Thread by @ProfDFrancis

How do ideas mutate into the worst possible version of themselves?

The same way viruses evolve. and much faster, because the selection pressure is greater.

#FOAMed

This one has a three-phase mutation.

ORIGIN. Doctor tells something to family. (Their relative ultimately dies and understandably they were not taking notes verbatim for later accuracy).

VULNERABLE POINT 1. Family relays something to Newspaper.

VULNERABLE POINT 2. Journalist interprets that to the best of their ability and publishes article.

VULNERABLE POINT 3. Reader interprets article to the best of their ability and tweets their interpretation.

Let's see where the misunderstanding arose, shall we?

Here are the links to:

The tweet addressed to me

https://twitter.com/alfonzoPgr/status/1313899416831623169

The news story
nbcsandiego.com/news/local/she…

Key part of the news story is here.

This is a very sad story, but do you think the relative was correct in saying "because"?

Do we ventilate people BECAUSE we blood tests show the heart muscle is inflamed?

Or because of gas exchange, or other features?

Clue - a ventilator supplies ventilation + gas exchange

Can't blame the relative.

If my relative was dying, I would absolutely not be interested in writing down every why and wherefore in detail.

All I would successfully take away was that they were dying, and it was something to do with X, Y and Z bad things they had.

I was about to blame the reporter for misreporting, but actually the reporter has been spot on.

First, the main message of the story, shown right at the beginning, is this.

This is that a perfectly healthy young person can die from Covid-19.

Not common, but it can happen.

This is why we are all trying to stop it spreading. Not so much to protect ourselves, but to protect others.

A young healthy person has a very low chance of dying from Covid. But (with R being about 3) if we all behave normally, that person will pass it on to lots of other people (e.g. 3), and they in turn will pass it on to lots × lots of people (e.g. 9), etc.

So EVEN IF you only mix with healthy young people, and THEY only mix with health young people, and so on, EVENTUALLY one of the healthy young people will have a terrible response to Covid and die.

THAT is why we wear masks and social distance, even though it is annoying. A lot of people annoyed is better than a few people being dead.

In older/frailer people, death is more common, but the reason for precautions is

"to protect others, of whom a small number will die"

So the message from the Journalist is focussing on the right thing.

The journalist quoted the relative saying the "because", so (strictly speaking) the journalist is right.

You MIGHT say "the journalist could have checked with the doctor" ...

... but the doctor probably wouldn't have replied in detail without all kinds of waivers and paperwork, so I can't really blame the journalist for just quoting.

So now we move on the Tweeter.

This phrase, I hope, was caught as unlikely to be correct, by any cardiologists reading?

It is highly unusual for us in cardiology to count heart attacks in a single admission. I suppose you could have a STEMI, and then another STEMI while waiting to go home. But other than that, we would rarely be willing to draw such a conclusion.

Let's assume that the person

isn't frankly lying, and
isn't unable to count.

By deduction, they must be misdescribing something as a heart attack.

What do you think is being misdescribed as a heart attack?

Yes, first answerer is correct.

I haven't seen the medical records.
The twitter correspondent hasn't seen them either.
The journalist hasn't seen them.
The relative probably hasn't seen them.

So the four of us are basically speculating with varying near-zero degrees of knowledge of the medical details.

Many patients close to death from a rip-roaring systemic viral infection will have raised CRP, CK and Troponin.

We may call it myocarditis or just part of a global all-body inflammation. Doesn't matter. It is a bad sign, but they have more obvious bad signs all over.

The point is, that for patients who recover from severe Covid, once the CRP and Troponin settle down, they should stop thinking about their heart, and think about something else instead.

Certainly you shouldn't glean information from any of these 3 sources.

1. Twitter commentaries
2. News articles.
3. Nor even first-hand reports from non-medical bereaved people

All can be unreliable (despite being 100% in good faith)

That's why you have an actual doctor.

Good point George.

HOWEVER.

I would take her as "No underlying conditions" because the reason for that designation is that we are calculating the chance of a random person who THINKS they have no conditions, dying.

If, after getting admitted with Covid, they are diagnosed with underlying conditions, that helps us SCIENTIFICALLY in the study of the pathogenesis, but doesn't help us in the PUBLIC HEALTH aspect of "Who should worry, and how much should you worry."

So I would reclassify such a person if writing a paper about MECHANISM,

but for papers about EPIDEMIOLOGY I would keep them as "No underlying conditions", because what happens to them, applies to random people walking around who have never had anything diagnosed.

Let's not be mean to the poor deceased lady !

https://twitter.com/WhatsupFranks/status/1314349155049975808?s=19

Even for a healthy slim young person there is a CHANCE, albeit very small, of a fatal Covid infection.

If millions of such people get infected, several will die.

That is why a 99.9% survival, or whatever it is, still means some deaths in this group.

They are rare, and so may get into the newspapers.

The whole point of this thread wa simply that small misunderstandings can snowball through retellings, and Twitter will end up having people mixing this up with MRI scans in recovered people that show extra water that has not yet gone away, and get scared of delayed myocarditis.

You absolutely can get inflammation of the heart, and the rest of the body, when you are nearly dead of a severe systemic virus.

But once you are better, stop worrying about it.

That is like worrying about a delayed broken bone from a car that was about to hit you, but didn't.

I disagree with this.

Reason 1.

Wearing masks is not to stop us GETTING Covid. It is to stop us passing it to other people.

Reason 2 to not ask about masks.

When a patient comes in ill with something, the one thing we try NOT to do as a doctor is to blame them for getting it.

They didn't come for a telling off, they came for doctoring.

We can tell them off afterwards, once they are better after the heart attack, and sitting up in bed asking for a cigarette.

But not when they are at death's door.