🆕 In @nejm.org "Critical Illness in an Adolescent with Influenza A(H5N1) Virus Infection"

Highlights of the article in a 🧵 👇

nejm.org/doi/full/10.10… (1/) Patient Profile: A 13-year-old girl in Canada with history of asthma was infected with H5N1 avian influenza, a strain commonly associated with wild poultry (D1.1). The source of infection remains unknown.

1/ 🦠 🆕 @NEJM article dives into the evolving threat of highly pathogenic avian influenza (HPAI) #H5N1
in humans.

Check out the article here. Full🧵👇
nejm.org/doi/full/10.10… 2/ Since its emergence in 1996, #H5N1 has primarily impacted birds. However, sporadic human cases have occurred, typically involving close contact with infected birds. So, what's changed?

✨@WHO published its first situation report for the multi-country #Monkeypox outbreak with data till 4 July 2022 there has been

👉6027 cases and 3 deaths in 59 countries in 5 WHO regions
👉2614 new cases (77% ⬆️) & 2 new deaths since last DON

Full🧵👇

who.int/publications/m… ✨Demographics
Sex is available for 73% (4406/6027) of cases
👉Of these, 99.5% (4385/4406) are males (median age 37 yrs)
👉Males 18-44 years of age account for 79% of cases
👉0.1% (6/5584) of cases with age data are aged 0-17 years of age.

✨Update from @UKHSA on #monkeypox cases

- 4 additional cases have been detected (3 in #London and 1 linked case in NE #England)
- These cases have NO connection to those announced on 14 May and the imported case from 7 May

Full details and more info👇
gov.uk/government/new… - The four new cases all appear to have been infected in #London and are gay, bisexual, or MSM
- Common contacts have been identified for 2/4 cases
-No link to travel to a country where #monkeypox is endemic
-All have West African clade of virus
-Further investigation is ongoing

New data out today from #Denmark demonstrating that #Omicron #BA2 is more transmissible than #BA1 and has immune evasive properties reducing protective effect of #vaccination

Full 🧵👇
1/ medrxiv.org/content/10.110… - Of 8,541 primary household cases with #Omicron, 2,122 were #BA2
- There were 5,702 secondary infections among 17,945 potential secondary cases
- In households with #Omicron, secondary attack rate was
29% - #BA1
39% - #BA2
2/

Latest @WHO #TechnicalBrief on #Omicron
Overall risk remains very high & threat depends on

1⃣Transmissibility of #variant
2⃣How protective vaccines & prior infection are
3⃣Virulence of variant
4⃣Understanding of dynamics & uptake PHSM

Full 🧵👇 (1/)
who.int/publications/m… Epidemiology (1)
-#Omicron has large growth advantage over #Delta - grows significantly more than Delta in countries with community transmission
- Evidence that immune evasion contributes to rapid spread
-Wk 52, global weekly #COVID19 incidence ⬆️ 71% compared to prior wk
(2/)

This narrative is exactly what I was worried about👇

We still don’t know #Omicron causes less severe disease but has become so politicized leaders say it only causes a “sore throat” without thinking of the immediate & long term (post #COVID19 condition #LongCovid) effects

https://twitter.com/marcorubio/status/1476991857699659777

#COVID19 and #Omicron most certainly does not only cause a “sore throat” we are seeing ⬆️⬆️ numbers of ICU admits and hospitalizations.
Yes some may have mild disease (thank you #vaccines) but these people can still transmit and put others (ie immunecompromised) at high risk.

💯agree with @jabarocas - in the past 24 hours 5 healthcare worker friends in different parts of the #US have been diagnosed with #COVID19.
At this rate as hospitalizations ⬆️ there will be an ⬆️ shortage of HCW's- who will care for patients & what will it look like a🧵
1/

https://twitter.com/jabarocas/status/1476640445987917824

✅The provider: patient ratio ⬆️⬆️⬆️
✅Patients wait longer for things like water, ice, food, & meds as nurses are stretched caring for more patients
✅The lab is stretched thin so bloodwork takes longer to return
✅Radiology is busier so it takes longer for an X-ray
2/

Here is a link to the @MMWR with the data from the #Provincetown outbreak which led @CDCgov to change their recommendation on #Masks due to the #DeltaVariant

Here is a🧵highlighting the important points
1/

cdc.gov/mmwr/volumes/7… -There were 469 cases of #COVID19 in Barnstable, MA in July 2021
- 346 (74%) cases in fully #vaccinated
- #Sequencing in 119/133 (89%) specimens confirmed #DeltaVariant
-274 (79%) with breakthrough infection were symptomatic
-4/5 hospitalized were fully #vaccinated

2/

Here is some of the @CDC data that was looked at and published by @washingtonpost to make the recommendations to re-implement #masks earlier this week

Note that the #DeltaVariant is MORE transmissible than
- MERS & SARS
- Ebola
- Seasonal Flu and the Flu of 1918
- Smallpox
1/ #DeltaVariant associated with lower Ct value in breakthrough cases, longer duration of Ct < 30, and higher risk of re-infecton
2/

1/
Information regarding the six patients who have developed CVST after the #JohnsonandJohnson #CovidVaccine
- All were white females
- Only one was on oral contraceptives 2/ Clinical features of the patients

Thoughts on #CovidVaccine Rollout

I see a lot of suggestions/posts about #vaccine rollout and since I have been involved with this thought I would provide insight based on my experiences

See thread below 👇

1/ 1. Expecting our hospitals/healthcare systems to absorb the #CovidVaccine rollout without support is unreasonable.

