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Dr Elisa Perego Profile picture
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Jul 3 • 10 tweets • 3 min read
Italy's healthcare is under growing pressure in the new covid wave, likely driven by BA.5.
The president of the emergency health service 118, M. Balzanelli: "we are seeing again severe cases of covid pneumonia, which may need mechanical assistance" ⚠️

ansa.it/sito/notizie/c…
"while the previous versions of omicron tended to spare the lowest respiratory tract, the pneumonia cases caused by BA.5 affect the pulmonary alveoli" (M. Balzanelli, emergency health service 118)
Another, longer interview with M. Balzanelli, 118 emergency service in Italy, where he also mentions BA.5 pneumonia's abilty to cause oxygen saturation drops and hypoxemia

interris.it/primo-piano/co…
Balzanelli, 118 emergency service, Italy, also draws attention to gastrointestinal symptoms in BA.5. He underlines the ability of BA.5 to cause severe disease and pneumonia, with particular regard to cancer and other vulnerable patients, even double boosted (4 doses)
Balzanelli, 118 emergency service, Italy, also notes BA.5 ability to elude prior immunity both from vaccination and infection "we're seeing severe cases in patients with 3 and even 4 vaccination doses. Infectious disease wards are filling up". He reccomends high-quality masks
Balzanelli: "high quality masks should be compulsory in indoor crowded spaces especially. We really need updated vaccines fast, as the available ones are based on the old Wuhan strain".
"Patients who are double boosted are presenting with cough and high fever. Patients with three doses have severe clinical presentations ... Gastrointestinal symptoms remain a symptom of SARS-CoV-2 with BA.5 too ... even in the summer season, we are having a significant impact"
Balzanelli also notes BA.5 is very very infectious and easy to spread
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I add my previous thread of a few days ago on medical professional Filippi, noting the growing numbers of people in need of oxygen for covid in Italy, including young people, presumably because of BA.5 too

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More from @elisaperego78

Dr Elisa Perego Profile picture
Jul 3
Hospitals etc.! Do you have in your databases information on extreme lymphopenia / other prolonged immune perturbations in omicron and/or #LongCovid, which you would, maybe, like to share? Researchers! Are you working on this critical topic?
My tweet is slightly ironic. We have known about severe lymphopenia and other forms of immune dysfunction in acute covid, and then in #LongCovid, since 2020 and 2021. Yet, there seems to be little urgency to do in depth analysis of this, especially for every day patients
Many #LongCovid patients arent being currently screened for these critical issues like prolonged lymphopenia and potential forms of immunodeficiency | see @loscharlos tweet and from others in Long Covid. The topic appears to be taboos to a certain extent in research circles
Read 6 tweets
Dr Elisa Perego Profile picture
Jul 2
Prevalence of #LongCovid in a group of non-hospitalized healthcare workers in Italy | study of vaccinated vs non-vaccinated patients | overall: at least 1 symptom lasting over 4 weeks: 31% of sample | non-vaccinated: 41% | 3 doses: 16%

@JAMANetwork 🧵
jamanetwork.com/journals/jama/…
Longitudinal study across the three main covid waves, largely in Lombardy, here defined as "wild type", followed by Alpha and Delta/Omicron, when vaccination started to be available. #LongCovid is defined as at least one covid-related symptom lasting more than four weeks
Symptoms considered as indicative of #LongCovid include profound asthenia = extreme fatigue, cardiovascular problems, headache, loss of smell, and cognitive impairment, like "brain fog"
Read 9 tweets
Dr Elisa Perego Profile picture
Jul 1
Airborne spread of SARS-CoV 1 in high-rise buildings

"Airborne spread .. appears to explain this large community outbreak of SARS, and future efforts at prevention and control must take into consideration the potential for airborne spread of this virus"
nejm.org/doi/full/10.10…
"We analyzed the temporal and spatial distributions of cases in a large community outbreak of SARS in Hong Kong and examined the correlation of these data with the three-dimensional spread of a virus-laden aerosol plume that was modeled using studies of airflow dynamics."
Published in one of the top medical journals in the world the @NEJM in 2004
Very sad this evidence on SARS was poorly or not considered at all in early 2020 by our policy makers as regards SARS-CoV-2

#COVIDisAirborne
Read 4 tweets
Dr Elisa Perego Profile picture
Jul 1
Case study of explosive spread of omicron in high-rise buildings in Hong Kong
Further evidence of airborne spread of SARS2 in environments with certain specifics, like high-rise buildings, where the virus can spread easily across different floors

🧵

sciencedirect.com/science/articl…
This confirms concerns, in my opinion, about crowded / high-rise/ multi-floor buildings in other countries, too, even if the architectural features might be different from Hong Kong. People living in such environments might be more exposed and at risk of covid/ Long Covid
Similar events have been reported with SARS-CoV-1 too, suggesting an airborne nature for the first SARS pathogen, too.

"Many incidents of vertical airborne transmission of SARS-CoV-1 and SARS-CoV-2 due to shared lightwell ... or faulty sewage drains have been reported"
Read 4 tweets
Dr Elisa Perego Profile picture
Jul 1
[covid, murder]

Prosecution has asked for 24 years in jail for the head physician C.M. in Lombardy, who is currently under process for killing 2 covid patients in hard-hit Brescia, during the first covid wave in 2020

🧵

ilgiorno.it/cronaca/farmac…
The alleged murders took place in the chaotic days of Lombardy's first wave, when the local healthcare was totally overwhelmed by covid. The Brescia province was one of the hardest hit areas, with Bergamo, in March 2020
The process started after evidence emerged that the head physician, allegedly, would have given severe covid patients lethal doses of medication to suppress them. A nurse had initially refused to carry out the administration, and has come forward to denounce the incident
Read 7 tweets
Dr Elisa Perego Profile picture
Jul 1
On the risk of developing lung fibrosis in #LongCovid | the role of markers of systemic inflammation | the need for early screening, with particular regard to patients with ground glass opacities visible on CT lung scan

🧵

@FrontiersIn

frontiersin.org/articles/10.33…
Summary of key points by authors: it has been reported that #LongCovid patients are susceptible to pulmonary fibrosis as a consequence of lung damage, and impaired gas exchange from covid-induced interstitial pneumonia, and acute respiratory distress syndrome (ARDS)
It is also thought that the fibrotic lung damage, which persists or develops after SARS-CoV-2 infection could correlate with excessive cytokine production. | note the authors mention the possibility of delayed onset of fibrosis in #LongCovid
Read 9 tweets

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