Ian Ricksecker Profile picture
Jan 5 43 tweets 14 min read
PSA: COVID-19 isn’t “just a cold,” isn’t “a respiratory virus,” and “mild” doesn’t mean what you think it does.

If you “aren’t scared of COVID”, this thread is for you.

Please R/T if it opens your eyes.
This thread is long, and hard to read - not just because of the technical language, but because “it’s just a cold,” “the vaccine protects me,” and “at least our children are safe” are comforting fairy tales.

I wish they were true.
This virus is like measles and polio: a virus with long-term impact.

Even a “mild” case in a vaccinated individual can lead to long-term issues which cause a measurable uptick in all-cause mortality in the first 6 months, and get progressively worse with time.
SARS-CoV-2 is a systemic disease which has multiple avenues to induce long-term impairment, attacking the brain, heart, lungs, blood, testes, colon, liver, and lymph nodes, causing persistent symptoms in more than half of patients by six months out.
The CoVHORT study, limited to non-hospitalized patients in Arizona - “mild” cases - found a 68% prevalence of 1 or more Covid symptom after 30 days, rising to 77% after 60 days. (We will explore an explanation later).
Bell et al, journals.plos.org/plosone/articl…
Despite a different definition of “symptoms”, the Bergen study in Norway found that 61% of patients had symptoms after six months, including 52% of patients aged 16-30 years who had not been hospitalized.
Blomberg et al, nature.com/articles/s4159…
To prevent panic, @CDCgov has been using the term “mild” to describe any case of COVID-19 which does not require hospitalization.

#LongCOVID, however, is anything but “mild”, as the replies to @ahandvanish's thread make heartbreakingly clear.
A University of Washington study found that 30% of Covid patients had reduced Health Related Quality of Life, with 8% of the patients limited in routine daily activities.
Logue et al jamanetwork.com/journals/jaman…
These patients are struggling with real physical issues.

This Yale study demonstrated reduced aerobic capacity, oxygen extraction. and ventilatory efficiency in “mild” COVID patients even after recovery from their acute infection.
Singh, et al journal.chestnet.org/article/S0012-…
It’s also a vascular disease. A Columbia study found "significantly altered lipid metabolism" during acute disease, which "suggests a significant impact of SARS-CoV-2 infection on red blood cell structural membrane homeostasis."
Thomas, et al pubs.acs.org/doi/10.1021/ac…
Oregon Health & Science University found that “symptomatic or asymptomatic SARS-CoV-2 infection is associated with increased risk of [fatal] cardiovascular outcomes and has causal effect on all-cause mortality.”
Tereschenko et al
Let’s review: SARS-CoV-2 causes an increase in mortality and reduced aerobic capacity even after asymptomatic cases, and remains in the body months after the initial infection.

No, it’s not “just a cold.”

But we’re just getting started. It gets worse. Way worse.
The virus appears to be able to cross the blood-brain barrier and cause significant neurological damage.

The ability of the spike protein to cross the blood-brain barrier was demonstrated in mice at the University of Washington.
Rhea, et al pubmed.ncbi.nlm.nih.gov/33328624/
A joint study by Stanford and Germany’s Saarland University found inflammation in the brain, and “show[ed] that peripheral T cells infiltrate the parenchyma.”
Yang, et al nature.com/articles/s4158…
For context, the parenchyma is the functional tissue of the brain - your neurons and glial cells. It isn’t normally where T cells are:

“In the brain of healthy individuals, T cells are only present sporadically in the parenchyma.”
Evans, et al ncbi.nlm.nih.gov/pmc/articles/P…
The Stanford study also discovered microglia and astrocytes which displayed “features .. that have previously been reported in human neurodegenerative disease.”
Yang, et al, above
Post-mortem neuropathology in Hamburg, Germany found “Infiltration by cytotoxic T lymphocytes .. in the brainstem and cerebellum, [with] meningeal cytotoxic T lymphocyte infiltration seen in 79% [of] patients.”
Matschke, et al sciencedirect.com/science/articl…!
An autopsy of a 14-month-old at Brazil’s Federal University of Rio de Janeiro found that “The brain exhibited severe atrophy and neuronal loss.”
Gomes, et al thelancet.com/journals/lanam…
The UK Biobank COVID-19 re-imaging study compared before and after images of “mild” cases, and found “pronounced reduction in grey matter” and an “increase of diffusion indices, a marker of tissue damage” in specific regions of the brain.
Douaud ++ medrxiv.org/content/10.110…
That seems to explain why there is evidence of persistent cognitive deficits in people who have recovered from SARS-CoV2 infection in Great Britain.
Hampshire et al thelancet.com/journals/eclin…
Also worrisome are syncytia, where an infected cell extrudes its own spike protein and takes over its neighbors, fusing together to create a large multi-nucleus cell.

