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1/ Big thanks all of you on @Twitter for the interest in my thread regarding current literature on #microthrombi and #COVID19!

It’s late, so of course, more thinking and more questions about #SARSCoV2

THREAD

@ASH_hematology @EricTopol @tmprowell @kari_jerge #medtwitter
2/ Conclusion 1: I am convinced the primary driver of #SARSCOV2 infection is in asymptomatic individuals #medtwitter #nursetwitter #epitwitter

SARS-CoV-2 titers in wastewater are higher than expected from clinically confirmed cases
medrxiv.org/content/10.110…
3/ Conclusion 2: #SARSCOV2 does not discriminate. It literally infects EVERYONE.

Newborns, kids, young adults, elderly you name it…it’s infected it. Everyone has #Ace2 receptors.

Children ARE getting it (see #China data and reports of acro-ischemia and
petechiae)
4/ #COVID19 SEVERITY is another topic that I will get to soon.

Note: For discussion of SYSTEMIC #healthcaredisparities & #racism please check out @ucheblackstock and @esterchoo. This is not my area of expertise but has SIGNIFICANT implications on who will disproportionately die
6/ This paper just came out on Friday showing

31% incidence of #thrombotic complications in #ICU patients with #COVID19 infections! (WHAT?!)

@ASH_hematology @EricTopol

Incidence of thrombotic complications in critically ill ICU patients with COVID-19
sciencedirect.com/science/articl…
7/ OK now for more questions:

Why are we seeing such a variety of presentations with #COVID19 ?


As with many infections with a pathogen, with #SARSCoV2, I think this comes down to:

- Pre-existing disease state
- Immune system status
- Viral load
- Genetics/hormones
8/ SARS2 is an upgraded SARS.
The more compact structure, and several other small differences, allows #SARSCoV2 to attach more strongly to the human #Ace2 receptor, enabling it to better infect cells and spread faster than the original SARS coronavirus.
research.umn.edu/inquiry/post/r…
9/ Random question...What about the eye?

While not the primary mode of transmission, it is certainly possible to get respiratory droplets in the eye

Could the reported cases of conjunctivitis be associated with microthrombi or damage to the eye capillaries?
@DGlaucomflecken
10/ Other interesting papers I ran across:

The modeling of COVID19 pathways sheds light on mechanisms, opportunities and on controversial interpretations of medical treatments. arxiv.org/pdf/2003.11614…
11/ Increasing Serum Soluble Angiotensin Converting Enzyme 2 Activity following Intensive Medical Therapy is Associated with Better Prognosis in Acute Decompensated Heart Failure
ncbi.nlm.nih.gov/pmc/articles/P…
12/ Lastly, I am a Women’s Health NP. I fully acknowledge that I am not an infectious disease specialist, epidemiologist, immunologist, cardiologist, geneticist, or physician.

I just keep asking questions.

Have to do something with my COVID-induced insomnia #WhenImUpAtNight
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Regarding presentations and treatment options, I'll defer to @farid__jalali 's excellent summary below:
Obviously these are #HOST variables.
There are also #PATHOGEN variables: ie strains/mutations to take into account
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