There appears to be an uptick of Acute Necrotizing Encephalitis among children this flu season. We've had reports here in No. Cal. Others out of Boston. We're piecemealing things together because there's no active surveillance for ANE, and CDC can't communicate with partners. This rare but terrifying condition progresses rapidly, causing brain swelling, and can quickly lead to coma and death. We're going to be increasingly relying on medical providers, counties, and states to help us understand what's happening, as CDC seems to be in the dark.

"There are so many cattle passing away from avian influenza that the rendering trucks are backed up...We are desperately overwhelmed at this point."

Cows w/H5N1 left exposed with no warning signs or biosecurity precautions.

"The footage was deemed too graphic for publication." newsweek.com/disturbing-foo…

Why is the Western region getting so slammed with cvid? Wastewater concentration is now higher than our winter surge and climbing. The "explanations" talk about summer surge being because it's too hot, we're all moving indoors but I don't think the Western region is the hottest. I mean you can't tell me Oklahoma is less hot than Washington state.

To the many getting c19 for the 1st time:
- Sorry to hear it! Hoping for your fast recovery.
- Good job delaying this long! We have treatment, know more about limiting household spread, etc.
- Go easy on yourself, physically and mentally. Stress & worry don't help the healing!🧵 - Thank you for your vigilance telling your contacts. This is how we limit spread and harm. Too few are doing this now.
- If you choose to post about it, I appreciate you for sharing as it may help others or even yourself. But don't feel obligated, and be ready for criticism.

You hate to see it. As we head into a summer wave, 65+ have the highest proportion of ED visits, followed by 0-11 year olds, who have extremely low vaccine uptake and virtually no available outpatient treatment. After Covid, children should rest and check in with their doctor. 🧵 In fact, the AAP recommends ALL children have a post covid consultation and be *cleared to return to sports*‼️

After a moderate case (4+ days fever; 7+ days other symptoms), they need physical exam, Amer Heart Assn 14 element assessment, and an EKG *before return to sports*.

DISGUSTING. While we were breaking ourselves trying to keep folks safe, the US govt was nefariously undermining our efforts with a morally bankrupt psyop campaign targeting South Asians, Filipinos and Muslims, using hundreds of fake social media accounts on multiple platforms. 🧵 “'We weren’t looking at this from a public health perspective,' said a senior military officer involved in the program. 'We were looking at how we could drag China through the mud.'”
This effort eroded trust not only in Sinovac (only vax many had access to) but vaccine generally.

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-…

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! 🧵 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…

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!

"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...🧵 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.

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.🧵 (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!

https://twitter.com/NohaAboelataMD/status/1768105429438287874?t=9xEcEG4ouhRI9aDDrrdrGA&s=19

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? 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/

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…
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.

Prop. 1 will help the state fully implement:
- a new court system for those with mental illness, even if no crime has been committed
- the recent CA law making it easier to force some with serious mental illnesses into involuntary treatment. 🧵
calmatters.org/health/mental-…
The plan seems to be to force *more* people into a system that's already overstretched. To layer in the court system, which is already biased. To empower lay people to compel the court to force individuals into treatment for mental illness, substance use, even chronic alcoholism.

The latest wave of covid propaganda is to claim that ~covid anxiety~ is the biggest pandemic problem we're facing. I have yet to see the data. I have, on the other hand, seen mountains of data indicating structural and functional changes to heart, lungs, brain, and more. 🧵 "But same with the flu!"

No. Via ACE receptors and otherwise, SARS-CoV-2 can affect every system, even damage inside blood vessels (yes the tubes that deliver blood everywhere). True, we've likely under-appreciated post-influenza sequelae. Still, it seems less and fewer organs.

Metformin & Covid. Metformin is widely used, accessible/cheap, and has been around for decades, so we'd love if it could help in our ongoing struggles with covid. So far it looks promising to prevent long covid, and those already on it should continue it during acute c19 infxn.🧵 In the COVID-OUT trial (multicenter randomized quadruple-blind parallel-group phase 3 trial), in 30-85yo's w/"overweight or obesity," Metformin cut the risk of long Covid by ~41%. And when started within 3 days of Covid symptoms, it reduced the incidence of long COVID by ~63%!

It's sad to see so much venom towards scientists, doctors, and covid-careful individuals on this app - one of the reasons so many have left. I left FB because it became a cesspool of disinformation, and I was impressed with the quality info direct from scientists and docs here.🧵 Having a common enemy - a mutating virus infecting, sickening, and killing so many - should have brought us together. And I think it did for a brief moment. Then, it became highly politicized, and bad actors exploited folks' uncertainty, unfamiliarity, and fear.

Despite baked-in racial bias, pulse oximeters continue to be relied upon for covid, qualifying for home oxygen, and more. They're used at home, on ambulances, in clinics and hospitals. The FDA is aware but moving slowly, which is why we filed a lawsuit.🧵
nature.com/articles/d4158…
This lawsuit demands pulse ox manufacturers/distributors fix the devices, label them as to their flaws, or stop selling them in California. But even if we're successful, this doesn't extend beyond CA, and the FDA can continue approving faulty devices as they've done for decades.

Thank you, @DrJudyStone and @Forbes for interviewing me for this fantastic article about California's shocking move, recklessly encouraging contagious people to go unmasked into schools and pubic places - in the middle of winter no less! 🧵1/4
forbes.com/sites/judyston… Just 1 contagious child can infect many more in 1 day, let alone coming to school contagious many days in a row! The order admits that the contagious period begins 2 days before symptoms start through 10 days after. There's a buried *recommendation* to mask x 10d. Seriously? 2/4

Thanks, @CalMatters, for interviewing me about these wild new "guidelines" encouraging contagious people to get back to school and work, despite our ability to easily test and prevent much unnecessary spread. Promoting reckless disregard for everyone.🧵1/8
calmatters.org/health/2024/01… “'Instead of staying home for a minimum of five days, individuals may return to work or school when they start to feel better,' state public health officials said in an unsigned statement."

I wouldn't want to sign it either. 2/

I haven't said anything about this yet - at first, it was because I was speechless. Then I hoped no one would notice. Now that advocates, reporters, concerned parents, and outraged colleagues have reached out, I see that's not going to be the case.🧵1/7
ktla.com/news/californi… Contagious people are being encouraged to go to work/school. This decision is not evidence-based, and it clearly does not consider the impacts of long covid, the need for people to rest and recover when sick, or the ramifications of increased transmission such as new variants. 2/