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ICYMI: Outcomes of Critically-Ill COVID Patients in NYC

Jack Cush, MD

Lancet has reported COVID outcomes from NewYork-Presbyterian hospitals in NYC during March 2020 showing high rates of hospitalization, ICU admission, mechanical ventilation and death. 

A prospective observational cohort study 2 2 NYC hospitals from March 2 to April 1, 2020, looking at laboratory-confirmed COVID-19 and were critically ill with acute hypoxaemic respiratory failure, and collected clinical, biomarker, and treatment data. The primary outcome was in-hospital death.

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Reminders on Masking: 1. Everyone should wear masks; most who are infected dont know they are infx (asymptomatic); 2. Risk of transmission is directly correlated with the duration and intensity of contact - especially in closed quarters; less so if outside https://t.co/9nw43kPrhN
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Great NY Times article on 30+ years of an adversarial friendship between Dr. Tony Fauci and AIDS activist Larry Kramer (who recently passed away). Keen that adversaries can still be on the same side, pushing for change differently https://t.co/lnfk6fXfF2
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23 yoF with 1 mos digital ulcers, hair loss, sicca Sxs, dysphagia; No sclerodactyly but finger tips cyanotic w/ distal pitting scars, ischemic ulcers, periungual erythema & dilated nailfold capillaries (no hemorrhages). +tests for ANA, Ro52, Ro60 and Scl-70 Abs. How to treat?
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CDC guidelines for Rx of Latent Tuberculosis; Preferred: A) 3 months of once-weekly INH plus rifapentine (3HP); B) 4 months of daily rifampin (4R); C) 3 months of daily INH plus rifampin (3HR) - Shorter, safer, effective with higher completion rates. https://t.co/a2iZczFTP2
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KDAO2011
A msg from my nurse friend: “A blood clot from my pt yesterday. Covid lungs. I helped changed his code to DNR, talked to his son/ex wife/brother&sister to say goodbye. He asked if I would pray w/him. I prayed. He cried. Then I walked out & lost it. The public doesn’t get it.” https://t.co/AOdXshjTWL
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KDAO2011
I have entered more patients with #COVID19 in the @rheum_covid registry in the last 3 days than I have in the last 3 months. Come on Texas- we can do better! Wear your mask, watch your distance, and help each other stay healthy #July4th @RheumNow
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Claims data study of nearly 3 million receiving influenza vaccination shows an increased risk of subsequent subdeltoid bursitis, but incredibly low with an attributable risk was 7.78 additional bursitis per 1 million vaccinated.https://t.co/qtzd8pWk4O
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UK population study shows fibromyalgia pts have a higher risk of Self harm (HR 2.06; 1.60,2.65)), RA (HR 1.59) & OA, but not ank spondylitis. Pain and depression are risk factors for self-harm & self harm is a key risk factor for suicide.https://t.co/vXmZKYq3Pe
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66 critically ill & 13 non‐critically ill COVID‐19 were tested for multiple anti‐phospholipid (aPL)Abs. APL common (47%) in critically ill, may be transient (35‐39d post onset). Multiple medium/high levels aPLs may identify at risk for CVA or APS
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According to the Agency for Healthcare Research & Quality, it is estimated that 40-80% of information a patient is told during an office visit is forgotten immediately, and that almost half of the information a patient does retain is actually incorrect https://t.co/XeGx2YXsOQ
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EBRheum
RECOVERY RCT, dexamethasone vs usual care in COVID19 ⬇️28d mortality in pts on O2 (21.5% vs 25%, NNT ~22) or IMV (29% vs 41%, NNT~8)... ?⬆️ for pts w/out O2 1. Preprint*️⃣ 2. No blinding, but hard outcome & meaningful benefit Will likely be adopted, kudos 🇬🇧 for a useful RCT! https://t.co/m5OAYMIvZy
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35 pregnant women w/ baseline & postpartum MRI-SIJ. 27/35 (77%) had SI bone marrow edema postpartum, 60% met ASAS definition of +MRI. 6 and 12 mos after, 46% and 12% still showed BM edema. Findings assoc w/ short labor & no epidural https://t.co/mhX3W96zR3
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The 5 states with the highest slope of case increasing, per million population, June 20th 1. Arizona (way out in front) 2. South Carolina 3. Florida 4. Texas 5. Oklahoma (pre-rally) https://t.co/M1PsBgmhJb
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African-Americans with Ank Spondylitis have worse disease compared to whites. Study of 10,990 AS patients shows AA to have high frequency of anterior uveitis, hypertension, diabetes, depression, and heart disease and higher ESR and CRP levels. https://t.co/YyLqlM85sD
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Measures to address Rheumatology Workforce shortages: 1) increase Rheum training programs; 2) expand use/utilization of NP, PA,pharmacists; 3) Telemedicine expansion; and 4) measures to reduce physician burnout https://t.co/oCE8ZxBpVv
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