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#COVID19 for the Nephrologist- Real life experience from Italy @caioqualunque Webinar now available on the ISN Academy
@caioqualunque Thank you for sharing your experience with the ISN community. On the panel ISN President @vjha126 Moderator @arvindcanchi. ISN education highlights by @gag_aggarwal
@caioqualunque STORY OF THE EPIDEMIC-Feb14 38yr old Italian starts with symptoms after being asymptomatic for weeks->Feb 20 only 3cases->fast forward to 2 weeks later the country is in lockdown #COVID #COVID2019italia #COVID2019india #COVID2019 #nCoV2019 #Covid_19
@caioqualunque STORY OF THE EPIDEMIC UNFOLDS-Feb14 38yr Pt1 led an active social life,asymptomatic for weeks->Symptomatic,seen by GP->Feb16 went to hospital with resp prob,no precautions taken,infected healthcare workers and patients #COVID #COVID2019italia #COVID2019 #Covid_19
@caioqualunque One Asymptomatic patient becomes a SUPER SPREADER, if not quarantined. Super spreaders are amongst us right now! #COVID #COVID2019italia #COVID2019india #COVID2019 #nCoV2019 #Covid_19
@caioqualunque Most COVID19 admitted to ICUs.50% of all ICU beds currently used by COVID19pts. Huge healthcare burden #COVID #COVID2019italia #COVID2019india #COVID2019 #nCoV2019 #Covid_19
@caioqualunque Only Symptomatic patients being identified and tested for COVID19 in Italy #COVID #COVID2019italia #COVID2019india #COVID2019 #nCoV2019 #Covid_19
Acc to WHO-SUSPECT COVID19 ->Acute Resp illness+H/OTravel/ contact w confirmed/probable case OR Severe Respiratory infection req hospitalistn+No other explainable etiology #COVID #COVID2019italia #COVID2019india #COVID2019 #nCoV2019 #Covid_19
CONFIRMED COVID19->positive test;
PROBABLE COVID19->inconclusive testing CONSIDER->HRCT Chest, RT PCR #COVID #COVID2019italia #COVID2019india #COVID2019 #nCoV2019 #Covid_19 #WHO
PROBABLE COVID19 for Nephrologist;In ESRD-> HRCT Chest may show vol overload/Ground glass opacities, RT PCR may have potentially high false negatives #COVID #COVID2019italia #COVID2019india #COVID2019 #nCoV2019 #Covid_19
87% affected COVID19 are between 30-79 yrs. Similar reports from Italy and China #COVID #COVID2019italia #COVID2019india #COVID2019 #nCoV2019 #Covid_19
@caioqualunque COVID19-clinical features different in ESRD, GI symptoms esp diarrhoea common, noticed fever higher than previously reported in affected pts #COVID #COVID2019italia #COVID2019india #COVID2019 #nCoV2019 #Covid_19
@caioqualunque COVID19-18% of infected had CKD3-5 (single centre experience), not particularly higher than expected acc to general prevalence of CKD in the popltn #COVID #COVID2019italia #COVID2019india #COVID2019 #nCoV2019 #Covid_19
@caioqualunque COVID19 Commonly noticed lab findings-Lymphopenia seen(not as commonly as reported from China),reduced Eosinophil count,High LDH,?Divergence between CRP&PCT #COVID #COVID2019italia #COVID2019india #COVID2019 #nCoV2019 #Covid_19
@caioqualunque COVID19 Diagnosis-nasopharyngeal swabs-1 test is NOT ENOUGH, repeat test within 72hrs #COVID #COVID2019italia #COVID2019india #COVID2019 #nCoV2019 #Covid_19
