Ziyad Al-Aly, MD Profile picture
May 30, 2024 16 tweets 8 min read Read on X
📣 New paper in @NatureMedicine

Three-year outcomes of post-acute sequelae
of COVID-19

By Miao Cai @Biostayan @EricTopol and me

A 🧵

nature.com/articles/s4159…
In a study of 5.3 million people including 135,161 people with SARS-CoV-2 infection and 5,206,835 non-infected controls.

We examined risk trajectories of 80 components of Long Covid over 3 years post-infection

nature.com/articles/s4159…
The good news: risks of death and post-acute sequelae declined over time in both people who had mild COVID-19 and those with severe COVID-19 that required hospitalization.

nature.com/articles/s4159…

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Among people who had mild COVID-19 , risk of death became insignificant 1 year after infection

Risk of new post acute sequelae declined over time, but residual risk remained even at 3 years in the pulmonary, GI and nervous systems.

nature.com/articles/s4159…

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This residual risk in the third year translates into 41 new sequelae/Long Covid components per 1000 persons in the third year (4 sequelae per 100 people)

nature.com/articles/s4159…

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In hospitalized patients

🚨Risk of death declined over time, but remained elevated even 3 years after infection

🚨Risk of new post acute sequelae declined over time, but significant risk remained even at 3 years in nearly all organ systems - cardiovascular, neurologic, GI, coagulation and pulmonary organ systems

nature.com/articles/s4159…Image
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This risk in the third year translates into 252 new sequelae/Long Covid components per 1000 persons in the third year (~ 25 sequelae per 100 people)

nature.com/articles/s4159…

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New conditions in the third year after infection led to

🔸 10 DALYs per 1000 persons in non-hospitalized
🔸 90 DALYs per 1000 persons in those who were hospitalized during acute COVID

One DALY equals one lost year of healthy life

nature.com/articles/s4159…

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The big revelation here is that the risk persists for 3 years in several organ systems (e.g. GI and nervous system) even 3 years after a mild infection.

Healthcare professionals are taught that acute infections as short-term events with health effects that manifest around the time of infection.

The data challenges those teachings and shows that mild Covid can still cause health effects even 3 years later.

Acute infections can have long-term health effects.

Covid continues to teach us something new at every turn and this is one very important new lesson.

nature.com/articles/s4159…
Why is this be happening?

Possibly viral persistence (perhaps far more common than most people think), chronic inflammation or chronic immune dysfunction or all the above.

nature.com/articles/s4159…
The story in hospitalized people is more stark – they have greater risk and longer risk horizon with resultant burden of disease that is astronomically much higher than non-infected people and higher than non-hospitalized individuals.

Hospitalization can have huge and wide-ranging effects on people's lives for years if not more. Preventing hospitalization is very important.

nature.com/articles/s4159…Image
While I talked about hospitalization in the previous tweet, I want to make it clear that most people with Long Covid had mild COVID-19.

In fact, 90% of people with Long Covid had mild
COVID-19.

nature.com/articles/s4159…
Thanks to the amazing @sourwine for developing this press release and @EbetheHolland for editing (link below).

@WUSTLnews
@WUSTLmed
@WUSTL

medicine.wustl.edu/news/covid-can…
Thanks also to our reviewers, editors, and all those who supported us in this project.

And to my wonderful co-authors Miao Cai and @Biostayan

Grateful for the collaboration with @EricTopol

@WUSTLmed @VREFSTL @VAResearch @vahsrd

nature.com/articles/s4159…
Coverage in @FortuneMagazine by @cbarbermd

fortune.com/well/article/c…
Great piece by @jwgale in @business

bloomberg.com/news/articles/…

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More from @zalaly

Jan 20
1. What are the benefits and risks of GLP1?

Our new study in @naturemedicine comprehensively maps all the benefits and risks of GLP-1 receptor agonists (GLP-1) (Ozempic, Wegovy, Mounjaro, Zepbound).

By @Biostayan, Taeyoung Choi and me
🧵

nature.com/articles/s4159…
2. Why we did this study?

We saw that GLP1 use has substantially increased, and reports emerged about some off-target effects. But we realized that no one had comprehensively investigated effectiveness & risks of GLP-1 across all possible health outcomes
nature.com/articles/s4159…
3. So, we decided to do the comprehensive study!

We did a discovery analysis which comprehensively examined 175 possible health outcomes (leaving no stone unturned) in 215,970 people on GLP1 and more than 2 million individuals not on GLP1

nature.com/articles/s4159…Image
Read 16 tweets
Dec 30, 2024
How the Pandemic Increased US Deaths!
Visualized in 8 charts by @jwgale in @business

1. The Covid Pandemic Fueled a 4-Year Mortality Surge in the US Image
2. Heart disease has long been the leading cause of death in the US and globally. The Covid pandemic worsened its effects. Image
3. Deaths From Heart Disease Accelerated as Covid Spread Image
Read 10 tweets
Oct 15, 2024
🚨 Long COVID is a significant health crisis in China too!

My commentary on the largest Chinese study to date, involving 74,075 participants, which found that 10-30% of them reported long COVID symptoms such as fatigue and brain fog #LongCovid

thelancet.com/journals/lanwp…
The features of Long Covid reported in this Chinese study are remarkably similar to those reported in studies conducted in other parts of the world.

This underscores the consistency of Long Covid features across national borders and cultures!!!

thelancet.com/journals/lanwp…
The study also shows that:

🔸Reinfections increase risk of Long Covid
🔸Vaccines reduce risk of Long Covid

This is also consistent with evidence from studies performed in other parts of the world.

thelancet.com/journals/lanwp…
Read 6 tweets
Sep 23, 2024
Here are key slides of my talk at the NIH-RECOVER-TLC
#RECOVERTLC
nature.com/articles/s4159…
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The number of people with Long Covid is huge. This demands global attention. nature.com/articles/s4159…
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The economic toll of Long Covid is significant.

nature.com/articles/s4159…
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Read 11 tweets
Sep 10, 2024
Here is the first randomized trial to show that an antiviral can prevent Long Covid.

In the PANORAMIC trial, people randomized to molnupiravir had less risk of Long Covid than people who received no antivirals

My comment in the link below. A short🧵
thelancet.com/journals/lanin…
The study included people with at least one risk factor for progression to severe COVID-19 illness.

People randomized to molnupiravir or usual care (no antivirals) were followed for 6 months

thelancet.com/journals/lanin…
People who were randomly assigned to molnupiravir during the acute phase of COVID-19 had better outcomes at 3 months and 6 months than those randomly assigned to usual care

thelancet.com/journals/lanin…
Read 9 tweets
Sep 1, 2024
400 million reasons to care about #LongCovid

ICYMI: our review on #LongCovid in @NatureMedicine

Long Covid has affected at least 400 million people worldwide at a cost of $1 trillion per year.

#LongCovid is a defining health crisis of our time!

nature.com/articles/s4159…Image
We review the mechanisms of Long Covid including viral persistence, immune dysfunction, thrombo-inflammation, neuronal inflammation, and microbiome dysbiosis.
nature.com/articles/s4159…
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We review the devastating impacts of Long Covid on individuals and communities, health systems, economies, and global health metrics.

nature.com/articles/s4159…
Read 6 tweets

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