WesElyMD
@WesElyMD
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Husband & Dad. ICU Doc. Vanderbilt. @CIBScenter studies Covid & Long Covid, ICU Survivorship, PICS, Dementia, Delirium. Tweets my own. Still learning.
Nashville, TN
Joined April 2020
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1/🧵 Beauty in simplicity
For too long in life, I thought success was about climbing in the 🌎’s eyes…higher, better, farther. My physician wife & I are “new parents” to my 58 y/o brother w
#DownSyndrome
& he’s giving me all kinds of new understanding of what matters.
#COVID
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1/🧵 Let’s talk Long COVID:
I’m grouping several important & interesting articles about the reality of
#LongCOVID
.
By studying brain fluid, viral persistence & MRIs, we’re building our understanding of the “how” & “why” of this devastating malady.
A train is coming, read on…
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1/🧵 Imagine 2 people, madly in love & married 28 years, in an impossible situation, both lives on the line & separated by different hospitals. Then imagine 2 sets of
#nurses
&
#doctors
separately determined to overcome ⛰ of obstacles…
(shared w perm)
#MedTwitter
#NurseTwitter
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1/🧵 Long COVID Brain Science: 🧠
For ~100M suffering 🌎, let’s use data to combat myths &
#Misinformation
COVID is biologically dangerous long after virus is gone
#LongCOVID
affects our….
📍Olfactory & Limbic Systems
📍 Interferon Autoimmunity
📍PET scans
📍Astrocytes
How?
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1/🧵Your brain “on COVID”🧠
Let’s integrate >20 studies on
#LongCOVID
neuropathology
My 24 y/o patient explained: “I don’t have a future because I can’t think anymore.”
Let’s talk:
Autopsy Studies
Viral persistence
Brain Size & Disability
Recovery & Hope
H/T pic 👁️ tw 13
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1/🧵 What is
#LongCOVID
⁉️
A disabling malady from ongoing inflammation, autoimmunity, & potential viral reservoirs (GI, brain?)
NEW DATA: The Lungs “light up” on special MRI Scans 3 to 9 months later in patients never hospitalized for COVID.
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1/🧵 Christmas Reflection on Gratitude
My patient today - IN THE ICU on Christmas - said:
“I’m sorry for complaining, Doctor. I realize that if I have time to complain, I have time to say ‘thank you’ too.”
WHOA!
I will be w my patients today & throughout the Holidays…
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My patients toes on
#COVID
.👇
Patient told me, “I feel like I’m learning to breathe again and failing.”
Imagine how bad his internal organs look now.
COVID19 is no cold.
My patient wishes so much he had gotten
#vaccinated
.
You have choices!
#Vaxx
#Mask
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1/🧵 The Haunting Brain Science of Long COVID 🧠
@washingtonpost
Aug 25
📍Brain shrinking
📍Corona ghosts
📍Autoimmunity
📍Clinical clusters
“The good news is that in some pts
#LongCovid
#BrainFog
may not be permanent.”
Link👇 but paywall so see 🧵
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1/🧵This weeks 2 important studies on Long COVID
📌Include ~340k COVID patients vs ~7M controls out to 2 yrs
📌Organ dysfunction persists in 33%
📌Levels of disability from
#LongCOVID
exceed those of cancer & heart disease‼️
Links at end of this thread
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Death💀of a team member from
#COVID19
is especially brutal. Nashville TN USA
#nurses
#nursepractitioner
#physicianassistant
#respiratorytherapist
and
#doctors
outside the room of 🙏 before he died of
#COVID
.
#MaskUp
#vaccine
#MedTwitter
#pandemic
#Hope
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Nurses are, by nature, problem solvers. When we block their innovative ideas of how to humanize care, it breaks their spirit. The job is hard enough. Allow
#nurses
to make pts wishes come true w music, ice cream, beer, & dogs! Otherwise we will lose our healers. ❤️🩹
#NurseTwitter
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1/🧵Our speed in understanding Long COVID is accelerating‼️
Here I cover a smorgasbord of recent COVID data on…
📍Brain Aging
📍Genetics
📍Epidemiology
📍PEM
📍Self-Protection
Knowledge is Power.
We are all at risk of losing Brain Power from
#LongCOVID
.
