>>WELCOME TO THE FINAL
PRESENTATION OF THIS YEAR'S
COVID-19 SCIENTIFIC INTEREST
GROUP LECTURE SERIES.
WE'VE MARKED A NUMBER OF SENIOR
INVESTIGATOR IN THE NHLBI'S
EPITHELIAL SYSTEMS BIOLOGY
LABORATORY AND I'M HAPPY TO BE
INTRODUCING TODAY'S SPEAKER
ZIYAD AL-ALY, WHOSE RESEARCH
GROUP HAS PUBLISHED ABSOLUTELY
EITHER SHAKING EPIDEMIOLOGICAL
STUDIES ON LONG ASHING OVER THE
PAST YEAR. TODAY'S
PRESENTATION IS THE LAST IN OUR
COVID LECTURE SERIES BEFORE THE
SUMMER GREAT.
COVID-19 SCIENTIFIC INTEREST
GROUP WITH MEMBERS THROUGHOUT
THE NIH AND FDA SCIENTIFIC
COMMUNITY BEGAN THESE LECTURES
BACK IN APRIL 2020 AND EACH
LECTURE HAS BEEN ABSOLUTELY
STELLAR AND TODAY'S WILL BE NO
EXCEPTION.
TODAY'S TOPIC LONG COVID HAS
BEEN TO MANY OF US A MYSTERIOUS
AND UNEXPECTED ASPECT OF THE
PANDEMIC, PROTEIN COMPLEXION AND
NATURE AND LIKELY TO COMMAND
MORE AND MORE OF OUR HEALTHCARE
RESOURCES IN THE COMING YEARS,
NO 1 IS BETTER SUITED TO TELL US
WHERE WE STAND WITH LONG COVID
THAN ZIYAD, AL-ALY, HE IS A
PHYSICIAN SCIENTIST WHO HIS
FIRST AND FOREMOST KIDNEY
RESEARCHER, HE'S A MEMBER OF THE
RENAL FAC ALL THEY AT WASHINGTON
UNIVERSITY IN ST. LOUIS, WORKING
AT THE VA HEALTHCARE SYSTEM,
WHERE HE'S DIRECTOR OF THE
CLINICAL EPIDEMIOLOGY CENTER,
HIS PRECOVID RESEARCH WAS
CHIEFLY ABOUT CHRONIC KIDNEY
DISEASE AND FACTORS THAT HAVE
CONTRIBUTED TO THE CHRONIC
KIDNEY DISEASE EPIDEMIC THAT WE
EXPERIENCED OVER THE LAST COUPLE
OF DECADES.
AMONG THE MOST INTERESTING
ASPECTS OF THIS IS HIS WORK ON
THE ROLE OF AIR POLLUTION IN
CHRONIC KIDNEY DISEASE AND
DIABETES.
NOT IN CONSEQUENTIALLY, HE'S
BEEN A MAJOR PLAYER IN THE
GLOBAL BURDEN OF DISEASE STUDY
PROJECT.
SO THEN COVID HAPPENED AND HE
WAS ABLE TO MARSHAL HIS
SUBSTANTIAL EXPERTISE IN
EPIDEMIOLOGY TO TACKLE THE
PROBLEM OF POST ACUTE SEQUELA OF
SARS KICKOFF 2 INFECTION, SO
CALLED LONG COVID, THE TOPIC OF
TODAY'S LECTURE.
NOW ZIYAD RECEIVED HIS
UNDERGRADUATE DEGREE FROM
BIOLOGY IN THE AMERICAN
UNIVERSITY OF BEIRUT, FOLLOWED
BY A MEDICAL DEGREE ALSO IN
BEIRUT IN 1999.
AFTER AN INTERNSHIP IN BEIRUT,
ZIYAD ACCEPTED A RESIDENCY AT
ST. LOUIS UNIVERSITY.
THIS WAS FOLLOWED BY A SERIES OF
FELLOWSHIPS, THERE AND AT NEARBY
WASHINGTON UNIVERSITY.
AT 2006, HE BECAME A STAFF
PHYSICIAN IN THE RENAL SECTION
OF THE ST. LOUIS DA IN 2013, HE
ASSUMED THE DIRECTORSHIP OF THE
CLINICAL EPIDEMIOLOGY CENTER AND
ALSO BECAME CHIEF OF THE
RESEARCH AND DEVELOPMENT SERVICE
AT THE VA.
AMONG HIS OTHER ACTIVITIES IN
THE KID ME WORLD HE'S A KEY
MEMBER OF THE EDITORIAL TEAM OF
THE JOURNAL OF THE AMERICAN
SOCIETY OF NEPHROLOGY, THE
WORLD'S TOP KIDNEY RESEARCH
JOURNAL.
MOST PERTINENT FOR TODAY'S TALK
ZIYAD SITS ON THE WHITE HOUSE
INTERAGENCY APPROXIMATELY SEE
COMMITTEE ON LONG COVID AND CO
CHAIRS THE COMMITTEE FOR
DEVELOPING A LONG ASHING
NATIONAL RESEARCH ACTION PLAN.
THE TITLE OF HIS TALK TODAY IS
LONG COVID, A BRIEF OVERVIEW.
ZIYAD, WELCOME TO THE NIH AND
THANK YOU FOR JOINING US.
>>THANK YOU VERY
MUCH FOR THE WARM DISTRIBUTION
AND DELIGHTED TO BE WITH YOU
TODAY FOR THE LONG ASHING
REVIEW.
IT'S A REALLY BRIEF OVERVIEW OF
LONG COVID, AND ENCOMPASS MORE
LITERATURE THAT WE HAVE AMASSED
FOR LONG COVID AND OUR
PERSPECTIVE WHAT WE THINK IS
GOING ON HERE, AND I WOULD LIKE
TO LEAVE AMPLE TIME FOR Q, ANDA
AND A DISCUSSION.
HOPEFULLY THAT'S SORT OF AN
ACTIVE DISCUSSION WILL BE
INTERESTING TO YOU ALL.
SO DUE TO DISCLOSURES, I'VE
CONDULTED FOR GILLIAD AND TONICS
AND I WOULD LIKE TO SAY THAT THE
OPINIONS EXPRESSED IN THIS
PRESENTATION ARE MY OWN AND NOT
THOSE OF THE UNITED STATES
GOVERNMENT.
SEVERAL OF MY MENTEES IN THE LAB
HAVE ALSO RECEIVED GENEROUS
SOCIETY AND AS MARK MENTIONED WE
DO A LOT OF KIDNEY DISEASE
RESEARCH AND NECESSARILY WORKING
FOR SEVERAL OF MY ARTICLES
TODAY.
--PIVOTED AND STARTED STUDYING
LONG COVID, I WOULD LIKE TO GIVE
A BROAD OVERVIEW OF LONG COVID,
WHAT WE THINK LONG COVID IS AND
SPECIFICALLY DELVE DEEPER INTO
THE CARDIOVASCULAR OUTCOMES AND
KIDNEY OUTCOMES, DIABETES, AND
MENTAL HEALTH OUTCOMES IN PEOPLE
WITH COVID-19.
IF I CAN BRIEFLY TOUCH UPON THE
EFFECTIVE VACCINATION ON RISK OF
LONG COVID, AND THEN PUT IT
UP--AND THEN PUT IT ALL IN
PERSPECTIVE, YOU KNOW DISCUSSING
IMPLICATIONS FOR HEALTH SYSTEMS
AND COMMUNITIES.
AND THEN I WILL PROVIDE A
SUMMARY AND THEN WE WILL OPEN IT
UP FOR Q&A.
SOPHISTICATED VERY EARLY ON IN
THE PANDEMIC WHEN THE PANDEMIC
HIT IN MARCH 2020 IT WAS REALLY
AN ENORMOUSLY STRESSFUL TIME FOR
ALL OF US HERE, MYSELF AND MY
TEAM MEMBERS, YOU KNOW ALL OF A
SUDDEN OUR LIFE WAS UPSIDE DOWN.
YOU KNOW, THINGS WERE REALLY,
REALLY VERY DIFFERENT AND REALLY
IN 1 OR 2 DAYS, YOU KNOW THINGS
SWITCHED SWITCHED PRETTY
DYNAMICALLY.
SO WE STARPTED THINKING HOW DO
WE DO, WHAT DO WE DO AS CLINICAL
EPIDEMIOLOGISTS HOW DO WE DO OUR
PART TO HELP FIGHT AGAINST
COVID-19.
AT THAT TIME WE DID NOT KNOW
THAT LONG COVID EXISTED OR THAT
IT COULD LEAD TO LONG-TERM
SEQUELA OR LONG-TERM SEQUENCES,
WE HAD THIS FORCE WITHIN US THAT
WE NEED TO DO SOMETHING HERE TO
HELP THE NATION DEVELOP A
RESPONSE TO LONG COVID--TO
COVID.
AT THAT TIME, MYSELF AS A
CLINICIAN, WITH THE FRONT LINE
AND WORK IN THE ICU AND WORK ON
RENAL SERVICE, ET CETERA, ET
CETERA, SO WE DID THAT, BUT A
LOT OF US IN MY TEAM ARE
ACTUALLY JUST REALLY--NOT JUST
CLINICAL EPIDEMIOLOGISTS SO WE
STARTED BRAINSTORMING ABOUT YOU
KNOW AVENUES WE COULD DO, THINGS
WE COULD DO TO CONTRIBUTE IN THE
FIGHT AGAINST COVID-19.
WE STARTED BRAINSTORMING A LOT
AND UNANIMOUSLY.
