Wes Ely, MD, MPH

Families mourned & Docs Cried on ICU rounds

🔹3 DEATHS in one morning
🔹3 times we did “THE PAUSE”
🔹A voluntary 30-60 sec unscripted bedside silence
🔹Do it for the patient
🔹Do it for yourself
🔹Do it for your team members

Pass it on…The Pause🙏

APP: apple.co/3Cj01qj

I agree! The Autumn Ghost is an important and enthralling read by Dr. Hannah Wunsch.

New CDC program hopes to combat health care worker burnout The new Impact Wellbeing program provides leadership resources on addressing burnout and encourages hospitals to administer well-being questionnaires.

Spoke w Amber at @scrippsnews.bsky.social about clinician burnout.
🔥Expect more from your systems and from your leadership.
🔥Know that they won't be enough, you need to care for yourself regardless. Therapy is an amazing resource. Use it.
www.ktvq.com/new-cdc-prog...

The cover of this week's Lancet and the accompanying article on the UK Covid inquiry by the Editor-in-Chief
thelancet.com/journals/lan...
Imagine if this was done in the United States

"I mean, life is a terminal illness. We're all going to die. And for the small slice of time where we're here, we might as well express ourselves and communicate with one another. It has been a blessing beyond blessings for me. It has been a fantastic journey."

Families mourned & Docs Cried on ICU rounds

🔹3 DEATHS in one morning
🔹3 times we did “THE PAUSE”
🔹A voluntary 30-60 sec unscripted bedside silence
🔹Do it for the patient
🔹Do it for yourself
🔹Do it for your team members

Pass it on…The Pause🙏

APP: apple.co/3Cj01qj

Adding to my 🧵 above…

“Depleted serotonin could especially explain memory problems and some neurological and cognitive symptoms of long Covid…”

Thanks Pam Belluck for this NYTs coverage:

nyti.ms/45tXc2U

3/fin
Through work like this, we legitimize not only LC, but also #MECFS #LongLyme etc & take one step closer to finding medical solutions for past & future post-infectious states + syndromes like #PICS
bit.ly/3Fjx3Jp

These are foods that contain lots of tryptophan like turkey and eggs and chicken

2/ Tryptophan is an essential amino acid - we don’t make it.

So if we’re “programmed” to absorb ⬇️ from our diet, we sleep poorly, think worse, and all sorts of other bodily functions go awry.

Will SSRI & SNRI meds help, or anti-virals, or immuno-modulators?

Trials will tell.

This is an info graphic showing how viral infection leads to alter tryptophan and serotonin metabolism and ultimately brain dysfunction

Long COVID Disease State
 
COVID infects us & Interferon causes 3 dastardly plots:
📌 We absorb ⬇️ tryptophan & convert ⬇️ Serotonin
📌 Platelet pathology ⬇️ stores of Serotonin
📌 Vagal nerve signals peripherally ⬆️ impairs brain function & memory

bit.ly/3M5F9ZV

Long COVID Isn't the Only Post-Viral Illness Post-viral illnesses are more common than you think—but they got little attention prior to the pandemic

Patients must be heard…Emerging data show post-infectious syndromes like MECFS, Long Covid, Long Lyme, fibromyalgia, and more have pathobiological & psychological components.
 
Let’s strive toward cultural unity and…
📍Dispel myths
📍Avoid gaslighting
📍Map a path to healing

t.co/nIiC8v3cKc

This is a picture of Greg, who has down syndrome, at his place of work.

Everyone deserves a place at the table of #Life‼️

🎈Human Flourishing is a worthy goal
🎈Greg works at the Nashville “Friend’s Life” Treat Truck
🎈@FriendsLifeCom1 works to integrate adults w disabilities into community

Its a model of human flourishing

(pic w perm)

This is the abstract for this excellent investigation and Lancet

This is a Figure Showing baseline and symptom complex is predicted for protective of long Covid

results of a multivariable analysis

This is a particularly interesting heat map of the symptoms most indicative of cluster see and be which were the most ominous

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?

bit.ly/3sHrwt9

1st lab assessment of BA.2.86, from Yunlong Cao’s group. Marked immune escape features of this variant, as expected by mutations, but low cell infectivity should dampen transmission potential
This is very good, but still possible BA.2.86 can evolve, pick up new mutations to be more infectious

Mom after her hair do smiling big. And they wearing in 95 mask on airplane to go see her

30 new mutations to #Spike

Keep your loved ones safe from Pirola BA.2.86👇

I’m flying to see Mom. She’s suffering dementia & called to ask if I’d get her “Hair Did.”

