Hi everyone,
Welcome back! Hope those who celebrate the holidays enjoyed their time off. I personally enjoyed the downtime.
Slight issue I wanted to call out was that I accidentally labeled the last issue as #74 when it was actually #73. This is the real issue #74!
A lot of research has been compiling over the last two weeks so there is a lot to cover here! Here’s to hoping for a more eventful year of Long Covid Research. On the positive side, I saw this interesting tweet that a bunch of Clinical Trials are expected to wrap up this year.
In this issue, we explore a range of topics, from potential treatments and emerging research to the impact on various aspects of our lives. We delve into recent studies examining the role of vagus nerve stimulation in relieving long COVID symptoms, the effects of the condition on marriage and financial well-being, and the prevalence of long COVID in workers' compensation claims. Additionally, we explore the implications for heart health, lung function, brain health, and immune responses in children and adults affected by long COVID.
Media
Article: Zapping the Vagus Nerve Could Relieve Some Long COVID Symptoms | Scientific American
DEFINITIONS:
Vagus Nerve Stimulation: a technique that uses electrical stimulation to activate the vagus nerve, which helps regulate many bodily functions.
SUMMARY:
Researchers are increasingly recognizing that long COVID is as much a neurological disorder as a cardiovascular and respiratory one.
Early small-scale trials of vagal stimulation have seen reductions in hallmark long COVID symptoms such as chronic fatigue, headaches, and irregular blood pressure.
Scientists are still studying which long COVID symptoms this technique can reliably address, which patients will benefit and how long the effects last.
Vagus nerve stimulation is already used to treat some other thorny neurological conditions, such as epilepsy and depression.
Vagus nerve stimulation works by turning up the body’s parasympathetic pathways, reducing the production of cytokines that promote inflammation.
My Take(AJE):
I participated in a study with a vagus nerve stimulator. While there’s no magic bullet, I’ve made significant strides with this treatment. Definitely worth it for me!
SUMMARY:
Long COVID is not only affecting people's health, but also their relationships.
The illness is often poorly understood, which leads to strain and fractures in marriages, friendships, and familial bonds.
Patients with long COVID often experience a range of debilitating symptoms, including fatigue, brain fog, shortness of breath, and muscle pain.
The lack of understanding and disbelief from others exacerbates the difficulties faced by those with long COVID.
Article: Long COVID present in 6% of comp claims: Study | Business Insurance
SUMMARY:
In a study released in August the Workers Compensation Research Institute found that 6% of workers with compensation claims for COVID-19 developed long COVID.
At an average of 18 months of post-infection experience, these workers received more than 20 weeks of temporary disability benefits and an average of $29,000 in medical care, 10 times that which was spent on workers who were not treated for long-term health issues.
That report also showed that the risks of long COVID are higher in female workers, workers over 50 years of age and workers who have comorbidities, and that comp claims that involve treatment for long COVID symptoms are four times more likely to result in permanent disability benefits.
\ [Even though they mention this in the article, I don’t think it’s super relevant to the article, it’s like Business Insurance telling us what they know about LC]
DEFINITIONS:
HRV: Heart rate variability refers to the variation in the time interval between consecutive heartbeats, which reflects the activity of the autonomic nervous system.
Parasympathetic tone: Refers to the activity of the parasympathetic branch of the autonomic nervous system, which slows down the heart rate and promotes relaxation.
SUMMARY:
The study aimed to evaluate the impact of long COVID on heart rate variability (HRV) in patients during rest and a deep breathing maneuver.
Patients with long COVID demonstrated altered HRV at rest, including higher heart rate and lower parasympathetic tone compared to controls.
During the deep breathing maneuver, patients with long COVID had lower HRV responses compared to controls, indicating reduced parasympathetic tone and lower heart rate dynamics.
The findings suggest that long COVID may affect autonomic function and cardiovascular risk in patients.
My Take:
These alterations may contribute to the persistent symptoms experienced by some patients with long COVID and could potentially increase their risk of cardiovascular complications.
AJE Take: for people with LC who use a wearable that tracks HRV, a low HRV is something we see a lot!
SUMMARY:
About seven percent of Americans have experienced long COVID, and 3.5 percent are currently living with the chronic disease.
Living in a rural area can compound the challenges of treating long COVID, due to the lack of access to specialized clinics and healthcare providers.
Clinical trials at Dartmouth-Hitchcock Medical Center are studying treatments for long COVID, including investigating possible treatments for brain-related symptoms and the use of the antiviral drug PAXLOVID.