UNANIMOUSLY, THE RESPONSE FROM
MY TEAM WAS WE DO WHAT WE DO
BEST.
WE IDENTIFY RESOURCE QUESTIONS
THAT ARE IMPORTANT TO THE NATION
THAT REALLY CONSEQUENTIAL IN OUR
FIGHT AGAINST COVID-19 AND WE
ADDRESS THEM USING OUR DATA AND
TOOLS, SO THAT WAS REALLY
UNANIMOUS ANSWER OR UNANIMOUS
RESPONSE ACROSS THE BOARD HAD IT
FROM ALL MY TEAM MEMBERS.
THAT'S WHAT WE HAVE TO DO.
WE HAVE TO FIGURE OUT HOW WE
CONTRIBUTE SCIENCE HERE TO TRY
TO ADVANCE OUR UNDERSTANDING OF
COVID AND THEN HELP TO FIGHT
AGAINST COVID-19.
AT THAT TIME, WE DID NOT KNOW
ANYTHING ABOUT LONG COVID AND
THEN, YOU KNOW SO 1 TECHNOLOGY
TRANSFER LED TO ANOTHER AND IN
THE EARLY REPORT WE GOT, WAS NOT
A CASE REPORT UNUSUAL MEDICINE
OR ANYTHING ELSE, WAS REALLY AN
UPEDGE PIECE BY THE NEW YORK
TIMES BY FIONA, LOWENSTEIN AND I
REMEMBER READ THANKSGIVING ON MY
COUCH IN THE LIVING ROOM, AND
THINKING TO MYSELF, THIS IS
REALLY BIZARRE, THIS IS--YOU
KNOW SHE WAS TELLING US HER
STORY, YOUNG AND HEALTHY,
PREVIOUSLY HEALTHY, DID NOT HAVE
ANY MEDICAL PROBLEMS, NO
CO-MORBIDITIES AT ALL, SHE GETS
COVID-19 OR SARS KICKOFF 2
INFECTION, WEEKS DOWN THE ROAD
SHE'S LEFT WITH LINGERING
SYMPTOMS AND THAT'S INTERNAL
AUDIT DEXTRAN SULFATE CASE OR AN
EQUAL 1.
AND KUDOS TO HER AND THE PATIENT
COMMUNITY AROUND HERE AND THEY
GENERATED A LOT OF RESPONSE FROM
THE PATIENT COMPLIEWNT.
THEY WERE AROUND HERE AND
LITERALLY WITHIN 48 HOURS HER
INBOX WAS FLOOD WIDE A LOT OF
MESSAGES FROM PEOPLE SHARING, OH
ME TOO, THAT'S MY STORY TOO, I
WAS ALSO DIAGNOSED WITH COVID-19
OR SARS KICKOFF 2 INFECTION IN
MARCH 2020 AND IN APRIL,
PREVENTIVUOUSLY YOUNG AND
HEALTHY, NOW STILL HAVING ALL
THESE PROBLEMS, ET CETERA.
ET CETERA.
SO THAT WAS LIKE THE INDEX OR
THE INDEX CASE IN MY
CONSCIOUSNESS AND OUR SORT OF,
YOU KNOW UNDERSTANDING AS TO
THINGS MAY BE HAPPENING IN
PEOPLE WITH SARS KICKOFF 2 THAT
ARE LINGERING FOR A LONGER
PERIOD OF TIME OR LINGERING FOR
YOU KNOW BEYOND THE ACUTE
INFECTION AND AGAIN, REALLY
KUDOS TO THE PATIENT COMMUNITY.
THIS IS REALLY A--I ARGUE THAT
THIS IS REALLY A REMARKABLE
POINT IN HISTORY OF MEDICINE
WHERE PATIENTS, YOU KNOW
REPORTED THEMSELVES, NOT DOCTORS
REPORTED ON PATIENTS, PATIENTS
REPORTED THEMSELVES IN THE FORM
OF AN UP EDGE PIECE, THE
EXISTENCE OF A POTENTIALLY
LONG-TERM OR POST SEQUELA 2
INFECTION, AND THEY FORM WHAT
THEY CALL NOW THE PATIENT LED
RESEARCH COLLABORATIVE.
REALLY AN AMAZING ENTERPRISE OF
REALLY YOUNG PEOPLE WHO ARE
PATIENTS AND AT THE SAME TIME
ALSO, YOU KNOW ENGAGED IN
RESEARCH, GAVE US REALLY THE
FIRST CLUES AS TO WHAT SORT OF
THE POST ACUTE SEQUELA MIGHT
LOOK LIKE SO THEY ORGANIZE
THEMSELVES INTO THE PATIENT LED
RESEARCH COLLABORATIVE.
AND THEY PUBLISHED IN AN
UNCONTROLLED STUDY, UNCONTROLLED
STUDY THIS IS NOT THE GOLD
STANDARD SCIENTIFIC INSTRUMENT
BUT IT REALLY PROVIDED US WITH
CLUES THAT THESE--YOU KNOW THESE
PATIENTS WERE HAVING A WHOLE LOT
OF SYMPTOMS THAT EITHER COULD
EXIST OR ARISE IN YOU AFTER THE
ACUTE PHASE OF THE DISEASE.
THOSE INVOLVE WEAKNESS, FATIGUE,
WEAKNESS, PAIN AND TO THEIR
CREDIT AS WELL, THIS IS NOT THE
PATIENT LED MOVEMENT OR
COLLABORATIVE BUT TO THE CREDIT
IT THEY COINED THE TERM LONG
COVID.
THEY GAVE THE DISEASE OOGHTS
NAME AND STARTED TO REFERRING TO
THEMSELVES AS LONG HAULERS.
SO I THINK THIS IS INTERESTING
IN THE HISTORY OF SCIENCE AND
MEDICINE THIS IS REALLY
REMARKABLE THAT PATIENTS
THEMSELVES CONTRIBUTED TO
ALERTING THE WORLD ABOUT THE
EXISTENCE OF POST ACUTE SEQUELA
OF SARS KICKOFF 2, GENERALLY THE
INITIAL CASE REPORT AND FORM OF
OPED PIECE AND SUBSEQUENTLY IT
REALLY AN EYE OPENING REPORT
ALBIET UNCONTROLLED, THIS IS NOT
A CONTROLLED STUDY.
UNCONTROLLED SURVEY OF THE
MEMBERSHIP, JUST LOGGING THE
BREDTHS OF PROBLEMS THEY'RE
EXPERIENCING IN THE POST ACUTE
STAGE OF THE DISEASE, THOSE ARE
SYMPTOMS THAT EITHER PERSISTED
OR MANIFESTED IN YOU IN THE POST
ACUTE PHASE OF THE DISEASE.
SO WITH THAT BACKGROUND AND
REMEMBER THIS IS ALL LIKE YOU
KNOW MARCH, APRIL, MAY OF 2020.
YOU KNOW, WITH THAT BACKGROUND
WE STARTED THINKING, ME AND MY
GROUP LIKE WHAT'S HAPPENING HERE
THIS, IS AN UNCONTROLLED STUDY,
IS THIS REALLY REAL?
THEY DIDN'T HAVE A CONTROL
GROUP?
SOME PEOPLE HAVE FATIGUE HERE
BUT WHAT'S THE BASE LINE FATIGUE
IN THE GENERAL POPULATION, DID
IT LEAD TO LOCK DOWNS AND BEING
AT HOME AND NOT EXERCISING AND
ALL THE OTHER THINGS, YOU KNOW,
A SURVEY CAN ONLY TELL YOU SO
MUCH, GIVE YOU A WATO LOOK BUT
NOT TD EVIDENCE THAT LONG COVID
ACTUALLY EXISTS OR IS A SAYING
IN THE MANIFESTATION, SO WE
STARTED ASKING THE QUESTION, THE
SIMPLE QUESTION, WHAT IS LONG
OVENG.
THESE PEOPLE ARE TALKING TO US
ABOUT LONG ASHING, YOU KNOW, MY
E-MAIL STARTED SORT OF GETTING A
LOT OF THESE THINGS AND WE ASKED
WHAT IS LONG COVID?
SO WE DECIDED TO TAKE A HIGH
DIMENSION APPROACH.
LEAVE NO STONE UNTURNED AND TAKE
THIS HIGH DIMENSIONAL WAY TO
CHARACTERIZE THE POST ACUTE
SEQUELA OF SARS KICKOFF 2, OR
POST ACUTE SEQUELA OF COVID-19.
AND WHAT WE DID HERE IS WE
AMASSED THIS WONDERFUL,
WONDERFUL MAGZ NATIONAL
RESOURCE, NATIONAL TREASURE OF
VA DATA.
THE VA OPERATES THE LARGEST
NATIONALLY INTEGRATED HEALTHCARE
SYSTEM IN THE U.S.
DOESN'T GET A LOT OF CREDIT BUT
I'M GOING TO TOOT THAT HORN NOW.
LIKE THE VA IS THE LARGEST
NATIONALLY INTEGRATED HELT CARE
SYSTEM IN THE U.S., WITH THE
FIRST TO PIONEER THE DEVELOPMENT
AND IMPLEMENTATION AND USE OF
ELECTRONIC HEALTH RECORDS AND AS
A RESULT, IT WAS REALLY THIS
AMAZING AND WONDERFUL, REALLY
NATIONALLY INTEGRATED HEALTH
RECORD ON MILLIONS OF VETERANS
SO VERY EARLY ON IN THE
PANDEMIC, WE YOU KNOW
STARTED,--MADE USE OF THE DATA
AND CATALOGED THIS COHORT OF
PEOPLE BUT MORE THAN 74,000
PEOPLE HERE ARE VETERANS WHO HAD
SARS KICKOFF 2 INFECTION
COMPARED TO SEVERAL CONTROL
GROUPS AND THEN WE FOLLOW THEM
FOR AT LEAST 6 MONTHS.
