Hi everyone,
As we approach the holiday season, there is a chance I may have to skip a newsletter one week. However, I will keep everyone updated as this evolves.
In this edition, we explore the prevalence of Long Covid symptoms among US veterans, the establishment of an advisory committee by the HHS to address the challenges of long Covid, and the urgent need for financial support for healthcare workers battling with the condition. We also delve into studies on long-term immunity after SARS-CoV-2 infection, potential drug interactions in long Covid patients, and the effectiveness of a nasal spray in protecting high-risk populations from Covid-19 variants.
Media
Article: Inside a Long Covid Clinic's Fight to meet crushing patient needs
SUMMARY:
Dr. Janna Friedly's Seattle clinic, which treats patients with long COVID, has received a multimillion-dollar grant from the US Department of Health and Human Services to meet the demands of long COVID care.
The clinic had previously limited referrals to the five-state "WWAMI" region it served due to an overwhelming number of patients, but the grant will allow them to expand access and care.
Challenges faced by long COVID clinics include insufficient funding and lack of training and education on long COVID within the larger medical community.
The grant of $5 million spread across nine clinics is seen as a small sum in relation to the complexity and magnitude of the long COVID problem.
The grant aims to support multidisciplinary clinics in improving patient care and collaboration, and to address the knowledge gap among general practitioners about long COVID.
My Take:
The grant received by Dr. Friedly's clinic is a much-needed boost to address the challenges faced by long COVID clinics, but it is still insufficient to fully address the symptoms of long COVID.
Article: HHS Establishes Secretary’s Advisory Committee on Long COVID | HHS.gov
SUMMARY:
Today, the U.S. Department of Health and Human Services (HHS) announces the establishment of the Secretary’s Advisory Committee on Long COVID and invites nominations for the Committee.
The Committee is called for in the National Research Action Plan on Long COVID, published in April of 2022, to make recommendations on research and innovation in the whole-of-government response to the longer-term impacts of COVID-19.
This Committee will bring perspectives from outside the government to help inform action on Long COVID and associated conditions, with a focus on health equity.
To the extent possible, composition of the Committee will reflect the experience of an inclusive and diverse cross-section of persons with Long COVID and multidisciplinary expertise of those supporting and caring for those affected as well as specific clinical, medical, public health, behavioral health, human services, employment, data science, and research expertise.
Article: Clinicians with long covid must get financial support, say unions | The BMJ
DEFINITIONS:
Occupational Diseases: diseases that are caused by factors or conditions in the workplace.
In this context, it refers to long-term conditions caused by covid-19 that healthcare workers caught at work.
SUMMARY:
The BMA and the Royal College of Nursing (RCN) in the U.K. have asked the government to designate long term conditions caused by Covid-19 as occupational diseases.
This would mean that staff with these conditions could receive financial assistance in recognition that they had, most probably, caught the initial infection at work.
The recommendation was made specifically for hospitals and other healthcare workers, as well as care home and home care workers, who were working with patients in the two weeks before their Covid-19 infection.
The BMA and the RCN wrote to Mel Stride, secretary of state for work and pensions, urging him to act on the Industrial Injuries Advisory Council's recommendations.
Kelly Fearnley, chair and co-founder of Long Covid Doctors for Action, said that having the five recommended conditions prescribed as an occupational disease was a welcome first step, but the symptomatology of long covid extended far beyond them.
Article: 'This isn't a life': The crushing burden of Long Covid
SUMMARY:
Between 6 percent and 10 percent of those who get Covid-19 end up with symptoms that persist beyond the period of acute illness.
The Long Covid Registry team wants to estimate the clinical, quality of life and economic impacts of Long Covid in New Zealand, as well as establish a registry to continually monitor health outcomes and inequities.
The Long Covid Registry put participants through a health-related quality of life test which checked how they were doing before and after getting Long Covid in five domains – mobility, self care, usual activities, pain/discomfort and anxiety/depression.