@caioqualunque 86.2% of COVID19 patients have abnormal HRCT. Difficult to interpret in ESRD-When in doubt get Basal CXR rule out vol.overload/pl effusions(not commonly seen in COVID19) #COVID #COVID2019italia #COVID2019india #COVID2019 #nCoV2019 #Covid_19
COVID19 co infections are relatively common upto6%. Acc to @caioqualunque testing for other viruses was a mistake. unnecessary and risky for nurses to collect samples #COVID #COVID2019italia #COVID2019india #COVID2019 #nCoV2019 #Covid_19
@caioqualunque Complications of COVID19- AKI ->4%,about half required CRRT; Italian experience->AKI similar in ICU vs Non ICU (?bias-mostly younger pts got beds in the ICU) #COVID #COVID2019italia #COVID2019india #COVID2019 #nCoV2019 #Covid_19
@caioqualunque COVID19 Leading cause of Mortality Respiratory failure, followed by ?myocarditis/myocardial damage #COVID #COVID2019italia #COVID2019india #COVID2019 #nCoV2019 #Covid_19
@caioqualunque In Italy Mean age of COVID19 Deaths~80 yrs, had higher burden of co morbidities;second most common comorbidity was CKD(18%) #COVID #COVID2019italia #COVID2019india #COVID2019 #nCoV2019 #Covid_19
@caioqualunque asks doctors in the remaining world the important question 'Are you ready to change in the face of this epidemic?' #COVID #COVID2019italia #COVID2019india #COVID2019 #nCoV2019 #Covid_19
@caioqualunque Handling COVID19-Move fast, Develop a strong team, Change ur practice and Reorganise your work before its too late #COVID #COVID2019italia #COVID2019india #COVID2019 #nCoV2019 #Covid_19
@caioqualunque TIPS for Docs-Reduce routine Outpatient work to mobilise workforce, opt for TeleHealth/phone services, avoid pt exposure to infection by reducing hospital visits #COVID #COVID2019italia #COVID2019india #COVID2019 #nCoV2019 #Covid_19
To prevent infection in HD PATIENTS- Screen everyone, Mandatory surgical masks from Home to Home, PPE for nurses #COVID #COVID2019italia #COVID2019india #COVID2019 #nCoV2019 #Covid_19
@caioqualunque COVID19-Ensure HD possible in isolation wards. Also Reserve some HD beds for COVID +ve dialysis patients! #COVID #COVID2019italia #COVID2019india #COVID2019 #nCoV2019 #Covid_19
COVID19-Personal Protective equipment for healthcare worker when dealing with a positive patient must include #COVID #COVID2019italia #COVID2019india #COVID2019 #nCoV2019 #Covid_19
@caioqualunque COVID19 Treatment in ESRD pts #COVID #COVID2019italia #COVID2019india #COVID2019 #nCoV2019 #Covid_19
COVID19 Kidney Transplant patients- STOP MMF, STOP CNI, increase dose of Pred; suggests @caioqualunque from Italian experience #COVID #COVID2019italia #COVID2019india #COVID2019 #nCoV2019 #Covid_19
@caioqualunque COVID19 Treatment-Use TOCILIZUMAB Max 3 infusions 8mg/kg (12-24 hrs apart) #COVID #COVID2019italia #COVID2019india #COVID2019 #nCoV2019 #Covid_19
@caioqualunque COVID19 To Steroid or Not to Steroid ?Methylprednisolone may help controlling symptoms #COVID #COVID2019italia #COVID2019india #COVID2019 #nCoV2019 #Covid_19
@caioqualunque COVID19 AKI-Role of Cytosorb/Oxiris?
