{"id":1250794802041557000,"conversation_id":"1250794798962872329","created_at":1587047694000,"date":"2020-04-16","time":"14:34:54","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"We put them in dedicated buildings apart from all younger people. We prohibit any visitors. We bring in all their food and necessities so they don't have to interact with the world. We don't allow them to leave the premises.","mentions":[],"urls":[],"photos":[],"replies_count":1,"retweets_count":0,"likes_count":7,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1250794802041556993","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1250794800980336600,"conversation_id":"1250794798962872329","created_at":1587047693000,"date":"2020-04-16","time":"14:34:53","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"Let's do a thought experiment to see how this might play out. We know that advanced age is far and away the greatest risk for adverse outcome in this epidemic. So, imagine for a moment we take our elders and do everything possible to isolate them from the community.","mentions":[],"urls":[],"photos":[],"replies_count":1,"retweets_count":2,"likes_count":7,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1250794800980336643","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1250794800007319600,"conversation_id":"1250794798962872329","created_at":1587047693000,"date":"2020-04-16","time":"14:34:53","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"Much of this is coming my way because we have posted some early pre-print data on high risk characteristics. A common question I am getting is, so if we know who is most high risk, can't we keep them isolated and let everyone else go back to work?","mentions":[],"urls":[],"photos":[],"replies_count":1,"retweets_count":1,"likes_count":9,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1250794800007319552","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1250794798962872300,"conversation_id":"1250794798962872329","created_at":1587047693000,"date":"2020-04-16","time":"14:34:53","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"As discussion starts to turn to easing of shelter in place restrictions, I am seeing a lot of what I consider to be magical thinking about our ability to protect our most vulnerable loved ones from #COVID19.","mentions":[],"urls":[],"photos":[],"replies_count":2,"retweets_count":34,"likes_count":118,"hashtags":["#covid19"],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1250794798962872329","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1249365360698146800,"conversation_id":"1249365355602096130","created_at":1586706888000,"date":"2020-04-12","time":"15:54:48","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"As for will we share the data: open in principle, devil in details. We are working daily with all other medical centers in NYC and beyond to put together a cross-institutional dataset open for research that could be even better; there are many other such initiatives springing up.","mentions":[],"urls":[],"photos":[],"replies_count":3,"retweets_count":2,"likes_count":24,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1249365360698146817","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1249365358856855600,"conversation_id":"1249365355602096130","created_at":1586706888000,"date":"2020-04-12","time":"15:54:48","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"3) warp speed review by IRB - submitted on a Friday night, approved Sunday am (after two sets revisions!) including personal review/comments by IRB director Helen Panageas","mentions":[],"urls":[],"photos":[],"replies_count":1,"retweets_count":1,"likes_count":10,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1249365358856855554","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1249319861601394700,"conversation_id":"1249319850331246592","created_at":1586696040000,"date":"2020-04-12","time":"12:54:00","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"Age >75 still risk for critical illness even given labs (OR 2.6), but smoking, pulmonary disease still nothing there. Male sex does not confer additional risk for critical illness.","mentions":[],"urls":[],"photos":[],"replies_count":1,"retweets_count":1,"likes_count":25,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1249319861601394688","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1249319860485660700,"conversation_id":"1249319850331246592","created_at":1586696040000,"date":"2020-04-12","time":"12:54:00","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"As for what makes someone likely to have critical illness when hospitalized? Evidence of inflammation on admission much stronger predictor than age/sex/comorbidities: CRP>200 OR 5.8; d-dimer >2,500 OR 6.9, plus of course whether already hypoxic (O2 sat <88 OR 7).","mentions":[],"urls":[],"photos":[],"replies_count":3,"retweets_count":8,"likes_count":42,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1249319860485660675","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1249319859378405400,"conversation_id":"1249319850331246592","created_at":1586696040000,"date":"2020-04-12","time":"12:54:00","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"Male sex is still a risk for hospitalization even after adjustment: OR 2.8. Note what is not, though: hypertension (OR 1.2 not sig), COPD/asthma (OR 1.3, not sig), current/former smoking (OR 0.7). Don't understand the smoking results yet, looking more at this.","mentions":[],"urls":[],"photos":[],"replies_count":9,"retweets_count":16,"likes_count":85,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1249319859378405377","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1249319858317246500,"conversation_id":"1249319850331246592","created_at":1586696040000,"date":"2020-04-12","time":"12:54:00","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"(Note, though, that 54% hospitalized patients < age 65; 34% <55 years. Don't assume that because advanced age is such a huge risk factor that younger people don't get hospitalized.)","mentions":[],"urls":[],"photos":[],"replies_count":1,"retweets_count":2,"likes_count":18,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1249319858317246464","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1249319857117593600,"conversation_id":"1249319850331246592","created_at":1586696039000,"date":"2020-04-12","time":"12:53:59","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"In multivariable modeling, age is far and away strongest predictor of needing hospitalization (age 75+ odds ratio (OR) 67!; age 65-74 OR 11 vs age 19-44) with obesity next (BMI >40 OR 6.2; 30-40 OR 4.3 vs BMI <30); also HF (OR 4.3), CKD (OR 3.1).","mentions":[],"urls":[],"photos":[],"replies_count":5,"retweets_count":7,"likes_count":23,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1249319857117593601","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1249319855846817800,"conversation_id":"1249319850331246592","created_at":1586696039000,"date":"2020-04-12","time":"12:53:59","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"Hospitalized pts more often male (63% vs 39%), cardiac disease (45% vs 16%), diabetes (25% vs 5%), obese (40% vs 15%). *Once hospitalized, though, less difference critical illness vs not*: male (68% vs 60%), CV dis (47% vs 42%), diabetes (27% vs 23%), obesity (40% vs 41%).","mentions":[],"urls":[],"photos":[],"replies_count":2,"retweets_count":2,"likes_count":21,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1249319855846817796","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1249319852440944600,"conversation_id":"1249319850331246592","created_at":1586696038000,"date":"2020-04-12","time":"12:53:58","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"There is so much to unpack in these results. Will point out a few highlights. First, who is in the sample? 