Mike Hoerger, PhD MSCR MBA Profile picture
Nov 13, 2022 13 tweets 8 min read Read on X
New article in @JAMANetworkOpen provides critical data on the long-term trajectory of COVID-19 symptoms.

Lots of bad news. 😕
Very bad news for ppl w/cancer or bad acute case of COVID. 😬
Also, a few rays of hope. 🌞
#LongCOVID #COVIDcancer

1/12
jamanetwork.com/journals/jaman… Title and graph, journal ar...
66% of adults had at least 1 symptom during the acute phase (first 2 months) of diagnosis of #COVID-19.

I’ve highlighted the symptoms experienced by at least 10%. Note that some of the less common symptoms are quite debilitating though (e.g., 9% w/lung pain).

2/12 Symptom table. Acute sympto...
If you had a #COVID symptom initially, what are the chances it persists beyond 2 months? See 2nd column, green highlights emphasize those enduring among >10%.

Many of the initial symptoms endure in about 20% of ppl. Russian-roulette like odds.

3/12 Table shows the percentage ...
If you know someone with a new #COVID infection/reinfection who is experiencing symptoms, dive deep into that particular row.

For example, while memory loss is rare (4.3%), it’s the most enduring symptom beyond 2 months (40% persisting).

4/12 Table mark up emphasizes on...
If you had an acute #COVID symptom, what were the chances it would resolve within 1 year?
See authors’ BLACK text.

I’ve also added a column with the chances a symptom persists (ORANGE text). Balanced framing. 🙂

5/12 Table on long-term persiste...
Now, let’s manually combine the acute (<2 month), near-term (>2 month), and long-term (>1yr) #COVID data into one figure. Silly JAMA. 😊

Some symptoms present at 2 months largely fall off. Others persist in >25% (palp, art pain, att/conc, memory, sleep).

6/12 Manually combining data fro...
Overall, the number of #COVID-19 symptoms each person experiences diminishes over time.

Caveats: Initial infections were all pre-vax (call for hope), but also pre-omicron and before many reinfections (call for caution). Note, %s are among those who had an acute symptom.

7/12 Graph: Number of COVID symp...
Older adults, women, and ppl w/>5 acute symptoms were more likely to have persistent #COVID symptoms at 1 year.

A history of #cancer predicted prolonged symptoms. #COVIDcancer

Higher BMI = more persistent symptoms. Bad for the U.S.

8/12 Fully adjusted model examin...
An Appendix figure models the typical time to resolution of a #COVID symptom (crude estimate, varies by symptom & individual).

I added the blue line, which suggest about 5% would experience symptoms at 3 yrs. That's >16 million Americans. Very rough estimate. #recession

9/12 Crude analytic model attemp...
Model of time to COVID-19 symptom resolution by subgroup.

#COVID has persistent effects for those with a history of cancer or who had a bad acute case. Either we have a critical gender health disparity or men are trying to walk off heart palpitations. 🤔

#COVIDcancer
10/12 Subgroup analyses show that...
An average of 10% of adults were experiencing long-term symptoms from #COVID-19.

The authors note that this is a critical public health problem b/c of the high incidence of infection. They are perhaps too optimistic. We have a high incidence of REinfections.

11/12 Authors' conclusions from t...
Limitations: The COVID-19 initial infections were all before the vaccine era, mostly before reinfections, and pre-omicron.

You cannot have long-term data AND up-to-date world events. Stay cautious until the long-term data are optimistic.

12/12
By the way, feel free to share any of this on other platforms (Mastodon, Discord, TikTok, Myspace, or even Facebook) and with family/friends. I tried to annotate the figures in a way that it would be relatable to a general audience. Where I failed, ask questions.

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More from @michael_hoerger

Sep 13
California COVlD Surge Rages Higher

🔸CDC SARS-CoV-2 wastewater levels "Very High," and up from last week
🔸1 in 21 estimated actively infectious
🔸>250,000 estimated new daily infections statewide

Four figures...
1/4🧵 CDC: Very High: PMC Estimate: 1 in 21 actively infectious
CDC wastewater data in California show COVlD cases increasing from the already "Very High" levels last week.

2/4🧵 Line graph of the past 6 months showing the surge in wastewater viral levels
With an estimated 1 in 21 (or 4.8%) of California residents actively infectious of COVlD, risk increases dramatically in larger and more frequent social gatherings.

Interact with 25 people of average risk of being positive, and that's a >70% chance of exposure.
3/4🧵 How Does Risk Increase with More Social Contacts? Number of People | Chances Anyone is Infectious 1	4.8% 2	9.4% 3	13.7% 4	17.9% 5	21.8% 6	25.6% 7	29.1% 8	32.5% 9	35.8% 10	38.9% 15	52.2% 20	62.6% 25	70.8% 30	77.1% 35	82.1% 40	86.0% 50	91.5% 75	97.5% 100	99.3% 300	99.9%
Read 4 tweets
Sep 10
Let's say you're a dairy farmer. You have 100 cows. Each year, about 5 cows die, and another 5 cows are born. Then, along comes a virus. Let's call it "cowvid"...
1/
Let's say "cowvid" wipes out about half the cows over the course of a couple years. Now, you're down to 50 cows....
2/
The local mayor declares "cowvid" to be over. This surprises you as a farmer because 5 of your cows keep dying annually. 5 of 50 instead of 5 out of 100. Seems like more, but you're not a city slicker...
3/
Read 12 tweets
Sep 7
#DuringCOVID is today.

