WesElyMD Profile picture
Dec 27 9 tweets 6 min read
1/🧵Can a Diabetes drug prevent Long COVID?
 
Most solid data yet of a medication preventing #LongCOVID from quadruple blinded, non-pharma sponsored COVID-OUT trial N=1,125.

A 42% relative ⬇️ in clinician diagnosed LC was seen (10.6% down to 6.3%).
 
bit.ly/3jvvKj4
2/ Metformin’s success (1 LC prevented for every 23 pts treated) could save millions from suffering.

<$1 per course = very cost effective.
 
Too good to be true?  Maybe but very solid science.

Let me unpack a bit more…

bit.ly/3jvvKj4
3/ This trial had 6 groups of patients because 3 meds (metformin/fluvoxamine/ivermectin) were randomized vs. placebo.
 
The other drugs showed no benefit toward Long COVID reduction.
 
Metformin also looked good for Acute COVID.
4/ In COVID-OUT, Metformin showed a similar effect on the acute early primary outcome w a 42% reduction (OR=0.58, 95% CI 0.35 to 0.94) in prevention of ED visits, hospitalizations, or death due to Covid and hospitalizations or death (OR 0.47, 95% CI 0.20 to 1.11) through Day 14.
5/ Definition: Long Covid @ 10 months was a pre-specified outcome in COVID-OUT.
 
LongCOVID Dx made by medical providers who rendered each diagnosis. And patients consented to medical record review for confirmation of these diagnoses. (so not just self-report as in many studies)
6/ Mechanism of Metformin in LONG COVID?

📍Anti-inflammatory
📍Human lung cells metformin restores autophagy
📍Inhibits release of interleukin-1𝛽 & interleukin-18
 
Metformin also prevented senescent (aging) phenotype induced by COVID

⁉️reduce cognitive aging in LongCOVID.
7/ Aging of Dopamine Neurons in COVID
 
In this study, metformin showed promise at reducing aging of neurons, which if confirmed might help future prevention of Long COVID brain dysfunction.

bit.ly/3Il9mn1
8/fin
📌 This prevention study doesn’t mean metformin will help TREAT #LongCOVID. That is a completely separate issue
📌 These are solid data about prevention that must be replicated
📌 People are desperate but they should NOT start taking metformin until we know more

Stay tuned
💥 Adding Vaxx point from authors @boulware_dr & @BramanteCarolyn - TY for your excellent science!

People who were vaccinated against Covid & who took #metformin had less #longCovid 10 months later👇

Another reason to get your bivalent booster.

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More from @WesElyMD

Dec 13
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
Read 21 tweets
Dec 12
1/🧵 Next Generation COVID Vaccines:

📌BF.7 & BQ1.1 have ⬆️ viral evasiveness
📌New variants pop up every 3-4 mos
📌All made worse by vaxx hesitancy & misinformation

We need a vaccine w longer protection & greater scope

But how?

bit.ly/3Bsf3v4
2/ New Vaccine Targets❓
 
🔹S protein viral sequences that are immutable, immunogenic & accessible to neutralizing Abs
🔹SARS viral membrane, envelope or nucleocapsid proteins & structurally hidden epitopes
🔹Vaccines based on T-cell receptor constructs

go.nature.com/3YaEGKt
3/fin
What would define Vaccine success?

✔️75% Protection >1 Year
✔️Not just help w death & hospitalizations
✔️Protect vs symptomatic disease
✔️Less viral transmission
✔️Fewer adverse events like myocarditis

TO DO:
Remain hopeful
Puh-leaze GET #BOOSTED

bit.ly/3hh5l7S
Read 4 tweets
Dec 9
1/🧵 Grasping for help in LC

📍as a #LongCovid patient you admitted on embarking to Turkey for pheresis that
📍this Tx was an UN-established long shot
📍but your life w this syndrome had devolved
📍as a scientist you now found yourself willing
📍while others conduct trials
2/ I see your choices in seeking therapy for #LongCOVID as brave & honest w cautious expectations cognitively & physically.

Most importantly, you’re demonstrating hope & a desire never to give up.

Knowing you, @pamelarbishop, and calling you friend is a gift beyond measure.
3/ For anyone who chides a highly intelligent person for pursuing alternative approaches to solving health problems #medicine scoffs at, seek empathy & read these truth-telling books 📚

@DouthatNYT @meghanor are my teachers…

#LongLyme #MECFS #LongCovid #Fibromyalgia
Read 4 tweets
Dec 7
1/🧵 Micro Clots & Endothelial Dysfunction in Long COVID

Plus new Epidemiology in @JAMA_current some say proves #LongCOVID is a hoax⁉️
 
Truth is…endothelial dysfunction plus inflammation can lead to life-altering brain & body dz.
 
Let’s explore data

Pic H/T @VirusesImmunity
2/ Remember that Vascular flow problems don’t occur in isolation from inflammation.

This new piece by @Jamie_Ducharme balances the discussion well.
 
It’s time for great studies & NOT immediate widespread treatment with blood thinners that might harm.
 
bit.ly/3He2FCj
3/ The urgency is that people are living w what amounts to newly acquired #dementia.
 
This WaPo piece starts w “Haze. Slow. Drunk. Lost.”
 
Our patients are adamant that descriptors like #fatigue & #brainfog don’t do justice to what makes them suicidal.
 
wapo.st/3YbRJLQ
Read 22 tweets
Nov 30
1/🧵 COVID Screws up sex & making babies

Face it, this virus invades our lives – even making babies.

The ACE2 receptor is in testicles, ovary, uterus, vagina & placenta

Pregnancy is affected, sperm counts are reduced, impotence occurs.

Updates…
 
bit.ly/3VIEaBc
2/ Pregnant women are wise to be afraid of COVID.

Thankfully, we have new data to show that Omicron causes 75% less critical illness than Delta & 43% less preterm birth. Less still birth.

All this despite Omicron being way more contagoius.

bit.ly/3XJ6FAO
3/ Since early in the pandemic, men have been complaining of impotence.

Now we have more compelling long-term data as far as 1 year out.

N=200 study shows the median number of sperm down by >50% vs. men without Covid.

H/T @DrEricDing
Read 5 tweets
Nov 29
1/ End-of-Life Discussion - Poll

(data from a ~13,000 patient study next tweet)

QUESTION:
Is it OK for doctors to make unilateral decisions to limit life-sustaining therapy (eg, remove a ventilators) without patient/family discussion?
2/ Variable Approach to Limiting Life Sustaining Treatment for ICU Patients
 
N=12,850 patients in ETHICUS-2
 
% “NO DISCUSSION” at EOL was 2% in North America vs 37% in Latin America
 
Culture is so important
 
bit.ly/3iddH0e
3/ Other regions of the world also have huge discrepancies. See Central Europe and Mid-East vs. Asia.
 
Two questions:
Would people agree w the medical teams approach if asked?

Should limited resources globally affect these rates?
Read 5 tweets

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