4,103 patients testing positive, of whom 1,999 hospitalized; 650 of those any of ICU/intubated/hospice/deceased (\"critical illness\"). This is largest US series I know of.","mentions":[],"urls":[],"photos":[],"replies_count":2,"retweets_count":1,"likes_count":18,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1249319852440944646","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1248338850746978300,"conversation_id":"1248338849622867976","created_at":1586462149000,"date":"2020-04-09","time":"19:55:49","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"Viruses mutate a little bit all the time, not in a clinically meaningful way, but enough so that researchers can build a \"family tree\" of parent strains and their children. If you know where each one was isolated, you can estimate how the virus has traveled in space over time.","mentions":[],"urls":[],"photos":[],"replies_count":1,"retweets_count":1,"likes_count":4,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1248338850746978305","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1246260294785151000,"conversation_id":"1246260290146230272","created_at":1585966583000,"date":"2020-04-04","time":"02:16:23","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"Consequently, it now seems reasonable to recommend universal mask wearing to reduce transmission, because we don't know who is sick. (But, it is STILL IMPORTANT to keep away from other people altogether as much as possible.)","mentions":[],"urls":[],"photos":[],"replies_count":3,"retweets_count":2,"likes_count":11,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1246260294785150977","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1246260293795225600,"conversation_id":"1246260290146230272","created_at":1585966583000,"date":"2020-04-04","time":"02:16:23","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"What *has* changed is how many sick people there are: lots, now. What has also changed is that it seems increasingly likely there is asymptomatic spread. Combined, that means there is much higher likelihood seemingly \"well\" people (maybe even you) are actually contagious.","mentions":[],"urls":[],"photos":[],"replies_count":4,"retweets_count":0,"likes_count":7,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1246260293795225600","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1246260292746649600,"conversation_id":"1246260290146230272","created_at":1585966582000,"date":"2020-04-04","time":"02:16:22","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"The secondary point also still stands: (procedure) masks largely work by reducing the spread of virus droplets. That is, wearing a mask protects others from your germs more than it protects you from theirs. But, by the same token, others wearing a mask protects you.","mentions":[],"urls":[],"photos":[],"replies_count":2,"retweets_count":3,"likes_count":11,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1246260292746649607","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1246260291639394300,"conversation_id":"1246260290146230272","created_at":1585966582000,"date":"2020-04-04","time":"02:16:22","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"The main point still stands: an ordinary person not surrounded by many highly contagious people (as opposed to some healthcare workers, who are) does not need the special kind of mask called an N95 respirator.","mentions":[],"urls":[],"photos":[],"replies_count":1,"retweets_count":1,"likes_count":10,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1246260291639394304","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1244800027559633000,"conversation_id":"1244800011264802824","created_at":1585618428000,"date":"2020-03-31","time":"01:33:48","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"More tips: A snack bag size ziplock is perfect size for an iPhone. Put it in a clean one every morning. Touchscreen, microphone work just fine through it. Wipe it down with bleach wipes periodically. Discard bag at night to have clean phone in home. (Explains blurry pics.)","mentions":[],"urls":[],"photos":[],"replies_count":16,"retweets_count":197,"likes_count":978,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1244800027559632897","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1244800019598848000,"conversation_id":"1244800011264802824","created_at":1585618426000,"date":"2020-03-31","time":"01:33:46","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"On the plus side: this is a great stint for those of you (like me) who are medical minimalists and #ChoosingWisely fans. On my 58 patients I ordered: 0 CTs, 0 echos, 0 ultrasounds. Turns out, you don’t really need them and minimizes iatrogenic spread and staff exposures.","mentions":[],"urls":[],"photos":[],"replies_count":8,"retweets_count":115,"likes_count":886,"hashtags":["#choosingwisely"],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1244800019598848000","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1244800018395082800,"conversation_id":"1244800011264802824","created_at":1585618426000,"date":"2020-03-31","time":"01:33:46","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"I rented an apartment for the week as I live far from hospital and also wanted to keep my family safe. This was lonely and I missed my kids/husband.","mentions":[],"urls":[],"photos":[],"replies_count":9,"retweets_count":60,"likes_count":714,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1244800018395082755","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1244800017220722700,"conversation_id":"1244800011264802824","created_at":1585618426000,"date":"2020-03-31","time":"01:33:46","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"Also, everything took so much time. Assume donning+doffing takes 5 min per room entry – with 17 patients on unit that’s 1.5 extra hours just to see everyone once, let alone more often if sick or to see new arrivals after old ones transferred. My days were much longer than usual.","mentions":[],"urls":[],"photos":[],"replies_count":3,"retweets_count":70,"likes_count":532,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1244800017220722688","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1244800016067301400,"conversation_id":"1244800011264802824","created_at":1585618425000,"date":"2020-03-31","time":"01:33:45","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"The visiting policy was very hard on families too. They were frantic trying to reach staff every to find out what was going on. Our operators overwhelmed. Gave my personal cell to families of the sickest patients.","mentions":[],"urls":[],"photos":[],"replies_count":7,"retweets_count":58,"likes_count":606,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1244800016067301382","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1244800014909616000,"conversation_id":"1244800011264802824","created_at":1585618425000,"date":"2020-03-31","time":"01:33:45","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"The emotional toll of seeing sick, terrified patients without any visitors was also high. Made it my top priority to get deteriorating patients to call/video chat family before too late. Sometimes this took hours and use of my own Skype account.","mentions":[],"urls":[],"photos":[],"replies_count":12,"retweets_count":142,"likes_count":916,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1244800014909616135","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1244800013747830800,"conversation_id":"1244800011264802824","created_at":1585618425000,"date":"2020-03-31","time":"01:33:45","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"The frustration of knowing certain patients were going to deteriorate and not being able to do anything about it except watch it happen was very tough emotionally. I’ve been spoiled by modern medicine – in general, I’m not used to feeling quite so helpless.","mentions":[],"urls":[],"photos":[],"replies_count":2,"retweets_count":101,"likes_count":655,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1244800013747830784","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1244800011264802800,"conversation_id":"1244800011264802824","created_at":1585618424000,"date":"2020-03-31","time":"01:33:44","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"After a week on #COVID19 service, I have some non-clinical reflections for #hospitalists. This is NOT your regular ward time. I’ll be honest, it was a tough week. I’ll start with the tough stuff. But stick with me – ending with more positivity and some helpful hints.","mentions":[],"urls":[],"photos":[],"replies_count":106,"retweets_count":918,"likes_count":2723,"hashtags":["#covid19","#hospitalists"],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1244800011264802824","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1244795569249419300,"conversation_id":"1244795551595614210","created_at":1585617365000,"date":"2020-03-31","time":"01:16:05","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"13th