SDJim Profile picture
Physician (Int Med, Geriatrics) - retired (too soon). Health/science reader/educator. Photographer. Day Trader. Rapid Cty DM open for info, questions, concerns.
13 Nov
TEST POSITIVITY - My view.

Disclaimer: I'm not an epidemiologist nor statistician. This is my understanding of the topic.

A simple internet search will yield a LOT of explanations with good graphics so you might consider going that route if I don’t provide what you need.
I am going to sacrifice brevity and density for clarity, so this could end up being a long thread. My apologies in advance. Someone who knows how might unroll this for us.

In my haste I won’t have diagrams or graphics so you’ll have to use your imagination at times.

This thread is obviously about the coronavirus pandemic so I won’t specifically refer to virus all that much. You know what I’m talking about.

To start, imagine a community of 1000 people in which 100 people are randomly infected. We’ll test a random sample of 100.
Read 30 tweets
12 Nov
If feel like making a shocking statement, a bold prediction. One of those statements a person immortalizes in a tweet that others repost a couple months later and say “This didn’t age well”.

If you’ll bear with me I’ll explain what is swirling around in my head.

Here’s a hint: Image
First, I should say that I don’t have any special access to information and I don’t really have any special skill in making predictions pertinent to the coronavirus pandemic in South Dakota. But it’s obvious I’ve been paying attention.

Some observations and assumptions:

COVID cases continue to rise in SD.
Community spread is SUBSTANTIAL just about EVERYWHERE in SD.
Some individual-level spread mitigation is happening.
No MEANINGFUL, broad governmental effort to mitigate spread is in effect.

Read 8 tweets
10 Nov
What good is FREE, MASS CoV TESTING to anyone who wants a test ...

IF you don't plan to quarantine until result is returned?
IF you are asymptomatic and are not a close contact?
IF results take 3-5 business days (up to a week!)?
IF you won't isolate 10+ days if positive?
IF ...
IF you are worried you might have COVID because you're sick or have had close contact with someone with COVID,

you MUST QUARANTINE until you receive the result otherwise the test does nothing to slow the spread. If you don't plan to quarantine why get the test?
IF your result is positive and you are unable or unwilling to NOTIFY OTHER with whom you've had close contact, or tell you employer about your result, the value of getting tested is very low.

The point of testing is to break the chain of transmission.
Read 8 tweets
18 Oct
I'm tired of the mask-debaters, anti-testers, herders and the like. I'm certain NOTHING will change their minds. People of that ideology, and it is an ideology, don't move to SD because they're welcome here, they are GROWN and nurtured here.

Many of them are my good friends.
...
So...

If anyone wants to discuss the pandemic or has a legitimate question about how it spreads & how it does damage to the human body or economy, sure, I'll engage. We can start as far back in the basics of science as they want. I have all the patience in the world for that....
If anyone wants to discuss their fears & concerns about how the virus is impacting their life, I'll listen as long as it takes. I get that this is overwhelming & financially devastating to many. I will listen, and I'll propose that to get back to "normal" we must face the virus..
Read 7 tweets
13 Sep
It is likely that HOSPITAL usage by COVID patients in South Dakota will become a hot topic in coming days & weeks.

Here are some questions that come to mind. It would be nice if media reps would consider pursuing this line of questioning at a press conf.

🧵 A short thread. Image
It should be easy to put this one to rest:

The # of "currently hospitalized", per DoH, "MAY include out-of-state cases". Does that mean SOME or ALL non-SD residents receiving care in SD hospitals? Or non-SD residents residing in SD for college? Or SD residents in non-SD hosp? Image
What are the current denominators used for these various CAPACITY METERS, and how are those numbers determined?

Does capacity value represent real-world, actively available beds or does is include "surge" capacities that would require re-appropriation of ORs, post-op beds, etc? Image
Read 7 tweets
27 Aug
I've noticed some confusion re discrepancies between # of CoV POSITIVES reported on a day & the # of POSITIVES for that same DATE on the TREND graph a couple days later.

I thought I could explain with a graphic. Unfortunately it became an uncontrolled, eye roll-worthy beast.
... Image
At the top, imagine @SDDOH receives results in 2 batches each day, 1 in the morning and 1 in afternoon. The POS results will be tallied & presented on trend graph for that date 2 days later (to allow time to verify & add in results that might arrive shortly before midnight).

...
Dashboard results are those received during a different 24 hr period, 13:00 one day to 13:00 the next. Once that period ends DoH uses rest of afternoon & next morning to process data, & then post the results. So, dashboard #'s are from the PM 2 days prior & AM prev day.

...
Read 4 tweets
22 Aug
SCIENCE - What is so great about science?

Science is like that NAIL you pounded into the wall a while back because you needed a place to HANG YOUR HAT.

Another Saturday morning THREAD (about “social” DISTANCING, and CONTACT TRACING).

Imagine you’re moving into a new place. You thought you saw a closet by the front door but were so excited to sign the lease you didn't notice.

NP. You get your toolbox & grab a hammer & nail. You pound a big nail deep into a wall stud &, voila: a place to hang your hat.