On average, Māori have taken 96 days without pay because of Long Covid and non-Māori 73 days.
My Take:
This is the first article I have seen highlighting LC in New Zealand.
Research
Article: Reduced Monocyte Proportions and Responsiveness in Convalescent COVID-19 Patients | bioRxiv
SUMMARY:
The clinical manifestations of COVID-19 suggest a dysregulation of the host immune response.
The proportion of total monocytes is decreased in convalescent COVID-19 patients compared to uninfected controls.
Classical monocytes from convalescent COVID-19 patients demonstrate a decrease in activation markers in response to stimulation with bacterial lipopolysaccharide (LPS).
Monocytes from convalescent COVID-19 patients produce less TNF-α and IL-6 in response to LPS stimulation than those from uninfected controls.
My Take:
The findings of this study suggest that convalescent COVID-19 patients have alterations in their monocyte populations and reduced responsiveness to LPS stimulation.
This is a really interesting finding. I never knew that LPS could lead to decreases in monocytes.
DEFINITIONS:
Monoclonal antibody: A type of antibody produced in the laboratory that can bind to specific targets in the body, such as viruses, and help the immune system fight against them.
VOCs (Variants of Concern): Variants of the SARS-CoV-2 virus that have specific genetic changes that may impact the transmissibility, severity, or effectiveness of vaccines or treatments.
SUMMARY:
The study evaluated the efficacy and safety of the F61 nasal spray, a broad-spectrum monoclonal antibody, in preventing SARS-CoV-2 infection.
The nasal spray showed a protective efficacy of 72.19% in the multiple-dose cohort and over 90% efficacy in a real-world study against circulating strains of SARS-CoV-2.
Adverse events associated with the F61 nasal spray were mild to moderate in severity and no serious adverse events were reported.
The results suggest that the F61 nasal spray could be a promising prophylactic treatment for SARS-CoV-2 variants.
My Take:
These findings highlight the potential of monoclonal antibodies as a prophylactic treatment for COVID-19 and provide further evidence for the importance of early intervention in controlling Covid.
DEFINITIONS:
Nucleocapsid-specific IgG: Antibodies that specifically target the Nucleocapsid protein of the SARS-CoV-2 virus.
Spike-specific IgG: Antibodies that specifically target the Spike protein of the SARS-CoV-2 virus.
T cell response: The immune response mediated by T cells, including both CD4+ and CD8+ T cells, which play a crucial role in viral clearance and limiting disease severity.
SUMMARY:
The study aimed to investigate the long-term humoral and cellular immune response to SARS-CoV-2 infection.
Participants were monitored for up to 20 months after infection, and their immune responses were measured using Spike- and Nucleocapsid-specific IgG levels and T cell responses.
The study found that while antibody levels and non-Spike-specific T cell frequencies decreased over time, a majority of participants maintained a durable immune response 20 months after infection.
DEFINITIONS:
Drug-Drug Interactions (DDIs): Refers to the potential negative effects that can occur when two or more drugs are taken together, altering the way the drugs work or increasing the risk of side effects.
SUMMARY:
The study aimed to assess potential drug-drug interactions (DDIs) among frequently prescribed medications in long COVID using two electronic databases: Micromedex and Drugs.com.
Among the 60 frequently prescribed medications analyzed, 488 potential DDIs were identified.
Of these potential DDIs, 271 pairs were reported by Micromedex and 434 pairs by Drugs.com, with 77 pairs labeled as contraindicated or major by both databases.
The most common mechanisms for these serious interactions were cytochrome P450 (CYP) inhibition, CYP induction, and QT interval prolongation.
My Take:
I thought this was important to highlight given that many patients are trying a lot of different supplements concurrently.
DEFINITIONS:
MSS: musculoskeletal system, refers to the system in the body that includes bones, muscles, joints, ligaments, and tendons.
