Associate Professor @ Weill Cornell; author of the international bestseller SUPERBUGS & other books. For speaking: areinhardt@penguinrandomhouse.com
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Jun 24, 2021 • 4 tweets • 2 min read
UPDATE: The arthritis drug tofacitinib decreases the risk of death for patients hospitalized with #COVID19. But I do not expect to use it anytime soon. Here’s why: 1/
This was a small study in a group that doesn’t match my experience treating coronavirus. Patients did not receive remdesivir, an FDA-approved antiviral that has become a standard of COVID care. 2/
Apr 9, 2021 • 4 tweets • 1 min read
Fully-vaccinated people have been reaching out with questions about resuming normal life. (Yesterday: Is it safe to fly to a bachelorette party?).
Here's how I think about these questions: 1/
I'm occasionally asked to "clear" a patient for surgery. This might be an older person with heart disease who needs a massive operation and the surgeons want to make sure it's safe to move forward with the procedure. In practice, I don't ever "clear" the patient.
Apr 7, 2021 • 4 tweets • 2 min read
Here’s a message I receive almost every day: “I have the opportunity to get the J&J vaccine but I’m considering holding out for Pfizer/Moderna. Thoughts?”
My advice: Take the J&J vaccine now. 1/
There is still a very high level of #coronavirus transmission in the United States and the J&J vaccine provides rapid protection. (You’re fully-vaccinated two weeks after a single shot).
Mar 10, 2021 • 4 tweets • 2 min read
UPDATE: The NIH-sponsored #COVID19 study, ACTIV-1, has now enrolled 470 patients at 31 medical centers in the United States. A data safety monitoring board will soon meet to evaluate preliminary results. This meeting could alter the way doctors treat #coronavirus. 1/
Hospitalized COVID patients who need oxygen are treated with two drugs: remdesivir (an antiviral) & dexamethasone (an anti-inflammatory). Patients in ACTIV-1 receive these drugs AND are randomized to one of 3 immunomodulators: abatacept, infliximab, or cenicriviroc (or placebo).
Mar 1, 2021 • 6 tweets • 2 min read
New York confirmed its first case of coronavirus one year ago today. I went on @CNBC the next day to discuss what was coming: "Widespread disruption to daily life." 1/
I treated my first confirmed case on March 9, 2020. I prescribed hydroxychloroquine and azithromycin and did not use steroids. These decisions would later prove to be wrong.
Feb 10, 2021 • 4 tweets • 1 min read
NEW from CDC: "Fully vaccinated persons who meet criteria will no longer be required to quarantine following an exposure to someone with COVID-19." Here's what it means to "meet criteria": 1/ cdc.gov/vaccines/covid…1. Fully vaccinated (≥2 weeks following receipt of the second dose in a 2-dose series, or ≥2 weeks following receipt of one dose of a single-dose vaccine). 2. Are within 3 months following receipt of the last dose in the series. 3. Have remained asymptomatic since the exposure.
Feb 8, 2021 • 4 tweets • 2 min read
COVID Mystery: Why are some patients asymptomatic while others need to be hospitalized? We've known for a year that #COVID19 patients who have trouble breathing often have too much inflammation in the lungs (alveolitis). Now we know what's happening on a microscopic level: 1/
Within the lungs, an inflammatory cell called a macrophage becomes infected with #coronavirus, prompting the cell to release signals that attract T cells. These activated T cells then stimulate macrophages, forming a feedback loop that drives inflammation. nature.com/articles/s4158…
Feb 8, 2021 • 6 tweets • 2 min read
The FDA has updated its emergency authorization for convalescent plasma, narrowing its use to a smaller subset of #COVID patients. It was a necessary move, but I'm concerned the revision doesn't do enough to curb the emergence of viral variants. Here’s the problem: 1/
Plasma is still authorized for hospitalized #COVID19 patients who have impaired humoral immunity. These patients have trouble making antibodies and other proteins. At first glance, this makes sense: People who can’t make antibodies should be given some. But it’s not that simple.
Feb 5, 2021 • 7 tweets • 3 min read
Speaking to students at @wakeforestmed today about the best ways to communicate the avalanche of new #COVID19 information to patients. The challenge: Enthusiasm for a new drug may be inversely related to the quality of data supporting its use. 1/
The two most controversial drugs at the moment are ivermectin and tocilizumab. Over the past few months, some doctors have been prescribing ivermectin (an anti-parasitic) to newly-diagnosed #COVID19 patients. The change in practice may be due to two things:
Feb 4, 2021 • 6 tweets • 2 min read
NEW: Variants pose a threat because they may weaken vaccines. COVID patients with impaired immune systems can have trouble clearing the virus, inadvertently serving as incubators for new variants. Insights from individual patients reveal why these cases deserve more attention. 1/
A cancer patient known as “Pittsburgh long-term infection 1" was unable to clear #coronavirus and died 74 days after diagnosis. Viral replication lasted more than 2 months, giving the virus ample opportunity to mutate.
Three key points from the case: academic.oup.com/cid/advance-ar…
Jan 19, 2021 • 8 tweets • 3 min read
Common #COVID question: When should we extend the duration of dexamethasone therapy? Dex is a steroid that has become a mainstay of treatment for hospitalized patients needing oxygen. After 10 days of treatment, some patients improve and no longer need the drug while others...
develop conditions (organizing pneumonia) that may benefit from a longer course of steroids. But there's a risk to extending the treatment. Dex can potentially compromise the immune system in a way that's harmful, making it more difficult to fight infection.
