Anil Makam
@AnilMakam
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#UCSF #HospitalMedicine Physician Researcher at #SFGH || Research in outcomes & health services || #EBM advocate, but not in the usual sense
San Francisco, CA
Joined August 2013
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To bring in the new year, here are the articles I thought about the most in 2023 that might have affected my practice in hospital medicine in a safety net hospital
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ZERO
#COVID19
patients on the
#SFGH
hospital medicine service as of 5pm today
Momentous day
@SFGHFoundation
@SF_DPH
@UCSF
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Who's going to tell him?
Overwhelming data show that early detection of cancer is the key to long term survival.
During the pandemic, a lot of routine healthcare and cancer screening was delayed, forgone.
It’s critical that we make a concerted effort to help people catch up on missed screenings.
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I'm working in the hospital this week. So many of my patients incidentally have COVID with no or minimal symptoms
Hospitalizations as a metric was diluted during BA 1 &2
With BA5 it's fairly useless if using claims or EHR data
We need better data not bigger data
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Wow
Just read perhaps the greatest article about a doctors’ diagnostic skills
Not in the medical literature, but in an economics journal!
If you think about diagnosis, follow along
It won’t disappoint
@RogueRad
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I'm back on service. Cared for ~20 unique people past 4 days
0 patients hospitalized FOR covid
0 patients hospitalized WITH covid
0 patients with long covid as comorbidity
good news!
severe covid is gone
long covid is real but not nearly at prevalence suggested
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@VPrasadMDMPH
you mean a national surveillance system run by an institution in charge of disease control?
too bad we don't have one of those centers
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There is literally just 1 person in the hospital at SFGH with COVID19
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Huge health policy implications
During ongoing public health emergency hospitals get a 20% add on payment for COVID hospitalizations
Needed in 2020 when we were in crisis & "elective" care canceled
Less needed in 2021
In 2022 this is a MASSIVE hospital subsidy by tax payers
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Embracing vaccines for US children over older adults abroad is perhaps the most schizophrenic dance for
#publichealth
&
#healthequity
leaders
The high end of risk for an adolescent to die from COVID19 in SF right now is 0.00035%
(0.35% prevalence x 0.1% CFR--likely even lower)
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It’s that time of year
Here are my top 12 studies from 2022 in no particular order that influence Hospital Medicine
I avoided:
-only abstracts (sorry SABATO & TRANSFORM-HF)
-COVID since the disease as we once knew it is uncommon
-Subspecialty or critical care only implications
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This is not controversial or dangerous
This virus will be endemic
The goal post is preventing serious illness & not overwhelm the health care system
The exit strategy is NOT
#ZeroCOVID
for all of eternity
It will hopefully be okay to harbor virus in your nose or have a cold
2- Given Delta’s contagiousness & the fitness of future mutations in order to beat it, this means SARS-CoV-2 will be contagious enough that everyone will get the virus.
The aim is simply that more people get it be vaccinated when they do so fewer get COVID. 5/
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I respect
@VincentRK
immensely but disagree
I am a hospital medicine doctor in SF
I SAW COVID+ patients these past 2 weeks
And many times I would think, "it's just with COVID, no big deal" (good news btw)
Rather I focused on their illness that landed them in the hospital
All this "with Covid" and not "of Covid" talk is nonsense.
You won't hear doctors who actually see patients say: "it's just with Covid, no big deal."
We know what's going on.
We are in the hospitals.
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To clarify to people wishing for worse news
In 2022 I've seen 1 person with COVID pneumonia. Not just this past weeks experience
Many other doctors on this bird app are saying the same thing
Listen to them, not grifters who follow test+ nonadjudicated data blindly
I'm back on service. Cared for ~20 unique people past 4 days
0 patients hospitalized FOR covid
0 patients hospitalized WITH covid
0 patients with long covid as comorbidity
good news!
severe covid is gone
long covid is real but not nearly at prevalence suggested
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Ha. True. My turn, my turn...