SO WHAT WE'VE DONE HERE IS WE'VE
DONE WHAT WE CALL A HIGH
DIMENSIONAL CHARACTERIZATION OF
SARS KICKOFF 2.
SO WE DIDN'T LOOK AT LUNGS AND
HEART, WE LOOKEDDA THE
EVERYTHING, TO TRY TO UNDERSTAND
AND USING A COUNTER FACTUAL
APPROACH IN EPIDEMIOLOGY, USING
IT AS SORT OF A WELL DEFINED
CONTROL, WHAT IS THE RISK OF
POST ACUTE SEQUELA, ON ANSWERING
THE QUESTION, WHAT ARE THE RISKS
OF POST ACUTE SEQUELA AND PEOPLE
WHO ARE EXPOSED TO SARS KICKOFF
2 INFECTION VERSUS A WELL
DEFINED CONTROL GROUP THAT DID
NOT HAVE ANY INFECTION AT ALL,
OR HAD NO KNOWN INFECTION WITH
SARS-ON 2 AND THE RESULTS WERE
REALLY EYE OPENING AND AT THE
TIME VERY JARRING AND THEY
REMAIN HERE OR SO MORE THAN A
YEAR AFTERWARDS AFTER WE
PUBLISHED THIS PAPER, I FEEL
THAT AFTER WE LOOK AT THESE
SLIDES AND THE BREDTH OF
DISFUNCHES, THAT IS--THAT IS
EXPERIENCED BY PEOPLE WITH
COVID-19 IS REALLY IT REMAINS
JARRING, SO WHAT WE'VE SEEN,
WE'VE SEEN INCREASE RISK OF
MENTAL HEALTH DISORDERS AND
INCLUDE ANXIETY, DEPRESSION,
SLEEP PROBLEM, SUBSTANCE ABUSE
PROBLEMS.
NERVOUS SYSTEM DISORDERS
INCLUDING INCREASE RISK OF
STROKES, EPISODIC DISORDERS LIKE
HEADACHES AND SEIZURES, MEMORY
PROBLEMS, BRAIN FOG, YOU KNOW
SMELL PROBLEMS, DIABETES,
HYPOLIPIDEMMIA, INCREASED RISK
OF GI PROBLEMS, CONSIPATION,
DISCIPLINARY RIA, ACID REFLUX
DISEASE, SKIN DISORDERS
INCLUDING RISK OF AIR LOSS AND
RASH, COAGULATION DISORDERS AND
THIS WAS SUBSTANTIAL BECAUSE OF
BLOOD CLOTTING IN PEOPLE WITH
COVID-19 AND A WHOLE HOST OF
CARDIOVASCULAR CONDITIONS
INCLUDING KID SYNDROME, HEART
PALITATIONS, ARRHYTHMIA,
RESPIRATORY SYMPTOMS, SHORTNESS
OF BREATH, LOW BLOOD OXYGEN,
ACUTE AND CHRONIC KIDNEY
DISEASE, MUSK LO SKELETAL FORM
IN THE FORM OF PAIN AND
WEAKNESS, MALAISE, PROFOUND
FATIGUE AND IN SOME PATIENTS
REALLY DEBILITATING FATIGUE THAT
REALLY ALMOST, IT'S ALMOST
INCAPACITATING AND LEAVES THISEM
IN BED FOR A LOT OF DAYS, A LOT
OF HOURS IN THE DAY AND ALSO
ANEMIA.
SO WITH THIS BACKGROUND, WE ASK
YOURSELF LIKE, WELL, THIS REALLY
HAPPENING, YOU KNOW VERSUS THE
CONTROL GROUP.
SO HOW DOES THE PICTURE COMPARE
WHEN WE EVALUATE PEOPLE WITH
COVID-19 VERSUS ANOTHER VIRUS,
ANOTHER WELL CHARACTEREDDIZED
RESPIRATORY VIRUS HAS BEEN WITH
US AT LEAST A HUNDRED YEARS
THAT'S SEASONAL INFLUENZA, SO
WE'VE DID A COMPARATIVE
EVALUATION OF COVID VERSUS FLU,
TRIED TO GET A DEEPER
UNDERSTANDING OF WHETHER, YOU
KNOW ALL OF THOSE THINGS THAT WE
SHOWED YOU THAT THEY ARE
MANIFESTING HERE ARE THESE SORT
OF--DO PEOPLE GET THESE WITH ANY
POST VIRAL IN THIS, ANY POST
VIRAL IN THIS, FOR THE PEOPLE
AND EXPOSE THEM TO RISK OF ALL
THESE COMPLICATIONS, OR IS THERE
SOMETHING SPECIFIC ABOUT SARS
KICKOFF 2.
AND REALLY 1 OF THE WAYS YOU GD
BE DO THIS IS ESTABLISH, YOU
KNOW AS CLOSE AS AN APPLES
TOANELS COMPARISON, EVALUATING
POST ACUTE SEQUELA AND SARS
KICKOFF 2 INFECTION VERSUS POST
SEQUELA IN PEOPLE WITH FLU,
SEASONAL INFLUENZA.
SO THE SHORT BRIEF ANSWER HERE
IS THAT THERE ARE 2 MAIN OR KEY
DIFFERENCES IN PEOPLE WITH SARS
KICKOFF 2 VERSUS SEASONAL
INFLUENZA, 1 KEY DIFFERENCE IS
THE MAGNITUDE OF RISK OF ALL
THESE SEQUELA IS MUCH HIGHER IN
COVID-19 VERSUS CEASEONAL INFLU
EANS AND 2, REALLY VERY
IMPORTANT IS THE BREDTH OF ORGAN
DYSFUNCTION, THE BREDTH OF
ORGANS THAT ARE INVOLVED AND MAN
TEST WITH SEQUELA IS MUCH, MUCH,
LARGER AND EXTENSIVE IN PEOPLE
WITH SARS KICKOFF 2 VERSUS
SEASONAL INFLUENZA, YOU KNOW THE
BROADER CONDITION HEAT IS A 1 OF
THE POST VIRAL INDROAM OR POST
VIRAL CONDITION.
BUT SARS KICKOFF 2 REALLY
PRESENTED DIFFERENT FORM OR
DIFFERENT KIND OF A POST VIRAL
SYNDROME.
AGAIN, IN DIFFERENTIATING ITSELF
IN 2 DIFFERENT KEY FEATURES, THE
MAGNITUDE OF RISK IS MUCH
HIGHER, MUCH MORE PRONOUNCED AND
THE BREDTH OF ORGAN DYSFUNCTION
IS REALLY MUCH MORE EXTENSIVE.
AND THEN WE ASK THE QUESTION
HERE, WELL, WE ALSO KNOW THAT
PEOPLE WHO REALLY SPEND TIME ON
THE ICU ON A VENTILATOR OR
PEOPLE WHO HAD BEEN IN THE
HOSPITAL FOR A LONG TIME COULD
BECOME DECONDITIONED AND HAVE A
LOT OF MANIFESTATIONS,
DESCRIBED, YOU KNOW FATIGUE,
MUSCLE PAIN, WEAKNESS AND
POTENTIALLY ANEMIA AND A LOT OF
THESE THINGS THAT CAN HAPPEN IN
THE POST HOSPITALIZATION COURSE
AND PEOPLE WHO HAD SPENT SOME
TIME IN THE HOSPITAL OR MORE SO
SPENT TIME IN THE ICU, OF COURSE
ICU SYNDROME, ESPECIALLY IF THEY
WERE ON A VENTILATOR FOR A
PERIOD OF TIME.
SO WE'VE DONE THIS TO TRY TO
UNDERSTAND THE LEVEL OF RISK IN
DIFFERENT POPULATIONS WITH SARS
KICKOFF 2 INCLUDING THOSE WHO
ARE NOT HOSPITALIZED YOU KNOW
PEOPLE WHO WERE HOSPITALIZED AND
THEN PEOPLE WHO WERE IN THE ICU
DURING THE ACUTE PHASE OF SARS
KICKOFF 2 INFECTION.
WHAT WE FOUND IS THAT THE RISK
OF EVIDENT EVEN AMONG THE
NONHOSPITALLIZED PEOPLE, THAT'S
A KEY FEATURE AND VERY IMPORTANT
BECAUSE A MAJORITY OF PEOPLE IN
THE U.S. AND GLOBAL WITH SARS
KICKOFF 2 INFECTION ARE
NONHOSPITALLIZED SO LONG COVID
OR THE POST ACUTE SEQUELA OF
COVID-19 WERE EVIDENT EVEN AMONG
NONHOSPITALLIZED TO A LESSER
DEGREE THOUGH, TO A LESSER
DEGREE BUT CERTAINLY EVIDENT,
THEY WERE COMPARED TO THE
CONTROL GROUP AND THE RISK
INCREASES, ACCORDING TO THE
SEVERITY OF THAT ACUTE
INFECTION, MEANING THE RISK
WAS--COMPARED TO THE
NONHOSPITALLIZED RISK WAS HIGHER
WHEN HOSPITALIZED AND HIGHEST IN
PEOPLE WHO WERE IN THE ICU
DURING THE ACUTE PHASE OF THE
INFECTION.
AND THIS IS BY THE WAY SORT OF
LIKE ALMOST LIKE A UNIVERSAL
STUDIES THAT REPRODUCED IN
MULTIPLE OTHER STTDS AND THE
SEVERITY OF THE ACUTE INFECTION
REALLY MATTERS.