Let’s learn…
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1/🧵🎥 A young mom suffering
#COVID
. Her husband is scared.
We need to prevent serious long-term complications. Her new normal will likely include PTSD, Dementia, Depression & severe physical disability. (shown w Perm)
Not so “mild” ➡️ Do you want this?
#vaccinate
#LongCOVID
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@charliemackesy
Charlie - i’m a doctor in a
#COVID19
ICU & one of my young patients is losing her arms & legs & has also gone deaf - all from COVID. She remains immensely hopeful & beautiful. Tomorrow I’m going to bring her a copy of the boy the mole the fox in the horse and read it with her.
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4/🎥 Dancing: Greg breaks out in
#Dance
spontaneously wherever we go. He loves to dance.
Why?
He says, “Wesley, let’s dance & go on a honeymoon today!”
Greg taught me that happiness is a state of mind. I have a choice & this level of joy can be mine…
…IF I CHOOSE IT.
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1/🧵 Long COVID’s “Disability Roulette”
🔺No longer a mass Death event…
🔺COVID-19 is an ongoing mass
#Disability
event
🔺You & I might get
#LongCOVID
🔺But society is yawning
This thread unpacks science, policy & hope.
No Paywall Boston Globe link:
Long COVID is Disability Roulette
@GlobeOpinion
✍🏻👇
✔️ This Op-Ed is to raise
#LongCOVID
public awareness
✔️I hope it helps
✔️It will never be enough
✔️The millions suffering deserve more
On Tuesday 5/30 I’ll unpack it & >20 references in a teaching🧵
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We now provide consenting non-Covid ICU pts a
#Covid19
vaccine 💉 before leaving the unit.
Small victories add up! 🏆
Still I’ll go on record as saying that we ideally want to
#vaccinate
people before the ICU!
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15/fin
Convinced yet⁉️
#LongCOVID
is real.
Do not deny your friends & colleagues who say they are disabled.
They really can NOT do their jobs or remember things. They are physically suffering.
Let’s prepare to help them for the years ahead. Global effort.
#Vaccinate
please!
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What’s Long COVID look like at 2 years? NOT GOOD‼️
In this Swedish study of previously hospitalized patients with COVID, more than 8 out of 10 of 185 people who met the diagnosis of Long COVID at 4 months (and 1 in 3 of the total 460 COVID-19 patients tracked, all of whom had…
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1/🧵
#COVID
Brain Changes Show Parallels w Alzheimer's Disease
Findings may point to potential mechanism for
#brainfog
in people with
#longCOVID
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1/🧵 Long COVID - new
@TheLancet
data
📌A picture is emerging
📌It’s not pretty
📌Most pts w months-long symptoms aren’t recovered @ 2-yrs
📌The cluster including neurocognitive & cardiovasc symptoms is ominous
📌These data fuel trial design
Thoughts…
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Death in ICU 🛑
🔹After death today, the Crit Care Fellow had our team take “The Pause” to show respect for his life👇
🔹She then took time from rounds to have us process our pain & talk it through
🔹Tears were shed
Valuable? Thoughts please.
Pause:
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1/🧵 COVID & Autoimmune Diseases - more data 💥
My patient w
#LongCOVID
has new Raynaud’s and SLE (Lupus). She’s in tons of pain and is losing her fingers.
Study: N=4M people. COVID ⬆️ risk of new autoimmune Dz & vaccine was protective
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1/🧵 Post-Infectious Syndromes
…a Doctor’s admission
📌 I didn’t think
#MECFS
was real till
#LongCOVID
opened my eyes
📌 It’s “mysterious” & we weren’t taught it in med school
📌 Yet 1,000s are suffering a disease traditional medicine doesn’t understand
📌 Let’s find answers
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Long COVID is Disability Roulette
@GlobeOpinion
✍🏻👇
✔️ This Op-Ed is to raise
#LongCOVID
public awareness
✔️I hope it helps
✔️It will never be enough
✔️The millions suffering deserve more
On Tuesday 5/30 I’ll unpack it & >20 references in a teaching🧵
While society yawns, impatient to move on from the COVID-19 pandemic, Americans still play disability roulette,
@WesElyMD
writes.
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3/ Hide and Seek: He taught me that if he can’t see me, I can’t see him!
