Lot of fuss on the 300 Death on Arrival (DoA) in Karachi story. Maybe my confirm bias but Im starting to believe these stories.Esp when these come from v competent colleagues working in ER’s across Punjab/LHR.Atleast a couple have reported such patients with pneumonia-like pic

Desaturating on arrival,unbelievable O2 Sat levels(1 was 57% vs normal >93%). Most of such pt’s die on arrival or Within a few hours. 1Problem is Heart Failure, Or Acute COPD, 2 v common cases in ER also present like that. X-ray can diff but Covid is known to have v xray present.

A different narrative coming from docs working in specialised COVID Centers in Punjab is that since docs in tertiary care are scared(v true btw), they prefer referring/labelling all resp distress pt’s with Covid. Maybe true but DOA is a different story.

DoA is not v high in Tert. cares settings. Add DoA with Resp distress plus X-ray findings of ARDS, &this makes #COVID a lot more probable than COPD, Asthma, bacterial Pneumonia, H Failure etc. Only way out of this unknown is availability of testing for all.

We are sailing in uncharted waters but we can solve a lot of problems by revealing these concealed cases. Any policy that doesn’t involve this (widesp testing) ll never be successful.

Correction/addend.1: ofc I meant to include alot more cases (near-death, gasping, early-death during hospitalization),other than just dead on arrival(DoA) in my tweet.Those who desat inside hospital premises& brought to imaging(not DoA)constitute largest suspect case population.