EHR v Covid-19. Follow the data: Visits, Testing, Symptoms, Codes?

It is time we looked back at the past month to update our data. Since we initiated social distancing in mid March, and then the Colorado Stay-at-Home order in late March and subsequent mask use, what has happened to Covid-19, and what about symptoms? other viruses, the geographic spread? Hold on to your hats. This is all UCHealth data from our Slicer de-identified data tool.

  1. Virtual visits are up, and stable at about 4000 visits a day. In person visits are way down from baseline in early March. Overall visit volume is way down, as it is for most health organizations right now. As Colorado starts to ease restrictions from “Stay at Home” to “Safer at Home”, we will see what comes next. Regardless, there will be repercussions from this some time to come.

2. Covid RNA testing is up (not enough), supplies for testing are short nationally, and unlikely to change quickly. The state is ramping up, and we all agree that widespread community testing is critical to safely opening up restrictions. Furthermore, antibody testing, although everyone’s working hard on this, is still not ready for prime time; the accuracy of the tests (false positive, false negative rates) are still too high to be trusted.

3. Cough, Fever, Shortness of Breath, Diarrhea is all decreasing as we reach the end of the worst virus seasons. What does this mean about Covid? Of course, mixed in, is the decrease in visits overall. This curve is worth watching over time as the state “opens up.”

4. Where is the spread across 12 hospitals. University of Colorado Hospital on the far right, Greeley Medical Center on the far left. The higher bumps in the middle are for Poudre Valley, Medical Center of the Rockies, Memorial North, Memorial Central. Some of our hospitals are seeing very little. Interesting regional variation. We are also intentionally protecting some of our hospitals to be Covid-free as much as possible, in case of future surge demand.

5. What about ICD10 diagnoses by docs? You may know that CMS published an new set of ICD10 codes (international classification of disease, version 10) that contain Covid-19: including: Confirmed Covid, Suspected Covid, Exposure to Covid, etc. Grouping them into Confirmed versus Suspected, here’s what you get in our visits since March (orange: suspected, blue: confirmed). This is a reflection of the scarcity of testing. Again, interesting to see where this goes. NOTE: The last down-tick on the orange may be due to counting a partial-week in the data.

So what do we learn?

A. We need more testing to figure out what the community prevalence is.

B. Virtual visits, even scalable at 20x previous volume, will not save the day.

C. Social distancing and stay-at-home are followed quickly by a dramatic reduction of Covid-like symptoms seen in clinics. BUT, be careful of conclusions: social distancing could also have affected the USUAL winter virus spread, OR patients are not choosing to be seen, OR the virus is mutating into a less severe form, OR distancing policies might really be working. Wouldn’t you like to know which it is?

D. ICD10 codes are being used in our clinics! But the trends don’t mean anything yet. It might be promising that “suspect Covid” codes are growing more slowly.

F. Covid is going strong into the late Spring (wasn’t it supposed to evaporate magically likes SARS CoV-1? That outbreak in 2003 largely evaporated by late May, early June). Covid-19 (more accurately, SARS CoV-2) is going strong and is likely to behave quite differently, not a good sign for us humans.

PREVIEW OF NEXT POST: How does testing for OTHER VIRUSES compare to COVID testing results in the late winter/spring? and what does Hemoglobin testing teach us about Covid-19?

CMIO’s take? The lessons from Pandemic are numerous and they just keep coming. Be sure to take a break, and take care of yourself. Don’t worry, I’ll be back soon.

Miso soup v COVID-19.

Miso soup. One of my late nite superpowers.

Here’s a Sunday post: Musing about miso soup and it’s role in my battle with the pandemic. If you’re here for data, clinical informatics, and health system thinking, you can leave now.

FLASHBACK, mid-1970’s.

When I was the age of my youngest niece (okay, my only niece), I remember telling my mother who had just served me a bowl of home-made soup, with a sprinkling of goldfish crackers:

THIS SOUP IS SO YUMMY. I think it must be the goldfish I put in there. Goldfish are the perfect food, and I think I’m going to make a soup just from goldfish crackers and hot water. Mom, can I have some hot water?

Of course I wasn’t watching my mother’s face at the time, I was so sure of my world-shattering upcoming invention: Delicious hot water-and-goldfish soup.

I stood by, as she boiled some hot water for me on the stove. I had carefully selected a big handful of goldfish, and was cautiously resisting eating them, KNOWING that the soup was going to be TOTALLY WORTH THE WAIT. I was bouncing with excitement.

