EHR v Covid-19. Follow the data: Hemoglobin, Viral tests, ‘data humility’

For all the talk about Covid-19 testing, and testing for respiratory viruses, keeping mind, that the UCHealth (and most health system) labs do SO MUCH MORE than virus testing. Hemoglobin, for example. Hemoglobin is the measure of how much oxygen-carrying protein we carry in our blood, a way to detect anemia, blood loss. Look at the dip in the orange hemoglobin line in early March. Our testing volume throughout UCHealth fell in HALF. As we all reconfigured our hospitals to prepare for pandemic, we also stopped all surgeries except for emergencies. And the various colored lines at the bottom are all our previously described viral tests (see previous post). How puny and miniscule.

Okay, so wait a minute, lets look back at those virus tests: what’s this? Remember that purple was Influenza B, Green was Influenza A, yellow was RSV (respiratory syncytial virus). Then there are 3 viruses (including Rhinovirus) that SPIKE in March! OMG! None of those are Covid-19.

CT Lin is a GENIUS! He has discovered the TRUE CAUSE of the pandemic: out-of-control mutated winter viruses! AND, there are THREE of them, all spiking at once! Triple infections for everybody!

Well? What do you have to say for yourselves? You gonna buy it? Pause and think. Hmm.

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Okay, you’re all smarter than me. Yes, you’re right. When we started Covid-19 testing, we also threw in RVP (Respiratory Virus Panel) testing on the same swab. This graph shows, not the “testing positive” results above, but TOTAL VOLUME OF TESTING, and RSV testing increased 700% in a month, due to co-testing on Covid-suspected patients. Aha!

So, layer in the Covid-19 positive results, and we see this, temporary bumps in 3 viruses (due to all the co-testing of Covid-suspect patients: blue, dark-blue, red), and a persistent and growing number of Covid-19 positive patients (purple). And then, we have cut back the co-testing since then. AND we near the end of the season for those other viruses anyway. Okay, this makes more sense.

Hooray! Let’s celebrate, we made some sense of the data!

But, wait.

Of course it is not a good sign that each week we detect more Covid-19 positive patients. It is either: more patients are showing up for testing, OR we have more test kits, OR we have relaxed the standards (all symptomatic patients can be tested now, instead of just health-care workers and critically ill patients), OR the exponential spread of the pandemic is not over, OR something else we haven’t thought of yet. Wouldn’t you like to know which one it is? Yes, so would I.

CMIO’s take? I hate living in the middle of the pandemic, when every night, we go to sleep in the middle of a cliff-hanger. I hated those season-ending episodes in those shows I loved so much. Here’s hoping our heroes solve the cliff-hanger in time for next season!

Author: CT Lin

CMIO, UCHealth (Colorado); Professor, University of Colorado School of Medicine

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