Thread by @jeffgilchrist

Why should we care about a virus with a "99.8% survival rate"?

This thread highlights the actual impact a virus with a high survival rate can have on the population and why it is all the people who survive that we should be most worried about. 🧵1/

#covid #LongCovid #Health

The web version of this article with nice table of contents and easy to share with others can be found here ( ). 2/ tinyurl.com/COVIDrealImpact

1. Virus can get into and damage almost every part of the body
2. Long term impact or disability even from mild infection (children & adults)
3. Increased risks of cardiovascular, cancer, diabetes and other disease after infection

3/

4. Repeat infections can cause cumulative damage (38% with Long COVID after 3 infections)
5. Healthcare cost increases
6. Healthcare system overwhelmed and understaffed
7. No approved treatments for long-term damage

4/

8. Impact on business from people exiting workforce due to long-term illness
9. Economy impacted by not enough healthy people to work
10. Real world examples of people after COVID

5/

11. 3rd leading cause of death in Canada and Australia despite most people surviving
12. What can we do now?

6/

"Long COVID is a multi-system disorder that can affect nearly every organ system." It affects the heart, the brain, nervous system, the endocrine system, the immune system, the gastrointestinal system and more ( ). 7/

https://twitter.com/amandalhu/status/1748027236576591990

Long COVID can induce cardiovascular, neurologic and metabolic symptoms from viral persistence, immune dysregulation, microbiome imbalance (dysbiosis), endothelial inflammation, neuronal inflammation, and mitochondrial dysfunction ( ). 8/ science.org/doi/10.1126/sc…

More than 90% of cases occur in people who had mild COVID infection. Reinfection contributes additional risks of Long COVID which can trigger new cases or make the current cases more severe. 9/

"Efforts to prevent reinfection are critical to reduce the risk of long-term population health loss." 10/

Want to easily share what people need to know about COVID in 2024? Olivia Belknap (@o_bel_) and Erin Batali have put together this great presentation for therapists but it has useful information for everyone ( ). 11/ covid-for-therapists.my.canva.site

** Impact on Brain **

Yes you saw that correctly, COVID damages the brain. Here is an image Dr. Danielle Beckman(@DaniBeckman) showing activated microglia on a non-infected brain compared to an COVID infected brain ( ). 12/

https://twitter.com/DaniBeckman/status/1759409769629335892

You can see in the COVID infected brain, the degraded myelin attracts more activated microglia to the region contributing to more neuroinflammatory responses. 13/

Another image showing brain injury comparing neurons in a brain without COVID to one after it has been infected with COVID and the much less dense network of neurons that remain ( ). 14/

https://twitter.com/DaniBeckman/status/1756117668971880777

Infection can cause a leaky blood-brain barrier which looks like this image on the right. Activated astrocytes (green) surrounding a blood vessel with more presence of activated microglia/macrophages (red) as well ( ). 15/

https://twitter.com/DaniBeckman/status/1763523807648886898

Non-infected brain on the left, "photo taken in the piriform cortex (primary olfactory region, near memory-related areas such as the hippocampus and entorhinal cortex)." 16/

"COVID-19 disrupts the blood vessels everywhere in the body and is not different in the brain! The result is not good and can take time to be cleared and can result in permanent damage." 17/

One of the most common complaints from people with Long COVID is cognitive impairment (brain fog, memory loss, difficulty concentrating) which affects almost half of people. 18/

One study identified biomarkers consistent with brain injury and found brain deficits in COVID-19 patients were equivalent to 20 years of brain ageing ( ). 19/medscape.com/viewarticle/ne…

A prospective study of 112k participants tested their memory from March 2020 to April 2023 and found those with COVID infections had worse memory problems (higher score) at all time points from 0-1 month all the way up to 36 months after infection ( ). 20/ nejm.org/doi/full/10.10…

Another study looking at more than 110k participants found that compared to uninfected controls, even people with mild COVID and resolved symptoms developed the equivalent of a 3-point loss in IQ ( ). 21/nejm.org/doi/full/10.10…

Those with unresolved persistent symptoms had the equivalent of a 6-point loss in IQ, and those who had been admitted to an ICU for COVID had the equivalent of a 9-point loss in IQ. 22/

While an IQ of 100 is average, an IQ below 70 generally indicates a level of intellectual disability that may require significant societal support. 23/

Dr. Al-Aly estimates that even a 3-point downward shift in IQ seen in people with mild COVID infection with resolved symptoms would increase the # of US adults with cognitive impairment that requires significant societal support by 2.8 million (
( ). 24/scientificamerican.com/article/covid-…

The mechanisms of cognitive dysfunction could be from COVID infection inducing fusion of neurons, prolonged neuroinflammatory responses, structural abnormalities, and accelerated ageing in the brains of persons with mild-to-moderate infection ( ). 25/ nejm.org/doi/full/10.10…