- Hospitals are running on empty and short staffed trying to manage caring for patients
- Rolling out this vaccine takes a lot of support and planning

2/

Since I am helping lead the #Pfizer #CovidVaccine rollout at our institution I have spent a lot of time doing town halls and engaging with people on the vaccine.

One of the most common questions I get is in regards to side effects so I thought I would post my slides Overall localized side effects of the #CovidVaccine

I want people to understand what we mean when we say that hospitals are at "capacity"

- That means there are no more beds for patients
- If you are in a trauma and need care there is not a bed
- Your elective surgery cardiac cath, or biopsy is will be postponed - When you come to the Emergency Room you are going to wait much longer because doctors and nurses are busy trying to manage all the patients
- You may have to stay in a bed in a hall (if you are lucky)
- Nurses will be further stretched and have less time to tend to you

Given the #surge of #COVID19 in the US we need to focus on containing the pandemic. Here are some things we need
1. We need a #NationalPlan to combat this infection
- Right now we have 50 states doing 50 different things
2. Scale up testing
- Use of PCR, saliva, rapid, Ag
1/ 3. Focus on community engagement at the local, state, and national level
- Empower communities and people to be proactive
4. Statewide #MaskMandates
5. Limitations on crowd and gathering sizes
6. Support of I&Q
- Paid sick leave, mental health, and healthcare
-Food delivery
2/

This statement made concerns for a "October surprise" alive and well. I can't believe I am typing words that say we may have a #vaccine for the greatest public health tragedy of the modern day that may not be vetted through the @US_FDA advisory panel of experts.

https://twitter.com/dandrezner/status/1290114428080275456

The continued politicization of this pandemic is a grave danger to the health and wellbeing of not just the public but to the very foundation of our democracy. I keep saying we need to let science lead and that is no where more true than with the development of a #vaccine.

I recognize that $22,200,000,000 a year to prevent a pandemic sounds astronomical, but honestly we should have been proactive and been doing this way before the #SARSCoV2 pandemic. We have had numerous warning signs over the years this was coming and did not take them. (1/9)

https://twitter.com/JeremyKonyndyk/status/1287598783111536642

We have seen re/emerging infections increase over the past 40 years. We have had SARS, MERS, Zika, and numerous Ebola outbreaks as warnings this was coming. Yes we did invest after the 2014 W Africa outbreak but it was not on the scale needed to prevent, prepare, for this (2/9)

#SouthKorea has done a fantastic job with #ContactTracing This article analyzed reports for 59,073 contacts of 5,706 #COVID19 index patients. I believe it has important info for decision making related to #SchoolReopening

wwwnc.cdc.gov/eid/article/26… - Of 10,592 household contacts, 11.8% had #COVID19
- Of 48, 481 nonhousehold contact, 1.9% had #COVID19
- All contacts were monitored for an avg 9.9 days after #SARSCoV2 was detected
- In houses with index 10-19 y.o, 18.6% of contacts had #COVID19

Exciting article in @NEJM on #remdesivir (Rx I had my eye on from the start, NOT #HCQ). Info below
1. Pts confirmed with #SARSCoV2 with O2 Sat < 94%
2. Received 10 days of drug (200 x 1 then 100 daily)
3. 36/53 patients (68%) had clinical improvement

nejm.org/doi/pdf/10.105… 4. 30 (57%) on mech ventilation and 4 (8%) ECMO
5. Median f/u 18 d
- 36 (68%) improvement with oxygen support
- 17/30 (57%) on mechanical vent, extubated
6. 25 pts (47%) were discharged
7. 7 pts (13%) died
8. Mortality
- (18%) (6/34) pts inv. vent
-(5%) (1/19) not w/ inv. vent

Interesting info from Wuhan. From 2/4/20-2/28/20 62 pts with #COVID19 randomized to receive SOC vs SOC+HCQ medrxiv.org/content/10.110…

1. Inclusion:
- >18
- RT-PCR positive #SARSCoV2
- Chest CT w/ PNA
- SaO2/SPO2 ratio >93% or P/F ratio >300
- Willing to be randomized 2. Exclusion:
- Severe/critical illness not deemed to meet benefit
- Retinopathy/Retinal dz
- Conduction block or arrhythmia
- Liver Dz (Child-Pugh >C or AST >2x ULN)
-Pregnant/Breastfeeding
-GFR <30 or CRRT
-Received other tx for COVID w/in 30d
-Transfer to OSH in 72h

Here are some additional slides from my presentation I gave to the @MDAndersonNews #Oncology healthcare providers. While I covered a lot, here is further information on #therapeutics for #COVID19

Not enough time to discuss everything so I highlighted a few.