WesElyMD Profile picture
Jan 3, 2023 8 tweets 4 min read Read on X
1/🧵 Our cell’s genes are rewired in MILD COVID 🧬
Stunning data in @Nature
White Cells (monocytes) switch gene expression from an established innate immune profile to a pro-clotting signature in COVID.
We’re immunocompromised.

Let’s unpack this…
2/ These data explain how the COVID virus places our bodies at risk for macro (large) blood clots in acute dz (which we see often), brain disease due to down-stream micro-clotting, and possibly later cardiovascular dz.
What did these London investigators find?
3/ Taking blood from 2 UK SARS CoV2 studies…

📍They compared COVID🩸(N=62 mild/mod dz) to normal controls
📍Then conducted genetic, metabolic & functional assays
👀 Look how different gene expression was (color difference) in COVID vs. HC (healthy control) pts
What’s it mean?
4/ Monocytes of COVID pts display abnormal markers of inflammation & clotting that drives us to immuno-thrombosis & vascular platelet+cell aggregates.
Very scary stuff if you want a body & brain to get blood, food & oxygen normally.

I highlighted excellent discussion points👇 Image
5/ Let’s pose some Important Questions:
✔️Are these findings COVID-specific?
✔️How long do these genetic/cell function changes last?
✔️Do they contribute to #LongCOVID?
✔️What’s the cost of repeat infections? Image
Our innate immunity is being re-wired by COVID‼️

📌These systems protect us from severe disease & secondary infections
📌My spidey-senses tell me to stay as protected as possible
📌COVID XBB variant is spreading fast
📌Het your Bivalent Vaxx
Clotting isn’t specific to #COVID, it’s just more profound & longer lasting w this 🦠

I’ve been shocked in COVID by my patients clotting on full heparin drips.

In🧵👇I give examples & discuss data - it can happen w bacteria, but the pathology persists in #LongCOVID
See tweets 12-14 in this 🧵 for specifics.

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More from @WesElyMD

Oct 17, 2023
1/🧵 Long COVID Disease State
COVID infects us & Interferon causes 3 dastardly plots:
📌 We absorb ⬇️ tryptophan & convert ⬇️ Serotonin
📌 Platelet pathology ⬇️ stores of Serotonin
📌 Vagal nerve signals peripherally ⬆️ impairs brain function & memory

2/ Tryptophan is an essential amino acid - we don’t make it.

So if we’re “programmed” to absorb ⬇️ from our diet, we sleep poorly, think worse, and all sorts of other bodily functions go awry.

Will SSRI & SNRI meds help, or anti-virals, or immuno-modulators?

Trials will tell. Image
This study by @maayanLevy_lab is a marvel of dozens of avenues of science that all point to a greater understanding of the realities of #LongCOVID as a chronic disease state.

Through work like this, we legitimize not only LC, but also #MECFS #LongLyme etc & take one step closer to finding medical solutions for past & future post-infectious states + syndromes like #PICS

TY @cooney_liz for this @statnews piece!

Read 4 tweets
Oct 10, 2023
1/🧵Catatonia - shocking & hopeful insights into a mysterious neurological disorder 💥

Did Oliver Sacks’s Catatonic “Awakening” Patients have a treatable Autoimmune Disease?
Here I unpack story & science from a stunningly well-done @WashingtonPost article Image
2/ Amazing Discoveries of Autoimmune Disease causing Decades of Catatonia, Schizophrenia
Autoantibodies and treatment with immunosuppressive medications are waking some patients up with crazy cool results. Here’s the article and my highlighted excerpts:
3/ “The first conclusive evidence was in her bloodwork: It showed that her immune system was producing copious amounts and types of antibodies that were attacking her body. Brain scans showed evidence that these antibodies were damaging her brain’s temporal lobes, brain areas that are implicated in schizophrenia and psychosis.”
Read 25 tweets
Sep 27, 2023
1/🧵 Post-Infectious Syndromes

…a Doctor’s admission
📌 I didn’t think #MECFS was real till #LongCOVID opened my eyes
📌 It’s “mysterious” & we weren’t taught it in med school
📌 Yet 1,000s are suffering a disease traditional medicine doesn’t understand
 📌 Let’s find answers Image
2/ Long COVID is estimated at 6% of US Population… @CDCgov
“Prevalence of #longCOVID among U.S. adults ≥18 ⬇️ from 7.5% during June 2022 to 6.0% during June 2023.”

More than 1 in 4 w LC have activity limitations, ie, it’s a LIFE altering disability.
3/ What is #LongCOVID?

Well, it’s not new…update👇
Acute Covid triggers #MECFS as do other infectious agents.
“Triggers” means temporal association not “cause” in a mechanistic sense.”

Think also #LongLyme #Fibromyalgia & more

Read 8 tweets
Sep 6, 2023
1/🧵 Long COVID - new @TheLancet data

📌A picture is emerging
📌It’s not pretty
📌Most pts w months-long symptoms aren’t recovered @ 2-yrs
📌The cluster including neurocognitive & cardiovasc symptoms is ominous
📌These data fuel trial design



2/ This Lancet investigation of just over 500 patients is not particularly large but is well done. The methodology used LC patients from Catalonia Spain from 3/2020 to 2/2022.

They included people who were unable to obtain Covid test but who had an acute onset of symptoms extremely consistent with the syndrome and who developed the same long-term definition of long Covid.

Some may argue about this point but the longCovid community has taught me how important these patients are to include in such research.
3/ Looking at this figure you can see the heat map emphasizing symptoms in clusters B & C that the authors are most confident indicate persistence.

💥 fatigue, headache, neurocognitive, dyspnea, arthralgia, chest pain and tachycardia 💥 Image
Read 8 tweets
Aug 24, 2023
1/🧵This weeks 2 important studies on Long COVID
📌Include ~340k COVID patients vs ~7M controls out to 2 yrs
 📌Organ dysfunction persists in 33%
 📌Levels of disability from #LongCOVID exceed those of cancer & heart disease‼️
Links at end of this thread
2/ Remember that these data complement the 8 or so other studies showing similar findings, and EXTEND the information using VERY large control groups w censoring if those controls got COVID.
First, these are US Military Veterans

✏️Thus, older and more white than the average #LongCOVID person
✏️They also do NOT help us with Delta and Omicron variant COVID
✏️These findings are robust and statistically sound and published by very astute and qualified investigators
✏️But they must be extended scientifically in cohorts that include a high number of younger women, people of color and lower SEC as well as newer COVID variants.
Read 6 tweets
Aug 17, 2023
1/🧵 COVID & Autoimmune Diseases - more data 💥

My patient w #LongCOVID has new Raynaud’s and SLE (Lupus). She’s in tons of pain and is losing her fingers.

Study: N=4M people. COVID ⬆️ risk of new autoimmune Dz & vaccine was protective


2/ New Autoimmune Diseases in #LongCOVID

There are multiple studies showing this now…

Here are two helpful figures from this Lancet article.

Note the hazard ratios >2 for Anti-phospholipid Ab syndrome, pemphigoid, and multiple sclerosis.


Here is an earlier tweet on same topic…
Read 4 tweets

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