WesElyMD Profile picture
Sep 13 22 tweets 16 min read
1/🧵 Land Mines in Long COVID - @BostonGlobe

Alex was training for 2024 Olympic Trials 🥇

That dream exploded 💣
 
New #LongCOVID science
📌Viral reservoirs at 1 year
📌Cardiac edema at 1 year
📌Dementia at 2 years
📌Hijacked mitochondria

ScreenShot👇
bit.ly/3U77u4r
2/ It’s one thing to concede that Long COVID exists as a societal problem for those w vulnerabilities like advanced age, pre-existing health conditions, or nearly dying in ICU.

What about nationally ranked D-1 long-distance runners⁉️

Paywall so read 🧵
bit.ly/3U77u4r
3/ Alex Schell is 21 & based his life decisions on making the 2024 Olympic trials.
 
“Not only can I not run due to #LongCOVID, I’ve also lost everything I hoped for. Who I envisioned myself to be is a past idea. It’s a monumental loss.” (story w perm)
 
What causes LongCOVID?
4/A cutting-edge explanation of what implants volatile “land mines” of long COVID throughout some patients’ bodies, after even mild COVID, is that people suffering long COVID end up w reservoirs of active SARS-CoV-2 virus in the lungs, brain & GI tract.
 
bit.ly/3Qw8Q5N
5/ This produces ongoing levels of viral spike protein in our blood sometimes as high at 1-year as we had during early infection.

This theory was corroborated in the majority of 37 patients w #LongCOVID & in NONE of 26 control patients.
 
WSJ: on.wsj.com/3DcJzKV
6/ Cardiac Edema:
A new investigation of a selected group of 346 patients with documented mild COVID found diffuse swelling of heart muscle on cardiac MRI at 3 & 12 months after infection vs 95 controls without COVID.
 
go.nature.com/3RRF2lm
7/ None of these people w heart muscle swelling at 3 & 12 months had any pre-existing cardiac conditions & none was even hospitalized for their COVID, yet 73% had shortness of breath, palpitations & chest pain at 3 months with 57% still had these symptoms at 1 year.
8/ In the thread below, I unpack the science of #BrainFog & #Dementia in Long COVID. Basically, our astrocytes & other glial cells are directly infected, which leads to indirect neuronal death & brain shrinking even after mild COVID.

Dastardly 😤
9/ Brain Science 🧠

…of Long COVID is summarized in this recent @WashingtonPost Op-Ed (screenshot below):
wapo.st/3Tf0WQR

Thank you, @EricTopol, for your highlighting:
10/ In case you missed it, here is @EricTopol’s recent 5 STAR review in @latimes that places new data in context for us.
 
He points out the urgent need for new trials & emphasizes that our best approach to avoid Long COVID is prevention.
 
Ask your doctor about the #BA5 #booster
11/ COVID hijacks mitochondria in both heart muscle & brain cells, which may provide a link to the neck-up & neck-down disease plaguing Long COVID patients.

#Mitochondria allow us to use food & oxygen to harness energy for everything we do in life.
 
bit.ly/3x70vP1
12/ Mitochondria inside Neurons & Astrocytes in the brain are hijacked.
 
This study used biomarkers from an array of patients to show mitochondrial health was sacrificed in long COVID patients, helping explain widespread neuropsychological disability.
 
bit.ly/3D8PCjK
13/ COVID is a form of viral sepsis, and we know that there is an association between recovery from sepsis & mitochondrial dysfunction.
 
@TheLancet - bit.ly/3QEe1AY
14/ People often compare Long COVID to #MECFS, which some posit is often driven by diseased mitochondria.

Unfortunately, we’re still early in this line of research w much to learn before specific therapies are available.
 
bit.ly/3ezusB2
15/ HOPE = Hang On Pain Ends
 
I see 3 paths forward:
☑️ Research
☑️ Prevention
☑️ Empathy & Validation

1st, we must have better trials. The NIH & other groups - eg @microbeminded2’s LCRI @research_long - offer great hope for answers on the near horizon.
16/ Second, prevention of infection.