Dear
#Oncologists
,
Please share with patient whether your prescribed treatment is intended to be
#curative
vs
#palliative
. And don't rely only on stage & metastatic to communicate
#prognosis
.
Sincerely,
All
#PCPs
,
#Hospitalists
, & EM docs
Dear surgeons,
Please don’t tell patients “you’re now cancer-free”.
Sincerely,
All medical oncologists
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Who actually believes acute COVID increases diabetes risk by 81%
My goodness we're lost. Elevating designs riddled with confounding and ascertainment biases
They state associations but then advise people to watch their diets after getting COVID
Doh
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My screening temperature of my forehead read 93.7 today upon entry
No one seemed worried, even when I told them it wasn't compatible with life
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Yikes. This is very very wrong. Important to not conflate a potential risk factor with being high risk. Most people in the US are not at high risk for bad outcomes from the flu or COVID. We deserve far better
#scicomm
from our institutions and public health leaders
If we’re going to have honest policy debates- which is what many claim they want- we can’t have people saying things that literally everyone- even if you’re against vaccinations- can clearly see / lookup are untrue.
And we can’t forget that a “let’s only focus on the high risk”
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Remember when we set the goal of reducing hospital strain & prevent most severe illness in 2020?
We've done both for 6+ months for a brand new illness that killed millions 2 years ago
Amazing
*Dont reply w/ test+ data. Ask any doc the last time they saw COVID pneumonia
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Complete disconnect between journalism coverage and what is actually happening in the hospital in SF
Rare to see covid respiratory failure now
I am on service and have 2 patients with but not for COVID
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The advantage of awful epidemiology studies is you can tell in plain sight who understands epidemiology and who doesn't
Follow people who know the difference
You may sleep, breathe, and feel better
Or apparently, just get COVID and you can accomplish the same things (satire)
🚨POST-COVID & Kids🚨
New
@CDCgov
report showing quite clearly that children are at significantly more risk for life-threatening diagnoses after COVID infection. Very convincing evidence that prevention of COVID-19 in children is very important to reduce childhood mortality.
/1
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Are others seeing this?
I practice in a safety net hospital in SF and care for the most individuals at greatest risk from covid and I haven't seen a single person with long covid in my 4 weeks of service this summer
Reflecting on recent ER shifts: There are so many folks, these days, seeking help for continued problems (shortness of breath, brain fog, dizziness) 1+ months after
#covid19
infection.
Wishing I had more to offer them.
This virus is - still - no joke.
#LongCOVID
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they're literally making up the next voting question on the fly
could be 50+, 60+, 65+, any body at high risk, older adults + healthcare workers
what is happening
why was this not planned in advance if there was a No vote?
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Took care of 20+ hospitalized adults this past week in a safety net hospital (aka most vulnerable)
Saw lots of comorbid diabetes, heart failure, emphysema
Saw Zero with long COVID
If 60% of US infected x 10-30% incidence it won't be subtle
It's real, but fortunately uncommon
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The current COVID burden at SFGH, safety net hospital in a high vax city
26 COVID+ patients (only 12 unvax)
11 are "for" COVID (6 ICU, 5 wards) & includes few with ambiguous ascertainment
True COVID hospitalization is ~40%
This is my last SFGH daily update as I'm off service
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To clarify the record,
@VPrasadMDMPH
does see patients
we cared for the same mutual patient this weekend
double trouble or platinum doublet?
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Case in point: new
@medrxivpreprint
study showing 3-fold higher hospitalizations with BA5 than BA2. Hospitalizations is defined as an admission with the virus. This is meaningless. Its more contagious and we routinely test in hospital for people who wouldn't be tested otherwise
I'm working in the hospital this week. So many of my patients incidentally have COVID with no or minimal symptoms
Hospitalizations as a metric was diluted during BA 1 &2
With BA5 it's fairly useless if using claims or EHR data
We need better data not bigger data
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Good read
I stopped listening to NPR in 2016
I stopped subscribing to
@nytimes
in 2023 (2 years too late)
Academic medicine has gone the same - narrative first, science second (or never)
Uri Berliner has worked at NPR for 25 years.