Delta's particular aptitude for this may partly explain its severity.
Lightfoot news-medical.net/news/20211006/…
And, yes, syncytia formation can happen in neurons. For our visual learners, here is video of syncytia and apoptosis (cell death) in a (bat) brain:
Aicher et al
Luckily, the University of Glasgow found that “Whilst Delta is optimised for fusion at the cell surface, Omicron .. achieves entry through endosomal fusion. This switch .. offers [an] explanation for [its] reduced syncytia formation.”
Willet et al gla.ac.uk/media/Media_82…
If you’re interested in further understanding the host of neurological symptoms and the mechanisms underlying them, this Nature article is an excellent primer:
Marshall nature.com/articles/d4158…
Let’s review: SARS-CoV-2 can cross the blood-brain barrier, and even “mild” or asymptomatic cases can cause loss of neurons and persistent cognitive defects?

That doesn’t sound “mild” to me; I like my brain.

But it keeps getting worse.
The brain isn’t the only organ affected: Testicular pathology has found evidence of “SARS-Cov-2 antigen in Leydig cells, Sertoli cells, spermatogonia, and fibroblasts” in post-morten examination.
A Duke pathology study in Singapore “detected SARS-CoV-2 .. in the colon, appendix, ileum, haemorrhoid, liver, gallbladder and lymph nodes .. suggesting widespread multiorgan involvement of the viral infection.”
Cheung, et al gut.bmj.com/content/gutjnl…
The same study found “evidence of residual virus in .. tissues during the convalescent phase, up to 6 months after recovery, in a non-postmortem setting,” suggesting that “a negative swab result might not necessarily indicate complete viral clearance from the body.”
It also causes microclots: “Fibrin(ogen) amyloid microclots and platelet hyperactivation [were] observed in [Long COVID] patients,” in this work by Stellenbosch University of South Africa, which also explored potential treatments.
Pretorius et al researchsquare.com/article/rs-120…
Let’s review - SARS-CoV2 attacks our veins, blood, heart, brain, testes, colon, appendix, liver, gallbladder and lymph nodes?

No, it’s not “just a respiratory virus”.

Not even close.
There are also immunology implications:

Johns Hopkins' @fitterhappierAJ found that “CD95-mediated [T cell] differentiation and death may be advancing T cells to greater effector acquisition, fewer numbers, and immune dysregulation.”
Leonardi et al frontiersin.org/articles/10.33…
This Chinese military study of the initial Wuhan outbreak concluded that “T cell counts are reduced significantly in COVID-19 patients, and the surviving T cells appear functionally exhausted.”
Diao et al frontiersin.org/articles/10.33…
The study authors went on to warn, “Non-ICU patients with total T cells counts lower than 800/μL may still require urgent intervention, even in the immediate absence of more severe symptoms due to a high risk for further deterioration in condition.”
Those warnings have since been proven by discovery of autoimmune features.

This study of 177 Los Angeles healthcare workers found that all had persistent self-attacking antibodies at least 6 months after infection, regardless of illness severity.
In the words of T-cell immunologist Dr. Leonardi (@fitterhappierAJ)
This Kaiser Permanente S.California study found that, although natural immunity provided substantial protection against reinfection, “Hospitalization was more common at suspected reinfection (11.4%) than initial infection (5.4%).”
Slezak et al
In fact, remember those cytokine storms? It turns out that even that even severe COVID-19 may not be a viral pneumonia, but an autoimmune attack of the lung.

Let’s review - it’s autoimmune: SARS-CoV2 convinces our body to attack itself.

