What we& #39;ve been missing, below the surface, about #COVID19. The focus has been on confirmed cases, hospitalizations and deaths. But there& #39;s so much more we& #39;ve been learning. United States data here
2. Let& #39;s start with the excess deaths, attributed to non-covid19 diagnoses. Here& #39;s a sampling to show excess causes of death in March-May in many places was likely inaccurately categorized. The estimates of actual covid-19 deaths suggests an additional >40,000 fatalities
3. Now the missed cases from lack of testing availability, mild/moderate symptoms that did not lead to testing, false negatives tests, and those never having discernible symptoms. Asymptomatics comprise at least 30% those infected
https://www.acpjournals.org/doi/10.7326/M20-3012">https://www.acpjournals.org/doi/10.73... @AnnalsofIM
4. There are now 3 series of lung CT scans in people who were asymptomatic. More than half of these patients show distinct GGO abnormalities consistent w/ #COVID19
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30364-9/fulltext
https://www.thelancet.com/journals/... href=" https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30482-5/fulltext
https://www.thelancet.com/journals/... href=" https://www.medrxiv.org/content/10.1101/2020.05.09.20096370v1.full.pdf">https://www.medrxiv.org/content/1...
5. This represents silence at 2 levels: lack of symptoms and lack of awareness of internal damage. It& #39;s especially concerning since other organs may be affected (like heart or kidneys) but have not been studied. Nor has the natural history of such subclinical covid-19 impact
6. Infection ≠ Infectious.
This big question about aymptomatics is how frequently they can infect others. All the studies to date show similar viral loads as people with symptoms.
Yesterday a new @CDCgov report provided some light from Japan& #39;s clusters
https://wwwnc.cdc.gov/eid/article/26/9/20-2272_article">https://wwwnc.cdc.gov/eid/artic...
7. 9 of 22 clusters originated from people without symptoms
"Probable primary covid-19 case-patients appear to transmit the virus and generate cluster even in the absence of apparent symptoms"& #39;
This occurred throughout all ages.
1= Asymptomatic in Figure
9. The magnitude of transmissibility from people without symptoms remains unknown and is hopefully low, but all the more reason to https://abs.twimg.com/emoji/v2/... draggable="false" alt="😷" title="Gesicht mit Mundschutz" aria-label="Emoji: Gesicht mit Mundschutz">https://abs.twimg.com/emoji/v2/... draggable="false" alt="😷" title="Gesicht mit Mundschutz" aria-label="Emoji: Gesicht mit Mundschutz">https://abs.twimg.com/emoji/v2/... draggable="false" alt="😷" title="Gesicht mit Mundschutz" aria-label="Emoji: Gesicht mit Mundschutz"> #masksforall and other mitigation measures. One last below the surface group are the chronic #COVID19 hits
You can follow @EricTopol.
Tip: mention @twtextapp on a Twitter thread with the keyword “unroll” to get a link to it.

Latest Threads Unrolled: