This short video from @EricTopol & @Danieloran summarizes key issues about Asymptomatic Spread of #COVID19. Watch & then read the🧵for my unpacking…there is so much at stake!
2/ In 2020, @danieloran & @EricTopol predicted that up to 40-45% of people infected w #COVID19 were totally asymptomatic, meaning HUGE risk of silently spreading the disease to others. 👁 highlights
3/ Now we know ~1 in 3 people infected with #SARSCoV2 remain asymptomatic. This is based on 61 studies & ~1,800,000 pts! Also, of those who test + w/out any symptoms, 75% stay asymptomatic. This poses a HUGE risk of silent spread to high risk patients.
4/ This @Lancet study found that asymptomatic #COVID-infected people are ~1/4 as infectious as people w symptoms (& other studies show about 1/3rd), so that is good, but there are absolutely people w/out symptoms giving covid to susceptible people.
5/ In an indoor space, you can bet there are #unVaxxed people around you w asymptomatic #COVID. If you ARE Vaxxed, you are NOT at risk for mod/severe disease, and that’s great, but YOU CAN GET INFECTED & give it to someone else without knowing it, which is where masks help.
6/ Today I was talking with a patient who declined the #Vaccine and is suffering severe blood clots and lung failure from COVID and she begged me to ask others to not make the same mistake she made…
7/fin
In order to ⬇️ asymptomatic spread, we must develop & use rapid, inexpensive home testing often as discussed by @michaelmina_lab. Financial assistance to under-resourced populations must happen. For now, #Vaccine + #Mask for indoor public spaces are still 🔑 considerations.
2/ 4-months after #COVID, this @JAMA_current study found 51% of N=478 pts had >=1 #LongCOVID symptom that wasn’t there before. 63% of those w CT scans had lung problems, with 1 in 5 showing scarring. What else?...
3/ This JAMA study also showed this important array of symptoms that essentially constitute #LongCOVID – 31% gross fatigue, 21% cognitive problems, and 23/18/7% anxiety, depression & PTSD. Their outsides look normal, but they aren’t!
Our patient wants to live 3 days to see his grandson graduate. He has #COVID19 pneumonia & is extremely short of breath. He’s chosen NOT to go on a ventilator & is on 100% O2 HiFlow Canula. He’s afraid of tight-fitting a bipap mask.
2/ The intern said, “I never saw a patient whose respiratory rate was twice his oxygen saturation!” Yep, last night his O2 sats dropped to 30% and he was breathing 60 times a minute! By morning he was 85% sat and RR was 28. Better but tenuous.
3/ All of this raises some complicated ethical + treatment questions that I’d like to cover. We addressed this on rounds several times this week & at times it got a bit heated. His #nurse said she noticed herself flushed, mad, and heart rate >130…why?
1/🧵This figure from CHEST on early tracheostomy in #COVID19 pts is helpful for 2 reasons: it points out different ways of care. Read the BLUE circles clockwise & then switch to OUTER RED ARROWS clockwise again. Clear and True.
2/ The #COVID pt with ARDS + Sepsis on a ventilator is TOO often subjected to TONS of sedation, which adds brain injury, immobilization & development of physical disability. NEW DISEASES added to the original problem. We call this Post-Intensive Care Syndrome #PICS.
3/ Early tracheostomy around day 10 can help (not always!) as outlined in the RED ARROWS. The goal is to lessen the added injury by waking people up, getting them out of bed and early mobilization plus talking with family. This is done via the #A2Fbundle. @SCCM
Mentees often tell me they feel stuck in time with no progress in achieving their goals. This is a Meanwhile. As humans, we want to get through meanwhiles, but they are important times of growth. Don’t rush meanwhiles!
Some thoughts…
2/ When I was in college, a mentor taught me about the 3 major types of meanwhiles.
1. Uneventful Occurrence. 2. Unknowing. 3. Not Yet.
Don’t let fear drive you past the riches of these meanwhiles!
Let’s break them down…
3/ Meanwhiles of Uneventful Occurrence:
Tedium is not just OK. It’s necessary. Ordinary times are preparation for fruit to come. Let the grace of your routine establish sustainable balance in your life…one day at a time…in this we grow.
N=428. In 1 study we go from 1. statistically significant ⬆️ Deaths w steroids 2. to no difference by adjusting 3. to statistically significant ⬇️ Deaths by subgroup phenotyping of inflammation…
All in the same study? Let’s unpack this... #MedTwitter
2/ Chen et al built on a 2014 @LancetRM study by Dr. Calfee of 1,022 pts, showing that sick people on a ventilator w ARDS (think #COVID19) are of 2 types, 1 of which is Hyperinflammatory (storm of inflammation) who might benefit from drugs like steroids.
3/ First Chen tried to overcome the biases associated with their observational data & showed that some observational methods (eg, multivariable regression including baseline SOI) can give the exact wrong answer (HR 1.97) because it does not include temporal biases.
1/ #COVID19’s “Long Loneliness” was exacerbated by our flawed decision to separate pts from family at just the time they needed each other most. @doctor_oxford has captured the sorrow & pleads for us to come to our senses.
2/ @doctor_oxford ✍🏻: “NHS did its best, but too many were isolated when they needed connxn most, leaving a legacy of deep trauma.” No doubt we dropped them “into Hades.” It was done w benevolent intent but in fear. PPE works & we must adjust visitation humanely.
3/ One daughter who lost her dad said, “Even when they told us they were going to withdraw Dad’s life support, no one from the hospital offered us the chance to come in or suggested a video call or a phone call.” This is flat out wrong at every level & we know it.