At last, hot water, in a cup on the kitchen table. =Plt-phtl-tlthtpl-plthth-ppth!= I slid all my goldfish from my sweaty palm into the cup, gave it a big stir,

…paused for a drawn-out moment to let the flavors swirl…

And took a big sip.

What did I think? It gradually dawned on me, as my face twisted into a surprised grimace, that the soup was not good … AT ALL. Just a bunch of semi-soggy flavor-less crackers and hot water.

I tried to fix it: added salt and pepper. Even some “Accent” (packaged MSG salt; hey it was the 1970’s! anything goes). Nope. Nope. And Nope.

I finally looked at my mom, who was silently watching, smiling and shaking her head at me. It was a lesson, I suppose, that her son had to learn for himself. Good soup was just not going to be that easy.

FLASH-FORWARD, present day.

I have always been obsessed with soup. Almost every restaurant we go to (or, used to go to), I would scour the soup offerings for candidates. I did let go of my soup-inventing dreams, but have lately been punching out Instant Pot – powered soups like Rosemary Cauliflower and Ginger Carrot, to some pretty good family reviews. But of course, they realize it’s Dad cooking, so the critic-grading-scale is set pretty low and forgiving to start.

Night-times are for miso soup, though. I’m a night owl and do some of my best thinking and working at night, and give me 1 teaspoon of Marukame Boy brand Miso paste, a cup from the hot-water pot, a sprinkling of scallions (pre-sliced and saved in a container in the fridge), and maybe some … GOLDFISH CRACKERS from a huge Costco bag. Heaven.

And, what do you know? Miso soup, consumed daily is supposed to have ability to FIGHT INFECTIONS! Hey! Who needs vaccines or treatments? Daily miso soup for EVERYONE, that’s the ticket. Okay, whatever, no.

Turns out, if my pre-teen self had just known SOMETHING about miso paste, I might have been a chef instead. Happy Sunday, everyone. Hi, Natalie!

EHR v Covid-19. Nurses help families of ICU patients, from home

ICU rounds at PVH, photo credit: Lydia Baldwin

These are our healthcare heroes at work: From ICU rounds at Poudre Valley Hospital, part of UCHealth: Starting from the left standing we have Respiratory Therapy, Palliative Care PA, and Chaplain. Sitting from the left are RN, intensivist MD and Charge RN. In front of the intensivist (in green scrubs) is a telephone on the desk. The telephone is on ‘speaker’ and dialed in to a conference line. Also dialed in are: Pharmacist working remotely, Nurse Communication Liaison working remotely, Social Work.

So many great things going on here: Social distancing as much as practical (too much further and you can’t hear each other over the din of electronic alerts across the ICU), N95 masks (all day every day), reviewing data together from so many disciplines, discussing each patient in detail and taking immediate actions (placing orders, creating consensus on medical decisions, dividing tasks for rapid action).

In times of pandemic, the hospital follows infection prevention protocol and isolates very sick, very infectious patients. In this case, we have grouped and isolated all Covid-19 patients into a distinct unit, away from non-Covid patients. AND, in most cases, patients are not allowed to have visitors.

This is both good medical practice, and heartbreaking to families who cannot be present at a patient’s most desperate hour.

Out of this swirl of confusion, Julie Griffin, Nurse Manager of Care Management, thought: we have highly qualified nurses on-leave at home (orthopedic unit nurses with no post-op surgical patients; pregnant nurses for whom Covid infection would be particularly dangerous); how might they help share the burden of patient care with bedside nurses, and still minimize risk of contagion and exposure?

And so was born: Nurse Communication Liaison. Nurses from home, helping keep families connected, and reducing the burden on bedside nurses. We haven nurses helping with med/surg units as well as ICU’s. As described by ICU nurse Molly:

7AM: My day starts at 7: I review the Epic EHR chart from home for patients in the ICU. I read the notes from the nurses and the doctors overnight in our 12 bed unit. By the way, our unit has moved to double occupancy, and we’ve expanded to be a 23 bed unit. So much has changed, we’re so much busier.

8-10AM: I start receiving calls from family members and I give them updates on their loved ones, that I can, based on what I know. I am using Epic secure chat (a HIPAA-compliant text message service) to communicate with the ICU bedside nurses, social worker, respiratory therapy to get and give updates. I LOVE secure chat because it means the bedside nurse: who is gowned, gloved, doesn’t have to scrub out to answer another nuisance phone call interruption; they can catch up with chat-messages when there’s a break in the action.