He still works there.
And today he published this essay in
@TheFP
:
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@GYamey
@ENirenberg
@GermHunterMD
Do you attend in the hospital? If not, have you spoken to to your critical care, hospital medicine, ED, ID colleagues? If not, please do and get back to me if their experience is much different.
The outcomes you follow are meaningless without adjudication given high immunity
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Current
@UCSFMedicine
policy with
@BrightHorizons
day care is to keep toddlers at home who are COVID positive for min of 10 days with a negative PCR
If symptoms resolve & rapid antigen negative still can't return
Tuition is not prorated
I wonder why people are tired & upset?
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Proton pump inhibitors are minimally effective to reduce GI bleed among the critically ill folks at high risk for stress ulcers. Take aways: no role for routine PPI for any patients on the WARDS, and shouldn't be considered 'routine' in the ICU
Original Article: Pantoprazole in Patients at Risk for Gastrointestinal Bleeding in the ICU (SUP-ICU)
Editorial: Proton-Pump Inhibitor Prophylaxis in the ICU — Benefits Worth the Risks?
#LIVES2018
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The FDA and CDC approval is all but predetermined
Imagine if Trump did this
2. As soon as FDA/CDC approval is granted, the administration expects to offer boosters during the week of September 20. Booster shots will be free, and widely available across 80,000 locations.
@VaccineFinder
will be used to help find vaccination sites.
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If you're a doctor & can't come up with your own conclusion by reading a study's methods & results you're practicing consensus-based medicine, not EBM
You're not alone. Its not your fault. An utter failure of
#MedEd
Do 2 things
-find the right experts
-learn critical appraisal
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Would you mandate intervention A for population B if it reduces an already very low risk of adverse outcome C, but is of smaller magnitude than the very low risk of complication D?
This isn't hard
Even if
A=mRNA vax
B=young boys/men
C=severe COVID
D=myocarditis
Third year medical student demonstrates better critical thinking and courage than the experts. I would want him to care for my son.
👇👇👇
Failing our kids: Myocarditis in young boys, by
@Sensible__Med
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I am covering the entire faculty hospital service at
@ZSFGCare
for the evenings these next few days over new years
Not a single patient admitted for COVID (or RSV or influenza)
@sfchronicle
will never write these stories, just articles on the new scariants
COVID is so over that an 82 year man can get it and keep working. We don't see ARDS from it like 2020. If the CDC actually had a robust method to separate hospitalizations with COVID (incidental) from hospitalizations from COVID (causal), the numbers would reflect the reality.
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I shared my experience to celebrate remarkable progress
I apologize for my tweet, which was flippant in its implications since it was clumsily worded and lacked context
Many chose to assume the worst—such is life
A longish thread if you will let me
I'm back on service. Cared for ~20 unique people past 4 days
0 patients hospitalized FOR covid
0 patients hospitalized WITH covid
0 patients with long covid as comorbidity
good news!
severe covid is gone
long covid is real but not nearly at prevalence suggested
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I'm convinced there isn't a single hospital in the world where you could drop off a loved one and on average expect to get high-quality, high-value, efficient, compassionate care with responsive communication
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This exact same study also finds kids with COVID have LESS sleeping issues, mental health, & the kicker, less respiratory problems!!!
