I’m starting a thread on #COVID19 just to keep everything I learn about it in one place.
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🌹" title="Rose" aria-label="Emoji: Rose"> New information
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🌹" title="Rose" aria-label="Emoji: Rose"> well summarized information
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🌹" title="Rose" aria-label="Emoji: Rose"> Things that changed my mind
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🌹" title="Rose" aria-label="Emoji: Rose"> Things that I did not expect
# #pathology #pulmpath #CoronavirusOutbreak #SARSCoV2
1. Thread
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# #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
https://abs.twimg.com/emoji/v2/... draggable="false" alt="👇🏾" title="Down pointing backhand index (medium dark skin tone)" aria-label="Emoji: Down pointing backhand index (medium dark skin tone)"> https://youtu.be/EXY76TKNy2Y ">https://youtu.be/EXY76TKNy...
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/smlungpat... https://twitter.com/smlungpathguy/status/1240376728305963010">https://twitter.com/smlungpat...
“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/smlungpat... https://twitter.com/smlungpathguy/status/1240376728305963010">https://twitter.com/smlungpat...
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/smlungpat... https://twitter.com/smlungpathguy/status/1240376728305963010">https://twitter.com/smlungpat...
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/smlungpat... https://twitter.com/smlungpathguy/status/1240376728305963010">https://twitter.com/smlungpat...
5. Here is a #COVID19 thread by @AnneMillsMD that residents will find helpful. She’s putting various resources in there
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https://twitter.com/annemillsmd/status/1239963734832902144?s=21">https://twitter.com/annemills... https://twitter.com/AnneMillsMD/status/1239963734832902144">https://twitter.com/AnneMills...
https://twitter.com/annemillsmd/status/1239963734832902144?s=21">https://twitter.com/annemills... https://twitter.com/AnneMillsMD/status/1239963734832902144">https://twitter.com/AnneMills...
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:
https://youtu.be/szueWSgLH... href="">https://youtu.be/szueWSgLH...
https://youtu.be/szueWSgLH... href="">https://youtu.be/szueWSgLH...
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
https://youtu.be/TKS1pahoPRU ">https://youtu.be/TKS1pahoP...
https://youtu.be/TKS1pahoPRU ">https://youtu.be/TKS1pahoP...
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
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https://www.worldometers.info/coronavirus/ ">https://www.worldometers.info/coronavir...
https://www.worldometers.info/coronavirus/ ">https://www.worldometers.info/coronavir...
9. Sorry, just realized I forgot to link to the first #COVID19 video by @JMGardnerMD
Very timely and well argued. A must-watch.
https://youtu.be/zkTVAVfI_fo ">https://youtu.be/zkTVAVfI_...
Very timely and well argued. A must-watch.
https://youtu.be/zkTVAVfI_fo ">https://youtu.be/zkTVAVfI_...
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
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PS: there’s no paywall https://www.washingtonpost.com/graphics/2020/world/corona-simulator/">https://www.washingtonpost.com/graphics/...
@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/">https://www.washingtonpost.com/graphics/...
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/smlungpat... https://twitter.com/smlungpathguy/status/1239774334580858880">https://twitter.com/smlungpat...
https://twitter.com/smlungpathguy/status/1239774334580858880?s=21">https://twitter.com/smlungpat... https://twitter.com/smlungpathguy/status/1239774334580858880">https://twitter.com/smlungpat...
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_piju... https://twitter.com/lara_pijuan/status/1240575428475092993">https://twitter.com/lara_piju...
Stay safe, my friend! #COVID19
https://twitter.com/lara_pijuan/status/1240575428475092993?s=21">https://twitter.com/lara_piju... https://twitter.com/lara_pijuan/status/1240575428475092993">https://twitter.com/lara_piju...
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">https://jamanetwork.com/journals/... @BDSouthern ?
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">https://jamanetwork.com/journals/... @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/jeremycyo... https://twitter.com/jeremycyoung/status/1239975682643357696">https://twitter.com/jeremycyo...
https://twitter.com/jeremycyoung/status/1239975682643357696?s=21">https://twitter.com/jeremycyo... https://twitter.com/jeremycyoung/status/1239975682643357696">https://twitter.com/jeremycyo...
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
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)
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/s... https://twitter.com/shkroft/status/1240637187814801409">https://twitter.com/shkroft/s...
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/s... https://twitter.com/shkroft/status/1240637187814801409">https://twitter.com/shkroft/s...
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">https://www.imperial.ac.uk/media/imp...
https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf">https://www.imperial.ac.uk/media/imp...
19. A wonderful infographic/explanation of the test for #COVID19
https://twitter.com/pathologistmag/status/1242372533267169295?s=21">https://twitter.com/pathologi... https://twitter.com/pathologistmag/status/1242372533267169295">https://twitter.com/pathologi...
https://twitter.com/pathologistmag/status/1242372533267169295?s=21">https://twitter.com/pathologi... https://twitter.com/pathologistmag/status/1242372533267169295">https://twitter.com/pathologi...
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">https://www.thenakedscientists.com/podcasts/...
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/s... https://twitter.com/joshtpm/status/1244119212701990913">https://twitter.com/joshtpm/s...
https://twitter.com/joshtpm/status/1244119212701990913?s=21">https://twitter.com/joshtpm/s... https://twitter.com/joshtpm/status/1244119212701990913">https://twitter.com/joshtpm/s...