10-11AM: Daily ICU rounds (picture above), where the team discusses every patient and I’m on the conference phone. It is a complete team with everyone pitching in.

11AM-430PM: We have designated ONE main contact family member for each ICU patient. We have found it can be overwhelming to have many family members calling each day for updates. I am so happy to be able to serve as the main contact for these family members and unburden our extremely busy bedside nurses to focus on their patients.

Some great unexpected moments:

Jamie: “Bedside nurses often spend 15 minutes on the phone with family. Multiply that by 5 patients and it becomes a big part of your day. We all wish we had more time to talk to families, but we’re often too busy caring for patients. I love helping connect with families and reassuring them.”

Jamie: “One gentleman was was not doing well. He was very quiet on the phone, and would never ask for anything. I spoke with his close friend at home, who noted that he was Jewish, and might appreciate a visit from a Rabbi or the Chaplain. I was able to arrange that.”

Jamie: “Being an ortho nurse on a medical unit, I was anxious at first. But communicating with the bedside nurses by secure chat and occasionally the phone, I found that even if I couldn’t answer families’ questions, I could always find out. Families are always so appreciative of the extra communication. I love this role. It is really awesome.”

Dawn: “The difference with this role is: There’s only the person on the phone. It is quiet at my home on my end. Normally when I’m at the bedside, I’m always trying to ‘wrap up the conversation’ with family: there are so many other things needing my attention. I can really feel good about being focused, connecting with family, and freeing up the bedside nurse to do their jobs.”

Dawn: “I was on the phone with the husband of a Covid patient. I noticed he would occasionally grunt, while we were talking about his wife. I had to ask him: ‘Are you okay?’ He told me he had had a fall, and had to pull on his pant-legs to go up the stairs. I recognized the signs of a major injury. It took some convincing, but I finally got him to call his doctor. Turns out the next day he was admitted and had emergency surgery himself.” As an ortho nurse, she was probably the perfect person to help.

Davida: “Sometimes you can remind the bedside nurse by secure chat: ‘his daughter would like to see his face today. Can you get the tablet in there for a Zoom visit?'”

Davida: “I feel really useful, being able to connect with PT, social work, bedside nurse all by non-interruptive but efficient Secure Chat, and then calling to make sure the family stays informed.”

Molly: “It is completely weird not to be an ICU bedside nurse right now. I think I will be better at charting in the future. Not being able to see the patient lets me understand what families want to know, that I rarely wrote down before: how do they look? are they following commands? can they squeeze? How scary this is for the family, and although it is a tricky role for us, it feels great to be helping.”

CMIO’s take? Thank you to our amazing UCHealth nurses: Lisa Claypool, Julie Griffin, Jamie Deschler, Davida Landgraf, Molly Carrell, Dawn Velandra for their experiences and stories.

UCHealth v Covid-19. The second surge (not what you think)

Mind the Brain Logo

https://medschool.cuanschutz.edu/psychiatry/about/in-the-news/psychiatry-news/mind-the-brain-mental-health-in-the-time-of-covid-19

I’m so proud to be part of a multi-disciplinary, talented group of clinicians. Our Department of Psychiatry is gearing up for what may become the second surge of our pandemic, as we relax the stay-at-home orders in Colorado:

Mental Illness. Depression. PTSD. Panic. Suicide.

These terms must no longer carry the stigma they do. There is no shame in reaching out for help. Appropriate and timely treatment can aid a person’s innate resilience and return him or her to health.

We have not experienced a pandemic of this scope for more than a century … We are psychologically inexperienced.

C. Neill Epperson MD

Read more of Dr. Epperson’s ideas and initiatives in this fight for mental health and the major investments UCHealth will be committing to improve the well-being of all residents of the State of Colorado. Welcome to the fight!

UCHealth v COVID-19. Patient success stories

https://www.uchealth.org/today/jbs-worker-with-covid-19-goes-home-after-son-prayed-outside-hospital-for-days

Thanks to the hard work of our outstanding nurses, staff, and physicians, many patients with Covid-19 are pulling through. Here’s a particularly poignant story from UCHealth’s own reporter, Katie McCrimmon. Have your tissues ready.

Dr. CT Lin’s Covid-19 advice for patients. KOSI 101 and Mile Hi Magazine

In the link below, it is the interview from April 12, 2020.

https://kosi101.com/mile-high-magazine-public-affairs/

I had the pleasure of being interviewed by Mile Hi Magazine last week in regards to questions about how patients can cope with Covid-19 at home.

