OK let's talk about hospital admissions (with a focus on #Indiana) and what we can maybe expect with Omicron

Last week I talked about ICU beds, but what about hospitalizations overall?


1/
A new report out of the United Kingdom suggests several things:
1. Omicron seems to hospitalize at about half the rate of Delta
2. Vaccination is protective against hospitalization, and boosters are important to extend this risk

Report: bit.ly/3Hwq0fC

2/
These data is based on a relatively small number of hospitalizations (815), so take it with a grain of salt.

These data suggest for Omicron, unvaccinated folks are 5 TIMES as likely to be admitted to the hospital as fully vaxxed folks (3 doses)

3/
So Omicron seems to hospitalize at half the rate as Delta- which is great

But In Indiana we are starting this wave at a VERY bad place- we average 10,000 hospitalized patients in normal times

We are currently at 13,000 hospitalized Hoosiers- we are well over capacity

4/
Since October 1 in Indiana, about 7.2% of cases have been admitted to the hospital.

If Omicron cuts this in half, that is 3.6% of cases admitted to hospital.

But cases are skyrocketing

5/
Here are some projections about what could happen with hospital admissions in Indiana

The equilibrium point for hospitalization is probably around 300-350 admits

The most daily COVID admissions we have seen is 539 (2 days in Jan, 2020)

6/
So the good news? Omicron appears to hospitalize less

The bad news? The volume of cases will overwhelm us quickly if we continue this rise

And in Indiana, we have barely 50% vaccinated. So it could be worse than this projection from a hospitalization standpoint.

fin/

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More from @gbosslet

30 Dec 21
If you are attending a large New Year celebration with strangers, please know that in many areas of the country you are contributing to the collapse of the health care system.

This applies regardless of your vaccination status.

I know this sounds dramatic- please read on.

1/
I am not chicken little when it comes to COVID

I have been a proponent of pulling back restrictions and mask requirements for the vaccinated

But the goal of public health measures is to protect hospital capacity

In Indiana, we are worse than ever.


2/
Omicron’s spread is nuts.

I’ve followed the data closely the entire time and I am floored by it.

3/
Read 11 tweets
27 Dec 21
This recent COVID-19 surge has put a major strain on hospital systems

I am an ICU physician and we have felt it acutely in this area of the hospital

Indiana has somewhere around 250 ICU beds currently unoccupied in the state (out of ~2100)

How can 250 feel like zero?

A 🧵

1/
First, a word about statewide data.

Never has there been a microscope on these data like this, and the transparency is awesome.

Both @ISDH and @HHS keep track of hospital metrics regarding occupancy.

@ISDH data: bit.ly/3qLcNJh

@HHS data: bit.ly/3erSk6l

2/
We feel a major crunch in ICU beds

constantly moving people out of the ICU to accommodate transfers

currently there is always a list of people waiting to come to our facility from other places

many of which report that they are out of room

3/
Read 15 tweets
20 Aug 21
mRNA injected into deltoid cells lasts about 72 hours and do not travel to distant sites in the body.

I get asked about this all of the time, so I went to find the primary science on this.

A couple of quick tweets

1/
The first paper I can find on this was in @ScienceMagazine in 1990 and showed the half-life of RNA in muscle cells to be less than 24 hours- RNA encoding the luciferase protein was injected into mouse quads and luciferase was undetectable at 60 hours. pubmed.ncbi.nlm.nih.gov/1690918/

2/
In 2007, a study agreed:

Luciferase-encoding mRNA injected into human ear dermis peaked transcription at 17h and was undetectable at 3 days (panel d).

They also looked for luciferase expression at distal sites in the ear and saw none (panel e).

pubmed.ncbi.nlm.nih.gov/17476302/

3/
Read 5 tweets
22 Jul 21
Earlier this summer I was adamant that school would be reasonable without masks, even for the ages for which vaccines are not available.

I have changed my tune. A quick 🧵as to why.

1/
Most data suggest that the SARS-CoV-2 virus affects kids in a generally quite benign way.

I know people get frustrated when COVID is compared to the flu, but for kids the data suggest the comparison is reasonable. And this accounts for "long COVID" and MIS-C.

2/
So when I suggest that masks should be mandatory in school for kids, I am not worried about the health of my unvaccinated 6 and 11 year olds.

I am worried about it causing widespread community transmission and overwhelming hospitals.

Again.

3/
Read 7 tweets
13 Apr 21
This week our manuscript on the role of in-person school on community spread of SARS-CoV-2 in Indiana was published online in Clinical Infectious Diseases.

This thread will outline our findings.

manuscript: bit.ly/3mIXvC5

1/17
This was a truly interdisciplinary effort.
@micahpollak (@iunorthwest): economics
Jeong Jang (@IUmedschool): biostats
@rebekah_roll (@IUmedschool): data gathering
Mark Sperling (@iunorthwest education): education
@deliriumkahn: analysis

I just sort of herded cats.

2/17
I’m going to target this thread to a wide audience, so my description of our work may leave some wanting more detail. The detail is in the online version and the supplement. Happy to answer any questions on the work as they come up.

3/17
Read 17 tweets
4 Apr 21
Over the last about 6 years I have adopted the practice of not checking email AT ALL on vacation.

When I mention this, many scoff and say that would never work for them.

I said the same thing when I started.

Join me for a 🧵 about my journey to vacation email freedom.

1/
I have a relatively busy job as a clinician, fellowship director, and assistant dean for faculty development/affairs.

I average 70-100 emails per day.

So committing to not checking it for a week (or 2!) away is admittedly no small task.

I adopted this practice in stages.

2/
My initial state was bad- there was one vacation in which I was answering emails on my computer on the beach as my kids were frolicking in the ocean.

This was when I knew I had to make a major change. This was my low point.

3/
Read 14 tweets

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