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Abraar Karan

@AbraarKaran

Feb 20

1/ Unmasked exposures & Long Covid 🧵

There is potentially a relationship between inoculum dose (amount of virus you are exposed to when you get infected) & development of #LongCovid

Having higher early viral load may increase risk of Long Covid

nytimes.com/2022/01/25/hea…

@MonicaGandhi9

2/ Earlier in the epidemic, @MonicaGandhi9 & Dr Rutherford from UCSF brought up variolation hypothesis as it relates to masking

Could masks have the benefit of reducing the viral load you are exposed to & could this potentially lessen severity of disease + prime immune system

3/ What is concerning now— if you pull back on mask mandates with high community incidence, especially in places with low vaccination / low booster rates

Lots more unmasked viral spread

Higher potential proportion of #LongCovid cases esp in these areas

Important to track this

Read 4 tweets

Abraar Karan

@AbraarKaran

Feb 19

False dichotomies like lockdowns versus dropping all safety measures (“restrictions) are largely unhelpful & serve only to polarize

We can have safer schools.

We can have safer workplaces.

We can have safer public spaces.

We can drive & keep incidence down.

2/ The immediate reflexive response to this is always “but vaccines”

‘Vaccine only’ strategies will not work

The roll out of boosters every season (or more) will not keep up with future virus surges

They won’t fully protect us if we are faced urgently w a deadlier variant

3/ Vaccines are amazing - they prevent severe disease & death. They likely play a role in reducing Long Covid/ significant inflammation. Get vaxx’d

But even now our roll out of both primary doses and boosters has been too slow and/or patchy across states. Omicron outpaced us.

Read 4 tweets

Abraar Karan

@AbraarKaran

Feb 7

@JAMA_current

In our ⁦@JAMA_current⁩ piece, we lay out a few key reasons that hospital-based #covid19 transmission is likely underappreciated.

1/ few hospitals systematically test patients throughout and following their hospital stays. jamanetwork.com/journals/jama/…

2/ “Most hospitals only test patients for SARS-CoV-2 at the time of admission and therefore may miss some infections acquired after admission, especially because approximately 40% of SARS-CoV-2 infections are mild or asymptomatic and thus do not trigger repeat testing.”

3/ “Furthermore, hospital stays for many non–COVID-19–related conditions are short, so some infections will only develop after discharge and will be missed or misattributed to posthospital exposures”

Read 4 tweets

Abraar Karan

@AbraarKaran

Feb 5

1/ The biggest confounder in this study was the possibility that those who were more likely to mask in 2021 were more likely to only be doing lower risk indoor activities vs those without masks who were more likely to be doing higher risk ones.

cdc.gov/mmwr/volumes/7…

2/ For example, it is possible that those who reported not wearing a mask indoors were also more likely to be eating indoors or drinking at bars indoors near others

while those reporting wearing masks indoor may have been shopping for essentials in less crowded settings

3/ Unfortunately, we don’t have that information (authors could run this analysis though)

We only know that those who reported always wearing a face mask were much less likely to test positive than those who reported never wearing a face mask

Read 10 tweets

Abraar Karan

@AbraarKaran

Feb 4

**New CDC MMWR**

Those reporting consistent mask use in indoor public settings were significantly less likely to test positive for #covid19

The effect was greatest in those reporting consistent N95 mask use

cdc.gov/mmwr/volumes/7…

2/ The data in favor of using N95 respirators for shared air / public indoor spaces during surges will continue to grow. Those who are skeptics will eventually come around. But the time lag will result in many needless infections, hospitalizations and deaths. It already has.

3/ Limitations of studies are always important.

Authors mention: “First, this study did not account for other preventive behaviors that could influence risk for acquiring infection, including adherence to physical distancing recommendations”

So one confounder here…

Read 6 tweets

Abraar Karan

@AbraarKaran

Feb 1

Writing up a case report that makes clear that immunologic consequences of #covid19 even weeks after recovering can be devastating; it’s unbelievably frustrating how many people outside of medicine confidently assert that “you’ll be fine” when doctors cannot even assert this.

2/ Any doctor that has been regularly taking care of #covid19 cases over the past two years can tell you that what we have seen has surprised us. There is still so much we are learning. Ascribing to a strategy that allows for wide spread is irresponsible.

3/ I know that many folks are tired & over it. I am also tired as are many colleagues who still understand that reducing transmission and creating safer environments within which we work, learn & socialize is what we should be demanding of our leaders.

Read 4 tweets

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