I responded to such questions as:

  • So many people contract but recover, is this what our body is designed to do?
  • Can people determine whether they have the virus without a test on symptoms alone?
  • When contracted, quarantine is the first step. What’s next in terms for two weeks – nutrition, special foods to eat to help the immune system fight?
  • Any special foods we should be eating now to be in top immune condition should we contract?
  • Any over-the-counter medicine to take for the fever or diarrhea?
  • Should people change out bed linen during the two-three weeks period?
  • Once fever breaks, is this a key sign that its over?
  • Should people exercise while body is fighting the infection?
  • Once over, should person we wait a couple days to ensure no symptoms return?
  • If Covid-19 is a flu strain, will it mutate into another strain as flu does each season for next winter?
  • Anything else you feel is pertinent to help people feel they can get over it if infected.

I made one particular point at the end of the interview. I shared our family’s strategy for coping with the anxiety and stress during this pandemic:

  1. Exercise every day
  2. Play or make music every day
  3. Limit yourself to 30 minutes of news or social media daily
  4. Three Good Things. At dinner each of us discusses THREE THINGS we are grateful for, today. INSTEAD of our natural tendency to focus on the negative, this exercise helps us reframe our day in a positive light.

CMIO’s take? I challenge all of us to do THREE GOOD THINGS with our loved ones at dinner every night.

Viral Misinformation vs Actual Virus (Medium.com)

https://medium.com/swlh/misinformation-goes-viral-1aad951e4492

This article “Misinformation Goes Viral” from the Medium is written by a PhD in Cellular and Molecular Medicine from Johns Hopkins School of Medicine, working now in Neurobiology at the University of Utah. Worth reading, and forwarding.

I agree with his well-written article and his sound reasoning, as a Professor of Medicine at the University of Colorado School of Medicine, the Chief Medical Information Officer at UCHealth, and a General Internal Medicine doctor seeing patients (now primarily via Telehealth!) in clinic.

His article has a number of main points with detailed explanations:

  • Americans did not have Covid 19 prior to Jan 2020
  • The virus is not man-made
  • Models are not deliberately misleading people
  • Covid is NOT the flu
  • Bill Gates is not a Bond villain
  • 5G cell towers do not spread Covid
  • Healthcare workers are not paid off by big pharma
  • Herd immunity must be achieved through vaccination, not unchecked infection

CMIO’s take? Let science and rational thought triumph in these difficult times.

EHR analyst v Covid. Making a difference with Ear Guards made with 3D printing (Guest post: Guy Ristoff)

Guy Ristoff, his sister-in-law Mollie, and brother Bill

My name is Guy Ristoff.  I work for the EPIC IT Team at UCHealth (Colorado) as an Analyst.  I also have a 3D printer.  A few weeks ago, I started seeing a bunch of people posting in 3D printer Facebook groups about ear guards to use with surgical masks.  I thought it was a great idea for me to explore here at UCHealth.

 I contacted a unit I have done some EPIC build for and asked if they would want some.  I created my first 10, delivered them to the hospital, and hoped they liked them.  I then contacted Gwen Martinez from the Clinical Informatics team and she sent an email blast to a group of people about the ear guards.  Within 20 minutes, we started to get responses.  It was amazing!  The first few “orders” were coming from the Northern Region.  My brother lives in Wellington and has 3D printer as well.  I called and asked him if he would be interested in donating ear guards to the Poudre Valley and MCR.  He was excited to help!  His kiddos even got in on the fun by making thank you cards for the staff.   

As for production, I can make 17 of them per batch, which takes about 4 hours.  It is not a super-fast process, but it is a lot of fun making something that helps people be more comfortable.  My brother has made and dropped off 80 of them.  I have created 122 of them for the AMC and MHC campus so far.   I am dropping those in the mail and at the hospital today!  I will keep up production, so keep the orders coming.  I am just happy to be able to help!