SUMMARY:
Musculoskeletal dysfunction after COVID-19 infection is found rather frequently in clinical forms of various degrees of general and muscular fatigue, myalgia, arthralgia, arthritis (about 50% cases).
We examined peculiarities of MSS lesions in a group of patients with PCS, who experienced an acute period of COVID-19 infection of moderate severity, non-oxygen-dependent variant during the period of dominance of Wuhan and later delta strains of COVID-19.
Musculoskeletal system lesions in patients with PCS are not the main constituent of this syndrome.
DEFINITIONS:
Myocarditis: inflammation of the heart muscle.
Multisystem inflammatory syndrome: a condition that causes inflammation in multiple organs of the body.
SUMMARY:
There is limited knowledge regarding the cardiovascular impact of coronavirus disease 2019 (COVID-19) on emerging adults aged 18-25, a group that disproportionately contracts COVID-19.
A comprehensive search strategy was applied to several academic databases and grey literature sources.
Reports identified COVID-19–associated cardiac abnormalities, vascular alterations, and multisystem inflammatory syndrome in emerging adults.
Prevalence estimates of myocarditis and cardiac abnormalities were 0.5%-3% and 0%-7%, respectively, based on data from student-athlete samples.
My Take:
The findings indicate that emerging adults are at risk of COVID-19–associated cardiac abnormalities, vascular alterations, and multisystem inflammatory syndrome
At scale, small percentage % points are massive sample size.
DEFINITIONS:
Neopterin: An inflammatory marker that indicates pro-inflammatory, antiviral immune responses.
SUMMARY:
PCS symptoms in previouslyhealthy, immunocompetent adults include fatigue, altered sense of taste, and shortness of breath.The study found that individuals with PCS symptoms tend to have a higher probability to experience COVID-19 specific symptoms during the course of the disease such as head and body ache, cough, shortness of breath, GI-tract issues, hyposmia and dysgeusia.
Neopterin levels, which indicate a pro-inflammatory immune response, were not elevated in individuals with PCS.
The decline in SARS-CoV-2 antibodies over time was similar in individuals with and without PCS.
The study did not detect elevated or altered levels of EBV VCA IgM, VCA IgG or EBNA IgG antibodies, neither did it detect any differences between individuals with and without PCS.Therefore, results obtained from molecular biological and serological screenings suggest that EBV is not reactivated
My Take:
This contradicts with a lot of other evidence but I always find these kinds of studies very interesting!
DEFINITIONS:
Calcitonin Gene-Related Peptide (CGRP): a peptide involved in migraine and neuroinflammatory processes.
SUMMARY:
In this study, researchers evaluated the effects of a CGRP receptor antagonist on acute neuroinflammatory and neurological responses to SARS-CoV-2 infection in mouse models.
They found that CGRP receptor antagonism reduced weight loss in older mice infected with SARS-CoV-2.
However, it did not have a significant effect on fever or motion-induced dizziness.
CGRP signaling blockade also reduced interleukin 6 (IL-6) levels in wildtype mouse lines, suggesting a potential protective effect against inflammatory events after SARS-CoV-2 infection.
Marc Daalder, who wrote the NZ Long Covid article, is one of the only journalists still writing about Covid and Long Covid in NZ, continuing to raise awareness when everyone else has “moved on”. Mostly he writes for
newsroom.co.nz which is then picked up by other media outlets 🙂
CARLO BROGNA
https://twitter.com/carlobrogna1/status/1726483356508942615
Good morning. They're getting there little by little. We already observed this two years ago.
Human microbiota is a reservoir of SARS-CoV-2 advantageous mutations
https://www.biorxiv.org/content/10.1101/2023.11.16.567485v1
PDF ⬇️
https://www.biorxiv.org/content/10.1101/2023.11.16.567485v1.full.pdf
SARS-CoV-2 steals mutations from bacteria in our body to reinforce its attack and evade our immune system. It commands the replicative machinery of our cells to graft bacterial mutations onto itself, producing chimeric viral RNAs