1st #NIHRECOVER adult cohort results are out today in @JAMA_current, proposing an expanded working definition of #LongCovid (aka post-acute sequelae of SARS-CoV-2 [PASC]). Led by @tthaweethai, this is a dense paper with a ton of results. Buckle up! 🧵
jamanetwork.com/journals/jama/… #NIHRECOVER Adult is a cohort study of ~15k adults with/without #COVID, followed prospectively. They answer symptom surveys every 3 months and do additional tests yearly. 93% of cohort has been enrolled; this paper includes 9,764 participants. recovercovid.org

Have been too busy enjoying seeing people in person and seeing so much great research at #SGIM22 to have been tweeting, but what a great meeting. @nyugrossman was out in force /1 Med student Kyle Smith had a wonderful oral presentation on how we have developed a method of finding people on oral anti psychotics who haven’t had a1c testing (no pics cause I was so busy watching!) with @SaulBlecker /2

Fascinating article about how research into types and efficacy of traffic stops in multiple CT communities led to changes that both reduced disparities in stops and better targeted actual public safety issues. Some examples follow:

https://twitter.com/greenwichtime/status/1487773064490332163

In Newington, 40% (1,608) traffic stops were for defective lights but found only 1 DUI. Dept switched focus to moving violations (defective lights ⬇️67%, moving violations ⬆️60%). Stops with DUI arrest ⬆️250%, from 18 to 63, and disparities substantially reduced: safer & fairer!

A lot of chatter about hospitalization "with" versus "for" COVID, implying current hospitalization wave isn't "real." NY state is going to start trying to report the distinction; UK already does. Some thoughts, with exemplar data. /1 1st, not so easy to tell. Our health system calls "for" COVID: patients with problem list or clinical impression of respiratory failure with hypoxia (various codes), or x "due to COVID" or COVID positive is the only problem. Specific, but likely not very sensitive. /2

Phenomenal preprint from South Africa on #omicron severity. Insanely fast analysis with multiple linked national datasets. Kudos to the authors. Results? You'll see headlines about reduced severity, but full story more complicated. My thoughts. medrxiv.org/content/10.110… First off, methods. They link lab tests, case data, genome data and hospital data from across all of South Africa. (Wow!) They use a proxy for omicron (SFTF) and require Ct <=30 ("real" infection).

Incomplete article in the @nytimes today re: vaccine effectiveness made me finally read last week's NEJM letter suggesting more waning of Moderna than NYT suggests. Will walk you through it. /1 nejm.org/doi/full/10.10… This reports data from a Moderna randomized trial, in which 14,746 people got vaccine Jul-Dec 2020 and 11,431 got placebo. The placebo group then got the real vaccine later, between Dec 2020-Apr 2021. /2

Took a Twitter break for several months to help get @NIH #RecoverCOVID up and running to study #LongCovid (AKA #PASC). Thrilled to report @UTHealthSA @UHHospitals have enrolled our first 7 participants! Congrats to them and cast of 1000s working night and day to kick it off. /1 #RecoverCOVID will follow >17K adults, >20K kids across nation + PR for 4 yrs to learn what #LongCovid looks like, how long it lasts, what causes it/increases risk, and, ultimately, what makes it better. Will also include autopsy data and electronic health records of millions. /2

Grateful to be part of the team @nyulangone leading the clinical science core for the @NIH long term outcomes of #COVID19 research, to be carried out by dozens of extraordinary investigators around the country. I take this responsibility very seriously. nyulangone.org/news/nyu-lango… “Post acute sequelae of COVID” (PASC) threatens to have major public health implications for years to come, and patients are suffering now. We must learn more about what causes long term effects, and how they can be treated. For more info, see recovercovid.org.

Excited to judge the finalists for the @SocietyGIM Lipkin Award (best student/resident/fellow abstract) for the third year in a row - tune in live at 12:20p EDT today, tomorrow and Thursday to see recorded presentations and live questions. Our trainees are our future. #SGIM21 Day 1

There is no perfect vaccination prioritization strategy, and every choice leaves out people who would really benefit from vaccine. That said, I think @GovNedLamont's new age-based strategy in CT is very sensible if primary goal is to reduce hospitalizations and deaths ASAP. /1 Context: CT has already prioritized those in congregate settings (nursing homes, corrections, group homes, homeless shelters) and those 65+. Now, plan is to go by age in ~3 wk intervals (55-65, 45-54, 35-44, 18-34), last group starts May 3. Teachers now. portal.ct.gov/Coronavirus/CO…

Today we commemorate half a million US deaths from #COVID19 - a staggering and heartbreaking figure. Millions are mourning. The only positive is that it is increasingly clear that this year will be better. A thread on #COVID19 mortality evidence: In October we published an analysis showing that death rates among hospitalized #COVID19 patients had dropped precipitously at @nyulangone even after accounting for changes in patient mix. @jhospmedicine journalofhospitalmedicine.com/jhospmed/artic…

So proud of this work led by @vincentjmajor & Erwin Wang w/@NicoleAdlerMD @hauck_kevin @AustrianMd
@yindalon @nyulangone in @nejmcatalyst. This is how to do thoughtful, collaborative integration of #AI into clinical care to create a learning health system catalyst.nejm.org/doi/full/10.10… At baseline, only 16% of our patients hospitalized within 6 months of death had documentation of advanced care planning. @vincentjmajor & clin colleagues developed 3 predictive models for 2 month mortality, set appropriate threshold (75% PPV), and integrated into the EHR.

