1/🧵 Brain + Body damage in #COVID & Critical Illness
 
Sepsis -bacterial, viral, fungal- can cause rapid-onset #dementia. Finishing this test should be easy at her age but Millions of brain cells are damaged!

Protect yourself & others: #Vaxx + #Mask

H/T @trishla_17 for helping
2/ Our brain depends on a delicate balance of blood flow, nutrients & oxygen. When someone gets critically ill w #Covid or from other causes, that balance is dramatically disrupted. Small blood clots, dropping oxygen levels cause 🧠 damage.

bit.ly/36K5F65
3/ It’s odd to me that people don’t see severe COVID as a form of VIRAL SEPSIS. Sepsis is when infection of any kind causes your organs to begin to fail – lungs, brain, heart, kidneys.  It’s EXACTLY what we see day-in day-out in the COVID ICU.
 
bit.ly/3eM8pUx
4/ Of ICU patients with #COVID, about 80% have sepsis, 90% have #ARDS, and 20% of ward patients with COVID get admitted to the ICU. Death Certificates should include “Viral Sepsis caused by Coronavirus.”
5/ #LongCOVID patients who were in the ICU will also have #PICS. So learn about the dementia, PTSD, depression, and physically disabling disease that plagues survival after COVID. The overall burden of the pandemic is staggering.

Read up…
bit.ly/3ER4uQM
6/fin
There is #HOPE for ICU survivors. If they work diligently with Physical and Occupational Therapists and do cognitive rehabilitation as well. Brain and body function will be optimized on the back-end to restore quality of life.

Of course, prevention via #Vaxx #Mask is best.

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More from @WesElyMD

4 Jan
1/🧵🎥 A young mom suffering #COVID. Her husband is scared.

We need to prevent serious long-term complications. Her new normal will likely include PTSD, Dementia, Depression & severe physical disability. (shown w Perm)

Not so “mild” ➡️ Do you want this?

#vaccinate
#LongCOVID
2/ what you need to know about ICUs, #PICS and #LongCOVID prevention:

I wrote this @thedailybeast piece👇 to help empower you as patients & families. It’ll tell you what you need to know & ask your team for amid the chaos and confusion.

There’s more…

bit.ly/3DhC6Xe
3/ This patient on 100% O2 and high-dose propofol & fentanyl did not need both agents. When able, we try to avoid prop & benzos. We stopped Prop, continued Fentanyl & added dexmedetomidine because it’s shorter acting & won’t build up so much in her brain.

This is the #A2Fbundle.
Read 7 tweets
4 Jan
1/🧵 You test positive for #COVID.

Should you take the COVID Pill?
 
Two free options available soon from stores like Walmart:
1. Paxlovid + Ritonavir
2. Molnupiravir

Who takes them?
Vaxxed or Unvaxxed?
Whats the deal?

Read this new thread to accompany data I posted👇
2/ Once available, people should take eg Paxlovid (2x daily for 5 days regimen) if they

1. are symptomatic
2. have 1 risk factor for progression to severe disease or 60 years and older
3. do not have severe liver and kidney disease.

bit.ly/3Jc0Nsp
3/ That’s who was studied. The Paxlovid study is not out yet so I’m waiting to read the list of risk factors but it’s stuff like obesity, immunosuppression, diabetes, asthma & hypertension.

Will this drug benefit people at less risk? Probably but we don’t know yet definitively. Image
Read 8 tweets
25 Dec 21
1/🧵 Christmas Reflection on Gratitude

My patient today - IN THE ICU on Christmas - said:

“I’m sorry for complaining, Doctor. I realize that if I have time to complain, I have time to say ‘thank you’ too.”

WHOA!
 
I will be w my patients today & throughout the Holidays…
2/ …many of these people are suffering #COVID lung failure that might end their lives. For them & for me, it brings into perspective what matters.

In the picture above (1st tweet), we are with a recovering pt, letting her see the 🌞.

It’s for #Hope & a vision of her future
3/🎥 “It’s a Wonderful Life”

We watched this classic last night and it helped me think of how we all must be in community to lift one another up during these hard times…see ending clip here ☺️

…this message never gets old!
Read 7 tweets
23 Dec 21
1/🧵 Molnupiravir & Paxlovid are BOTH approved for EAU (emergency use) as pills for #Covid to reduce hospitalization and/or death if taken EARLY (w/in 5 days).

This ⬆️ our need for Rapid Tests!

Primary prevention is #Vaxx. 🤛

A few thoughts…

FDA - bit.ly/3ElTef1 Image
2/ Which drug? When? Why?

Both drugs reduce likelihood of you being hospitalized if you take them early. The actual scientific publication of Pfizer’s #Paxlovid is not out yet, so I’m waiting to read peer-review data before firm stance.

But...

bit.ly/3Jc0Nsp
3/ Molnupiravir - 👇 @NEJM paper & conclusion.

You might think the story is clear. But it’s not.

1st half of study period yielded strong results but 2nd half did not…see 1 & 2.

Only 3% difference, so 1 improvement for every 33 pts treated.

bit.ly/3FEJ377 Image
Read 9 tweets
23 Nov 21
1/🧵🎥 COVID & Thanksgiving Safety: 🍁

Use of Rapid Antigen Testing❓

I’m getting lots of QUESTIONS about eating Tgiving turkey w people who are not #Vaxxed. A very safe thing to do is have people cleared by a rapid Ag test.

Watch 2 min👇: @michaelmina_lab & I’ll unpack…
2/ It’s NOT a brain biopsy like PCR. More like picking your nose. 😂

Legit Rapid Ag tests you get commercially at a drugstore or online will tell you: AM I INFECTIOUS?

Am I shedding COVID virions in a quantity that places others at risk.

I’m NOT endorsing any one test here. Image
3/ PCR is the most sensitive way to detect COVID globally. @US_FDA & @CDCgov say so and that’s technically accurate. But (1) PCR takes too long & is not practical for YOUR purposes (outdated by the time you’re w mom). (2) PCR will stay positive way longer than you are infectious!
Read 8 tweets
17 Nov 21
1/🧵COVID Antibody Lunacy 🌚

Antibodies can NOT be used “rule out” #LongCOVID and should NOT be used to determine if you are immune or if the vaccine “worked.” This perspective in @JAMA_current outlines flaws in such thinking. I review highlights…👇

bit.ly/3ckYFQ0
2/ The FDA already stated we don’t have established thresholds to interpret Antibody tests.

They are NOT usable reliably to see if you were infected (esp after vaccine). The tests are not standardized yet & WHO doesn’t include in #LongCOVID definition.

bit.ly/3ljLpQK
3/ If you’re trying to prove you had COVID or #Vaxx response, don’t fall for $170 direct to consumer testing for routine Antibody checks. It’s not nearly that simple.

EG: #Vaxxed or previously infected people could test negative on some assays despite having immunity.
Read 8 tweets

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