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Tatiana Prowell, MD

@tmprowell

23 Dec

🧵 Your risk of dying if you get #Omicron in the next few wks as opposed to a few months from now will be dramatically different. We are facing huge surges in Jan that will make it hard to get seen in an ER in a timely fashion & even harder to get admitted to a hospital.

2/ Should you be fortunate enough to find a bed, you will have drs & nurses overwhelmed with patient volume, who will have very limited time to spend w/ you. Dr to patient (& nurse to patient) ratios will be unsafe, like unthinkable in pre-#pandemic times. #Omicron #MedTwitter

3/ This alone will dramatically increase your odds of death. That’s been seen in the prior surges. With #Omicron, the # falling ill at once is 🚀 off the charts. I’m seeing attack rates of 75-100% even in fully #vaccinated (& some #boosted) gatherings & households. #MedTwitter

Read 13 tweets

Tatiana Prowell, MD

@tmprowell

23 Dec

📣#Preprint #COVID19 #ConvalescentPlasma
📌RCT (N=1.2K)
📌Outpatients age 18+
📌High-titer CCP (>1:320) vs placebo plasma w/in 9d of symptoms
📌Primary endpt: Hosp/death by d28
📌CCP 🏆: 54% ⬇️, driven by non-ICU hospitalizations (NNT=29); HR 0.46, p<.01
medrxiv.org/content/10.110…

2/ A few important points about this #COVID19 #convalescentplasma trial
📌High-titer CCP was much higher than that used in some other studies (median titer of >1:14,580 & 95% had >1:4820)
📌Median days to plasma: 6d
📌53 of 54 hospitalizations were in unvaxxed (#GetVaccinated!)

3/ 📌 Only 3 deaths in post-hosp period, all in controls
📌 Few #COVID19nCancer or #immunocompromised
📌 Study used #convalescent plasma mostly from Apr-Dec 2020 (ie pre-#vaccine availability)
📌Would *predict* CCP from #vaccinated to perform well vs #Omicron & #covidvariants

Read 9 tweets

Tatiana Prowell, MD

@tmprowell

20 Dec

🧵I have to say it: Christmas break is going to be bad. I'm watching confirmed #COVID19 cases⬆️ exponentially at our highly-#vaccinated school w/ a #MaskMandate & HEPA filters in every class. Make a plan now for how you'll handle Xmas & #quarantine when someone gets #Omicron.

2/ Think about how you can create a separate space for the person(s) infected. Remember #OmicronIsAirborne. Pick a rm w/ windows to open & its own door if your home allows. Today put a fan there that can be used to improve air exchange. Put a 🌡️, an O2 sat monitor, good masks.

https://twitter.com/tmprowell/status/1472411895273504771?s=20

3/ Go get a MERV13 filter for your HVAC at Home Depot or Lowe's or online. While here, get the stuff to build a simple, inexpensive, highly-effective Corsi-Rosenthal box. You can see what this is here. Build it now so it's ready.

https://twitter.com/tmprowell/status/1472411895273504771?s=20

Read 15 tweets

Tatiana Prowell, MD

@tmprowell

20 Dec

https://twitter.com/babbymd/status/1472794321455779841

I’ve been contacted 2x just this wk—1 IRL acquaintance & 1 person I know only via Twitter—after they got imaging results in portal before their dr. They DM’d w/ screenshots, panicked, asking for help. I’m 💯 for pt access to #EHR, but #CuresAct implementation needs a MAJOR reboot

https://twitter.com/babbymd/status/1472794321455779841

Whenever I have expressed concern about #CuresAct, #advocacy often tells me it’s still better. But it def was not better for these folks, nor for me dropping everything to help ppl who aren’t my pts, whose records I lack, & whose drs I don’t even know, i.e., it’s bad care. 😔

And I’m always happy to help patients, genuinely. I actually started using Twitter to be able to report out from #SABCS17 (I think) for #advocacy. But I don’t like providing bad medical care, & this is a set-up for doing so. We need a systems fix so pts aren’t left hanging…

Read 4 tweets

Tatiana Prowell, MD

@tmprowell

19 Dec

🧵It is now clear that we are going to have to get people to #MaskUp to get thru winter without US health care system collapse. #Omicron is way too contagious. #VaccinesWork & #GetBoosted, but they will not be enough on their own. So this thread is for people who hate masks:

2/X: If you hate masks because the ear loops make your ears sore, google "ear savers." That's the term I've seen used for various products that spare your ears w/ masks. Examples in pics, but if you can sew on a button, make some. What else are you gonna do in #quarantine?

3/X: You can get a beanie, headband, baseball cap, head scarf, whatever & attach button or hooks of any kind that you can get from any sewing store or online, & attach your mask loops to that. Ear pain solved! It's important to have a snug fit so try diff distances.

Read 17 tweets

Tatiana Prowell, MD

@tmprowell

19 Dec

I know personally 3 people receiving monoclonal antibodies this evening. All have had 3 doses of #COVID19 #vaccine or prior infection + 2 doses of vaccine. All are careful. They all have risk factors, but all are pretty symptomatic. Jan is gonna be…rough. #MaskUp. #Omicron

Tweet 2: A lot of people seem to be panicking based on this anecdote. Panic is NOT productive. Instead you need to calmly plan & act to reduce your risk. These are some effective things you can do right now:
👉Upgrade your masks. No more cloth alone. Best is N95/KN95/KF94...

@projectn95

Tweet 3: As an alternative to N95/KN95/KF94, if you can't tolerate those or don't have them, I rec a surgical mask (ASTM level 3, 3-ply is great) w/ cloth mask over it. Read this: scientificamerican.com/article/why-we…. The non-profit @projectn95 has vetted, affordable PPE including masks.

Read 13 tweets

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