Image pack 1 of 9 🧵 Graph of the 11 waves of the pandemic in the U.S., tailored to a key message noted in the post.
1 million New Daily Infections.

Today!

Image pack 2 of 9 🧵 Graph of the 11 waves of the pandemic in the U.S., tailored to a key message noted in the post.
Where are the free vaccines, N95s, and tests?

Image pack 3 of 9 🧵 Graph of the 11 waves of the pandemic in the U.S., tailored to a key message noted in the post.
Read 9 tweets
Sep 3
PMC Dashboard Update (U.S.) 🧵1 of 8

The 11th wave is still rising.
🔥23 states/territories High/Very High
🔥Very High: Alabama, DC, Guam, Hawai'i, Louisiana, Nebraska, Nevada, South Carolina, Texas, Utah
🔥1 in 56 estimated actively infectious
🔥876,000 new daily infections CDC heat map, very high states noted in post. PMC estimate of 1 in 56 actively infectious nationwide
PMC Dashboard Update (U.S.) 🧵2 of 8

Note that the CDC has modified 📉 how transmission levels correspond to the categorical bins.

Take California. We estimate 1 in 30 actively infectious statewide. This would have previously been "Very High," now just "High."
#NewNormal CDC heatmap, with PMC estimate of 1 in 30
PMC Dashboard Update (U.S.) 🧵3 of 8

Here are the prevalence estimates for the first half of states/territories.

Notice how high the levels are in some of the "Moderate" states. State	CDC Level Alabama	Very High Alaska	High Arizona	High Arkansas	Moderate California	High Colorado	Moderate Connecticut	High Delaware	High District of Columbia	Very High Florida	High Georgia	Moderate Guam	Very High Hawaii	Very High Idaho	High Illinois	Very Low Indiana	Moderate* Iowa	Low Kansas	Low Kentucky	High Louisiana	Very High Maine	Low Maryland	Moderate Massachusetts	Moderate Michigan	Very Low Minnesota	Moderate Mississippi	High*
Read 9 tweets
Aug 21
During times like these when COVlD transmission heats up in the U.S., expect to see a lot more angry outbursts for three central reasons.

First, "displacement," or people trying to deny the reality of their anxiety by taking it out on other people....
Second, a lot of people can sustain a strong denial of reality about the ongoing pandemic during lulls. They suppress the existence of COVlD waves and excess deaths, disability, and retirements.

During waves, those defenses burst. Loss of control = anger...
Third, a lot of people (many reading this) understand COVlD correctly & experience righteous indignation during COVlD waves. We quite reasonably do not like all of the unjust and gratuitous suffering.

I find it helpful to channel that intensity into helping other people....
Read 6 tweets
Aug 19
I submitted my comment to endorse universal high-quality masks (respirators) in healthcare. Today is the final day.

Alt text continues in the following posts. RE: Z94.4, Selection, use, and care of respirators (New Edition)  Dear Colleagues,  As the director of a population science program at a major U.S. cancer center, I strongly endorse this draft proposal to increase the use of high-quality well-fitting masks (respirators) in medical settings. I will comment on the relevance of this proposal mainly for cancer care. In the U.S., cancer care is commonly more organized than other specialty care and, thus, often leads the way on policy initiatives, which then translate to other elements of care over time.  1. COVID-19 continues to cause excess dea...
They put forth projections, with the most granular detail for the U.S. and U.K., suggesting excess deaths will persist through at least 2033. Their projections do not show excess deaths stopping in 2033; that is simply the final year of their current analysis. Moreover, while they provide the most data for the U.S. and U.K., their analysis suggests a more general trend throughout the globe. The COVID-19-associated excess deaths are commonly identified as cardiovascular and cancer causes of death.   Swiss Re Institute. (2024). The future of excess mortality after COVID-19. https://www.swissr...
Alt text continued 2. The SARS-CoV-2 virus that causes COVID-19 continues to transmit at high rates worldwide. Overall, 28 nations continue to use wastewater surveillance to monitor SARS-CoV-2 levels. A directory is available at the dashboard that I oversee (pmc19.com/data). In the U.S., we are currently experiencing our 11th wave of transmission. Many nations are experiencing annual or twice annual waves of transmission.
Alt text continued 3. International consensus standards identify a broad range of patients at known high-risk of severe outcomes of COVID-19. The largest group at known high risk of severe outcomes is patients with cancer. Other diagnoses associated with above average risk include people undergoing transplants or receiving dialysis, and patients with any of these diagnoses: immunodeficiencies, renal disease, systemic-immune mediated or single-site immune-mediated inflammatory conditions, asplenia, anatomical barrier defects, pregnancy, and diabetes. These findings underscore the importance of standards in hea...
Read 7 tweets

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