PSA: COVID-19 isn’t “just a cold,” isn’t “a respiratory virus,” and “mild” doesn’t mean what you think it does.

If you “aren’t scared of COVID”, this thread is for you.
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Please R/T if it opens your eyes.
This thread is long, and hard to read - not just because of the technical language, but because “it’s just a cold,” “the vaccine protects me,” and “at least our children are safe” are comforting fairy tales.

I wish they were true.
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This virus is like measles and polio: a virus with long-term impact.

Even a “mild” case in a vaccinated individual can lead to long-term issues which cause a measurable uptick in all-cause mortality in the first 6 months, and get progressively worse with time.
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SARS-CoV-2 is a systemic disease which has multiple avenues to induce long-term impairment, attacking the brain, heart, lungs, blood, testes, colon, liver, and lymph nodes, causing persistent symptoms in more than half of patients by six months out.
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To prevent panic, @CDCgov has been using the term “mild” to describe any case of COVID-19 which does not require hospitalization.

#LongCOVID, however, is anything but “mild”, as the replies to @ahandvanish's thread make heartbreakingly clear.
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Davis https://twitter.com/ahandvanish/status/1423017721822949376
Let’s review: SARS-CoV-2 causes an increase in mortality and reduced aerobic capacity even after asymptomatic cases, and remains in the body months after the initial infection.

No, it’s not “just a cold.”

But we’re just getting started. It gets worse. Way worse.
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The virus appears to be able to cross the blood-brain barrier and cause significant neurological damage.

The ability of the spike protein to cross the blood-brain barrier was demonstrated in mice at the University of Washington.
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Rhea, et al https://pubmed.ncbi.nlm.nih.gov/33328624/ 
The Stanford study also discovered microglia and astrocytes which displayed “features .. that have previously been reported in human neurodegenerative disease.”
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Yang, et al, above
An autopsy of a 14-month-old at Brazil’s Federal University of Rio de Janeiro found that “The brain exhibited severe atrophy and neuronal loss.”
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Gomes, et al https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(21)00038-7/fulltext
The UK Biobank COVID-19 re-imaging study compared before and after images of “mild” cases, and found “pronounced reduction in grey matter” and an “increase of diffusion indices, a marker of tissue damage” in specific regions of the brain.
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Douaud ++ https://www.medrxiv.org/content/10.1101/2021.06.11.21258690v3
And, yes, syncytia formation can happen in neurons. For our visual learners, here is video of syncytia and apoptosis (cell death) in a (bat) brain:
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Aicher et al https://twitter.com/nytimes/status/1429604323047133185
Luckily, the University of Glasgow found that “Whilst Delta is optimised for fusion at the cell surface, Omicron .. achieves entry through endosomal fusion. This switch .. offers [an] explanation for [its] reduced syncytia formation.”
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Willet et al https://www.gla.ac.uk/media/Media_829360_smxx.pdf
Let’s review: SARS-CoV-2 can cross the blood-brain barrier, and even “mild” or asymptomatic cases can cause loss of neurons and persistent cognitive defects?

That doesn’t sound “mild” to me; I like my brain.

But it keeps getting worse.
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A Duke pathology study in Singapore “detected SARS-CoV-2 .. in the colon, appendix, ileum, haemorrhoid, liver, gallbladder and lymph nodes .. suggesting widespread multiorgan involvement of the viral infection.”
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Cheung, et al https://gut.bmj.com/content/gutjnl/early/2021/06/13/gutjnl-2021-324280.full.pdf#page1
The same study found “evidence of residual virus in .. tissues during the convalescent phase, up to 6 months after recovery, in a non-postmortem setting,” suggesting that “a negative swab result might not necessarily indicate complete viral clearance from the body.”
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ibid
Let’s review - SARS-CoV2 attacks our veins, blood, heart, brain, testes, colon, appendix, liver, gallbladder and lymph nodes?

No, it’s not “just a respiratory virus”.

