When all the dust settles, we realize we've lost azithromycin, right?
Doctors from DC to Kampala give azithromycin for COVID even though it's a virus, even though <4% on hospital admit have a superinfection
It's not helping patients but makes providers feel good to do something
In case it needs to be said, azithro doesn't have superpowers. Added to standard treatment, it doesn't help thelancet.com/article/S0140-…
Azithromycin, prescribed for every cold for the last couple of decades, was already faltering. It has already been removed from US IDSA/ATS first line treatment recs for community acquired pneumonia. Too much resistance thoracic.org/statements/res…
Azithromycin resistance is not yet prevalent everywhere. Too expensive for many parts of the world it has been studied as a blanket means of reducing child mortality. Thing is, use it enough and you lose it. It can only last so long
nejm.org/doi/full/10.10… ncbi.nlm.nih.gov/pmc/articles/P…
And we, the world, do need azithromycin. It's not just a drug to take or dispense when we feel like it. It's not just a med for those with penicillin allergies who don't really need an antibiotic. It has some important roles.
Notably, azithro is needed for Typhoid.

Typhoid kills about 200K a year and causes about 11-21 million cases. Those who die often have little voice in the world. They have poor sanitation and little access to running water. Hospitals and IV treatments can seem out of reach.
There is now XDR Typhoid.
There is a form of typhoid for which only one oral treatment remains - azithromycin, seen most notably in Pakistan.

We shouldn't waste the one oral treatment for a disease of the poorest people for no good reason.
wwwnc.cdc.gov/travel/notices…

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More from @InfectiousDz

21 Nov
Lines snake around the block for pre-Thanksgiving COVID testing

Not a good idea.

You can test negative on Saturday and be positive on Thursday, on Sunday, on Saturday night. The moment you switch from negative to positive you are at your most infectious and likely will not know
Of those who will develop symptoms, most will by 5 days after exposure. Many will start shedding 1-2 days before symptoms. Any exposure 5 days before Thanksgiving is incredibly risky and a negative test today doesn't mean you won't be maximally infectious on Thursday.
In fact, if you're positive today, you may not even be infectious by Thursday. 10 days after your initial symptom (or first positive test) you are considered non-contagious, as long as you have no fever and your symptoms are improving.
Read 5 tweets
9 Nov
So what do we know about the Pfizer vaccine.

1. Great news: vaccine, so far, 90% effective in reducing symptomatic COVID, as opposed to saline injection

2. Study enrolled 43,538 volunteers and 38,955 had 2 doses; 94 cases in unvaccinated
statnews.com/2020/11/09/cov…
3. Interim analysis found 94 cases in the non-vaccinated sooner than 1st expected. Surges in cases will mean more potential cases and faster vaccine study results

4. Authorization process will not begin in US until 2 months after 2nd doses given. Likely late Nov.
5. Phase 3 trial still on-going, will need over 164 cases for final analysis, which given recent surges will likely coincide with the 2 months after 2nd dose time period.

6. No mRNA vaccine has been approved in any country ever, though such vaccines have been studied for years
Read 10 tweets
9 Nov
Pfizer vaccine is good news.

There's still a lot of work.

Safety and longevity data still needed

The vaccine relies on mRNA, which can disintegrate unless kept quite cold. The vaccine needs to have 2 doses of a vaccine kept at neg 80 C (neg 112 F) until just before injection.
Each country will have its own vaccine approval pathway. Many will take months.

Production, distribution will remain hurdles, as will the infodemic and potential public hesitancy over the virus.

washingtonpost.com/health/2020/11…

statnews.com/2020/11/09/cov…
The US FDA will only allow companies to file for an emergency use authorization (EUA) when half the patients in their study have been observed for safety issues for at least two months following their 2nd dose. Pfizer - 3rd week of November
statnews.com/2020/11/09/cov…
Read 4 tweets
16 Oct
Hawaii, opening up to tourism with testing may not be the best idea.
Islands like Aruba, French Polynesia, and Iceland had seen terrific control of COVID until tourists, fully tested tourists, arrived and then COVID rates exploded.
Aruba opened to tourism in July 1. All tourists were tested immediately before or after arrival. By August, Aruba saw the highest rate per capita in the world. travelpulse.com/news/destinati…
French Polynesia opened to tourism July 15th. All visitors over the age of 6 had to have negative PCR testing. COVID cases stayed low until they didn't. Cases shot up over the last month and now French Polynesia has the highest per capita COVID rate in the world.
Read 10 tweets
5 Oct
Infection Prevention and Control 101.
1. Do not rely on one tool. Do not build a Maginot Line
2. Work from broadest communal protection down to personal protection. Reduce entry, design environments with reduced contacts, ensure rules allow for compliance.
3. The slices of Swiss cheese, each line of defense, have to line up for the pathogen to pass through the holes. Line up so many slices that probability makes this an impossibility.
4. Don't allow for work arounds and honor codes. We're all in denial about having an infection.
5. Design is a tool for health. Layout can permit communication (or observation) without contact/exposure. Flows of traffic can be designed to reduce mixing. Natural ventilation and outdoor spaces can be maximized.
Read 10 tweets
4 Oct
Nurses of Filipino descent comprise just 4% of the US workforce, but nearly a third of registered nurse deaths due to COVID-19, according to National Nurses United union
businessinsider.com/filipinos-make…
Nurses of Filipino descent make up of the staff in many hospitals hit hard by COVID.
There are about 150,000 Filipino nurses working in the United States — and 20% of the nursing force in California.
usatoday.com/story/opinion/…
Vulnerability to infectious diseases though is not always due to increased exposure. There may be increased genetic vulnerabilities as well, as we have seen certain immune differences that can be genetic, such as seen with Interferon genes.
genengnews.com/news/severe-co…
Read 4 tweets

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