#MedTwitter
There is a widespread outbreak of #norovirus, a GI virus that causes projectile vomiting & profuse diarrhea usually lasting 24-48 hrs. Wastewater levels nationwide are high. It’s miserable & incredibly contagious. So many friends are texting us SOS, so here’s a 🧵. /1 Norovirus spreads when as few as 10 viral particles get in the mouth. This happens via direct contact (eg, kissing), contaminated food/water, or touching contaminated surfaces (countertop, toy, soiled clothes) then mouth (eg, toddler toys in mouth, eating by hand, nailbiting). /2

🧵 #MedTwitter IMPORTANT
The case of this 🇨🇦 adolescent with #H5N1 #BirdFlu is terrifying. Her only medical history was mild asthma, & symptoms started w/ fever and conjunctivitis. On d5 from symptom onset, she was admitted in respiratory failure, kidney failure, in shock … /1 Despite 3 antivirals (oseltamivir, amantadine, & baloxavir) to which her virus appeared to be susceptible & plasma exchange (three times !!), she spent 2 wks on ECMO and almost 3 wks on a ventilator and was dialysis-dependent. She survived. Let her be a warning, #MedTwitter /2

#MedTwitter
NEW Analysis of 641K hospital admissions in 3.5y finds ending universal masking & #COVID19 testing was assoc w/ a 25% ⬆️ in hospital-onset resp viral infections (w/ longer stay & ⬆️ mortality) & resumption of universal hospital masking with a 33% ⬇️. #WearAMask /1 #MedTwitter
The ⬇️ in respiratory viral infections w/ universal masking included #COVID19, #influenza, & #RSV: .

We need universal masking in hospitals, especially now when #SARSCoV2, #flu, & #RSV levels are high nationwide based on wastewater testing. /2 ja.ma/3Z5fdn7

President Jimmy Carter died today at age 100, having lived w/ melanoma that had spread to his brain & liver for >9y. I grew up in GA admiring him, so as an oncologist, I’d like to honor his life by teaching you a bit. #melsm #MedTwitter

First, the ⚠️ signs (ABCDE 👇) & pics

/1


It’s important to know who’s at ⬆️ risk for #melanoma (see 📸 ).

UV exposure (☀️ or tanning bed) is the major risk.

Having 5 sunburns doubles your lifetime risk of melanoma. Age matters. Even ONE blistering sunburn as a kid/teen doubles lifetime risk!

🔑 AVOID BURNS! /2

NEW 📣 Nat’l study in #Sweden: 86% of people on sick leave due to #COVID19 in wave 1 of #pandemic still had symptoms 18m later, esp fatigue, cognition, sleep, movement. Risks higher if hospitalized or female. Vax didn’t exist then.
#MedTwitter #LongCovid

journals.sagepub.com/doi/10.1177/14…
The study also found nearly half of respondents also had problems w/ functioning in daily life 18 mos after they were infected w/ #COVID19. That is #LongCovid. This is a stunning number.

Sweden never had a full lockdown or mask mandate in wave 1. /2

#MedTwitter

NEW Longest prospective study of #LongCovidKids: 1.3K kids who tested pos for #COVID19 were followed up to 3y. Of note, 89% of cases were “mild” & 9% had no symptoms, & 80% had zero doses of vaccine. Mix of variants, but most were Omicron then Delta. /1 thelancet.com/action/showPdf…
Sadly, 23% of kids had #LongCovid at 3 mos. While #s fell over time, 13% at 6 mos, 8% at 1 yr, 6% at 18 mos, & 7% at 2 yrs still had #LongCovid. This is tragic, both because it means that 1 in 12 kids are still suffering a year later, & most of those remain ill longer term. /2

#MedTwitter #NurseTwitter I have a small but important rant about medical gaslighting. I booked a pharmacy appt for vaccines for myself & my family. This evening when we all went to get them, the pharmacist said to me: “You only booked an appt for yourself, not the others.” 1/ No, I’m sure I booked all of us. I had actually booked a time & when it didn’t let me add others, I had cancelled & rescheduled for an hr later when they could take us all. I explained that to the pharmacist who could SEE the cancellation & rescheduling just as I said, but… /2

#MedTwitter

Great to see independent groups demonstrate that passive transfer of IgG from people w/ #longCovid (LC) to mice produces symptoms.

