Covid: Look how far we've come!
Not a good week for the public. A number of leaders have surrendered to Covid and now we all must live with increased risk.
As an ~antidote, I wanted to share the progress scientists and doctors have made in beating Covid and reducing risk.
🧵
Not a good week for the public. A number of leaders have surrendered to Covid and now we all must live with increased risk.
As an ~antidote, I wanted to share the progress scientists and doctors have made in beating Covid and reducing risk.
🧵
What is Covid?
We understand both the virus (SARS-CoV-2) and the disease (Covid-19) so much better now.
The disease starts as a viral infection and then in a few people develops into a severe inflammatory response. This can then cause Severe Acute Respiratory Syndrome (SARS).
We understand both the virus (SARS-CoV-2) and the disease (Covid-19) so much better now.
The disease starts as a viral infection and then in a few people develops into a severe inflammatory response. This can then cause Severe Acute Respiratory Syndrome (SARS).
In a sense, some bodies overreact to the virus.
We think the level of initial viral infection has some say over the degree of overreaction. It is also apparent that individual factors (genetics, exposures, etc..) govern the level of inflammatory response and thus severity.
We think the level of initial viral infection has some say over the degree of overreaction. It is also apparent that individual factors (genetics, exposures, etc..) govern the level of inflammatory response and thus severity.
How healthy a person is does have an influence over how well they can handle the inflammatory response and thus outcomes. But we are currently unable to reliably predict who will develop the more severe forms of the disease. In this way, severe disease is a bit random.
Sadly, we have had a lot of clinical experience with COVID. Many doctors and nurses will have seen more Covid Pneumonia or Pneumonitis (inflammation of the lung) in two years than they have seen severe Flu over their entire careers.
It starts for most as a mild viral infection, with typical symptoms of sore throat, headache, stuffy/runny nose, ,,,. For many the disease ends there. A few days and they are back to normal.
Some develop fever, body aches, fatigue, cough, etc... and become more flu like.
Some develop fever, body aches, fatigue, cough, etc... and become more flu like.
A few do go on further to develop persistent fever, bad cough, severe fatigue, confusion, breathlessness,...
Some do go straight to severe disease (day 1). Some can develop if after about six or seven days.
Most improve by day 3/4.
bmjopenrespres.bmj.com/content/8/1/e0…
Some do go straight to severe disease (day 1). Some can develop if after about six or seven days.
Most improve by day 3/4.
bmjopenrespres.bmj.com/content/8/1/e0…
So, onto the good news. We have tools to kick Covid's ass at various points along this pathway.
Firstly, we can reduce how much the virus can multiply through prior-vaccination. Vaccines train the body to respond better to the infection, stopping it before inflammation starts.
Firstly, we can reduce how much the virus can multiply through prior-vaccination. Vaccines train the body to respond better to the infection, stopping it before inflammation starts.
It may even train the body to not overreact. The vaccine is a controlled (v small dose) of part of the virus. In effect, it stops the 'novel coronavirus' being 'novel' in a controlled way. Exposure to the virus does this too, except in an uncontrolled way.
https://twitter.com/EricTopol/status/1494693255212007432?s=20&t=-Rblgsrbthyuu2X4xToCnQ
Some with mild illness and many with severe initial illness develop Long Covid. The 'good' news here is that Long Covid will not be denied. Sadly, too many people have it and researchers are delving deeper than they have for other post-viral complications. Answers are emerging!
Antibodies
We now have ways of helping the body once it gets Covid. Antibody therapies can boost the immune system early on to reduce how much virus there is about. This can then reduce the body's reaction to the virus. Less virus = less overreaction. But not always effective.
We now have ways of helping the body once it gets Covid. Antibody therapies can boost the immune system early on to reduce how much virus there is about. This can then reduce the body's reaction to the virus. Less virus = less overreaction. But not always effective.
Anti-virals
Drugs that act like antibiotics, directly killing or halting viral growth, now available in some countries. They have to be taken early (< 5 days symptoms) and are only used for people at high risk, but some can reduce mortality by nearly 90%.
Drugs that act like antibiotics, directly killing or halting viral growth, now available in some countries. They have to be taken early (< 5 days symptoms) and are only used for people at high risk, but some can reduce mortality by nearly 90%.
https://twitter.com/EricTopol/status/1494069081586216966?s=20&t=-Rblgsrbthyuu2X4xToCnQ
Steroids and similars
For the few that go on to develop the severe inflammatory response we can use a short course of steroids. This calms the immune system down and limits/stops any further damage. It has saved 100s of thousands worldwide. We have several other similar drugs.
