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Farzad_MD's profile
Farzad Mostashari
Farzad Mostashari
Farzad Mostashari
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@Farzad_MD

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Farzad MostashariVerified account

@Farzad_MD

Founder, Aledade. Former National Coordinator for Health IT NYC Health Dept CDC EIS Officer

Washington, DC
aledade.com
Joined April 2011

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    1. Farzad Mostashari‏Verified account @Farzad_MD 24 Apr 2020

      Farzad Mostashari Retweeted Farzad Mostashari

      1/ It's time to look at week 16 (April 12-April 18) #COVIDView Are things getting better or worse overall in the US? Are there pockets of concern or good news? What new data have we gotten in the past week? How would an epidemiologist look at the data?https://twitter.com/Farzad_MD/status/1251272054986416128?s=20 …

      Farzad Mostashari added,

      Farzad MostashariVerified account @Farzad_MD
      1/ Is the #COVID19 outbreak in the US going down? Are we ready to lift lockdown? How would an epidemiologist look at the data to help us understand these questions? Let me take you through the @CDCgov COVIDView data released today, w some commentary. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html …
      Show this thread
      3 replies 46 retweets 99 likes
      Show this thread
    2. Farzad Mostashari‏Verified account @Farzad_MD 24 Apr 2020

      2/ Let's run through the big 5: A) Case growth B) Hospitalizations/Deaths among Cases C) Test positivity D) Non-specific Influenza-Like Illness (ILI) trends- Ambulatory/ ED visits E) Non-specific Pneumonia/Influenza trends- deaths & new data: F) Serosurveys G) Symptoms surveys

      1 reply 6 retweets 23 likes
      Show this thread
    3. Farzad Mostashari‏Verified account @Farzad_MD 24 Apr 2020

      3/ CASE GROWTH Case growth is pretty flat- ~30k new cases a day But that's no cause for complacency 30k diagnosed cases now is probably >300k infections a day! + some heavy hitters (NY, MI) are down, so that means that a lot of other places are flat (MA, NJ worrisome) or uppic.twitter.com/G4vrBGCj0E

      1 reply 4 retweets 20 likes
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    4. Farzad Mostashari‏Verified account @Farzad_MD 24 Apr 2020

      4/ DEATHS ...are delayed This paper got a ton of attention ("87% of all ICU patients die!") but @DrJohnScott nailed it in this string: https://twitter.com/DrJohnScott/status/1253284899752009728?s=20 … "Among 1,151 pts who were mechanically ventilated, 3% had gone home, 25% had died, & 72% were still in the hospital"pic.twitter.com/YPIFOAFwCi

      1 reply 5 retweets 25 likes
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    5. Farzad Mostashari‏Verified account @Farzad_MD 24 Apr 2020

      5/ This is what worries me the most about this reliance on the IHME models- they rely on deaths to fit their model curves and make projections Makes sense cause it's less affected by under-reporting, but IT ASSUMES YOU KEEP DOING WHAT PRODUCED THOSE DEATH CURVES if we reopen..pic.twitter.com/6hFyJ09fIK

      2 replies 7 retweets 25 likes
      Show this thread
    6. Farzad Mostashari‏Verified account @Farzad_MD 24 Apr 2020

      6/ Then we've changed the course of the outbreak- sure, they can always refit the models when deaths rise after the outbreak flares again...but that will take weeks to show up, and the number of ensuing infections could be catastrophic good quotes here:https://www.statnews.com/2020/04/17/influential-covid-19-model-uses-flawed-methods-shouldnt-guide-policies-critics-say/ …

      1 reply 7 retweets 20 likes
      Show this thread
    7. Farzad Mostashari‏Verified account @Farzad_MD 24 Apr 2020

      7/ TEST POSITIVITY to control for changes in testing influencing what we see on diagnosed cases, makes sense to look at percent of tests that are positive this piece from a while back is still highly relevant https://www.statnews.com/2020/03/24/we-need-smart-coronavirus-testing-not-just-more-testing/ … But I have to say-WE NEED MORE TESTING TOO

      2 replies 6 retweets 20 likes
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    8. Farzad Mostashari‏Verified account @Farzad_MD 24 Apr 2020

      8/ It would have ben unfathomable to me that we could be sitting here a month after that article, and be seeing that the total number of tests reported by CDC went DOWN to 575k in week 16, compared with 680k in Week 15. Now, maybe public health isn't getting all the lab tests?pic.twitter.com/expTy4Wmql

      2 replies 9 retweets 22 likes
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    9. Farzad Mostashari‏Verified account @Farzad_MD 24 Apr 2020

      9/ It could well be! "Results from testing where patient addresses were not provided or available are being held to allow @QuestDX ... to provide this information, before issuing the public health reports" It's essential for public health to get complete AND TIMELY lab resultspic.twitter.com/it5pfZX8iK

      1 reply 3 retweets 12 likes
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    10. Farzad Mostashari‏Verified account @Farzad_MD 24 Apr 2020

      10/ Another problem could be those WONDERFUL point of care test device that give you results within minutes? surely you've heard of them. They don't seem to have a way to electronically report to public health yet. (also some safety concerns)https://khn.org/news/abbotts-fast-covid-test-poses-safety-issues-lab-workers-say/ …

      2 replies 4 retweets 19 likes
      Show this thread
      Farzad Mostashari‏Verified account @Farzad_MD 24 Apr 2020

