Many of us are 🤷🏽‍♀️about the news that remdesivir may not, actually, change mortality for #COVID19.

Why?… @KatherineJWu @ginakolata
First: a prior series of articles about remdesivir in @NEJM - including one from 10/8 - suggest at best, minimal effects of this drug. It may decrease time to recovery... but also, may not. No effect on mortality.

So this result is not surprising.…
Second: the new preprint SOLIDARITY study was HUGE, but also included a number of other treatments, and a wide heterogeneity of healthcare systems & standards.

So despite its great statistical power, it has limitations, which stop us from "throwing the baby out."
Third: Like the NEJM studies, this study gave remdesivir to the sickest patients.

Some suspect that it may be more effective in LESS sick patients - those who have not yet experienced the immunologic over-reaction that causes the worst symptoms of #COVID19.
..... At the end of the day, to many of us, this feels similar to oseltamavir (aka Tamiflu), which may/may not actually help in severe flu, but which we give anyhow, because we have no good alternatives…
We worry that this is a medication in search of a use.... and that we are all so desperate for a treatment, that we'll take the smallest signals of efficacy and run with it.

/ fin

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More from @meganranney

17 Oct
The news about #COVID19- when and how to test, when and how to stay home, when and how to mask - can seem impossible to decipher.

So let me break it down to 4️⃣ simple rules we can all follow:
RULE NUMBER ONE: If you feel sick, stay home.…

Always wear a mask when with people who aren't in your household.…
Read 7 tweets
16 Oct
As all of us prepare for the coming tsunami of #COVID19 cases, I'm curious:

What do your ERs *currently* look like?
1. Overflowing - pts in hallways; long waits for beds upstairs
2. On the edge - getting busier
3. Empty - lots of empty beds, no wait
And if you chose "overflowing" or "on the edge", is it because of #COVID19, or because of the high number of "regular" medical/surgical emergencies?
(Hypotheses & commentary to come later :))
Read 4 tweets
16 Oct
ICYMI: the great Barrington declaration is a bunch of baloney written by ppl who know nothing about #publichealth:

📉only 10% of Americans have been infected
📈herd immunity requires 50-70% of Americans to be infected
🤒this presumes most won't get sick(wrong)
Moreover, it sets up a straw man.

Most good public health professionals see lockdown as a last resort. *If we mask and test* we can avoid it.…
"The declaration is not a strategy, it is a political statement."

This virus - and our population - deserves more than a political statement.
Read 5 tweets
12 Oct
We @LizGoldbergMD & I created this app with @BrownDigiHealth in response to the q's we were getting every day from friends:

Is it safe to do xxx?
What if I wear a mask?
What if it's indoors?

(Huge thx to all the scientists who shared infexn models w/us!)
An even huger thank you to @olgakhazan for covering the bigger story of inadequate #publichealth messaging about what's safe and what isn't…
She highlights the challenges of figuring this out on our own, and the impossibility/impracticality of telling people "just stay home".

(Abstinence-only messaging is not a recipe for long-term compliance, as @JuliaLMarcus keeps reminding us. ) Image
Read 6 tweets
10 Oct
I am leaving the ER right now and reading @edyong209's newest masterful piece on #covid19 for the second time.

I have to say - tonight, this piece is everything.…
Because ---

My patients with #COVID19 are still afraid. They may be "strong", but they are scared. With good reason.

And so are we, the healthcare providers: bc PPE & testing are still in short supply, yet the 2nd wave is here.

And the rhetoric makes us feel like failures
So this piece!!!

It reinforces that REAL strength is so very far apart from the toxic salespitch of Trump & co.

He suggests that the strongest amongst us are not those who boast the most. It is those of us who can hold space for uncertainty, and then move forward.
Read 8 tweets
9 Oct
Appreciating the challenge from @lindaginzel during @WIMSummit to write down our own, personal definition of #leadership.

Great leadership is listening, empowering, and bringing what is possible to life. It requires stewardship of resources, development of vision, empathetic candor, & impeccable vulnerability.
It can occur at any level of an organization or a hierarchy. At any age. At any title.

It just requires being present, being honest, and creating space.

It requires championship for what is right, and what is better.

It requires elevating others.
Read 6 tweets

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