Here is my machine making a batch of them

Example of a clinician wearing a mask protected by the ear guard

CMIO’s take? Thanks to all our creative Epic/IT team members like Guy, to step up and help in every way that they can. –CT Lin MD

EHR v Covid-19. Video Visits: How to Improve the Patient Experience

The new normal? No white coat during Video Visits! (c) CT Lin

Executive Summary: We have a global pandemic, daily policy changes, we work from home, have new video tech, and we are learning to communicate and build relationships in new ways. It is easy to forget that there may be a scared patient on the other end, counting on us. How might we improve the patient experience? Some ideas:

IDEA                                                    DETAILS

Secure Chat with your MAScrub your schedule together, days ahead for patients more appropriate for telehealth vs in-person visits, med rec, troubleshooting, visit focus
Arrange your room, selfSee tipsheet in Epic “Demonstrate Professionalism.“ How is: your room, your light, your clothing?
Eye Contactand, put a sticky note on PC cam to “LOOK HERE!”Arrange the camera at eye level if possible. For some, looking down = frowning? Eye contact on video visits is EVEN MORE important. “If I look away it is because I’m looking at information in your chart”. 
Avoid running lateIf you DO, inform your MA by Epic secure chat & they can inform patient
Greet the patientI like to raise my arms in surprise when we connect: every human connection now, is amazing. Maybe thank them for connecting with you. Ask if they’re in a safe private spot (eg: advise patient NOT to be driving!)
Talk, human to humanAsk: how are you coping (aside from medical concern)? Scared? Worried?  
Reflective ListeningEven more important now in this time of anxiety. You can reflect or say back Data, Ideas, Feelings, Values. It strengthens connection: for example  DATA: “It has been 5 days of worse symptoms?”  IDEAS: “so you think it might be gout?”  FEELINGS: “you’re worried about work? Hmm.”  VALUES: “so, what’s important to you is your family.”
PEARLSSome clinicians may have taken the Excellence in Communication course. The PEARLS acronym can also be helpful. Some examples:   Partnership: “We’ll get through this together.”  Empathy: (reflective listening, as above)  Apology: “I’m really sorry that happened.” “I’m sorry for my part in it.”  Respect: “You have worked really hard on this.”  Legitimization: “Anyone in your situation would feel that way.”  Support: “My team and I are here for you. We aren’t going anywhere.”
Physical Exam creativityTeach them to take a pulse “say beep when you feel it” and YOU can count. Patients may have a BP cuff, Pulse ox, flashlight, thermometer. 
Ask for help from familyOthers may help add to history or exam findings
They may ask about YOU as a human“How are YOU doctor? Are you staying safe?” So many surprising comments from patients worried about their doc. Thank them! 
Brief LIFE adviceDuring pandemic, consider: A) Limit news/social media to 30 min/day. B) Exercise daily. C) THREE GOOD THINGS exercise: proven to reduce depression, anxiety if done consistently “What 3 things are you grateful for today?” Can become a great family habit at dinner. 
AVS,
Open Notes
From My Health Connection, they can see your AVS (after visit summary) and your Progress note (called Clinical Note) to remind them of details of your visit. Maybe at end of visit, ask: “Sometimes I don’t explain myself well. Can you tell me what you’ve heard, so we’re on the same page?”
Reassurance and Hope“We’re going to get through this!” “Stay in touch with your loved ones.”
Ending the visitConsider: a handwave OR palms together, nod OR thumbs up OR “You Got This!” Forecast next steps or if your MA will call them after.
Secure chat with your MAHandoff any items after visit for continuity (referral, next visit, lab, etc)

Link to PDF of this document.

And, here is how our Medical Office looks now, deconstructed. One part is in my basement …

The deconstructed doctor’s office (c) CT Lin

And here’s Medical Assistant Becky, hard at work keeping both the patient and the doctor on track at her home. That virus has got no chance against us.

CMIO’s take? Hang in there! You Got This!

Thanks to all my colleagues for letting me “borrow” their ideas for this post.

EHR v Covid-19. Cough, fever, shortness of breath in the data

Okay, I acknowledge that I’m a data dilettante. Hmm. Interesting concept. I guess that is one step up from me being a data ignoramus. Having an anonymized population graphing tool in the EHR leads to amateur data exploration. Come along, won’t you?

DATA SET 1: 3 Years of CHIEF COMPLAINTS

The above graph shows 3 winters of data from our records, chief complaints of patients across our healthcare enterprise (4000+ doctors, several million patients) and number of patients each month with complaints of Cough (purple), Fever (blue), Shortness of Breath (yellow), and Diarrhea (red). Keep in mind: UCHealth grew in size over the past 3 years, with a growing number of hospitals and clinics, so the denominator number of patients is not the same from left to right. It also does not account for individual medical assistant or physician behavior who may or may not enter similar chief complaints across different patients, across different practices.

Nevertheless, I think you’d agree there is an interesting pattern here, including a higher peak of cough and fever this year! Wow: Covid19! But wait, that peak started in January. Unlikely the Covid-19 arrived IN SUCH VOLUME in January. But our old friends, other cold and flu viruses are plentiful. Hmm. So: Rhinovirus? RSV? Flu? See last post.

