Hi everyone,
Sorry about the late send-out this week! I was away from my keyboard this weekend. I will try to be more transparent next time.
There is a lot of cover so let us just jump in.
Media
Article: The Long Haul of Long Covid | NEJM
DEFINITIONS:
RECOVER study: A research initiative funded by NIH that seeks to define post-acute sequelae of SARS-CoV-2 comprehensively, incorporating symptoms, lab tests, and clinical examination variables.
SUMMARY:
Long Covid symptoms can vary widely and affect multiple organ systems, making it difficult to define and diagnose.
Many patients with long Covid report experiencing dismissal and disbelief from healthcare providers, leading to frustration and lack of support.
Efforts are being made to better define long Covid through initiatives such as the RECOVER study, which aims to establish a comprehensive definition and improve understanding and management of the condition.
Article: Derby: New anti-viral drug study aims to cure long Covid - BBC News
DEFINITIONS:
Remdesivir: an antiviral drug that has been previously used to treat acute Covid-19 infections.
SUMMARY:
A new trial is being conducted to test if an anti-viral drug, remdesivir, could cure people with "long Covid."
The £1.2m study is led by the University of Derby and involves around 100 individuals who have experienced long Covid for more than two years.
The study aims to shed light on whether existing antiviral treatment can help address the global challenge of long Covid.
Around 1.9m people in the UK and over 144m globally are estimated to have long Covid, with a quarter of sufferers having symptoms for more than two years.
Article: The Coronavirus Still Doesn’t Care About Your Feelings | The Nation
DEFINITIONS:
Pandemic: An epidemiological term referring to a disease that spreads over a wide geographic area and affects an exceptionally high proportion of the population.
Public health crisis: Refers to a situation in which the health of a population is at risk or compromised, requiring coordinated efforts to control and mitigate the impact of the crisis.
SUMMARY:
The Covid-19 pandemic is not a state of mind—and telling us not to panic isn’t healthcare.
Recent coverage of the so-called Pirola variant, which is acknowledged to have “an alarming number of mutations,” led with the headline “Yes, There’s a New Covid Variant.
experts have been offering the public advice about how to feel about Covid-19 since January 2020, when New York Times columnist Farhad Manjoo opined, “Panic will hurt us far more than it’ll help.”
This “moral calm”—a sort of manufactured consent—impedes risk mitigation by promoting the underestimation of a threat.
A pandemic is a public health crisis, not a public relations crisis.
My Take:
The author argues that conflating the way people feel about responding to the pandemic with the actual spread of the disease is illogical and can hinder effective risk mitigation.
It is important to prioritize public health efforts and avoid treating the pandemic as a public relations crisis.
Article: Do better: advice to policymakers on long COVID – Croakey Health Media
SUMMARY:
The true burden of long COVID on Australia's healthcare system is not well understood and potentially underestimated.
Lack of accurate, real-time data attributed to the absence of a single nationally accepted long COVID case definition.
Need for improvements in identification, recognition, and consumer engagement to address the challenges of long COVID.
Mitigating the spread of COVID-19 is critical to managing the future burden of long COVID on both consumers and the healthcare system.
Research
Article: Serotonin reduction in post-acute sequelae of viral infection: Cell
DEFINITIONS:
Serotonin: a neurotransmitter that regulates mood, appetite, sleep, and other bodily functions.
Type I interferon: a group of signaling proteins released by the immune system in response to viral infections.
SUMMARY:
Post-acute sequelae of COVID-19 (PASC) are associated with serotonin reduction.
Viral infection and type I interferon-driven inflammation reduce serotonin through three mechanisms: diminished intestinal absorption of the serotonin precursor tryptophan, platelet hyperactivation and thrombocytopenia, and enhanced MAO-mediated serotonin turnover.
Peripheral serotonin deficiency impairs the activity of the vagus nerve, leading to hippocampal dysfunction and memory loss.
My Take:
This study suggests that serotonin deficiency may be a key factor in the development of post-acute sequelae of COVID-19.
The findings also highlight the impact of peripheral serotonin deficiency on the vagus nerve and hippocampal function, leading to neurocognitive symptoms such as memory loss.
This could end up being a super important article, must read!
DEFINITIONS:
Astrocyte: Astrocytes are star-shaped glial cells in the brain that play a critical role in maintaining brain homeostasis and supporting neuronal function
Glutamate: Glutamate is the main excitatory neurotransmitter in the central nervous system.
SUMMARY:
FDG-PET scans have revealed a glucose hypometabolic pattern in patients with long COVID.
The researchers hypothesize that glutamatergic dysregulation related to astrocyte dysfunction could be the substrate of brain PET hypometabolism in long COVID patients with brain fog.
These changes can disturb glutamatergic homeostasis, ultimately leading to cognitive fatigue, which has been described in other clinical situations.
Based on these elements,… propose that therapeutics targeting astrocytic glutamate regulation could help mitigate long COVID neurological manifestations.
DEFINITIONS:
Financial toxicity: A term used to describe the financial burden and stress experienced by individuals as a result of medical expenses, loss of income, or other financial consequences.
Sleep problems: Refers to any difficulties or disruptions in the sleep patterns, including trouble falling asleep, staying asleep, or poor sleep quality.
SUMMARY:
The study investigates the association between financial toxicity and sleep problems one year after COVID-19 hospitalization.
