Thanks Shimmaa, for your suggestion. So choose specific use case(s) and customize ? Do you have a real use case in mind? If so, what is its specification? At present our system is a generic simulator but has been calibrated from real clinical studies (Yang et al., 2020; Hotchkiss et al., 2013): the inputs are patient previous health state and virulence on day 1 entering the hospital (related to viral load) and the system then simulates (over a 20 day time period) the evolution of the viral load, M1, IL6, among others (so these can be considered outputs for a given point in time).

Suggest using several different clinical COVID scenarios.

1. Patient with normal vital signs, complaining of cough, congestion and shortness of breath but has history of HTN, and Diabetes- treatment plan is discharge and out pt follow up for monoclonal antibodies, etc. Triage green (walking wounded)

2. Patient with mild tachycardia and moderate hypoxia O2 sat 85% complaining of cough, congestion and shortness of breath - treatment plan is supplemental O2 via NC, admission, steroids, anticoagulant, etc. Later, the O2 sats drop even lower to 70% (while on O2 via NC) requiring HFNC and consider proning pt to improve O2 sats

Triage yellow

3. Patient with moderate tachycardia (HR 140) and severe hypoxia O2 sat 70% complaining of cough, congestion and minimal shortness of breath - treatment plan is supplemental O2 via HFNC and consider proning pt to improve O2 sats.

Additional treatment plan includes admission, steroids, anticoagulant, etc.

triage red

4. Patient with moderate tachycardia (HR=140) tachypnea RR=50 and severe hypoxia O2 sat 70% complaining of cough, congestion and severe shortness of breath - treatment plan place pt on HFNC and prepare pt and equipment for intubation. Additional treatment plan includes admission, steroids, anticoagulant, etc.

Triage red

5. 95 year old nursing home patient with hx severe dementia in cardiac arrest known COVID positive for one week ago. DNR no treatment triage black

Dear Juan,

Thank you very much for your detailed suggestions for the scenarios.

I have passed this on to the other co-authors and we will send you any further feedback/comments.

As an initial thought, we can revise our control parameters and formulas to take into account/incorporate the symptoms you mention, O2 sat and treatment plans/actions.

Best regards,

David

Amazing what simulators can do these days. Today making a dynamic scenario can now be full automated with fluctuating oxygen levels, blood pressure, cardiac arrhythmias, etc. These dynamic changes can based on either time from the start of a scenario or the student not performing the right intervention in a timely manner. Best wishes.

Dear Juan,

With respect to your clinical scenarios, we would need some data relating to these scenarios to be able to try or match them. So we would ask if you have some corresponding data available or know of available datasets?

Then, with respect to the simulators, thanks for suggesting this. What you mention seems to be a vital signs simulator, which we would understand is (relatively) simpler than our simulator of the immune system. Could you recommend such a simulator (commercially available or research)?

Thanks and best regards,

David

I do not have a specific data set. Those were just common real life scenarios that I have seen repeatedly since the start of the pandemic here in North Carolina that began in March 2020.

Several different simulators on the market here in Northern America. Not sure which ones are available in Europe. But below are three brands that we looked at Leardal, Simulaids, and Nasco.

Ok, thanks Juan. We will follow those up.