You have probably seen the record-breaking, terrible COVID-19 stats for Dec 2nd in the US

Daily cases: 195,695
Currently hospitalized: 100,226
Daily deaths: 2,733

You need to understand these numbers in context

It makes them even more frightening

covidtracking.com/data/charts/us…

🧵
Let's start with hospitalizations: 100,226 total on 12/2/20.

On the average day in 2018, there were 612,000 hospitalized patients. Assume this is 620,000 in 2020 without Covid

So roughly **16%** or ONE in SIX hospitalized patients in the US has Covid.

guide.prod.iam.aha.org/stats/historic…
This is WAY higher than ANY OTHER reason for hospitalization, including childbirth.

Top 3 reasons for admission in US, 2017 (36.5 million annual admissions):
Childbirth - 10.1%
Sepsis (infection) - 5.7%
Arthritis (elective surgery mostly) - 3.4%

hcup-us.ahrq.gov/faststats/Nati…
The estimate of 16% of hospitalizations for Covid-19 right now assumes that all elective surgeries are happening as planned and includes kids and childbirth.

So this is a big underestimate of what hospitals are seeing in standard adult inpatient units.
Mortality next - 2,733 deaths on 12/2.

In 2018, there were ~7,800 daily deaths in the whole US on average. Let's assume that's 8,000 for 2020 without Covid.

That means that 34% of ALL DEATHS daily in the US right now are from Covid. Over ONE in THREE.

cdc.gov/nchs/fastats/d…
That far exceeds the daily death toll for any other cause of death

Top 3 causes of death:
Heart disease: 1,795 daily
Cancer: 1,642 daily
Accidents: 437 daily

Covid-19 won't be the #1 cause of death in the US in 2020 but based on 2018 stats it will be #3

cdc.gov/nchs/fastats/d…
Here's the most frightening part. We are in the eye of the storm.

We won't see the biggest bump in hospitalizations or deaths from Thanksgiving travel for another 1-2 weeks

And then there's Xmas + new year travel

Don't get numb. Please be safer than you have ever been in 2020
@walidgellad raised an important technical point which is that my estimates don't represent what the final numbers will be for Covid-19 % of hospitalizations or deaths.

That is true - BUT - my point here is just benchmarking how bad this is compared to typical stats.

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More from @ml_barnett

13 Nov
I spent the entire month of February 2020 in a state of silent panic.

Watching Europe + US outbreaks play out, I knew something terrible was coming. But few of my colleagues shared the depth of my fear.

It feels like this again. And I think the public still has no idea.

🧵
Just. look. at. this. graph.

Did late March feel terrible and apocalyptic? We are FAR past that point right now.

And guess what? We have not yet reached the BUSIEST HOLIDAY TRAVEL WEEK OF THE YEAR

My patients are asking me about travel plans. They have no idea what is coming
And how can I blame them? Even *I* am uncertain about how to best counsel them.

Honestly guys ... as a PCP my best source of COVID-19 guidance is #epitwitter and #medtwitter.

If this is how I feel, as a PCP and a professor at @HarvardChanSPH then I fear for our country.
Read 9 tweets
10 Nov
New in @JAMA_current today on a new bundled payment model based in skilled nursing facilities (SNFs)!

Turns out that SNFs can save money too with bundled payments

W/ wonderful co-authors @kejoynt John Orav @DavidCGrabowski Arnie Epstein

brief thread

jamanetwork.com/journals/jama/… Image
@JAMA_current @kejoynt @DavidCGrabowski A little discussed bundled payment model run by CMMI from 2013-2018 was focused on nursing facilities as risk-bearing providers - so called "BPCI Model 3"

How did this program work for total joint replacement - the most common surgery in Medicare?

innovation.cms.gov/innovation-mod…
@JAMA_current @kejoynt @DavidCGrabowski We studied episodes at 448 SNFs from 2013-2017 and matched them to similar SNFs

Outcomes: spending, SNF days and admission/death

This was also my first chance to walk the walk of @laura_tastic @jamie_daw's excellent work on matching in diff-in-diff

Read 7 tweets
25 Aug
🚨 New in @JAMA_current 🚨

"Secret shopper" survey of 368 residential addiction programs for opioid use

TL;DR:

Fewer than 1/3rd offered maintenance treatment with buprenorphine while over 1 in 5 actively discouraged buprenorphine use

More below

jamanetwork.com/journals/jama/…
@JAMA_current Lots written about shoddy quality at residential addiction programs, but there is little hard data out there

We set out to get data on what programs offer to potential patients

Led by @tamarabeetham w/ coauthors @BrendanSaloner @DrSarahWakeman + Marema Gaye, Richard Frank
@JAMA_current @tamarabeetham @BrendanSaloner @DrSarahWakeman We called 368 residential programs as "secret shoppers" posing as individuals looking for opioid use disorder (OUD) treatment.

We asked what therapies do they offer, and do they nudge callers in any direction?
Read 9 tweets
23 Aug
It's been a depressing news week so is another thread of beautiful pictures from Google Earth to make you happy.

#1: Dramatic angles framing a river in Germany

Pics from Chrome extension: chrome.google.com/webstore/detai… Image
#2: An amazing city with respect for its neighbor forest in Ecuador Image
#3: One very scenic cloud in Vietnam Image
Read 9 tweets
20 Aug
New paper out today in @Health_Affairs on shortages of PPE and staff in nursing homes nationally.

We did an in-depth analysis of shortages reported in @CMSGov's COVID-19 nursing home survey (98% of facilities in the US)

healthaffairs.org/doi/abs/10.137…

with @McGarryBE @DavidCGrabowski Image
@Health_Affairs @CMSGov @McGarryBE @DavidCGrabowski Nursing homes have been devastated by COVID-19 - only 1.3 million older adults in the US but >40% of ALL COVID-19 deaths in the US.

Part of the challenge has been persistent PPE and staff shortages. These are widely reported but there hasn't been much data on what is happening.
@Health_Affairs @CMSGov @McGarryBE @DavidCGrabowski We looked at nursing homes' answers about whether they had 1 week or less of 6 critical PPE supplies (e.g. gloves, N95, gowns) and whether they had shortages of staff in 4 categories (e.g. nurses, nurse aides).

We compared responses in late May to mid-July
Read 9 tweets
3 Aug
Two important studies today in @JAMAInternalMed on digital access among older Americans.

They are framed as relevant to telemedicine access but really this is about accessing almost ANY service in the Covid-19 era

Brief thread

jamanetwork.com/journals/jamai…

jamanetwork.com/journals/jamai…
@JAMAInternalMed The first study by @eric_t_roberts @Ateevm uses Census data from 2018 to ask how many Medicare enrollees have access to:
1) any computer with high speed internet
2) smartphone with data
3) any digital access

And over 1 in 4 lack ANY digital access as above ImageImage
@JAMAInternalMed @eric_t_roberts @Ateevm Other stats:

Proportion that lack digital access:
- 50% of those 85+
- 45% of those with less than HS education
- 50% of those below the federal poverty limit
- 36% of those on Medicaid

Clearly video telemedicine won't be accessible to wide swaths of vulnerable older adults Image
Read 9 tweets

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