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WesElyMD Profile picture
@WesElyMD
May 30 • 12 tweets • 11 min read Twitter logo Read on Twitter
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1/🧵 Long COVID’s “Disability Roulette”

🔺No longer a mass Death event…
🔺COVID-19 is an ongoing mass #Disability event
🔺You & I might get #LongCOVID
🔺But society is yawning

This thread unpacks science, policy & hope.

No Paywall Boston Globe link:
bit.ly/3OGfSb1 Image
Friends, I have an entire 20 tweet thread 🧵 uploading here (links, PDF images, etc etc -

but it’s stuck in twitter world.

I apologize for the glitch here. Oy!
2/ The heartbreak we see has scientists working to discover answers💔

Drs. @VirusesImmunity & @PutrinoLab explore hypotheses

📍viral persistence
📍vital reactivation
📍autoimmunity
📍inflammation

Testing antivirals, immune modulators, blood thinners. bit.ly/45E1F4v Image
3/ Data from 223 unvaxxed Mild/Mod COVID survivors

✔️ Show abnormal MRI 🧠 white matter inflammation at 9 mo vs matched controls
✔️Prolonged cellular changes occur & we don’t yet know the significance
✔️Clinical outcomes vary strikingly across studies

bit.ly/43f0vL2 ImageImage
4/ Brain inflammation in other types of #Dementia…

🔸Is often present YEARS before memory & executive dysfunction deficits appear
🔸Don’t be complacent or assume #LongCOVID is safe for peoples’ brains
🔸It’s precarious!
🔸 I covered this haunting brain science in 🧵👇
5/ Dr. @EricTopol tackles important new COVID-19 brain data beautifully

Topol warns us…⛔️
“Recall post-polio syndrome appears 15-30 YEARS after polio - a leading theory is viral persistence.

H/T fig @SutherlandPhD

Read his new substack here: bit.ly/3OMOzfi Image
6/ COVID survivors who died of non-covid causes (N=20)

📌 In autopsies, 60% had “enormous amounts of Spike Protein” in skull, meninges & brain - ✍🏻 author @erturklab
📌Not seen in controls
📌Similar findings in skull & brain of mice
📌 Vaxx not studied

bit.ly/3MZDINI ImageImage
7/ It is highly curious how these problems occurred in “neck-up” skull-meninges-brain structures 🤔

📎 Think again of long-term implications of this virus
📎 When >200 symptoms/signs occur in #LongCOVID after even mild infection
📎 Direct + indirect viral causes are at play Image
8/ We are sorting out risk factors for Long COVID

✔️ Eg: Obesity dampens the initial immune response to COVID
✔️ Pts w high BMI have less expression of IFN & TNF
✔️ “Leptin Resistance”👇
✔️ Could this allow ongoing viral replication & worse #LongCOVID?

bit.ly/43vvZfB ImageImage
9/ More direction come from >200k Medicare pts

🔹Using narrow and broad definitions of Long COVID
🔹Risk factors found = hypertension, chronic lung disease, obesity, diabetes & depression
🔹Time between initial COVID & LC was ~8 mos

bit.ly/3MCrvgt ImageImage
10/ How “Long” is Long COVID?

☑️ Swedish study found 85% of people w LC at 4 mos still had cognitive, muscle & fatigue problems at 2 yrs😔
☑️ Of those unable to work at 4 mo due to LC, ~50% unable to work at 2 yrs
☑️ Massive implications if plays out 🌎

bit.ly/3WG6Cp5 Image
11/ A new “Scorecard for PASC” @JAMA_current

✏️ This is meant #Research
✏️ Not validated for clinical diagnostic use
✏️ N=9,764 pts

Notable:
10% pts had PASC at 6 mo
⬆️ COVID Reinfections ⬆️LC risk!

bit.ly/45ztWsQ

TY @tthaweethai @LisaAMcCorkell @leorahorwitzmd ImageImage

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More from @WesElyMD

WesElyMD Profile picture
May 30
2/ The heartbreak we see has scientists working to discover answers💔

Drs. @VirusesImmunity & @PutrinoLab explore hypotheses

📍viral persistence
📍vital reactivation
📍autoimmunity
📍inflammation

Testing antivirals, immune modulators, blood thinners. bit.ly/45E1F4v Image
3/ Data from 223 unvaxxed Mild/Mod COVID survivors

