Thread by @cleverwebber

OK! @ErinMcCreary and I have been giving weekly #COVIDー19 updates to the entirety of @UPMCnews. Until I figure out whether or not I can post the recording, here is a synopsis (thread follows). @IDPittStop @IDPittStop

Fever (defined as > 38C or > 100.4 F) in #COVIDー19 only happens in about HALF of cases. Do not rely on fever to rule #coronavirus in or out. The “more than 90 percent” data come from the papers from China, which defined fever as > 37.3—it’s in the methods!

Most (80% or so) have non-severe disease. Older patients are more likely to have severe disease. There's all this chatter about "comorbidities" (high blood pressure etc) being associated with severe disease, but tbh I wonder if this is just a signal of advanced age.

Symptoms of #COVIDー19 are completely nonspecific. It's just a viral illness with viral labs. There's been a lot of chatter on social media about loss of taste/smell: finally published! It happens. Not sure if this any different than other viruses.

People with severe #COVIDー19 disease are sick: lots of shock, ECMO, hypoxemia, and long, long LONG intubation times.

Testing! We need to stop asking "how sensitive is RT-PCR." These are not answerable questions at this time. If there's RNA there and the sample is collected well, your RT-PCR test is MOST LIKELY going to be positive.

Also, read the fine print of studies. Do NOT conflate “sample positivity” with “sensitivity.” Also, as compelling as the CT data are, I am not sure it’s prudent to be CTing these patients for diagnosis only.

What about antibodies? Sure, testing exists. Emerging data (much of it “noise”) suggesting a role in early disease, esp if paired with PCR. I liked this study from CID @IDSAInfo

Here's a list of #coronavirus PCR and antibody tests available in the USA. Proceed with caution:

fda.gov/medical-device…

fda.gov/medical-device…

Lots of chatter about #virus shedding and asymptomatic spread. Shedding goes on for a while, maybe up to 37 days (mostly 20?). Does that mean it's infectious? Probably not. People can spread #coronavirus without symptoms; all studies are small ("and here is a family of 7").

Here's a comparison with H1N1 #influenza. I thought #COVID would be worse. Maybe not enough time has passed.

I will end this #soapbox with a sobering series of maps from @CDCgov showing how quickly this has spread in just 2 weeks. #COVID2019 #COVID19US. #BeSafe

And finally:
-We know how it presents

This is what we need:
-GOOD diagnostics data
-robust epi on asymptomatic spread
-who are the young people who are dying?!
-BIG trials

Investigations must stop publishing small trials because these just create chaos and confusion.