Long Covid Weekly 43: Immune system issues, Researchers not wearing masks & more
Plus Viral Reactivation Review from ReCover
Welcome to Long Covid Weekly #43! We are closely inching our way to edition #50. It is crazy this newsletter has been going on for almost a year!
In this issue, we bring you a selection of articles that shed light on different aspects of Long COVID, from neurological symptoms and pulmonary circulation abnormalities to the impact of the condition on employment and cognitive function. We also highlight the experiences of those who are speaking out about their struggles with Long COVID, including a prominent doctor in Hong Kong. As always, our aim is to raise awareness of Long COVID, provide support and resources for those affected, and promote ongoing research into this important topic.
Media
Article: No Masks in Long COVID Study? Participants Aren't Happy | MedPage Today
SUMMARY:
Participants in a long COVID clinical trial at Stanford University have raised concerns that some investigators are not wearing masks during clinic visits, putting them at risk.
In an emailed statement, a spokesperson for Stanford Health Care School of Medicine said the organization "has a record of offering patients high-quality care in a safe setting."
The statement continued, "Across all of our Stanford Medicine clinical facilities, the safety of our patients, families and staff continues to be our highest priority," and "In accordance with the California Department of Public Health and Santa Clara County Public Health, wearing masks in all clinical settings is no longer mandated but recommended."
Spier explained that long COVID patients are concerned about reinfection and how that might impact their long COVID and their health. They have generally been unhappy with a lack of masking in healthcare settings.
My Take:
This is important because patients in the trial should feel safe and protected from possible reinfection.
The lack of consideration by the researchers is pretty concerning
Article: Bethenny Frankel Details Long COVID and Autoimmune Disorder Journey
SUMMARY:
Bethenny Frankel is in New Orleans to meet with a doctor from Tulane University to help her find out what her health problem is.
Frankel has been diagnosed with long COVID and postural orthostatic tachycardia syndrome (POTS), and experienced a near-fatal allergic reaction to fish last year.
Frankel had health complications while snowboarding due to the altitude, which led to her swelling up and feeling dangerous.
Frankel is here to listen to her body and solve this puzzle and promises to help others once she finds the answer.
SUMMARY:
The findings offer insight into biological mechanisms, pointing to possible treatments for long-term COVID-19 symptoms.
People with Long COVID had lower levels of immune cells involved in fighting off the virus, and increases in the numbers of B cells and other types of immune cells, suggesting that immune dysregulation may play a role in mediating Long COVID.
People with Long COVID also had problems with their autonomic nervous system, which controls unconscious functions of the body such as breathing, heart rate, and blood pressure.
Taken together, the study's findings add to growing evidence that widespread immunological and autonomic nervous system changes may contribute to Long COVID and may benefit from immunotherapy treatment.
My Take:
Also, the results suggest possible therapeutic strategies, such as immunotherapy, which may improve the diagnosis and treatment of Long COVID patients.
This also confirms what many people have been hypothesizing about.
Article: 1 in 8 patients with long COVID also deal with unemployment | American Medical Association
SUMMARY:
Long COVID symptoms can impact an individual's ability to work, leading to higher rates of unemployment and financial hardship.
Of those with long COVID, 12.3% reported being unemployed compared to 8.7% without symptoms.
Long COVID was associated with a lower likelihood of working full-time and a higher likelihood of being unemployed.
Physicians should pay attention to functioning, inquire about prior COVID-19 infection, and ask about long COVID brain symptoms to help patients who are struggling with long COVID symptoms.
My Take:
It is important for physicians to be aware of the impact that long COVID can have on an individual's ability to work, which can lead to financial hardship and unemployment.
To effectively care for these patients, physicians should focus on functioning, inquire about prior COVID-19 infection, and ask about long COVID brain symptoms.
SUMMARY:
Dr Judith Mackay, a public health advocate, is suffering from long COVID and has not found a cure through various treatments.
She feels a responsibility to speak out about her experience with the hope of bringing more attention and research to the issue.
The unpredictable and long-lasting effects of COVID have made it difficult for people to find solutions and control their symptoms.
Dr. Mackay wonders how others are managing and coping with long COVID.
Research
Article: Viral persistence, reactivation, and mechanisms of long COVID | eLife
DEFINITIONS:
Viral persistence: in the context of this article, the continued presence of SARS-CoV-2 RNA or antigens in some organs even after the virus has been cleared from the body.
