Common question: If I contract coronavirus tomorrow, what meds would I want? Short answer: Depends where I am. If you sift through all of the breathless #COVID press releases, the only "game-changer" is dexamethasone, a cheap & widely available steroid that saves lives. But... 1/
I would only want it if I'm really sick. Otherwise, it could actually make things worse. Drugs that work in some groups fail in others. Lilly's antibody, bamlanivimab, is weakly effective (maybe?) for patients outside of the hospital but makes things worse for sick patients. 2/
This matters as we think about the vaccine roll out: different groups may respond differently. For example, patients in longterm care facilities (nursing homes, assisted living facilities) may be quite different than the people who actually enrolled in #COVID vaccine trials. 3/
They're presumably older; some may require supplemental oxygen; others may not be able to walk. How do these characteristics affect the immune response? Vaccinating high-risk groups is the right thing to do, but it won't be the end of the story. 4/
We'll need to collect data for months (or years?) to figure out how to optimally protect our most vulnerable (the very old, the very young, the socially marginalized), who are often unable to participate in clinical trials. An important priority for 2021.

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More from @DrMattMcCarthy

18 Nov
Here's a controversial paper that's often referenced during ethics meetings when we discuss how to allocate the limited supply of #COVID19 vaccines. Lead author is Ezekiel Emanuel, a member of Biden's coronavirus task force. Key arguments: 1/…
Frontline health care workers should be given priority "not because they are somehow more worthy" but because they're essential to pandemic response. Younger patients should not be prioritized. Avoid first-come, first-served distribution as it may encourage crowding or violence.
If vaccine supply is insufficient for high-risk patients, consider a lottery. People who participate in COVID research (think of someone who enrolled in a remdesivir trial) should receive some priority.
Read 7 tweets
17 Oct
UPDATE: The #coronavirus case fatality rate continues to drop. Here's one reason that doesn't get a lot of attention: We're getting much better at triage. During the first few months, we really couldn't tell which hospitalized patients were going to get worse. That has changed:
Why were we bad at this? Many with #COVD19 suffer from 'silent hypoxemia,' where oxygen levels appear incompatible with life yet patients feel no symptoms. The President may have had a subtle, less aggressive variation of this when he was airlifted to Walter Reed but felt fine.
Vital signs have proven unreliable for effective triage, so we've turned to lab tests for help. One that quickly emerged as a potentially-helpful candidate was interleukin-6 (IL-6), a marker of inflammation that is usually absent (or present in low levels) in blood.
Read 8 tweets
16 Oct
This is a stunning and inaccurate claim. Rewriting history is a mistake. Some key points about the #coronavirus surge in New York City:
1. Our stockpiles of PPE were unable to withstand the first wave. We went from using 4k masks/day to 40k masks/day to 90,000 masks/day at the peak & we did not have the stockpiles to keep up.
2. Hospitals had to create I.C.U.s out of operating rooms, procedure suites, and conference areas. We created ventilators out of anesthesia machines and split ventilators to help two patients simultaneously. We redeployed doctors to the ICU who didn't typically work there.
Read 5 tweets
16 Oct
NEW: There's an emerging argument that masks don't actually work. It's based on a recent study published by the CDC, which reportedly showed that 85% of mask-wearers contract #COVID19. This is a dangerous mischaracterization of the study. Here's what the work really showed:
CDC looked at 154 adults with symptomatic #COVID19 and compared them to an uninfected control group. Of the patients with #coronavirus, 70.6% reported ALWAYS wearing a mask and 14.4% OFTEN did. From a distance, it looks like 85% of mask-wearers got COVID.…
But you've got to read the actual study. Here's the key detail: COVID patients were twice as likely to have dined at a restaurant. Why does this matter? Because people take off masks to eat. You might report that you ALWAYS wear a mask but we know it comes off when you're eating.
Read 4 tweets
14 Oct
1. Employees should stay home for 14 days after contact (within 6 feet for 15 minutes) with a person who has #COVID19. Period. Even if someone tests negative or feels well, they must quarantine for the full 2 weeks because symptoms can appear 2 to 14 days after exposure.
2. Mike Pence's VP debate appearance 11 days after the ceremony led many to believe that quarantine can terminate early with a negative test. This fallacy was reinforced by the CDC Director, who cited "serial negative test results" to end quarantine early. That is not a thing.
3. It's possible, although unlikely, to develop symptoms more than 14 days after exposure. The Labor Secretary's wife, Trish Scalia, attended the Rose Garden ceremony and tested positive outside of this window. It is unclear when her infection occurred.
Read 4 tweets
13 Oct
UPDATE: I expect a recommendation for the general public to continue wearing masks EVEN AFTER a #coronavirus vaccine is rolled out. This is rarely mentioned in discussions of Operation Warp Speed, but the first #COVID19 vaccines may offer only moderate protection. Some thoughts:
1. Approval of a #COVID19 vaccine does not mean a quick return to normal. Volunteers who receive a "successful" vaccine may still get sick. (In June, the FDA set target efficacy at 50%). There will be protection, but it could be leaky. We haven't prepared the public for that.
2. Johnson & Johnson and AstraZeneca have paused trials to explore illnesses in volunteers. We should be reassured by this transparency, not alarmed. Adverse events are an expected part of any large study. Potentially noteworthy that both use adenovirus vectors to deliver genes.
Read 4 tweets

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