WesElyMD Profile picture
Jun 13 5 tweets 4 min read
1/🧵 95% COVID Immunity⁉️

@JAMA_current data show that in Dec 2021, 95% of US Blood Donors had Immunity from infection or vaccination.🧐
Then why do we have record high rates of #Omicron?
Does that mean we should have herd immunity?
Not so fast…
2/ First, we make estimates using a combination of the COVID spike Ab & nucleocapsid Ab to determine what proportion of our population is protected at a given time.

ie, either previous infection (nucleocapsid) or vaccination (spike Ab) or combined Infection & vaccination.
3/ But if there was 95% immunity in 2021, how did #Omicron go bonkers infecting so many in 2022?
The infection rates reflect #Evolution. The I ntense contagiousness of this variant & enhanced immune escape mutations plus waning protection from previous vaccination & infection.
4/ Every study has limitations & two here include the obvious selection bias based on who decides to donate blood & kids. While there is a wide swath of the population who donates, maybe it’s not representative of the general population. Also, kids here were excluded.
Take Home: #Impermanence
Don’t get complacent.

Good immunity on an individual or societal level today will NOT be enough to hold off the next variant AND we must accept that #boosters & #masks are a new way of life for us if we want to stay safe & not get #LongCOVID.

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More from @WesElyMD

Jun 8
1/🧵Is Paxlovid Rebound real?👇

Short answer: I say Yes @JAMA_current

It’s when you go from COVID ++ to - to ++ after Treatment.
Prior to #Omicron & Pax, rebound seemed rare.
We need more data.
This article has pearls I want to share…
2/ 1st “If you’re ++, you must assume you’re infectious to others,” he explained.

“PCR test confirmed his positive rapid Ag test & it was back to jail for Dr. Ho.”
Recently, similar cases have been reported & @CDCgov issued a health advisory May 24:
3/ There are just way too many anecdotal cases to ignore.

In recent weeks, prominent physicians in the US including @tmprowell @Bob_Wachter @PeterHotez have all discussed the reality of #PaxlovidRebound.

Yet, @pfizer downplays this & the early papers don’t mention it.
Read 12 tweets
May 25
1/🧵 An exacerbating factor in #LongCOVID is the “Quality of Life (QOL) Gap”🧵👇

…when a person’s expectations about QOL are at odds w their reality.
“Covid was over & Long COVID hit my brain, heart & GI.”
Let me unpack a study of ICU survivors…
2/ Read the thread I attached to the first tweet.

From the cancer literature, we learned about the QOL Gap.

If people appropriately prepare for their “ACTUAL” QOL, there’s a narrow gap and all is well.

If not, #Depression & #Despair too often set in.
3/ This study from Johns Hopkins by @vitaincerta & team adds to our understanding in a way that will apply so well to #COVID ICU survivors.

These are ARDS patients, which is almost always what lands COVID pts in the ICU and later with #PICS.
Read 8 tweets
May 2
🧵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
Read 23 tweets
Apr 28
1/🧵 What does it mean to be human?

How do I magnify human dignity?

I face this daily as we have dying ICU patients.

Recently 2 young men w #COVID, both progressive lung failure, chose not to be put on a ventilator.

Both young & fearful they wouldn’t survive if put on vent…
2/ I kept turning up HiFlow & Bipap. At one point each asked,

“What treatment is NEXT, Doc?”

Knowing I’d exhausted our solutions, I looked up again into each man’s eyes.

Honesty is the only way...

“Sir, your disease pushed beyond our tools. There’s no ‘next.’ No cure.”
3/ “What are you saying, Doc?

Then we went through his options again, which were narrow.

Talked with family, a holy time for all…still, no vent…

“Doc, are you saying I’m going to die? Wait, I want to go home.”
Read 8 tweets
Apr 26
1/🧵 Does Alcohol shrink the brain?
Yes, all liquor can hurt our brains if we drink too much. The disease of Alcoholism, which is NOT the fault of the person afflicted, causes brain injury slowly over time.
A picture is worth 1,000 words. Look below at a diseased brain…
2/ Gray on this CT scan indicates actual brain tissue.

Do you see the black areas pointed out here by RED arrows?

These are called sulci (grooves).

This <40 year old person has VERY large grooves that show the amount of brain tissue as we would see in someone >80 w dementia.
3/ Normally brain grooves are small in young people. See example👇.

When someone gets dementia, s/he can lose actual brain tissue (less gray) and the area fills in with fluid (BLACK - sulci).

SO this is atrophy & manifest in life as memory problems & executive dysfunction.
Read 6 tweets
Apr 25
1/🧵 I DARE YOU 👍

When we’re busy, relationships become I-It & should be “I-Thou”

How can we fix it?

I asked him 4 Questions:

What’s your favorite song, hobby, food, pet’s name?

Do this for 1 WEEK. How does it change the way you SEE & CARE for others?

Read on…(pic w perm)
2/ Hecame to our ICU service over night after his spinal fusion.

He would only be w us a short time & would then be gone. So why dive deeply into his history??

Because he’s an ENTIRE PERSON.

So every minute with him is a gift. What did I learn?
3/ His favorite 🎶 is anything by the Eagles. Hobby is cars. Food is Thai. Pet is a “white golden” named Hondo!
Read 11 tweets

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