The Omicron variant has increased neurotropism (ability to invade and live in neural tissue) and penetrates the central nervous system via the olfactory bulb (bottom of brain above the nasal cavity, involved in sense of smell) ( ). H/T: @HarrySpoelstra 26/onlinelibrary.wiley.com/doi/10.1002/mc…

"This direct invasion induces inflammation and neuronal damage." The study found the presence of COVID virus in the cerebrospinal fluid of a significant proportion of Neuro-COVID patients who displayed more pronounced symptoms of acute brain disease. 27/

** Risk of Developing Long COVID **

If "99.8% of people survive" infection, what are the chances of getting Long COVID? Statistics Canada recently published a report and found the risk increased with the number of infections ( ). 28/www150.statcan.gc.ca/n1/pub/75-006-…

Even with mild cases, a quarter (25.4%) of people with 2 infections suffered from Long COVID and 1.7x more likely to have prolonged symptoms compared those with only 1 infection while 37.9% of people with 3 or more infections suffered from Long COVID and 2.6x more likely. 29/

You can see from this graph the cumulative risk of developing Long COVID (data points from Statistics Canada in orange) adds up quickly with every infection so with every infection you are rolling the dice ( ). 30/

https://twitter.com/DavidSteadson/status/1733246631959507246

By the time you hit 10 infections with this model, the risk of long term symptoms is 80% and the younger you are, the more years of infections you will be subjected to so the longer you will have to live with any consequences. 31/ Click "Show replies" 👇 to continue.

How long are people's Long COVID symptoms lasting? Almost half of Canadians who continue to experience Long COVID symptoms report no improvement over time and 42% have been 1 year or more while 37% have experienced symptoms 6 months to 1 year ( ). 32/www150.statcan.gc.ca/n1/pub/75-006-…

It is not just Canada but all over the world. The US Census Bureau found that nearly 1 in 4 American adults (24.4%) who get COVID-19 suffer from Long COVID but some States are worse such as Oklahoma with 34.1% ( ).33/helpadvisor.com/community-heal…

It is estimated that at least 20 million Americans (likely more and increasing every day) suffer from Long COVID. That is more than half the entire Canadian population! 34/

"More than 200 symptoms have been identified with impacts on multiple organ systems. At least 65 million individuals worldwide are estimated to have long COVID, with cases increasing daily." ( ) 35/nature.com/articles/s4157…

Does Long COVID only impact our oldest adults? In the USA the Census Bureau found the adult age range the most impacted are those age 25-39 followed by age 40-54 and 1.7x more women reported symptoms than men ( ). 36/ usatoday.com/story/news/hea…

** Impact on Children **

What about children, isn't COVID supposed to be mild? Japan recently released a study that found 35% of children had Long COVID symptoms at their initial recovery, 11% after 3 months and 7% after 1 year ( ). 37/nature.com/articles/s4159…

With the children in the study, 90% were infected with the Omicron variant (Dec. 2021 - Jul. 2022) and there were no severe cases. 38/

It is important to understand that Long COVID doesn't just happen to people who are hospitalised, the vast majority of people develop it from mild infections. 39/

Long COVID also impacts most organs and systems in children which can be seen in this diagram and more details of each symptom found in this study ( ). 40/ publications.aap.org/pediatrics/art…

Many people don't realise that common symptoms with COVID infection are gastrointestinal (GI) like vomiting, nausea, abdominal pain, diarrhea/constipation, weight loss, and loss of appetite. That might not just be a 24 hour stomach bug that your child has. 41/

The study estimates that in the United States there are up to 5.8 million children affected by Long COVID, representing a significant community impact. 42/

Want to simulate how long it might take for a group of people to develop Long COVID? Take a look at this thread to find out how and what happened to our family. It was much faster than we hoped for... 😢 ( ). 43/

https://twitter.com/jeffgilchrist/status/1751312872372572221

Children can and still do develop serious COVID infections that require hospitalisation, especially our youngest. 44/

In Ontario last year infants <1 years old were hospitalised for COVID at a rate 120 per 100,000 population which is higher than those aged 60-79 at 98 per 100,000 people. Children 1-4 years old (14.6 / 100k) were almost the same rate as those aged 40-59 (16.8 / 100k). 45/

One infant only 5 months old has already been hospitalised three times from viral infections. She was first infected with COVID at 2.5 months old, then infected with Influenza a month later and then RSV less than a month after that ( ). 46/

https://twitter.com/CovidintheChart/status/1765557960598860266

Viral infections can knock down your immune system so you are more prone to secondary infections and in this case the infant was hospitalised each time, still in hospital a week after the 3rd infection, requiring a g-tube for feeding and not gaining/maintaining weight. 47/

In a group of hospitalised US children a new study found that almost a third (29.1%) were not recovered up to 4.4 years later and 67% overall had new or persistent symptoms ( ). H/T: @elisaperego78 48/pubmed.ncbi.nlm.nih.gov/38410766/