SUMMARY:
A National Institutes of Health-sponsored initiative, RECOVER: Researching COVID to Enhance Recovery, has sought to understand the basis of long COVID in a large cohort.
In this review, the authors focus on the emerging literature supporting the role(s) that viral persistence or reactivation of viruses may play in PASC.
Understanding the mechanisms of persistence of RNA, antigen or other reactivated viruses and how they may relate to specific inflammatory responses that drive symptoms of PASC may provide a rationale for treatment.
My Take:
Nothing super revolutionary is highlighted here but is definitely worth a read, IMO.
SUMMARY:
The majority of patients were females (72.2%), single (55.7%) and without children (62.5%).
In this cohort, patients had documented ME/CFS for a mean 13.7 years, whereby half (50.3%) stated their condition was progressively worsening.
An infectious disease was associated with a singular or part of multiple events by 72.9% and 80.6%, respectively.
DEFINITIONS:
Persistent hypercoagulability: the person's blood is thicker and more sticky than it should be
Microangiopathy: A disease of the capillaries (very small blood vessels), in which the capillary walls become so thick and weak that they bleed, leak protein, and slow the flow of blood. For example, diabetes predisposes to the development of microangiopathy in many areas, including the eye.
SUMMARY:
PACS can involve functional mobility impairments, pulmonary abnormalities, and mental health disorders.
Persistent respiratory symptoms may be due to true respiratory complications or sequelae of SARS-CoV-2 pneumonia.
The goal of the study was to evaluate COVID-19-related abnormalities in the pulmonary circulation in patients remaining symptomatic a year after hospitalization.
Delayed follow-up showed CT features of acute and chronic PE but also two types of perfusion abnormalities suggestive of persistent hypercoagulability as well as unresolved/sequelae of microangiopathy.
DEFINITIONS:
RANKL/OPG: A protein complex that regulates bone metabolism and is involved in the development and function of osteoclasts and osteoblasts.
osteoblast: large cell responsible for the synthesis and mineralization of bone during both initial bone formation and later bone remodeling
TNF: Tumor necrosis factor is a cytokine involved in inflammation, cell death, and immune response.
SUMMARY:
The study investigates the impact of acute COVID-19 infection on bone metabolism in patients and a mouse model.
The findings show that coronavirus can trigger bone resorption, leading to an osteoporotic phenotype, dependent on TNF and macrophage/osteoclast infection.
This is in accordance with the clinical evidence of enhanced RANKL/OPG ratio observed in severe COVID-19 patients.
some authors hypothesize that bone cells could be themselves targets for coronavirus infection
My Take:
This study offers insight into the effects of COVID-19 on bone metabolism, which is becoming increasingly important as more people survive the infection.
I found this super interesting because I had never heard of this potential side effect of Covid.
SUMMARY:
The study surveyed 766 patients with SARS-CoV-2 infection and found that 36.1% of patients perceived cognitive deficits within 4 weeks of hospital discharge or outpatient infection.
The study also found that patients with perceived cognitive deficits at 30 days were twice as likely as patients without perceived deficits to report symptoms of PCC at 60 to 90 days.
The study found that patients reporting cognitive deficits in the first 4 weeks after SARS-CoV-2 were more likely to report PCC symptoms at 60 to 90 days than those without perceived cognitive deficits
Women were more likely than men and patients aged 40 to 59 years were more likely than younger patients to report perceived cognitive deficits.
Hope
[ABSTRACT, ONLY]
DEFINITIONS:
Pharmacological interventions: drug treatments aimed at managing symptoms.
SUMMARY:
Postural orthostatic tachycardia syndrome (POTS) has been associated with COVID-19 as part of long-COVID.
There were 68 individuals identified with POTS after COVID-19 through a systematic review.
Non-pharmacologic treatments were largely ineffective in treating POTS after COVID-19.
POTS after COVID-19 appears to be better managed with pharmacological interventions.
My Take:
Targeted research should be conducted to further understand the epidemiology, pathophysiology, and optimal treatment approaches for POTS after COVID-19, as it seems like a super common problem for many.
Thank you so much for all the work you do to provide this information to us.
I would be interested in someone studying how initial infection with different strains of the virus from the early 2020 strains to the most recent might result in statistically significant different post covid syndromes. Perhaps there are more than one long haul syndrome, each with different trajectories.