“You bet, Mom & we’ll get some great gumbo & shrimp busters”‼️

(new pic w her perm)

bit.ly/3sxkZBf

This is a screenshot of the nature medicine study abstract and I’ve included the link.

This is a screenshot of the Jama study and I’ve included a link to the investigation

2 recent & 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 dz‼️
 
Links:
Nature Med - go.nature.com/3OMNfHl
JAMA: bit.ly/45mk8lw

Pt w new visual problems.

In ICU, unvaccinated diabetic pt COVID+ and 4+ Staph Sepsis from infected dialysis catheter (now removed). Retinal exam to look for Roth Spots (pic w arrows) & find fluffy white spots…

He’s on COVID tx & anti-Staph ATBs.

1. What else does he have?
2. What should we add?

Among over 4.2 million people, Covid was associated with a significant increased risk of developing multiple types of autoimmune diseases compared with uninfected, and vaccination provided protection https://thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00331-0/fulltext

A visit to the doctor in 2023 :-(

Reading CXRs - pro tips 🏆 

Get the most out of your pts CXRs…

You can see my measurements showing a normal VPW on the first which support other data that her SOB was not due to volume overload.
The other chest x-ray shows a wide VPW -supported more diuresis & w 2.5 L out he’s much better.

As a Doctor, I live in a state of Reverence💥

🔹Healing merits my reverence (ie deep respect)
🔹Reverence begets humility
🔹Humility allows me to see her pricelessness & mystery

Once I see her pricelessness, I am in a better place to serve

What do you think of this cascade?

During COVID, who got “unilateral DNR” orders?

ie, team chose FOR you

📍Black & LatinX – Odds 4-6X
📍Spanish Speaking – Odds 4.5X
📍Covid Pos vs Neg – Odds 8x

Communication barriers ⬆️ vulnerability of having a doc choose EOL plan FOR you.

Is this OK?

Link: bit.ly/44PGWtn

Real Suffering: Long COVID

We need to discover scientific answers & medical treatments

In our recent Neuro LongCOVID paper
Link: https://bit.ly/458yuW2

With permission we present this husband, firefighter, EMT who developed mild acute COVID-19 in 2021 & now has long COVID w bilateral hearing aids

On Acceptance💥

This weekend we went to a wedding. Of 200+ people, guess who had the best time & why?

It was Greg (my brother-in-law, pic w his perm). He ACCEPTS life on life’s terms better than anyone I’ve ever met.

What’s your TOP TAKE HOME about Acceptance?

An important NEJM editorial by HHS Secretary Becerra and
Ashish Jha on Project NextGen 🧪
—"our fight against SARS-CoV-2 is not over"
—"$5 billion investment will focus on 3 main areas" better, variant-proof, pan-sarbecovirus vaccines; mucosal (nasal) vaccines; and monoclonal antibodies

Important oped by my colleague Julia Moore-Vogel on the pressing need to find treatments for Long Covid

https://www.latimes.com/opinion/story/2023-07-31/long-covid-prevalence-research-treatments

With a few basic steps, most of us can finally ignore COVID - The Boston Globe People who are up-to-date on their vaccines and get treated when infected rarely get seriously ill.

Do NOT “Ignore” COVID

@BostonGlobe Published an overly confident Headline

Highlights from @ashishkjha:
📍Paxlovid helps prevent severe COVID
📍Vaccines reduce longCOVID
📍Wear N95 masks indoors
📍The virus continues to evolve - be smart‼️

https://bit.ly/3QiOJvu