At first that seems nutty, but in truth, for me to enter “into
#relationship
” w you, we do need to SEE EACH OTHER, right?
So who’s teaching who here?!
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1/🧵Long COVID Brain Problems are a global disaster
📌Hiding in plain sight
📌Too often ignored by doctors
📌Read our new Lancet-RM article
📌On the intersection of
#LongCOVID
&
#PICS
📌I’ll unpack below
Link gives 6 weeks of open access:
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COVID Vaccine reduces Long COVID
JAMA data in 2.5k people shows (vs 0 vaccine doses & adjusting for pt differences) 2 to 3 doses of vaccine ⬇️
#LongCOVID
by 75% to 85% 👊
B5
#Omicron
is SUPER contagious & lessening LC risk is a great incentive to
#Vaxx
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1/🧵 Land Mines in Long COVID -
@BostonGlobe
Alex was training for 2024 Olympic Trials 🥇
That dream exploded 💣
New
#LongCOVID
science
📌Viral reservoirs at 1 year
📌Cardiac edema at 1 year
📌Dementia at 2 years
📌Hijacked mitochondria
ScreenShot👇
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2/ These data explain how the COVID virus places our bodies at risk for macro (large) blood clots in acute dz (which we see often), brain disease due to down-stream micro-clotting, and possibly later cardiovascular dz.
What did these London investigators find?
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6/fin
Our innate immunity is being re-wired by COVID‼️
📌These systems protect us from severe disease & secondary infections
📌My spidey-senses tell me to stay as protected as possible
📌COVID XBB variant is spreading fast
📌Het your Bivalent Vaxx
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3/ Believing those with
#LongCOVID
complaints is our 1st basic show of support!
“If people tell us they have new thinking & memory issues, I think we should believe them rather than require that they meet certain severity criteria.”
Dr. Apple UCSF
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During months of isolation in
#COVID19
, my mentally sharp 85 yo mom, living alone, descended into
#dementia
that shocked me. As a physician who studies
#LongCOVID
, I was wholly unprepared for the enduring effects social isolation would have on some who never even got
#COVID
.
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5/ Imaging the brain before & after
#COVID
show changes.
Our
@CIBScenter
#LongCovid
support group patients tell us daily that even "mild" COVID leaves people unable to work, care for families, or complete tasks in their job & daily life.
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9/ To give you a practical understanding of what these 🧠 brain changes did to these people, this figure shows that it increased the time to process cognitive tests by as much as 30%.
How frustrating would it be in daily life to think that slowly?
You don’t want this.
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4/ Monocytes of COVID pts display abnormal markers of inflammation & clotting that drives us to immuno-thrombosis & vascular platelet+cell aggregates.
Very scary stuff if you want a body & brain to get blood, food & oxygen normally.
I highlighted excellent discussion points👇
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4/ The cause of
#LongCOVID
may be persistence of virus in the body.
This study N=29 found viral RNA in 51% (plasma, stool or urine) of those w fatigue, pain, lung & heart symptoms. 55% had only mild COVID.
Treating with antivirals helped & offers
#hope
.
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We all love to feel needed‼️
Greg often helps us w housework and today mopped our kitchen.
He asked to share this photo w you all so you would “clean your house, too!” 😂
(Pic w his perm)
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@ANPsummerfield
@doctor_oxford
Amazing act of love and kindness in
#COVID19
. Thanks
@ANPsummerfield
for sharing!
See below we did same thing and here is their story -
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1/🧵Fusion of Neurons in COVID
🔹At 2 yrs many
#LongCOVID
pts still suffer 🧠
🔹We’re beginning to understand why
🔹“Fusogens” activated by viruses like COVID can create irreversible cell-to-cell damage & miscommunication
Pic = Spike infected neuron
Link in Tw 3
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1/🧵The Haunting Brain Science of Long COVID
📍Here I use science to raise awareness of a growing public health nightmare hiding in plain sight
📍Matt & Barbara tell their stories
📍20 relevant medical articles
📍See 🧵unpacking science in Tweet
#2
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Two brothers getting Donuts
Greg: “Wez-uh-leeeeee, can we get ‘Chockel’ donuts?”
Me: “Let’s go!”
