Thread by @WesElyMD

1/🧵 Update on Long COVID Prevention‼️

Do meds & vaccines ⬇️ #LongCOVID risk?

1st meet @pamelarbishop, a scientist in forced early retirement due to LC:

“I oscillate between fierce determination to get better & abject horror at the daily destruction of my body."

read on…

2/ A case-control study of 9k unhospitalized COVID pts treated w Paxlovid btwn March & June 2022 versus 47k patients w no antiviral or antibody treatment.

All >= 1 risk factor for hospitalization.

The results are surprising if you think about it.

Why?
bit.ly/3WKmo1V

3/ It’s NOT a randomized trial, so we don’t know why people did or didn’t get Paxlovid.

In practice, we givemeds more aggressively (or want them ourselves) if we’re sicker.

So you might think those who didn’t take Pax would be less sick & do better. That’s not what was found…

4/ Compared to controls, treatment w nirmatrelvir (Paxlovid) was associated w 26% ⬇️ risk of #LongCOVID (HR 0.74 95% CI (0.69, 0.81).

Improved outcomes in 10 of 12 LC problems related to heart, blood clotting, fatigue, liver llung & kidney disease & brain outcomes.

Impressive.

5/ There was also a reduced risk of death by 50% and less likelihood of hospitalization by 30%.
 
Perhaps more striking is that there was a reduced risk of #LongCOVID among those unvaxxed, vaxxed and boosted.
 
But remember, it’s NOT RANDOMIZED.

Why does this matter?

6/ There is a LONG history of Case-Control studies being proven wrong once patients are placed into groups randomly, which is done to reduce bias & establish rigor in science.

There are all kinds of reasons that these people did & didn’t get Paxlovid, so to really know…

7/ We physician-scientists are designing randomized controlled trials w prospective data collection on risks & subgroups of #LongCOVID as primary outcome.

We do need longer follow-up bit for now I think these results are actionable. TY @zalaly

I have several additional points…

8/ The only way to 100% prevent Long COVID is NOT to get Covid.

Duh right?

So let’s review the data on #Vaccine reduction of Long COVID…

But first, let’s talk briefly about the status of human disability and societal costs of the #pandemic.

9/ Since mid-2020, the US alone has ~2 million newly disabled people from this post-viral syndrome.

Society won’t understand the full effects for decades.

The financial cost is estimated in the TRILLIONS 💰💰💰

nyfed.org/3NQ4BCp

10/ This study of 1.2 million people who had symptomatic COVID looked at Brain, Lung, and Fatigue+Pain clusters of #LongCOVID.
 
6.2% (which is on the low end of large cohort studies, most averaging 10-15%) had at least 1 cluster

Fascinating that…

bit.ly/3t9cxVH

11/ The mean duration of symptoms was 9 mos for hospitalized & 4 mos non-hospitalized

15% of those still suffering symptoms at 3 mos after COVID had #LongCOVID at 1 year 😔

If only 6% of >600M w COVID on 🌎 get LC, that’s 36M people!

Its likely a gross underestimate⁉️
#harsh

12/ SO…
What are the data on risk of Long COVID in vaxxed vs. unvaxxed?

I will review 4 studies.

Bottom line: there’s about a 30% to 50% risk reduction (though the range across studies is 15% to 80%)

✔️ btw I’m paid $0 to share these data & have no stocks in pharma companies

13/ This UK study showed that receiving two COVID-19 vaccinations at least 2 weeks before COVID was associated with a 41% decreased odds of developing #LongCovid symptoms 3 mos later versus not being vaccinated when infected.
 
bit.ly/3vi7STT

14/ 6 studies of 17M people analyzed together showed #Vaxx assoc with ⬇️ risk of #LongCOVID, 2 doses better than 1.

Overall 17 studies had grade III evidence (out of IV) that vaccination before COVID can reduce subsequent Long COVID.
 
bit.ly/3TdBeLq

15/ In 740 healthcare workers with COVID who didn’t require hospitalization, 2 or 3 doses of vaccine was associated with 75% lower #longCOVID risk versus no vaccine.

Cool dose response: 41% LC in unvaxxed vs. 30% vs 17% vs 16% w 1, 2 & 3 doses 🎶
 
bit.ly/3pDyZEI

16/ in @TheLancet

“Even if COVID-19 doesn’t kill us, the high morbidity of #LongCOVID justifies vaccinating all. The reasons for vaccination beyond averting severe disease & deaths are manifold, but the foremost is to prevent longCOVID.”

Preach! 💥
 
bit.ly/3DNeRqx

17/ an aside…I'm not leaving Twitter but

✔️ I also on Mastodon to post #science & #love there
✔️ Let’s work to lift ourselves from #suffering into #recovery
✔️ Hoping to learn, do good & provide a way forward.

Handle: [e-mail]

med-mastodon.com

18/ What are aome ways antiviral meds & vaccines might ⬇️ LongCOVID risk?

📍Reduce the initial viral load
📍Create a more controlled immunological response to the virus that the body can shut off later
📍 Prevent viral “ghosts” from creating ongoing antigenic stimulation.

19/fin
In conclusion, we’re learning how to stay in safe water

👇fig below
 
Reduce your risk of disabling #LongCOVID by…

📌 Getting vaccinated - benefits outweigh risks for most people
📌 Take antiviral meds quickly
 📌 Mask indoors
📌 Enduring effects of #COVID are not over

https://twitter.com/weselymd/status/1521104355964948481