Disregarding these as not newsworthy or valid is selective reporting to seek a narrative
FWIW, I don't think COVID is protects against those
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What the blood clot?!?! Submitted a peer reviewed research study that was accepted AS IS
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For people who assume the worst
its not 1 weeks experience
To clarify to people wishing for worse news
In 2022 I've seen 1 person with COVID pneumonia. Not just this past weeks experience
Many other doctors on this bird app are saying the same thing
Listen to them, not grifters who follow test+ nonadjudicated data blindly
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Higher skilled radiologists were older, more experienced, and spend MORE TIME on reports BUT ISSUE SHORTER ones
“I didn’t have time to write you a short letter so I wrote a long one instead” – Twain
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I honestly wouldn't recommend even if it was free
UPDATED WITH THE DRUG PRCE: $26,500. F.D.A. Approves New Treatment for Early Alzheimer’s
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Waiting for the twitter pile on
Not okay to inadvertently insinuate severe covid respiratory failure is gone (even if in reality over 90% is)
But okay to declare we can end all cancer?
btw, cancer is not a single illness caused by the same thing
I believe we can end cancer as we know it and even cure cancers once and for all.
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Since pfizer showed vaccine efficacy after just 7 cases I crudelt did the same for Moderna in 2-5 yo with prior COVID
Point estimate is -95%
[((1/109)-(6/336))/(1/109)]*100
Assumptions
-includes positive & missing infection status
-equal follow-up
I interpret as no reduction
7| There were too few COVID infections in 2-4 yo to look at vax efficacy in subgroup of kids with prior infections
Raw data:
-Moderna (3:1 randomization) infections similar vs placebo (Left pic)
-Pfizer (2:1 randomization): reinfections similar vs placebo (Right pic)
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Others are seeing the same in other hospitals and regions
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Great
@Health_Affairs
study
For Medicaid MCO beneficiaries
-1 in 5 in-network docs were ghosts
-1 in 3 see < 10/year
-25% of a small number of listed in-network docs comprise 75-85% of care
"in-network" is grossly misused
insurance ≠ access to care
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Important PSA: you can email your congratulations to the person individually without replying all
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Vaccines no longer decrease transmissions or contagiousness like before Omicron. Now it's purely for personal reasons based on ones' views of risks and benefits
COVID has evolved, but our thinking and policies have not
I am happily vaccinated and boosted, but strongly disagree with DC's decision to mandate Covid-19 vaccination for fall school attendance.
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The
@nejm
special report out today on RAAS & COVID should have been edited down to this 1 sentence:
"Insufficient data are available to determine whether these observations readily translate to humans, and no studies have evaluated the effects of RAAS inhibitors in Covid-19"
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He's back and unfortunately not much more wisdom
Very thoughtful writing on ME/CFS
But slight of hand, overstating evidence, & offers recommendations that IMO are dangerous
This is the worst type of misinformation - in plain sight and accepted by the intellectual mainstream
Between long COVID, ME/CFS, and other energy-limiting chronic illnesses, millions of people in the U.S. alone experience debilitating fatigue.
Researchers have started to figure out why—but don’t yet know how to stop it.
@edyong209
reports:
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10 minutes to review and deliberate the whole body of evidence on the vaguest of eligibility indications where there is none to guide
essentially a popularity contest of boosters at this point
Booster 10 min break: then voting on
65 and older
High risk of occupational exposure
Underlying disease
-- so vague-- will lead to mandates among 20 year old health care workers.
Literally no good evidence supporting any of this.
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WTF is this?
I've never written, revised, nor published this article ascribed to me
and the title is from a different
@JACCJournals
article
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Agree, this is bad science. Disappointing to see it amplified by those who should know better
It's not a test negative design. So comparisons are moot since confounding too great
Top line findings are descriptive, and still instructive...
What happened to science?
When the pandemic ends, and people have no faith in public health, it would be wrong to blame Joe Rogan. It's institutions like the CDC and our leaders who push bad info masquerading as science.
My analysis:
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His entire line of research is a giant confounder machine
Curves diverge instantly
The Michigan research group has published 2 high quality papers using same national VA data with very different results
COVID is just the flu.
A talking point we've all heard before. 😐
@zalaly
's new research in
@theLancet
addresses it head-on—and obliterates it.
Compared to flu, which mainly affects the lungs, COVID poses higher risks to all body systems, pointing to its multisystemic nature.