Lastly, one of the biggest concerns for non-critically ill patients was persistent painful cough. Most had paroxysmal dry, wheezy coughing spasms, often precipitating desaturations. Tried cough syrup, albuterol MDI with spacer (avoiding nebs), codeine, with little effect.","mentions":[],"urls":[],"photos":[],"replies_count":199,"retweets_count":510,"likes_count":3430,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1244795569249419265","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1244795567999459300,"conversation_id":"1244795551595614210","created_at":1585617365000,"date":"2020-03-31","time":"01:16:05","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"12th Most of my patients didn’t eat anything. Partly lack of taste/smell, partly misery with fever, partly hypoxia with exertion, partly lack of visitors/staff in room to encourage and help. Several asked me for soft diet to reduce effort of chewing. Must attend to nutrition.","mentions":[],"urls":[],"photos":[],"replies_count":35,"retweets_count":504,"likes_count":3114,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1244795567999459329","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1244795566871269400,"conversation_id":"1244795551595614210","created_at":1585617364000,"date":"2020-03-31","time":"01:16:04","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"11th Proning is now standard in our ICU and I tried hard to get my sicker patients to do it too to head off intubation. This is much harder than it sounds. Most patients couldn’t get into position on their own, found it uncomfortable (back pain), refused.","mentions":[],"urls":[],"photos":[],"replies_count":46,"retweets_count":365,"likes_count":2282,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1244795566871269380","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1244795565625487400,"conversation_id":"1244795551595614210","created_at":1585617364000,"date":"2020-03-31","time":"01:16:04","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"10th Our standard protocol right now is azithro/hydroxychloroquine/zinc but I have little faith in efficacy. For the patients I really worried about (fast O2 requirement rise, high inflammatory markers) I gave tocilizumab off label. Clinical trial of sarilumab starting this week.","mentions":[],"urls":[],"photos":[],"replies_count":93,"retweets_count":558,"likes_count":2844,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1244795565625487361","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1244795564488831000,"conversation_id":"1244795551595614210","created_at":1585617364000,"date":"2020-03-31","time":"01:16:04","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"9th On the topic of syncope, I admitted 3-4 COVID+ patients with presenting complaint of syncope (2 with head lacs), all early in course, with orthostatic hypotension without significant antecedent fevers. Could COVID be having some effect on autonomic system?","mentions":[],"urls":[],"photos":[],"replies_count":72,"retweets_count":454,"likes_count":2735,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1244795564488830978","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1244795563192787000,"conversation_id":"1244795551595614210","created_at":1585617364000,"date":"2020-03-31","time":"01:16:04","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"8th I kept underestimating their exertional hypoxia. Learned my lesson when I transferred one pt to lower acuity floor and he had a syncopal event getting from wheelchair to new bed. Walked all patients with pulse ox prior to d/c.","mentions":[],"urls":[],"photos":[],"replies_count":13,"retweets_count":372,"likes_count":2606,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1244795563192786945","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1244795562035163100,"conversation_id":"1244795551595614210","created_at":1585617363000,"date":"2020-03-31","time":"01:16:03","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"7th, as noted by others, these patients deteriorate fast. Really fast. I started calling ICU for any patient who went from RA to 6L in <24 hours; nearly all wound up at least on 100% NRB or high flow if not intubation.","mentions":[],"urls":[],"photos":[],"replies_count":14,"retweets_count":442,"likes_count":2520,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1244795562035163143","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1244795560856600600,"conversation_id":"1244795551595614210","created_at":1585617363000,"date":"2020-03-31","time":"01:16:03","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"6th, I found CRP and ferritin often to move in opposite directions (usually CRP ↘️while ferritin still ↗️; CRP leading indicator?). This was confusing. Moreover, I had patients with ferritin >3,000 who did well and others with <800 who struggled. So, not universally helpful.","mentions":[],"urls":[],"photos":[],"replies_count":19,"retweets_count":289,"likes_count":2074,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1244795560856600578","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1244795559724159000,"conversation_id":"1244795551595614210","created_at":1585617363000,"date":"2020-03-31","time":"01:16:03","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"5rd, as noted by others, just about all of my patients had had symptoms for 7-10 days before needing admit for O2. This posed a conundrum for the few who were admitted with <5d sx (all on RA) – keep to await nadir? Can’t afford the beds. Had to discharge with warning.","mentions":[],"urls":[],"photos":[],"replies_count":16,"retweets_count":415,"likes_count":2526,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1244795559724158976","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1244795558407155700,"conversation_id":"1244795551595614210","created_at":1585617362000,"date":"2020-03-31","time":"01:16:02","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"4th I did have a bunch of mild troponin elevations, but mostly demand ischemia. No EKGs c/w myocarditis. Suspect too late a complication for me to see.","mentions":[],"urls":[],"photos":[],"replies_count":11,"retweets_count":284,"likes_count":2060,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1244795558407155712","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1244795557073375200,"conversation_id":"1244795551595614210","created_at":1585617362000,"date":"2020-03-31","time":"01:16:02","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"3rd, this is not your usual sepsis picture. NONE of my patients, even the deaths/ICUs, developed meaningful AKI or liver failure (most had trivial transaminitis). There is no multiorgan failure. Just respiratory failure (I know reported later cardiac; I didn’t see those).","mentions":[],"urls":[],"photos":[],"replies_count":21,"retweets_count":436,"likes_count":2741,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1244795557073375232","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1244795555806679000,"conversation_id":"1244795551595614210","created_at":1585617362000,"date":"2020-03-31","time":"01:16:02","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"2nd, the fevers did not seem particularly related to outcome. In fact most of my ICU transfers did not have persistent fever. They did, however, make patients miserable.","mentions":[],"urls":[],"photos":[],"replies_count":10,"retweets_count":358,"likes_count":2546,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1244795555806679040","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1244795554628067300,"conversation_id":"1244795551595614210","created_at":1585617362000,"date":"2020-03-31","time":"01:16:02","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"1st, I was shocked by the persistence of fevers. My patients had fevers every day, often all day, often >39, for days on end, not especially Tylenol responsive. And they had all had several days fevers before admission.","mentions":[],"urls":[],"photos":[],"replies_count":19,"retweets_count":543,"likes_count":3149,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1244795554628067328","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1244795553298464800,"conversation_id":"1244795551595614210","created_at":1585617361000,"date":"2020-03-31","time":"01:16:01","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"My