Not getting enough attention now: lack of hospital beds to care for sick children. Perfect storm:
1) General hospitals closed pediatric wards post Covid
2) Massive RSV and noncovid viral surge
3) Children's hospitals overcapacity to begin with

short 🧵
nbcnews.com/health/health-… 2/ During Covid many general hospitals shifted their pediatric wards to taking care of adult of patients during Covid surges. After Covid surges, pediatric wards never got reinstated resulting in a net decrease in acute care capacity for children....

healthaffairs.org/do/10.1377/for…

Pulse oximeters are widely used to monitor for low oxygen levels among #Covid19 patients at home.

But does pulse oximetry improve outcomes over monitoring for symptoms of shortness of breath?

Our team provides some answers today in @NEJM 🧵👇
nejm.org/doi/full/10.10… #SGIM22 ..First some context, early in the pandemic there were widespread accounts of #Covid19 patients presenting to the ER with relatively minor symptoms, but with markedly low oxygen levels, a phenomenon known as “silent hypoxia"...
nytimes.com/2020/04/20/opi…

Some thoughts from seeing a ton of Covid in the ER this week

Good news: Aside from a few patients with compromised immune systems, didn't have to hospitalize anyone who was vaxxed/boosted

Bad news: Health systems are stressed to the max

We need to adapt...quickly

Thread👇 Below I’m going to cover

1) Clinical presentations based on vax status
2) The 3 types of hospitalization: For Covid, chronic disease exacerbated by Covid, incidental Covid
3) Differences in severity/hospital needs
4) Disruptions in care Covid+ patients
5) Health system adaption

>310,000 people died from gun injuries in the U.S. from 2009-17. But unlike #Covid19 stats, the total # of cases is not well established due to data gaps.

Proud of @ElinoreJKaufman who led our new paper (jamanetwork.com/journals/jamai…) that dives deep into this epidemic

THREAD👇 2/ We can get exact counts of how many deaths there are per year. Those data are available on death certificates (wonder.cdc.gov/ucd-icd10.html) collected by @CDCgov. Here’s a nice overview by @jasongoldstick @cartpatr @StrohCunningham

jamanetwork.com/journals/jamap…

1/ Had a patient present to the ER with severe nausea and vomiting. As has become my practice, I asked "Have you struggled with pain killers, heroin, or fentanyl?" and to my surprise he answered yes. This was his first episode of severe opioid withdrawal....

cont 2/ I gave him buprenorphine and within minutes, his symptoms were relieved. Avoided labs, CT scan. Wrote him a prescription to get him through next week. Couple of weeks go by, got a message from a primary care doc colleague that he has been doing great in clinic. Made my day

A friend of mine of who runs an essential, office-based business with ~50 employees and 1 employee just tested + for #COVID19 after finding out about an exposure over Memorial Day weekend family gathering

A thread on running a business in the time of #coronavirus👇 2/ The business has had a zero-tolerance policy on coming to work with any symptoms. This employee who tested positive apparently felt a little tired last week, but no fever, cough, or obvious symptoms. The employee was notified via contact tracing of the exposure on Memorial day

1/ Many lawmakers are citing preventing preventing "deaths of despair" (drug use, overdose, alcoholism, suicide) as the rationale to reopen prematurely. @meganranney & @drjessigold have written a must-read piece in @statnews addressing this. A thread 👇

statnews.com/2020/05/31/dea… 2/ First, while we have ample evidence of the impact of #COVID19 (>100,000 deaths, ~4x as many hospitalizations lasting 1-2 weeks, a lasting debility among younger adults that has yet to be quantified), we don't have any data yet on deaths of despair

https://twitter.com/kit_delgadoMD/status/1264921326407561216?s=20

Appreciated the opportunity to comment on 2 excellent cohort studies led by @jLewnard (Kaiser) and @leorahorwitzmd (NYU) in @bmj_latest that give us a much better understanding of who gets sick from #COVID19. A thread putting this work into perspective👇

bmj.com/content/369/bm… 2/ Take away #1: It's not just the elderly who get sick.

Most who were hospitalized for #COVID19 were *under* the age of 65:
- 53% (n=1,452) in NYU cohort
- 60% (n=1,108) in Kaiser

1/ The focus on #COVID19 death rates neglects the fact there are 4x as many people who spend 1-2 weeks in the hospital. True, elderly die at much higher rates, but younger adults hospitalized at high rates. Of 2,741 hospitalized:
- Most (53%) were age<65
- 437 (16%) were age<45

https://twitter.com/AlexBerenson/status/1264784997178839040

2/ When looking at the 990 #COVID19 patients in this cohort who developed critical illness (ICU admission, intubated on life support, death, or discharge to hospice):
- 40% were age <65
- 91 patients were 19 to 44 years old

(1/x) As an ER doc I have treated many patients who lost jobs due to the #CoronavirusOutbreak & they don't look like the protesters in the news
- chest pain/anxiety after losing job as a cook
- alcohol withdrawal after running out of $
- depression and suicidal thoughts

👇thread 2/ There’s ample evidence that beside the economic impact, that job and income loss leads to enormous public health impacts. For example, when auto plants shut down, there are an additional ~9 opioid overdose/100,000 people five years down the line

https://twitter.com/PennLDI/status/1211681176278183942?s=20

1. A tale of 2 #COVID19 case maps:

Left: Shows total cases (bigger circles, more cases) arcgis.com/apps/opsdashbo…

Right: Shows cases per 10,000 residents. Much easier to see very concerning #rural outbreaks in ID, LA, CO, ID
geodacenter.github.io/covid/map.html#

thread 2. Focusing on #COVID19 cases per 10,000 people helps identify locations that are likely going to exceed local hospital capabilities very quickly. See rank list here. Blaine, ID (tourist ski area) has the highest infection rate in the country

nytimes.com/interactive/20…

Millions of smart thermometers are picking up higher than expected rates of fever readings in #Florida. How many more canaries in the coal mine do we need?
healthweather.us

#CoronavirusOutbreak A “smart” thermometer is showing some unexpectedly high rates of fever measurements in Florida the week leading into 3/20 during the #CoronavirusOutbreak (healthweather.us). Is this a signal or just noise? Does it matter? A thread from an ER doc/epidemiology professor:

What do all these #coronavirus outbreaks have in common?

Iran - 12,729 cases
South Korea - 8,086 cases
France - 4,481 cases
US - 2,952 cases (NY 613 cases)

All tied to religious gatherings. It's imperative to keep #FaithAtHome. Our op-ed & a thread:

inquirer.com/health/coronav… 2/ Iran was one of the first countries to have an explosion in community transmitted #coronavirus cases when a merchant traveled from Wuhan to Qom, a religious pilgrimage site

newyorker.com/news/our-colum…

1/ Last night my wife and I made the decision to cancel my 7-year-old daughter's gymnastics birthday party this weekend due to #COVID19. Why? How did she react?

A thread from an ER doc/scientist who doesn’t freak out about most things: 2/ With less than 2,000 cases of #COVID19 in the US many people think we are already over-reacting. Wrong. We are under-reacting. The truth is there have been countless patients US ER docs have wanted to test, but haven’t been able to: inquirer.com/health/coronav…