I want people to understand what we mean when we say that hospitals are at "capacity"
- That means there are no more beds for patients
- If you are in a trauma and need care there is not a bed
- Your elective surgery cardiac cath, or biopsy is will be postponed
- When you come to the Emergency Room you are going to wait much longer because doctors and nurses are busy trying to manage all the patients
- You may have to stay in a bed in a hall (if you are lucky)
- Nurses will be further stretched and have less time to tend to you
- It will take longer to get your x-ray, blood draws, and any other tests you need
- Doctors will have more patients to take care of and are unable to spend as much time thinking about your care
Normally we would be able to get backup from other areas, but not in a pandemic
This is what happens as healthcare systems reach capacity and become overwhelmed
Once this happens they collapse from the overburden of patients. We have seen this before- NY, Italy, Spain, China
We need to stop this now as cases continue to exponentially worsen.
• • •
Missing some Tweet in this thread? You can try to
force a refresh
Given the #surge of #COVID19 in the US we need to focus on containing the pandemic. Here are some things we need 1. We need a #NationalPlan to combat this infection
- Right now we have 50 states doing 50 different things 2. Scale up testing
- Use of PCR, saliva, rapid, Ag
1/
3. Focus on community engagement at the local, state, and national level
- Empower communities and people to be proactive 4. Statewide #MaskMandates 5. Limitations on crowd and gathering sizes 6. Support of I&Q
- Paid sick leave, mental health, and healthcare
-Food delivery
2/
7. Scale up of contact tracing once we get case counts lower 8. Support for public health departments and schools so they can carry out recommendations 9. Support for heathcare workers who are burned out 10. Scale up PPE production 11. Financial support for small businesses
3/
This statement made concerns for a "October surprise" alive and well. I can't believe I am typing words that say we may have a #vaccine for the greatest public health tragedy of the modern day that may not be vetted through the @US_FDA advisory panel of experts.
The continued politicization of this pandemic is a grave danger to the health and wellbeing of not just the public but to the very foundation of our democracy. I keep saying we need to let science lead and that is no where more true than with the development of a #vaccine.
Developing a safe and efficacious #vaccine is paramount to having the public uptake this important intervention. If there is perception science has been "skipped" over then we have already defeated ourselves out the door.
People will not get a vaccine that doesn't appear safe.
I recognize that $22,200,000,000 a year to prevent a pandemic sounds astronomical, but honestly we should have been proactive and been doing this way before the #SARSCoV2 pandemic. We have had numerous warning signs over the years this was coming and did not take them. (1/9)
We have seen re/emerging infections increase over the past 40 years. We have had SARS, MERS, Zika, and numerous Ebola outbreaks as warnings this was coming. Yes we did invest after the 2014 W Africa outbreak but it was not on the scale needed to prevent, prepare, for this (2/9)
Look at the world right now, in addition to the #COVIDー19 pandemic we have ongoing outbreaks of Ebola, measles, cholera, plague, monkeypox, drug resistant typhoid along with others being battled which could become a regional epidemic or evolve into a pandemic as well. (3/9)
#SouthKorea has done a fantastic job with #ContactTracing This article analyzed reports for 59,073 contacts of 5,706 #COVID19 index patients. I believe it has important info for decision making related to #SchoolReopening
- Of 10,592 household contacts, 11.8% had #COVID19
- Of 48, 481 nonhousehold contact, 1.9% had #COVID19
- All contacts were monitored for an avg 9.9 days after #SARSCoV2 was detected
- In houses with index 10-19 y.o, 18.6% of contacts had #COVID19
Conclusion
- Rates were higher for contacts of children than adults
- Reports from other countries estimate secondary attack rate for close contact ~ 35%
-High infection rate within family, so use personal protective measures should be used at home to reduce risk of transmission
Exciting article in @NEJM on #remdesivir (Rx I had my eye on from the start, NOT #HCQ). Info below 1. Pts confirmed with #SARSCoV2 with O2 Sat < 94% 2. Received 10 days of drug (200 x 1 then 100 daily) 3. 36/53 patients (68%) had clinical improvement
4. 30 (57%) on mech ventilation and 4 (8%) ECMO 5. Median f/u 18 d
- 36 (68%) improvement with oxygen support
- 17/30 (57%) on mechanical vent, extubated 6. 25 pts (47%) were discharged 7. 7 pts (13%) died 8. Mortality
- (18%) (6/34) pts inv. vent
-(5%) (1/19) not w/ inv. vent
Full Breakdown of Study Below
- 61 pts received at least one dose, 8 excluded due to missing info-->53 remained
- 40 (75%) received full 10 d course
- 40 (75%) male
- Age range 23-82 yrs (median 64)
- Majority 34(64%) receiving invasive ventilation w/ median time 2d prior to rx
1. Inclusion:
- >18
- RT-PCR positive #SARSCoV2
- Chest CT w/ PNA
- SaO2/SPO2 ratio >93% or P/F ratio >300
- Willing to be randomized
2. Exclusion:
- Severe/critical illness not deemed to meet benefit
- Retinopathy/Retinal dz
- Conduction block or arrhythmia
- Liver Dz (Child-Pugh >C or AST >2x ULN)
-Pregnant/Breastfeeding
-GFR <30 or CRRT
-Received other tx for COVID w/in 30d
-Transfer to OSH in 72h
3. Patients:
- 62 patients randomized to SOC vs SOC + HCQ 200 mg bid x 5 d 4. Endpoints:
- Time to clinical recovery (TTCR) normalization of temp and cough relief
- Change in CT lung findings