Our new paper in @JAMANetworkOpen shows no disparity in adjusted outcomes between Black/Hispanic/White #COVID19 patients @nyulangone once hospitalized; if anything, Blacks seem to do a little better. Is this an anomaly? @gbengaogedegbe ja.ma/3n1NKhC /Thread Actually, several other papers have now found the same. This study of 11,210 hospitalized patients at 92 @ascensionorg hospitals found no sig difference in mortality between Blacks & Whites @BYehia jamanetwork.com/journals/jaman…

Yesterday the world lost a shining light, much too soon. @marjoriesue’s life was marked by tragedy – widowed early with two young children, then metastatic cancer – but she radiated joy and empathy and was an astonishingly gifted writer. In memoriam, some of my favorite pieces: Margi was a pediatrician, writer, friend, researcher and community activist, but also a single mom who raised two extraordinary young women. Here, she wrote nicer words about other people's mothers (including mine @renalis) than I have ever said to my own:
wbur.org/cognoscenti/20…

My periodic reminder that WE ARE NOT GOING TO SOLVE #COVID19 THROUGH NON-VACCINE HERD IMMUNITY. For those who need more convincing, thread follows.

https://twitter.com/leorahorwitzmd/status/1295802319288913927

First, we have NEVER gotten to herd immunity without vaccine for a virus. If you are over 40, you almost certainly had chicken pox as a kid. Until vaccine in 1995, we had >4 million cases/year (& ~125 deaths) - about the same as how many kids are born each year.

*Caution non-peer reviewed preprint* There have been many anecdotes about prolonged #COVID19 symptoms but little systematic data collection. Here, results from prospective study of 152 patients @nyulangone hospitalized with #COVID19. /1 medrxiv.org/content/10.110… tl;dr results: 113/152 (74%) reported persistent shortness of breath 30-40 days after discharge. 13.5% still needed oxygen. Overall physical health was rated 44/100 after vs 54 before - full standard deviation drop vs national norms. Mental health score dropped from 54 to 47.

*Caution non-peer reviewed preprint* US #COVID19 death rates are lower now than in the spring. Is disease less lethal (better treatments, etc), or just younger people getting sick? We examined @nyulangone outcomes over time to explore. /1 @PetrilliMD medrxiv.org/content/10.110… We know that risk of mortality is highly dependent on characteristics like age, comorbidity, severity of illness on presentation. We also know that the current epidemic is skewing younger. That alone could explain lower mortality. /2 vox.com/2020/7/18/2132…

I hate recording talks. I rely so much on audience cues to see if they are lost, confused, interested, engaged, annoyed, and I adjust accordingly. I love interaction. Live talks make me energized and I have so much fun giving them. But. I recorded a talk for #MLHC2020 /1 And instead of maybe 25 or 50 people seeing it live, now over 300 have watched it on YouTube, including my mother in law (thanks, Mom!) and apparently people in Ghana (thanks @aowusuda!) and Ireland (thanks @EvaDoherty!). @HardeepSinghMD even summarized it beautifully. /2

The @US_FDA has now authorized “pooled testing” for #COVID19 to save testing reagents and speed results. I’m a big fan. But, this only works in low prevalence situations. To see why, here is some fun Sunday morning math for you all.

fda.gov/news-events/pr… Pooled testing works like this. You get individual swabs from a bunch of people, set aside some of the sample for each person in case needed later, and mix the rest together. Now test the mixed (pooled) sample. If negative, you’re done! One test for N people, saving N-1 tests.

I posted earlier about the currently known state of the (limited) science on pediatric #COVID19 transmission. Of course, the question is how to apply that knowledge to schools. Many have already posted thoughtfully about this problem. Thread.

https://twitter.com/leorahorwitzmd/status/1281638107796910080?s=20

Harms of closing schools are enormous: e.g., loss of academic progression, worsening disparities, food insecurity, strain on working parents/impaired economy, delayed social/emotional development, social isolation, increased incidence/reduced reporting of domestic violence, etc.

Oy. Schools. This is really tough. As we debate risk/benefit, understanding whether schools are a major source of transmission to the community (and high risk people) is the billion dollar question. Thread: the science to date. Tons of data showing kids (especially younger) disproportionately not diagnosed with #COVID19. BUT, that’s not definitive – maybe they get infected as often but don’t get symptoms. Asymptomatic disease would actually make school openings harder.