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(((Howard Forman))) Profile picture
(((Howard Forman)))
@thehowie
Physician & Professor; Medicine/Finance/Healthcare among other topics; Former Senate Staff; 🏳️‍🌈 Views are MY OWN
8 subscribers
Jul 29, 2022 • 9 tweets • 2 min read
THREAD:
Unfortunately, it has taken WAY longer (preprints, anyone?) than expected to get a good summary of Monkeypox symptoms in (mostly) gay men.

But this is a VERY important paper and @benryanwriter summarizes it well. I will highlight still more: 1/ All patients were male & all but one was a male who has sex with men. (MSM).

96% reported sexual contact with a male partner in the last 21 days.

36% were HIV positive, majority treated (most zero viral load)
2/
Apr 21, 2022 • 4 tweets • 1 min read
107K drug overdose deaths in last 12 months.

Glad to see Biden administration making serious efforts to address problem from supply & demand side:

1. Expand high-impact harm reduction interventions like naloxone.
1/ 2. Ensure those at highest-risk of an overdose can access evidence-based treatment.

3. Improve ability to do the research that can inform future policy.

2/
Jan 13, 2022 • 4 tweets • 2 min read
THREAD/To clarify, since it's been a while.

Florida reports deaths irregularly, but in "dumps" & assigns them to actual date of death. This is helpful from epidemiological point of view, less so to compare with other states: most report deaths as they appear to PH authorities. The New York Times will report the large boluses of deaths reported by Florida on the date of the report (today will have 262).

@Worldometers will follow the epi curve convention and import Florida's assignment of deaths to the date of death.
Jan 12, 2022 • 9 tweets • 5 min read
This is the CDC article that has been so grossly misinterpreted by seemingly every rightwing pundit.

Vaccines work: very well. But even as well as they work, the most vulnerable continue to have the greatest risk, however much REDUCED by the vaccines.

cdc.gov/mmwr/volumes/7… Here is @ClayTravis showing that he didn't read the article.
Jan 11, 2022 • 6 tweets • 2 min read
*Incidental* COVID admissions:
1. Often they ARE caused by COVID. Just not the obvious COVID pneumonia.
2. They strain the health system because you can't willfully put another patient at risk.
3. They are NOT (typically) acquired INSIDE the hospital. If a patient is in a car accident and tests positive, we all can recognize that this is true *incidental* covid. This is a small minority of such cases.
Dec 30, 2021 • 14 tweets • 3 min read
Thread/ What have we learned from Florida?

TL; DR:
1. Omicron is milder, per case. Not in aggregate.
2. If allowed to spread w/o mitigation, it can get out of control.
3. Hospitals can & will be over-run.
4. We don't know enough about deaths, but likely to follow... 1/ First, some assumptions:
1. Florida reports to CDC; we get data 1 day late & w/o positive rate. (always looking backward & somewhat blindly).
2. We presume Omicron has been completely dominant in Florida, since Delta cases were so low when this outbreak began. 2/
Dec 19, 2021 • 4 tweets • 2 min read
Florida:

Reasons I am expecting (hoping) Florida will look more like South Africa than other regions w/Omicron:

1. Very late and hard hit by Delta: huge amount of recent infection-acquired immunity.
2. Late, and ultimately above average, vaccinations, including elderly. 1/4 The combined immunity should bode better for them than even some states with higher vaccinations but more remote or lower infection-acquired immunity.

OTOH, they appear to be below average, for boosters among the highest risk (elderly) groups. 2/4
Dec 6, 2021 • 4 tweets • 1 min read
"...it calls two Army generals — Gen. Charles Flynn, who served as deputy chief of staff for operations on Jan. 6, and Lt. Gen. Walter Piatt, the director of Army staff — “absolute and unmitigated liars” for their characterization of the events of that day." "the Army has created its own closely held revisionist document about the Capitol riot that’s “worthy of the best Stalinist or North Korea propagandist.”
Nov 7, 2021 • 8 tweets • 3 min read
Thread:

In 1958, my mother was a NYC teacher. Early in the year, she was exposed to a student with Rubella ("German Measles").

Rubella is almost always a very mild illness. Most don't even know they have it. My mother had no symptoms. 1/8

ecdc.europa.eu/en/rubella/fac… Why do we care about Rubella (sufficient to require vaccination in all states)? Because pregnant women exposed to Rubella in their first trimester have a substantially increased likelihood of having a child w/birth defects/Congenital Rubella Syndrome (CRS) or fetal demise. 2/8
Nov 5, 2021 • 4 tweets • 2 min read
"Fewer than 1% of patients taking the drug needed to be hospitalized and no one died. In the comparison group, 7% were hospitalized and there were seven deaths."

THIS is a game changer, with caveats:

bostonglobe.com/2021/11/05/bus… via @BostonGlobe "Treatment began within three to five days of initial symptoms, and lasted for five days."

This means people need to have ACCESS to testing, clinical evaluation and a prescription. (True for Monoclonal antibodies, as well).

In the real world, people often present TOO late.
Nov 5, 2021 • 10 tweets • 2 min read
Incredible investigative journalism on why Africa was seemingly *spared* the worst of COVID.

The answer is not younger pop, more Ivermectin, nor climate.

Answer: Lack of testing and massive cover-up.

Great reporting by @JoeWSJ .

Short thread of his findings: "At the Kondo graveyard in Dar es Salaam, Tanzania...We used to bury one a week [before the pandemic], but over the past year we have reached 17 a day.”
Oct 30, 2021 • 7 tweets • 2 min read
CDC quietly released this VERY consummate REVIEW (not new study) of existing evidence about vaccine-acquired & infection acquired immunity.

It is a VERY good summary and everyone should read it.

Key points in this thread. 1/7

cdc.gov/coronavirus/20… Love that they start with humility. Everyone should feel this way. Most don't.

"New data continue to emerge, and recommendations (the science brief, this webpage, etc.) will be updated periodically, as needed."
2/7
Oct 18, 2021 • 7 tweets • 2 min read
Yale Update (short thread)
0.15% pos.rate for students (0.17% undergrads⬆️; 0.1% grad students⬇️)
0.25% for faculty staff⬇️

Vaccination rates creep higher.

We are at VERY similar case levels to last year: why should be celebrate? Because we are MUCH closer to normal. Last year, there were few classes held in-person and those that were held, were near empty. This year, full census in classrooms.
Oct 18, 2021 • 6 tweets • 2 min read
Brief thread:

We have a "rheostat". It works by dialing up and down *some* de-densification, masking, TESTING, & OBVIOUSLY vaccinations, but also boosters at some point.

We can AND SHOULD dial these up when outbreaks present. It does not mean that we can't have social events, but we need to offset this in other ways.

Wear a mask if you are speaking face to face with someone.
Oct 12, 2021 • 5 tweets • 1 min read
Key findings from KFF:

"...91% of Democrats, 85% of independents, and 76% of Republicans, as well as majorities of seniors (84%), who would be most affected by such a provision [favor drug price negotiations by Medicare prior to learning more]" "...most (84%) of the public, including 3/4 (78%) of Republicans, say the argument in favor – “this is needed because Americans pay higher prices than people in other countries, many can’t afford their prescriptions, & drug company profits are too high” – is convincing."