Jan 15, 2021 • 8 tweets • 3 min read
UPDATE: Coronavirus is the only respiratory virus I have ever encountered that causes inflammation of blood vessels (vasculitis). One of the great challenges in #COVID medicine is understanding why so many of these patients also get blood clots. 1/
In some cases, these clots are fatal. During the first wave of the pandemic, my team and many others focused our attention on factors in the blood to explain this phenomenon (d-dimer, fibrinogen, INR, etc.). Tests didn't solve the mystery.
Jan 4, 2021 • 13 tweets • 5 min read
UPDATE: COVID medicine has changed substantially over the past few months. The questions we're grappling with today are very different than the ones we were dealing with just a few months ago.
Here are some of the #COVID19 questions recently posed to me by frontline doctors: 1/1. Why isn't anyone using baricitinib? The drug just received emergency authorization but we never hear about it. 2. How does cenicriviroc work & why is the NIH studying it?3. Does dexamethasone cause secondary bacterial infections?
My thoughts:
Dec 30, 2020 • 5 tweets • 2 min read
UPDATE: Operation Warp Speed won't hit its goal of 20 million Americans vaccinated against #coronavirus by the end of 2020. To improve the rollout, we should: 1) Look back, 2) Look ahead, and 3) Look in the mirror. My thoughts:
1. Look back: This isn't the first mass vaccination in the midst of an outbreak. In 1947, New York City inoculated millions against smallpox in a matter of days. How did they do it? Vaccination was available at more than 250 hospitals, clinics, police stations, and schools.
Dec 29, 2020 • 6 tweets • 2 min read
UPDATE: A #coronavirus patient is considered contagious as long as they carry "replication-competent" virus. Based on limited CDC data, patients with severe immune impairment are thought to be contagious for up to 20 days after onset of COVID19 symptoms. This may soon be revised:
We've known that patients with weakened immune systems can remain contagious for up to twice as long as those without immune impairment (20 days vs. 10 days) and these findings have informed transmission-based precautions around the country.
But 20 days may be insufficient.
Dec 29, 2020 • 5 tweets • 2 min read
Hospitalized patients and research subjects often ask me about antibody treatments. They touch on a recurring theme: Many believe these treatments go unused because a) Doctors don't think to order them or b) We don't have the connections to acquire them. Here are key points: 1/
Monoclonal antibodies made by Regeneron and Eli Lilly are not authorized for patients who are hospitalized due to #COVID19. Trials have been stopped because antibodies don't help these patients. Nevertheless, many are distressed they're not being used. 2/ nytimes.com/2020/10/27/wor…
Dec 27, 2020 • 5 tweets • 2 min read
UPDATE: Vaccinologists like to say they breathe a sigh of relief after 3 million inoculations of a new vaccine. That's when we get a real handle on side effects. We'll soon reach that milestone with mRNA vaccines (Pfizer, Moderna). There's another phenomenon we should follow: 1/
It's important to determine if people are contracting #coronavirus after vaccination. The phase 3 trials that were the basis for emergency authorization looked at prevention of symptomatic disease; they did not assess prevention of transmission. 2/
Dec 27, 2020 • 10 tweets • 3 min read
Here are 3 #COVID19 questions we're trying to answer: 1. Why do monoclonal antibodies fail hospitalized patients? Cocktails made by Eli Lilly & Regeneron may be useful for high-risk outpatients, but they don't help hospitalized patients. Why does the treatment setting matter? 1/
Part of this is timing. By the time someone shows up in the ER with symptoms, they may have been infected for a while (incubation is ~6 days). Most COVID treatments fail if they're given late in the course of disease and antibodies are no exception. They should be given early. 2/
Dec 24, 2020 • 8 tweets • 2 min read
COVID question doctors are wrestling with: Should patients with profoundly impaired immune systems receive monoclonal antibody therapies after contracting #coronavirus? 1/
These patients are often prioritized for antibody treatments (made by Regeneron and Eli Lilly). And this makes sense: Their immune systems are weak, and antibodies can potentially help fight infections. But there's an issue. 2/
Dec 23, 2020 • 10 tweets • 4 min read
UPDATE: Coronavirus has mutated into a new variant, B.1.1.7, that has the world's attention because it may be more contagious.
Some thoughts on where this came from and how it impacts patient care: 1/
The novel #coronavirus typically acquires a mutation every few weeks. The new variant is interesting because it seemingly developed a bunch mutations all at once: 17 mutations in viral proteins, including 8 changes in spike protein, the target for all of our vaccines. 2/
Dec 22, 2020 • 5 tweets • 2 min read
Here's one of the points I made in this #COVID19 lecture: When I see a politician taking drastic action that is not supported by data, I ask myself, "How did this person respond to warnings in March?"
An example: 1/
While most of the world was focused on mitigation in mid-March, the United Kingdom implemented “delay.” As many experts noted at the time, this was a mistake. The UK inadvertently served as the placebo-controlled arm of a global study aimed at limiting death and disease. 2/
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