Short🧵How #Covid is killing Health Care Workers ?? Today I met Mrs Tandon.Her husband a 52/M physician had #Covid during #Delta wave which had injured his lungs BUT he came back home & started his private practice.He remained fine till 10 days ago when he made a short trip ctd) 2/n He felt weak on returning & wanted rest .Next day he was feeling body ache , joint pain & slight fever.He tested & found his platelets ⬇️to 23,000 .Further testing showed Dengue-ve.He started feeling dyspnea & was shifted to hospital where his oxygen suddenly plunged.ctd)

🧵 on why the past experiences aren't good enough #monkeypox disease was first confirmed in humans in 1970.When the outbreak happened most thought it will be a few cases based on earlier outbreaks BUT some of us believed otherwise. See the old tweet ctd)

https://twitter.com/Rpshahmemorial1/status/1527142495284756481?s=20&t=S7RHY-pUNH4M5hAfRXTBSQ

2/n We were plain lucky to have the West African clade of #monkeypox spread and not the #Congo clade spread , had that happened those who are lecturing is would have been scurrying for cover. Whether it is #Nigeria or it is Globally #monkeypox has broken a lot of barriers.ctd)

Short🧵 on the story of the swollen toe - A known of mine phoned 2 days ago, their 19 yr old daughter had suddenly developed a swelling in toe - 2 hrs earlier along with sore throat & slight fever. On my urging they did a rapid test-ve, the RT-PCR ordered for next day -ve ctd) 2/n The fever subsided with naproxen but thereafter neded paracetamol to keep it under check. The mother did not want further testing currently BUT the kid would be in isolation because they have a 90 yr old grandmother living with them .They will watch carefully &masked ctd)

Short 🧵 On Persistence of #Ebola - Patient infective over 500 days & spreads infection by Sex- So with the risk of spill over we may see repeated outbreaks. In 2016, Guinea had recorded 3 probable, 7 confirmed cases, of which 6 were admitted at an Ebola treatment unit ctd) 2/n 4 patients died in the community ,4 patients in the ETU.Fatality ratio among probable & confirmed cases in this cluster in Guinea was 80% (8/10).They were closely related to viruses from the 2014–2016 outbreak, ruling out a new introduction from an animal reservoir ctd)

Short 🧵 on why some people are showing resistance to acceptance of risk of #Covid. This is a thread not on those who have fallen to misinformation BUT on those who initially took good care, till the vaccines came through - Suddenly become extremely careless & don't mask ctd) 2/n When the pandemic started a physician with army background told me - You know when do maximum casualties take place usually and went to explain & I quote" the maximum casualties dont happen during the 1st 2-3 days when the armies face each other - both sides dig into - ctd

Short🧵Why I think #Covid can cause existential consequences for Human Race ?? For any species to continue it has to procreate,that depends on fertility of both men & women.We started getting edgy couple of months ago.Here's the original ctd

https://twitter.com/Rpshahmemorial1/status/1501962752558252034?s=20&t=cHLP272GR5Nj7dIFhdcrGA

Ctd2) Then we found more correlation, the infection was really causing changes in hormone levels ctd)

https://twitter.com/Rpshahmemorial1/status/1531258713025429505?s=20&t=cHLP272GR5Nj7dIFhdcrGA

Small 🧵on how repeated infections are causing mayhem - I treat kids who have #clubfeet , the kids have to be plastered every week and finally a small incision has to be made I prefer sedation ( sleep) because it allows me to do the small incision without the kid fighting me ctd) 2/n The reason why I called my friend the Pediatrician in the first place in the tweet below was that kids have to have a clear 6 weeks "No Chest Infection "history ,for us to take them to Operation Theater & do the surgery & I wasnt finding that zone ctd

https://twitter.com/Rpshahmemorial1/status/1576253180245004288?s=20&t=-6win2i0V-irvKl_3gQBjg

Short 🧵 My pediatrician batchmate always called me a little over concerned about #Covid effects in kids .Normally he picks up my phone in 1st ring BUT today he didn't. He called a couple of hours later apologizing for the inability - He said & I quote "I really dont know - Ctd) Ctd1) " what is happening anymore - I am getting kids having infection & fever every 15- 20 days. Havent seen this ever in my life. They don't respond to antibiotics.All basic investigations okay. Looks like a viral infection.Kids get okay BUT the parents are very tensed ctd)

First doctor falls to #Ebola Dr. Mohammed Ali, a Tanzanian national, 37-year-old Male,pursuing further studies in te country .He tested+ve on September 26 & died while receiving treatment at a hospital in Fort Portal, a town about 300 kilometres west of the capital Kampala. Dr. Ali may be the 2nd health worker to have succumbed to Ebola. The first could be a midwife from St. Florence Clinic, a probable case because she died before testing,at the moment 5 more health workers are battling the disease including an anesthesiologist & a medical student.

