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Aug 30 • 5 tweets • 3 min read
1/🧵 Paxlovid in Omicron⁉️
 
🔸Large study of 4k treated pts vs. 105k not on Pax
🔸Robust 80% ⬇️ in death prevention in elderly
🔸Hospitalization 70% lower if >65 y/o
🔸No help in young?

Why will I keep using in young & old patients?

Read next tweet…
 
bit.ly/3PRbbId
2/ This retrospective observational cohort in @NEJM only showed statistical benefit in patients 65 & older.

Does that mean Paxlovid does not work in the young during #omicron times?

I don’t think so.

Here are reasons why I will keep using the drug in young patients as well…
3/ Subgroup analysis of studies are mainly meant for hypothesis generation.

Usually in clinical trials there are not qualitative differences in how a medication works by age cut off.

There can be, but it’s unusual.

Original Paxlovid data showed efficacy across age.
4/ One of the hypotheses of acute & #LongCOVID relates to overall viral burden.

Antivirals reduce viral burden and the hope would be that Paxlovid would not only reduce acute illness but might indirectly help w reduction of LongCOVID.

We do not have those data yet. Stay tuned.
5/fin
✔️Clinical trial data & FDA EUA for Paxlovid are for 12 yrs & older
✔️I will use it as indicated & not just in elderly
✔️I hope this will ⬇️ acute & long-term burden of disease
✔️Paxlovid rebound & rates of LC must be studied further
✔️I have no financial COI w Paxlovid

• • •

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More from @WesElyMD

WesElyMD Profile picture
Aug 25
1/🧵 The Haunting Brain Science of Long COVID 🧠

@washingtonpost Aug 25

📍Brain shrinking
📍Corona ghosts
📍Autoimmunity
📍Clinical clusters

“The good news is that in some pts #LongCovid #BrainFog may not be permanent.”

Link👇 but paywall so see 🧵

wapo.st/3wvPBlF
2/ Mild Covid is biologically dangerous long after initial viral infection.

81 mild COVID pts:

Study revealed:
✔️Astrocytes (🧠 support cells for neurons) get infected
✔️Neurotransmitters are altered
✔️Neurons die indirectly
✔️Then we lose brain power

bit.ly/3pcqbFV
3/ Epidemiology💥

Long COVID is tightening its grip on society.
 
We’re still losing >600 people a day to death from COVID in US alone

Over 100,000 new infections per day (Johns Hopkins data).
 
This is an epic global 🌍#PublicHealth catastrophe.

wb.md/3SKjGrh
Read 28 tweets
WesElyMD Profile picture
Aug 22
1/🧵Mild Traumatic Brain Injury (TBI) isn’t “Mild” 🧠
 
Our daughter fell off a high diving board headfirst to cement years ago. Though she had 2 cracks through her foramen magnum, her GCS was 15 & CT had no bleeding.
 
“She’s OK,” they said.
 
Wrong answer 😔

#TrackTBI Data…
2/ Mild TBI isn’t mild at all. Lives & entire families are uprooted.
 
Over half of these N=991 patients with GCS of 15 & negative head CT scan reported incomplete recovery at 6 months.
 
90% w incomplete recovery were unable to return to preinjury life.
 
bit.ly/3pxd4ze
3/ Medicine & Trauma are only now waking up to the realities of this “invisible” yet devastating injury.
 
I’d been trained in all modern #CriticalCare & you’d think I would know better.

But I didn’t.
 
bit.ly/3R0enCt
Read 4 tweets
WesElyMD Profile picture
Aug 10
1/🧵 Is MonkeyPox airborne?

I’m not an ID specialist, but evidence from this often cited 2001 @Nature study does NOT speak to usual #MPX exposure.

The Methods describe high dose, highly lethal variant. This is more like being sprayed w viral fluid.

go.nature.com/3vMCbkP
2/ Is MPX airborne?

This 🧵 is to alert readers that methods of studies are critical to analyze. These authors set up an experiment that was designed to be as HIGHLY infectious as possible w a dose & delivery highly unlike what we see in society. They even got rectal lesions.
3/ There’s no doubt that respiratory secretions from prolonged close physical contact (kissing) are a way to transmit monkeypox. That is NOT the type of droplet transfer across multiple feet of physical separation we have to worry about.
Read 4 tweets
WesElyMD Profile picture
Aug 8
1/🧵 The Animal Rule & TPoxx for MonkeyPox

Huh⁉️
 
📌This antiviral drug Tecovirimat or TPoxx was FDA-approved for SmallPox by testing it in animals (not humans) w #MPox

📌 We need lots more data in humans to know how good it is.

What does this mean?

bit.ly/3PWJWwI
2/ First, be clear that the vesicles & pustules of #MonkeyPox rash can be super painful.

The infection can include eyes and soft tissue super infections.
 
Stay clear of close skin to skin contact with anyone infected (contagious for duration of rash, ie, 2 to 4 weeks-ish).
3/ I highlighted this fascinating @NEJM paper for you...
 
Essentially the drug approval process for TPoxx, a med you’ll get if you get seriously sick with MPox, goes back 34 years to the HIV epidemic and also Small Pox.
 
Read up…link to this paper is in tweet #1
Read 7 tweets
WesElyMD Profile picture
Aug 3
1/🧵 MonkeyPox, ChickenPox, SmallPox:

Let’s talk poxpoxpox…
 
✔️#MonkeyPox has 4 deaths
✔️Is it a panedmic?
✔️What do you need to know?
✔️Here are key take homes
 
JAMA -bit.ly/3S6IKs9
2/ Many people are holding off calling #MonkeyPox a pandemic.
 
Epidemics that “get passports” travel.
 
Mpox seems to have a global passport.
 
Sustained spread in >80 countries seems likely.
 
bit.ly/3ShYQzf
3/ The window for controlling Mpox is closing - eternal optimists are hoping enough vaccination can beat it.
 
Judging by how we handled #COVID, I’m betting Mpox will win.
 
@DrEricDing @kavitapmd make great points:

wapo.st/3NSdGcr
Read 18 tweets
WesElyMD Profile picture
Jul 29
1/🧵 Worrying
 
If I’m #worrying, I’m usually either troubled over a past event or fearful of some hypothetical future event that might never happen.

📍Neither is real time.

The #present moment is where the action is if I really want to make a difference & find peace.
2/ In #Al-Anon (a spiritual but non-religious program I attend), we say that worrying is like a rocking chair. I’m doing something, but I’m getting nowhere.

If I want to get to a place of spiritual enlightenment, I must learn to #Live in the #NOW.

It’s easier said than done.
3/ Try moving thoughts of the past & future from your mind to create space in your 🧠 to completely soak up the “now” you’re living in. Imagine when you remove those past & future thoughts that are you actually have space to allow the present moment to fill your thoughts.
Read 4 tweets

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