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Noha Aboelata, MD Profile picture
@NohaAboelataMD
Jul 18 • 8 tweets • 4 min read Twitter logo Read on Twitter
How will we know if a covid wave is coming? The short answer is we might not, but there are some earlier indicators that can clue us in:

1- Wastewater
2- Emergency Department (ED) Visits with/for covid
3- % positivity

Here's where we are on each:
Many parts of the US are seeing wastewater upticks. Here are 4 good resources - you may be able to locate a sewershed near you. Oakland wastewater is showing a clear uptick.

https://t.co/qVD6HZGBLU
https://t.co/xtpAcPM7cj
https://t.co/aTJpDOj1va https://t.co/xPTLaawMIEdata.wastewaterscan.org
publichealth.verily.com/?v=SC2_N
cdc.gov/nwss/wastewate…
biobot.io/data/
Oakland CA wastewater SCAN showing clear upward trend.
Unfortunately we don't have ED visits by county, and reporting of this metric seems patchy. Still, all things being equal, an upward trend is an indication of increasing covid. Here we see a slight upward trend over the last couple of weeks (thru 7/14).
https://t.co/Y5LBwejIbicovid.cdc.gov/covid-data-tra…
Covid ED visits with slight upward trend over the last couple of weeks, through July 14, 2023.
Lastly, % positivity. This is a tough one because so few tests are being performed/reported, so it’s also a reflection of who's getting testing. But since this behavior is unlikely to change (barring something unusual), changes in test positivity should still be an indicator.
The CDC tracker shows % test positivity by state/region lagging behind a couple of weeks (not so helpful), but your county may still maintain updated data. Here is Alameda County's - increasing and currently at 8%. Alameda County covid % test positivity increasing. Now at 8%
The Walgreens tracker - again, small testing numbers but we're looking at trends - also showing an increase. Surely people who are more likely to be positive are showing up for testing, but assuming that pattern of behavior is relatively consistent, the increase is an indicator. Walgreens covid positivity tracker showing a 2.9% increase the week ending 7/8 compared to the week before
So, for those still interested in trying to understand what's going on with covid, three different early indicators are all pointing to a current uptick. We'll need to stay tuned to see if this correlates to anything else, and we need lags in data to improve to facilitate this!
In the meantime, stay #PreparedNotScared (h/t @ModelAyshaMirza). You *can* have fun and protect yourself at the same time! Gather outdoors, mask indoors, improve ventilation, test, isolate if sick. Have a treatment plan if you should be treated. Stay safe out there! 🙏🏾

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More from @NohaAboelataMD

Noha Aboelata, MD Profile picture
Jul 12
Things continue to slowly improve, but we still have >6000 hospital admissions and >500 deaths weekly in the US due to COVID. Many of these could be prevented with timely testing and treatment. 25 min briefing on current covid status, real-world data on home covid tests & more.👇🏾
This study looked at serial antigen tests every 48 hrs and PCR. 154 people were PCR+. Ag tests are most reliable in symptomatic individuals. A single test was 82.5% sensitive. Sensitivity increased to 93.4% if conducted twice, 94.3% if conducted 3 times.
acpjournals.org/doi/10.7326/M2…
Sensitivity was significantly lower for those without symptoms. For a single test, sensitivity was 34.4%. For two tests, it was 55.3%, and for 3 tests, it was 68.5%. But the negatives did correspond to higher cycle thresholds, meaning relatively less virus.
Read 10 tweets
Noha Aboelata, MD Profile picture
Jun 6
Uncovering the obvious: "Stopping universal admission testing in the national health systems of 2 countries (England and Scotland) was associated with significant increases in hospital-onset SARS-CoV-2 infections relative to community-onset infections." 🧵
jamanetwork.com/journals/jamai…
"Potential mechanisms include more unrecognized present-on-admission infections causing transmissions to other patients and health care workers, who in turn infected other patients."

Ya think? With abandonment of masks on top of everything else this is likely just getting worse.
"Hospitals should exercise caution before stopping universal admission testing for SARS-CoV-2 infections."

We have the tools, and we're refusing to use them. 3/4
Read 4 tweets
Noha Aboelata, MD Profile picture
May 17
The relationship between COVID and diabetes is a 2-way street. Those with diabetes are at greater risk of a poor outcome from Covid, and those who get COVID are at greater risk of worsening or even *new onset* diabetes. 1/5
The risk of severe covid/covid complications is increased with poorer diabetes control. This is similar to other infections like flu and pneumonia. 2/5
diabetesjournals.org/diabetes/artic… Image
And the risk of *new onset* diabetes is increased post COVID. We don't fully understand why. With such a high burden of diabetes already, this is major cause for concern. This study found a 1.4x increased odds of diabetes post COVID. 3/5

diabetesjournals.org/diabetes/artic… 1.4 times higher odds of di...
Read 5 tweets
Noha Aboelata, MD Profile picture
May 6
Still getting too many "covid is the flu" comments, so it must be time for a refresher. I reviewed this in detail in this video (4:54).

TLDR/W, our ability to manage covid has definitely improved, but it’s still NOT the flu!

My longest ever🧵

1/16
Covid and flu do have similar symptoms at the onset. Respiratory symptoms, fever, etc. With flu, diarrhea more commonly seen in children; with covid GI symptoms can be seen at any age.

Thankfully, we have outpatient antivirals for both - should be started asap for those at risk.
How they infect humans is different:

COVID - Spike proteins bind to ACE2 receptors which are on MULTIPLE organ systems (lungs, heart, kidneys, liver, intestines, brain, fat, etc.)

Flu - viral surface proteins bind to acids on the surface of RESPIRATORY epithelial cells

3/
Read 16 tweets
Noha Aboelata, MD Profile picture
May 5
Thank you @mercnews for publishing my op-ed!

"Opinion: California health care providers’ retreat from COVID masking is shameful

In what universe is it ethically appropriate for physicians and hospitals to infect their own patients with COVID?" 🧵

1/8
 mercurynews.com/2023/05/05/opi…
Decisions to unmask aren't data driven or supported by experiential evidence. That is why hospital-issued statements fail to cite science for their policy changes. Instead, faceless committees issue platitudes about being in a “new phase” and reference available treatments. 2/8
But having treatment for an infection has never been an excuse to *inflict* that infection upon a patient! When HIV initially spread, we recognized the need for gloves & safe sharps disposal. We didn't abandon these preventative measures when HIV treatments were later developed.
Read 8 tweets
Noha Aboelata, MD Profile picture
May 3
👏🏾👏🏾👏🏾

Sadly, this explainer was badly needed, and I am grateful to the authors for having the patience to write it. This needs to go in elementary school textbooks so we can avoid further embarrassment on the topic. 🧵 1/7
statnews.com/2023/05/02/do-…
"RCTs have value only when researchers can be sure that the treatment is administered as intended...Without that knowledge, an RCT produces noise, and meta-analyses produce piles of noise."

"Piles of noise," such a polite way to say it! 😅

2/7
"With behavioral interventions like wearing masks, it may be impossible to produce anything *but* noise without vastly more ambitious studies than have been conducted to date."

I've been screaming this into the void for a while.

3/7
Read 7 tweets

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