Whether by masking or vaxx or both.
 
Remember that COVID-related deaths in 2022 are 5-times lower in vaccinated than in unvaccinated people.
 
Updated graphs available here: bit.ly/3BmgcV5
17/ In addition, vaccination lowers the risk of Long COVID by as much as 75% to 85%, and the new bivalent B5 booster vaccine is now available.

Read 🧵 w data: 👇@JAMA_current
18/ Third, we can work together as a community to be more empathetic, validate & advocate for those suffering #LongCOVID.

Too many are still silenced & made to feel their invisible injuries are fabricated.

As @edyong209 teaches, they are very real -

bit.ly/3ByYI8h
19/ When interviewing patients for #EDDB, they told me they wished their hand was cut off:

“At least then, Doc, people could see HOW I’m disabled.” Audun Huslid
 
Doesn’t that tear you up?

We must help more, better, faster

Real #People #Real Disease

👇 bit.ly/3tBDVLw
20/🎥👇The disability of Long COVID has kept many people at home for 2 years!
 
The reality of this #publichealth disaster was outlined well by CNN’s @DrSanjayGupta when he recently came to our @CIBSCenter:

See this powerful interview below.
21/ For this @BostonGlobe piece (tweet 1), Alex Schell told me:

“New research is happening. Maybe a medicine will come out, because I'm not ready to face the possibility that I don't get better. I mean, I just think back to the joys that I experienced through running…
22/fin
…I think of the joys I experienced before I had #LongCOVID. I think life can be that sweet again. There's no choice but to look up.” Alex Schell
 
Today I’m grateful for scientists @virusimmunity for advancing our understanding & hope -

bit.ly/3Buya8e

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with WesElyMD

WesElyMD Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @WesElyMD

Sep 12
1/🧵🎥 How do “Dominoes of life” fall in critical illness⁉️

A pt arrives awake & talking but vomiting. In just 8 hrs he nearly dies of sepsis 🤯

Lung & kidney failure, heart attack, coma.

How can this happen & can we save him?

This🧵can help us understand the “arc of illness”
2/ His disease is Ascending Cholangitis

A gall stone lands in his common bile duct

📍Pain & vomiting
📍He’s admitted to the ICU
📍GI performs an ERCP to place a stent, bypass the stone, drain pus & control the source of sepsis
📍Add fluids & antibiotics
📍But he gets worse
Why?
3/ We bypassed the septic source (stone) & drain the pus, but dominoes were already falling.

Bacteria had gotten into his blood.

Too much inflammation & capillary blood clotting occurred, just like in COVID.

What happens when “cellular” dominoes start to fall uncontrollably?
Read 11 tweets
Sep 6
1/🧵 Beauty in the Now…

While normally Greg doesn’t #worry, in this case, he succumbed to fear of change.

He was screaming and Crying in Fear - see tweet below.

How did he get through it?
What did he teach me?

#NothingDownAboutIt #DownRightPerfect #UpSyndrome #Tribe321
2/ Greg held his head in his hands and trembled with worry.

We were disrupting his usual Saturday of watching “I Love Lucy.”

Think Rain Man type of dependence on routine &
that’s Greg.

So when Kim and I took him to the mountains, it totally messed him up.

What happened?

#T21
3/ At first Greg got angry with us for taking him on this trip.

I mean, REALLY angry.

And we know that #ANGER is just one letter away from #DANGER.

He was heading in a dangerous path of rejecting something that could be healing & good in his life.

#TheLuckyFew #FindYourTribe
Read 7 tweets
Aug 30
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.
Read 5 tweets
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
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
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

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Don't want to be a Premium member but still want to support us?

Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal

Or Donate anonymously using crypto!

Ethereum

0xfe58350B80634f60Fa6Dc149a72b4DFbc17D341E copy

Bitcoin

3ATGMxNzCUFzxpMCHL5sWSt4DVtS8UqXpi copy

Thank you for your support!

Follow Us on Twitter!

:(