Small #monkeypox thread - detected in 10 of the 11 sewer systems that SCAN (Stanford’s Sewer Coronavirus Alert Network) tests, including Sacramento, Palo Alto & several other cities in California’s Bay Area. So we are going to see big outbreak in 2-3 weeks apparently.ctd) 2/n Bavarian Nordic can produce 30 million doses/ year and so far hasn’t turned down any orders from governments, considering night shifts & other tweaks would bring production above 30 million but in 3-4 weeks they will reach the tipping point - with the virus ripping ctd)

1/n A small thread on what I found problematic with Dr Jha's & what I liked - first ❤ " I always lean on people getting more rest - so people who were pushing for @Potus to work dont have Dr Jha's support -Potus isn't Superman ,he should rest & that should be the messaging ctd) 2/n I have trouble in accepting that its going to be simple- already seeing pet animals being infected - a reservoir is being fast built , we wasted crucial time in thinking it will remain within the MSM circuit , didn't stop pride marches-didnt trace well - missing chance ctd)

Why are we going to see an avalanche of infertility,problems in conceiving in the next couple of years?? Well this is a 500 plus young men less than 29 yrs cohort in swiss army who were evaluated & higher incidence of lipid issues,pre -diabetes found ctd)
doi.org/10.1101/2022.0… Ctd2 we already know from past studies that 26% of young take more than 2 weeks to be " Normal", interestingly this one study used a larger number of parameters to prod a little more than others ctd)

Long Thread on Health Risks with Reinfection . While the Herd Immunity brigade has been pushing their agenda,we need to understand the risk of multiple reinfections .It is an interesting cohort with 12.29% with 2 reinfections 0.76% with 3,.08 with 4 ctd).doi.org/10.21203/rs.3.… Ctd2)Clearly the time for reinfections is getting shorter 79 for 2nd to 65 days for 3rd & so on.Also the hazard is not only to the lungs BUT also to heart,blood vessels ,Gastrointestinal systems, kidney , the brain, the soft tissues and bones & the brain in that order ctd)

Was talking to a physician colleague 50/M who said he has increased incidence of migraine like attacks lately and also reported a bad #Omicron bout 4months ago that caused him bed bound with weakness 1 week , cough for 3 weeks.Then while discussion he casually described ctd) Ctd2) That after 3 months of the infection he faced a peculiar situation- for 4 days he was trying to remember the name of anti fibrotic agent , he said he could have easily opened the book or internet and checked BUT he wanted to assess , the antifibrotic he was trying to ctd)

1/Prolonged discussion with Pediatric colleagues in the core group @Rpshahmemorial1- findings - we are having increased incidence of red eye, apthous ulcer ,recurrent fever every month & Lymphopenia like this in kids , we will watch this but we are very concerned #COVID19 ctd) 2/ Though it is currently anecdotal information we hope that in a day or two we will be able to collate more data on this , most of these kids turn out to be negative on testing BUT have had family members who were positive in the recent period , others ctd)

Top 225 updates on #monkeypox, we posted until 200 here , again posting them & will start a thread from 201 onwards below this tweet

https://twitter.com/Rpshahmemorial1/status/1530575977876975616?s=20&t=-aO_Mw3AvDEwHnVOFsidGA

Here you go .... 201/n @mdc_martinus posted how #PublicHealthOntario accepted potential for #airborne transmission of #monkeypox, agree that this is the correct public health policy ctd)

After touching 175 we will try and keep everyone updated about #monkeypox, will post the 175 first followed by the updates all the way till 200 .Here we go

https://twitter.com/Rpshahmemorial1/status/1529782918503370752?s=20&t=6EV3jX8DfdIV0YKq_hfyYQ

Updates below ctd) 176/n @karmonyk has graciously shared a story, these delays have cost the patient the chance to prevent a bad outcome , vaccine best within 4 days and works all the way till 2 weeks , we've lost that window period , we are up for a bad outcome if we treat #monkeypox this way ctd)

151/n Germany has ordered 40,000 doses of a Bavarian Nordic vaccine to be ready to vaccinate contacts of those infected with monkeypox.Rest 150 news here ctd)

https://twitter.com/Rpshahmemorial1/status/1529290155575898112?s=20&t=iWzocsS7SUMcBJ10n58sWQ

152/n Spanish woman tests positive for monkeypox, the 1st woman to be conclusively linked to the outbreak ctd)

After 120 updates on #monkeypox we will now put up 150 updates . The previous 120 are herein below

https://twitter.com/Rpshahmemorial1/status/1528894483307192322?s=20&t=y_8IPyURo2sOBZaqKjX4Fg

The next set will start from 121 & further in thread below ctd) 121/n WHO warns that the outbreak is "only the tip of the iceberg" It , however, does not believe that the spread of the monkeypox virus outside of Africa requires mass vaccinations as measures like good hygiene & safe sexual behaviour will help control its spread🤔 ctd)

After top 100 updates we will put the top 120 updates , we will start with a thread of top 100 & then move along .

https://twitter.com/Rpshahmemorial1/status/1528352416185597952?s=20&t=tgUf07q3YAFXwTuytXLEQQ

It is a concerning since we may end up seeing either multiple pandemics together or relay race as new organisms try jump into humans ctd) 101/n Whie people like all of us were fighting #Covid , #Hepatitis in kids we all missed how 1284 people got #monkeypox with lethality of 4.5 % ctd)

Small Thread on who are " ASHA workers " & why did the WHO recognize them . These million plus workers have helped India put more than 1.8 billion doses in arms over rough terrain , mountains , snow filled gorges & overwhelmed rivers, sometimes at huge risk to their lives ctd) 2/n They climbed over difficult terrains , over snow full mountains , across deep gorges.... these are strong women of #India 🇮🇳🙏ctd)