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Ashish K. Jha

@ashishkjha

25 Oct

@SWAtlasHoover

President Trump, advisor @SWAtlasHoover arguing there's lot of false coding of COVID

This is junk news

Like junk food, junk news tastes good but has no nutritional value

So what are the facts?

Don't hospitals get more $ for COVID?

Thread on hospital billing, COVID, and fraud

Our payment system is insanely complex

So this is a simplification

Hospitals get paid based on what condition patient has

A patient with pneumonia?

Typical hospital might get between $8K to $11K from Medicare, depending on whether pt has major comorbid conditions or not

2/n

So what happened in COVID era?

Cares Act gives hospitals a 20% bump (to about $9600 – 13K) if pneumonia is from COVID

Additional $1600 - $2200 for a typical COVID pneumonia patient

To get this bump, hospitals must document that patient is COVID positive

3/n

Read 11 tweets

Ashish K. Jha

@ashishkjha

21 Oct

@GovHolcomb

On 9/23, Indiana's @GovHolcomb lifted nearly all COVID19 restrictions

wfyi.org/news/articles/…

This struck me and other public health folks as dangerous

A month later, how's it gone?

Pretty badly. Like really badly.

Don't take my word for it.

Let's look at data!

Thread

@COVID19Tracking

First, let’s look at Infections over past 2 months

All numbers 7-day moving avg from @COVID19Tracking

Between August 1 and September 23, cases fluctuating between 700-900 per day

Restrictions lifted 9/23

Infections start to take off by Oct 1

By 10/19, over 1800 cases per day

Test positivity was around 9% on 9/23

Today? Around 18%

Meaning Indiana missing way more cases now than they were a month ago

So identified infections AND missed infections way up

Ah you say, but what about hospitalizations?

Isn't that what matters?

3/n

Read 7 tweets

Ashish K. Jha

@ashishkjha

19 Oct

You know about dramatic increases in cases, hospitalizations across US

Surge began after labor day

But one state has done well during this time

Big state that would move national numbers

And what they've done holds a lesson for all of us

Yes -- let's talk California

Thread

Walk down memory lane:

California early to act in March, preventing surge of cases that affected many others

Over April/May, CA cases were low

But California had an awful summer surge, especially in SoCal

Cases peaked in late July: over 12,000 cases, 150 deaths / day

2/6

@CHHSAgency

But in August, strong leadership from @CHHSAgency Health Secretary Mark Ghaly and @GavinNewsom

What did they do? Huge increases in testing including bringing new capacity online

Created highly customized approach on a county by county level -- micro targeting policies

3/6

Read 7 tweets

Ashish K. Jha

@ashishkjha

12 Oct

https://twitter.com/ashishkjha/status/1315655616627650565

So this tweet is getting me lots of flak

Few points

I've become more optimistic that with proper masking, some distancing, more schools can open safely

Why? Because evidence base changing

Schools open in many places and aren't generally seeing large outbreaks

Short thread

https://twitter.com/ashishkjha/status/1315655616627650565

@ProfEmilyOster

I've been particularly swayed by work of the brilliant @ProfEmilyOster.

She brings evidence, not bluster, to this topic. Its inspiring

She's actually tracking data (!!). Yup, its not perfect. But its the best we have

Read her in @TheAtlantic

theatlantic.com/ideas/archive/…

Will we see some spread in schools?

Sure

Will it be worse than spread happening outside of school?

Not that we see in the (limited) data

But isn't it just "safe" to keep kids online until some unspecified future time?

No

So let's talk costs of keeping kids remote only

3/5

Read 5 tweets

Ashish K. Jha

@ashishkjha

12 Oct

Cases and hospitalizations are rising across the US

And I’m getting asked repeatedly whether we're heading toward lockdowns

Short answer – no – not if we are smart

Long answer? Its complicated

So let’s talk about lockdowns – and how we get through next few months

Thread

Lockdowns – shelter in place orders – are extreme

And awful. Super costly and usually not necessary

We locked down in March/April because virus spread across US in Jan/Feb

And we were blind. We had no testing. We had little choice

Situation now different. We know more

2/n

First, let’s talk about why everyone is concerned:

Cases rising in most states

Hospitalizations rising in most states

Test + going up too

As weather gets colder, expect things to get worse in much of nation

Why?

People will spend more time indoors. But not just that

3/n

Read 11 tweets

Ashish K. Jha

@ashishkjha

8 Oct

Have been getting asked a lot about whether its safe for President Trump and VP Biden to debate in person on October 15.

So here are some thoughts.

Bottom line: depends on how luck we feel

But here's a bit more detail

Thread

CDC recommendations for isolation for people with mild to moderate disease is 10 days after symptom onset.

If we assume symptom onset was October 1, then debate Oct 15 should be fine

But for "more severe" disease, infected people remain infectious out to 20 days

2/n

But there's a twist

President got steroids early in disease course (day 3) which likely affects duration of viral shedding

Steroids likely extend shedding of SARS-CoV2

We saw this with MERS (another coronavirus) and have some evidence with COVID

frontiersin.org/articles/10.33…

3/n

Read 5 tweets

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