Looking at hospital data, there's something concerning happening in America's ICUs

There are 27,000 COVID patients in ICUs right now

On October 2, there were 7,000

And in order to accommodate the increase, hospitals are reducing access of non-COVID patients to ICU care

So let’s talk data, hospitalizations, & rationing

Think like a hospital leader facing a surge of COVID patients

What do you do?

First, as # of COVID patients starts to spike, you expand capacity

You convert ORs and anesthesia units to ICUs

You open up field hospitals

But what if surge continues?

At some point you can’t expand further – you're running out of staff

So you tell your doctors & nurses: Hey, ICU is full

Implicit message: slow down ICU admissions

As ICUs fill w COVID pts, ability of non-COVID pts to get ICU care diminishes

So let’s look at data from HHS Protect.

Graph shows

Weekly ICU capacity (blue)
Weekly census of COVID patients (gray)
Weekly census of non-COVID pts (orange)

Why focus on ICU? Because obviously where sickest patients are

And failing to get ICU care when you need it is bad
On October 2, we had in US:

78K ICU beds
8K COVID ICU patients
48K non-COVID ICU pts

As COVID pts rise through October, hospitals add capacity

In Nov/Dec, COVID pts in ICUs more than double

Hospitals add just a few more beds (hitting capacity constraints)

So how do hospitals manage? By reducing Non-COVID pts

By January 1, we have

86K ICU beds (up from 78K)

27K COVID pts in ICU (up from 8K)

39K non-COVID pts in ICU (down from 48K)

Imagine a patient with moderate to severe lung disease or stroke

In October, they would have gone to the ICU

By December, many such patients aren’t getting ICU care

But let’s be clear, they would be better in the ICU

But ICUs are full. So hospitals forced to ration

But let's look at some states where picture clearer
Here’s Arizona

From October 2 --> January 1:

ICU capacity up 50%

COVID patients in ICU up 1250% (75 to 1011)

Non-COVID patients down 14%

By January 1, more COVID patients than non-COVID pts in ICUs
And California

October 2 --> January 1:

ICU capacity up 22%

COVID patients in ICU up 829% (from 492 to 4569)

Non-COVID patients down 30%

More COVID pts in ICUs than non-COVID patients
And a few more so I'm not just cherry picking

Georgia -- similar picture
And Texas

Where again, about half of all ICU beds are occupied with COVID patients

And # of non-COVID patients has fallen about 20% to accommodate surge of COVID patients
So that’s where we are

When you hear disinformation spreaders say hospitals have plenty of room...they don’t

If they had plenty of room, they wouldn’t cut back on ICU care for non-COVID patients

Reduced access to ICU care for non-COVID pts despite increased capacity

Bottom line is this

COVID is directly killing 3K-4K people every day

It is also filling up ICUs across the nation, particularly in hot spots

This appears to be reducing access to ICU care for sick non-COVID patients

Years from now, careful analysis will likely find that during this time, sick people without COVID in hot spots died at much higher rates

That's what happens when hospitals become strained

Their deaths won’t count as a COVID-related deaths

But may be, it should


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More from @ashishkjha

12 Jan
We are in the worst days of the pandemic

How do we get through this?

So I’m teaming up w/ my friend, colleague, @MeganRanney to teach a new rapid-response course in Pandemic Problem Solving at @BrownUniversity


Quick thread on why & what to expect
Things are bad with this pandemic

Our institutions continue to confront major disruptions

The healthcare system is reeling

The vaccine rollout is slow

Businesses keep having to adjust their operations

Policymakers are struggling with how to devise good policy

But we have learned a lot already from how we navigated earlier waves of this pandemic

From sourcing PPE to our struggles to implement robust testing and tracing

Each week in this course, we will hear from leaders who will share their lessons learned

Read 6 tweets
11 Jan
Just spoke with a close colleague, thought I'd share his story

Have changed minor details to protect him

He's an ER Doc, working in a hot spot

Few days ago, early evening, vaccine team showed up with a bunch of extra doses of Moderna vaccine

They were looking for unvaccinated employees

Most employees there had been vaccinated. Rest were unwilling

Found several EMTs & patients who were excited to be vaccinated

But hospital policy was clear: non-employees aren't eligible

My friend, ER Doc, incensed, intervened

He tried to persuade vaccine team but they wouldn't over-ride hospital policy.

He called ER leadership. They wouldn't over-ride

Next, hospital leadership. They initially said no, claiming state mandate

He is persuasive and persistent....so they eventually relented

Read 5 tweets
10 Jan
Important @apoorva_nyc piece. Highlights bigger issue

Hospitals rightly prioritized for vaccines because of front-line workers: nurses, doctors, staff

But many vaccinating non-front-line staff, administrators, even wealthy donors on their Board


I have mixed feelings here

We need to get shots out

Reasonable to vaccinate folks working in hospital lab

But administrators? donors on boards? Their families?

There is a better way

Hospitals should use left-over doses for elderly, at-risk folks in their community

Hospitals are getting mixed messages

Told to use their vaccines quickly (good)

Told to not let any cut in line (appropriate)

Told not to give it to non-hospital folks (ugh)

Hospitals have doses left over (due to staff hesitancy)

They are worried about not using it right

Read 4 tweets
8 Jan
Things are very concerning with the pandemic

Not just vaccine distribution but outbreak itself

It's bad

Yesterday we had more than 4,000 deaths from COVID19

Highest single day ever

But story is worse when you look at cases, hospitalizations

And thus, urgency to act

Let's talk data -- via @COVID19Tracking

7-day moving averages from yesterday

Daily deaths 2761: highest ever

Daily new hospitalizations: 4284: highest ever

Daily new cases: 224K: highest ever

% positive: 16.6%: highest since Apr 21

You know what's not highest ever? Testing
So this is a problem for lots of reasons

Obviously, having more Americans dying is horrible

But yesterday's deaths represent infections from mid-December

Before the holiday surge

And back then, cases were lower

And the percentage of tests positive was lower

Read 8 tweets
3 Jan
I've been thinking about the debate of delayed vs. immediate 2nd dose for some time

Over past week, have become convinced that getting all doses out now is better

Its NOT a no-brainer

Reasonable people can (and do!!) disagree

So here's why my thinking evolved

Obviously, if you want to stick to the trials (reasonable position), then stay with standard interval

But soon, we'll be confronted with question -- do we give 2nd shot to some people or 1st shot to more people

Is there clinical trial evidence that 1 dose is helpful?



There is compelling data from Pfizer and Moderna trials that after about 10 d after 1 dose, you get 80-90% efficacy



So the BIG question is -- is that going to be durable beyond 21 to 28 days?

We don't know for sure

Read 10 tweets
30 Dec 20
Really important news out of UK

Important for UK and the world

But I have mixed feelings about the science here

So what's the news?

UK MHRA (their FDA) has authorized the Oxford Astra-Zeneca vaccine

Why such a big deal & why am I conflicted?


First, the data

UK regulators suggesting that the data they evaluated suggests vaccine has 70.4% efficacy


With zero hospitalizations & zero severe disease in vaccine arm

So that’s good

But not as good as Moderna or Pfizer vaccines (in efficacy)
So why is it such a big deal?

1st, UK will start vaccinating people next week at large scale

2nd, India, other countries will likely now approve this vaccine

And India likely has tens of millions (if not more) doses ready to go

Read 9 tweets

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