"The most common symptoms were fatigue (37%), weakness (25%), and headache (24%), all with frequencies higher in children not recovered." 49/

COVID infection during the neonatal period impacts the brain while it is still developing leading to poorer psychomotor development and much greater mildly delayed performances at 18-24 months ( ). H/T: @GosiaGasperoPhD 50/ijponline.biomedcentral.com/articles/10.11…

These infected toddlers even had smaller head circumferences at 12 months despite no difference at birth implying an impact on their early development and might help explain their worse neurodevelopmental score. It will be important to follow up when they are older. 51/

A study found a substantial proportion of pediatric COVID-19 patients with neurological symptoms exhibit abnormal neuroimaging findings ( ). H/T: @vipintukur 52/nature.com/articles/s4159…

These include abnormalities in multiple areas: neurovascular (8.22%), ADEM-like lesions (7.69%), encephalitic pattern (13.95%), myelitis (4.60%), transient splenial lesions (16.26%), and other (12.03%). 53/

What about the impact of COVID infection on children and school? 54/

A study of undergrad students at a university in Spain found that outstanding academic achievement was only achieved by 4% of students who had been infected compared to 7.3% of students who had not ( ). H/T: @pjavidan 55/link.springer.com/article/10.118…

Preventing our children and young adults from being infected is important to safeguard their educational outcomes and shows the detrimental impact COVID has on student's academic performance. 56/

** Repeat Infections **

Many people are getting infected one or more times a year now and some families I know are already on their 6th COVID infection so their time is running out before there are long-term consequences if it has not already happened. 57/

Studies have started measuring the impact of 3+ reinfections from COVID on various conditions including 4-5x higher risk for Kidney, Cardiovascular, Blood clots and Pulmonary... 58/

... 3.5x higher risk for Fatigue and GI problems, 3x higher risk for Diabetes, and 2-3x higher risk for mental health, neurologic, and musculo-skeletal ( ). 59/ nature.com/articles/s4159…

Is it dangerous to keep getting COVID-19? “For somebody who is already on the edge of developing diabetes and then gets COVID-19, that could damage the pancreas and the endocrine system enough to change things,” ( ). 60/time.com/6553340/covid-…

"Similarly, having high rates of inflammation before COVID-19 could raise the risk of heart events such as stroke or a heart attack after an infection." 61/ Click "Show replies" 👇 to continue.

"Regardless of a person's health status, each COVID-19 infection can raise the risk of developing blood clots, which can travel to the brain or lungs." 62/

"The data are showing that [some] people still display increased risk of problems even two years after an infection." 63/

Even those people infected by COVID who didn't develop Long COVID, the "No PCC" group had a 5x increase in severe cognitive slowing compared to the No COVID group ( ). 64/ thelancet.com/journals/eclin…

The Long COVID (PCC) group had a 13.3x increase compared to the No COVID group and more than half (53.5%) suffered from severe impairment. Unfortunately for the participants with Long COVID (PCC), "the data indicate that this impairment does not improve over time." 65/

Since not everyone develops Long COVID after infection, is health loss worse during initial infection while fighting a high viral load (acute phase) or afterwards (post-acute phase)? ( ). 66/

https://twitter.com/zalaly/status/1735444941206098351

It turns out there is a much larger burden of health loss that occurs after the initial acute phase of an infection is finished in both COVID and Influenza. 67/

The study observed that COVID is worse than flu, acute COVID is worse than acute Flu, and post-acute COVID (Long COVID) is worse than post-acute Flu ( ). 68/

https://twitter.com/zalaly/status/1736035113735975016

Following participants for 18 months after infection, the COVID group had a 1.5x increased risk of death, an excess rate of hospital readmission (20.5 per 100 persons) and excess rate of ICU admission (9.2 per 100 persons) compared to Influenza ( ). 69/thelancet.com/journals/lanin…

COVID had a higher risk of adverse health outcomes in all organ systems than flu except for the pulmonary system. COVID is more multi-systemic but less respiratory than Flu. This wasn't just found in the early variants of COVID but also the more recent Omicron variants. 70/

We know there are cases where people have been infected with a different variant of COVID only weeks (20-42 days) or months after their last infection ( ) but how often do we actually get infected by Influenza? 71/wwwnc.cdc.gov/eid/article/29…

Is it normal historically for humans to be infected with a virus like Influenza (that can cause major health issues) regularly every year or multiple times a year like is happening for some with COVID? 72/

Apparently not. A study found that with Influenza A the majority of people were only infected once every 5 years or longer ( ). H/T: @LazarusLong13 73/ journals.plos.org/plosbiology/ar…

Getting infected once a year or more with a virus that can cause as much short and long-term damage as COVID is not something humans have experienced before. 74/

We should not underestimate the potential long-term impact in 5, 10, 20 years from now if we continue to do nothing to mitigate its spread and constant mutation. 75/

** Healthcare Costs **

Even when people didn't develop Long COVID there was still a substantial health and economic burden for healthy adults during the year after infection. 76/

In a group of almost 4000 patients where 94% did not require hospitalisation in the post-acute period after infection, there were the following increases in diagnoses: 166% for blood disorders, 123% for endocrine and metabolic... 77/

... 115% for nervous system, 76% for digestive system and 75% for mental and behavioural. ( ).

