Hi everyone,
Happy Monday!
In the treatments sections, there is a highlight on intravenous immunoglobulin (IVIG), because there is a lot concurrent stuff going on looking at its effectiveness at treating long covid. For those who have not heard of it, IVIG ‘is a therapy treatment for patients with antibody deficiencies. It is prepared from a pool of immunoglobulins (antibodies) from the plasma of thousands of healthy donors. Immunoglobulins are made by the immune system of healthy people for the purpose of fighting infections.[Source]’ There has been some mixed results from using IVIG to treat ME/CFS in the past, but curious about what larger studies find!
📰 Media
Is the Fed ignoring long Covid in its inflation fight?
From CNN:
central bankers decided to no longer list public health readings among the data points they’ll consider in assessing economic conditions and prescribing monetary policy changes going forward.
“The bottom line is that long Covid is why the labor force participation rate has not recovered to pre-pandemic levels, even in a situation with solid wage growth,” wrote Torsten Slok, chief economist and partner at Apollo Global Management, in a recent note.
The bottom line: “Ultimately long covid is a key reason why the Fed will have to keep the Fed funds rate elevated for an extended period,” said Slok.
Tim Kaine pushes for long COVID solutions
From Axios:
The first long COVID summit in the country to bring a U.S. Senator, federal health officials, state providers and patients together was held in Richmond on Friday.
The $10 million Congress allocated to research long COVID and possible treatments in December was a steep scale back from the $750 million the Biden administration asked for. Long haulers need disability support in schools and workplaces and more educated providers that won’t dismiss their symptoms, a panel of Virginia patients told the crowd — which included State Health Commissioner Colin Greene — on Friday.
My Take: How was Long Covid only allocated 10 million in December? This will do little to nothing.
Thousands of NHS staff with long Covid risk losing their pay
From BBC:
Thousands of NHS staff across the UK are facing pay cuts because of a change in Covid sickness policy.
At the start of the pandemic, the government brought in special Covid sick pay for staff directly employed by NHS Trusts.
It was a temporary measure and the scheme ended last summer.
My Take: This should be addressed ASAP. Feel so sorry for all those affected here.
🔍 Research
Endothelial dysfunction in ME/CFS patients
post-occlusive reactive hyperemia:is
used to investigate and assess microvascular function (endothelial function).
The test involves blood perfusion measurements before, during and after occlusion.
Flow-mediated dilation: is a non-invasive vascular function test
that measures the change in artery diameter in response to reactive hyperemia.
While FMD is traditionally performed in the brachial artery, some studies
have also used the radial and femoral arteries
From Plos One:
The present study is one of the first studies to investigate vascular function in ME/CFS patients, and was a substudy of a multi-center, national, randomized and placebo-controlled trial that investigated the effect of B-cell depletion using the monoclonal antibody rituximab in this poorly understood disease.
We found significantly lower endothelial function measured with FMD(Flow-mediated dilation), and lower microvascular regulation measured with PORH(post-occlusive reactive hyperemia), in patients with ME/CFS compared to healthy control groups. The vascular dilation after administration of glyceryl nitrate in ME/CFS patients was similar to healthy controls, showing that the intrinsic ability to dilate adequately was present.
Our study does not answer the question of why these patients have reduced endothelial function. Reduced endothelial function might be an associated symptom rather than a central mechanism of the disease.
My Take: Is vascular dysfunction a cause or result of me/cfs and long covid? I guess only time will tell. We really need to understand why this is happening.
Post-COVID-19 interstitial lung disease: Insights from a machine learning radiographic model
From Frontiers:
Fibrotic lung disease was observed in a substantial minority of COVID-19 survivors. These patients might experience benefit from antifibrotic initiation at the time point that fibrotic-like changes are “immature.”
we demonstrated that a short course of antifibrotics could significantly improve lung function. Third, based on the fact that the majority of our cohort was unvaccinated against COVID-19, we provided indirect evidence that vaccination against COVID-19 is not only the best way to contain the pandemic but also the best way to limit post-acute sequelae of COVID-19.