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1| So very, very proud of our latest
@JAMAInternalMed
study led by
@OanhKieuNguyen
!
For undocumented
#Immigrants
, scheduled
#dialysis
SAVES lives and REDUCES healthcare use at LOWER costs (& way more humane)
Thread
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Anyone else curious about steroids for influenza pneumonia?
@nature
review in 2020 found 19 studies
Only 1 was an RCT
of 24 patients
1st influenza epidemic was in 1173
We've randomized 24 humans with flu pneumonia to steroids over a millenium
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New
@NEJM
study on 4th dose vs 3 doses using observational data from Israel (level A evidence to many)
Need to read closely but this KM curve seems biologically implausible except for selection bias-those who get 4th doses are different
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Study isn't worth its salt
1. super restricted salt diet (500mg) is cruel
Once science becomes the thief of joy it ceases its purpose
2. Comparing to super high salt is like comparing couch potatoes vs ultra marathoners
extreme restriction = only 8 point less BP
Sodium reduction significantly lowered blood pressure in the majority of middle-aged to elderly adults in this study.
#AHA23
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glaringly bad coverage in the ny times on paxlovid well summarized by
@adamcifu
reads like a pfizer press release
imagine an observational study of the association of stents on angina using ICD10 codes getting this type of press
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timeline cleanser
final update after finishing up my 5th shift
4 people in our entire service tested + for covid
3 incidental (routine screening)
1 likely incidental but possibly contributed
the obligatory yes it still exists, few get really sick
but immunity is amazing!
I am covering the entire faculty hospital service at
@ZSFGCare
for the evenings these next few days over new years
Not a single patient admitted for COVID (or RSV or influenza)
@sfchronicle
will never write these stories, just articles on the new scariants
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How do we change this messaging? She is seeking additional medical treatment--it's called
#HOSPICE
. Medical care that focuses on keeping her home, managing symptom burden, & honoring her wishes and goals of care. Not all medical treatment is curative
#HPM
JUST IN: Barbara Bush will not seek additional medical treatment and will focus on comfort care for failing health, according to statement from the office of George H.W. Bush.
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@jrovner
problem is hospitalization is no longer as useful of a metric. In high vax areas or high prior prevalence of pre-Omicon COVID, ~60% of hospitalizations for COVID+ people are "with" and not "for" COVID
So 1/3rd rate x 40% true COVID hospitalization = 13% hospitalization rate
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Back to the intent of my original tweet
I wanted to celebrate progress - a stint on the wards w/o severe covid
We have largely reduced severe covid – an incredible feat considering where we were in 2020 facing a brand new virus
This doesn’t erase the past or ongoing suffering
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What to do if you test positive on rapid antigen test beyond 10 days?
Shoulder shrug. Just another evidence free zone
I really wish we had a Center with the capacity to answer meaningful questions about how best to Control Diseases
Studies suggest that while people are most likely to test positive on antigen tests during the first week of illness, a notable subset of people continue to test positive for 10 days or longer.
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in 2024...
UCSF is requiring all employees get updated COVID boosters or decline it. In the declination form it lists two options to decline the booster. Can we add a third of “waiting for clinical trial results to show that yearly winter boosters targeting the summer variant is helpful?”
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Given that *most* cases are asymptomatic, the only sensible algorithm for hospitals is mass testing every single patient and health care worker. Anything short of this is because of shortages of testing
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With a new academic year there's a new wave of COVID policies
Here a few from day care & some from work that just make no sense
1. return from international travel requires a PCR test d1 & d5 (can remain in school)
narrator: you can get COVID in the US. but it shouldnt matter
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I greatly appreciate my ID consultants, but does any ID doc truly believe their involvement in these patients' care decrease absolute mortality by 20% by day 1 and 40% at 1 week after consultation?