Substantial increases in all measures of healthcare utilisation were observed with increases in related prescriptions. 78/bmcmedicine.biomedcentral.com/articles/10.11…

In healthcare systems that were already stretched before the pandemic, thousands of Canadians died last year while waiting for surgery (
). 79/toronto.citynews.ca/2023/12/09/can…

"The report also states that health care costs per person have risen substantially from $1,714 in 1992-93 to $5,607 in 2022-23. Spending has grown well above inflation, and it keeps getting worse and worse and worse." 80/

At least 17,032 patients died in Canada last year while waiting for surgery or diagnostic scan (not incl. QC, NL, and MB) with 101 patients in Ontario died waiting for heart surgery while 179 patients in Alberta died waiting for a diagnostic scan ( ). 81/ secondstreet.org/wp-content/upl…

** Economic Burden **

Since employers will often pay for some of the medical and drug coverage (nearly 50% in the USA), COVID-19 is going to have a big impact on profits and the economy hinges on reducing the impact from infections ( ). 82/

https://twitter.com/JeromeAdamsMD/status/1754904968237023373

Even the Chief Science Advisor of Canada warns that Long COVID "has the potential to become a mass-disabling event" ( ). 83/science.gc.ca/site/science/e…

Did the provinces know the impact of Long COVID? Yes! The Government of Canada sent evidence summaries to all provinces every 2 weeks and started informing Chief Medical Officers of Health from summer 2020. See the right to information request ( ). 84/protectnb.ca/2848.html

More details about the @PoPNB_kindness information request here ( ). 85/

https://twitter.com/PoPNB_kindness/status/1768650084034478139

Looking at BC disability claims up to the end of 2022 you can see a big jump in the # of claims for "Occupational Disease" from 4k-5k claims before the pandemic to 7.8k in 2021 and 14.9k in 2022 ( ). H/T: @beansprouts_mom 86/ worksafebc.com/en/resources/a…

Just 2021-2022 accounted for 60% of claims from 2018-2022 which resulted in more than 1.5 million days lost and over $500 million in disability costs (not including rehab or healthcare). 87/

These were just the people who could *prove* their infections happened at work so does not measure the vast majority of people who were impacted in the population. 88/

ONS UK Labour Market statistics showed that by Nov 2023 the # of people aged 16-64 out of work due to long-term sickness increased 31% since 2020 to a record 2.81 million or 1 in 15 working age people ( ). 89/

https://twitter.com/_CatintheHat/status/1758929009339994183

Brookings calculated that even back in 2022 there were up to 4 million people likely out of work due to Long COVID in the US with an economic burden of lost wages approaching $200 billion a year and likely much more now ( ). 90/brookings.edu/articles/new-d…

US Bureau of Labor Statistics: the population age 16 and older with a disability ranging between 30M-31M people before the pandemic has since jumped to over 34M people disabled in a short period of time ( ). 91/ Click "Show replies" 👇 to continue. fred.stlouisfed.org/graph/?g=QaRH#

The unfortunate reality is that pretending COVID infection is mild is causing a major impact on the economy. Companies have been ignoring Long COVID risk for too long and now they are literally paying for it. 92/

COVID infection substantially diminishes cognitive performance in those affected and is one of the more common symptoms ( ). H/T: @brownecfm 93/manager-magazin.de/hbm/long-covid…

"A virus that slows down cognitive processes, leading to persistently higher absenteeism and increased occupational disability, is a concerning prospect for the business world." 94/

"Companies who invest a medium amount in protective solutions today can save large sums in the long term." 95/

A study estimated the Long COVID costs for Germany's economy, health care, and pension system ( ). 96/bmchealthservres.biomedcentral.com/articles/10.11…

The following estimates are using Long COVID numbers from 2021 which have significantly risen since then so likely an underestimate. 97/

They calculated 84 days of work incapacity per person and a total production loss worth 3.42 billion euros, rehabilitation costs of 332 million euros, and 2.07 billion euros in pension payments for just 1 year. 98/

More recent data from 2022 found that employees who suffered from Long COVID reported an average of 237 days of sick leave resulting in a labour loss of 22,200 euros per person. 99/

Many of these employees are no longer able to work at their previous capacity so will need to be replaced. 100/

COVID can also damage the immune system even in mild cases so many people who recover from infection will be more susceptible to infections from other pathogens like cold viruses, strep, RSV and flu. 101/

Germany reached a new record level of sickness rate in 2023 which caused the country to slip into recession due to the large number of employees on sick leave. 102/