All is good, for a while. You later realize there is a better place to hang your hat. You know if you pry out that first nail it will leave a big hole & you’ll likely damage the wall a bit too.

You can just leave it and put a NEW NAIL somewhere else.
So that’s what you do.

Read 9 tweets
21 Aug
How can we make sense of this?

Contact tracing is supposed to identify/warn potential contacts of a CoV infected person. Risk times include 2 days before symptoms started until the person was isolated.

When do you think this person was tested?
Do you think they had symptoms? Image
Image
Seriously, think about it and offer a plausible scenario.

Open to hearing from a contact tracer or epidemiologist at
SD Dept of Health. @SDDOH @sddohkmr

I will chime in later.
Read 4 tweets
18 Aug
Most following here are prob aware of news about UNC shutting down in-person undergrad classes due to a bunch of CoV clusters among students.

I can't help but wonder why this wasn't fully anticipated & why stronger measure weren't enacted to prevent.

...
unc.live/3iVHtlr
On-campus planning, rules & mitigation won't prevent students getting & spreading CoV infections if they engage in known, risky behavior off-campus.

As a parent of 3 college/grad students I accept one can only ask & expect so much, but I'm reminded of that "ass u me" saying.
...
Maybe universities are doing more direct communication of which I am unaware, but I think something more than a beige banner that links a page of "wash hands" suggestions might be required. I've clicked 3 & 4 levels deep on the USD site but could not find any plea for logic.
... Image
Read 6 tweets
17 Aug
People who have recovered from COVID will presumably have blood full of antibodies against the virus. These folks can donate the liquid part of their blood, so-called CONVALESCENT PLASMA, so it can be given to someone fighting the infection.

Short THREAD

bit.ly/3kP5wnM
The transfer of antibodies from one person to another via convalescent plasma transfusion is an old, tried and true treatment for many infectious diseases. It makes sense, and it works.

Pharma companies can manufacture antibodies (aka monoclonal antibodies) against CoV.

...
So this hopeful treatment modality adds to the arsenal of therapeutics against COVID. But as with just about everything else related to CoV, clinical researchers using the scientific method will need time to sort this out.

...
Read 4 tweets
16 Aug
Inpatient and Outpatient Deaths - Distinctions of Honor

South Dakota Dept of Health @SDDOH reports deaths among SD residents as either INPATIENT or OUTPATIENT.

The death location might seem academic but I think there’s something to it.

A rambling THREAD… Image
I have no special info from DoH re location criteria but I suspect it’s fairly straightforward.

If you die while ADMITTED TO HOSPITAL then you are tallied as INPATIENT death.

Any death not labeled inpatient is OUTPATIENT.

Outpatient deaths would included deaths at NURSING HOMES, ASSISTED-LIVING facilities and other elder care facilities. I believe these locations would be the source of most outpatient deaths.

Deaths at home are also outpatient.

Read 9 tweets
16 Aug
This South Dakota Dept of Education's @sddoe school reopening guidance. At first glance it looks like a lot of thought & work went into it. On deeper review it strikes me as extremely WEAK. No real guidance at all. Lots of "limit this", "consider that".

bit.ly/3h30dim
I have not studied all the links yet. The one re mitigation in schools indicates that if there are cases in a school they should look for gaps in prevention strategies. Why not assume there will be cases and look for gaps NOW, implement them NOW to prevent the cases? Image
I find it interesting that there is no consideration given to the degree of community spread of CoV in a school's community, and likewise, no consideration given to a known close contact of an CoV-infected person entering and spending the day in a school. Image
Read 6 tweets
15 Aug
Reality check time. Maybe my expectations are too high.

I believe that South Dakota Dept of Health @SDDOH should have used their platform to educate & inform people in the state –locals & visitors alike– about the GROSSLY ILLOGICAL use of CoV ANTIBODY TESTING in Sturgis.

THREAD
The @SDDOH EPIDEMIOLOGIST was asked about a vendor selling ANTIBODY testing at STURGIS rally. He said something to the effect of “NOT MY JOB to regulate the testing or results” and said it’s UP TO THE PEOPLE to ask questions. He said test should be given by healthcare pros.

I am NOT an epidemiologist, and I am NOT a SD gov official,

— but if I were—

I would have taken the opportunity at the press conference to explain to the MEDIA & the public that NO ONE should get “PEACE OF MIND” on their way out of town due to a CORONAVIRUS antibody test.

Read 8 tweets
13 Aug
Coronavirus ANTIBODY TESTING IN STURGIS is likely to give FALSE or MISLEADING results to concerned bikers.

TLDR: If you arrived at the rally on Saturday 08 Aug & were exposed to CoV that day, you might have detectable IgM antibodies today, 13 Aug. MIGHT.

Let me explain…
THREAD
When a person is infected with a new virus, a healthy immune system immediately gets to work to track down the infected cells, kill those cell, attack the virus, and set into motion the production of antibodies.

...
ANTIBODIES are molecules that attach to the virus, destroying it directly or by activating other immune responses that prevent further replication of the virus in our cells. Antibodies are very specific to a particular virus.

