Thread by @JSchuurMD

How much should the State of R.I. prepare for #COVID19 surge?

this is an important debate.

I am an ER doc and chair. I am conservative when planning. We should be prepared for a surge. But how big will surge be?

Important bc #NYC needs resources now
1/

There is difference between models: @IHME_UW vs. model used by @RIHEALTH
Both predict peak in 2-3 weeks
@IHME_UW predicts ~850 hospitalized pts
@RIHEALTH predicts many fold more hospitalized pts
2/

here is @IHME_UW model for RI
3/
covid19.healthdata.org

key assumptions of @IHME_UW model:

-model based on death rates not +cases (death is a lagging indicator, but RI had first case on 3/1 - same as NY)
-social distancing works 100% (we know it doesn't)
-testing doesn't influence model
model FAQs
4/
healthdata.org/covid/faqs

@RIHEALTH models summarized by @GovRaimondo on 4/4
“We’ve more than doubled our rate in hospitalizations this week. Were that to continue, you can imagine very quickly going from 97 to 2000 or more. I’m not saying we will, but we have modeling we could go much higher.”
5/

“I do foresee using 2000 field beds,” said @GovRaimondo when asked. “Our mission is to prepare for the worst. Our hospitals will be overwhelmed. That’s what we know will happen."
6/

“There will be thousands of people in the hospitals in Rhode Island in the months to come. Whether that’s 3,000, 4,000, 5,000, or 6,000 depends on whether the people of Rhode Island continue to obey the social distancing rules,” said @GovRaimondo
7/
golocalprov.com/news/ri-hospit…

Who is correct?
What data do we have?
Why does it matter?
8/

are we seeing spike in influenza-like illness? this is a "leading indicator"
No.
here is CDC ILI tracker
9/
gis.cdc.gov/grasp/fluview/…

here are RI ILI cases vs. NE and U.S.
Everywhere else ILI cases are rising
*?? how accurate data are bc docs offices are closed...but ERs are open, and other states also have doc office closures.
10/

health.ri.gov/data/flu/index…

Current hospitalizations for #COVID19 in RI.
This is a lagging indicator (1w+ from infection until hospitalization)
Going up, but linear or exponential???

You can fit either curve to this.
11/

Cases in R.I. -- going up.
This is lagging indicator. Also not a perfect sample, as testing is scattered, focused on the most ill, not random and widespread.
Again can fit linear or exponential curve to these data.
12/

lots of unknowns:
-how well is social distancing working? we see pics of people on beaches, & also know most businesses shut
-will movement of people from out of state create new hotspots? (yes, NYC mainly, and I am from NYC originally, so only love for the big Apple)
13/

First, this is NOT a comment on social distancing. @GovRaimondo has been a leader in getting ahead on this and w/ clear communication. Listen to her!
PLEASE #StayHomeSaveLives
Stay home so our hospitals will not be overwhelmed!
14/

Second, I am not criticizing @RIHEALTH numbers or @GovRaimondo guidance on preparing.
Have been impressed with leadership and collaboration.
Understand reason to be conservative. Once the surge happens -- to late to create hospital beds or obtain vents, see NYC.
15/

Why does this matter? We are competing for limited resources: vents
Better to over-prepare, than under-prepare.
But how will we feel if NYC runs out of vents in 2 days and we never use some of our vents in 2 weeks?
p.s. @OregonGovBrown sent NYC 100+ vents yest
16/

This is one more reason that lack of federal leadership & coordination is so harmful. States figuring this out on our own, competing for scarce resources will harm people.
17/

I don't have the answer.
Just trying to work through an important topic worthy of more data, more models, & public debate.

fin/

@threadreaderapp roll-up

Today's updated RI Hospitalizations (4/5/2019)
+10

looks linear

one more data point. @kinsa smart thermometer data

we look "hotter" than the CDC ILI tracker...
healthweather.us --

Data for today 4/6

+6 hospitalizations

@IHME_UW model updated.

RI peak pushed back to 4/27
Hospital needs doubled!