experience perfectly matched published reports. Procal universally low. Ferritin, CRP, d-dimer elevated. Lymphopenia prominent. Patchy infiltrates on CXR. Diarrhea common. So, I want to share some other things I haven’t seen talked about as much.","mentions":[],"urls":[],"photos":[],"replies_count":34,"retweets_count":534,"likes_count":3057,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1244795553298464768","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1244795551595614200,"conversation_id":"1244795551595614210","created_at":1585617361000,"date":"2020-03-31","time":"01:16:01","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"In my 7 days on one of our (now 12!) non ICU #COVID19 units, I admitted 58 patients for COVID rule out, of whom 50 tested positive. Two died (DNR), 2 went to hospice, and 5 went to the ICU. That is… not my typical gen med service week. Following, some clinical observations.","mentions":[],"urls":[],"photos":[],"replies_count":697,"retweets_count":10196,"likes_count":30156,"hashtags":["#covid19"],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1244795551595614210","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1244793166139621400,"conversation_id":"1244793159244304385","created_at":1585616792000,"date":"2020-03-31","time":"01:06:32","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"Thanks too to hospital admin, working to combat unimaginable demands with tremendous flexibility. Opened new ICU and/or floor COVID units every day. Repurposed, acquired vents. Created new EHR capabilities (order sets, flags, telehealth). Found disposable stethoscopes. Much more.","mentions":[],"urls":[],"photos":[],"replies_count":1,"retweets_count":1,"likes_count":16,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1244793166139621377","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1244793165124681700,"conversation_id":"1244793159244304385","created_at":1585616792000,"date":"2020-03-31","time":"01:06:32","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"Thanks to the incredible lab team who got us our COVID results within hours, running 500 tests/day (soon to be >1500).","mentions":[],"urls":[],"photos":[],"replies_count":1,"retweets_count":1,"likes_count":21,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1244793165124681733","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1244793160523559000,"conversation_id":"1244793159244304385","created_at":1585616791000,"date":"2020-03-31","time":"01:06:31","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"Huge shout out to the nurses & PCAs: unflappable, cheerful and can-do. They took on additional work (like bringing food into rooms) without complaint to help minimize staff entry. And this despite the fact that most were reassigned from non-medicine services, new to the work.","mentions":[],"urls":[],"photos":[],"replies_count":1,"retweets_count":1,"likes_count":23,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1244793160523558913","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1244793159244304400,"conversation_id":"1244793159244304385","created_at":1585616790000,"date":"2020-03-31","time":"01:06:30","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"Emerging, blinking, from a week of #COVID19 service and ready to share some of my clinical/practical experiences. But first, a thread of appreciation.","mentions":[],"urls":[],"photos":[],"replies_count":2,"retweets_count":24,"likes_count":109,"hashtags":["#covid19"],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1244793159244304385","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1241104036612452400,"conversation_id":"1241102730833416192","created_at":1584737235000,"date":"2020-03-20","time":"20:47:15","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"Unfortunately, the testing is showing our current crisis. 7,845 confirmed cases, 1,250 hospitalized (19%). 5,151 cases in NYC. Hospitals are running out of PPE. And we have a long way to go. #StayAtHome","mentions":[],"urls":[],"photos":[],"replies_count":1,"retweets_count":9,"likes_count":15,"hashtags":["#stayathome"],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1241104036612452352","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1239869156272504800,"conversation_id":"1239867971943759872","created_at":1584442817000,"date":"2020-03-17","time":"11:00:17","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"Also wld help those earlier in course who need support/isolation but not quite hospital (homeless, existing SNF residents, older community dwellers); might head off some admits. Hospital beds our most expensive and precious resource. Must do better about preserving availability.","mentions":[],"urls":[],"photos":[],"replies_count":0,"retweets_count":0,"likes_count":6,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1239869156272504832","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1239867971943760000,"conversation_id":"1239867971943759872","created_at":1584442534000,"date":"2020-03-17","time":"10:55:34","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"Many calls for making new hospitals/beds in NYC. I think more feasible and effective to make SNF beds. We will soon have many people recovering, but still infectious, needing some care. Creation safe discharge options = earlier discharge = more hospital capacity. #COVID19","mentions":[],"urls":[],"photos":[],"replies_count":6,"retweets_count":11,"likes_count":32,"hashtags":["#covid19"],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1239867971943759872","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1238508069652435000,"conversation_id":"1238508069652434945","created_at":1584118308000,"date":"2020-03-13","time":"16:51:48","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"So you know how we all make fun of ICD-10 for anticipating absurdities like V95.43XA \"Spacecraft collision injuring occupant, initial encounter\"? Well, gotta hand it to them - they even anticipated #COVID19 with B97.29 \"Other coronavirus as the cause of diseases\"","mentions":[],"urls":[],"photos":[],"replies_count":1,"retweets_count":1,"likes_count":21,"hashtags":["#covid19"],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1238508069652434945","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1237348705931534300,"conversation_id":"1237348705931534336","created_at":1583841894000,"date":"2020-03-10","time":"12:04:54","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"What cognitive bias am I displaying by still taking a crowded commuter train to work but avoiding the front two cars in case the train crashes? #COVID19 🤔","mentions":[],"urls":[],"photos":[],"replies_count":5,"retweets_count":0,"likes_count":30,"hashtags":["#covid19"],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1237348705931534336","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1236323434059239400,"conversation_id":"1236323423997104130","created_at":1583597451000,"date":"2020-03-07","time":"16:10:51","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"Which brings me back to the main point: we don't yet have massive spread. We probably have a lot of micro clusters. NOW IS THE TIME to find them and mitigate aggressively. The rest of us can help by hand washing, avoiding crowds, self-isolating if sick.","mentions":[],"urls":[],"photos":[],"replies_count":1,"retweets_count":8,"likes_count":24,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1236323434059239425","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1236323428786937900,"conversation_id":"1236323423997104130","created_at":1583597449000,"date":"2020-03-07","time":"16:10:49","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"As expected, we have indeed found many #COVID19 cases in the past week (now at 338 from <75 a week ago), *though testing is still woefully inadequate, so only highest risk are being tested in most areas.