Are there enough guardrails in place to prevent a second peak?

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All fifty states have entered at least the early stages of easing COVID-19 lockdown restrictions within the past two weeks. These steps come amidst a push and pull between government officials eager to jump-start the economic recovery and public health experts warning that states may be opening before they are safely able to.

The data, as always, demands a closer look. Nationally, we are in a period of a long plateau and gradual decline in the number of new daily cases and deaths — as I predicted when comparing the lockdown measures in the US with those instituted in Italy…


We must remember side effects and unintended consequences

Image from freestocks.org

A rare side effect or complication will never happen to me, right? With enough patients, however, even the rarest side effect becomes commonplace.

In this short article, I present two simple scenarios to illustrate the danger of rare medication side effects when improperly prescribed. Such risk-benefit exercises are at the core of all medical decision-making.

In the case of hydroxychloroquine (HCQ), we have heard repeatedly that it is an old medication with minimal side effects used by patients with lupus and rheumatoid arthritis. President Trump, among others, have pushed for easier access for more people to take the medication —…


Photo: Sarah Pflug from Burst.

What does the curve look like now in the United States? What might we expect in the coming weeks? What questions should we be asking as we consider the restart of our economy?

Ultimately, I have more questions than answers.

The Curve Appears to be Flattening

The number of new daily COVID-19 cases seems to have plateaued at approximately 30,000/day across the United States. In some states such as Michigan, the number of new daily cases appears to be declining.

This is good news.

The bad news is that we still have 30,000 new cases/day. A helpful analogy to consider is the number of daily cases…


A 91.7% success rate with hydroxychloroquine and azithromycin — too good to be true? A critical review of the latest data.

Hydroxychloroquine is the latest buzzword in the COVID-19 discourse. As I wrote previously, finding an effective treatment could significantly alter the trajectory of our global response to the pandemic. At his daily briefing on Sunday, Apr. 5, President Trump asked the country, What do you have to lose? and has been pushing for patient access to the drug through right-to-try legislation.

Hydroxychloroquine has been shown in the laboratory to be effective against coronaviruses including SARS and COVID-19 by blocking entry of the virus into cells. What works in a test tube, however, doesn’t always work in humans. In the case…


Social distancing in China. Getty Images.

The IHME COVID-19 model assumes social distancing in the United States will be as effective as in Wuhan, China — is this realistic?

When President Trump extended the national guidance for social distancing until Apr. 30, it was revealed that policy decisions are being informed by a model prepared by the University of Washington Institute for Health Metrics and Evaluation (IHME). This model combines available data with the timing of state government-mandated social distancing measures to project hospital resource utilization and deaths in each state. The four social distancing measures recommended are:

1. School closures
2. Closure of non-essential business including…


https://www.nytimes.com/interactive/2020/world/coronavirus-maps.html

A guide to interpreting COVID-19 data

With the endless stream of headline-grabbing numbers and figures being reported about the COVID-19 pandemic, it is easy to lose sight of what we might learn from the data. As a physician, I believe decisions must be guided by science and data, and for that we must understand data in context. Ultimately, we are all desperately hoping to see signs that the COVID-19 pandemic might be improving.

This article will be a brief guide to understanding and interpreting the various forms of data being reported on COVID-19. Questions I hope to answer in this post including the following:

  1. What are…


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It is hard to believe how much life has changed in just a few weeks. With unprecedented economic collateral damage as states issue stay-at-home orders, we all recognize that the end to this global nightmare cannot come soon enough. The trillion-dollar question is how and how quickly — what will it take to stop COVID-19?

In my analysis, there are 4 possible ways to stop COVID-19:
1. A treatment.
2. A vaccine.
3. Herd immunity.
4. Breaking the chain of transmission.

First, a word on the fundamental epidemiology of a viral epidemic. The basic reproduction number of a virus, R0…


Medical personnel at a hospital in Brescia, in northern Italy, on Tuesday. Claudio Furlan/LaPresse via AP

How can we avoid being the next Italy?

Among the many fears surrounding COVID-19, the one most critical to our future in the United States is the question of how our healthcare system will manage the influx of COVID-19 patients. The mantra of #flattenthecurve tells us that we need to minimize the surge of patients so as to “not overwhelm” the healthcare system. What exactly does it mean for a healthcare system to be overwhelmed and how does it happen?

First, I want to address the question of just how dangerous is this virus? While I will not speculate on…

Kenny Lin, MD

Otolaryngologist; former resident at New York Presbyterian Hospital. All views my own.

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