Why do some pts w/ #COVID19 get sick & stay sick after their acute infection has resolved?

What exactly is #LongCOVID, "post-acute COVID19" or "chronic COVID19 syndrome" (whatever we call it)?

Learn what's known about this complex, poorly understood condition: A thread (1/15)
(2/15) First, a review:

🦠#COVID19 is a non-segmented, enveloped, (+)-sense virus
🦠Named "SARS-CoV-2" (like the SARS-CoV-1 virus from 2003)
🦠Illness it causes is #COVID19 infection
🦠Binds to ACE-2 receptors
🦠Causes a spectrum of disease w/ variable presentation & LT-sequelae
(3/15) In this thread, we call it #LongCovid. It occurs when symptoms persist ≥ 12 weeks after acute infection clears & are not better explained by an alt Dx🤷

Some key ❓s are:
❓Genes involved
❓Best #prevention
❔Best Rx
❓Will vax help
(4/15) #LongCovid is a growing #publichealth #crisis. It causes persistent symptoms & #debility

~1 in 4 are painful. Many body systems may be involved beyond CV & pulm. Top 3 most freq. reported s/s include:

🥱#Fatigue (&⬇️#stamina)

dig.abclocal.go.com/wls/documents/… Image
(5/15) #COVID19 infection often requires intubation, prolonged #ICU stays, time under sedation & NMB, & causes SIRS

#LongCovid thus can clinically resemble post-intensive care syndrome, or PICS, &➡️👇 QoL. However, its exact pathogenesis remains elusive

aftertheicu.org/what-is-pics Image
(6/15) How common is it? According to #research from @TheLancet 3 in 4 pts will suffer at least 1 sign or symptom 6 mo after #COVID19 infection!

The ambidirectional cohort study followed subjects D/C'd from a Chinese hospital bet. January & May of 2020:

(7/15) Extrapulmonary manifestations include, but are not limited to:
🫀 Cardiovascular

The list is not exhaustive. Are you seeing anything else? Tell us below👇
(8/15) A note about neuro sequelae: 2/3rd of #LongCovid pts present w/ neuro symptoms🤯

It is well documented that #coronaviruses exhibit neurotropism. In post-mortem & prospective studies, a #neuroimmune rxn was demonstrated s/p #COVID19 infection but…

(9/15) …the secondary effects of critical illness & prolonged hypoxia seemed to explain disease, NOT neuroinvasive properties of the virus

TL;DR still too early to tell whether #LongCovid is due to an overreactive #immune response or the virus itself 🤔

(10/15) #COVID19 infection creates an extremely pro-inflammatory, pro-coagulopathic cytokine milieu. Pts w/ ⬇️ "#endothelial reserve" are at special risk

#Hypercoagulability results from interaction of:

pubmed.ncbi.nlm.nih.gov/32311448/ Image
(11/15) So what do we do for #LongCovid ? What’s the standard of care? We don’t have one yet, but we can at least assemble a high-quality, specialized IDT🤝

We would like everyone’s input on therapies that work well for your pts – please share who [ELSE!] is on your A-team👇
(12/15) For now, the best Rx for #LongCovid is #prevention & symptomatic care. Make sure to consult #Physiatry! To start, consider:

✅Early #mobilization (demonstrated to be safe in ICU-pts)
☑️Maintain #independence
✅Proactively identify deficits in #function
☑️DVT ppx PRN
(12/15 cont’d)

✅Prevent complications
☑️Quantify & improve QoL
✅Identify LT-sequelae
☑️COVID clinic & telemedicine

@JulieSilverMD, THE subject matter expert in #Prehabilitation, also suggests right sleep, #diet, #exercise, #education, & more:

(13/15) To summarize, key takeaways:

🔑Pro-inflammatory, pro-coagulopathic cytokine milieu
🔑⬇️Endothelial reserve as risk factor
🔑Presentation variable & unpredictable, resembles PICS
🔑Define your pts' needs
🔑Draft an all-star #team
🔑Best Rx = prevention & #supportive care
(14/15) “Courage & cheerfulness will not only carry you over the rough places in life, but will enable you to bring comfort & help to the weak-hearted & will console you in the sad hours when, like Uncle Toby, you have to ‘whistle, that you may not weep’” ~ Sir William Osler
(15/15) That’s it! Thank you @NHausMD, @dromarselod, @Beckwith_MD, @GeorgeRaumMed, & @jorgebilbao for your👀& guidance💪

This is my first #Tweetorial, so please be kind & drop suggestions/constructive criticisms

Also want to hear how YOU are managing #LongCovid below:

@JorgeBilbao15 sorry Jorge!

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