Look carefully, though, there is an interesting uptick in Shortness of breath in March 2020, out of proportion to the last 3 years … hmm. Interesting, but inconclusive.

And interestingly, diarrhea does not spike in winters, and doesn’t spike this winter either, despite (some) reports of Covid-related GI symptoms. Notably abdominal pain did not spike either (data not shown).

CONCLUSION 1: Fever, Cough, Shortness of breath are prevalent in our region BEFORE major Covid-19 activity, but some peaks seem higher.

DATA SET 2: REGIONAL CHIEF COMPLAINTS

Okay, lets take another step. What if we track SYMPTOMS (chief complaints), group them together and then see if we can find a Hot Spot where ONE region (UCHealth has 5-ish distinct geographic regions) has symptoms going up, disproportionate to other regions?

SURELY this means something!

See the yellow line shooting up at the beginning of March! This is the Denver region, compared to northern Colorado, southern Colorado, and a couple of other regions. These are percentages, not actual volume.

So, what does ACTUAL visit volume look like?

Slightly different view, by county and by actual volume of visits, and now you see a consistent plummeting of patients with “chief complaint” of fever, cough, shortness of breath. What is going on here?

The larger phenomenon is the Social Distancing order 3/21 and then the Stay at Home order on 3/26 by the governor of Colorado. So the sharp drop begins on the week of 3/21 and continues to plummet. At the same time UCHealth ramps up its Virtual Urgent Care and Primary Care service (allowing patients to see healthcare providers by video visits from home), which grows by hundreds and thousands of visits in late March. And who are likely the folks driving up Virtual visit volume at end of March? Yes, probably patients with Covid-19 symptoms.

Furthermore, Denver Metro is (I believe) more likely to have heard of UCHealth’s virtual urgent care and virtual visit service, more so than people in other Colorado communities.

Finally, looking at the newly Covid+ patients in each of our hospitals during that same time frame (not a cumulative hospital census number), you DO see an increase in admissions the week of 3/20, and yes, more cases in the more densely populated metro Denver (blue line) but the peaks are synchronous and NOT trending differently from the other regions. If the divergent yellow Denver line (above) represented a real increase in spread, the below blue line should spike and continue to grow off the chart.

CONCLUSION 2: Be careful what you conclude! Knowing some of the underlying story, I conclude the divergent yellow line is NOT a disease spike, but a change in behavior and a new service starting AND some increased rate of spread in Denver.

DATA SET 3: COMPARE ONE REGION’S SYMPTOMS VS HOSPITALIZATIONS

One more exploration: could chief complaints (Cough, Fever, Shortness of Breath) of patients presenting to clinics BY REGION possibly explain an increase in Covid+ patients a few weeks later BY REGION? Perhaps use the data as an early-warning signal for hospitals that a Surge is coming, that the curve is about to go exponential? A leading indicator and not a trailing indicator?

Here’s Chief Complaint in Denver Metro (percent of visits):

Here’s Chief Complaint in Denver Metro (actual visits):

Here’s hospital admissions for Covid+, Denver Metro:

What is your analysis? Make up your mind … then scroll on.

CONCLUSION 3: I see the “percentage” of complaints start growing steeply on Feb 21. I see the hospitalizations start to rise Mar 13, about 4 weeks later. I see “actual count” of complaints peak and decline after Mar 13. I see hospitalizations peak and decline Mar 27, about 2 weeks later. We Found a Signal!

Danger, Will Robinson!

This is post-hoc data analysis at its best, looking back at the data in hindsight and saying “Of course I was right all along.” It fits a good story, infection rising in the community and the sickest showing up about 4 weeks later, infection falling in the community, and Covid-19 admission cases falling a couple weeks later. Maybe there is some truth here.

However, looking at data and graphs from another region, the Fever/Cough/Shortness of breath curve stays mostly flat, and yet the Covid-19 hospitalization bumps same time as Denver.

Go figure.

I hope this jaunt through the data gets you interested in thinking about data, in seeking patterns, in questioning your findings, in considering viral behavior, disease behavior, human behavior, health system behavior, government behavior.

And, we are thankful that our infection rate, our hospital capacity, our leaders in Colorado, our government/business/public health/health system/community leader relationships are strong and can work well together.

CMIO’s take? Data analysis is hard. Sometimes you find signal. Sometimes you find noise. Sometimes you mistake the one for the other. Armchair theorists and even amateur data dilettantes (including some enthusiastic CMIO’s) should be careful.