My Take:
We need more clinical trials ASAP
Research
SUMMARY:
A significant percentage of children who survived COVID-19 experience persistent general and respiratory symptoms for months after recovery, a condition known as Long-Covid syndrome (LCS).
The pathophysiologic mechanisms underlying LCS in children are still poorly understood.
A study was conducted to investigate the lung function and lung ultrasound patterns in children with LCS compared to asymptomatic children with previous COVID-19.
Children with LCS complained more frequently of fatigue, dyspnea, and exercise intolerance.
This study found that children with LCS did not demonstrate significant differences in lung function and lung ultrasound findings compared to asymptomatic children with previous COVID-19.
The study did find that children with LCS had lower fractional exhaled nitric oxide (FeNO) values, and suggests a potential role as a marker for LCS.
Another interesting finding was thatthere was a higher prevalence of LCS in older children.
SUMMARY
COVID-19 increases the risk of cardiovascular disease, including arrhythmias.
This study aimed to determine the risk and duration of increased risk of cardiac arrhythmias following COVID-19.
The study analyzed data on 1,057,174 individuals with COVID-19 and 4,076,342 matched unexposed individuals.
The results showed that there is an increased risk of cardiac arrhythmias following COVID-19, especially in elderly vulnerable individuals and those with severe COVID-19.
The findings of this study highlight the importance of monitoring and managing cardiac arrhythmias in individuals who have had COVID-19, particularly in older individuals and those with more severe disease.
SUMMARY:
This prospective cohort study aimed to assess whether COVID-19 hospitalized patients have long-term cognitive, psychiatric, or neurological complications compared with healthy controls and patients hospitalized for other medical conditions of similar severity.
The results showed that patients hospitalized for COVID-19 had worse cognitive status than healthy controls, but not hospitalized controls matched for age, sex, and severity of disease.
Although COVID-19 patients performed worse than healthy controls on all other psychiatric and neurological assessments, the brain health impairment was not more severe than among hospitalized control patients.
This study suggests that post-COVID-19 brain health was impaired, but not more than brain health impairment in patients hospitalized for other diseases of similar severity.
Article: Severe Stiff-Person Syndrome After COVID | Neurology Neuroimmunology & Neuroinflammation
DEFINITIONS:
Stiff-person syndrome (SPS): characterized by stiffness in the limb and axial muscles, episodic painful muscle spasms, and startle responses resulting in stiff and spastic gait and uncontrolled falls leading to disability.
GAD-positive stiff-leg syndrome (SLS): a milder form of SPS characterized by stiffness and spasms limited to one leg.
SUMMARY:
This case report describes the first recorded case of severe GAD-positive stiff-person syndrome (SPS) after mild COVID-19.
The patient had a history of mild GAD-positive stiff-leg syndrome (SLS) that worsened 1 week after COVID-19 infection leading to severe full-blown SPS.
Symptoms rapidly progressed, causing the patient to become unable to walk without support and experiencing painful stiffness and spasms in the lower extremities and paraspinal muscles.
The patient showed improvement after receiving monthly intravenous immunoglobulin (IVIg) infusions, but his gait remained significantly stiff.
My Take:
I had never heard of Stiff Person Syndrome until a couple of weeks back when I heard Celene Dion had the affliction ( I do not know what caused her condition though).
DEFINITIONS:
Avidity: refers to the strength or stability of the interaction between an antigen and an antibody or T cell receptor.
SUMMARY:
The study aimed to investigate the clinical manifestation and immune mechanisms of pediatric post-acute COVID-19 sequelae (PASC).
PASC symptoms include shortness of breath/exercise intolerance, paresthesia, smell/taste disturbance, chest pain, dyspnea, headache, and lack of concentration.
The study found higher frequencies of spike (S) reactive CD4+ and CD8+ T cells among the PASC group, characterized by production of inflammatory cytokines TNFα and IFNγ and low functional avidity.
The results suggest a possible involvement of persistent cellular inflammation triggered by SARS-CoV-2 in the development of PASC symptoms in pediatric patients.
My Take:
The findings of this study provide insights into the immune response and potential mechanisms underlying PASC in pediatric patients.
Similar findings have been found in numerous studies that have been cited in this newsletter over time
SUMMARY:
This pilot study aimed to investigate the metabolic signature of patients with Long COVID (LC) through urine metabolome analysis.
The study found that patients with LC had disturbed amino acid metabolism and neurotransmitter synthesis compared to healthy controls and patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).
Specifically, LC patients had lower levels of phenylalanine and certain downstream metabolites of tryptophan and tyrosine.
