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Noha Aboelata, MD Profile picture
@NohaAboelataMD
Jun 12 • 9 tweets • 2 min read • Read on X
More Paxlovid clarification. We have:
*clinical trials* showing it:
-reduces the risk of death & hospitalization for those at risk
-did not have benefit in a group of patients with LC

Some *observational studies* showing an association with lower LC risk if taken for acute C19🧵
Observational studies have been mixed, but this meta-analysis of 9 such studies showed that Paxlovid treatment in the acute phase of Covid was significantly associated with a lower risk of developing LC.

h/t @JN1171 and @TogetherWeMask journalofinfection.com/article/S0163-…
But we don't really know why. Is it because it reduces risk of severe disease? Clears the virus better? Prevents progression to the inflammatory phase? Something else? We don't know because observational studies by definition aren't conclusive. We'd need an experiment to confirm.
All observational studies I've seen on this so far show either no difference or reduced risk. It's good no study has found a negative association - everything roughly points the same way. Observational studies are great to help us generate hypotheses & determine what to do next.
A clinical trial on LC prevention with antiviral treatment would have its challenges. It's unethical to withhold Paxlovid from someone who needs it, so you may need to focus on low risk people, which means leaving out some of the very populations we're concerned about.
Just 2 small examples of difficulties with clinical trials, not to mention time and expense that sometimes make them prohibitive.

For now, several observational studies do suggest that taking Paxlovid for covid may reduce the risk of LC, but more study is still needed.
If you're otherwise someone who should take Paxlovid, it's easy: you're taking it to prevent progression, hospitalization & death with this potential added benefit. If not, unfortunately I still don't think we have sufficient data to support prescribing it just for LC prevention.
We still have a lot to learn and a lot more work to do to even begin to address the increasing burden of long covid. I'm glad to see more trials being conducted and hope for more positive results soon. In the meantime, please stay safe. 🙏🏾❤️
I go over this meta-analysis as well as the recent clinical trial that did not show benefit in people who already have LC in today's briefing.

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More from @NohaAboelataMD

Noha Aboelata, MD Profile picture
Jun 9
CO2 is MORE than just a proxy for ventilation! Increased CO2 *itself* appears to increase the likelihood of successful covid transmission by increasing viral viability.

CO2 on my DC plane trip 👇🏾. I did not realize that this concentration of CO2 helps covid tremendously! 🧵 Co2 monitor showing 2559
Brilliant work by @ukhadds et al shows that even modest increases in CO2 (eg 800) result in a significant increase in SARS-CoV-2 aerostability, which increases transmission risk. Understanding impact of environmental factors on aerosol viral load is key!
nature.com/articles/s4146…
In fact, the authors suggest that previous aerovirology experiments may need to be reinterpreted now that we know what we know. I'm certainly rethinking some things since coming across this fascinating research.

H/t @njsmyth and check out this explainer.
Read 6 tweets
Noha Aboelata, MD Profile picture
Jun 5
Despite what airlines may say, the evidence points to what we know: airplanes meet criteria of a high-risk environment as enclosed vessels with a high density of occupants, often for prolonged periods of time, where aerosol particles are well-mixed.🧵
mdpi.com/1660-4601/21/6…
This study demonstrated that flight duration predicted the incidence of cases when masking was not enforced. Medium flights (3-6h) had 4.7 times higher incidence of Covid cases compared to short (<3hr) flights, and long flights (>6h) were associated with a 26x increase!
Masking changed the game. Even on the long (6h+) flights, those with enforced masking had NO transmissions reported! Surprise, surprise masks work (even on long-haul flights where, without masking, transmission risk is 26x short flights). Too bad there's no more 2-way masking.
Read 8 tweets
Noha Aboelata, MD Profile picture
Jun 2
"One of the biggest success stories of the nation’s response to COVID 19:" Oakland & Alameda County! "While the country struggled to get people vaccinated and protected from infection, Alameda County and Oakland were among the best performers in the country when it comes to...🧵 National Civic League article. Photo of a testing site.
death rates and vaccinations, despite having a large proportion of more-vulnerable residents, including many people living in poverty."

In terms of deaths, compared with US big cities, Oakland was 3rd, only after wealthier (not to discount their success) SF and Seattle.
Covid deaths 2020 https://bigcitieshealthdata.org/compare/
Covid deaths 2021 https://bigcitieshealthdata.org/compare/
"Research has shown that, in countries with greater trust and civic engagement, deaths from COVID 19 were lower." Transparency and collaboration are key. It took the City, the County, the school district, community & faith leaders and more, all focused on protecting one another.
Read 7 tweets
Noha Aboelata, MD Profile picture
May 12
Phone medical visit coverage is ending 12/24.
Study: "...those who received audio-only care were more likely to be African American or Black, have medically complex conditions, and be dually eligible." These patients will be disproportionately impacted by this loss of coverage.🧵 Research Letter May 10, 2024 Audio-Only Telehealth Use Among Traditional Medicare Beneficiaries Jiani Yu, PhD1; Yasin Civelek, PhD, MA, MS1; Lawrence P. Casalino, MD, PhD1; et al
(Dually eligible = low-income)
Flexibilities afforded by the Public Health Emergency are set to expire Dec 31. *Fifteen* bills to expand/maintain telehealth access are currently being considered. Congress should make telehealth flexibilities permanent!
Audio/video visits of course can't replace all in-person care, but are an efficient way to mitigate provider shortages, reduce unnecessary exposure to illness, and be responsive to patients with transportation, mobility, childcare & other barriers. Hope we've learned this much.🙏🏾
Read 4 tweets
Noha Aboelata, MD Profile picture
May 6
Documents obtained under FOIA reveal "at least 6,212 patients caught COVID in hospital in 24 months...Of those, 586 died...with men dying at a higher rate than women [11% vs 8%]."

Nearly 1 in 10 patients who caught COVID in the hospital died. How can anyone find this acceptable? Hundreds of patients died after catching COVID in Victorian hospitals, new data shows
An infection mortality rate of 10% is staggering, and studies have shown it's much higher in certain areas of the hospital (e.g., oncology). Yet we're still doing a "you do you" approach to infection control in hospitals. Unacceptable. 2/
We need this type of data for the US and everywhere, and it shouldn't take a FOIA to get it. This should be routinely reported. If hospitals deciding to ditch masks and testing is sound policy, the data will speak for itself. But we know it's not sound policy - it is reckless. 3/
Read 8 tweets
Noha Aboelata, MD Profile picture
Mar 28
Post-covid vs post-flu: retrospective study based on a global research network investigates post-infection conditions, long-term risk of ED visits, hospitalization & death. Looked at 6614 patients in each group hospitalized 1/22-1/23 w/90-180d followup. 🧵
doi.org/10.1186/s12916…
Comparison of post-acute sequelae following hospitalization for COVID-19 and influenza
The Covid group had a higher incidence of overall post-infection conditions compared to the influenza group, including a difference in what each group was experiencing. The Covid group had more abnormal breathing, more abdominal issues, more fatigue, and more cognitive issues. Comparison of post-acute sequelae following hospitalization for covid-19 and influenza
The COVID group also had a significantly higher risk of the composite outcomes during all-cause ED visits, hospitalizations & deaths compared with the flu group.

--> Hospitalized COVID patients are at higher risk of long-term complications when compared with influenza survivors.
Read 4 tweets

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