A few reactions:

👉 We need #clinicaltrials of repurposed drugs (& novel agents) to treat autoimmune disease now

BUT…

https://twitter.com/virusesimmunity/status/1803517986764103874

We have GOT to be able to identify patients w/ #longCovid who instead (or also) have persistent #SARSCoV2 &/or other reactivated virus. If we immunosuppress them (w/o treating 🦠), we can inadvertently harm them AND potentially abandon therapy that could help others w/ LC.

2/

The postmortem exams of cats who died of #H5N1 #BirdFlu on dairy farms show devastating effects on the heart, lung, eyes, & brain.

‼️Do not consume raw (unpasteurized) dairy products.

#MedTwitter, 👀 at the screenshot. #AvianFlu #IDTwitter

wwwnc.cdc.gov/eid/article/30…
Because some are asking me to translate this, the very brief version is that massive inflammation & cell death occurred in heart, lungs, brain, & eyes of cats who drank unpasteurized milk from cows with #H5N1. In all, >50% of cats at that dairy farm died. #MedTwitter #BirdFlu

NEW: Prosp study in 225 pts w/ “mild” #COVID19 & future surgery or other procedures. People w/ viral RNA detection in tissue or🩸5.2 times more likely to dev #longCOVID symptoms (OR 5.2, 95% CI 2.6–10.1, p<0·0001). Higher copy #, higher odds. #MedTwitter
thelancet.com/journals/lanin… Months after a positive #COVID19 test, viral RNA was found in 10 diff types of tissue, incl the liver, kidney, stomach, intestine, brain, blood vessel, lung, breast, skin, & thyroid + blood cells, which could explain the wide range of reported #longCovid symptoms. #MedTwitter /2

I’ve received 4 major media requests in the 2h since #KateMiddleton announced her #cancer diagnosis. I have declined them all. She has not revealed what type or stage of cancer she has, & any dr, including oncologists such as myself, appearing on the news would be speculating. /1 I’ve been asked questions on live broadcasts before that we had agreed were off-limits. I know if I agreed here, I’d be asked to speculate on the type of cancer, type of treatment, how long it might last, what the side effects might be, what her prognosis is. I won’t do it. /2

Devastating study in NEJM. Prospective study of 257 patients having carotid artery surgery: micro/nanoplastics (MNP) in 58% of atheromas & those w/ MNP present had 4.5x ⬆️ risk of stroke, heart attack, & death at mean of 34 mos follow-up. #MedTwitter nejm.org/doi/full/10.10… Add this to the list of health concerns about micro/nanoplastics (MNP) in food. For example, this recent thread I wrote expressing concern about how we're seeing more young-onset colon cancer. Unfortunately MNP are already in soil, water, foods, etc. This is a big problem.

https://twitter.com/tmprowell/status/1744722775204602072

#MedTwitter, This is an important 🧵 from a bereaved husband’s perspective as a caregiver. I’ve been an oncologist for >20y; all of my patients by definition have a serious illness. So I hadn’t thought much about the power of affirming it. When the #COVID19 #pandemic began… 1/

https://twitter.com/greg_travis/status/1748019838105100483

& we all did more outpatient care via 📱, I had the good fortune of overhearing bits of how my husband (an infectious diseases dr) speaks to his patients. I don’t know them or their diagnoses of course, but I know it’s not all cancer, which everyone agrees is real & serious. /2

