There’s another organ that bridges the skin and gut, which nobody has mentioned …
The mouth!
Your mouth is amazing!
Think of all the incredible things you can do with your mouth.
You can speak, sing, shout, scream, kiss, chew, taste, smile, whistle …
If you have good oral health then your mouth acts an immune organ, a physical barrier which protects your body from outside pathogens (such as bacteria), just like your skin protects you
If you have poor oral health, then your mouth is like an open wound, allowing bacteria to pass directly into the bloodstream, just like an open wound on the skin
In future tweets I will be explaining how the mouth is an immune organ and how it is increasingly clear that poor oral health plays an important part in keeping our bodies healthy
(For info on links between #oralhealth and #COVID please see pinned tweet)
In the meantime, please take good care of your mouth, visit the dentist/hygienist regularly, campaign for free/affordable access to these dental services, and demand the best possible oral healthcare in every setting (hospital, care home etc.)
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The COVID-19 Pathway: A Proposed Oral-Vascular-Pulmonary Route Of SARS-CoV-2 Infection And The Importance Of Oral Healthcare Measures bit.ly/36uEwar
What has changed since then?
Please see this thread ...
The world has caught up and #COVID-19 is now widely understood to be a vascular disease. This includes the severe acute lung disease which itself is not a respiratory 'pneumonia' but a 'vasculopathy'
See this explanation of the imaging (Nov 2020)
Prothrombotic inflammatory processes are now understood to be central to the disease. We used a first principles model of direct viral interaction with endothelial ACE2 (see this short video) but clotting processes are more complex than we describe.
Important news about XXB1.5 pointing out that infection is more via the ACE2 receptor than previous Omicron variants.
But … the mouth is not mentioned as an important site of infection…. cambridgeindependent.co.uk/news/fast-spre…
A thread … 1/
2/ Minor salivary glands over the surface of the tongue, inner surface of the lips, the fauces and soft palate are highly susceptible to infection and replication. Epithelial cells in these areas express the ACE2 receptor. nature.com/articles/s4159…
3/ The mouth can be considered a viral factory with viral entry into saliva in high quantity - 100 million per ml (equivalent to half a billion viruses in a single 5 ml teaspoon). ncbi.nlm.nih.gov/pmc/articles/P…
Based on imaging of the lung disease post acute #COVID/#longCOVID there might be 2 things going on
1- fibrosis due to the acute phase lung injury
2 - endothelial damage - not related to the acute disease
The literature doesn't yet reflect the complexity but getting there ...
In those with respiratory symptoms at 3 months - on Dual Energy CT scans
- 5% have visible clots in lung arteries
- 65% have microangiopathy (disease of small blood vessels of the lungs)
Imaging which assesses perfusion (blood supply) to the lungs is likely to be most helpful post-COVID, not conventional imaging (eg X-ray or CT - other than Dual Energy CT).
- 'such imaging should be embedded in routine post-COVID-19 follow-up pathways'