Greg reminds me to take time for simple things in life that matter most‼️
#DownSyndrome
#NothingDownAboutIt
#UpSyndrome
#MoreAlikeThanDifferent
#DifferentNotLess
#TheLuckyFew
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10/ For our
#Neuroscience
junkies, here’s what they saw on the MRIs:
Greater reduction in gray matter thickness & tissue contrast in orbitofrontal cortex, parahippocampal gyrus & olfactory cortex.
“REDUCTION IN GLOBAL BRAIN SIZE.”
Not good at all. 👎🤬
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5/ Let’s pose some Important Questions:
✔️Are these findings COVID-specific?
✔️How long do these genetic/cell function changes last?
✔️Do they contribute to
#LongCOVID
?
✔️What’s the cost of repeat infections?
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🎥
#FathersDay
gift like no other ♥️
Dancing w your daughter at her outdoor wedding surrounded by Mother Nature & Tons of Love.
I’m putting this
#dance
in the brain bank for the hard days…
🎵 “Happened long time ago. A-little bitty pretty one. I’ve been watching you grow”
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1/🧵Can a Diabetes drug prevent Long COVID?
Most solid data yet of a medication preventing
#LongCOVID
from quadruple blinded, non-pharma sponsored COVID-OUT trial N=1,125.
A 42% relative ⬇️ in clinician diagnosed LC was seen (10.6% down to 6.3%).
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1/🧵 Micro Clots & Endothelial Dysfunction in Long COVID
Plus new Epidemiology in
@JAMA_current
some say proves
#LongCOVID
is a hoax⁉️
Truth is…endothelial dysfunction plus inflammation can lead to life-altering brain & body dz.
Let’s explore data
Pic H/T
@VirusesImmunity
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1/🧵🎥
#Delta
COVID ALERT‼️
4th wave has Teens phoning parents to say Goodbye. Beds & Staffing are too tight to monitor visitation.
Infxs Dz doc
@katieoneallsu
told me we’re descending to new lows in a crisis of the
#unvaccinated
. Listen as she describes a nightmarish reality.
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3/ Consider this:
A study of 150k COVID survivors, hospitalized & not.
COVID survivors had 10-15X ‼️higher risk of considering
#suicide
at 1 year than 11M control patients.
This is horrifying, yet people still deny
#LongCOVID
’s importance.
WHY?
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1/🧵 Let’s learn about Ace inh-induced angioedema
His lips & tongue swelled up hours after taking a blood pressure med he’d been on 10 years - lisinopril.
📍What’s the treatment?
📍Is it an allergy?
📍What’s a common thought error?
(Pic w Perm - trigger warning tweets 2 & 4)
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The fact that mild Covid infections impact the 🧠 brain are completely consistent with many 1,000s of people who were never hospitalized & are suffering “brain fog” a YEAR later. We
@CIBScenter
are studying this in our NIH-funded investigations. Young people are disabled by this!
For all those worried about the vaccine 👀
Early research shows even mild COVID-19 impacts brain, but unclear for how long via
@timesofisrael
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3/ Taking blood from 2 UK SARS CoV2 studies…
📍They compared COVID🩸(N=62 mild/mod dz) to normal controls
📍Then conducted genetic, metabolic & functional assays
👀 Look how different gene expression was (color difference) in COVID vs. HC (healthy control) pts
What’s it mean?
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7/ The abnormalities were found primarily in the limbic system & olfactory (smelling) areas.
The limbic system is involved in our behavioral & emotional responses for survival like feeding, caring for our young & fight or flight responses.
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🎥 Serious
#COVID
lands you in the hospital & in 7-10 days you will have tremendous weakness, loss of >20% of muscle & nerve disease (
#PICS
)
OT/PT Therapists work w our patients to bring them back into the land of the living.
Listen up…👇
Avoid all this by
#Vaccination
#Mask
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1/🧵 Long COVID’s “Disability Roulette”
🔺No longer a mass Death event…
🔺COVID-19 is an ongoing mass
#Disability
event
🔺You & I might get
#LongCOVID
🔺But society is yawning
This thread unpacks science, policy & hope.
No Paywall Boston Globe link:
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"Brains donated by people who died of Covid-19 also show widespread problems in the cells lining the blood vessels and exaggerated clotting, supporting the idea of Covid-19 as a blood flow disorder that brings on brain disease."
