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Céline Gounder, MD, ScM, FIDSA

16 Oct, 12 tweets, 4 min read

1/ LOVELY in THEORY, but herd immunity WILL NOT work:
POTUS "vowed to shield America’s senior citizens from the coronavirus & directed them to stay home amid the pandemic" politico.com/news/2020/10/1…

2/ Measles has infected humans since at least the 9th century. Smallpox? Since the 3rd century BC. Both are respiratory viruses, like coronavirus.

3/ We have yet to eradicate measles via natural infection & immunity. We only reached herd immunity to smallpox with a vaccine & a MASSIVE eradication effort. When you let respiratory viruses like measles, smallpox, and coronavirus spread naturally, you get big epidemic spikes:

4/ When you get big epidemic spikes, it is impossible to shield the vulnerable. How do you "cocoon" all the elderly AND everyone with an underlying risk factor? Is this our plan!?

5/ OBESITY is a risk factor for severe COVID.
Here's the prevalence of obesity in the U.S.:
- 40.0% of young adults in the U.S. ages 20-39
- 44.8% of middle-aged adults ages 40-59 years
- 42.8% of adults aged 60+
HOW will we SHIELD all of them? cdc.gov/obesity/data/a…

6/ HIGH BLOOD PRESSURE is a risk factor for severe COVID.
Here's the prevalence of high blood pressure in the U.S.:
- 7.5% in 18–39 year-olds
- 33.2% in 40–59 year-olds
- 63.1% in 60+ year-olds
HOW will we SHIELD all of them? cdc.gov/nchs/products/…

7/ DIABETES is a risk factor for severe COVID.
Here's the prevalence of diabetes in the U.S.:
- 4.2% in 18-44 year-olds
- 17.5% in 45-64 year-olds
- 26.8% in 65+ year-olds
HOW will we SHIELD all of them? cdc.gov/diabetes/data/…

8/ AGE is a risk factor for severe COVID.
17% of Americans are over age 65.
HOW will we shield all of them? statista.com/statistics/457…

9/ Is our plan put everyone over age 65 and everyone who has obesity, high blood pressure, diabetes (and other risk factors) on a rocket ship into space? On their own a desert island? Or even just imprison them in their homes until we have a vaccine? THAT IS NOT A PLAN.

10/ THE AMERICAN "PLAN" for the coronavirus pandemic? It's been HERD IMMUNITY from the beginning. The result? One of the highest death rates from COVID in the developed world. jamanetwork.com/journals/jama/… OUR "PLAN" ISN'T WORKING.

@CharlesBHolmes

11/ More on why herd immunity WILL NOT work and is straight-up IMMORAL from my friend @CharlesBHolmes:

https://twitter.com/CharlesBHolmes/status/1316195810296696832?s=20

@DrTomFrieden

12/ And also more from @DrTomFrieden:

https://twitter.com/drtomfrieden/status/1317250975489527809

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More from @celinegounder

Céline Gounder, MD, ScM, FIDSA

@celinegounder

7 Oct

@CDCgov

1/ Late last month, Dr. Bill Foege—@CDCgov Director '77-83, central figure in smallpox eradication, former Task Force for Global Health & Carter Center leader, Senior Fellow at the @gatesfoundation, and a devout Christian—sent this plea to @CDCDirector Bob Redfield.

@CDCgov

2/ We are witnessing a "colossal failure of the public health response in this country." The result of "incompetence and illogic." The @CDCgov is the preeminent public health institution in the world. They should have been leading the response from the beginning.

3/ Basic tenets of public health:
- "Know the Truth." This White House is about obfuscation & confabulation.
- "a coherent FEDERAL plan," not a patchwork response: podcasts.apple.com/us/podcast/epi…
- We need cooperation & coalition, not division. The virus is winning by divide & conquer.

Read 8 tweets

Céline Gounder, MD, ScM, FIDSA

@celinegounder

5 Oct

@Elemental

1/ Great speaking with @Elemental's @smithdag today.
elemental.medium.com/everything-we-…
Some highlights:
- “If the fever came down on its own, that’s a very good sign prognostically. If the fever required medication to come down […] it wouldn’t necessarily mean he’s getting better..."

2/ Steroids like dexamethasone and medications like aspirin, Tylenol, and ibuprofen will reduce a fever.

3/ On Fri/Sat, Trump had an oxygen saturation below 94%. Dr. Conley said it didn't got down to the low 80s. So that would imply it dropped to the upper 80s.

Read 12 tweets

Céline Gounder, MD, ScM, FIDSA

@celinegounder

5 Oct

1/ POTUS says he's leaving Walter Reed and going back to the White House: washingtonpost.com/elections/2020…
Assuming he got sick Wed/Thurs, he's on day 5 or 6 of COVID. It's too early.

2/ On day 2 or 3 of COVID POTUS already had evidence of severe COVID with oxygen saturation under 94% on room air (& likely into upper 80s) & supplemental oxygen requirement.

3/ COVID patients often get worse at 7-10 days into illness (i.e. this Fri or Sat). I hope that doesn't happen. But he should be closely monitoring in a hospital NEAR AN INTENSIVE CARE UNIT until then.

Read 13 tweets

Céline Gounder, MD, ScM, FIDSA

@celinegounder

4 Oct

@CNN

1/ It's concerning that President Trump got so sick so quickly. Here's my take for @CNN: cnn.com/2020/10/04/opi…

2/ Today we learned that POTUS had a fever & an oxygen saturation level below 94% on Friday morning, prompting his transfer to Walter Reed. Reading between the lines of what Dr. Conley did & did not say, it's possible that the POTUS' oxygen levels dropped into the upper 80s.

3/ He again had a drop in his oxygen saturation level to 93% Sat AM. It is unclear whether he again was given supplemental oxygen at that time. He is now on at least 3 medications for severe COVID, including Regeneron's monoclonal antibody cocktail, remdesivir & dexamethasone.

Read 62 tweets

Céline Gounder, MD, ScM, FIDSA

@celinegounder

4 Oct

1/ What did we learn about the President's health today?
- He had a fever and oxygen saturation level under 94% on Friday, which prompted his transfer to Walter Reed Hospital.
- His oxygen saturation dropped Saturday AM. He was started on dexamethasone.

2/
- The President's kidney & liver function have remained normal.
- His cardiac function is normal or improving? Was it ever abnormal? We know he's had an ultrasound. Was this an ultrasound of the heart (echocardiogram)?

3/
- He received Regeneron's monoclonal antibody cocktail on Thursday.
- He was started on remdesivir on Friday and dexamethasone on Saturday.

Read 12 tweets

Céline Gounder, MD, ScM, FIDSA

@celinegounder

3 Oct

@meganranney

1/ Why do doctors like me & @meganranney ask how high the POTUS' fever has been, if his O2 levels have been low, whether he's required supplemental oxygen? It's the difference between moderate & severe COVID. This tells us a lot about prognosis & what treatments are indicated.

2/ If the president required supplemental oxygen, he has SEVERE COVID and should hand power over to VP Pence until he is clinically improved.

3/ POTUS was given remdesivir. *Assuming* evidence-/guideline-based use of remdesivir, this would also indicate that the president has SEVERE COVID (i.e. oxygen saturation less than or equal to 94% on room air, requiring supplemental oxygen/ventilator/ECMO).