARS in 2003 suggested that nosocomial transmission accounted for 72% of cases in Toronto and 55% of probable cases in Taiwan.

Of the cases, 44% in Toronto and 18% in Taiwan were in healthcare workers.

ncbi.nlm.nih.gov/pmc/articles/P…

3/
Read 23 tweets
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Ayman Hossam Fadel
@aymanfadel
Thread on #Georgia @GaDPH Mar 13 Interim Guidance for Clinicians Evaluating, Reporting, and Requesting Diagnostic Testing for Possible #COVID19 Cases #coronavirus #publichealth. Original document available at dph.georgia.gov/document/docum…. I've archived it here drive.google.com/open?id=1QKgAt…
Let me preface this by saying I have no medical training or special knowledge. I urge those who can to correct anything I get wrong here.

My main concern is that it remains difficult to get #COVID19 testing. People who are reluctant to take other #publichealth measures such as
social isolation frequently say things like "There are no confirmed cases in our area." IMO, that's true because too few people have been tested. So let's examine the document.
Read 18 tweets
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Dr Amit Pawa
@amit_pawa
Wow - incredible work from the @AAGBI producing a webinar on #COVID19 & what we need to know on the frontline.

I have put some of my take home points together in a thread.
Bottom line- I am genuinely worried about what lies ahead, and it is clear, we are not ready for this yet
1. PPE - there are national variations & inconsistencies. Intubation is an Aerosol Generating Procedure (AGP) - maximal protection should be used - what is that though?

2. What drugs are we going to use?
Propofol & Alfentanil vs Isoflurane?
Will we have enough?
3. Equipment- we need more infusion pumps, ventilators, NIV/CPAP machines. Per hospital or Central for redistribution?

4. We are NOT ready. We need to be prepared. We have up to 15 days to get ready

5. Do we need CT scans for diagnosis in all patients? It is NOT practical
Read 13 tweets
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👩🏻‍⚕️Hi, I’m Dr Chen and older than I look
@Chenbariatrics1
1/ Notes from the front lines:
#Sharing from another physician:

From an ID conference in California

3/8/2020

Infectious Disease Association of California (IDAC) Northern California Winter Symposium on Saturday 3/7.
2/
In attendance were physicians from Santa Clara, San Francisco & Orange Counties who had all seen and cared for COVID-19 patients, both returning travelers and community-acquired cases. Also present was the Chief of ID for Providence, who has 2 affected Seattle hospitals.
3/
Erin Epson, CDPH director of Hospital Acquired Infections, was also there to give updates on how CDPH and CDC are handling exposed health care workers, among other things. Below are some of the key take-aways from their experiences.
Read 22 tweets
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Brittany Bankhead-Kendall
@BKendallMD
Found this info very helpful about #COVID19. Not my own; paraphrasing from Physician Moms in Massachusetts Group via Martha Blum, MD PhD, & Women in Critical Care Medicine groups. Would be helpful for PCP’s, ER docs, & Critical Care/intensivists.
#medtwitter
(thread⬇️)
“Most common presentation is 1wk prodrome myalgia, malaise, cough, low grade fevers leading to more severe trouble breathing in the second week of illness. Avg 8d. to dev. of dyspnea and avg 9d. to onset of PNA/pneumonitis. (not like Influenza with classic sudden onset)
Fever was not very prominent in several cases.Most consistent lab finding was lymphopenia (with either leukocytosis or leukopenia). Most consistent radiographic finding was bilateral interstitial/ground glass infiltrates. Aside from that,other markers (CRP, PCT)were inconsistent
Read 12 tweets

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