Hi everyone,
In this issue, we will explore various aspects of Long Covid, delve into the pathophysiology of post-acute neuroCOVID-19 syndrome, and discuss the need for a new name and frame for this condition. Additionally, we will examine the impact of Long Covid on work and provide strategies for supporting colleagues who are returning to the workplace.
It’s been a while since I plugged my Twitter (or X, as it is known now) but here it is in case anyone wants to give me a follow! I try to post interesting research and or opinions as I run into them.
Media
DEFINITIONS:
Post-acute infection syndrome: Refers to chronic diseases that occur after an acute viral, bacterial, or parasitic infection.
SUMMARY:
The Yale School of Medicine has launched its new Center for Infection & Immunity (CII) to study post-acute infection syndromes.
The center will focus on researching Long COVID, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and post-treatment Lyme disease.
The prevalence of these syndromes has increased significantly due to the COVID-19 pandemic and its long-lasting effects.
The CII aims to provide a greater understanding of the underlying science of infectious diseases and develop prevention and treatment strategies.
My Take:
The establishment of the Center for Infection & Immunity at Yale School of Medicine is a crucial step in addressing the growing prevalence of post-acute infection syndromes.
By focusing on Long COVID, ME/CFS, and post-treatment Lyme disease, the center aims to uncover the underlying causes and develop prevention and treatment options.
This is a huge step for syndromes that have been historically underfunded and underesearched. Yale is arguably the premier research university in the world.
Article: How can I support my colleague returning to work with long covid? | The BMJ
SUMMARY:
There are things you can do to ease a colleague’s return to work when they are living with long covid.
Openly acknowledging and validating their illness and experience is important.
Each person with long covid may have different challenges and the approach to returning to work should be personalized.
It is important to be understanding and supportive of occasional sick days for recovery.
My Take:
By acknowledging their illness, respecting boundaries, and providing personalized support, you can make a significant difference in their experience.
Article: Long Covid needs a new name — and a new frame - STAT
SUMMARY:
Long Covid, which refers to the persistent symptoms experienced by some individuals after recovering from Covid-19, is not a new condition but rather an old syndrome known as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).
While significant investments have been made in research and clinical care for long Covid, there has been little progress in understanding its causes, prevention, or treatment.
Long Covid has a significant health, social, and economic toll, with an estimated impact of $3.7 trillion on the U.S. economy.
Rethinking long Covid as a form of ME/CFS could lead to more productive strategies, improved patient care, and better allocation of resources.
My Take:
I do not entirely agree that ALL of Long Covid is ME/CFS, but some studies show that a subset of Long Covid patients have symptoms that meet the criteria for ME/CFS
Research
DEFINITIONS:
Reactive gliosis: a process in which glial cells, specifically microglia and astrocytes, become activated in response to injury or infection.
Neuroinflammation: inflammation that occurs in the central nervous system, involving the activation of glial cells and release of inflammatory cytokines.
Microglia: resident immune phagocytes of the central nervous system that play a crucial role in immune surveillance, phagocytosis, synaptic pruning, and other functions.
Astrocytes: a type of glial cell in the central nervous system that regulate CNS blood flow, glucose metabolism, synaptic activity, and provide neuroprotection.
SUMMARY:
NeuroCOVID-19 Syndrome, known as neurological symptoms of post-acute sequelae of COVID infection (NeuroPASC), is characterized by neurological impairments and cognitive deficits.
This mini-review explores the mechanisms underlying NeuroPASC, including reactive gliosis and neuroinflammation, and their role in neurological impairment.
Glial cells, specifically microglia and astrocytes, play crucial roles in the CNS and their dysfunction can lead to cognitive impairment and neurodegenerative diseases.
SARS-CoV-2 infection can lead to the activation of glial cells, both through indirect pathways such as peripheral immune cell activation and CNS infiltration, and direct pathways such as olfactory route, hematogenous spread, and cerebrospinal fluid.
Microglial priming and persistent neuroinflammation are believed to be culprits of NeuroPASC, leading to chronic glial reactivity and maladaptive inflammatory responses.
DEFINITIONS:
Posttreatment Lyme disease syndrome (PTLDS): a chronic illness characterized by severe fatigue, cognitive slowing, chronic pain, and sleep difficulties that can persist for months to years after properly treated Lyme disease.
SUMMARY:
This systematic review seeks to highlight the similarities between ME/CFS and PTLDS.
The most shared characteristics are symptoms lasting greater than 6 months, fatigue, sleep difficulties, and brain fog.
Both syndromes begin after an infectious event from which approximately 10% of patients never truly recover.
The symptoms of ME/CFS outlined by Wong and Weitzer in 2021 are comparable to the PTLDS symptoms described by participants in the 18 included articles.
SUMMARY:
The analysis of immunological parameters during the course of a SARS-CoV-2 infection is of great importance, both to identify diagnostic markers for the risk of a severe course of COVID-19, and to better understand the role of the immune system during the infection.
Multicolor flow cytometry revealed a strong enrichment of NKG2C expressing NK cells in response to the acute viral infection.