NEW 🔥Retrospective study in OFID Effect of ID Consultation on Mortality in Hospitalized Patients With MRSA,Candida & PSA BSIs
📍Patients without ID consultation had 4.5 ⬆️ hazard of death at 3
months had a 5.9 ⬆️ hazard of death in hospital.
#IDTwitter
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This isn't hard & it hasn't changed with this study
COVID vaccines are incredible & mostly very very safe
One demographic (young men & boys) where uncommon risks from mrna vax > uncommon risks from virus
Acting like it doesn't exist doesn't build trust IMO
A study of 40 million people found those infected with COVID-19 before receiving a vaccine were 11x more at risk for developing myocarditis within 28 days of testing positive for the virus. Risk was cut in half if infected after receiving vaccination!
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Beyond disappointing article to equate all symptoms reported in studies and surveys after a covid illness to a specific syndrome known as long covid
👋I’m back. And I wrote about the current wave of attempts to downplay long COVID—less outright denial & more "it’s real but no big deal".
Except: it very much is. It’s a substantial and ongoing crisis that still demands our attention. 1/
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Healthy user bias in action
Not specific to mammography
Exact problem with relying on real world observational designs to study effectiveness of boosters
Can't adjust well for health seeking
Current mammogram guidelines made them optional for women 40-49 because of the risk of false positives. This paper finds that these guidelines actually increased the risks of false positives by 3.5x because now the women who do chose to get mammograms are those at the lowest risk
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@walidgellad
@SarahKarlin
@VPrasadMDMPH
tech/audio issues
accidental vote
made up new voting question on the fly
10 minutes to deliberate the evidence
used most vague terms in the vote
not much confidence for "trust the science"
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Knowing nothing else, I'd take an IMG with no US residency training over an NP/PA 10 times out of 10
Is this a good news for IMGs( international medical graduate ) ? New Law in Tennessee will allow you to practice in USA without doing residency in USA ? Is it good or bad for IMGs or reflects Ugly shortage of Healthcare Workforce in certain parts of USA ?
@VPrasadMDMPH
@NEJM
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My goodness
It's the policies, not failure of mitigation strategies
Masking toddlers doesn't work when eating & sleeping side by side
Vax doesn't stop spread vs current O variants (viral shedding same) and best evidence we have frankly doesn't prevent reinfections in kids
Breaking update: 5th quarantine in young preschool class in less than 3 months. 25 days without childcare x 10+ kids in the class. That means at least 250 missed work days.
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Good news--despite a surge in Omicron BA.2, there have been few deaths and intensive care stays in SF because of high vax rates
These are the best indicators of severe illness --not cases or hospitalizations
Vaccines & boosters work even for this highly contagious variant
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you cannot achieve health equity in a hospital if you do not have adequate staffing of essential services 7 days a week. may seem obvious, but it's not how most hospitals work
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Things have changed for goof
@GYamey
@snpsandsnRNPs
@aerosmith2k1
@TraceyKent
Things evolve fast
2020-2021 test+ data was mostly right
2022 test+ data mostly wrong
Most are incidental or asymptomatic
Some are "for" but classic resp failure from pneumonia is rare
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The community masking trial in Bangladesh by
@Jabaluck
@mushfiq_econ
et al is AMAZING & EXCEPTIONALLY well done
Joy to read & I learned a LOT
Encourage all scientists in related disciplines to read, even if not your content
Thread on study
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We get this instead of a story on
@pfizer
decidedly negative EPIC-SR trial of paxlovid in largely vaccinated standard risk (which is most people in 2023)
Paging journalists
An epic story waiting to be written
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@VPrasadMDMPH
that's aiming too high
let's start with not changing guidelines every 2 weeks based on scant evidence
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Strong co-sign
IMO, this is the most consequential blunder in US
#COVID19
response
Benefit of vaccinating older adults in places like India are
>>>> (3200 times) >>>>
than vaccinating children in US
vaccine nationalism destroys global health equity
Now in the Atlantic,
@TracyBethHoeg
@MonicaGandhi9
and I argue that we ought to vaccinate OLDER people around the globe before we vaccinate children in high income nations. It is in OUR best interest to do so
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The role of our FDA is to approve any drug that is safe that has a chance to benefit, even if it's unlikely
Other countries don't do this
Maybe we shouldn't either
23% of 2017-20 FDA approvals were refused authorization or not recommended for coverage in other countries due to risk vs. benefit concerns, unclear benefit over existing drugs, or unacceptably high price. Median US cost of those drugs: $115K patient/year.