It is not just Germany. Britain and Japan have also sunk into recessions with Japan losing its spot as #3 economy as the world shows some chronic weakness associated with Long COVID ( ). 103/theglobeandmail.com/business/comme…

The World Bank predicates the world economy will grow at its slowest rate in three decades and European manufacturing is now in a recession. The world economy never recovered from the COVID-19 pandemic. 104/

** Real people with Long COVID **

Are you not worried about Long COVID because you have income protection insurance? 105/

You might want to read this story about Sammie McFarland (@SammieFMc) who was a fit and strong Pilates coach before getting infected and developing Long COVID ( ). 106/

https://twitter.com/SammieFMc/status/1700634792440504621

She has had chronic, diagnosed, life changing Long COVID since March 2020 and then reinfected a second time in March 2022 and Feb. 2023 with each reinfection triggering significant relapses and worsening of symptoms. 107/

Her insurance provider required her to take a Chronic Pain Abilities Determination (CPAD) test, a combined physical and cognitive assessment conducted across two days to determine the working capabilities of individuals. 108/

Despite her being extremely disabled by Long COVID, she attempted the test the best she could and even the assessor terminated the test because it wasn't safe for her to continue. 109/

She returned another day to complete more of the test but the test left her exhausted, nauseous, dizzy and her brain felt like it was on fire. 110/

Then 6 weeks later she received a notice from the insurance company that her coverage was being terminated since they did not believe the test scores as they were "lower than patients suffering from severe traumatic brain injuries, stroke, and dementia". 111/

Guess what? Studies have actually found that symptoms of Long COVID can lower quality of life more than some people with advanced metastatic cancers, such as stage 4 lung cancer ( ). 112/bmjopen.bmj.com/content/13/6/e…

In the UK there is an estimated 1.9 million people with Long COVID including 62,000 children. 113/

You can watch this short video to see what that actually looks like since the media does not use realistic images which convey how serious the illness can be ( ). 114/

https://twitter.com/long_covid/status/1748980202795892934

Toronto emergency physician Dr. Jennifer Hulme @jenniferhulme was diagnosed with COVID in spring 2022 which developed into Long COVID and persists today. You can read more about her experience here ( ). 115/uhn.ca/corporate/News…

"I was mostly bed bound with relentless post exertional malaise, fatigue, cognitive impairment, memory loss, headaches, pulsatile tinnitus – which is a constant whooshing in the ear, and a disturbing sensitivity to sound called hyperacusis." 116/

"I lost hearing in one ear and developed constant ringing in it. I was breathless at rest. I couldn't remember my address. I went off work and onto disability." 117/

What does Dr. Hulme want physicians and the public to know about Long COVID? "The tests are not normal – we are just not ordering the right tests." 118/

"Every study of long haulers shows unbelievable pathology: immune dysregulation, mitochondrial dysfunction, neuroinflammation, brain damage, vascular damage, gut dysbiosis, poor perfusion of the brain, lungs and other organs." 119/

"We just don't have an easily accessible biomarker yet." While there are no approved treatments for Long COVID yet, there are some things that can help assuming your physician understands Long COVID and believes you might have it. 120/

"Antihistamines, antidepressants for neuroinflammation, aggressive treatment of autonomic dysfunction, or POTS, resting and pacing for post-exertional malaise – these things can help." 121/ Click "Show replies" 👇 to continue.

"The best way to prevent long COVID is to avoid getting COVID. I use Can95 masks, nasal sprays and HEPA filters. And, if you do get COVID, have a plan to enrol in CanTreatCOVID ( ) to contribute to the science on long COVID secondary prevention." 122/cantreatcovid.org

"We need a rapid acceleration of double-blinded, placebo-controlled, randomized clinical trials. Of the trials that are ongoing right now, only 12 of them are looking at pharmaceutical treatment of long COVID." 123/

"This is in part because we don't fully understand the root cause of post-viral illness – whether this is persistent virus, viral debris, reactivation of latent viruses, gut dysbiosis..." 124/

"... – and what is driving all of the downstream effects of end organ, vascular damage and microclotting." 125/

Dr. Hulme also discusses her experience in a Long COVID awareness day presentation hosted by the Canadian Covid Society @CanCovSoc ( ). 126/

A Colorado teen who used to be a competitive soccer player has had Long COVID for 4 years and needed to celebrate prom from the hospital. Read her story here ( ). 127/ people.com/colorado-teen-…

