Thread by @WesElyMD

1/🧵COVID Re-Infection⚠️

Let’s learn
🔹Re-infection is a worry
🔹⬆️ plasma Nucleocapsid (N) Antigen levels predict outcomes
🔹If you get COVID, the best predictor of ⬇️ N-Ag levels (ie, viral replication) is having Spike Ab
🔹You get S-Ab by Vaxx

Read on
bit.ly/3Ha8q2g

2/ These data (N=2540) come from ACTIV-3 study of adults hospitalized for COVID in 114 centers in 10 countries Aug 2020-Nov 2021
 
I’m going back over this because there are so many people walking around without adequate protection due to waning immunity over time.

3/ N-Antigen levels (which we don’t measure in practice) are a measure of viral replication & predict outcomes

Plasma N-Antigen levels are highly associated w Antibody (Ab) status

⬆️ anti-S (spike) Antibodies at time of COVID infection predicts ⬇️ virus & safety

How so?

4/ People w no anti-S (spike) Antibodies had 6X higher N-Ag levels (ie, way more virus, levels over 1,000 ng/l)
 
And there was a dose-response such that more N-Ag (more viral replication) landed people w more oxygen & ICU needs.

5/ Being unprotected (no/low Spike Antibodies) & getting COVID is a big vulnerability.
 
N-Ag levels area a barometer of unbridled viral replication.
 
We have vaccines to help you get more protection w S-Ab. #Bivalent

6/ Viral Persistence & Long COVID

Viral clearance is what we want

It’s sometimes hard to come by

This study (N=73) found delayed clearance (>28 days) was a risk for brain & muscle problems at 18 mo (adjusting for vaxx, BMI, age, sex)

bit.ly/3H8mw4u

7/fin
Viral persistence & “ghost” Ag stimulation are #LongCOVID hypotheses being tested
 
Multiple RCTs of Paxlovid in Long COVID patients are planned
 
Meanwhile, the best way to avoid persistent virus not to get infected AND to have Spike Ab (via Vaxx)

nbcnews.to/3HE8rx4