* That makes severity rate appear falsely high for now. /3","mentions":[],"urls":[],"photos":[],"replies_count":1,"retweets_count":0,"likes_count":6,"hashtags":["#covid19"],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1236323428786937856","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1235912544386248700,"conversation_id":"1235906708070961157","created_at":1583499487000,"date":"2020-03-06","time":"12:58:07","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"And not touching your face, and avoiding large crowds. Nothing is perfect but those will help a great deal.","mentions":[],"urls":[],"photos":[],"replies_count":0,"retweets_count":1,"likes_count":0,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1235912544386248705","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1235906708070961200,"conversation_id":"1235906708070961157","created_at":1583498095000,"date":"2020-03-06","time":"12:34:55","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"All media and public health outlets should change reporting of case count to something like “the number of KNOWN cases has increased to x.” Simple change to signal both that these are not all brand new infections and also that there is clearly a reservoir of untested unknowns.","mentions":[],"urls":[],"photos":[],"replies_count":0,"retweets_count":12,"likes_count":47,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1235906708070961157","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1235890317964034000,"conversation_id":"1235890315283910658","created_at":1583494188000,"date":"2020-03-06","time":"11:29:48","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"CFR=proportion of people with symptomatic disease who die. IFR=proportion of all with infection who die (including asymptomatic). Because of aggressive screening on diamond princess, can guess asymptomatic N (though many went on to have symptoms, so I am wary of this too)","mentions":[],"urls":[],"photos":[],"replies_count":0,"retweets_count":0,"likes_count":2,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1235890317964034048","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1235890317196484600,"conversation_id":"1235890315283910658","created_at":1583494188000,"date":"2020-03-06","time":"11:29:48","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"Bottom line: estimated case and infection fatality ratios (CFR, IFR) on Diamond Princess 2.3% (0.75%–5.3%) and 1.2% (0.38–2.7%) implies in China 1.1% (95% CI: 0.3-2.4%) and 0.5% (95% CI: 0.2–1.2%). BUT only 7 deaths and only among >70 years, so IMO estimates warrant caution.","mentions":[],"urls":[],"photos":[],"replies_count":1,"retweets_count":0,"likes_count":2,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1235890317196484608","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1235019003858505700,"conversation_id":"1235018922023440385","created_at":1583286450000,"date":"2020-03-04","time":"01:47:30","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"N95s keep healthcare workers safe who are in prolonged close proximity to people who are definitely sick and who are putting large amounts of virus in the air right next to them. They are also good for stopping us from getting you sick if we have caught it. That’s it. /The End.","mentions":[],"urls":[],"photos":[],"replies_count":27,"retweets_count":165,"likes_count":1057,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1235019003858505728","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1235019002210025500,"conversation_id":"1235018922023440385","created_at":1583286450000,"date":"2020-03-04","time":"01:47:30","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"Regular surgical masks are great for people who are sick. Stops them spreading disease by coughing far. (You should stop buying those too btw; they don’t keep viruses out so they don’t keep you safe, and I promise you don’t know how to take them off safely either.) /12","mentions":[],"urls":[],"photos":[],"replies_count":24,"retweets_count":194,"likes_count":982,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1235019002210025474","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1235019000616231000,"conversation_id":"1235018922023440385","created_at":1583286449000,"date":"2020-03-04","time":"01:47:29","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"If you want there to be enough equipment at least in the short term for people who you may need to stay healthy to take care of you, *stop buying the masks.* So, what are masks good for?\n/11","mentions":[],"urls":[],"photos":[],"replies_count":6,"retweets_count":158,"likes_count":979,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1235019000616230913","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1235018999462793200,"conversation_id":"1235018922023440385","created_at":1583286449000,"date":"2020-03-04","time":"01:47:29","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"I also guarantee you that your purchase of this mask, which is useless to you, restricts supply for frontline healthcare workers. Every hospital is facing shortages. I suspect most are rationing already. The FDA been forced to allow emergency use of construction N95s. /10","mentions":[],"urls":[],"photos":[],"replies_count":43,"retweets_count":501,"likes_count":2129,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1235018999462793216","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1235018997923541000,"conversation_id":"1235018922023440385","created_at":1583286449000,"date":"2020-03-04","time":"01:47:29","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"I guarantee you that a) your mask doesn’t fit properly b) you have no idea how to put it on and take it off safely and c) you are probably putting yourself at more risk by messing with it. Which, whatever, it’s a free country. But here’s the thing. /9","mentions":[],"urls":[],"photos":[],"replies_count":22,"retweets_count":311,"likes_count":1576,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1235018997923540993","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1235018996338102300,"conversation_id":"1235018922023440385","created_at":1583286448000,"date":"2020-03-04","time":"01:47:28","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"I get the aspartame sprayed in the hood again, without the mask. This time if I DON’T taste it, I fail (to make sure I don’t have some weird genetic immunity to tasting artificial sweetener). After all this, the hospital staff agrees that yes, I am still a size small... /8","mentions":[],"urls":[],"photos":[],"replies_count":14,"retweets_count":66,"likes_count":746,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1235018996338102275","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1235018995075551200,"conversation_id":"1235018922023440385","created_at":1583286448000,"date":"2020-03-04","time":"01:47:28","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"I have to take the mask off while demonstrating proper procedure not to accidentally contaminate myself. If I don’t do this correctly, I fail the test. This, my friends, is much harder than it sounds. (But wait, it’s not over yet!) Then... /7","mentions":[],"urls":[],"photos":[],"replies_count":1,"retweets_count":72,"likes_count":731,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1235018995075551232","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1235018993884442600,"conversation_id":"1235018922023440385","created_at":1583286448000,"date":"2020-03-04","time":"01:47:28","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"I have to read a ridiculous paragraph out loud about the science of rainbows and the pot of gold at the end or some such. It is hard to do this without laughing. But if I taste the aspartame... you get the idea. Then... /6","mentions":[],"urls":[],"photos":[],"replies_count":17,"retweets_count":72,"likes_count":812,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1235018993884442625","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1235018992634540000,"conversation_id":"1235018922023440385","created_at":1583286448000,"date":"2020-03-04","time":"01:47:28","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"I have to crouch to the ground and stand up several times while aspartame is sprayed in. If I taste it, I fail. Then... /5","mentions":[],"urls":[],"photos":[],"replies_count":2,"retweets_count":71,"likes_count":559,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1235018992634540032","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1235018991627907000,"conversation_id":"1235018922023440385","created_at":1583286447000,"date":"2020-03-04","time":"01:47:27","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"I have to nod