Given that a considerable proportion of infected individuals has functional impairment several months after infection, screening 3 months following infection is encouraged, especially for severe cases that have been hospitalized for prolonged periods.
Representative images from Imbio Lung Texture Analysis 2.1 of a patient with post-COVID-19-ILD
Patient-Centered Paradigm for Managing Autonomic Long COVID Symptoms During Sports and Exercise
From The Clinical Journal of Sports Medicine:
Several weeks after Covid-19 infection, she manifested a new postural orthostasis and exertional tachycardia.
The symptoms were felt to align with postural orthostatic tachycardia syndrome (POTS), and accordingly, these interventions were tried in the following order:
Returning an athlete with post-COVID POTS-like symptoms to sports and exercise requires determining an optimal range of the heart rate for the sport for the patient's age and tailoring the medication both for activities of daily living and for exercise.
Cardiovascular Manifestations of Long COVID: A Review
☣️Abstract Only
From Cardiology in Review:
Research has identified increased rates of cerebrovascular disease, dysrhythmias, ischemic and inflammatory heart disease, cardiopulmonary symptoms, and thrombotic events among those with Long COVID, though the risk rates and potential mechanisms behind each cardiovascular event vary. Finally, we discuss the current gaps in the literature as well as how COVID compares to other viral infections when it comes to causing long-term cardiovascular sequelae.
My Take: Wish I had access to this one…
🩺 Hope & Potential Treatments
Long-term high-dose immunoglobulin successfully treats Long COVID patients with pulmonary, neurologic, and cardiologic symptoms
From Frontiers:
Based on the evidence that immune dysregulation may be a major factor in some COVID-related disorders, high-dose intravenous immunoglobulin (IVIG) has been administered alone or in conjunction with immunosuppressive drugs as part of the treatment during the acute phase
Because some of our patients had been suffering from Long COVID symptoms for months to years and with the above-mentioned concerns in mind, we chose an IVIG regimen of 0.5 g/kg administered every 2 weeks, with a plan to continue for at least 6 months to 1 year depending on the individual case. With this regimen, there has been no thrombosis, and only two patients have experienced a significant adverse event.
All nine patients exhibited significant immune perturbations prior to treatment. One patient declined this treatment, and insurance support was not approved for two others. The other six have been treated, and all have had a significant to remarkable clinical benefit.
Back to the Future? Immunoglobulin Therapy for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
☣️ Old article but super pertinent.
From MDPI:
Interest in researching immunoglobulin (IgG) therapy in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) began in the mid-1980s, prompted by emerging evidence of immunoregulatory defects including disordered cell-mediated immunity
Four double-blind randomised placebo-controlled trials (RCTs) on the use of IV IgG to treat patients suffering from ME/CFS have been conducted.
From the evidence outlined in this review, we hold that immunoglobulin is a potentially curative treatment for a proportion of patients with ME/CFS and that the interpretation of some of the literature regarding the issue has been faulty. Considering the lack of any other curative treatment for this debilitating disease, we find this regrettable.
Immunotherapy for Neurological Post-Acute Sequelae of SARS-CoV-2
☣️ Results are not in yet
From ClinicalTrials:
To learn if methylprednisolone (steroid) and human immunoglobulin (IVIG) will help with symptoms of Long-Haul COVID.
JAMA article from last week about vaccination and effects on the incidence of Long Covid.
file:///Users/aimeeengebretson/Desktop/JAMA-long%20covid%20and%20vaccination.pdf
Love your newsletter - thank you! Though the cardiovascular manifestations paper you cited is behind a paywall, a probably similar review, published in the journal Cereus a few weeks before that (Nov, 2022) is free: https://pubmed.ncbi.nlm.nih.gov/36582565/