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With talk about asymptomatic transmission & #superspreaders with #COVID19, dug into a first & most fascinating story in public health when George Soper identified Mary Mallon as the healthy carrier of #typhoid, responsible of many outbreaks in #NYC.

link: dropbox.com/s/gen02hdeehtb…
I was able to find and reconstruct the 1919 article by George Soper in Military Medicine (thanks to Google, JSTOR, others) and put it together in the PDF link above for your enjoyment and consideration!

Here are some excerpts from this article which I found particularly amusing.
And if you want to be a hard-core historian of medicine, here is the link to Dr. Soper's original report in @JAMA_current from 1907!

JAMA link: jamanetwork.com/journals/jama/…

PDF: dropbox.com/s/n41tb69dw37l…
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More from @FranciscoMarty_ see all

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Francisco Marty, MD
@FranciscoMarty_
Updated the #RECOVERYtrial topline results summary table of the #dexamethasone arm compared to usual care for treatment of hospitalized patients with #COVID19.

Got additional information colleagues shared in Twitter.

Thread with some comparisons with #ACTT1

#IDtwitter 1/
the #ACTT1 authors have only reported (preliminary) Day 14 mortality, and the #RECOVERYtrial has only posted Day 28 mortality.

But these days the Supplementary Appendices in trial reports have additional relevant information:
nejm.org/doi/full/10.10…

#DontCoverDiscover
The paper says they were not reporting day 29 mortality, but If you look at Figure S3 in the #NEJM #ACTT1 preliminary report, you have KM estimates out to day 30.

From there you can visualize the probability of death at day

28 (see figure) have left lines and scales
Read 12 tweets
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Francisco Marty, MD
@FranciscoMarty_
Tabulated the topline results released by the #recoverytrial team on #hydroxychloroquine & #dexamethasone, and went over their protocol (recoverytrial.net/results) to better digest them.

Basic stuff:
- hospitalized patients @ 175 NHS centres
- open label, 5 initial arms
- thread—
Important point from #RECOVERYTrial protocol

- if a patient had a #contraindication to one of the intervention arms, according to the clinical care team at the site, that particular arm was not available to that patient at the time of #randomization
So if a patient enrolled in #recoverytrial had a contraindication to #dexamethasone, that patient was not allowed to be randomized to that arm. So the results need to be interpreted in the context of no contraindication to steroids: already on steroids, #immunosuppression, etc.
Read 11 tweets
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Francisco Marty, MD
@FranciscoMarty_
#Remdesivir begins distribution in the #USA today via #EUA.

I thought would write down some practical #tips based on my #qualitative anecdotal experience after personally treating close to 200 patients with #COVID19.

For quantitative results, wait for the papers¬—thread
“this juice works, doc!” When you hear similar expressions 1-2 days after starting #remdesivir multiple times, you start to wonder. Don't recall a similar proportion of patients smile after feeling so sick 1-2 days earlier with #COVID19. x/n? Wait for the papers.
Like #treatment for any severe infectious disease (meningitis, Gram-negative bacteremia, influenza pneumonia, etc), earlier is always better. #COVID19 is no different. #Remdesivir stops #SARS-CoV2 replication, but won’t heal the lung injury.
Read 13 tweets

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