Thread by @DrJacobsRad

Thanks for looping me into the conversation @DFisman.

Trepidation by those who lobbied for school closures and further lockdowns, that their interpretation of the data may not be a true reflection of the clinical burden of the #Omicron variant, is understandable.

#Cdnpoli
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https://twitter.com/DFisman/status/1478370475038412805

So, let's review the situation locally, and see what the experts in the US and the UK are saying and doing.

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Currently, at my 722 bed urban hospital, we have 80 patients with COVID. Of those, 35 have been identified as having COVID unrelated to their diagnosis. That's 44% of patients and includes some in the ICU.

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Your argument is that this metric is irrelevant because COVID complicates clinical outcome is valid, but not in every situation. It's particularly relevant in the geriatric population, but the argument weakens in the younger population and the asymptomatic.

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The first study that you presented as evidence in support of your hypothesis speaks to seasonal peaks in mortality related to influenza. It's a bit of a stretch to say that it speaks against classification of patients as symptomatic vs asymptomatic.

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academic.oup.com/aje/article/16…

Dr. Fauci, who as you know is not a radiologist, was asked if case counts cause unnecessary worry and if deaths and hospitalization are better metrics says the following: (next page)

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theguardian.com/us-news/2022/j…

“The answer is, overall, yes, this is particularly relevant if you’re having an infection that is much, much more asymptomatic and minimally symptomatic, particularly in people who are vaccinated and boosted."
-Dr. Fauci

/7
theguardian.com/us-news/2022/j…

His position on dividing hospitalization counts into patients in hospital because of COVID, or with an incidental COVID infection is also quite clear.

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newsweek.com/fauci-children…

Since all hospital admissions are tested for COVID-19, "many are hospitalized with COVID, as opposed to because of COVID... They may go in for a broken leg, or appendicitis, or something like that. So it's overcounting..."
-Dr. Fauci

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businessinsider.com/some-hospital-…

But don't listen to me (I'm just a radiologist as you've pointed out numerous times). Listen to Dr. Fauci speak. As head of the National Institute of Allergy and Infectious Diseases, he's arguably a reliable source.

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https://twitter.com/TPostMillennial/status/1476710278096166917?t=iBrgKxsvGusWJNVq6bYxQw&s=03

In the UK, Chris Hopson, the CEO at NHS Providers, also supports drilling down deeper into the data to understand the true burden of COVID on the hospital system.

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https://twitter.com/ChrisCEOHopson/status/1475540064121806856?s=20

He goes on to quote another CEO who says that,
“we’ve seen a 30% increase in covid positive inpatient numbers compared to 7 days ago. But largest proportion are incidental finding on admission."

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https://twitter.com/ChrisCEOHopson/status/1475540079628201990?s=20

In conclusion, it would be wrong to dismiss the impact of a symptomatic COVID infection as a comorbidity, particularly in the elderly, but it would be equally wrong to ignore the fact that as many as 44% of COVID positive patients in hospital aren't hospitalized because of COVID.