Kelly (@broadwaybabyto) wants people to know about her experience and that even those who practise healthy living like she does still ended up with Long COVID and chronic illness ( ). 128/

https://twitter.com/broadwaybabyto/status/1744209480219324860

M_P (@MchP66592467) went from a fit weightlifter, cyclist and a VP at a major financial institution to mostly housebound, in bed or couch laying flat nearly all the time with severe ME/CFS after a COVID infection ( ). 129/

https://twitter.com/MchP66592467/status/1753493985975280128

Dr. Deepti Gurdasani (@dgurdasani1) talks about what she learned and her experience after nearly a year of Long COVID which includes POTS (Postural Orthostatic Tachycardia Syndrome), PEM (Post-exertional malaise) , and debilitating fatigue ( ). 130/

https://twitter.com/dgurdasani1/status/1755906357302374759

This is a video of a child with Long COVID who was infected 3 times and had no pre-existing medical conditions before 2020 ( ). 131/

https://twitter.com/keetmuise/status/1764638310033752558

Unfortunately the child has lost fine motor skills to the point they can't button shirts, tie shoelaces or hold pencils properly. He has also developed childhood epilepsy, sensory integration dysfunction, and developmental coordination dysfunction. 132/

Keith (@keetmuise) is hoping that anyone who has experienced similar symptoms with children and Long COVID please share any information with him to help their family move forward. 133/

Fatigue can shatter a person. "Everyday tiredness is nothing like the depleting symptom that people with long COVID and ME/CFS experience." Read real-life experiences here ( ). 134/theatlantic.com/health/archive…

Sylvie Gagnon who used to work 60 hours a week now spends most days confined to her recliner and has been struggling with Long COVID since early 2023 after her 4th COVID infection ( ). H/T: @RougeMatisse 135/ montrealgazette.com/news/local-new…

"Some people still think long COVID is just having a bad, continuous cold, but that’s not the case." 136/

Gagnon's first 3 infections resulted in a persistent cough and shortness of breath but eventually improved. After her 4th infection, "the symptoms not only lasted longer but worsened to the point of being debilitating." 137/

Like many people with Long COVID, most tests come back inconclusive while a diverse set of symptoms bother her including lungs, heart, and brain. "Any effort made, whether physical, mental or even emotional, can take days to recover from." 138/

Gagnon had to move in with her son after one too many close calls while alone at home. People should be asking themselves, if they develop Long COVID and can no longer work or take care of themselves, who will look after them or their children? 139/

Marta Esperti had multiple COVID infections that have exhausted her eggs and became almost totally infertile at the age of 36 despite being very fertile before March 2020 ( ). 140/

https://twitter.com/MartaEsperti/status/1768016430341971970

David Steadson's eldest son has had Long COVID since January 2021 and for the last 3 years has essentially been housebound, doing high school remotely on a reduced load ( ). 141/

https://twitter.com/DavidSteadson/status/1767094036924432838

David also has a younger son who is 13 and doesn't seem to have Long COVID but is getting sick *all the time*. None of the standard tests have found anything wrong with him so doctors are no longer investigating what might be causing this. 142/

For the last 3 years the boy has missed so many days of school from getting frequently sick he has missed the equivalent of 40% of classes. His school never closed or went remote during the pandemic so did not experience lockdown but has been home so much because he's sick. 143/

It is not just adult workers needing many more sick days but kids are being significantly impacted as well. 144/

** Impact on Immune System **

Another thing that Long COVID impacts is the immune system itself, manifesting T cell dysregulation, systemic inflammation and an uncoordinated adaptive immune response ( ). H/T: @ScottGottliebMD 145/nature.com/articles/s4159…

They found people with Long COVID "displayed increased frequencies of CD4+ T cells poised to migrate to inflamed tissues and exhausted SARS-CoV-2-specific CD8+ T cells". 146/

"higher levels of SARS-CoV-2 antibodies and a mis-coordination between their SARS-CoV-2-specific T and B cell responses." 147/

The study also found evidence further supporting a potential persistent reservoir of virus with higher COVID antibody levels in Long COVID individuals. 148/

Coordination of humoral and cellular immune responses to COVID was lost in about half of Long COVID participants with no detectable COVID B cell antibodies but detectable COVID T cell responses creating a large disconnect resulting in a persistent inflammatory state. 149/

"Patients with Long Covid display signs of immune dysfunction and exhaustion, persistent immune cell activation, and autoimmune antibody production, which are also pathological features of acute COVID-19." ( ). 150/science.org/doi/10.1126/sc…

A study found the relatively common occurrence of persistent COVID in the gut months after infection. 151/ Click "Show replies" 👇 to continue.

They detected COVID nucleocapsid proteins (found only in the virus and not in the COVID vaccine) in 30.5% of patients, primarily in upper gastro endoscopy ( ). H/T: @inkblue01 152/ ncbi.nlm.nih.gov/pmc/articles/P…

Less than half of those patients had any prior gut symptoms in their COVID-19 infection. Despite biopsies initially looking like healthy tissue, indications of strong immune response were seen in samples that were positive for COVID nucleocapsid protein. 153/

"Smokers and patients with diabetes seem to be at an elevated risk of continuous viral gut infection and the subsequent onset of long COVID-19 syndrome." 154/

Researchers found tissue-based T cell activation and viral RNA persistence up to 2 years following COVID-19 infection suggesting that tissue viral persistence could be associated with long-term immunological perturbations ( ). 155/ncbi.nlm.nih.gov/pmc/articles/P…

