Thread by @FOAMpodcast, COVIDcast at @BaystateEM #EMConf today

FOAMcast

FOAMpodcast

COVIDcast at @BaystateEM #EMConf today - If we could go back and have a "do-over" from 3 months ago....what would we tell ourselves about #COVID19, clinically? (1/)

We wish we& #39;d known how important asymptomatic transmission of #COVID19 was (incredible modeling by @biomathematicus @JacobBAguilar https://www.medrxiv.org/content/10.1101/2020.03.18.20037994v3">https://www.medrxiv.org/content/1... (2/)

We wish we& #39;d known our testing strategies for #COVID19 were quite flawed
1. (see asymptomatic transmission)
2. Co-infections on resp panel up to 21%
3. antibody tests have problems (Santa Clara Ab paper used test w/cross-reactivity, LFIA test characteristics aren& #39;t ideal) (3/)

We wish we& #39;d known #COVID19 symptoms are broad (/nonexistent):
1. GI symptoms aren& #39;t uncommon
2. in addition to sniffles/URIs, can see strokes / MI / VTE
3. also dysgeusia and anosmia (4/)

We wish we& #39;d designed better research (and not let the media/politicians get ahold of papers):
1. see the breadth of hydroxychloroquine "studies" (no control group, observational, retrospective)
2. remdesivir @NEJM article (5/)

We wish we& #39;d known more about the outcomes of patients on mechanical ventilation with #COVID19 when we were told to intubate early, and more about awake proning (and not ignored our usual respiratory failure care) (6/)

we wish we knew:
*who with #COVID19 to anticoagulate
*who benefits from steroids
*what viral shedding = transmissibility
*how much immunity is conferred by infection
*what, besides excellent supportive care and appropriate VTE prophylaxis, would fix these patients (7/)

we wish we didn& #39;t have so much knowledge via #COVID19 about
* PPE or PPE supply chains
* fomites and decontamination
* virtual end of life conversations (8/)

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