Hi Everyone,
In this issue, we delve into the pathogenic mechanisms of PASC, long-term lung perfusion changes, the effect of long COVID on the careers of top athletes, and a unique case of persistent prosopagnosia following COVID-19. As we continue to learn more about the complex challenges faced by those who suffer from long COVID, our aim is to keep you informed and connected, shedding light on the ongoing efforts to better understand and manage this perplexing condition.
I have a big announcement coming in the next couple of weeks, watch out!
[I apologize if there appears to be formatting issues, Substack has some pretty imperfect editing options]
Media 📰
What is it like to have long COVID? Utah teacher shares his story - Deseret News
In January 2022, Blake Bockholt tested positive for COVID-19, but thought he recovered relatively unscathed until he began experiencing symptoms of long COVID-19. Over a year later, he is still struggling with fatigue and difficulty breathing
He has received little help in terms of a definitive diagnosis and treatment, leading to serious depression and even suicidal thoughts
However, he finds strength in connecting with others suffering from the same condition and in the support of his school, which has accommodated his needs and inspired him to provide lessons in resilience to his students
Should You Take an Antiviral to Prevent Long COVID? | TimeThe only guaranteed way to prevent Long COVID is to avoid getting infected by SARS-CoV-2
Recently, researchers have found that certain drugs may reduce the risk of developing Long COVID if they're taken shortly after infection
Studies have recently highlighted two promising drugs: Paxlovid and metformin
Paxlovid, an antiviral authorized to treat COVID-19 among people at high risk of severe disease, was found to reduce the risk of Long COVID symptoms after 90 days among high-risk people
Metformin, a Type 2 diabetes treatment, was found to cut the risk of Long COVID by more than 40% among overweight or obese adults who took it when they had COVID-19
It's too soon to recommend taking these drugs for the general population
Long-Covid Treatment? Docs Are Prescribing Addiction Drug Off-Label – Rolling Stone
The demand for low-dose naltrexone (LDN) to treat Long Covid has , exploded, according to a compounding pharmacist in Philadelphia
Naltrexone, which was first developed in 1963, is approved by the FDA to treat opioid addiction and alcohol use disorder, but some doctors prescribe it off-label in much smaller doses for chronic conditions
LDN, which is considered an immunomodulator, has anti-inflammatory properties, especially in the neurological system, and targets the immune system, calming down inflammation
While LDN hasn't been extensively studied as a potential treatment for Long Covid, anecdotal evidence shows that people experience symptom relief after taking it. That evidence, along with having doctors at reputable institutions who are prescribing it, suggests that it's on its way to becoming more mainstream
How Long COVID affects the careers of top athletes – DW (Deutsche Welle) – 03/24/2023Rower Marie-Sophie Zeidler is preparing for qualification events for the Paris 2024 Olympics, but has had to deal with two bouts of Long COVID in the last three years
Treatment for Long COVID remains challenging, with 200 different symptoms that have to be differentiated
Physical exhaustion is often observed in Long COVID patients, making it difficult to manage everyday life
Long COVID has had a lasting impact on the lives of several athletes including top rower Marie-Sophie Zeidler, who is facing uncertain chances of qualifying for the Olympic Games
RESEARCH 🔬
Robust T cell responses to Pfizer/BioNTech vaccine compared to infection and evidence of attenuated peripheral CD8+ T cell responses due to COVID-19
CD8+ T cell responses play a critical role in controlling disease after SARS-CoV-2 infection
BNT162b2 vaccination resulted in polyfunctional CD8+ and CD4+ T cell responses across all volunteers, likely contributing to its remarkable efficacy
The induction of CD8+ and CD4+ T cells after mRNA vaccination is unusual, which may be a unique feature of mRNA vaccines
The circulating antigen-specific CD8+ T cell response was much lower in SARS-CoV-2 infection versus vaccination
We observed a major reduction in both the magnitude and functionality of peak CD8+ T cell responses in previously infected individuals after vaccination
My Take: I made a Twitter thread on this one, earlier this week. The findings here are definitely pretty concerning.