my head up and down in the hood while aspartame is sprayed in. If I taste it, I fail. Then... /4","mentions":[],"urls":[],"photos":[],"replies_count":3,"retweets_count":67,"likes_count":583,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1235018991627907073","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1235018990650642400,"conversation_id":"1235018922023440385","created_at":1583286447000,"date":"2020-03-04","time":"01:47:27","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"I have to turn my head side to side in the hood while aspartame is sprayed in. If I taste it, I fail. Then... /3","mentions":[],"urls":[],"photos":[],"replies_count":1,"retweets_count":72,"likes_count":599,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1235018990650642434","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1235018988175884300,"conversation_id":"1235018922023440385","created_at":1583286446000,"date":"2020-03-04","time":"01:47:26","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"First, I have to put the right size mask on and have a big plastic hood put over my head. Aspartame is sprayed into the hood. If I can taste it, I fail the test. Then... /2","mentions":[],"urls":[],"photos":[],"replies_count":10,"retweets_count":87,"likes_count":729,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1235018988175884288","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1235018922023440400,"conversation_id":"1235018922023440385","created_at":1583286431000,"date":"2020-03-04","time":"01:47:11","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"Non medical friends, let’s have a chat about masks. So, you’ve bought yourself a box of N95 masks and you think you’re good for #COVID19. Let me tell you what my hospital makes me do EVERY YEAR to make sure my N95 mask fits (yes, they come in sizes). Watch out: long thread ahead!","mentions":[],"urls":[],"photos":[],"replies_count":375,"retweets_count":6868,"likes_count":12184,"hashtags":["#covid19"],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1235018922023440385","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1232503339897835500,"conversation_id":"1232503073806913537","created_at":1582686669000,"date":"2020-02-26","time":"03:11:09","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"Here are just some accounts that occur to me at this moment but there are many others, so this is a thread I will keep adding to over time.","mentions":[],"urls":[],"photos":[],"replies_count":1,"retweets_count":1,"likes_count":6,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1232503339897835520","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1232503073806913500,"conversation_id":"1232503073806913537","created_at":1582686606000,"date":"2020-02-26","time":"03:10:06","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"As a hospitalist physician and health systems researcher, I have been following #COVID19 news closely. Finding myself answering lots of ?s from friends, so am posting some summaries for others with questions. Last topic: what are reputable sources to follow?","mentions":[],"urls":[],"photos":[],"replies_count":5,"retweets_count":17,"likes_count":39,"hashtags":["#covid19"],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1232503073806913537","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1232497560515948500,"conversation_id":"1232496496643198976","created_at":1582685291000,"date":"2020-02-26","time":"02:48:11","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"I'm not a #COVID19 expert, so I won't be answering these questions, but there are lots of great ones out there to follow. Next thread: what are some reputable sources?","mentions":[],"urls":[],"photos":[],"replies_count":0,"retweets_count":0,"likes_count":6,"hashtags":["#covid19"],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1232497560515948545","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1232497263198404600,"conversation_id":"1232496496643198976","created_at":1582685220000,"date":"2020-02-26","time":"02:47:00","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"7) Is it spread by airborne or droplet mechanism? (Droplet much easier to contain)\n8) What medications work against the virus? (antivirals, steroids etc)","mentions":[],"urls":[],"photos":[],"replies_count":1,"retweets_count":0,"likes_count":4,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1232497263198404608","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1232497093731901400,"conversation_id":"1232496496643198976","created_at":1582685180000,"date":"2020-02-26","time":"02:46:20","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"5) How infectious is this disease? (Is there really asymptomatic infection, and how often?)\n6) Is the virus contagious from stool? (We can detect virus in stool, but are those infectious particles?)","mentions":[],"urls":[],"photos":[],"replies_count":1,"retweets_count":1,"likes_count":3,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1232497093731901440","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1232496966916927500,"conversation_id":"1232496496643198976","created_at":1582685150000,"date":"2020-02-26","time":"02:45:50","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"2) Is it worse if you get it again?\n3) What is the incubation period typically, and what is it at maximum?\n4) At what time frames are people infectious?","mentions":[],"urls":[],"photos":[],"replies_count":2,"retweets_count":1,"likes_count":2,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1232496966916927489","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1232496801409716200,"conversation_id":"1232496496643198976","created_at":1582685110000,"date":"2020-02-26","time":"02:45:10","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"There is so much we don’t know yet that may change predictions and outcomes. Keep a look out for answers to these ?s as the international scientific community discovers them.\n1) Do people who have had the disease once become immune (like chicken pox), or can they get it again?","mentions":[],"urls":[],"photos":[],"replies_count":1,"retweets_count":1,"likes_count":2,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1232496801409716225","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1232496496643199000,"conversation_id":"1232496496643198976","created_at":1582685038000,"date":"2020-02-26","time":"02:43:58","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"As a hospitalist physician and health systems researcher, I have been following #COVID19 news closely. Finding myself answering lots of ?s from friends, so am posting some summaries for others with questions. Fourth: What do we still not know?","mentions":[],"urls":[],"photos":[],"replies_count":2,"retweets_count":6,"likes_count":9,"hashtags":["#covid19"],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1232496496643198976","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1232494170855444500,"conversation_id":"1232494170855444480","created_at":1582684483000,"date":"2020-02-26","time":"02:34:43","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"As a hospitalist physician and health systems researcher, I have been following #COVID19 news closely. Finding myself answering lots of ?s from friends, so am posting some summaries with evidence for others with questions. Topic 3: what can US government do to mitigate risk?","mentions":[],"urls":[],"photos":[],"replies_count":5,"retweets_count":26,"likes_count":55,"hashtags":["#covid19"],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1232494170855444480","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1232493090457473000,"conversation_id":"1232492804116504579","created_at":1582684226000,"date":"2020-02-26","time":"02:30:26","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"The case fatality rate seems clearly to be ~2% (20x higher than flu). I had hoped we were missing lots of mild/asymptomatic denominator cases falsely elevating CFR, but likely not the case. Same CFR among early non-China cases (where contact tracing/testing robust, few missed).","mentions":[],"urls":[],"photos":[],"replies_count":2,"retweets_count":5,"likes_count":16,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1232493090457473025","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1232492947192475600,"conversation_id":"1232492804116504579","created_at":1582684191000,"date":"2020-02-26","time":"02:29:51","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"Friends, I’m