See article and 🧵👇
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2/ Cerebrospinal Fluid Offers Clues to
#BrainFog
Most pts w new “thinking problems” after mild
#COVID
had abnormalities in fluid from lumbar punctures (image); controls did not.
Delayed
#LongCOVID
was common in younger people who thought they were safe.
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5/ Rodents won’t “dream up” symptoms or tissue changes.
An animal model of
#LongCOVID
helps STOP claims that this is just in patients’ minds.
Pts are too often victims of Testimonial
#Injustice
(being silenced) & asked, “Have you seen a psychiatrist?”
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Real Suffering: Long COVID
We must do more to discover scientific answers & medical treatments for LONG-COVID
In our recent Neuro
#LongCOVID
paper in
@LancetRespirMed
…read 🧵👇
We had permission to present the true story of this 32-year-old father, husband, firefighter, and…
1/🧵Long COVID Brain Problems are a global disaster
📌Hiding in plain sight
📌Too often ignored by doctors
📌Read our new Lancet-RM article
📌On the intersection of
#LongCOVID
&
#PICS
📌I’ll unpack below
Link gives 6 weeks of open access:
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1/🧵💥 NEW COVID THERAPY SAVES LIVES
Adding baricitinib to steroids will save 1,000s of hospitalized
#COVID
pts. Our
@LancetRespirMed
COV-Barrier study is FREE.
I explain👇why it’s such a great
#Pandemic
discovery story: a new way to ⬇️ COVID19 deaths.
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Our patient with Covid pneumonia on 70% & PEEP 14 writing to me about her scary dream. She started crying and desaturated and said she’s thankful not to be heavily sedated so she can communicate. Don’t assume heavy sedation is necessary. Every patient’s needs are different.
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1/🧵ANTICIPATORY REGRET &
#COVID
#VAXX
❗️
This pt was transferred from an outlying hosp on
#Ivermectin
. She worsened & was intubated. She asked the nurse for a phone to call her family. This is what the patient wrote…look at BOTH PICS (shown w perm)
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25/fin ✔️✔️
#LongCOVID
is a REAL, multi-faceted syndrome
It has cognitive, mental health & physical impairments
It can persist years after the virus is gone
It has an emerging molecular basis
Never lose hope for recovery
Sit & Listen
Pts are the expert of their own disease
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Ivermectin – High dose, Low dose, ANY dose…
It. Does. Not. Work. For COVID.
This group of N=1200 outpatients during Omicron, largely vaccinated with mild to moderate disease, achieved no benefit compared to Placebo.
Are we done w this worm med?
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DOCTORS & NURSES are burning out
❗️Leading ICU doctor
@DavidJanz5
begging Congress for help…”We used to worry about if we’d have enough ventilators. Not now. Now we’re worried we won’t have enough
#nurses
&
#doctors
!”
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6/ In the now famous Mar 7, 2022 UK Biobank
@NatureMedicine
study, 401 people, most with MILD
#COVID
& not hospitalized, had MRIs before & after infection.
Startling findings were seen in comparison to 384 controls who never had COVID.
Let’s unpack…
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8/ The second scans were ~5 months after COVID.
These SCARY 😱 findings may be due to degenerative spread of the virus through olfactory nerve (think anosmia) & neuroinflammation.
The pts w MRI changes had more cognitive decline even after removing those who’d been in hospital.
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❤️ &
#COVID19
:
Couple married 65 YEARS! Now convalescing as
#pandemic
survivors. They came to ED holding hands. Initially in separate rooms 👎& got
#delirium
😤 so we pushed for same room & now thriving as our Prom 👑 sweethearts.
#MedTwitter
#TipsForNewDocs
#pulmcc
#geriatrics
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2/ First, Epidemiological comparisons…
FLU vs. COVID
Survivors of viral infxns like
#Flu
don’t complain of 200 long-term symptoms & ~90% ongoing mood disorders.
#LongCOVID
pts do.
Flu kills 0.5M/year vs COVID has killed 10X that (5M) in just 2 years.
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I wanted our ⭐️ med student to learn tons. Of 20 wildly interesting pts, I assigned her a gentle man likely to die that day. WHY?
What matters most in life is seen in death.