IT DOES NOT MEAN THAT WE DON'T
HAVE PEOPLE WITH LONG COVID OUT
THERE WHO HAD ASYMPTOMATIC ACUTE
INFECTION OR PEOPLE WITH LONG
COVID OUT THERE WHO HAD REALLY
MILD ACUTE INFECTION WITH SARS
KICKOFF 2 THAT PUT THEM IN THE
HOSPITAL, WE'RE NOT SAYING THAT,
LONG COVID IN THESE PATIENTS
ABSOLUTELY EXISTS AND WE
RECOGNIZE IT AND REALIZE IT BUT
WE'RE SAYING HERE THAT THE
MAGNITUDE OF RISK POST ACUTE
SEQUELA IS HIGHER IN PEOPLE WHO
WERE HOSPITALLED AND HIGHEST IN
PEOPLE WHO SPENT TIME ON AN ICU,
ESPECIALLY IN A VENTILATOR
DURING THE ACUTE PHASE OF SARS
COV 2 INFECTION.
YOU SHOULD BE ASKING, WELL THIS
IS ALL FINE BUT WHOSE AT RISK
HERE OR ON DO WE KNOW?
AND IT'S LONG COVID ISN'T LIKELY
TO BE 1 THING.
SO WE SORT OF LUMP ALL OF THESE
THINGS UNDER THE UMBELLA TO LONG
COVID AND ACTUALLY, YOU KNOW,
OTHERS, I THINK NIH CALLS IT
POST ACUTE SEQUELA SARS COV2 AND
OUR DEFINITION OF LONG COVID IS
PRETTY MUCH ALINE WIDE WHAT MOST
NIH CALLED P A SCS ARER OR POST
ACUTE SEQUELA OF SARS COV 2, AND
IN THE DISEASE, EITHER PERSISTS
FROM THE ACUTE PHASE OR AND THE
POST ACUTE PHASE OF THE DISEASE.
THOSE CAN INVOLVE MULTIPLE ORGAN
SYSTEMS WE DISCUSSED AND IT'S
UNLIKELY AT THE END OF THE DAY
WHEN WE FULLY UNDERSTAND LONG
COVID AND HOPEFULLY SOON BUT
WHEN WE FULLY UNDERSTAND IT, YOU
KNOW LONG COVID HAS TO BE
MULTIPLE ENTITIES AND NOT 1
SYMBOL OR DISEASE, IT HAS IT'S
OWN SET OF RISK FACTORS, HEALTH
TRANSLATIONAL RESEARCH JECTORS
AND OUTCOMES.
SOA THIS POINT WE CATALOG THE
MAIN FEATURES OF SARS COV 2, AND
MAIN CONDITIONS, 30 OF THEM.
AND ASKED THE QUESTION, ARE
THOSE REALLY HIGHER IN MALES OR
FEMALES?
HIGHER IN PEOPLE WHO HAD IN
BLACK INDIVIDUALS OR WHITE
INDIVIDUALS?
WERE THEY HIGHER IN PEOPLE HAD
IN OLDER ADULTS OR YOUNGER
ADULTS, OR ACCORDING TO BASE
LINE HEALTH STATUS.
AND IF--IF YOU CAN SEE 1 THING
FROM THIS HEAT MAP, IT'S REALLY
ALL OVER THE PLACE.
IF YOUR BRAIN WENT TO THE
CONCLUSION THAT OH MY GOD THIS,
IS REALLY ALL OVER THE PLACE,
YOU'RE ABSOLUTELY RIGHT ON
POINT.
THAT'S EXACTLY WHY LONG COVID IS
NOT REALLY 1 THING.
SOME FEATURES OF LONG COVID,
SOME OF THOSE POST ACUTE
SEQUELA, ACTUALLY THE RISK IS
HIGHER IN YOUNGER ADULTS, SOME
OF THEM ARE ACTUALLY HIGHER OR
THE BURDEN IS MUCH, MUCH, HIGHER
IN OLDER ADULTS WITH THE
EVIDENCE THAT SOME OF IT ALSO
UNEQUALLY DISTRIBUTED ACCORDING
TO RACE, AND SOME UNEQUALLY
DISTRIBUTED ACCORDING TO SEX.
SOME OF THE SEQUENCES OF LONG
ASHING OR THE POST ACUTE SEQUELA
OF SARS COV 2 ARE MORE EXPRESSD
FEMALE, SOME MORE IN MALES.
UNIVERSALLY THOUGH IN THIS
PAPER, YOU KNOW AGAIN FROM MY
TEAM, REALLY CONVINCINGLY SHOWED
AGAIN THAT THE RISK AND BURDEN
ACCORDING TO THE SEVERITY OF THE
INFECTION, THAT'S CONSISTENT OUT
THERE, THAT'S REALLY VERY
IMPORTANT, CONSISTENT FOR ALL
THESE PAPERS THAT THE RISK SEEMS
TO INCREASE GRADUALLY, IN A
RELATED WAY ACCORDING TO THE
THIS VERY ACUTE INFECTION, BUT
WHEN YOU ANALYZE THE INDIVIDUAL
COMPONENTS ACCORDING TO AGE,
RACE, SEX AND BASED ON HEALTH
STATUS, HAVE YOU SOMETHING LIKE
THIS.
YOU GET LIKE OH, IT'S ALL OVER
THE PLACE, SOME CONDITIONS ARE
HIGHENER MALES, SOME HIGHER IN
FEMALES, ET CETERA, ET CETERA.
SO REALLY THE CONCLUSION IT'S
NOT ALL THE SAME WAY, WHEN YOU
READ IN THE PRESS OR OTHER
PLACES THROUGH GENERALIZATION,
LONG COVID IS MORE EXPRESSED OR
HIGHER IN FEMALES, WELL, ASK
THEM, WHAT'S YOUR DEFINITION OF
LONG COVID, WHICH SEQUELA ARE
YOU TALKING ABOUT, FATIGUE,
BRAIN FOG, METABOLIC SEQUENCES
OF LONG COVID, DERMA TO LOGIC
MANIFESTATIONS OF LONG COVID SO
WHAT ARE YOU TALKING ABOUT WHEN
YOU GENERALIZE THESE BROAD VERY,
SWEEPING STATEMENTS ABOUT LONG
ASHING BEING HIGHENER 1 AGE
GROUP OR ANOTHER AGE GROUP OR 1
SEX GROUP OR ANOTHER SEX GROUP.
SO REALLY LONG COVID IS NOT A
MODERNISTIC ENTITY, IT DOES NOT
ALL BEHAVE IN THE SAME WAY.
THE COMPONENTS OF WHICH ARE
ACROSS AGE, RACE, SEX AND BASED
ON HEALTH STATUS AND THAT LEADS
US HERE TO THE--STILL SORT OF
THE BROAD UMBRELLA TERM TO LONG
COVID, FOR WHAT WE THINK WE ARE
INTERESTED IN AND WHAT WE THINK
ARE CONSEQUENTIAL SEQUELA THAT
MIGHT CLASH FOR SOME PEOPLE FOR
A LONG TIME AND THOSE INCLUDE,
OR THE SEQUELA OF CONCERNS, TO
US, AND THAT'S REALLY, YOU KNOW
OBVIOUSLY SORT OF DEBATABLE, ARE
THE CARDIOVASCULAR DISORDERS
PEOPLE CAN GET AFTER SARS
KICKOFF INFECTION, THE INCREASES
OF DIABETES, SARS KICKOFF 2
INFECTION, INCREASED RISK OF
KIDNEY DISEASE AND THE INCREASED
RISK OF NEUROLOGIC MENTAL HEALTH
DISORDERS SO I WILL DIVE A BIT
DEEPER INTO EACH 1 OF THOSE IN A
SLIDE OR TBO AND THEN SORT OF
TRANSITION TO THE NEXT PART OF
THE TALK.
SO WHAT WE'VE DONE HERE IS
EVALUATE THE LONG-TERM OUTCOMES
OF PEOPLE WITH SARS COV 2
ENFEKS, SO AGAIN TBR AN
EPIDEMIOLOGIC PERSPECTIVE, THE
BEST WAY IS TO DEVELOP A COHORT
OF PEOPLE WITH KNOWN SARS COV 2
INFECTION AND COMPARE THEM TO
CONTROL GROUPS WITH NO KNOWN
INFECTION, NO KNOWN SARS COV 2
INFECTION AND THIS ANALYSIS, WE
REALLY ELECTED TO FOCUS ON 2
CONTROL GROUPS, 1 WE CALL IT
CONTEMPORARY COHORT, OR
CONTEMPORARY CONTROL, PEOPLE WHO
LIVE IN THE SAME TIME PERIOD
DURING THE PAN DEMIC, MEANING
THEY'RE EXPOSED TO SAME BROADER
CONDITIONS OF THE PANDEMIC, SOME
SARS COV 2 WITHOUT INFECTION AND
A SOLE CONTROL GROUP OF PEOPLE
WHO LIVE IN AN ERA THATY
PRACTICES DATES THE PANDEMIC, A
PREPANDEMIC ERASO COMPARED TO
THESE CONTROL GROUPS WE FOUND
PEOPLE WITH SARS INFECTION, WERE
MANIFESTING OF HIGHER RISK UP TO
A YEAR AFTER SARS COV 2
DIAGNOSIS AND CARDIOVASCULAR
CONDITIONS THAT WERE EVIDENT
ACTUALLY SPANNED FOR
CARDIOVASCULAR DISEASE AND THESE
ARE DISORDERS AND STROKES AND
TIA, DISRYTH METRICSA AND
INFLAMMATORY HEART DISEASE THAT
INCLUDES PERICARDITEIS AND MY O
CARDITEIS AND ESCHEMIC HEART
DISEASE AND SEVERAL CARDIAC
DISORDERS INCLUDING HEART
FAILURE AND THROMBOTIC
DISORDERS, THOSE INCLUDE DEEP
VAIN THOMBOSIS AND THE ORGANS OR
THE BREDTH OF CARDIOVASCULAR
MANIFESTATIONS IS REALLY--IS
EXTENSIVE, AND THIS IS WHAT MAKE
ITS HARD FROM MECHANISTIC
PATHWAY AND I UNDERSTAND A LOT
OF YOU GUYS ARE, YOU KNOW BASIC
SCIENTISTS AND MECHANISMS
DRIVING BIOLOGY OF THE DISEASE,
IT MAKES IT REALLY HARD TO SORT
OF HAVE A 1 UNIFYING HYPOTHESIS
THAT EXPLAINS ALL OF THESE
MANIFESTATIONS AND THIS IS
REALLY SORT OF A--IN DIFFERENT
VASCULAR BEDS AND SORT OF
DIFFERENT, YOU KNOW LITERALLY
HAVE DIFFERENT BUT BIOLOGIC
MECHANISMS SO IT'S UNLIKELY THAT
1 SORT OF UNIFYING MECHANISM,
CAN EXPLAIN ALL OF THIS.