pretty worried. It is a virtual certainty that #COVID19 will be a global pandemic, meaning it will have sustained local transmission in much of the world. We are well past possibility of containment. If it is a pandemic, there are many serious concerns.","mentions":[],"urls":[],"photos":[],"replies_count":1,"retweets_count":6,"likes_count":28,"hashtags":["#covid19"],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1232492947192475648","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1232492804116504600,"conversation_id":"1232492804116504579","created_at":1582684157000,"date":"2020-02-26","time":"02:29:17","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"As a hospitalist physician and health systems researcher, I have been following #COVID19 news closely. Finding myself answering lots of ?s from friends/family, so am going to post some summaries with evidence for others with questions. Topic 2: how bad will this be?","mentions":[],"urls":[],"photos":[],"replies_count":5,"retweets_count":29,"likes_count":61,"hashtags":["#covid19"],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1232492804116504579","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1232492656933998600,"conversation_id":"1232492230562107392","created_at":1582684122000,"date":"2020-02-26","time":"02:28:42","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"* If there are many cases in your area, avoid crowds.\n* If you take chronic medications, stock up on several month’s supply if you can.\n* Wear a mask if you have fever/cough (and stay home if possible).\n* Once a vaccine is available, get it if offered to you.\nNext up: severity","mentions":[],"urls":[],"photos":[],"replies_count":0,"retweets_count":3,"likes_count":14,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1232492656933998592","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1232492454693097500,"conversation_id":"1232492230562107392","created_at":1582684074000,"date":"2020-02-26","time":"02:27:54","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"* Wash your hands. Wash your hands. Wash your hands.\n* Reduce the amount you touch your face or public surfaces.\n* Get a flu shot (surely you don’t want flu AND coronavirus?). It’s not too late, and we are having a bad flu season. 3/n","mentions":[],"urls":[],"photos":[],"replies_count":1,"retweets_count":10,"likes_count":19,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1232492454693097472","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1232492345838329900,"conversation_id":"1232492230562107392","created_at":1582684048000,"date":"2020-02-26","time":"02:27:28","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"We are at best 12-18 months to a vaccine, so early interventions will need to rely heavily on source control and minimizing spread: rapid identification/isolation of cases, social distancing (minimizing dense crowds), individual precautions (wash hands!). So what should you do?","mentions":[],"urls":[],"photos":[],"replies_count":1,"retweets_count":1,"likes_count":7,"hashtags":[],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1232492345838329856","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1232492230562107400,"conversation_id":"1232492230562107392","created_at":1582684021000,"date":"2020-02-26","time":"02:27:01","timezone":"UTC","user_id":1183050590,"username":"leorahorwitzmd","name":"Leora Horwitz","place":"","tweet":"As a hospitalist physician and health systems researcher, I have been following #COVID19 news closely. Finding myself answering lots of ?s from friends, so am posting some summaries for others with questions. First up: what can individuals do to mitigate risk? 1/n","mentions":[],"urls":[],"photos":[],"replies_count":1,"retweets_count":21,"likes_count":39,"hashtags":["#covid19"],"cashtags":[],"link":"https://twitter.com/leorahorwitzmd/status/1232492230562107392","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1183050590","username":"leorahorwitzmd"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1271041498696560600,"conversation_id":"1271041496729468928","created_at":1591874882000,"date":"2020-06-11","time":"11:28:02","timezone":"UTC","user_id":14177696,"username":"marcelsalathe","name":"Marcel Salathé","place":"","tweet":"I deleted an earlier tweet that didn't have the quotes, as this is a direct quote from the article. Still waiting for the edit button on Twitter...","mentions":[],"urls":[],"photos":[],"replies_count":2,"retweets_count":0,"likes_count":10,"hashtags":[],"cashtags":[],"link":"https://twitter.com/marcelsalathe/status/1271041498696560640","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"14177696","username":"marcelsalathe"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1270243919427707000,"conversation_id":"1270243917951307776","created_at":1591684725000,"date":"2020-06-09","time":"06:38:45","timezone":"UTC","user_id":14177696,"username":"marcelsalathe","name":"Marcel Salathé","place":"","tweet":"I've used \"truly asymptomatic\" before, but the \"truly\" often gets lost. It's the timing of being asymptomatic that matters, hence the suggestion of “never symptomatic”, and “presymptomatic”. \n\n2/2","mentions":[],"urls":[],"photos":[],"replies_count":2,"retweets_count":1,"likes_count":18,"hashtags":[],"cashtags":[],"link":"https://twitter.com/marcelsalathe/status/1270243919427706880","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"14177696","username":"marcelsalathe"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1270243917951307800,"conversation_id":"1270243917951307776","created_at":1591684724000,"date":"2020-06-09","time":"06:38:44","timezone":"UTC","user_id":14177696,"username":"marcelsalathe","name":"Marcel Salathé","place":"","tweet":"I would much prefer that we’d now stop to use the term “asymptomatic” in the COVID context; and instead used “never symptomatic”, and “presymptomatic” - at least historically, i.e. looking back.\n\nIn the early days of an infection, simply say “not symptomatic yet”. \n\n1/2","mentions":[],"urls":[],"photos":[],"replies_count":5,"retweets_count":23,"likes_count":99,"hashtags":[],"cashtags":[],"link":"https://twitter.com/marcelsalathe/status/1270243917951307776","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"14177696","username":"marcelsalathe"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1272029926007373800,"conversation_id":"1271917395158937600","created_at":1592110542000,"date":"2020-06-14","time":"04:55:42","timezone":"UTC","user_id":1094762324097822700,"username":"michaelmina_lab","name":"Michael Mina","place":"","tweet":"The COVID mortality rate in the US is likely higher. I don’t know by how much but underlying conditions certainly higher in US. \n\nTo give perspective, Among *Symptomatic* cases of influenza in the US, under 50 mortality is around 0.01%. Adding asymptomatic -> rate will go down.","mentions":[],"urls":[],"photos":[],"replies_count":15,"retweets_count":15,"likes_count":96,"hashtags":[],"cashtags":[],"link":"https://twitter.com/michaelmina_lab/status/1272029926007373834","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1094762324097822720","username":"michaelmina_lab"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1271921595859288000,"conversation_id":"1271919137770606594","created_at":1592084714000,"date":"2020-06-13","time":"21:45:14","timezone":"UTC","user_id":1094762324097822700,"username":"michaelmina_lab","name":"Michael Mina","place":"","tweet":"Also, by discussing risk of mortality does not imply ignoring morbidity and lasting effects of infection. They are both important. \n\nMortality is just one important outcome to consider.