Day 6/14 in ICU. Morale has rebounded. Higher level thought of the day: I see some resident nihilism creeping in regarding COVID therapies. It's not their fault, this stuff is hard and they're getting mixed messages. 1/x

Specifically, residents are consistently mentioning remdesivir has been shown not to work, referencing the Solidarity trial by the WHO. I'm curious what others think about this, but I disagree with this interpretation. 2/x

What I mean: Solidarity and ACTT-1 looked at different outcomes. Solidarity looked at mortality, ACTT-1 looked at time to recovery. (Solidarity also looked at other repurposed meds for COVID) 3/x

ACTT-1 found substantially quicker time to recovery, particularly in "less sick" patients, with those on mech ventilation or ECMO not getting benefit. Solidarity found no mortality benefit. 4/x

BUT the theme is consistent among the trials: if you're going to give remdesivir to someone the "less sick" are the target population. Solidarity showed trends toward better outcomes in those not intubated. 5/x

Moreover, I'd gladly take quicker time to recovery as an outcome. These patients are miserable, and we suspect overwhelmed hospital systems are leading to morbidity/mortality for these patients. 6/x

One of my colleagues volunteered in a hard-hit area and shared a story of rounding on a patient who had a lingering chest tube in for weeks, which the staff had completely missed. They were overwhelmed, not their fault. 7/x

But that's a good story of iatrogenesis in COVID! If we can get people out of the hospital then I am game for giving it. So, higher order thoughts: 1) ACTT-1 and Solidarity don't seem too discordant to me. 8/x

2) Mortality isn't the only outcome we should look at. 3) Getting people out of the hospital is a fantastic goal and helps systems efficiency. (Bonus: 4) Solidarity's prose makes it a very hard article to read. Hope it cleans up in peer review.) 9/x

There's a fair number of Utah residents who follow me, so I felt compelled to share thoughts and try to make this easier to understand despite the media s***show this has all become.

To the Utah residents: You guys are doing great work! We are very proud of you. 10/10