The researchers found a significant cross-sectional association between financial toxicity and sleep problems.
Financial toxicity, which includes factors such as job loss and financial strain, was found to be predictive of sleep problems.
The findings suggest that the economic consequences of the pandemic may have long-lasting effects on sleep quality.
My Take:
The findings underline the long-term consequences of the pandemic, specifically in relation to job loss and financial strain.
In my opinion this supports the idea that stress (here measured through financial means), is a predictor of sleeping issues
Article: Frontiers | Gut-brain pathogenesis of post-acute COVID-19 neurocognitive symptoms
DEFINITIONS:
Gut-brain axis: The bidirectional communication between the gut and the brain, involving neural, endocrine, and immune pathways.
Dysbiosis: Imbalance or disruption of the microbial communities in the gut, characterized by a decrease in beneficial bacteria and an increase in harmful bacteria.
SUMMARY:
Approximately one third of non-hospitalized COVID-19 patients report chronic symptoms after recovering from the acute stage, and many of these symptoms are cognitive in nature.
The mechanisms behind these chronic cognitive symptoms are currently unknown, but it is hypothesized that SARS-CoV-2 damages cerebral blood vessels and the intestinal wall, compromising the brain's neurovascular unit and the intestinal barrier.
Pathogenic microbiota in the gut may flourish as a result of intestinal dysbiosis caused by COVID-19, producing neurotoxic and neuroinflammatory substances that can permeate the brain and cause cognitive deficits.
The gut-brain axis model of post-acute COVID-19 syndrome (PACS) suggests that the interaction between the gut and the brain plays a crucial role in the development of cognitive symptoms.
My Take:
The hypothesis that COVID-19 leads to dysbiosis and the production of neurotoxic substances in the gut, which then penetrate the damaged neurovascular unit and affect the brain, provides a potential explanation for the cognitive deficits observed in Long Covid
DEFINITIONS:
Immunoadsorption (IA): is an apheresis technique used to remove immunoglobulins from a patient's plasma.
SUMMARY:
A recent study conducted in Germany aims to evaluate the efficacy of immunoadsorption (IA) in patients with post-COVID-19 Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS).
The study focuses on patients with elevated ß2-adrenergic receptor autoantibodies (ADRB2 AABs), which have been associated with symptom severity in ME/CFS.
The interim results of the first 10 patients showed that 7 patients responded positively to IA, with an increase of between 10 and 35 points in the Short-Form 36 Physical Function (SF36-PF) at week four after IA.
This study provides the basis for future randomized controlled trials (RCTs) to further evaluate the efficacy of IA in post-COVID-19 ME/CFS patients.
Article: JCM | Free Full-Text | Thyroid Autoimmunity and SARS-CoV-2 Infection
DEFINITIONS:
ACE2: angiotensin-converting enzyme 2 receptor, a receptor that allows the entry of SARS-CoV-2 into cells.
GD: Graves' disease, an autoimmune disorder that leads to overactivity of the thyroid gland.
HT: Hashimoto's thyroiditis, an autoimmune disorder causing chronic inflammation of the thyroid gland.
SUMMARY:
COVID-19 seems to be followed by both new onset and the recurrence of Graves’ disease (GD) and Hashimoto’s thyroiditis (HT), raising concerns about the virus’ potential role in triggering autoimmunity.
The endocrine system and, particularly, the thyroid gland, can be affected from the SARS-CoV-2 virus either directly, as with other post-viral subacute thyroiditis, or indirectly, via the systemic immune activation and “cytokine storm”.
Several mechanisms have been hypothesized to explain this induction of autoimmunity by SARS-CoV-2 infection: the immune system hyper-stimulation, the molecular mimicry between the self-antigens of the host and the virus, neutrophils extracellular traps, and finally, the virus induced transcriptional changes in the immune genes. ``
DEFINITIONS:
Oxidative stress: refers to an imbalance between the production of reactive oxygen species (ROS) and the body's ability to neutralize them, resulting in damage to cells, tissues, and organs.
Mitochondrial dysfunction: refers to impaired functioning of the mitochondria, the powerhouses of the cells, leading to decreased energy production and increased generation of reactive oxygen species.
Endothelial dysfunction: refers to impaired functioning of the endothelium, the inner lining of blood vessels, leading to increased inflammation, oxidative stress, and clot formation.
SUMMARY:
The review discusses the role of oxidative stress and free radicals in the pathogenesis of COVID-19, including the generation of oxidants during the cytokine storm and the subsequent damage to cells, tissues, and organs.
It highlights the importance of oxidative stress in endothelial dysfunction, which increases the risk of complications in COVID-19 patients.
The review also mentions the role of mitochondrial dysfunction and impaired redox signaling in COVID-19-induced endothelial damage.
The article emphasizes the need for further research to better understand the mechanisms underlying oxidative stress in COVID-19 and to develop targeted therapeutic strategies.
My Take:
Definitely an interesting review!
Great information here, thank you
In the Times article about the serotonin study, the authors said they’ll be starting a clinical trial of Prozac.
https://www.nytimes.com/2023/10/16/health/long-covid-serotonin.html
Interestingly, I think there have already been other studies showing Fluvoxamine (another SSRI) was not helpful in treating Long Covid. I’m not optimistic that Prozac will be any different. But the new findings are still encouraging.