SOPHISTICATED AND FROM AN
EPIDEMIOLOGIC PERSPECTIVE HERE,
THE FINDINGS WERE CLEAR THAT
WHEN WE COMPARE THEM TO ABOUT
5 MILLION PEOPLE, WHO HAD LIVED
DURING THE SAME TIME PERIOD BUT
DID NOT HAVE SARS COV 2
INFECTION, SO IN TOTAL MORE THAN
10 MILLION CONTROLS THROUGH THE
ADCO VASEY OF PEOPLE WITH SARS
COVID INFECTION HAD A MUCH
LARGER HIGHER CARDIOVASCULAR
RISK WITH THE SEQUELA.
WE GO BACK TO THIS AGAIN AND
AGAIN, THE RISK WAS HIGHER TO
PEOPLE IN HOSPITALIZED AND
COMPARED TO NONHOSPITALLIZED AND
HIGHEST IN PEOPLE WHO NEEDED ICU
CARE DURING THE ACUTE PHASE OF
THE DISEASE.
AND YOU CAN SEE THAT THE GREEN
BARS ARE BARELY VISIBLE AND
THAT'S ACTUALLY GOOD.
THAT MEANS HOSPITALIZED THE RISK
IS THERE, IT'S EVIDENT BUT
ACTUALLY QUITE SMALL.
SO WHEN YOU TALK TO PEOPLE, MORE
THAN 80 OR 90% OF THE PEOPLE OF
SARS COV 2, VERY FEW OF THEM
WILL GO TO TO DEVELOP HEART
DISEASE AND OTHER SARS COV 2, SO
THE BURDEN HERE IS ACTUALLY
QUITE SMALL, IT'S NOT A VISUAL,
IT'S NOT 0, IT'S NOT TRIVIAL,
BUT IT'S QUITE SMALL, REAH
SURINGLY SMALL SO THIS IS LIKE A
SILVER LINING THAT THE FEW THAT
HAD--NEEDED ICU CARE OR WHAT
HOSPITALIZED EXPRESSED THE
HIGHER RISK AND THE MAJORITY WHO
ARE NOT HOSPITALIZED ACTUALLY
HAVE YOU KNOW THE LOWEST RISK
HERE.
LET ME ASK THE QUESTION, ARE
THESE CARDIOVASCULAR
MANIFESTATIONS DOES IT SPED ANY
SPECIFIC GROUP, SO WE DID
ANALYSIS BY AGE, RACE, SEX,
OBESITY, SMOKING, HYPERTENSION,
DIABETES, CHRONIC KIDNEY
DISEASE, HYPOLIP DEEMIA AND
CARDIOVASCULAR DISEASE AND THE
MORAL OF THE STORY OR THE SHORT
OF THE SLIDE IS, IT DOESN'T
MATTER IF PEOPLE WERE YOUNG OR
OLD, IT DIDN'T MATTER IF THEY
WERE BLACK OR WHITE, FEMALE OR
MALE, THEY HAD OBISITY OR DIDN'T
HAVE OBESITY, IF THEY SMOKED OR
NOT, OTHER CARDIOVASCULAR RISK
FACTORS INCLUDING HYPERTENSION,
DIABETES, CHRONIC KIDNEY
DISEASE, HYPER LIPIDEMIA, ANY
PRIOR CARDIOVASCULAR DISEASE,
NONE OF THIS MATTERS, LIKE,
THEY--IF THEY GOT SARS COV 2
INFECTION, THEY STILL MANIFESTED
WITH INCREASED RISK OF
CARDIOVASCULAR RISK OF SEQUELA,
AND WE WENT INTO THIS THINKING
THAT THOSE ARE GOING TO BE
HAPPENING IN PEOPLE WHO HAD
PRIOR CARDIOVASCULAR RISKS,
PEOPLE HAD HYPER LIP DEEMIA I
JUST TALKED WITH, PEOPLE WITH
OBISITY, PEOPLE WHO SMOKED A LOT
OR PEOPLE WHO DIDN'T EXERCISE
MUCH, PEOPLE WHO HAD PRIOR
DIABETES OR SOME METABOLIC
DYSFUNCTION AND THAT PUT THEM AT
A HIGH RISK OF VARDIO CASKULAR
DEC AND WE THOUGHT, YOU KNOW
BEFORE--BEFORE GETTING THESE
RESULTS WE THOUGHT THAT THOSE
PEOPLE AT HIGH RISK TO START
WITH, BEFORE GETTING SARS COV 2,
THEY GOT HIT WITH SARS COV 2 AND
THEY CAN GET THEM OVER THE EDGE
TO MANIFEST WITH THE DISEASE.
BUT IT WAS CLEAR HERE THAT EVEN
PEOPLE AT LOW RISK, PEOPLE WHO
HAD NO PRIOR RISK FACTORS, KNOW
DIABETES, NO HYPERTENSION, NONE
OF THIS STILL ALSO MANIFESTED
WITH INCREASED RISK OF
CARDIOVASCULAR CONDITION AND
THAT'S REALLY IMPORTANT BECAUSE
MECHANISTICALLY 2 THINGS COULD
BE AT PLAY HERE, 1 THING COULD
BE THAT SARS COV 2 MIGHT
ACCELERATE UNDERLYING RISK SO
SOMEONE HAD PRIOR ENDOTHELIAL
DYSFUNCTION OR SOME SORT OF FORM
OF DISEASE BECAUSE OF SMOKING OR
SMOKING FOR A LONG TIENL, THOSE
PEOPLE WHEN THEY GET THE
SARS-COV 2-INFECTION AND IT PUTS
THEM OVER THE EDGE AND THEY
MANIFEST WITH CLINICAL DISEASE
AND THEN 2, WHAT MAY BE
HAPPENING IS SARS MAY BE
PROVOKING THE DE NOVO INJURY
THAT MIGHT CASCADE DOWN WITHIN
THE SPAN OF A YEAR, THIS IS A
YEAR FOLLOW UP COHORT TO
MANIFEST WITH CARDIO LASKULAR
CONDITIONS AND DISEASE.
SO WE ALSO TURN OUR ATTENTION,
WE ARE NEPHROLOGIST, WE DO A LOT
OF KIDNEY DISEASE WORK PRIOR TO
THE PANDEMIC AND WE WANT TO SORT
OF LEAD THE KIDNEY UNATTENDED TO
WHEN WE ARE EVALUATING LONG
COVID, WE ALSO LOOK AT KIDNEY
MANIFESTATIONS OR THE RISK OF
KIDNEY DISEASE IN PEOPLE WITH
LONG ASHING AND REALLY THE SHORT
OF IT HERE THAT PEOPLE WITH SARS
KICKOFF 2 INFECTION, YOU KNOW
CAN HAVE UP TO A YEAR LATER CAN
HAVE AN INCREASED RISK OF YOU
KNOW ACUTE KIDNEY INJURY END
STAGE KIDNEY DISEASE, WHAT WE
CALL MAKE OR MAJOR ADVERSE
KIDNEY EVENTS AND THOSE INCLUDE
END STAGE KIDNEY DISEASE, ALL
CAUSE MORTALITY OR EGF ARE
DECLINED MORE THAN 30%.
THAT'S QUITE SUBSTANTIAL DECLINE
IN EGFR OR A MARKER OF KIDNEY
FUNCTION.
ESTIMATED RATE, THE MARKER OF
KIDNEY FUNCTION.
AND REALLY, YOU KNOW THIS IS
WORK LED BY BENIA MIN BOLT FROM
MY LAB, THE AMAZING THAT ALL THE
ANALYSIS, ALSO BY CARE SETTING
AND PEOPLE WHO ARE REALLY NOT
HOSPITALIZED, HOSPITALIZED BUT
DID NOT HAVE AKI DURING THE
ACUTE PHASE AND ALSO
HOSPITALIZED AND HAD AKI ACUTE
PHASE, AND FOR THOSE THAT WERE
HOSPITALIZED AND AKI MANIFEST
WIDE A HIGHER RISK BUT AGAIN
EVEN PEOPLE WHO WERE NOT
HOSPITALIZED AT ALL DURING THE
ACUTE PHASE STILL MANIFESTED
LATER ON WITH INCREASED RISK OF
AKI IN THE POST ACUTE PHASE,
INCREASES RISK OF ESKD AND
INCREASED KIDNEY DISUSE AND
INCREASED RISK OF MAJOR ADVERSE
KIDNEY EVENT.
