I’m starting a thread on #COVID19 just to keep everything I learn about it in one place.
🌹 New information
🌹 well summarized information
🌹 Things that changed my mind
🌹 Things that I did not expect

# #pathology #pulmpath #CoronavirusOutbreak #SARSCoV2

1. Thread 👇🏾👇🏾
2. Great update with Dr. Fauci
Most interesting tidbit: why is well controlled hypertension a risk factor? Could ACE inhibitors be predisposing to coronavirus infection by increasing ACE receptors?

Link to video 👇🏾
3. Podcast episode 3/17 by @nytimes . Very moving interview with a pulmonologist who has treated dozens of patients in Bergamo, Italy. Warning: it will make you cry.

“Nothing is as before”

They see 50-70 patients with severe pneumonia every single day

https://twitter.com/smlungpathguy/status/1240376728305963010?s=21 https://twitter.com/smlungpathguy/status/1240376728305963010
4. “My colleagues, nurses and physisicians, we cry everyday”

460 nurses are home sick or burned out or quarantined

Personal protective equipment “impossible to find”

Patients “die alone”

https://twitter.com/smlungpathguy/status/1240376728305963010?s=21 https://twitter.com/smlungpathguy/status/1240376728305963010
5. Here is a #COVID19 thread by @AnneMillsMD that residents will find helpful. She’s putting various resources in there 👇🏾👇🏾

https://twitter.com/annemillsmd/status/1239963734832902144?s=21 https://twitter.com/AnneMillsMD/status/1239963734832902144
6. Two excellent free youtube videos by my guru @JMGardnerMD who is trying his best to get the word out. The first video was watched by 125,000 people in 5 days. He covers a LOT of ground in a way that only he can:



7. Incredible, scary, moving and educational interview by the @JAMA_current editor in chief Dr. Bauchner with another doctor on the frontlines in Italy. If this doesn’t make you take #COVID19 seriously, nothing will

8. Great site by Johns Hopkins with updated numbers. The screen capture refers to the numbers as of today, March 18, 2020. Thank you for the link @damilnermd 🙏🏾

https://www.worldometers.info/coronavirus/ 
9. Sorry, just realized I forgot to link to the first #COVID19 video by @JMGardnerMD

Very timely and well argued. A must-watch.

10. Incredibly well-made animated simulations on social distancing by the
@washingtonpost

It makes intuitive sense that you should stay away from contagious people but seeing it at this scale is a game changer 👇🏾👇🏾

PS: there’s no paywall https://www.washingtonpost.com/graphics/2020/world/corona-simulator/
These simulations show how to flatten the coronavirus growth curve

The early trickle of new coronavirus infections has turned into a steady current. By creating simple simulations, we can see how to slow it down.

https://www.washingtonpost.com/graphics/2020/world/corona-simulator/
11. I’m adding my video on #ARDS to this thread. It’s heavy on pathology, but is useful if you want to understand what happens is likely happening inside the lungs of the unlucky few who get very sick or die of #COVID19

https://twitter.com/smlungpathguy/status/1239774334580858880?s=21 https://twitter.com/smlungpathguy/status/1239774334580858880
12. Here’s the situation in Spain on March 19, 2020, described by our good friend and Tweeple, #pathologist @lara_pijuan

Stay safe, my friend! #COVID19

https://twitter.com/lara_pijuan/status/1240575428475092993?s=21 https://twitter.com/lara_pijuan/status/1240575428475092993
13. One of the first studies of #COVID19 from the United States. This is from Seattle, WA. Sounds pretty bad.

Important: these are ONLY numbers for people admitted to ICU.

100% ARDS
67% mortality
9.5% discharged from ICU

https://jamanetwork.com/journals/jama/fullarticle/2763485

Thoughts @BDSouthern ?
13. One of the first studies of #COVID19 from the United States. This is from Seattle, WA. Sounds pretty bad. Important: these are ONLY numbers for people admitted to ICU. 100% ARDS 67% mortality 9.5% discharged from ICU https://jamanetwork.com/journals/jama/fullarticle/2763485Thoughts @BDSouthern ?
13. One of the first studies of #COVID19 from the United States. This is from Seattle, WA. Sounds pretty bad. Important: these are ONLY numbers for people admitted to ICU. 100% ARDS 67% mortality 9.5% discharged from ICU https://jamanetwork.com/journals/jama/fullarticle/2763485Thoughts @BDSouthern ?
14. Terrifying numbers from the Imperial College report with a great explanation by @jeremycyoung . Consequences of doing nothing (massive death) vs. “mitigation” (very bad) vs. “suppression” (possibly the best option but there’s a catch)

https://twitter.com/jeremycyoung/status/1239975682643357696?s=21 https://twitter.com/jeremycyoung/status/1239975682643357696
15. Here are some figures and passages from the actual Imperial College report.

There are LOTS of assumptions here but If they are right it’s pretty grim.