      11/ I am dwelling on the testing piece because in order to reopen relying on contact tracing, we need to have a very high percent of all infections diagnosed. If half are asymptomatic, then we better be doing a bang-up job on the rest. Are we? The positivity rate is still 19%pic.twitter.com/nYENITYMxr

      2:42 PM - 24 Apr 2020
      • 11 Retweets
      • 27 Likes
      • Moan Chomsky Medical Synchronicity Marwa Mansour Caroline PacoPathogen News Junkie tim s #CountryOverParty #GQP Tom Ceresini Brendo RN
      2 replies 11 retweets 27 likes
        1. New conversation
        2. Farzad Mostashari‏Verified account @Farzad_MD 24 Apr 2020

          12/ If you're panning for gold (+ cases) and every 5th time you took your pan out of the river you find a gold nugget, you know that there's a rich vein where that came from. That's what this is saying. We'll know we're doing a good job when it becomes HARD to find a + case

          1 reply 8 retweets 32 likes
          Show this thread
        3. Farzad Mostashari‏Verified account @Farzad_MD 24 Apr 2020

          13/ Now, those are official CDC results. @covidtracking has more updated data (though probably less reliable) scraped from each state- they show an increase in testing in Week 17, and a dip in positivity rate 🤞 NY (39%->28%) MI (28%->18%) are continuing to see drops 😅

          2 replies 3 retweets 13 likes
          Show this thread
        4. Farzad Mostashari‏Verified account @Farzad_MD 24 Apr 2020

          14/ But there are also a number of states on that seem to be having increases in percent positivity. DE 25%->34% ?? OH 15%->19% IA 15%->20% NE 10%->19% KS 9%->16% Do you see a pattern in those supposedly safe homeland states? Not time to reopen

          3 replies 12 retweets 24 likes
          Show this thread
        5. Farzad Mostashari‏Verified account @Farzad_MD 24 Apr 2020

          15/ Speaking of reopening- here are some notes on who's announced reopening plans: Most famously, @GovKemp who's been roundly criticized, including by Trump, and rightly so (no decline in cases, several worrisome counties, >15% positivity rate) https://thehill.com/homenews/state-watch/493717-heres-when-all-50-states-plan-to-reopen-after-coronavirus-restrictions …pic.twitter.com/kYdQYOwU5e

          2 replies 3 retweets 11 likes
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        6. Farzad Mostashari‏Verified account @Farzad_MD 24 Apr 2020

          16/ Which brings us to syndromic surveillance (be still my heart) The national rates of ED visits (NSSP) and ambulatory visits (ILINet) with symptoms compatible with COVID19 continue to drop. That's good. But averages can be deceiving- what about the state/local level?pic.twitter.com/fcBGzojBRc

          1 reply 3 retweets 13 likes
          Show this thread
        7. Farzad Mostashari‏Verified account @Farzad_MD 24 Apr 2020

          17/ The Sentinel ILI sites seem to be dropping, though still a few hotspots parenthetically, it's nuts that we don't have lab testing for COVID at these sentinel sites so we could actually know what percent of those "ILI" visits were actually COVID. Give em tests+PPE, & Pay em!pic.twitter.com/XQd0kzZntP

          1 reply 4 retweets 18 likes
          Show this thread
        8. Farzad Mostashari‏Verified account @Farzad_MD 24 Apr 2020

          18/ The other problem w Sentinel ILI is that there are too few sites to get good geographic granularity- you don't get much info on the people w ILI, like their zip codes. (also hard to investigate spikes) This is where ED syndromic shines. But guess what? No state maps/graphs

          1 reply 1 retweet 11 likes
          Show this thread
        9. Farzad Mostashari‏Verified account @Farzad_MD 24 Apr 2020

          19/ If we're going to rely on this data for closures and reopening, then every state should have this on their websites every day some do: MI https://www.michigan.gov/coronavirus/0,9753,7-406-98163_98173_99449---,00.html … AZ https://www.azdhs.gov/preparedness/epidemiology-disease-control/infectious-disease-epidemiology/covid-19/dashboards/index.php … NC https://www.ncdhhs.gov/divisions/public-health/covid19/covid-19-nc-case-count#surveillance-report … FL https://floridadisaster.org/globalassets/covid19/dailies/covid-19-data---daily-report-2020-04-23-1638.pdf … ID https://public.tableau.com/profile/idaho.division.of.public.health#!/vizhome/DPHIdahoCOVID-19Dashboard_V2/Story1 …

          2 replies 2 retweets 15 likes
          Show this thread
        10. Farzad Mostashari‏Verified account @Farzad_MD 24 Apr 2020

          20/ Finally, instead of looking at just COVID-ILI recorded deaths, we should also be looking at "Pneumonia and Influenza" deaths, in case COVID is under-diagnosed. There's good evidence (public soon!) of increases in P&I deaths prior to recognized outbreaks in several statespic.twitter.com/FBY29Jn2ui

          3 replies 2 retweets 26 likes
          Show this thread
        11. Farzad Mostashari‏Verified account @Farzad_MD 24 Apr 2020

          21/ So what kind of forecast would I give the US right now? Americans' extraordinary physical distancing has -for the time being- calmed down the storm substantially, but there are millions of infectious people, and pockets of real concern if reopening happens too soon, too fastpic.twitter.com/zbUi5fhIJR

          4 replies 8 retweets 39 likes
          Show this thread
        12. End of conversation

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