AND HE DID A WONDERFUL,
WONDERFUL MATH MALICAL MODELING
OF THE EGFR DECLINE IN THESE
PATIENTS, WE APPRECIATE IT EVEN
AMONG THOSE HOSPITALIZED
ILLUSTRATED HERE IN RED,
SIGNIFICANT DECLINE IN GFR OVER
THE SPAN OF A YEAR.
IT'S ABOUT, YOU KNOW BETWEEN 2
AND 3, IT'S ABOUT LIKE 3 LITER
PER MINUTE AND THATIA REALLY
ALMOST LIKE A COVID OF AGING 2-3
YEARS, IN THE SPAN OF 1 YEAR.
THAT'S REALLY SORT OF A REALLY
CONSEQUENCIAL THING SO 2 LITER
PERMINUTE PER YEAR IS NOT A
WHOLE LOT.
IT'S ACTUALLY A WHOLE LOT ON TOP
OF NORMALIGING AND
ERESPONSIBLELY IF THIS WERE TO
PERSIST FOR A LONGER TOWARD OF
TIME.
WE ARE DOING ANALYSIS TO TRY TO
TRACK THESE PATIENTS FOR 2IERS
TO GET A DEEPER UNDERSTANDING
WHETHER THAT'S SORT OF DECLINE
MELLOWS DOWN.
THIS FIGURE SUGGIESTS IT MIGHT
SO WE'RE VERY, VERY INTERESTED
IN NEW DATA TO TRY TO SORT OF
GET A DEEPER PERSPECTIVE AND HOW
CHRONIC OR HOW REALLY--WHETHER
THE DECLINE WILL CONTINUE TO GO
ON OR NOT.
AND THEN WE DID SOME STUDIES TO
UNDERSTAND DEEPER TO UNDERSTAND
THE RISK OF DIABETES IN PEOPLE
WITH SARS COV 2 INFECTION IN THE
POST ACUTE PHASE OF THE DISEASE.
AND THE RISK OF DIABETES WAS
EVIDENT, IT WAS NOT ONLY THAT
PEOPLE GOT DIAGNOSED WITH
DIABETES BASED ON HEMOGLOBIN AC1
C CRITERIA, BUT ALSO GOT
INITTIAITED ON THE HYPER
GLYCEMIC THERAPY AND THAT'S
IMPORTANT BECAUSE THIS IS JUST
NOT A DIAGNOSIS PEOPLE THOUGHT
OR PHYSICIANS, PROVIDERS THOUGHT
THAT THIS DIABETES IS,--IS TRUE,
IT'S IMPORTANT ENOUGH FOR THEM
TO BE INITIATED TREATMENT.
AND OUR THEME HERE TO PRODUCE
MULTIPLE TIMES THAT THERE IS A
GREATER ASSOCIATION OF RISK IN
THE SENSE OF PEOPLE WHO WOULD
ADMIT INTENSIVE CARE FOR THE
HIGHEST RISK OR THE HIGHEST
RISK.
IT DOESN'T ABSOLUTE RISK HERE,
SO THEY GIVE YOU APPRECIATION OF
THE MAGNITUDE OF THE ABSOLUTE
RISK IN THESE THINGS, YOU KNOW
HERE IS ABOUT 1-2%, SO 1-2% OF
PEOPLE, OF PEOPLE WHO WERE
EXPOSED TO SARS COV 2 MIGHT GO
ON TO DEVELOP DIABETES IN OUR
COHORT, AND 1 MAY SAY WELL, LIKE
1-2% IS NOT A WHOLE LOT, YOU
KNOW IF YOU MULTIPLY THAT BY THE
SIGNIFICANT NUMBER OF SARS COV2
IN THE U.S., THAT WAS
TRANCEALATED TO A SIGNIFICANT
BUMP IN DIABETES.
BUT IT ALSO MAKE ITS HARD TO
DETECT CLINICALLY BECAUSE YOU
CAN SEE HUNDRED PATIENTS WITH
SARS COV 2 AND ONLY 1 OF THEM
WILL ACTUALLY HAVE DIABETES AS A
RESULT OF SARS, A-THERE'S NO
BIOMARKER TO DIFFERENTIATE THAT
DIABETES FROM AND OTHER THINGS.
AND 1 OUT OF A HUNDRED IS ALMOST
LIKE A NEEDLE IN THE HAY STACK
SO IT MAKES IT REAL ACTUALLY,
IT'S SORT OF EASY FOR US TO SEE
IT VERY LARGE COLOSSAL DATA
APPROACH, USING OUR DATA AND
TOOLS, MUCH HARDER TO SEE IT IN
THE FRONT LINE WHEN YOU ARE
REALLY LOOKING FOR THAT 1 IN A
HUNDRED PATIENTS WITH COVID-19
COMING BA BEING TO THE CLINIC
AND ONLY 1 WILL HAVE METABOLIC
DYSFUNCTION AS A RESULT OF SARS
COV 2 ESPECIALLY IN THE ABSENCE
OF BIOMARKERS OR THE THING THAT
COULD DEFERENTIATE IT FROM
EVERYTHING ELSE.
AND I HAVE TO SAY HERE, LET'S GO
BACK TO THIS THAT THE REST OF
THE PAPER HERE AGAIN LED BY YAN
XIE, IN MY TEAM, BRILLIANT MAN
FROM MY TEAM, BUT THE RISK WAS
EVIDENT FOR THOSE THAT HAD NO
PRIOR RISK FOR DIABETES AT ALL
AND THAT'S AN IMPORTANT
COMPONENT HERE THAT MAYBE IN
THOSE INSTANCES SARS COV 2 IS
RESULTING IN DE NOVO DISEASE
ALTOGETHER, DIDN'T NECESSARILY
HEAD TO PEOPLE WHO HAD PRIOR
METABOLIC DYSFUNCTION OR PRIOR
PREDELICATION OR DIABETES, BUT
IT ALSO CAN AFFECT PEOPLE WHO
HAD NO PRIOR RISK FACTOR FOR
DIABETES AT ALL.
AND THEN WE TURN OUR ATTENTION
TO TRY TO UNDERSTAND THE RISK OF
MENTAL HEALTH OUTCOMES, THIS IS
ALSO WORK LED BY THE AMAZING YAN
XIE AND MY TEAM, CATALOGING THE
BREDTH OF MANIFESTATIONS THAT
CAN HAPPEN IN PEOPLE WITH SARS
COV 2 INFECTIONS UP TO A YEAR
LATER, SO THIS IS AGAIN A GROUP
COMPARED TO NEARLY MORE THAN
10 MILLION CONTROLS.
ONE CONTROL GROUP IN THE
CONTEMPORARY ERA, MEANING THERE
WERE EXPOSED TO THE SAME BROADER
CONDITIONS OF THE PANDEMIC LOCK
DOWN, NO GYM, NO STARBUCKS FOR
YOU AND ALL THESE STRESSORS THAT
AFFECTED OUR LIVES ALL OF A
SUDDEN STARTING MARCH 2020 AND
THEN FOLLOW THEM FOR A YEAR AND
THEN ALSO HISTORICAL CONTROL
GROUP PREPANDEMIC ERATHOSE
PEOPLE WERE NOT EVEN EXPERIENCE
THE PANDEMIC AT ALL AND WHAT YAN
SHOWS HERE REALLY WONDERFUL,
EARLIER THIS YEAR THAT YOU KNOW
I SHOULD PREFACE THIS BY SAYING
THAT WE'VE KNOWN ALL ALONG THAT
ALL OF US, ALL OF US DURING THIS
PANDEMIC, MOST OF US DURING THE
PANDEMIC EXPERIENCED SOME SORT
OF STRESS.
INCLUDING MYSELF, I WAS STRESS
TD OUT A LOT, MY TEAM WAS
STRESSED OUT IT WAS AN ENORMOUS,
IT A CHALLENGING TIME FOR ALL OF
US HERE.
SO WE KNEW THAT A LOT OF THE
POPULATION MNCHT HAVEOME
STRESS BUT WE ASKED THE QUESTION
HERE, DO PEOPLE WITH SARCOV 2
INFECTION HAVE IT WORSE?
DO PEOPLE WITH SARS COV 2
INFECTION EXHIBIT A HIGHER RISK
THAN [INDISCERNIBLE] WHO DID NOT
GET SARS COV2 INFECTION, DID
THEY EXHIBIT HIGHER RISK OF
MENTAL HEALTH PROBLEMS AND THE
ANSWER IS ABSOLUTELY, ABSOLUTELY
YES, PEOPLE WITH SARS COV 2
INFECTION, HAVE HIGHER ANXIETY
DISORDERS, DEPRESSIVE DISORDERS,
STRESS AND,A JUSTMENT DISORDERS
AND NOT ONLY DIAGNOSIS, PEOPLE
THOUGHT OF THESE ACTUALLY
CONSEQUENTIAL AND IMPORTANT
ENOUGH TO START THEM ON MEDICAL
THERAPY INCLUDING SSVIs
ACCIDENT BENZO DIAZ PENES, ET
CETERA, ET CETERA.