The concentrations of neurotransmitters such as serotonin, dopamine, and catecholamines were also found to deviate from the reference ranges in many LC patients.
These dysregulations in amino acid metabolism and neurotransmitter synthesis could serve as potential biomarkers for identifying underlying pathomechanisms and enabling personalized treatment strategies for LC and ME/CFS patients.
My Take:
I’d be curious if anyone could translate the findings from this study [into biomarkers?].
DEFINITIONS:
Extracellular Vesicles (EVs): Small membrane-bound structures released by cells that contain various bioactive molecules, such as proteins, nucleic acids, and lipids.
EVs play important roles in intercellular communication and have garnered interest for their potential therapeutic applications.
SUMMARY:
Initial investigations suggest that extracellular vesicles (EVs) contribute to the virus's attack on the central nervous system (CNS) in COVID-19.
EVs have both pro-inflammatory and immunomodulatory properties that may drive neuroinflammation and cerebral thrombosis in COVID-19.
Mesenchymal stromal/stem cell (MSCs) secreted EVs are being evaluated as a potential therapeutic for COVID-19 due to their innate homing properties, low immunogenicity, and ability to cross the blood-brain barrier (BBB) freely.
EVs offer promising opportunities for diagnosis, prognosis, and therapy in COVID-19, including as biomarkers for neurological injury, reliable delivery systems for therapeutic agents, and potential preventions and treatments for COVID-19-related central neuropathology.
DEFINITIONS:
Griffithsin: A lectin derived from red algae that has shown inhibitory activity against a wide variety of viruses, including SARS-CoV-2.
SUMMARY:
The lectin Griffithsin has shown inhibitory activity against a wide variety of viruses, including SARS-CoV-2.
Researchers have explored Griffithsin's efficacy against SARS-CoV-2, and it has been shown to inhibit viral entry and infectivity.
The structural proteins of the SARS-CoV-2 virion, such as the M, N, and E proteins, may impact the inhibitory activity of Griffithsin.
DEFINITIONS:
Metabolic syndrome (MetS): a syndrome characterized by a cluster of conditions that include increased blood pressure, high blood sugar levels, excess body fat around the waist, and abnormal cholesterol or triglyceride levels.
SUMMARY:
The study aimed to assess the immunothrombotic profiles and inflammatory biomarkers in individuals with long COVID (LC) following SARS-CoV-2 infection.
The results showed elevated levels of IL-6, sCD40L, p-Selectin, and other biomarkers in individuals with LC, particularly in those with metabolic syndrome (MetS).
Von Willebrand factor (vWF) levels were found to be increased in patients with sequelae and MetS.
The findings suggest the persistence of an active immunothrombotic state in individuals with LC, especially those with MetS.
SUMMARY:
This study investigated the associations of the major Vitamin D Receptor (VDR) genetic variants ApaI, FokI, and TaqI with the severity and long post-infection symptoms of COVID-19.
A total of 100 Jordanian patients with confirmed COVID-19 were genotyped for the VDR ApaI, FokI, and TaqI variants using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method.
The findings revealed that the TaqI polymorphism was significantly associated with the severity of symptoms after infection with the SARS-CoV-2 virus, while the ApaI and FokI polymorphisms showed no significant associations.
The TaqI genotype was associated with persistent shortness of breath after COVID-19, and the ApaI and TaqI genotypes were significantly associated with persistent fatigue and muscle pain.
SUMMARY:
Out of 146 patients who had been hospitalized due to COVID-19, 82 completed a one-year follow-up study.
After one year, these patients had higher levels of high-sensitivity cardiac troponin T, larger left atrium diameter, higher respiratory exchange ratio, and increased total body water content percentage compared to the 3-month assessment.
They also had lower forced vital capacity in liters and percentage.
Factors such as lower body mass index, higher left ventricular volumes, and higher fat content were associated with a decline in maximum oxygen uptake.
Thank you Brandon, for collecting all this research and presenting it in such a way that it is very easy to pick what is relevant for me, your reader who is not up to browsing all this information myself. It’s challenging (because of brainfog and because I’m Dutch 😊) but most important to try and keep up with all the new info. Especially because here in the Netherlands they won’t open up long Covid clinics because of politics. Long Covid care over here is really bad, Germany and the UK are doing so much better work with this.
So to make la long story short: thanks for your help and a very happy and healthy 2024 for you!
Brandon, happy new year to you and thank you SO much for your continued work on the weekly newsletter. I really appreciate it. 🙏🏻