The movies get viral hemorrhagic fevers wrong

The granddaddy of all - Ebola - is often mistaken for malaria, sometimes cholera or the flu

It spread for months in West Africa undiagnosed before one salient symptom was noticed - hiccups - by someone who knew Ebola
Ebola starts off mild
It's just a sudden fever. "It must be malaria"
Symptoms are "dry" - maybe a cough, headache, fatigue
Wet symptoms may take a week to develop - lots of watery diarrhea, vomiting.
Viral loads climb with illness and virus spreads more easily with wet symptoms
Most Ebola patients do not have heavy bleeding and never like the movies
Heavy bleeding with miscarriage or delivery, exposing midwives and other attendants, is common
Bruising or bleeding with IV's also happens
Bleeding zombies in the movies, not so much
ncbi.nlm.nih.gov/pmc/articles/P…
Likewise, other viral hemorrhagic fevers will cause no such hemorrhaging in most patients - from Marburg to Lassa to yellow fever to dengue to RVF to CCHF. Many may even be asymptomatic.

Bleeding may even be more common from other causes - sepsis, malaria, a fall

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with Infectious Diseases

Infectious Diseases Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @InfectiousDz

2 Jan
We can't pretend our way out of an epidemic. Paxlovid has tremendous promise. Problem is, there are more cases in one day than Paxlovid courses expected during this surge.
We need ethical means of allotting these courses for maximal benefit. Otherwise, it's 1st come, 1st served🧵
Headlines say the US bought 10 million courses. These won't arrive until July. The total allotted in January and December will be fewer than the almost 500,000 cases the US is recording a day

This is what the US has sent to each state and territory:
phe.gov/emergency/even…
NY State reported 85K new cases yesterday. NY state currently has 3,180 courses, that's not for one day, that's total currently allotted. full stop.

DC reports over 2000/day on average. It has 40 doses allotted.
Read 11 tweets
2 Jan
The criteria for prescription of Paxlovid are starkly different in different geographic areas and between public and private health systems.

This is a huge equity issue.

First come, first service apparently.
Paxlovid will run out soon.
NY State guidelines allow for Paxlovid for vaccinated individuals under 65 and 2 risk factors

NY City public health system only has the med for
immunocompromised or over 65, unvaccinated, with risk factors

This prioritizes those with private doctors and private pharmacies
The US state of Maryland has 960 courses. The guidelines would mean with almost 9000 cases a day that there would be enough eligible persons to use up the supply in one day.
Read 6 tweets
9 Dec 21
For those not working in epidemiology:

Omicron isn't Pac Man

It's not chasing down the few with no past infection or vaccination

Most have been infected or vaccinated in South Africa and worldwide

To spread this fast, this variant has been infecting those with some immunity
This changes how we quantify its risk.
It is a bit of the tortoise and the hare.

Variants that quickly infect in naive populations are like the hare. High R0

Variants that keep chugging along despite immunity may be the tortoise. High Immune Escape

Tortoise can win in the end
A bit of terminology
R0: # 2ndary infections per initial infection in a naive population
Intrinsic R0 no longer alone determines spread as the world is no longer naive to COVID

Rt or Reffective describes 2ndary infections in real time in an outbreak w/immunity, behavior change
Read 5 tweets
29 Sep 21
In August, an 80 year old man woke up to find a bat on his neck. Bat tested positive for rabies. The man reportedly refused the vaccine. He died of rabies. First death in Illinois from rabies since 1954.
dph.illinois.gov/news/illinois-…
So far this year, 30 bats have tested positive for rabies in Illinois. More than 1,000 bats are tested for rabies each year in Illinois due to a possible exposure. Approximately 3% of tested bats are positive for rabies.
So what is post-exposure prophylaxis for rabies?
- Clean wound with soap and water (or povidine-iodine)
- Immunoglobulin if never vaccinated for rabies
- 4 doses (immediately, then days 3, 7, 14) Image
Read 16 tweets
2 Sep 21
Which countries are rolling out 3rd vaccine shots?
Israel offering 3rd doses currently to all vaccinated 12+
reuters.com/world/middle-e…
Starting in September, Germany will offer another dose of Pfizer or Moderna to older people, residents of care homes, and people with compromised immune systems — and also to anyone who was already fully vaccinated with the 2-dose AZ or single-dose J&J
nytimes.com/2021/08/02/wor…
Read 24 tweets
1 Sep 21
HIV made the news because yet another vaccine failed. The real story is the impact of COVID on HIV and in turn on COVID. Roll out of a new med worldwide, dolutegravir, delayed. Many missed appointments, refills, doses. Others weren't diagnosed.
This impacts not just HIV but COVID
The cascade of HIV care - learning diagnosis, starting treatment, returning for appointments and viral load testing, adherence, HIV viral suppression - has had interruptions over the past 1.5 years worldwide.
Worldwide we have seen drop offs in service delivery along this cascade of care.
theglobalfight.org/covid-aids-tb-…
This means people are missing their diagnosis, their meds, their control of the virus, and the chance to be healthy and also non-infectious
Read 13 tweets

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal

Or Donate anonymously using crypto!

Ethereum

0xfe58350B80634f60Fa6Dc149a72b4DFbc17D341E copy

Bitcoin

3ATGMxNzCUFzxpMCHL5sWSt4DVtS8UqXpi copy

Thank you for your support!

Follow Us on Twitter!

:(