Here I go again:
ER visits for #CovidIsNotOver are declining.

That is usually followed by a decline in hospitalization.

I know it is unpopular to talk of declining numbers, but that is what I am seeing.

We should see a 50-75%+ decline in hospitalization over the next 8 weeks.
COVID is not mild.

ER visits are going down and hospitalization may peak between 45K-55K-I posted this before

It was similarly unpopular in January when I said hospitalization will go down in February '22 down by 80%

Others were calling for end of time
The one indicator that I have touted since the pandemic began is ER visits. It is useful to look at all indicators.

It has proven to be more accurate than other indicators, particularly for severe disease, hospitalization, and critical disease (vents, respiratory failure/arrest)
How many #clinicians, #epidemiologists, #virologists, #statistians, and #PublicHealth experts have gathered all data, research, and observational first hand experience can say that hospitalization in the end of September will reach a new trough since the pandemic began?

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More from @MdFacep

Jul 27
I get asked why do I post that cases and hopsitalizations will be so drastically reduced by late September?

Our immunity with three key elements:

1. Vaccine induced circulating immunity (cnAbs-blood)
2. Mucosal alveolar imm. (lungs)/PI
3. Cellular imm.

Based on our mucosal alveolar immunity from prior infection, and the circulating immunity gained from vaccination, supported by our humoral immunity, and having an estimated 60-70% of the US previously infected, I hope for a reduction of 50-75% in hospitalization before late Sept
"The risk of SARS-CoV-2 reinfection and COVID-19 hospitalisation in individuals who have survived and recovered from a previous infection remained low for up to 20 months."

sciencedirect.com/science/articl…
Read 5 tweets
Jul 26
Let's discuss boosters. 🧵

How many are there?
What are they?
When do we expect them?
Which one would do the most good in the big picture?

That means the one that reduces infection, transmission, and reduce hospitalization so you may make an informed decision.

1/12
How maqy are there?
Moderna will have 3 options. Pfizer 2-TBA
1. The current 1273 S-protein targeting vaccine(first gen. monvalent vaccine against the ancestral VOC)

2. A 1273-214 bivalent vaccine (ancestral + BA.1)

3. A 1273-222 bivalent 'upgraded' (ancest + BA.4/5 VOC)

2/12
What are they and when can we expect them?
1. The mRNA vaccine based on the ancestral strain is the currently used for the primary series-the 1273.
It is currently available

2. The mRNA vaccine combining both the ancestral strain and BA.1 which could be available by Sept.

3/12
Read 12 tweets
Jul 10
SARS-CoV-2 and Lyphocytopenia

CV-19 enters cells with ACE2 receptors

Llymphocytes express the main receptor for SARS-CoV-2, called angiotensin-converting enzyme 2.

SARS-CoV-2 can also use ACE2-independent pathways to enter lymphocytes.

CV-19 enters other ACE2 expressing cells
In addition to type 2 alveolar cells, the ACE2 expression has been indicated in various organs such as intestine, heart, liver, bladder, kidney, brain, thyroid and testis.

These are areas of SARS-CoV-2 insult when we get infected

webofscience.com/wos/woscc/full…
Lymphopenia and Dysregulated Host Response-a marker of multi-organ dysfunction leading to cytokine storm and death

Lymphopenia as a major immunological abnormality is observed in up to 96.1% of severe COVID-19 patients, and its degrees correlate with disease outcome.
Read 15 tweets
Jul 8
BA.5 key observations. We need data!
🧵

Even in the extremely advance aged patient, regardless of vaccination status, presenting with BA.4/5 infection, diffuse bilateral ground-glass opacity airway disease is RARE.

Despite seeing some pts. w/ evidence of heme injury
Lymphopenia (LPA) with total lymphocyte count below 20% (normal range is 20%-40%), and absolute LPA below 1.0 (normal is 1.0 - 4.0) is seen to much lesser degree and severity than with Delta.

Even in those patients, diffuse bilateral multifocal pneumonia is NOT often seen!

WHY?
BA.5 has some increased ability to bind via ACE2 receptors and gain cell entry, but does this very poorly in cells expressing TMPRSS2.

It enters and replicates efficiently is cells devoid of TMPRSS2

The unresolved fact is BA.5 (Omicron in General) fails to kill cells w/TMPRSS2 Image
Read 10 tweets
Apr 16
Not long ago, I proposed the possibility of progression of SARS-CoV-2 , through recombination with other Human Corona Viruses (HCoVs) which would expand target organ of infection to include Liver, pancreas, and GI system organ.

Collecting data now-

I have been urging forward thinking and grasping that Omicron's mutation (insertions and through recombination) will most likely evolve and we must consider an OSV-Omicron Specific Vaccine.

See my posts on Multivalent vaccines- a Vaccine combining a SARS-CoV-2 ancestral + OSV
Should this happen between April and June:
We'll need to protect the children and the very vulnerable, as I expect severe GI distress, markedly elevated liver enzymes, and perhaps marked hyperbilirubinemia causing JAUNDICE.

next/
Read 13 tweets
Feb 6
My Omicron Up To Date Review:

Based on my comprehensive literature search and extracted data within PubMed, Scopus, Web of Science, bioRxiv, ScienceDirect, medRxiv, NEJM and JAMA COVID resources, I can make these statements:

Omicron is well studied and has the following-
1. Omicron spreads faster than any other previous variants.

2. It has higher transmissibility which can be ascribed to its advanced ability to evade immunity developed by both vaccinations and previous infections.

3. It is less severe than Other VOCs
Omicron has an observed marked lower incidence of hospitalization.

Lower intensive care unit, & mechanical ventilator use.

It has a shorter hospital stay, and lower fatality rates than Delta and other variants.

The unveiled danger of Omicron was its IMMUNE EVASIVENESS
Read 6 tweets

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