The graph is particularly worth looking at carefully @JMGardnerMD @Aiims1742
15. Here are some figures and passages from the actual Imperial College report. There are LOTS of assumptions here but If they are right it’s pretty grim. The graph is particularly worth looking at carefully @JMGardnerMD @Aiims1742
15. Here are some figures and passages from the actual Imperial College report. There are LOTS of assumptions here but If they are right it’s pretty grim. The graph is particularly worth looking at carefully @JMGardnerMD @Aiims1742
15. Here are some figures and passages from the actual Imperial College report. There are LOTS of assumptions here but If they are right it’s pretty grim. The graph is particularly worth looking at carefully @JMGardnerMD @Aiims1742
15. Here are some figures and passages from the actual Imperial College report. There are LOTS of assumptions here but If they are right it’s pretty grim. The graph is particularly worth looking at carefully @JMGardnerMD @Aiims1742
16. Sorry the graph didn’t quite make it into the previous tweet! Here we go again @JMGardnerMD @Aiims1742

The red line (close to bottom) is the estimated ICU bed surge capacity in the US

Y axis is critical care beds occupied per 100,000 population

X axis is time (months)
17. A new article in @AJCPjournal on handling #Covid_19 specimens in the laboratory

Bottom line: formalin fixation inactivates the virus, so routine processing should not be a problem

Frozens: different story

https://twitter.com/shkroft/status/1240637187814801409?s=21 https://twitter.com/shkroft/status/1240637187814801409
18. Full report from the Imperial College

https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf
19. A wonderful infographic/explanation of the test for #COVID19

https://twitter.com/pathologistmag/status/1242372533267169295?s=21 https://twitter.com/pathologistmag/status/1242372533267169295
20. An interview on #COVID19 I did with @NakedScientists (very accessible and easy to understand) https://www.thenakedscientists.com/podcasts/naked-scientists-podcast/coronavirus-explained-how-covid-19-works
Coronavirus Explained: How COVID-19 Works

We take a detailed look at the coronavirus - from how it affects the body, to developing a vaccine..

https://www.thenakedscientists.com/podcasts/naked-scientists-podcast/coronavirus-explained-how-covid-19-works
21. Really striking running tally of #COVID19 cases. The United States went from 0 to the most in the world. This at least partially depends on who is testing the most. If you have thousands of cases but can’t test any you would show up as zero.

https://twitter.com/joshtpm/status/1244119212701990913?s=21 https://twitter.com/joshtpm/status/1244119212701990913
22. Great educational thread in language we can all understand about lab testing (old vs. fast and new) by @jenheemstra 👇🏾👇🏾

https://twitter.com/jenheemstra/status/1244043096301731845?s=21 https://twitter.com/jenheemstra/status/1244043096301731845
23. A video on ARDS and #COVID19 by the incredible @jonah_kessel for the New York Times

It was an incredible experience for me to be able to contribute to the international discussion on this topic.

@CLEClinicLabs https://www.nytimes.com/video/health/100000007056651/covid-ards-acute-respiratory-distress-syndrome.html
How Coronavirus Attacks the Body

It doesn’t take long for mild coronavirus symptoms to turn serious. These virtual reality images show how the virus can invade the lungs and kill.

https://www.nytimes.com/video/health/100000007056651/covid-ards-acute-respiratory-distress-syndrome.html
24. If you prefer to watch on Twitter, bite sized pieces of the video are in this thread 👇🏾👇🏾

https://twitter.com/jonah_kessel/status/1247231134515281929?s=21 https://twitter.com/jonah_kessel/status/1247231134515281929
25. If you prefer to watch this COVID-19 video on YouTube, the link is here. Amazing visuals and graphics! Nearly a million people have watched in the first 2 days.

Here’s the link 👇🏾👇🏾👇🏾👇🏾


#pathology #pulmpath #COVID19 @pembeoltulu @GeronimoJrLapac
25. If you prefer to watch this COVID-19 video on YouTube, the link is here. Amazing visuals and graphics! Nearly a million people have watched in the first 2 days. Here’s the link #pathology #pulmpath #COVID19 @pembeoltulu @GeronimoJrLapac
25. If you prefer to watch this COVID-19 video on YouTube, the link is here. Amazing visuals and graphics! Nearly a million people have watched in the first 2 days. Here’s the link #pathology #pulmpath #COVID19 @pembeoltulu @GeronimoJrLapac
25. If you prefer to watch this COVID-19 video on YouTube, the link is here. Amazing visuals and graphics! Nearly a million people have watched in the first 2 days. Here’s the link #pathology #pulmpath #COVID19 @pembeoltulu @GeronimoJrLapac
25. If you prefer to watch this COVID-19 video on YouTube, the link is here. Amazing visuals and graphics! Nearly a million people have watched in the first 2 days. Here’s the link #pathology #pulmpath #COVID19 @pembeoltulu @GeronimoJrLapac
26. A great thread by @01sth02 on how pathologists are joining the battle against #COVID19 in new ways. Kudos to anyone and everyone in ANY specialty who walks fearlessly into harm’s way to help sick people 🙏🏾