AN ALARMING FIEBDING IN OUR DAT
WE FIND THAT SOME PEOPLE ARE
COMING BACK TO THE CLINIC FOR A
VARIETY OF REASONS BUT PRIMARILY
PAIN, AMONG PEOPLE WITH SARS
COV2 AND HAVE LONG COVID ARE
BEING PRESCRIBED OPIOIDS AND WE
SEE AN INCREASED RISK OF OPIOID
UTILIZATION IN THIS POPULATION
AND HIGHLIGHTING BECAUSE WE ALL
NEED TO PAY ATTENTION IT, ALL OF
US LIVE THROUGH THE HORROR OF
THE OPIOID EPIDEMIC AND WE'VE
ALL THOUGHT THAT WE ARE TRYING
TO CURVETILIZATION AND P IT TO E
IT AND SUPPRESS IT AND WE'VE
DONE ACTUALLY QUITE A GOOD JOB
BEFORE THE PANDEMIC AND THE
PANDEMIC HIT AND WE'VE SEEN OUR
SIGNALS NOW ARE DATA, I HOPE
THIS DOES NOT CONTINUE.
THESE ARE EARLY SIGNALS OF
RESURGENCE OF OPIOID USE
SPECIFICALLY IN PEOPLE WITH SARS
COV2 INFECTION, THAT DEMANDS
ATTENTION TO NIP IT IN THE BUD
AND CURVE IT AGAIN TO PREVENT IT
FROM CASCADING DOWN TO ANOTHER
OPIOID EPIDEMIC TO LEAD DOWN TO
MAYBE MAJOR PROBLEMS.
WE SEE INCREASED RISK OF
SUBSTANCE USE DISORDERS,
NEUROCOGNITIVE DECLINE AND SLEEP
PROBLEMS, SO REALLY, IT REALLY
SPANS THE GAMUT HERE WHEN YOU
TALK ABOUT CLINICAL HEALTH
DISORDERS.
AND AGAIN, NOT TOO SPEND TOO
MUCH TIME ON THIS SLIDE THERE
THE RISK IS A GREAT ASSOCIATION
WITH CARE SETTING AT BASE LINE.
EXCUSE ME, I USED TO ASK NOW,
WELL, DO THESE PEOPLE, YOU KNOW
CAN YOU SORT OF GET US A LITTLE
BIT OF AN UNDERSTANDING HOW DOES
SARS COV2 BEHAVE VIS A VIS
SEASONAL INFLUENZA SO WE DID
ANALYSIS TO TRY TO DEEMERGING
HERE ARE THESE INCREASED RISKS
REALLY SPECIFIC TO SCARS COV2 OR
CAN THEY BE PRESCRIBING WENT ANY
VIRAL ILLNESS AND AGAIN HERE IN
OUR WORK, WHEN WE AM CO PAIR IT
HEAD-TO-HEAD OR APPLES TO
HAPPENLES COMPARISON AS NEAR TO
IT AS WE CAN DO IT, IT'S VERY,
VERY CLEAR PEOPLE WITH SARS COV
2 INFECTION HAVE A HIGHER RISK
OF THESE DISORDS.
THERE'S ALSO HIGHER RISK FOR
HOSPITALIZED FOR ANY OTHER
CAUSE, MEANING WHEN WE COMPARE
PEOPLE WHO ARE HOSPITALIZED FOR
SARS COV 2, VERSUS HOSPITALIZED
FOR AND OTHER CAUSE THOSE
HOSPITALIZED FOR SARCOV2 EXHIBIT
A HIGHER RISK OF MENTAL HEALTH
DISORDERS.
THERE'S SOMETHING ABOUT SARS
COV2 OR SPECIFICITY TO IT
RESULTING IN ALL THESE POST
ACUTE SEQUELA WE'VE SEEN IN
EPIDEMIOLOGIC ANALYSIS.
THIS IS FRESH OFF THE PRESS,
THIS WAS PUBLISHED LAST WEEK IN
NATURE MEDICINE.
EVALUATING THE RISK OF POST
ACUTE SEQUELA IN BREAK THROUGH
SARS COV-2, THESE PEOPLE ARE
PREVIOUSLY VACCINATED AND
SUBSEQUENTLY GOT BREAK THROUGH
SARS COV2 AFTER COMPLETING A
SERIES OF VACCINATION YOU KNOW
FOR COVID-19.
SKI ASKED 2 KEY QUESTIONS, WE
WANTED A-UNDERSTAND PEOPLE WITH
PEOPLE WITH SARS COV2 INFECTION
GET LONG COVID?
AND THE ANSWER IS ABSOLUTELY
YES.
QUALITATIVELY, IT IS NOT
DIFFERENT THAN POST ACUTE
SEQUELA OR LONG ASHING THAT
HAPPENS IN PEOPLE WHO ARE
UNVACCINATED IN THE SENSE THEY
GET BRAIN FOG, FATIGUE, MUSCLE
PAIN, YOU KNOW, IT'S
INDISTINGUISHABLE QUALITATIVELY.
FROM LONG COVID OR POST ACUTE
SEQUELA HAPPEN IN UNVACCINATED
INDIVIDUALS.
AND THEN 2, QUESTION 2 THAT WE
WANT TO ANSWER IN THIS PAPER WAS
THAT YOU KNOW DOES VACCINATION
DO ANYTHING?
DOES VACCINATION HELP?
AND THE SHORT ANSWER IS IT
ACTUALLY DOES BUT NOT REALLY NOT
A WHOLE LOT, OVERALL WHEN WE
ANALYZE THE RISK OF ANY POST
ACUTE SIGNIFY QUELLA VACCINATION
REDUCES THE RISK BY ONLY 15%,
1-5.
HOWEVER RISK REDUCTION IS
VARIABLE ACROSS DIFFERENT ORGAN
SYSTEM, IT'S MOST PRONOUNCED
RISK REDUCTION IS MOST
PRONOUNCED MOST EVIDENT, MOST
CLEAR IN 2 ORGAN SYSTEMS,
A-COAGULATION DISORDERS THAT
BLOCK CLOTS THAT I TOLD YOU
ABOUT THAT WE SEE PEOPLE IN THE
SARS COV2 INFECTION, PULMONARY
DISORDERS AND CARDIO DISORDERS,
THESE 2 SEEM TO BE MOST AFFECTED
BY VACCINATION AND THE RISK IS
MOST EVIDENT IN THESE 2 SPECIFIC
DOMAINS.
THIS IS A SLIDE ABOUT MECHANISMS
AND THESE ARE MECHANISMS WE
DON'T REALLY KNOW WHY PEOPLE,
WHY SOME PEOPLE WITH SARS GO ON
TOO FAST WITH POST ACUTE SEQUELA
OF SARS COV 2, BUT THERE ARE
SEVERAL HYPOTHESIS HERE, YOU
KNOW THIS IS REALLY FROM
[INDISCERNIBLE] IN SCIENCE, NOT
SO LONG AGO, WONDERFUL LUCID
THINKING ABOUT THE POST ACUTE
SARS COV 2 AND POTENTIAL
HYPOTHESIS LEADING TO THAT.
ONE IS REALLY AUTOIMMUNITY AND 2
IS MICRO BIOME DISBIOSS, SARS
COV 2 IN THE ACUTE PHASE
DISTURBS THE MICROBIOME, AND
THIS IS SPHBL FOR EXPHELGT
DISEASE CAN SORT OF TRIGGER
INFLAMMATION, ET CETERA, ET
CETERA, LEADING TO SOME OF THE
MANIFESTATION WE SEE IN THE POST
ACUTE PHASE OF THE DISEASE.
ONE OTHER HYPOTHESIS AND YOU
KNOW STILL REMAINS TO BE REFUTED
OR PROVEN, IS THE IDEA OF THE
PRESENCE OF A VIRAL RESERVOIR OR
REMNANTS OF VIRUS IN
QUOTE-UNQUOTE IMMUNE SIZE, THEY
ARE NOT ACCESSIBLE TO THE IMMUNE
SYSTEM AND THE PERSISTENCE OF
THE VIRUS OR ITSELF FRAGMENTS
AND THOSE SITES WILL ILLICIT AND
PROLONG THE LOW GRADE BUT
LONG-TERM INFLAMMATION THAT MAY
RESULT IN ORGAN INJURY.
SOME OF THE MANIFESTATIONS WE
SEE IN SARS COV-2 BEYOND THE
ACUTE PHASE AND THE LAST 1 IS
REALLY TISSUE DAMAGE THAT CAN
HAPPEN IN THE ACUTE PHASE AND
MAYBE THE BODY'S ON ITS WAY TO
REPAIRING IT OR, YOU KNOW SORT
OF THAT TISSUE DAMAGE MAY THEN
SUBSEQUENTLY RESULT IN POST
ACUTE SEQUELA, I HAVE TO SAY
THESE ARE SORT OF ALL MECHANISMS
OF THE DISEASE AND
[INDISCERNIBLE], THIS IS A
LITTLE BIT OF A SORT OF THE WHY
NEUROLOGIC MANIFESTATIONS HAPPEN
IN PEOPLE WITH SARS COV2, BUT
IT'S MISUNDERSTOOD BUT IT'S FROM
NIH, FROM THE [INDISCERNIBLE] AT
NIH AND SERIES POINTSA
[INDISCERNIBLE] FROM YALE, AND
RECENTLY IN SCIENCE, WONDERFUL
WONDERFUL LUCID THINKING ABOUT
NEUROLOGIC MANIFESTATIONS AND
PEOPLE WITH POST COVID CONDITION
OR P A, C AND THIS IS THEIR
HYPOTHESIS THAT THIS SCHEMATIC
FOR WHAT'S POTENTIALLY GOING ON,
AND THE SHORT ANSWER IS THAT WE
DON'T FULLY UNDERSTAND, THESE
ARE PUTATIVE MECHANISMS OF
DISEASE, THAT INVOLVES THE
RECRUITMENT OF OTHER CELLS AND
INFLAMMA ARE TOY CELLS,
SUBSEQUENT CYTOKINES AND CELLS
AND ACTIVATION OF MICROGLUE
MARIOUSA IN THE BRAIN AND
ENDOTHEL YIETIS THAT MIGHT
PROVOKE COAGULATION LEADING TO
MICROCLOTS OR MICROBLEEDS
EXPLAINING THE MINISTROKES OR
STROKES OR BRAIN DISTORTION OR
BRAIN FOG OR OTHER
MANIFESTATIONS OF THE DISEASE
THAT WE SEE IN PEOPLE WITH SARS
COV 2 INFECTION AND I HAVE TO
CAVEAT THIS BY THIS IS A LOT OF,
YOU KNOW SPECULATION, AT LEAST
OUR MECHANISMS THAT ARE BEING
WORKED ON BY A LOT OF PEOPLE
THROUGHOUT THE WORLD, BUT NONE
OF THEM REALLY IS ESTABLISHED AS
A PROVEN MECHANISM THAT EXPLAINS
THE POST ACUTE MANIFESTATION OF
SARS COV 2.