“They took me in, Dr. Ely. I learned more at his side & talking w his family than anywhere else!” ❤️🩹
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🧵1/ Here’s your “Big Picture” of COVID & Long COVID for 2022
See my new Figure👇 summarizing
#COVID19
Management & Outcomes
Two years in & we have splendid choices.
Stay in peaceful waters of prevention (green) or risk treacherous cliffs of
#LongCOVID
& Death (red & black)…
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‼️ Dr. Keith Scott is a respected voice in ICUs. He got COVID Pre-vaccine from his 1st
#COVID
pt. He healed & months later developed Guillain Barre (neuromuscular paralysis) & almost died. Now >1yr later he’s unable be a doctor due to
#LongCOVID
. Tragic
🎥 Get
#Vaxxed
‼️
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Yes 💯
@DrNadiaChaudhri
you are powerfully and wonderfully made! You are why we come to work in ICU medicine. TY for sharing your shuffle!
#A2Fbundle
#PICS
reduction ❤️🩹
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1/🧵 BEWARE: Mild” COVID can cause
#LongCOVID
‼️
@Nature
study of N=147 (31 w LongCOVID) found Covid infection exerts unique & prolonged effects on our innate & adaptive immune system over 8 months later.
This may drive Long Covid.
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1/🧵 Are you happy?
My brother w
#DownSyndrome
is teaching me tons of life lessons.
In medicine & in life, I make big decisions based on guesstimates of other’s Quality of Life
#QOL
.
I often GET IT WRONG!
What do adults w
#disability
teach me about TRUTH?
Can I learn?
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Exposure to Spike Protein via a Vaxx is safer than exposure by an actual COVID infxn.
📍Risk of vaccine-related myocarditis is 20 per million
📍Risk of life-altering
#LongCOVID
after infection is 125,000 per million.
📍I choose the “benefit to risk” ratio of
#Vaxx
.
Get
#Boosted
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2/ These
#LongCOVID
pts had NORMAL CT scans but when asked to inhale Xenon, an inert gas, the MRI showed their lungs transferred gases (think oxygen) into the bloodstream abnormally. This is alarming evidence of another weird form of organ damage from COVID not visible on CXR/CT.
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1/🧵 “Live every day like you have a terminal illness.”
The most important thing I learned
@ISICEM
, after 3 ✈️ & 4,400 miles to Belgium for this huge meeting of
#COVID
ICU doctors, had nothing to do w science.
The iconic
@JRandallCurtis1
taught me…(pic & story shared w perm)
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🎥
#COVID19
took her hands & feet👇
I cried when she sent me this yesterday: Her physical resilience & mental fortitude are my
#Inspiration
. She sent this 🎥 of her walking w new legs and said to tell YOU…
“Blood clots of
#COVID
can be prevented w a
#Vaccine
!”
(shown w perm)
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Friends - today we honor all our brothers and sister who live w trisomy 21. Greg my brother teaches me every day what really matters.
Beauty in simplicity & that includes this new
#TedLasso
ice cream Biscuits w the Boss ‼️
#WorldDownDyndromeDay
#T21
#UpSyndrome
@DSAInfo
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11/ Here’s how the article ends:
"This is the first longitudinal imaging study comparing brain scans acquired from individuals before & after SARS-CoV-2 infection to those scans from a well-matched control group…
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1/🧵 You’re dying in a hospital bed, and we grant you “THREE WISHES.” What would they be?
My dying patient is stunningly beautiful INSIDE & out. I asked what 3 wishes she had?
This video of the Birthday 🎂 party we had for her son is her BONUS Wish!
Read on for her share ❤️
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13/ Summary of things we are learning:
Chronic inflammation in the olfactory system affects our emotional, sensory, and brain function (cognition).
Hamsters, for example, after the virus is gone, have problems with normal behavior.
Guess what? So do people.
Let’s build more…
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7/ Olfactory lining tissue was thinned out “permanently” in the COVID (not Flu) infected animals, which increases vulnerability to bacterial infections.
Similar findings were seen in autopsy findings of humans thought to be healed from COVID who went on to die of other causes.
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What NOT to say to a grieving person ❤️🩹…add your tips too‼️
I met today w the father of a women who died 1 year ago in my ICU
📍“Doc, tell people NOT to say:
‘She’s in a better place’
‘I know how you feel’
📍“I know they mean well, but I’m mad. She had a good life with me.”…
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