https://twitter.com/01sth02/status/1247482118223073280?s=21 https://twitter.com/01sth02/status/1247482118223073280
26. Fantastic, easy to understand thread by a virologist explaining why SARS-CoV-2 is different from the first SARS, and why it is more dangerous

https://twitter.com/peterkolchinsky/status/1246975276053118976?s=21 https://twitter.com/PeterKolchinsky/status/1246975276053118976
27. Excellent recent paper in @NEJM from Washington.
👉🏾 Nearly all residents of long term care facility who were tested were positive for COVID-19
👉🏾 High case fatality rates for elderly with high comorbidities. Nearly 1 in 3 infected people died https://www.nejm.org/doi/full/10.1056/NEJMoa2005412
Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington | NEJM

Original Article from The New England Journal of Medicine — Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington

https://www.nejm.org/doi/full/10.1056/NEJMoa2005412
28. An in-depth conversation on #COVID19 between myself and @NatalieBanet on her podcast

We discussed #pathology #pulmpath #COVID19 #virtuallearning #anxiety and much more. Easily accessible and FREE!

https://twitter.com/nataliebanet/status/1247828317312557058?s=21 https://twitter.com/NatalieBanet/status/1247828317312557058
29. Third in a series of YouTube videos on COVID19 by @JMGardnerMD

The language is simple. Jerad tackles very complex concepts and tries to appeal to reason. He tries to communicate all that he has learned in the past few weeks. Must-watch: 👇🏾👇🏾
30. Is DAD caused by ventilators or #COVID19 ?

https://twitter.com/smlungpathguy/status/1249228777894416384?s=21 https://twitter.com/smlungpathguy/status/1249228777894416384
31. #COVID19 virology 101.

https://twitter.com/smlungpathguy/status/1249350444461195265?s=21 https://twitter.com/smlungpathguy/status/1249350444461195265
32. Great thread on pathology of #COVID19 thus far. Some of it is published, some not. It’s in Spanish but you can use the translate button to read it in English. Thank you @banavarrete 🙏🏾🙏🏾

https://twitter.com/banavarrete/status/1249350855251329031?s=21 https://twitter.com/banavarrete/status/1249350855251329031
33. Wonderful article on China’s “bat woman” and her years long study of bat-borne viruses. True scientist. 🙏🏾 https://www.scientificamerican.com/article/how-chinas-bat-woman-hunted-down-viruses-from-sars-to-the-new-coronavirus1/
How China’s ‘Bat Woman’ Hunted Down Viruses from SARS to the New Coronavirus

Wuhan-based virologist Shi Zhengli has identified dozens of deadly SARS-like viruses in bat caves, and she warns there are more out there

https://www.scientificamerican.com/article/how-chinas-bat-woman-hunted-down-viruses-from-sars-to-the-new-coronavirus1/
34. A thread on #covid19 serology. My summary: in a population with far more healthy people than infected people, even a tiny false positive rate matters. In such a population people who test positive are more likely to be false + than true +

https://twitter.com/amykatherine/status/1248787138704887808?s=21 https://twitter.com/amykatherine/status/1248787138704887808
35. Podcast episode by Scientific American featuring @DMarshallMD and myself chatting about autopsy findings in #COVID19 with @WaytGibbs

https://twitter.com/stevemirsky/status/1253491354010816515?s=21 https://twitter.com/SteveMirsky/status/1253491354010816515
36. Great info in plain language on droplets, coughing, sneezing, and risk of getting infected by SARS-CoV-2 depending on setting (indoor vs outdoor, short contact vs prolonged contact) by @ErinBromage https://www.erinbromage.com/post/the-risks-know-them-avoid-them
The Risks - Know Them - Avoid Them

Please read this link to learn about the author and background to these posts. It seems many people are breathing some relief, and I’m not sure why. An epidemic curve has a relatively predictable...

https://www.erinbromage.com/post/the-risks-know-them-avoid-them
37. Scary experiment beautifully showing easily viruses can spread at a dinner party. Another reason to hate cruise ships (my apologies to cruise ship aficionados!)

https://twitter.com/johnny_suputama/status/1258786799851376641?s=21 https://twitter.com/Johnny_suputama/status/1258786799851376641
38. Excellent article on the remdesivir trial. Very technical, but shows you what goes on behind the scenes. Tricky decisions and judgement calls.

https://twitter.com/jamesheathers/status/1259813549934809091?s=21 https://twitter.com/jamesheathers/status/1259813549934809091
39. Excellent thread by @Bob_Wachter that covers a lot of ground, including vaccines. Beautifully summarized.

https://twitter.com/bob_wachter/status/1264027988795904000?s=21 https://twitter.com/bob_wachter/status/1264027988795904000
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