Long-term lung perfusion changes related to COVID-19: a dual energy computed tomography study
Perfusion Deficits (PDs) were detected on the follow-up DECT scans of 16 (36.3%) patients after a mean of 80-90 days after COVID-19 pneumonia
Patients with persistent lung PDs had significantly higher mean initial D-dimer, fibrinogen, and C-reactive protein values than patients without PDs
Persistent PDs are commonly observed along with persistent COVID-19 symptoms
Persistent prosopagnosia following COVID-19
[DEFINITIONS]:
Prosopagnosia: A neurological impairment characterized by severe deficits with facial identity recognition.
[SUMMARY]:
Here, we provide the first report of prosopagnosia following COVID-19.
In this article, we presented data from Annie, a 28-year-old woman, who is suffering from face recognition and navigational difficulties in daily life after being ill with what appeared to be COVID-19 and suffering from long COVID/PASC.
To investigate whether other people who had COVID-19 also experience perceptual and specific cognitive deficits, we asked individuals who have had symptoms for more than 84 days (PASC group) as well as those who had recovered from COVID-19 (control group) to respond to a survey.
Our findings suggest that there are a substantial number of individuals with PASC/long COVID who are experiencing selective visual deficits and indicate that future work should aim to understand the nature of these deficits and whether interventions can be developed that reduce their impact.
My Take: This is my first time hearing of this symptom. I’d be curious if any of the readers of this newsletter are familiar with this symptom and how it is effectively diagnosed?
Long COVID Now Looks like a Neurological Disease, Helping Doctors to Focus Treatments
Long Covid now looks like a neurological disease, helping doctors to focus treatments.
The most common symptoms of long COVID are neurological.
Some are easily recognized as brain- or nerve-related: many people experience cognitive dysfunction in the form of difficulty with memory, attention, sleep and mood.
Others may seem rooted more in the body than the brain, such as pain and postexertional malaise (PEM), a kind of “energy crash” that people experience after even mild exercise.
Research on other viruses, and on neurological damage from the human immunodeficiency virus (HIV) in particular, is guiding work on long COVID.
Pathogenic mechanisms of post-acute sequelae of SARS-CoV-2 infection (PASC) | eLifeComparisons between PASC and other virus-initiated chronic syndromes such as myalgic encephalomyelitis/chronic fatigue syndrome and postural orthostatic tachycardia syndrome will be addressed
The discussed contributors to PASC symptoms include sequelae from acute SARS-CoV-2 injury to one or more organs, persistent reservoirs of the replicating virus or its remnants in several tissues, re-activation of latent pathogens such as Epstein–Barr and herpes viruses in COVID-19 immune-dysregulated tissue environment, SARS-CoV-2 interactions with host microbiome/virome communities, clotting/coagulation dysregulation, dysfunctional brainstem/vagus nerve signaling, dysautonomia or autonomic dysfunction, ongoing activity of primed immune cells, and autoimmunity due to molecular mimicry between pathogen and host proteins
PASC is more common in individuals who suffered a severe vs mild acute COVID-19 illness
The prevalence of PASC appears to be lower in the more recent COVID ‘waves’, especially with the Omicron variant, and lower in people who were vaccinated prior to contracting COVID-19, suggesting that SARS-CoV-2 variants, availability of newer treatments and immune responses may impact the pathogenesis of PASC
My Take: This is a great review piece! Definitely check it out.
Hope & Potential Treatments
RECOVER Initiative
The National Institutes of Health (NIH) created the RECOVER initiative to learn more about the long-term effects of Covid.
Whether or not you’ve had Covid, you may be able to participate in RECOVER research
The last few weeks seem to have been frustratingly quiet on the treatment front - quite a bit of news came through in January and February. Hopefully more trials announced before too long - I think RECOVER will reveal which clinical trials they’ve selected in the next month or so