...
Read 8 tweets
8 Aug
I have become increasingly critical of South Dakota governor @govkrisinoem & Dept of Health @SDDOH & about how they’re managing SD response to CoV pandemic.

It’s easy to criticize from my comfortable chair, But WHAT WOULD I DO if I were in charge?

THE MOTHER OF ALL THREADS …
The first thing I would do is acknowledge that the greatest, present threat to South Dakotans is the coronavirus pandemic. Controlling its spread is the key to safely opening businesses and schools, and getting closer to our new normal.
I would acknowledge that I need help. I would surround myself with serious, smart people with a passion for helping all citizens of SD. I need sound advice, not opinions. Tell me the data, the fact and the science. Challenge me. Push me to do better.
Read 26 tweets
5 Aug
TPR vs. P-TPR
We've discussed TPR a lot but recently @SDDOH started reporting persons tested vs. tests used.

It's an important distinction, but which value should be used for calculation of POSITIVITY RATE?

I think there are good reasons to support either denominator.

THREAD
At first I thought we should focus on PERSONS, not tests, but I'm not so sure.

If tests are used, as I advocate, to repeatedly test NH staff & other front-line workers one could argue each test (same person) does help assess status of disease in the community.

BUT...
I don't know multiple, sequential testing of front liners is being done. I know multiple tests are done on an individual that DO NOT add to assessment of comm dz.

My mom is an example. Tested on hospital adm. then tested 4 days later to get discharged to NH, then 3 days later. Image
Read 4 tweets
2 Aug
Let’s discuss test positivity rate (TPR) again.

Review: TPR is the % of total RESULTS (+ & -) that are positive. I chose those words carefully as nowadays a batch of results presented one day might represent tests conducted over many preceding days.

It’s crude metric.

THREAD… Image
TPR is influenced by testing practice in an area of interest.

For example, if tests only done on people with symptoms there is a high chance many will be positive. TPR will be high.

If tests only done as pre-op screening in people likely to be negative, TPR will be low.

...
If tests are used for a blend of these examples TPR might produce an OK “value”.

Experts say a TPR value consistently AT OR BELOW 5% indicates a sufficient # of people in a community are being tested. BUT for # to be valuable a BROAD SAMPLING of the community is necessary.

...
Read 7 tweets
1 Aug
I don't want be labeled a fear-monger, but issue of reopening schools is heating up quickly as Sept approaches and it'll be messy.

I suppose it's good that some SD schools have delayed opening so nationwide experience can be factored in to ultimate plan. nytimes.com/2020/08/01/us/…
If I were advising a large SD school district I would recommend embracing FULL, REMOTE LEARNING as the foundation for academic year 20-21. Get that planned to the best it can be, and only then add in-person experiences, first focusing on special needs of students and families.
The issue of home supervision of students is probably the greatest challenge and I don't have a great suggestion to address that. Maybe those families who genuinely cannot make it work at home will be the first to go in-person. IDK. Sacrifices will be required of many. Pandemic.
Read 5 tweets
26 Jul
What happened at Camp Judson, a nice church camp nestled in the Black Hills of Pennington Co., @southdakota ?

Apparently an outbreak of coronavirus infections has caused camp to temporarily close. LMK what you know.

What lessons can be learned re school opening?

(OLD photo.) Image
I posted this link a while back but shared it with Camp Judson Facebook page this morning. It looks like there are no more youth camps scheduled this summer; maybe they can learn from experience & literature that the pandemic is real & worthy of attention. scientificamerican.com/article/how-su…
I suppose church camp families might not be litigious but I suspect Camp Judson may be at legal jeopardy (negligence) as secondary and tertiary cases come to light in coming weeks and will be traced back to a camper. The notion that no one knows how they caught the bug is silly.
Read 4 tweets
11 Jul
Should we focus on DEATHS as a measure of pandemic success in South Dakota?

Some say we’re doing fine because we have so few recorded COVID deaths among South Dakotans.

At what level would the death count be too high?

My sense is this is the WORST METRIC of SUCCESS.

THREAD...
Not every COVID death is preventable but in theory, most are. If you don’t get infected you won’t get sick and you won’t die.

Success should be measured in how the coronavirus pandemic GOALS are enumerated, communicated, operationalized and executed by state and local officials.
For example, a goal of limiting disease spread & thus illness & death should be a top priority -not accepting a quota of deaths- at same time providing clear guidance & regulations to businesses to allow safe, ongoing commerce.

“I trust you to do the right thing” is not a goal.
Read 10 tweets
10 Jul
TEMPERATURE CHECKS - and academic and instructive example of how knowledge evolves.

THREAD (short, just a few thoughts).

Here's a STAT News article, to start, but read on for my take.
...statnews.com/2020/07/02/sme…
As businesses & other public venues, & maybe schools, are seeing more human movement within their walls, many owners and admins are trying to provide safe environments.

Some recommend or require masks and physical distancing.
Some limit numbers of people or require appts.
...
And some are checking temps on the way in. WHY?

Early on, months ago, this seemed like an obvious and easy way to screen for illness - specifically coronavirus infection. Fever is a common symptom among COVID-19 patients. Makes sense.

But...
Read 7 tweets