22. Great educational thread in language we can all understand about lab testing (old vs. fast and new) by @jenheemstra
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https://twitter.com/jenheemstra/status/1244043096301731845?s=21">https://twitter.com/jenheemst... https://twitter.com/jenheemstra/status/1244043096301731845">https://twitter.com/jenheemst...
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">https://www.nytimes.com/video/hea...
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">https://www.nytimes.com/video/hea...
24. If you prefer to watch on Twitter, bite sized pieces of the video are in this thread
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https://twitter.com/jonah_kessel/status/1247231134515281929?s=21">https://twitter.com/jonah_kes... https://twitter.com/jonah_kessel/status/1247231134515281929">https://twitter.com/jonah_kes...
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
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https://youtu.be/BuzP-uLctYE
https://youtu.be/BuzP-uLct... href="https://twtext.com//hashtag/pathology"> #pathology #pulmpath #COVID19 @pembeoltulu @GeronimoJrLapac
Here’s the link
https://youtu.be/BuzP-uLctYE
https://youtu.be/BuzP-uLct... href="https://twtext.com//hashtag/pathology"> #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
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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/peterkolc... https://twitter.com/PeterKolchinsky/status/1246975276053118976">https://twitter.com/PeterKolc...
https://twitter.com/peterkolchinsky/status/1246975276053118976?s=21">https://twitter.com/peterkolc... https://twitter.com/PeterKolchinsky/status/1246975276053118976">https://twitter.com/PeterKolc...
27. Excellent recent paper in @NEJM from Washington.
https://abs.twimg.com/emoji/v2/... draggable="false" alt="👉🏾" title="Right pointing backhand index (medium dark skin tone)" aria-label="Emoji: Right pointing backhand index (medium dark skin tone)"> Nearly all residents of long term care facility who were tested were positive for COVID-19
https://abs.twimg.com/emoji/v2/... draggable="false" alt="👉🏾" title="Right pointing backhand index (medium dark skin tone)" aria-label="Emoji: Right pointing backhand index (medium dark skin tone)"> 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">https://www.nejm.org/doi/full/...
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/natalieba... https://twitter.com/NatalieBanet/status/1247828317312557058">https://twitter.com/NatalieBa...
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/natalieba... https://twitter.com/NatalieBanet/status/1247828317312557058">https://twitter.com/NatalieBa...
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:
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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/smlungpat... https://twitter.com/smlungpathguy/status/1249228777894416384">https://twitter.com/smlungpat...
https://twitter.com/smlungpathguy/status/1249228777894416384?s=21">https://twitter.com/smlungpat... https://twitter.com/smlungpathguy/status/1249228777894416384">https://twitter.com/smlungpat...
31. #COVID19 virology 101.
https://twitter.com/smlungpathguy/status/1249350444461195265?s=21">https://twitter.com/smlungpat... https://twitter.com/smlungpathguy/status/1249350444461195265">https://twitter.com/smlungpat...
https://twitter.com/smlungpathguy/status/1249350444461195265?s=21">https://twitter.com/smlungpat... https://twitter.com/smlungpathguy/status/1249350444461195265">https://twitter.com/smlungpat...
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
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https://twitter.com/banavarrete/status/1249350855251329031?s=21">https://twitter.com/banavarre... https://twitter.com/banavarrete/status/1249350855251329031">https://twitter.com/banavarre...
33. Wonderful article on China’s “bat woman” and her years long study of bat-borne viruses. True scientist.
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🙏🏾" title="Folded hands (medium dark skin tone)" aria-label="Emoji: Folded hands (medium dark skin tone)"> https://www.scientificamerican.com/article/how-chinas-bat-woman-hunted-down-viruses-from-sars-to-the-new-coronavirus1/">https://www.scientificamerican.com/article/h...
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/amykather... https://twitter.com/amykatherine/status/1248787138704887808">https://twitter.com/amykather...
https://twitter.com/amykatherine/status/1248787138704887808?s=21">https://twitter.com/amykather... https://twitter.com/amykatherine/status/1248787138704887808">https://twitter.com/amykather...
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/stevemirs... https://twitter.com/SteveMirsky/status/1253491354010816515">https://twitter.com/SteveMirs...
https://twitter.com/stevemirsky/status/1253491354010816515?s=21">https://twitter.com/stevemirs... https://twitter.com/SteveMirsky/status/1253491354010816515">https://twitter.com/SteveMirs...
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">https://www.erinbromage.com/post/the-...
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_su... https://twitter.com/Johnny_suputama/status/1258786799851376641">https://twitter.com/Johnny_su...
https://twitter.com/johnny_suputama/status/1258786799851376641?s=21">https://twitter.com/johnny_su... https://twitter.com/Johnny_suputama/status/1258786799851376641">https://twitter.com/Johnny_su...
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/jamesheat... https://twitter.com/jamesheathers/status/1259813549934809091">https://twitter.com/jamesheat...
https://twitter.com/jamesheathers/status/1259813549934809091?s=21">https://twitter.com/jamesheat... https://twitter.com/jamesheathers/status/1259813549934809091">https://twitter.com/jamesheat...
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_wacht... https://twitter.com/bob_wachter/status/1264027988795904000">https://twitter.com/bob_wacht...
https://twitter.com/bob_wachter/status/1264027988795904000?s=21">https://twitter.com/bob_wacht... https://twitter.com/bob_wachter/status/1264027988795904000">https://twitter.com/bob_wacht...