Tip- Modify your prescription to limit contact of dialysis nurse with patient and machine.Regional Citrate Antic. may warrant repeated contact, hence Heparin was used #COVID #COVID2019italia #COVID2019india #COVID2019
@caioqualunque Many centres in Italy- HD/Nephrology wards had to be converted to COVID wards with nephrologists doubling up as generalists to manage the crisis #COVID #COVID2019italia #COVID2019india #COVID2019 #nCoV2019 #Covid_19
@caioqualunque “Dealing with COVID19 has been a life changing experience! It is unprecedented, and nothing can prepare you for it” #COVID #COVID2019italia #COVID2019india #COVID2019 #nCoV2019 #Covid_19
@caioqualunque Italian lessons with COVID19- felt shortage of ventilators, ICU beds, ICU doctors and nurses. Nurses from dialysis were called back to ward and icus, leading to shortage in HD units #COVID #COVID2019italia #COVID2019india #COVID2019 #nCoV2019 #Covid_19
@caioqualunque “COVID19 reminded all of us- Our hospital is our family.We try and support each other everyday. We are all in this together” #COVID #COVID2019italia #COVID2019india #COVID2019 #nCoV2019 #Covid_19
@caioqualunque Some COVID19 patients exhibit Sub nephrotic Proteinuria and Macroscopic hematuria. But collect and test Urine samples cautiously, as Urine is infected #COVID #COVID2019italia #COVID2019india #COVID2019 #nCoV2019 #Covid_19
@arvindcanchi asks How do u go back safely to your family? @caioqualunque recommends-throw the disposables, scrubs at the hospital, create a decontamination area at entrance of home, use sanitiser #COVID #COVID2019italia #COVID2019india #COVID2019 #nCoV2019 #Covid_19
@caioqualunque Don’t rely too much on the COVID19 RT PCR, if the suspicion is too strong. False negative could spread the infection, esp in HD/high risk patients #COVID #COVID2019italia #COVID2019india #COVID2019 #nCoV2019 #Covid_19
@vjha ISN President, @arvindcanchi, #Nephtwitter thanks @caioqualunque for sharing his experience with us and his invaluable guidance in handling COVID19 #COVID #COVID2019italia #COVID2019india #COVID2019 #nCoV2019 #Covid_19
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Josh Swihart
@jswihart
This thread is my story battling symptoms this last week. They started differently than what has been reported, which caused some confusion and later fear, and might have led to other's exposure. I believe there are a things we (collectively) can do to better combat #COVID
My wife (Melody) and I were exposed to someone that was sick and in our home a few days before we started seeing symptoms. Melody developed a mild fever, headache and was nauseous a little over a week ago. She also had digestive issues.
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Anthony Costello
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My longish thread on the Academy of Medical Science News Briefing with Sir Patrick Vallance and Prof Chris Whitty last night, and the London School of Hygiene and Tropical Medicine Global Health Lab chaired by Richard Horton and Prof Martin McKee. panopto.lshtm.ac.uk/Panopto/Pages/… (1)
The News briefing. Medics/scientists are used to robust debate. It should not descend into personal abuse. For example, I’m happy to be told I’m ‘utterly wrong’ and to debate about strategies. Debate is the essence of evaluation and finding a way forward. But no abuse.(2)
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Participating in an intern'l webinar with the Chinese Cardiology Association to discuss lessons learned with #COVID-19. Learning from our colleagues. Helping us to prepare. Teamwork. @ACCinTouch #ACCIntl All welcome. From 8-10 EDT. Today March 18.heartm.docbook.com.cn/#/meeting_noti… #COVID19
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To our @Grubhub community,

I wanted to personally connect with you about the actions we’re taking to help you, our restaurant partners, and our drivers, to ensure the health and safety of everyone while supporting our entire community.

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Alex V
@altryne
The whole world is learning the meaning of staying home for prolonged periods of time. For a lot of them, it will give them time to familiarize with new technology they haven't needed before. Prediction thread.
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Chicago Community Bond Fund
@ChiBondFund
This is a thread about why it is absolutely essential that we get people out of jails, prisons, & immigration detention during the #COVIDー19 pandemic. It will include information & demands for how to #StopCOVID19inJails .

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This piece by @premaldharia explains how #COVIDー19 could spark a humanitarian crisis inside prisons and jails. slate.com/news-and-polit… #StopCOVID19inJails
Jails and prisons are the perfect incubators for #COVIDー19. Health care in these facilities is often abysmal. This article from @nhbaptiste explains what jails and prisons should be doing to improve access to healthcare. motherjones.com/politics/2020/… #StopCOVID19inJails
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