Sen @BernieSanders opens Senate HELP Committee mtg on #LongCovid stating that 16M in the US are currently living w/ #LongCOVID, a syndrome w/ brain fog, memory loss, language problems, fatigue, & more. “Long COVID can affect anyone…It poses a severe threat to #publichealth.” A former endurance athlete Angela Vasquez shares her story of becoming severely disabled after an otherwise mild #COVID19 infection in 2020. She now requires 12 prescription meds. Notes that people w/ #longCovid may be too ill to navigate the disability system. #HELPLongCovid

Wading into this water bottle debate as a cancer doctor. There has been a striking increase in #coloncancer in people under age 50. When you see an abrupt change like this by generation, it always raises concern for an environmental cause. #MedTwitter cancer.gov/news-events/ca… We don’t know why this is happening, but I think it’s logical to ask what may be spending time sitting in the colon, i.e., things we eat or drink. This rise in #coloncancer is occurring in #Millenials & younger #GenX. Look at the birth years & ages in the screenshot. #crcsm /2

🧵 LOTS of folks with #COVID19 in my text messages this week for the first time in months, & many of my #MedTwitter friends are saying the same. This has happened before every recognized 🇺🇸 surge. Be careful, esp if you are higher risk. All, please 😷 & test if you feel sick. 1/ Some insurers (incl Medicaid) are still covering #COVID19 home rapid tests. If you have rapid tests at home that have expired, check this list before discarding them. Many have had their expiration dates extended: . /2 #MedTwitterfda.gov/medical-device…

In May 2019, Dr. @rschilsky & I co-chaired the #AAADV19 Workshop Plenary Session "Decentralized #ClinicalTrials: The Future is Now." An incredible group of panelists from academia, industry, govt, & patient #advocacy 👇discussed the rationale, challenges, & opportunities of DCTs. No one knew yet that the #COVID19 #pandemic was just around the corner. In Mar 2020, FDA released a guidance on conduct of #clinicaltrials during the pandemic: fda.gov/media/136238/d…, & colleagues wrote about the impact on #OncTwitter trials: ncbi.nlm.nih.gov/pmc/articles/P…. /2

Students from 🏠 with annual income <$50K were half as likely to be accepted to med school as students with 🏠 annual income >$200K. We all knew this was a problem, but the magnitude is shocking. We all have a role in addressing this, #MedTwitter… /1

https://twitter.com/MytienTNguyen/status/1656766277384302592

Students from lower income 🏠 are at an educational disadvantage that begins well before college. A concrete intervention: volunteer to tutor students. I did this multiple times per month the whole time all 3 of my kids were in elem school. files.eric.ed.gov/fulltext/EJ898… /2

A study from #Brazil finds 1 in 4 adults who had mild #COVID19 demonstrated cognitive deficits. The average age of study participants was 38. See what happened when they were asked to copy a diagram. We are not prepared for this. #MedTwitter #LongCovid brainfacts.org/diseases-and-d… Many people are replying “I wouldn’t have been able to copy that drawing accurately even before #COVID19.” This is true. On avg, 5-8% of population are unable to reproduce this. What concerned researchers was that in this study of ppl w/ mild COVID, 25% of them could not.

A survey of 20K people found the most productive people:
👉Set objectives & priorities before beginning to read, write, or plan day
👉Insist on short, focused mtgs & clear, efficient comms
👉Develop consistent strategy to handle 🌊 of msgs/tasks
hbr.org/2019/03/what-m… 2/ A couple interesting observations. Americans work more hours than much of the world but are not more productive. I suspect this is because 🇺🇸 culture values “workaholics,”
so we push through with diminishing returns.

🔥IMPORTANT! #MedTwitter & all workers: the @FTC is proposing to make noncompete clauses illegal. Employers would be prohibited from establishing them & forced to rescind existing ones, incl notifying past employees of the change! 👏👏 @MedicineForward nytimes.com/2023/01/05/bus… ~ 1/5 of US workers are currently under non-compete clauses. They harm workers in many sectors, incl #MedTwitter, e.g., by preventing them from taking a better position w/ another company unless they’re willing to move or travel a long way to work. 2/