Thread by @WesElyMD

🧵1/ Here’s your “Big Picture” of COVID & Long COVID for 2022

See my new Figure👇 summarizing #COVID19 Management & Outcomes

Two years in & we have splendid choices.

Stay in peaceful waters of prevention (green) or risk treacherous cliffs of #LongCOVID & Death (red & black)…

2/ Knowledge is Power, and our knowledge has grown dramatically.

Let’s take a look at where we were just 2 years ago - even though it seems like 20 yrs ago.

April 2020: our approach & understanding of COVID looked like this👇.

We didn’t even know about #LongCOVID yet 🤯

3/ Remember, with #LongCOVID, your brain & heart are at stake.

@JohnsHopkinsSPH reports on emerging data: “COVID doesn’t discriminate when it comes to heart problems.”

Anyone affected may develop clots, arrhythmias & strokes >1 yr later.

Link &🧵below
bit.ly/3KzYcbp

https://twitter.com/drericding/status/1518443600081739777

4/ Covid is going ENDEMIC:

We’re moving from full-blown #pandemic into endemicity.

In US alone, we still have >50,000 people/day contracting #COVID & ~350 deaths/day.

We’ll be living w COVID & LongCOVID essentially indefinitely, so get yourself a plan.

wapo.st/3EUkGm5

5/ The numbers are smaller now, so why should you care?

1 of every 3 people you see is #unvaxxed & many deaths are among unboosted.

We are ALL getting exposed & at risk over time.

You know people who will die & become disabled. It may be your family.

wapo.st/3y4yyc4

6/🎥 My greatest anguish as a doc comes from seeing young people who just never thought they’d be a victim of this disease go over the #COVID cliffs & ask me,
“What’s next, Doc?”

When I have no more treatment to offer them.

Let’s consider the power of human story…

7/🎥 My thoughts on why it’s important to make a commitment to work hard at prevention.

Let’s build on the classic upstream vs. downstream #PublicHealth concepts that gave me the idea for my main figure in this 🧵👆.

📍Vaxx
📍Mask
📍Distance
📍Rapid Test
📍(Evusheld for some)

8/ In just 2 years, we’ve developed these “LIVING” @WHO Guidelines for #COVID19.

They’re updated regularly with treatments listed as strong vs weak both for & against different options.

Keep this link & share w friends because they are evolving!

bit.ly/3I61baM

9/ Friends, over 100 MILLION people have #LongCOVID 😰

We must ALL be aware of this burgeoning public health disaster.

Even after mild COVID, people are suffering or have suffered long-term symptoms.

It’s very unpredictable.

wb.md/3klbMEE

10/ The worst problem of #LongCOVID is how it affects our brain…

This🧵 tackles data on the topic.

Our patients tell us they feel like they’ve dropped off a cliff, so the figure is not an exaggeration.

This is often life-altering disability.

JAMA: bit.ly/3F5xpmc

https://twitter.com/weselymd/status/1501717860942553089

11/ Here’s another helpful schematic from @NEJM.

It shows specific evidence-based treatments for #Covid19 based on whether you are uninfected, exposed, or already infected.

H/T: Look back at my “waterfall” figure & note how I built on this earlier work.

bit.ly/3oqkK67

12/ Adopt a mindset that “fully vaxxed” will evolve as years unfold.

New shots & rules mean we’re keeping up w viral evolution.

Absent Vaxx + Booster(s), you’re vulnerable. Period.

Previous infection isn’t adequate.

No shortcuts.

Boosters save lives: bit.ly/3vnYBcG

13/ On this figure, the Yellow Zone is when you’re Exposed or Infected but only mildly symptomatic.

Treatments boil down to neutralizing monoclonal antibodies or antivirals like Paxlovid, Molnupiravir or Remdesivir.

14/ Paxlovid is an excellent antiviral combo medication w great data.

Unfortunately, it’s super complex to make is just now gaining widespread availability.

This is a great weapon in the quiver (see this new @JAMAnetwork “Patient Page” with highlights.

bit.ly/3xQtGXQ

15/ Paxlovid Bottom Line:

📌 Prevents SARS-CoV-2 from multiplying
📌 ⬇️ hospitalization
📌 Recovery from symptoms takes up to 2 weeks
📌 Don’t use w severe liver/kidney dz or pregnancy
📌 Paxlovid is ⬆️ effective than molnupiravir

Hospitalized pts w incidental COVID may qualify

https://twitter.com/weselymd/status/1478362356677754882

16/🎥 Unfortunately though, just like bacterial resistance to antibiotics, we will likely see #SARSCoV2 evade antiviral drugs.

Listen up on @aslavitt46’s @InTheBubblePod w Dr. David Ho:

#Prudence

17/ When you are sick enough w COVID to be on Oxygen or Bipap or a Ventilator, you enter what I call the Orange & Red zones.

Now your health is plummeting & the body’s demise is due not so much to viral replication as inflammation causing lungs, heart, brain & kidneys to fail‼️

18/ Alongside respiratory support, we treat you w a combination of meds to suppress inflammation.

Usually either Baricitinib (proven to save lives in >10,000 pts & given to over 1,000,000 pts to date) or Tocilizumab PLUS Steroids.

FYI: I have no financial COI whatsoever w Bari

19/ Remember that COVID is a disease of the blood vessels, and there is a ton of blood clotting that goes on.

So we use heparin or some other blood thinner in either preventive doses or full treatment dose.

This patient’s blood clotted even on heparin. It was crazy.

20/ The discovery of #Baricitinib as life saving medicine for COVID is a neat story.

A computer chose it (see fig).

We then designed N=1,500 patient phase III placebo-controlled trial that worked.😅

Largest life saving benefit of any drug in COVID yet.

bit.ly/3t244CR

21/ When someone falls over the RED ZONE cliffs of COVID…

either outpatient care that leads to perilous #LongCOVID or ICU care that lands them with Post-Intensive Care Syndrome (#PICS) and often also #LongCOVID…

They have 2 big ways to suffer:

bit.ly/2Zb9S2J

22/ Take heart.

Go back to the GREEN ZONE of prevention. We want to adopt the safest way forward.

2/3rds of us chose #Vaxx.

When unable, get Evusheld if high risk.

Harness the power of frequent Rapid At-Home tests to start early treatment when you get COVID.
 @michaelmina_lab

23/fin
Friends, every day we must face our physical, mental & emotional challenges to maximize our potential.

Shortcuts to success will fail.

Use the science in this 🧵to keep yourself safe.

In so doing, you will practice an act of charity that will likely save others as well.