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Having a neck is the only relevant preexisting condition if you die after being knelt on for 8 minutes and 46 seconds
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Inefficiency of research is astounding. 1 lousy observational study with implausible basis and effect size led to 19 RCTs!!!
An accompanying editorial in JAMA practically calls for the 18 remaining Vitamin C cocktail trials to be halted for presumed futility. The author doesn’t go that far but he points out how much research funding is going towards this all, just based on the one Marik study from 2017
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I attend on our faculty COVID service tomorrow, April 1. No joke
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Stop effing funding and publishing studies on
#vitaminD
! I don't get the obsession. Let's move on to answer the 50-75% of usual practice that we kinda just guess at
Among healthy adults, treatment w vitamin D for 3 y at 4K or 10K IU vs 400 IU per day resulted in statistically significant lower radial BMD; tibial BMD was lower only w the 10K IU per day dose, and there was no difference in radial or tibial bone strength
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One unintentional effect of a misrepresented tweet out of context is it shows people's true colors
I'm glad I don't get my COVID news from these accounts
Progress can't be real since it challenges the unquestioned wisdom & scripture
Back to the intent of my original tweet
I wanted to celebrate progress - a stint on the wards w/o severe covid
We have largely reduced severe covid – an incredible feat considering where we were in 2020 facing a brand new virus
This doesn’t erase the past or ongoing suffering
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So many wrong answers to this
Retesting positive without symptoms is not rebound in that people arent doing worse
This is not a call for longer courses
If high risk and unvax take a 5 day course
In vax + boosted likely less effective than tamiflu for flu. Not good company
An update from Dr. Kevin O’Connor, Physician to the President.
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1| This thread is for other parents who are also deciding about
#COVID
vax for their toddlers (2-4 yo) who have ALREADY had Omicron
TLDR: Will wait to see: 1) vax effectivness vs BA4/5; 2) whether new vax to O variants available; 3) most importantly, how day care policies evolve
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How is it possible that the final results for remdesivir, which has a $9 billion market and growing, sneaks in under the radar, and NO ONE cares
Not a single news story. No press release by
@gilead
or
@NIH
. No tweets by COVID KOLs
Fascinating that it looks like the ATCC-1 Day 28 mortality results everyone has been pining for were dropped without press release, preprint, or publication. Just quietly put onto clinicaltrials dot gov on September 25th (a Friday).
Credit to
@FateAugmented
for finding it
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Barely need vitals too for many
First day of service, I stop most daily labs/Tele/ins & outs/weights, reasses Foley need, decrease vital sign frequency to once or twice daily
You don’t need a daily WBC.
You don’t need a daily CRP.
What you do need is vitals and a focused history and physical.
Treat the patient, and stop ordering the number.
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@drsiyabmd
People do die from many illnesses daily who happen to also have test+ covid
Wasn't true before 2022
Now disconnect with how uncommon severe covid pneumonia is from many doctors from many different hospitals in different regions
To clarify to people wishing for worse news
In 2022 I've seen 1 person with COVID pneumonia. Not just this past weeks experience
Many other doctors on this bird app are saying the same thing
Listen to them, not grifters who follow test+ nonadjudicated data blindly
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This incredibly bad interpretation of this study using real world data comes from the person who wants to approve more drugs based on real world data
Call me skeptical
Importantly, those with previous vaccination but no updated vaccine appeared to be unprotected.
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