Thread by @WesElyMD

1/🧵Our speed in understanding Long COVID is accelerating‼️
 
Here I cover a smorgasbord of recent COVID data on…
📍Brain Aging
📍Genetics
📍Epidemiology
📍PEM
📍Self-Protection
 
Knowledge is Power.

We are all at risk of losing Brain Power from #LongCOVID.

Let’s learn…

2/ COVID ages our brains 😫
 
Cognitive decline is part of growing old, but this is scary.
 
Hot new data w age-matched uninfected control ICU patients show how COVID is associated w Molecular Signatures of an Aging Brain.
 
See Fig 2 a/b/c BELOW
 
go.nature.com/3UHvyKh

3/ Genetics

This study included normal controls. Gene expression changes occur during acute COVID19 in hospital that are associated w subsequent LongCOVID.

This was especially seen in antibody producing Plasma Cells, which explained symptom clusters.
 
go.nature.com/3FMcois

4/ The BRAIN…it’s “so much more than its constituent cells. Each neuron connects with thousands of other neurons—and instead of a cacophony of connections, we have a synchronized symphony.
 
Until it’s NOT a symphony…as in #LongCOVID brain fog
 
bit.ly/3FSrlQf

5/ Epidemiology & Global Burden of Long COVID
 
📌54 studies, 1.2M people reporting
📌6.2% estimates of LC symptom clusters: body/severe fatigue, lung & cognitive
📌Women more pronounced
📌Duration ~9 mos among hospitalized & 4 mos non-hospitalized
 
bit.ly/3t9cxVH

6/ Many regions are experiencing an upsurge of Covid infections right now.

Follow leaders like @Bob_Wachter who update us regularly and make your risk/benefit behavior decisions.

Keep reading…more data👇

https://twitter.com/bob_wachter/status/1602463864313913344

7/ Epidemiology - UK
 
🔹33k COVID vs 63k controls followed 1.5 yrs
🔹6% of COVID patients had not recovered
🔹Predictors of non-recovery included hospitalization, female, lung dz, older age, depression
💥Vaccination assoc w reduced symptoms in 7 domains

go.nature.com/3RUNZKm

8/ Post Exertional Malaise PEM is real
 
My ignorance is being replaced w an appreciation for something now included in WHO guidelines👇

✔️PEM & Post-Exertional Symptom Exacerbation (PESE)
 
Please read up and consider the ramifications. Let’s talk…
 
bit.ly/3iZAmxK

9/ We’ll need to rethink & retest approaches typical for physical & cognitive rehabilitation from usual ICU illness (#PICS) vs #LongCOVID due to realities of PEM/PESE.

Could this profound “fatigue” be due to widespread changes in mitochondrial biology?
 
bit.ly/3WcU0UX

10/ Many previously healthy patients can’t get by in daily life (eg, once hard core athletes now suffering Long COVID) w/out intense pacing approaches due to PEM & PESE

Guidelines help them.

Many scientists are studying exercise & cognitive protocols.
 
bit.ly/3FTEGYp

11/ Mechanisms of Long COVID

LC brain & body disease may be caused by multiple mechanisms. These are reviewed well by @michelle_monje @VirusesImmunity ❤️

In the next tweets, I offer 5 different scenarios being considered…beware LOTS of overlaps likely
 
bit.ly/3g0W4jm

12/ Mechanism & Possible Treatment for Long COVID: 1
 
Ongoing viral replication (SARS-CoV-2 or EBV or CMV or other) which causes apro-inflammatory injury responses whereby at least antivirals are needed +/- immune modulation

13/ LC - Mechanism & Possible Treatment: 2
 
Persistent viral antigens cause a pro-inflammatory response (eg, microglial activation) whereby antivirals are no benefit but immune modulation could help
 
bit.ly/3yt5Z7L

14/ LC Mechanism & Possible Treatment: 3
 
All evidence of the virus is gone but the pro-inflammatory response is triggered & will not resolve until immune dysregulation is fixed. Immune modulation may help vs tincture of time
 
bit.ly/3ytldJF

15/ LC Mechanism & Possible Treatment: 4
 
Again the virus is gone & the immune system is creating an auto-antigen (mimicry) w auto-antibodies (think lupus) that won’t resolve so immune modulation will ultimately be required
 
bit.ly/3CJkvuo

16/ LC Mechanism & Possible Treatment: 5
 
A primary endothelial disease now exists leading to micro-clots & downstream hypoxemia / cell death and even angiogenesis.

See 🧵👇

https://twitter.com/weselymd/status/1600470718403133440

17/ PROTECTION
 
Just a reminder 😎

In this study of 192,509 people from Jan 2021 to April 2022, the rate of hospitalization for COVID was up to 18X higher in people who for whatever reason were NOT vaccinated.

Hospitalization lowest w #Booster
 
bit.ly/3Mgy1sI

18/ Sadly most people don’t plan on getting a booster👇

Individually & for society at large, this is risky.
 
(I get NO money for sharing these data)
 
Winter is here. Stay Safe. Get #COVID + #Flu shots today.
 
reut.rs/3CmxaSy

19/ No one likes to feel sick.

If you get COVID, you’ll feel much better if you’ve been #Vaxxed

COVID Symptoms are less if Boosted, look at this infographic from a study of 1,062 people.
 
bit.ly/3VX21xW

20/ Summary

Long COVID is a real syndrome occurring in the bodies of millions related to different types of pathology.
 
People are left w profound disability to exercise physically & mentally.
 
Support, validation, science, and robust preventive measures are in high demand.

Updated news on Vaccine science…

We really need to act quickly in pursuing next generation COVID Vaxx as the virus continues to emerge its immune evasion stealth.

See op-ed H/T @DrEricDing

bit.ly/3HvCKpU