Abraar Karan Profile picture
Mar 10 5 tweets 2 min read
Perhaps unsurprising, those most readily downplaying the risks of #covid19 infection, incl #longcovid, have also never treated a covid patient.

You’ll be hard pressed to find many doctors doing this— we have seen enough patients die, or survive & still suffer afterwards.
2/ We have had a lot of spread — & we are at risk of a lot more (unmasking of course not helping). Telling ourselves it is mild doesn’t make that true, esp re more chronic health consequences.

Masking alone won’t solve this either. There’s a lot more needed than that.
3/ While many have been infected with #Omicron, there are likely many who have not been. With increases in BA2 variant, I suspect we will have enough susceptible people to sustain some level of resurgence soon, but unclear what that will look like. I hope I’m wrong. @jlsalinas7
4/ Of course, our response right now to unmask is as much a political one as it is a recognition of a lower community incidence post-Omicron wave number 1

& understandably people are exhausted & want to catch this break now

My bigger concern is we may not prepare fast enough
5/ People would be wise to also count the benefit of delaying infection— when we have a better understanding of the true costs to our health; and when we have better therapeutics & a better sense of when to use them most optimally

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More from @AbraarKaran

Mar 10
1/ Over the past two years, we have discovered therapeutics that work for #covid19 such as Remdesivir; later we figured out the optimal time to use them. Months from now, we will have even more data & meds to use.

Delaying infections does have a benefit
2/ Over the past two years, we have discovered that #covid19 has effects on the body that are significant, even if they don’t kill you. The virus affects the heart, brain, vascular system & more. The costs become clearer over time.

Delaying infections makes those costs clearer
3/ When big waves of infection come down, the chance of getting infected during any given activity also goes down. We have certain measures— such as high filtration masks— which, if used right, can protect you through a wave. There are many who haven’t been infected.
Read 6 tweets
Mar 1
1/ The US #covid19 dialogue is overly focused on how restrictions are being lifted and what experts think about that

The questions I care about right now:
-what are we doing for preparedness?
-what are we doing for health equity?
2/ I want specifics from my government and leaders

How is indoor air/ventilation going to be improved in schools, businesses and public places? What's the timeline? What's the cost? Who is paying? What's the accountability mechanism if this doesn't happen?
3/ When will N95 mask supply be increased and to what extent? How will it be distributed? What were previous bottlenecks & how have they been addressed? When will more comfortable options be added? Will poorer communities have more access & supply? What about the terrible comms?
Read 5 tweets
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…
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
Feb 20
More hospital-based spread of #covid19 during #Omicron than any prior waves. We knew this was a problem from prior waves— yet there is ongoing resistance to acknowledge it, to test for it, or do more to prevent it.

@politico
politico.com/news/2022/02/1…
2/ We wrote about this issue in @JAMA_current outlining ways to slow hospital-based spread with Omicron.

It remains to be seen whether this will be utilized in hospitals, or if we’ll keep the status quo and pretend this isn’t a problem.

jamanetwork.com/journals/jama/…
3/ & even this is an undercount!

“The total # of people who contract Covid-19 while in the hospital remains unclear bc these figures only count patients who were in the hospital at least 14 consecutive days & don’t account for people who test positive after leaving.”
Read 5 tweets
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
Feb 7
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

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