Not even close.
(30/🧵) https://twitter.com/LazarusLong13/status/1429635784278044673
The study authors went on to warn, “Non-ICU patients with total T cells counts lower than 800/μL may still require urgent intervention, even in the immediate absence of more severe symptoms due to a high risk for further deterioration in condition.”
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ibid
In the words of T-cell immunologist Dr. Leonardi ( @fitterhappierAJ)
(35/🧵) https://twitter.com/fitterhappierAJ/status/1475227891034210314
In fact, remember those cytokine storms? It turns out that even that even severe COVID-19 may not be a viral pneumonia, but an autoimmune attack of the lung.

(37/🧵) https://twitter.com/DaveLeeERMD/status/1413816137570205697
Let’s review - it’s autoimmune: SARS-CoV2 convinces our body to attack itself.

That might explain why the Arizona study saw more symptoms after 60 days than at 30 days.

It also means “natural immunity” isn’t something to count on.
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But if you’re counting on vaccination to feel safe, there’s even more bad news.

A study of Israel healthcare workers found that “Most breakthrough cases were mild or asymptomatic, although 19% had persistent symptoms (>6 weeks).”
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Bergwerk et al https://www.nejm.org/doi/full/10.1056/NEJMoa2109072#.YRK8mDsAjKw.twitter
Perhaps the most terrifying study is from Oxford University, which examined the effects of vaccination on long COVID symptoms, because not only did it find that vaccination does not protect against Long Covid, but that Long Covid symptoms become more likely over time:
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“The narrow confidence intervals rule out the possibility that these negative findings are merely a result of lack of statistical power. The inclusion of death in a composite endpoint with these outcomes rules out survivorship bias as an explanation.”
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ibid
However, the structural limitations of the Zoe study - discussed in detail by @dgurdasani1 in the linked thread - may explain why it is particularly susceptible to bias against detecting a progressive degenerative condition.
(44/🧵) https://twitter.com/dgurdasani1/status/1422802883632893952
Let’s review: we’ve now shown that vaccination appears to offer no protection against the long-term autoimmune effects of COVID - which we know causes T-cells to attack the lungs, and can cause T-cells to enter the brain.

Why are we letting this run wild?!
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You may think, at least our children are safe.

They are not.

The CDC is tracking incidence of a life-threatening multisystem inflammatory syndrome in children following an acute COVID-19 infection, with 5,973 cases as of November 30, 2021.
(46/🧵) https://www.cdc.gov/mis/cases/index.html
Children also suffer from Long Covid.

"More than half [of pediatric patients] reported at least one persisting symptom even 120 days [after] COVID-19, with 42.6% impaired by these symptoms during daily activities."
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Buonsenso et al https://doi.org/fv9t 
Focusing exclusively on pediatric deaths is vastly underselling the danger to children.

Anybody telling you that SARS-CoV-2 is “just a cold” or “safe for children” is lying to you. They are ignoring the massive body of research that indicates that it is anything but.
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Since our vaccines don’t stop transmission, and don’t appear to stop long-term illness, a “vaccination only” strategy is not going to be sufficient to prevent mass disability.

This isn't something we want to expose our kids to.
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https://www.scientificamerican.com/article/a-tsunami-of-disability-is-coming-as-a-result-of-lsquo-long-covid-rsquo/
Let’s review: even for children and vaccinated people, a “mild” case of COVID causes symptoms that point to long-term autoimmune issues, potentially causing our own body to attack our brains, hearts, and lungs.

Scared? Good.

Now we’re ready to get to work.
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“This is the virus most Americans don’t know. We were born into a world where a virus was a thing you got over in a few weeks.” -- @sgeekfemale, to whom I owe a "thank you" for her editing assistance on this thread.
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The viruses they know in Kolkota, Kinshasa, and Wuhan are different: dangerous, lethal beasts.

Since 2020, the field has been leveled. Willing or no, we’ve rejoined the rest of the world. We are, all of us, vulnerable in the face of an unfamiliar threat.
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The first step is acknowledging the threat.

That means acknowledging that our response has been woefully inadequate, and that is going to be uncomfortable.