\n\nPolicies/science often focus on mortality -  but morbidity of course is also crucial.","mentions":[],"urls":[],"photos":[],"replies_count":5,"retweets_count":10,"likes_count":74,"hashtags":[],"cashtags":[],"link":"https://twitter.com/michaelmina_lab/status/1271921595859288070","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1094762324097822720","username":"michaelmina_lab"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1271919137770606600,"conversation_id":"1271919137770606594","created_at":1592084128000,"date":"2020-06-13","time":"21:35:28","timezone":"UTC","user_id":1094762324097822700,"username":"michaelmina_lab","name":"Michael Mina","place":"","tweet":"It should not be considered controversial to discuss risk of COVID by age when determining how to keep society running. \n\nIn considering severity in elderly vs young, this does not advocate for getting young sick. It is simply a fact of this virus that should be considered.","mentions":[],"urls":[],"photos":[],"replies_count":31,"retweets_count":47,"likes_count":250,"hashtags":[],"cashtags":[],"link":"https://twitter.com/michaelmina_lab/status/1271919137770606594","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1094762324097822720","username":"michaelmina_lab"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1265143087912890400,"conversation_id":"1265002686916820994","created_at":1590468592000,"date":"2020-05-26","time":"04:49:52","timezone":"UTC","user_id":1094762324097822700,"username":"michaelmina_lab","name":"Michael Mina","place":"","tweet":"That is not at all what I was implying. I’m saying that a single mortality rate does not define this virus. We can consider different avenues if we consider this piece - specifically how to best protect the most vulnerable.","mentions":[],"urls":[],"photos":[],"replies_count":3,"retweets_count":0,"likes_count":1,"hashtags":[],"cashtags":[],"link":"https://twitter.com/michaelmina_lab/status/1265143087912890369","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1094762324097822720","username":"michaelmina_lab"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1265003824001036300,"conversation_id":"1265002686916820994","created_at":1590435388000,"date":"2020-05-25","time":"19:36:28","timezone":"UTC","user_id":1094762324097822700,"username":"michaelmina_lab","name":"Michael Mina","place":"","tweet":"When thinking of getting economies back to work, we need to consider the strong age structure of mortality. Mortality rates are driven largely by older age classes. Considering age structure of mortality in policy could yield new creative ways of thinking about opening economies.","mentions":[],"urls":[],"photos":[],"replies_count":14,"retweets_count":7,"likes_count":52,"hashtags":[],"cashtags":[],"link":"https://twitter.com/michaelmina_lab/status/1265003824001036289","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1094762324097822720","username":"michaelmina_lab"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1264338264699424800,"conversation_id":"1264336998875136000","created_at":1590276707000,"date":"2020-05-23","time":"23:31:47","timezone":"UTC","user_id":1094762324097822700,"username":"michaelmina_lab","name":"Michael Mina","place":"","tweet":"Should have written in first tweet... This CID paper is from Michael Tom (current Harvard medical student) and myself.","mentions":[],"urls":[],"photos":[],"replies_count":2,"retweets_count":2,"likes_count":10,"hashtags":[],"cashtags":[],"link":"https://twitter.com/michaelmina_lab/status/1264338264699424771","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1094762324097822720","username":"michaelmina_lab"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1264337973883089000,"conversation_id":"1264336998875136000","created_at":1590276637000,"date":"2020-05-23","time":"23:30:37","timezone":"UTC","user_id":1094762324097822700,"username":"michaelmina_lab","name":"Michael Mina","place":"","tweet":"This recommendation comes with all of the caveats of test validation - if the Ct is reported back, then pathology labs would have to validate that the Ct value is itself an accurate measure of biological viral load. Interpretation would have to be taken in clinical context.","mentions":[],"urls":[],"photos":[],"replies_count":1,"retweets_count":2,"likes_count":13,"hashtags":[],"cashtags":[],"link":"https://twitter.com/michaelmina_lab/status/1264337973883088896","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1094762324097822720","username":"michaelmina_lab"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1264337511180046300,"conversation_id":"1264336998875136000","created_at":1590276527000,"date":"2020-05-23","time":"23:28:47","timezone":"UTC","user_id":1094762324097822700,"username":"michaelmina_lab","name":"Michael Mina","place":"","tweet":"Currently results are provided as a positive or negative. Viral titers change over as many as 10 orders of magnitude. Interpreting the ct value could give clinicians more insight into their patient’s course of infection and offer new ways to conserve PPE.","mentions":[],"urls":[],"photos":[],"replies_count":3,"retweets_count":5,"likes_count":19,"hashtags":[],"cashtags":[],"link":"https://twitter.com/michaelmina_lab/status/1264337511180046342","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1094762324097822720","username":"michaelmina_lab"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1262980848288182300,"conversation_id":"1262980848288182272","created_at":1589953073000,"date":"2020-05-20","time":"05:37:53","timezone":"UTC","user_id":1094762324097822700,"username":"michaelmina_lab","name":"Michael Mina","place":"","tweet":"For #COVID19 seroprevalence studies - if prevalence is low & test specificity not great, + tests should be confirmed with different Antibody test. \n\nThis is routine for serology - such as with HIV testing. \n\nConfirming COVID antibody + using a second test can solve many problems","mentions":[],"urls":[],"photos":[],"replies_count":7,"retweets_count":58,"likes_count":222,"hashtags":["#covid19"],"cashtags":[],"link":"https://twitter.com/michaelmina_lab/status/1262980848288182272","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1094762324097822720","username":"michaelmina_lab"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1260835766135120000,"conversation_id":"1260832328533905408","created_at":1589441646000,"date":"2020-05-14","time":"07:34:06","timezone":"UTC","user_id":1094762324097822700,"username":"michaelmina_lab","name":"Michael Mina","place":"","tweet":"On a different note - I'm surprised and impressed that Cepheid reports positives above a Ct of 40. It provides a terrific sensitivity.\n\nReporting Cts >40 takes massive trust in knowing you're free of non-specific amplification. \n\n40 cycles amplifies a single hit 1 trillion times.","mentions":[],"urls":[],"photos":[],"replies_count":6,"retweets_count":5,"likes_count":30,"hashtags":[],"cashtags":[],"link":"https://twitter.com/michaelmina_lab/status/1260835766135119872","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1094762324097822720","username":"michaelmina_lab"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1260833947719733200,"conversation_id":"1260832328533905408","created_at":1589441212000,"date":"2020-05-14","time":"07:26:52","timezone":"UTC","user_id":1094762324097822700,"username":"michaelmina_lab","name":"Michael Mina","place":"","tweet":"On second comparison - comparison was between NP swabs on cepheid v anterior nare swab on Abbott. \n\nThis is a poor comparison. If comparing #COVID19 assays, keep the sampling the same. Don't collect a known poorer sample type and blame loss of sensitivity on assay. \n\n#ClinPath101","mentions":[],"urls":[],"photos":[],"replies_count":5,"retweets_count":5,"likes_count":28,"hashtags":["#covid19","#clinpath101"],"cashtags":[],"link":"https://twitter.com/michaelmina_lab/status/1260833947719733248","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1094762324097822720","username":"michaelmina_lab"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
{"id":1260833274244595700,"conversation_id":"1260832328533905408","created_at":1589441052000,"date":"2020-05-14","time":"07:24:12","timezone":"UTC","user_id":1094762324097822700,"username":"michaelmina_lab","name":"Michael Mina","place":"","tweet":"In the first comparison, swabs were placed in solution (VTM). Per Abbott, the swabs should go directly into the IDNow instrument by design\n\nEven with VTM, IDNow mostly missed those with very low viral copies that might be deemed negative on any other instrument too (ct >40)\n\n2/n","mentions":[],"urls":[],"photos":[],"replies_count":2,"retweets_count":6,"likes_count":17,"hashtags":[],"cashtags":[],"link":"https://twitter.com/michaelmina_lab/status/1260833274244595712","retweet":false,"quote_url":"","video":0,"near":"","geo":"","source":"","user_rt_id":"","user_rt":"","retweet_id":"","reply_to":[{"user_id":"1094762324097822720","username":"michaelmina_lab"}],"retweet_date":"","translate":"","trans_src":"","trans_dest":""}
