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Ranu Dhillon Profile picture
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5 Oct, 4 tweets, 5 min read
(1/3) The 3 greatest health challenges of this century - pandemics, non-communicable diseases, health effects of climate change - will require

(1) health systems premised on primary care that integrate population health

(2) stronger mechanisms for global coordination & action
(2/3) #1 can be achieved by merging best practices that thus far happen in isolation into integrated systems that leverage technological- connectivity, AI, automation- tools to orchestrate/facilitate high-quality replicable execution at scale

(More soon @OptimizeHealth_)
(3/3) #2 is less of a technical & logistical challenge than a human, social & political one & therefore much more complicated to find a clear path towards achieving but achieve it we must
@EricTopol @richardhorton1 @sri_srikrishna @MartenRobert @petmongrels @daniel_kraft @yates_rob @DrTedros @BarkleyMD @Atul_Gawande @ashishkjha @devisridhar @sri_srikrishna @sarita @amymaxmen @BhadeliaMD @BillGates @FareedZakaria @FukuyamaFrancis @IlvesToomas

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More from @RanuDhillon

Ranu Dhillon Profile picture
5 Oct
(1/5) To put Trump being started on dexamethasone in perspective, we do it for patients when they become hypoxic

Some patients I've had are on remdesivir/dexa like Trump is now & only require a touch of oxygen (eg, 2L) for a day or two & then come off it.
(2/5) Even when on oxygen, they may look, feel, talk etc. like they're fine & you wouldn't know they were hypoxic unless you took off the oxygen & saw their O2 saturation
(3/5)Others on remdesivir/dexa end up as sick as anyone can be including on a ventilator, paralytics, etc & either pass away or recover after a prolonged & arduous course

Bottom line: there's huge variation which makes it tough to pinpoint where someone might be on that spectrum
Read 5 tweets
Ranu Dhillon Profile picture
4 Oct
(1/4) Other than the experimental antibodies, Trump has gotten what - remdesivir, dexamethasone - we give to our Covid patients with hypoxia
(2/4) From the way questions were answered, the fact that dex was started (which can have side effects including confusion) & he was on supplemental O2 suggests to me that his O2 may have been lower than they are letting on

Supplemental O2 usually isn't given unless O2 sat <90%
(3/4) With Covid19 & pneumonias in general, you typically don't get 'transient' drops in O2 as much as persistent (& potentially progressive) hypoxia lasting for at least hours

Transient drops usually happen from mucous plugs or aspiration

Unclear to me what the actual story is
Read 4 tweets
Ranu Dhillon Profile picture
14 Sep
1/ A hang-up on rapid tests that I've heard is that it'll be difficult for health depts to track results

Decentralized screening makes that difficult but stopping spread should be the overwhelming priority; monitoring indirectly helps stop spread but is a secondary consideration
2/ We shouldn't hold up something that can stop transmission because it will be harder to monitor or collect data on

The current counterfactual is that we're missing most infections anyway & neither stopping onward transmission from them or getting any data on them
3/ What's generally been missing from the rapid testing discussion are counterfactuals

Anyone can point out issues that arise if using them but that is meaningless without considering what is happening w/o them & thoughtfully strategizing on how to address potential downsides
Read 5 tweets
Ranu Dhillon Profile picture
8 Sep
1/ This is an important point - models are not all bad/good or about prediction but rather tools for guiding what needs to be done

In the Ebola epidemic, we modeled spread in each locality to plan where we needed testing sites & calculate how many treatment beds may be needed
2/ There was a lag between determining a need & getting it established so the best we could do was use modeling to start deployment &, if transmission shifted & changed, we revised our models & adjusted our projections & plans
3/ In many instances, we were part of the way towards establishing a testing or treatment site when transmission shifted differently & they were no longer needed at the place we planned but required elsewhere
Read 4 tweets
Ranu Dhillon Profile picture
7 Sep
1/ I work in a hospital with a steady flow of Covid. Just a few weeks ago, we were overcapacity- more ICU patients than beds, more Covid patients than isolation rooms, more telemetry patients than telemetry beds

This was in August when we usually have a lull in overall caseload
2/ In pre-Covid winters, we typically fill to capacity & periodically have to 'surge' not even because of flu but other respiratory viruses & environmental triggers for chronic lung disease

If that happened a few weeks ago, there'd literally be no way to manage the patient load
3/ Without more aggressive reductions in circulating virus, we are on pace for not a 'twindemic,' but a 'multidemic'

This will come at a time when many hospital systems are actually cutting back staffing due to revenue losses from elective procedures
Read 4 tweets
Ranu Dhillon Profile picture
7 Sep
There is real-world data showing that what we are doing right now isn't working

Widespread serial rapid screening hasn't been done before bc regulatory agencies have blocked it. At minimum, many more cases will be caught early

And remember, nothing has to work 100% to get R<1
And here is some modeling data that suggests that rapid testing in this manner could have reduced the number of infections in the West African Ebola epidemic by *a third*

nature.com/articles/natur… Image
And, if used aggressively as a concerted strategy, may be even more abruptly:

thelancet.com/journals/lanin… Image
Read 4 tweets

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