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Leora Horwitz Profile picture
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2 Dec, 16 tweets, 7 min read
Yesterday the world lost a shining light, much too soon. @marjoriesue’s life was marked by tragedy – widowed early with two young children, then metastatic cancer – but she radiated joy and empathy and was an astonishingly gifted writer. In memoriam, some of my favorite pieces:
Margi was a pediatrician, writer, friend, researcher and community activist, but also a single mom who raised two extraordinary young women. Here, she wrote nicer words about other people's mothers (including mine @renalis) than I have ever said to my own:
wbur.org/cognoscenti/20…
On dating while on chemo
nytimes.com/2020/09/04/sty…
On baby birds and empty nests
cnn.com/2019/08/22/opi…
On getting bad news instead of giving bad news
nytimes.com/2020/03/13/wel…
On how to truthfully remember a deceased loved one, set in the context of a (different) plague; this one is especially poignant to re-read right now
tabletmag.com/sections/commu…
On adapting to a cancer diagnosis pubmed.ncbi.nlm.nih.gov/28973150/
On connecting at a distance
nytimes.com/2020/05/05/wel…
On why parenting (and quality improvement) is like my favorite movie medium.com/@marjorie.rose…
On relating differently to patients as a single parent pubmed.ncbi.nlm.nih.gov/16820535/
On the misguided push to encourage patients to shame doctors and nurses into washing their hands
wbur.org/commonhealth/2…
In her writing, fairly bursting with a deep love and compassion for others, she leaves an indelible gift to her daughters, family, friends and countless strangers: a deeply personal record of who she really was.
I wish you all had had the privilege of knowing her in person. But I know her writing will make her memory a blessing for many beyond her many friends. @muffysart @lesliecyale @joshmoejo @lfiellin @thehowie @nicoleFluhr @hkgn @EmilyMelnick7 @JsscHlhn

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More from @leorahorwitzmd

Leora Horwitz Profile picture
29 Sep
My periodic reminder that WE ARE NOT GOING TO SOLVE #COVID19 THROUGH NON-VACCINE HERD IMMUNITY. For those who need more convincing, thread follows.
First, we have NEVER gotten to herd immunity without vaccine for a virus. If you are over 40, you almost certainly had chicken pox as a kid. Until vaccine in 1995, we had >4 million cases/year (& ~125 deaths) - about the same as how many kids are born each year.
In other words, EVERY NON-IMMUNE PERSON (i.e. every kid) STILL GOT IT, even though antibody rates among adults were 90-95%, and immunity is near lifelong. With circulating virus and no vaccine, most without immunity will eventually catch it even if the pop is largely immune.
Read 10 tweets
Leora Horwitz Profile picture
19 Aug
*Caution non-peer reviewed preprint* There have been many anecdotes about prolonged #COVID19 symptoms but little systematic data collection. Here, results from prospective study of 152 patients @nyulangone hospitalized with #COVID19. /1 medrxiv.org/content/10.110…
tl;dr results: 113/152 (74%) reported persistent shortness of breath 30-40 days after discharge. 13.5% still needed oxygen. Overall physical health was rated 44/100 after vs 54 before - full standard deviation drop vs national norms. Mental health score dropped from 54 to 47.
Details: We enrolled 152 (38% of eligible) patients; all had lab confirmed #COVID19 & needed at least 6L oxygen during hospitalization; each completed the PROMIS 10 global health questionnaire and the PROMIS dyspnea scale, answering for current and pre-COVID state. ImageImage
Read 9 tweets
Leora Horwitz Profile picture
19 Aug
*Caution non-peer reviewed preprint* US #COVID19 death rates are lower now than in the spring. Is disease less lethal (better treatments, etc), or just younger people getting sick? We examined @nyulangone outcomes over time to explore. /1 @PetrilliMD medrxiv.org/content/10.110…
We know that risk of mortality is highly dependent on characteristics like age, comorbidity, severity of illness on presentation. We also know that the current epidemic is skewing younger. That alone could explain lower mortality. /2 vox.com/2020/7/18/2132…
But, it's possible we've also gotten better at #COVID19 care. It's also possible people are distancing/wearing masks more, and getting a lower viral innoculum, causing less severe disease. Disentangling these issues is important to help understand expected future outcomes.
Read 6 tweets
Leora Horwitz Profile picture
10 Aug
I hate recording talks. I rely so much on audience cues to see if they are lost, confused, interested, engaged, annoyed, and I adjust accordingly. I love interaction. Live talks make me energized and I have so much fun giving them. But. I recorded a talk for #MLHC2020 /1
And instead of maybe 25 or 50 people seeing it live, now over 300 have watched it on YouTube, including my mother in law (thanks, Mom!) and apparently people in Ghana (thanks @aowusuda!) and Ireland (thanks @EvaDoherty!). @HardeepSinghMD even summarized it beautifully. /2
Does this make up for the loss of engagement and interaction that #COVID19 is forcing on us? I admit it is a real benefit I had not appreciated. Being able to reach people around the world who would otherwise be unable to access the conference is rewarding in its own way. /3
Read 4 tweets
Leora Horwitz Profile picture
19 Jul
The @US_FDA has now authorized “pooled testing” for #COVID19 to save testing reagents and speed results. I’m a big fan. But, this only works in low prevalence situations. To see why, here is some fun Sunday morning math for you all.

fda.gov/news-events/pr…
Pooled testing works like this. You get individual swabs from a bunch of people, set aside some of the sample for each person in case needed later, and mix the rest together. Now test the mixed (pooled) sample. If negative, you’re done! One test for N people, saving N-1 tests.
If the pool is positive, you have to go retest each individual sample to identify the positive(s). Plus, you already did one extra test for the initial pooled sample. So a positive pool costs N+1 tests. You can see where we are going here...
Read 10 tweets
Leora Horwitz Profile picture
10 Jul
I posted earlier about the currently known state of the (limited) science on pediatric #COVID19 transmission. Of course, the question is how to apply that knowledge to schools. Many have already posted thoughtfully about this problem. Thread.
Harms of closing schools are enormous: e.g., loss of academic progression, worsening disparities, food insecurity, strain on working parents/impaired economy, delayed social/emotional development, social isolation, increased incidence/reduced reporting of domestic violence, etc.
But, harms of opening schools could also be substantial if they cause significant infections in staff/students, and/or increase community spread. @meganranney has done a great job outlining the stakes.
Read 14 tweets

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