✔️ Show abnormal MRI 🧠 white matter inflammation at 9 mo vs matched controls
✔️Prolonged cellular changes occur & we don’t yet know the significance
✔️Clinical outcomes vary strikingly across studies

bit.ly/43f0vL2 ImageImage
4/ Brain inflammation in other types of #Dementia…

🔸Is often present YEARS before memory & executive dysfunction deficits appear
🔸Don’t be complacent or assume #LongCOVID is safe for peoples’ brains
🔸It’s precarious!
🔸 I covered this haunting brain science in 🧵👇
Read 19 tweets
WesElyMD Profile picture
Feb 16
1/🧵The Haunting Brain Science of Long COVID
 
📍Here I use science to raise awareness of a growing public health nightmare hiding in plain sight
📍Matt & Barbara tell their stories
📍20 relevant medical articles
📍See 🧵unpacking science in Tweet #2
 
bit.ly/3ItiANv
2/🧵👇Here’s the science I included in the above @statnews piece

…one medical article after another, with take home messages about neuro #LongCOVID you can digest to keep yourself safe, find hope & teach other people what we’ve learned…
3/ Matt Fitzgerald’s story shakes me - a young engineer now disabled by #LongCOVID
 
“I feel like I’m underwater. When you talk to me, I can hear you, but my 🧠 doesn’t understand words. I can’t comprehend what you’re saying. I have no intellectual capacity to digest data.”
Read 8 tweets
WesElyMD Profile picture
Feb 6
1/🧵Your brain “on COVID”🧠
 
Let’s integrate >20 studies on #LongCOVID neuropathology
 
My 24 y/o patient explained: “I don’t have a future because I can’t think anymore.”
 
Let’s talk:
Autopsy Studies
Viral persistence
Brain Size & Disability
Recovery & Hope

H/T pic 👁️ tw 13 Image
2/ Autopsy Data 🧠

Despite initial improvement from COVID, these (N=27) pts got progressively sicker & died

From their autopsies, the authors found “SARS-Cov-2 infection persisted significantly longer than suggested by standard PCR-negative tests.”

bit.ly/3JrcX3l ImageImage
3/ Brain donation from 1st wave COVID patients (N=9) shows widespread endothelial activation, microclots & platelet aggregation supporting COVID as a vascular disease that yields real brain pathology.

IMAGE👇shows microglial nodules & neuronal injury

bit.ly/3kVCW8M ImageImageImage
Read 29 tweets
WesElyMD Profile picture
Feb 1
Simulation in ICU - #Empathy👇

A doctor volunteer trying to understand what it’s like to be tied down & sedated.

More & more we must dive down into what we do to others to understand their experiences

To improve our care…#A2Fbundle
Asking:

“What is causing their agitation? How can you respond to it? Do they have contraindications to mobility? How do you start?”
She @DaytonICU gives complex scenarios & walks us through the process of asking, “What is their RASS? Why are we concerned about delirium? What are their risk factors for ICUAW? Why are we concerned about ICUAW? Do they have an indication for sedation?”

“Now what do you do⁉️”
Read 4 tweets
WesElyMD Profile picture
Jan 30
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?
Read 7 tweets
WesElyMD Profile picture
Jan 17
1/🧵 Real-World Long COVID
 
🔹She got COVID Oct 2020
🔹59 y/o walked 5mi 4x /wk
w no prior cognitive problems
 
🔹“I got better but 4 mo later my memory faded. I struggled.
🔹HR came after me, ‘You can’t do your job.’”
 
Husband: “I want my wife back!”

(Pics & story w perm)
2/ Could her new #dementia be unrelated to COVID?

Maybe, but…
 
Her excellent neurologist feels her negative work-up, young age, speed of demise, temporal onset in relation to COVID all fit LongCOVID-related brain dysfunction & not a pattern of Alzheimers.
 
They want to share
3/ Husband through tears: “I want my wife back.”
 
Her Description – “I walk down the hall & see pictures of family & trips. I feel like a ghost because I don’t remember. My husband cries because I seem gone to him.”
 
“I’m trying to figure out who Barbara 2.0 is going to be.”
Read 10 tweets

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