The thought that we could have prevented this, but didn’t, will feel unconscionable to some.
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The knowledge that we could start preventing this today, but haven’t, is unconscionable to me.

https://twitter.com/IanRicksecker/status/1426584062827712512
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It’s time to quit pretending “it’s just a cold,” or that there is some magical law of viruses that will make it evolve to an acceptable level.

There’s no such law of evolution, just wishful thinking, easily disproven by:

Ebola. Smallpox. Marburg. Polio. Malaria.
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There are things we can do to reduce our individual risk, immediately.

That starts with wearing a good mask - an N95 or better - and choosing to avoid things like indoor dining and capacity-crowd stadiums.

(55/🧵) https://twitter.com/LazarusLong13/status/1440398111445188618
“Those who would sacrifice essential liberty for a little bit of temporary security deserve neither!”

What is the essential liberty here?

It is the liberty to be able to breathe clean air, to live our lives without infecting our families and risking disability.
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To get there, we need to listen to our epidemiologists and public health experts - the ones who have been trying to tell us this since the beginning:
(59/🧵) https://twitter.com/EpiEllie/status/1444088804961304581
It is time -- long past time -- to give up on the lazy fantasy that we can let it become “endemic” and “uncontrolled” because it inconveniences us, because it is killing our political opponents, or because the virus will magically evolve to some “mild” state.
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It is time -- long past time -- to begin controlling this virus.
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It’s possible: Japan, New Zealand, and South Korea have done it.
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It saves lives:
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It’s time.
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Coda:

For those of you who are reading this having just received a positive COVID test, please don't despair.

I'd like to direct you to @Survivor_Corps and their website -- I suggest you start at:

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https://www.survivorcorps.com/homecare 
For anybody who has a shared living space, such as a dorm room, who wants to mitigate risk in that space while still taking your masks off, eating, etc, I recommend this thread by @CorsIAQ:

(68/🧵) https://twitter.com/CorsIAQ/status/1478567649915256832
For school administrators and business owners who want to make their workplace safe for employees, customers, and students alike, I recommend @kprather88's thread on the mitigations she put in place at @UCSanDiego and in the @sdschools district:
(69/🧵) https://twitter.com/kprather88/status/1424796471711264768
For parents looking to protect their children with quality masks, my family used @masknerd's detailed analysis to select one that fits our daughter. She loves it - and it's so comfortable she doesn't mind grabbing it even for outdoor play.
(70/🧵) https://twitter.com/masknerd/status/1476668499649044484
For those of you battling your own Long Covid symptoms, who read this and thought, "I feel seen", I recommend the great support community:

@long_covid
@patientled
@itsbodypolitic
@elisaperego78
@ahandvanish

Patient-led research into Long Covid inspired this thread.
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Update: in reviewing this thread, @dgurdasani1 pointed out an important nuance I'd failed to mention.

The Oxford University paper's primary analysis counted a single dose as "vaccinated," which doesn't match our colloquial usage of the word to mean fully vaccinated.
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The paper's sub-analysis, however, showed protection against several persistent symptoms with 2-dose vaccination, even though the primary analysis didn't.

That's very good news!
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That corroborates the findings from the Université de Paris study which Professor Iwasaki ( @VirusesImmunity) described in this thread.

The graph of complete remission in her second tweet is of particular interest to anyone battling Long Covid.
(74/🧵) https://twitter.com/VirusesImmunity/status/1444306456266825732
Anybody currently exposed or worried about their personal risk of Long Covid will be happy to read that the study found

"Vaccination reduced the symptoms of long COVID and doubled the remission rate of long COVID symptoms at 120 days."
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Tran, et al https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3932953
Let's review: vaccines do offer benefits against Long Covid, with a 2-dose sequence increasing the chances of full remission, and providing protection against a number of pernicious sequelae.
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Adding this meta-analysis to the thread, so that people can find it in a single place:

(79/🧵) https://twitter.com/ahandvanish/status/1478525881475907587
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