However, in areas with rising measles cases due to vaccine hesitancy and misinformation, even individuals previously considered immune may face increased risk. High community transmission can lead to breakthrough infections, particularly among those whose immunity has waned.

@purveshkhatri khatrilab.stanford.edu

Abatracts available at journals.lww.com/ccmjournal/t...

Q3) How will impending Medicare (and Medicaid) cuts impact your institution’s care for patients with (insert critical care condition here) you are discussing today?

Q2) how will the gutting of our public health infrastructure, layoffs of science and knowledge work-force and participation in WHO global surveillance impact (insert critical care condition here) you are discussing today?

"However the remdesivir RCT is going to be enrolling and there will be options for open label. Until then..my suggestion is that we opt for compassionate release for positive patients". (Enrollment opened 3/17/2020) None of our compassionate use requests were approved.

Denver's 1st confirmed critically ill COVID-19 patient (early March). We knew quite a bit by 3/10/20: "Our ID folks indicate that the Kaletra (boosted ritonavir) is not likely to be virocidal at the doses we could give. Chloroqune is an option - alkalization of the phagasome; we should consider.💔😞

Italian colleagues @DrMCecconi were sharing on SoMe and WhatsApp, alarming reports of the first European wave of cases filling and overwhelming ICUs. “Feb 20, 2020, the 1st patient … developed respiratory failure and was admitted to one of the ICUs of Lombardy.” pmc.ncbi.nlm.nih.gov/articles/PMC...

In late Feb 2020 there was that “1 case” of severe CAP progressing to severe ARDS (54yo business man) who had a weird “peripheral” distribution of airspace infiltrates. Our fabulous ID doc sent respiratory samples to our regional lab. COVID-PCR
testing reported “negative” 4 days after discharge.

The first US case was probably in Washington identified in samples from Jan 18th 2020. By Jan 23rd Wuhan was in lockdown.
> 1000 deaths were officially reported globally by Feb 10. While there was almost certainly domestic person to person transmission, we were busy managing “flu in the ICU”
3/

While it wasn’t until Jan 5 that an outbreak was recognized, @who.int did “not recommend any specific measures for travellers. In case of symptoms suggestive of respiratory illness travellers are encouraged to seek medical attention and share travel history with their healthcare provider.”
/2

…. And then remind you what you said several years later when they’re readmitted or you see them in clinic! Humbling.