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1/ Many lawmakers are citing preventing preventing "deaths of despair" (drug use, overdose, alcoholism, suicide) as the rationale to reopen prematurely. @meganranney & @drjessigold have written a must-read piece in @statnews addressing this. A thread 👇

statnews.com/2020/05/31/dea…
2/ First, while we have ample evidence of the impact of #COVID19 (>100,000 deaths, ~4x as many hospitalizations lasting 1-2 weeks, a lasting debility among younger adults that has yet to be quantified), we don't have any data yet on deaths of despair

3/ Second, the economic conditions that lead to deaths of despair tend not to be temporary. For example,
@atheendar found that it took 5 years after factory closures to see full impact on opioid overdoses
jamanetwork.com/journals/jamai…
4/ Third, there is a false assumption that reopening quickly, before the risks of #COVID19 transmission have sufficiently decreased, will lead to robust improvement. The problem is demand for shopping/travel/leisure/dining still lags while risks are there
ldi.upenn.edu/healthpolicyse…
5/ Fourth, the best thing we can do for the economy is to get the #CoronavirusOutbreak under control faster with robust public health measures

6/ Goal is to reduce unemployment to previous levels by 2 years from now. Fits and starts of reopening and closing while #COVID19 remains unchecked and business demand remains weak won't do that. If we beat #COVID19 faster, we reduce deaths of despair
7/ Fifth, as @meganranney and @drjessigold point out, these lawmakers who are now keen on addressing deaths of despair, where we were you before? Oh yeah, some of you were actually trying to make it harder for us to prevent deaths of despair
8/ As I've said before in @USATODAY, "we don’t have to pick between...deaths from coronavirus, or income loss and resulting deaths of despair. More aggressive public health measures and buy-in will prevent both and get us back to normalcy faster."
9/ To conclude, we all want the same thing to be healthy, secure, to be employed, and have a sense of normalcy. This bi-partisan statement in @USAToday on how to #OpenSafely shows us how to come together and get there the right way.

fin/

usatoday.com/story/opinion/…
Copying authors of the #OpenSafely statement: @ASlavitt @cmyeaton @T_Inglesby @EricTopol @DrLeanaWen
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M. Kit Delgado, MD, MS
@kit_delgadoMD
Appreciated the opportunity to comment on 2 excellent cohort studies led by @jLewnard (Kaiser) and @leorahorwitzmd (NYU) in @bmj_latest that give us a much better understanding of who gets sick from #COVID19. A thread putting this work into perspective👇

bmj.com/content/369/bm…
2/ Take away #1: It's not just the elderly who get sick.

Most who were hospitalized for #COVID19 were *under* the age of 65:
- 53% (n=1,452) in NYU cohort
- 60% (n=1,108) in Kaiser
3/ Take away #2: Those who were hospitalized spent 1-2 weeks in hospital. A trip to the hospital is no joke.

Median length of stay (75th percentile)
- NYU cohort: 7 days (13 days)
- Kaiser cohort: 10 days (17 days)
Read 11 tweets
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M. Kit Delgado, MD, MS
@kit_delgadoMD
1/ The focus on #COVID19 death rates neglects the fact there are 4x as many people who spend 1-2 weeks in the hospital. True, elderly die at much higher rates, but younger adults hospitalized at high rates. Of 2,741 hospitalized:
- Most (53%) were age<65
- 437 (16%) were age<45
2/ When looking at the 990 #COVID19 patients in this cohort who developed critical illness (ICU admission, intubated on life support, death, or discharge to hospice):
- 40% were age <65
- 91 patients were 19 to 44 years old
3/ And for those who think #COVID19 poses no risk to the non-elderly population, spend a few minutes browsing some of the #COVID19 survivor group facebook pages. Ailments and debility persist for weeks. You do not want these things to happen to you:
facebook.com/groups/COVID19…
Read 6 tweets
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M. Kit Delgado, MD, MS
@kit_delgadoMD
(1/x) As an ER doc I have treated many patients who lost jobs due to the #CoronavirusOutbreak & they don't look like the protesters in the news
- chest pain/anxiety after losing job as a cook
- alcohol withdrawal after running out of $
- depression and suicidal thoughts

👇thread
2/ There’s ample evidence that beside the economic impact, that job and income loss leads to enormous public health impacts. For example, when auto plants shut down, there are an additional ~9 opioid overdose/100,000 people five years down the line
3/ And individual-level poverty alone is associated with an estimated 130,000 deaths per year in the U.S. More job and income loss and worsening poverty will lead to loss of health insurance and contribute to worsening mortality in the short and long term
ncbi.nlm.nih.gov/pmc/articles/P…
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