The US hits a million COVID cases in one day. Shit.
Hospitalizations also rising rapidly.

The key is that “milder” ≠ “mild”

A variant that is 2x infectious but 30% less virulent is still very bad & has potential to overload our hospitals.
Also important: most people in the hospital don’t have COVID but everyone’s care is harmed when we don’t have enough staff.

Some hospitals have >30% of acute care staff out sick.

Today is a bad day to need the cath lab or OR.

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More from @nickmmark

27 Dec 21
Finally read the new @American_Heart AHA guidelines & they are absolute garbage.

Providers shouldn’t delay compressions or defib to put on PPE? Seriously?!? It takes like 10 seconds to put on an N95!

1/
Also were they afraid to actually *recommend* vaccination?

How about saying “vaccines substantially reduce the risk of DYING or getting SERIOUSLY ILL from COVID. All healthcare workers *should* be vaccinated”

Instead they went with a toothless “may reduce their risk” blah
2/
Others have pointed out the utter hypocrisy of people who are NEVER the first responders to a code writing this guideline. This is true.

Also, logistically, who do they think will respond to a code when a dozen RNs are home sick after being exposed at the last one?
3/
Read 5 tweets
25 Dec 21
Nothing conveys so much scientific ignorance so concisely as “Dandelion 22.7pH”
It’s a common misconception that you can’t have a pH above 14.

You actually CAN have a strong base with pH >14 (or an acid with a pH <0). It’s just super duper hard to dissolve that much base in water.

🧪 Let’s look at what it would take to make a BASIC solution with pH=22!
1/
First off what do we mean when we say BASIC?

I guess it could be any of these things…
2/ ImageImageImageImage
Read 19 tweets
25 Dec 21
Doing a coding refresher while my kids were watching a movie, resulted in an epic crossover: Home Alone ICD10

First the title. 3 options:
Z62.29 Other upbringing away from parents
Z60.2 Problems related to living alone
T76.02XA Child neglect or abandonment, initial encounter
1/
The movies opens with household chaos. The protagonist (Kevin) is bullied by his older Brother “Buzz”.

Don’t worry there’s not one but two ICD10 codes for this:
1️⃣Y07.41 Sibling, perpetrator of maltreatment
2️⃣F93.9 Childhood emotional disorder, unspecified
2/
Kevin fears that Fuller (played by his real life brother Kieran) will wet the bed.

You can code this concern from Fuller’s perspective or from Kevin’s:
1️⃣N39.44 Nocturnal enuresis
2️⃣W55. contact with urine of unspecified mammal

3/
Read 32 tweets
23 Dec 21
More good news! FDA authorizes another oral COVID treatment today: molnupiravir

A short 🧵 about how molnupiravir (MOLN) works & how/when to use it.

1/
fda.gov/news-events/pr…
Molnupiravir is a pro-drug that is converted to the ribonucleoside analog N4-hydroxycytidine (NHC).

Phosphorylated NHC is incorporated into SARS-CoV-2 RNA by the viral RNA polymerase. This causes many mutations in the virus (“viral error catastrophe”), preventing replication.
2/
But wait aren’t mutations bad? Isn’t Omicron a bunch of mutations that make it more infectious?

The distinction is the *number* of mutations.

RNA viruses are error prone - accumulating on average 1-5 mutations with every copy.

MOLN induces many DOZENS of mutations at once.
3/
Read 18 tweets
18 Dec 21
Yesterday I gave grand rounds lecture at @NJHealth about the Omicron Variant: molecular biology, epidemiology, and clinical pearls.

Here's the video & link to download my slides.
🎥
📂 onepagericu.com/blog/grand-rou…
Google says AH-MUH-KRAN is 🇺🇸 & OH-MU-KRON is 🇬🇧
Oversimplified..

In ancient Greek, there were 2 letters pronounced similarly:
Ω made a long Oooo - it was called big O or O Mega
Ο made a short Oo - it was called little O or O Micron

Thus, OH-MI-KRON is probably more accurate
2/ Image
To understand Omicron, we need to understand pandemic surveillance:

A sick person 🤒 gets COVID tested.
The (+) results get sequenced (depending on where in the 🌎 ) & published to @GISAID (or other platform).
Sequences are used by researchers globally, such as @nextstrain.
3/ Image
Read 9 tweets
27 Nov 21
There’s a new SARS-CoV-2 variant of concern: Omicron (aka B.1.1.529) #OmicronVariant

What is this Omicron COVID variant & is the panic of it justified? (spoiler alert: no)

A short #OmicronExplainer 🧵 about what we actually know, what we suspect, & what’s still unknown.
1/
4 reasons Omicron is worrisome:
1️⃣ it is spreading rapidly in South Africa (known)
2️⃣ it is highly mutated (known)
3️⃣some mutations likely increase transmissibility (suspected)
4️⃣others *may* allow it to evade existing immunity or vaccines (unknown)

We’ll talk about all 4...
2/
First some nomenclature:
B.1.1.529 (its Pango lineage) is the same as “Omicron" (WHO declared it a variant of concern & assigned a Greek letter) #OmicronVariant
It’s also known as K21 (Nextstrain clade)

It’s erroneously been called the #NuVariant ... yeah that’s not a thing
3/
Read 16 tweets

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