In addition, investigators found an overrepresentation of highly activated NK cell subsets with an exhausted phenotype
Moreover, data show long-lasting phenotypic changes within the NK cell compartment that did not completely reverse up to 2 months after recovery.
This demonstrates that NK cells are involved in the early innate immune response against SARS-CoV-2.
My Take:
The findings suggest that NK cells play a crucial role in the early innate immune response against the virus.
The study also reveals long-lasting phenotypic changes in NK cells after recovery from the infection.
DEFINITIONS:
End-tidal CO2: the partial pressure of carbon dioxide at the end of exhalation, which provides an indirect measure of the body's overall CO2 levels.
Cerebral blood flow (CBF): the amount of blood circulating in the brain per unit time, which is essential for maintaining oxygen and nutrient delivery to brain tissue.
SUMMARY:
The study investigates the influence of end-tidal CO2 on cerebral blood flow during orthostatic stress in individuals with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).
The authors found that ME/CFS patients had a larger decrease in cerebral blood flow compared to healthy controls during orthostatic stress.
The reduction in cerebral blood flow was not primarily attributable to changes in end-tidal CO2 levels but rather to a decrease in cardiac output and venous pooling.
The study suggests that CO2 reactivity, as measured during tilt testing, is similar between ME/CFS patients with a normal heart rate and blood pressure response and those with postural orthostatic tachycardia syndrome.
DEFINITIONS:
Respiratory post-acute sequelae of COVID-19 (Resp-PASC): refers to persistent respiratory symptoms occurring after recovery from COVID-19, such as shortness of breath and lung fibrosis.
Lactate dehydrogenase (LDH): an enzyme that is involved in energy production and is released into the bloodstream when there is tissue damage or inflammation.
SUMMARY:
This meta-analysis evaluates the association between plasma lactate dehydrogenase (LDH) and long COVID.
The study found a significant association between LDH elevation and respiratory post-acute sequelae of COVID-19 (Resp-PASC), but not with cardiovascular, neurological, or gastrointestinal PASC.
LDH may be used as a biomarker for predicting Resp-PASC.
The association between LDH and PASC symptoms may be influenced by age and gender.
DEFINITIONS:
Lipidomic analysis: A technique used to study and analyze the complete set of lipids (fats) present in a biological sample.
PC (O-20:1/20:1), PC (O-20:1/20:0), and PC (O-18:0/18:1): Different types of phosphatidylcholine lipids with specific fatty acid compositions.
SUMMARY:
Lipidomic analysis of plasma samples from COVID-19 patients revealed 175 differentially expressed lipids associated with SARS-CoV-2 infection, disease severity, and viral persistence.
Some lipids, such as PC (O-20:1/20:1), PC (O-20:1/20:0), and PC (O-18:0/18:1), were found to better distinguish asymptomatic infected individuals from healthy individuals.
Different lipid subclasses, including glycerophospholipids, glycerolipids, sphingolipids, and sterol lipids, showed significant changes in COVID-19 patients compared to healthy controls.
My Take:
The identification of specific lipids that distinguish asymptomatic individuals from healthy individuals could be useful in identifying and monitoring individuals at risk of spreading the virus.
Anecdotally, I have heard stories of people who had their cholesterol levels skyrocket after Covid.
SUMMARY:
SARS-CoV-2 infection leads to a prolonged alteration of the gene expression profile of circulating T, B, and NK cells and monocytes.
The altered transcriptional profile is detected in COVID-19 patients for at least 2 months after the onset of symptoms.
The pro-inflammatory transcriptional alterations are not observed in response to influenza infection or sepsis.
Gene network analysis suggests a central role for the transcription factor NF-κB in the regulation of the observed transcriptional alterations.
My Take:
This prolonged pro-inflammatory status may contribute to long-term health consequences, autoimmune diseases, reactivation of other viruses, and disruption of the host immune system and/ormicrobiome ecosystem in post-acute COVID-19 patients.
Hope
DEFINITIONS:
Stellate Ganglion Block (SGB): a procedure where anesthetic is injected near the stellate ganglion, a group of nerves in the neck, to relieve symptoms such as pain or nerve dysfunction.
SUMMARY:
The study evaluated the use of stellate ganglion block (SGB) in the treatment of long COVID-19 syndrome.
Out of the 41 patients who received SGB, 86% experienced a reduction in their symptoms.
The most frequently reported symptoms were fatigue and brain fog, which showed the highest response to treatment.
My take: (by Amy E - contributor to the newsletter)
This is what I had done and it has been the biggest game-changer out of all the things I’ve tried!
Do you want a Bluesky invite? We are rebuilding med, immuno, and epi Twitter over there. I can put you in touch with the invite distribution system we have
Totally agreed with you (in my newsletter yesterday) about the STAT article: not all LC is ME/CFS. I happen to have both, but I have friends who have no fatigue/PEM manifestation and are still really suffering.
https://open.substack.com/pub/longcovidandme/p/theydies-and-gentlethemsintroducing?r=o3zsi&utm_medium=ios&utm_campaign=post
Also, my cholesterol skyrocketed just before year three as a long hauler. Right around when I emerged as pre-diabetic and my TSH went bananas. These metabolic changes this far out are pretty strange.