"We observed that T cell activation in spinal cord and gut wall was associated with the presence of Long COVID symptoms. Increased T cell in these tissues was also observed in many individuals without Long COVID symptoms." 156/

During acute COVID, the complement and coagulation system can become activated but in Long COVID patients this can remain locally activated in various tissues ( ). 157/ science.org/doi/10.1126/sc…

"Together, these feedback loops can maintain local complement activation and inflammation, as well as generating microclots that could underlie some of the features of Long Covid." 158/

"The complement system is crucial for innate immune defense by effecting lytic destruction of invading microorganisms, but when uncontrolled, it causes cell and vascular damage." 159/

A study found a state of persistent enhanced immune ageing in adults after severe COVID, "potentially contributing to increased susceptibility to ongoing and future ill health in these patients." ( ). 160/immunityageing.biomedcentral.com/articles/10.11…

** Leading Cause of Death **

Despite the massive negative impact on all the people who survive a virus with "99.8% survival rate", what does this high of a survival rate actually mean? 161/

It turns out that a "99.8% survival rate" means the 3rd leading cause of death (#1 infectious disease killer) in Canada during 2022 according to Statistics Canada with cancer as the 1st leading and heart disease as the 2nd leading cause of death ( ). 162/www150.statcan.gc.ca/t1/tbl1/en/cv.…

Unfortunately as you have learned throughout this thread, COVID infection increases the risk of heart disease and also cancer therefore making the #1 and #2 leading causes of death even worse. 163/

Similarly in Australia, COVID was also the 3rd leading cause of death in 2022 accounting for more than 1 in 20 deaths and the first infectious disease in the top 5 causes of death since 1970 ( ). 164/abs.gov.au/media-centre/m…

What about kids? In Brazil, out of 235,829 children that were hospitalised, kids with a positive COVID test were 3x more likely to die than hospitalised kids who tested negative ( ). H/T: @DaniBeckman 165/publications.aap.org/pediatrics/art…

Kids hospitalised with COVID had a 6.5% chance of in-hospital death compared to 2.9% for adenovirus, 2.3% for influenza and 1.8% for RSV so COVID is not the same as flu and shouldn't be treated that way. 166/

Since most kids survive infection there is another problem kids have to deal with, becoming caretakers of parents disabled by Long COVID or becoming orphans if their parents didn't survive. 167/

By the end of 2022 there were an estimated 238,500 COVID orphans in the USA and globally more than 8 million orphans now suffering the pain and trauma of losing a parent or primary caregiver ( ). H/T: @RevivalCare 168/amp.cnn.com/cnn/2023/03/26…

What about in 2024? To protect people from death on the road, vehicles are constantly being redesigned to improve safety, there is innovation and testing to ensure safety, and people are required to wear seat belts to protect themselves. 169/

Drivers need to obtain a licence and train to ensure they understand the rules and have the basic skills to drive safely like checking mirrors and double checking blind spots. Drivers warn others of what they are about to do (turning signals, brake lights). 170/

The laws are enforced and fines given to people who break them, and people fix and maintain their vehicles to ensure better performance. 171/

We use multiple layers of defence every day including engineering like traffic lights to prevent every road death that we can ( ). 172/

Despite all those layers, in 2023 there were still at least 397 people who died in Ontario road crashes, more than 1 person a day which everyone finds unacceptable ( ). 173/

https://twitter.com/OPP_HSD/status/1740077143374389271

We have no layers of protection in place for COVID anymore and even though there are less people dying of COVID in Ontario now than in 2022, it took less than 2 months in Nov/Dec 2023 to surpass the road deaths for all of 2023 ( ). 174/data.ontario.ca/dataset/deaths…

That means more than 5 people a day are still dying from COVID but in this case most people don't seem to care or even notice. This is the impact of a virus with a "99.8% survival rate". 175/

** What can you do? **

Isn't it inevitable that you are going to get COVID and possibly Long COVID so why bother doing anything? Considering there is no cure and currently no officially approved treatments for Long COVID the longer an infection can be delayed the better. 176/

The less infections you get, the less times you roll the dice on getting Long COVID as well ( ).

Sadly methods to protect people from COVID infection have been known for the majority of the pandemic but are rarely being used. 177/erictopol.substack.com/p/a-covid-upda…

"We know the importance of vaccines, and we know that masking and ventilation, testing, reporting and isolation are important to reduce the spread of airborne viruses, including measles, influenza, RSV and COVID-19." ( ). H/T: @nilikm 178/ottawacitizen.com/opinion/kaplan…

Clean air including ventilation and filtration can be implemented at an infrastructure level and people don't need to do anything different to get the benefits like we already benefit from clean water infrastructure. 179/

Governments and policy makers need to put the appropriate standards and monitoring in place and then mandate them. There is the new ASHRAE Standard 241, Control of Infectious Aerosols that could be mandated by governments ( ). 180/ashrae.org/technical-reso…