That might explain why the Arizona study saw more symptoms after 60 days than at 30 days.

It also means “natural immunity” isn’t something to count on.
But if you’re counting on vaccination to feel safe, there’s even more bad news.

A study of Israel healthcare workers found that “Most breakthrough cases were mild or asymptomatic, although 19% had persistent symptoms (>6 weeks).”
Bergwerk et al nejm.org/doi/full/10.10…
Perhaps the most terrifying study is from Oxford University, which examined the effects of vaccination on long COVID symptoms, because not only did it find that vaccination does not protect against Long Covid, but that Long Covid symptoms become more likely over time:
(40/🧵) Graph shows % long COVID fe...
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More from @IanRicksecker

Jan 15
After my recent long thread on Long Covid, one of the most common questions I received was "What can I do to protect myself and my family?"

Here are my answers - this is more personal, with less linked support.
The first thing is to understand that COVID is AIRBORNE.

That means, viral particles linger in the air, like motes of dust do, circulating but not necessarily landing.

So, what can we do?
LPT: Don't breathe them.

Obviously, no measures are 100% to prevent infection, but you can do a lot to reduce your odds of infection per exposure.

Importantly, every step each individual takes is an improvement for everybody in the family's odds.
Read 34 tweets
Jan 14
@POTUS @CDCDirector @CDCgov
This change is not helpful for public discourse about pandemic mitigations.

This change in information gathering will happen right at the peak of deaths from those being infected with Omicron.

It looks a lot like "hiding the toll of our decisions."
I strongly encourage the administration to reverse this decision, and keep "Previous Day's COVID Deaths" as a reliable metric at national, state, and local levels.

Whether we wish it or no, the disease is not becoming endemic: data is critical for making informed decisions.
Here is further discussion: this change is removing ONE channel by which these deaths are reported (hospital to federal), but not all channels.

Read 7 tweets
Jan 14
Received from @sdschools, to all parents:

"Dear San Diego Unified Family,

Across the country, the Omicron variant is challenging school communities and preventing large numbers of students and teachers from coming to class every day. Although San Diego Unified is ...
"... experiencing these same challenges, we continue to believe that school is the best place for students to be. This has been demonstrated by multiple studies showing students are actually safer in school than in communities where the virus is widespread.
"We are encouraged by the advice we have received from medical experts predicting that the current COVID-19 surge is a temporary situation. However, we cannot afford to be complacent. It is clear the new variant is highly contagious and has infected thousands of children ...
Read 23 tweets
Jan 13
Local situation: San Diego, Wed 12th Jan 2022

Rₑ is 2.08 - each new case goes on to infect two more. Graph, shows increase in Rₑ...
14,734 new cases 11th January 2022 with 46,885 tests reported (positivity: 31.4%)

The 7-day average of positivity is 28.1%.

ICU capacity is at 20%

Hospitalization increased 16.7% in the past 3 days.

The community Case Rate is 100 times the "desired" level of 1.9. Case rate: 196.4 per 100,00...
Read 7 tweets
Jan 12
Let me be very clear: no matter how much you disagree with their policies, committing arson* at the home of our duly elected representatives does not make you a "patriot". It makes you a terrorist and a traitor.

(* - suspected)
Supervisor @nathanfletcher is a decorated Marine, honorably discharged as a Staff Sergeant, who saw combat in Iraq.

He has continued to serve the public as an elected servant, and he honors his oath to uphold the Constitution of the United States.

If, as suspected, this was an intentional act, it is a criminal act of cowardice, and a betrayal of the United States.

I hope any patriot with information about the craven criminal responsible will turn their suspicions over the the @SanDiegoPoliceD.
Read 4 tweets
Jan 8
After an exposure scare in our family, we built a Corsi-Rosenthal box at home today.

Total supplies: $93 USD, in stock for same-day pickup at Home Depot.

Addt'l tools needed: 1 ruler, 1 knife, 1 scissors.
The folks at @CleanAirCrewOrg have great, easy-to-follow instructions at

And after taking a look at the Hall of Fame, my ten-year-old is super excited to decorate ours.

DIY art project that protects her family? Yes, please, Dad!!!

Read 5 tweets

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