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Tatiana Prowell, MD

@tmprowell

May 18

https://twitter.com/BNODesk/status/1527033475131445248

So I wasn’t that worried a few hrs ago. This dials it up a little.

For anyone who has ever played the collaborative board game #Pandemic, you may know how it goes when there’s uncontrolled spread of one pathogen throughout 🌎 & then outbreak of a new one in mult countries. 😖

https://twitter.com/BNODesk/status/1527033475131445248

The current #monkeypox outbreak now includes cases in #UK, #Spain, #Portugal, #Canada, #US…from what I’m reading, this sounds like person-to-person transmission, which historically was thought to be rare, & evidence of community spread. Wow. #MedTwitter

npr.org/sections/goats…

Smallpox vaccination provides at least partial protection against #monkeypox, but routine smallpox vaccination in the 🇺🇸 stopped in 1972. Most Americans under age 50, including myself, are not #vaccinated.

Read 4 tweets

Tatiana Prowell, MD

@tmprowell

May 17

https://twitter.com/apoorva_nyc/status/1526191168169680898

We have either rapid re-infection, or rebound #Covid19 after Paxlovid, in my own 🏡 . Vaxxed & boosted. Symptoms & rapid test pos 5/2, 5d of Pax 5/4-5/8, all symptoms gone, neg rapid test x 2 5/8 & 5/9.

5/16 new symptoms & RAT instantly pos (📸). Our #MedTwitter 🏡 is weary.

https://twitter.com/apoorva_nyc/status/1526191168169680898

By the way, the right answer is not “So Paxlovid doesn’t work.” It works very well to ⬇️ risk of severe illness, which matters a lot. And right answer is not “so let’s just give 10d.” Right answer is we need data to understand this phenomenon & direct rational antiviral use.

I’m sharing this because:
👉Anecdotes can generate scientific hypotheses that THEN MUST BE STUDIED WITH RIGOR &
👉The public needs to know for #publichealth reasons that, one way or another, we can end up symptomatic & contagious again a wk after apparent #COVID19 recovery.

Read 11 tweets

Tatiana Prowell, MD

@tmprowell

May 9

@NoNutTraveler

Per @NoNutTraveler, “the @united pilot came back, & he & the flight attendant began asking me if we had Epi-Pens. I said, of course we do. To which the flight attendant gaily said: ‘Well then, we can serve anything because he can just use the pen.’” NO! /1
allergicliving.com/2022/05/09/i-w…

This represents a fundamental misunderstanding of anaphylaxis, including #peanutallergy. In fact, this fallacy—if you’ve got an Epipen, exposures aren’t a concern—was the topic of a past corrective ad that FDA required the maker of Epipen to air. /2 mmm-online.com/home/channel/o…

I’m speaking here as a dr & the mom of a kid who has nearly died of inadvertent peanut exposures even with an Epipen, which we always carry. Airlines & the public need to know that Epipens are a rescue med, not a preventative, & do not eliminate the need to avoid the allergen. /3

Read 4 tweets

Tatiana Prowell, MD

@tmprowell

May 7

Lots of chatter in my feed & my DMs this AM about Paxlovid & “rebound.” Let’s be mindful of the diff ways this term is getting used & interpreted, #MedTwitter. Some are referring to return of symptoms after feeling better, others to triggering more severe symptoms… /1

Others are using “rebound” to mean going from rapid test neg (not contagious) back to positive (contagious) again; still others are using it to mean increased short-term risk of new infection w/ same #Covidvariant. People are suggesting alt dosing, duration. Stop, stop, stop. /2

Learn from #pandemic yr 1&2. This conversation has gotten way ahead of the data. We risk inadvertent #publichealth harm from the mis/dis-info machinery if we speak/act imprecisely here, esp without data. Next tweet has an article w/ a good summary of what we do & don’t know. /3

Read 4 tweets

Tatiana Prowell, MD

@tmprowell

May 7

@CDCgov

Here are 2 family members, similar ages/#MedTwitter history, #vaxxed & #boosted, dev symptoms & tested pos same day, got Paxlovid same day. Day 4 tests below. Why are we still using a 'one size fits all' strategy to exit isolation when rapid tests are readily available, @CDCgov ?

I doubt policy will change (note: shortening isolation to 5d was done to minimize societal impact from loss of essential workers to isolation in Jan #Omicron wave), so you should choose to rapid test to exit isolation. A positive = contagious, no matter how many days it's been.

Here's another example. Two more people, again similar age/health history, both vaxxed and boosted. On the left, patient #1 on day #13. On the right, patient #2 on day #5. We'll see what happens with patient #2 but I'd be willing to bet they can leave isolation well before 2 wks.

Read 4 tweets

Tatiana Prowell, MD

@tmprowell

Apr 28

There's another 🌊 of #COVID19, y'all. I have gotten more texts since Mon asking questions about monoclonal antibodies, about Paxlovid, about rapid tests, & on & on than I have in the whole month preceding. Be aware. All these folks tested at home & are uncounted in tallies.

This is anecdotal, but a pattern recently: people staying pos longer on rapid test. Here's an older pt, 4 doses Moderna #COVID19 #vaccine, mono Ab on d1, feels 100% now, & still quickly/strongly pos (ie very contagious) on d10. Had he not retested, he might be infecting others.

@CDCgov

@CDCgov shortened isolation to 5d in Jan b/c they were concerned society may fail to function w/ huge #s of essential workers out for 10d in #Omicron surge. This has to be changed. People are leaving at d5 w/o masking or testing. They need to rapid test to exit or isolate longer.

Read 4 tweets

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