A free preview of ASHRAE 241 can be found here ( ). 181/ Click "Show replies" 👇 to continue.ashrae.org/technical-reso…

"Learning to live with COVID" means upgrading air quality, now ( ). 182/thegauntlet.news/p/learning-to-…

Learn about the COVID-safe strategies Australian scientists are using to protect themselves from the virus ( ). 183/abc.net.au/news/2024-01-2…

This thread provides more details about the importance of indoor air quality ( ). 184/

https://twitter.com/jeffgilchrist/status/1607379781892575234

Since the infrastructure is not currently in place and most do not have any control over the indoor air quality of buildings they visit or work, another layer of protection is a well fitting respirator. 185/

Respirators protect individuals who are healthy and help reduce the chance of individuals who are sick from infecting others even in well ventilated places where short-range transmission is a concern. 186/

Yes, respirators actually work, read this thread to learn how ( ). 187/

https://twitter.com/jeffgilchrist/status/1602994049815908353

But do they really work if I can still sometimes smell nasty things while wearing a respirator? Yes, read here to learn why ( ). 188/

https://twitter.com/jeffgilchrist/status/1728039593700647259

But can respirators actually filter tiny viruses and bacteria specifically? Yes, they actually tested these scenarios ( ). 189/

https://twitter.com/jeffgilchrist/status/1728039680195568075

But how do I know a respirator will actually work on *my* face? This thread will help explain ( ). 190/

https://twitter.com/jeffgilchrist/status/1728039708825924001

Do you need a high quality respirator but don't have access? If you are in Canada, you can request free respirators from @DonateMask here ( ). 191/donatemask.ca/request

If you are feeling unwell and test using a rapid test (RAT) it might be tempting to think you only have a cold if you get a negative result. 192/

It is important to remember a recent study found that half of people's COVID-19 viral loads peaked on day 4 of symptoms so you may not test positive on a rapid test in the first few days ( ). 193/cidrap.umn.edu/covid-19/evolv…

Recall that RATs do not amplify the virus like PCR tests so they will only test positive after you have a high viral load which may take several days to get to while your symptoms are from your immune response which can start right away even when viral loads are low. 194/

When a rapid test is positive it is almost always correct so assume you have COVID-19, but if it is negative there are many ways to get a false negative so RATs cannot be used to rule out a virus infection ( ). 195/

https://twitter.com/jeffgilchrist/status/1563118397633597440

** Where to learn more **

You can find statistics, calculators, guides, useful information and hundreds of articles about COVID on my site ( ) and ( ). 196/covid.gilchrist.ca
gilchrist.great-site.net/jeff/COVID-19/

Information on Indoor Air Quality General Introduction, Ventilation, CO2, Filtration, Upper room UV, Far-UV, UV Light Against Diseases, Humidity, and Air Distribution can be found here ( ). 197/itsairborne.com/indoor-air-qua…

Many other air quality related topics and information can be found here from Joey Fox @joeyfox85 and guests ( ). 198/itsairborne.com

Overview of the Medium and Long-Term Complications Associated with COVID-19 ( ). 199/pandemicpatients.org/home/covid-19-…

A literature hub for tracking up-to-date scientific information about COVID with over 400,692 publications ( ). 200/ncbi.nlm.nih.gov/research/coron…

A zotero group with categorised research studies ( ). 201/zotero.org/groups/5006109…

Long COVID Rehabilitation: A Guide for Health Care Professionals ( ). 202/mshs.broadcastmed.io/packages/2/view

Infosheets and presentations for why your patient is COVID cautious, why I take COVID precautions, COVID safety isn't an anxiety disorder, What you need to know about COVID and more available here ( ). 203/ linktr.ee/o_bel

This thread can be seen in one easy to view and share web document here ( ) and ( ). 204/tinyurl.com/COVIDrealImpact
docs.google.com/document/d/16j…

Thank you to everyone whose posts helped contribute to this thread:
@_llebrun @o_bel_
@DaniBeckman
@HarrySpoelstra
@elisaperego78
@GosiaGasperoPhD
@vipintukur
@pjavidan
@Wikisteff
@LazarusLong13
@PoPNB_kindness
@beansprouts_mom
@brownecfm
@SammieFMc
@jenniferhulme

205/

So many people to thank it didn't fit in one tweet, part 2:
@CanCovSoc
@broadwaybabyto
@MchP66592467
@dgurdasani1
@keetmuise
@RougeMatisse
@ScottGottliebMD
@inkblue01
@RevivalCare
@nilikm
@DonateMask
@joeyfox85

206/

This is the longest thread I have ever written and has taken the most time to put together so if you made it this far, thank you for reading all of that. Hopefully there was something new or worthwhile that you found. 207/

I used content or links to studies from so many people I also forgot to include thanks to:
@amandalhu
@_CatintheHat
@DavidSteadson
@JeromeAdamsMD
@long_covid
@MartaEsperti
@CovidintheChart

208/