For the few that go on to develop the severe inflammatory response we can use a short course of steroids. This calms the immune system down and limits/stops any further damage. It has saved 100s of thousands worldwide. We have several other similar drugs.
Blood thinners
We learned that SARS-CoV-2 can also cause an increase in clotting and therefore unwanted blood clots. The risk of this is higher if inflammation is high and or oxygen levels are low. So in patients admitted to hospital we often use meds to slightly thin the blood.
We learned that SARS-CoV-2 can also cause an increase in clotting and therefore unwanted blood clots. The risk of this is higher if inflammation is high and or oxygen levels are low. So in patients admitted to hospital we often use meds to slightly thin the blood.
Oxygen therapies
We have learned so much about how best to give oxygen to patients and how best to help them breathe. Earlier is better. And we have managed to avoid ICU in many cases by using what we have learned.
We have learned so much about how best to give oxygen to patients and how best to help them breathe. Earlier is better. And we have managed to avoid ICU in many cases by using what we have learned.
The net effect is a dramatic reduction in how deadly (and disabling) the virus is.
But only with vaccination and access (earlier the better) to healthcare.
But only with vaccination and access (earlier the better) to healthcare.
We also know how to reduce the chance of getting the virus.
We now know the virus is airborne. This means it hangs in the air for a long time - hours. So, for example, if someone coughs in a lift, the viral particles will sit in the air for the next person.
We now know the virus is airborne. This means it hangs in the air for a long time - hours. So, for example, if someone coughs in a lift, the viral particles will sit in the air for the next person.
There was some uncertainty at the start of the pandemic, but now we know masks protect and good masks (FFP2 and above) protect a lot!
Good masks no longer just protect those around you, we know they actually carry huge protection to the wearer.
Good masks no longer just protect those around you, we know they actually carry huge protection to the wearer.
https://twitter.com/trishgreenhalgh/status/1414300686435631107?s=20&t=-Rblgsrbthyuu2X4xToCnQ
Ventilation also matters!
It may sound too simple to be true, but we know opening windows and allowing air to circulate makes a considerable difference to the chance of catching Covid.
Other ventilation system also seem effective at filtering the air of virus particles.
It may sound too simple to be true, but we know opening windows and allowing air to circulate makes a considerable difference to the chance of catching Covid.
Other ventilation system also seem effective at filtering the air of virus particles.
Staying well generally is likely to improve your ability to fight off the virus without complication. Improving ones health where possible certainly improves the chance of avoiding more severe disease and hence complications of disease.
https://twitter.com/danielgoyal/status/1467065405709639680?s=20&t=-Rblgsrbthyuu2X4xToCnQ
Special attention to high risk groups.
Around 1 in 4 adults are considered high risk. Some are considered extremely high risk. Risk ⬇️ in same way.
And at present some regions offer anti-virals to extremely high risk groups. Risk of severe outcome reduces up to 90%.
🧵 to follow
Around 1 in 4 adults are considered high risk. Some are considered extremely high risk. Risk ⬇️ in same way.
And at present some regions offer anti-virals to extremely high risk groups. Risk of severe outcome reduces up to 90%.
🧵 to follow
So, in a fully vaccinated, good-masked individual, being reasonably hygienic, utilising ventilation, with reasonable access to healthcare if needed, what are the risks?
Certainly much much lower than they were.
Certainly much much lower than they were.
For those in the extremely high risk group it is worth discussing the level of risk you carry with your specialist/GP. I am sure they will be more than willing to help guide you through.
We are all in a better position thanks to science and sense.
No, far from ideal.
But better!
We are all in a better position thanks to science and sense.
No, far from ideal.
But better!
Risk is individual and can vary over time - it's a judgment call.
We do have the tools to prevent infection and treat it.
Finally, I will leave you with this short animation about what to do if you get Covid.
We do have the tools to prevent infection and treat it.
Finally, I will leave you with this short animation about what to do if you get Covid.
https://twitter.com/danielgoyal/status/1480998399373676547?s=20&t=-Rblgsrbthyuu2X4xToCnQ
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