SO WHEN WE TALK ABOUT LONG
ASHING, IT'S REALLY AN UMBRELLA
TERM AND I HOPE, WE ALL HAVE AN
AAPPRECIATION THAT PEOPLE WHO
GET HOSPITALIZED ESPECIALLY IF
THEY SPEND TIME IN THE HOSPITAL
ISSUE GOOD TIME IN THE HOSPITAL
OR IN THE ICU, THEY ACTUALLY
HAVE A POST ICU SYNDROME AND
LONG ASHING SOME OF THE FEATURES
ACTUALLY OVERLAP WITH POST ICU
AND HOSPITALIZATION SYNDROME.
AND ALSO NEEDS TO BE UNDERSTAND
WITHIN SORT OF BROADER POST
VIRAL ILLNESS AND YOU KNOW WE
HAVEN'T DONE A LOT CHARACTERIZED
IN DETAIL WHAT HAPPENS IN THE
POST FLU CONDITION BUT TO BE
VERY CLEAR THAT YOU KNOW
ACTUALLY PEOPLE WITH FLU ALSO
SOME OF THEM EXPERIENCE, YOU
KNOW POST ACUTE SEQUELA AND THIS
WAS REALLY EVIDENT EVEN A
HUNDRED YEARS AGO AND THAT TIME
IT WAS CALLED ENSIEVE LIGHTIS OR
SICKNESS OR POST ENCEPHALETTIC
PARKINNISM, MEASLES COULD ALSO
PRODUCE POST ACUTE SEQUELA AND
ALSO PAN-ENCEPHALITIS, WE
LEARNED THAT EVV CAN BE LINKED
TO MULTIPLE SCLEROSIS DOWN THE
ROAD THAT IS THE POST EBOLA
SYNDROME AND POST POLIO
SYNDROME, SO ME/CFS AND THERE
ARE A LOT OF SIMILARITIES AND
DIFFERENCES WEAN ME/CFS OR THE P
A SC.
SO AS WE DELVE DEEPER INTO
BRAINSTORMING AND RESEARCHING
AND AIMS AND HYPOTHESIS FOR THE
MOST COVID CONDITION, LONG COVID
OR P A SC, IT'S IMPORTANT TO PUT
THAT IN THE CONDITION AND
OVERLAP WITH THE [INDISCERNIBLE]
OF ICU.
SHOULD BE ASKING NOW, IS LONG
COVID RARE?
IT'S NOT RARE.
ALTHOUGH THE FIGURES FROM OUR
REPORTS ALMOST ALL UNIVERSALLY
IN THE SINGLE DIGIT, AND WE PUT
IT OUT BETWEEN 4 AND 7% BUT
BECAUSE THE SCALE OF THE PEOPLE
INFEC WIDE SARS IN THE U.S. AND
GLOBAL 4-7% OF POPULATION IS
REALLY, REALLY A HUGE NUMBER.
SO PEOPLE HAVE A HIGHER FIGURE
AND OUR FIGURES IS REALLY AROUND
47%, SO WHAT ARE THE
IMPLICATIONS FOR HEALTH SYSTEMS,
I THINK THE BURDEN IS LIKELY
SUBSTANTIAL.
IN OUR WORK WE THINK WHRRP
BETWEEN 4 AND 7%, AGAIN THAT'S
MUCH, MUCH, LESS THAN WHAT YOU
READ IN THE PRESS OR IN THE NEWS
AND OTHER REPORTS UNCONTROLLED
REPORTS.
IT'S POSSIBLE WE ARE
UNDERESTIMATING THE PROBLEM, BUT
EVEN 4 TO 7-% OF PEOPLE WHO ARE
INFECT WIDE SARS COVR 2 HAVING
LONG COVID COULD REALLY HAVE
LONG SERIOUS APPLICATION ON OUR
LIFE.
IT IS A DEC THAT CAN AFFECT
NEARLY EVERY ORGAN SYSTEM AND WE
THINK BECAUSE IT AFFECTS, YOU
KNOW AT LEAST INCREASES
DIABETES, CHRONIC KIDNEY
DISEASE, MENTAL HEALTH
DISORDERS, CARDIOVASCULAR
DISEASE, THAT WOULD LEAD TO A
RISE IN THE BURDEN OF
NONCOMMUNICABLE DISEASES, SO WE
THINK IT'S IMPORTANT, WE
CONTRIBUTE A RISE OF THE BURDEN
OF NONCOMMUNICABLE DISEASES IN
THE U.S. AND ELSEWHERE.
SO WE THINK IT'S VERY IMPORTANT
THAT GOVERNMENTS AND HELT
SYSTEMS PREPARE FOR PEOPLE WITH
POST COVID OR WITH LONG COVID
THAT NEED CARE.
THE [INDISCERNIBLE] HEALTH
SYSTEM HAS STOOD UP SEVERAL
CLINICS, SERL U.S. HEALTH
SYSTEMS ARE DOING SO, THE VA HAS
STEPPED UP TO THE PLATE AND DONE
A REMARKABLE JOB IS SETTING UP
POST COVID CLINICS AND THAT'S
THE BEST WAY TO GO FOR CARING
PER PEOPLE WITH LONG COVID AND
IT'S IMPORTANT THAT THE HEALTH
SYSTEM REALIZE THE IMPORTANCE OF
THIS AND BE PREPARED TO ADDRESS
THE NEEDS OF THE PATIENTS.
THE BEST WAY TO PREVENT LONG
COVID IS TO PREVENT COVID IN THE
FIRST PLACE.
IF YOU HAVEN'T ENCOUNTERED IT
YET, DO YOUR BEST TO PREVENT
YOURSELF AND YOUR LOVED 1S FROM
ACTUALLY HAVING COVID.
THE BEST WAY IS TO PREVENT COVID
IN THE FIRST PLACE AND OBVIOUSLY
THE BEST WAY WE KNOW TO PREVENT
SEVERE DISEASE AND
HOSPITALIZATION AND THAT FROM
ACUTE COVID IS REALLY
VACCINATION.
IT IS VERY IMPORTANT, I CAN'T
REALLY GIVE A TALK ON COVID OR
LONG COVID WITHOUT TALKING ABOUT
MISINFORMATION, DISINFORMATION
AND GAS LIGHTING.
SO IT'S REALLY IMPORTANT TO
REALIZE THAT THIS IS HAPPENING
IN THE PUBLIC SPHERE AND U.S.
AND ELSEWHERE AND EUROPE AND A
LOT OF OTHER PLACES AND IT'S
VERY IMPORTANT TO TAKE YOUR ROLE
VERY, VERY SERIOUSLY AND
ACTIVELY COMBATING GAS LIGHTING.
IT'S REALLY IMPORTANT.
WE CANNOT BE SWITTER LAND AND
TAKE A NEUTRAL APPROACH HERE.
I WOULD ARGUE WE HAVE AN
OBLIGATION TO STEP UP TO THE
PLATE AND ACTIVELY COMBAT, YOU
KNOW MISINFORMATION,
DISINFORMATION GAS LIGHTING.
WITH DATA, WITH SCIENCE, WITH
FACTS, AND TO PROMOTE PUBLIC
UNDERSTANDING OF THIS CONDITION.
AND REALLY WE CANNOT IGNORE THE
PATIENT ADVOCACY IN THIS TALK AS
LI WOULD NOT BE RESEARCHING, MY
GROUP WOULD NOT BE RESEARCHING
LONG COVID, WE WILL NOTED BE
KNEE DEEP BO IT HAD IT NOT BEEN
FOR THE WONDERFUL PATIENT
ADVOCACY WHO GAVE US A LOT
STRENGTH, THE WARMTH IN OUR
HEART REALLY TO PURSUE THIS AND
REALLY A CHALLENGING JOURNEY,
THIS IS NOT EASY TO DO ALL OF
THIS, BUT REALLY HAD IT NOT BEEN
FOR THEM, WE WOULD NOT BE HERE
TALKING ABOUT THIS.
WHEN WE TALK ABOUT LONG ASHING,
THAT'S REALLY NOW, STILL BENEATH
THE TIP OF THE ICEBERG, TIP OF
THE ICEBERG IS THE ACUTE
DISEASE, THIS IS DISEASE, LIFE
EXPECTANCY, CHANGES OR
REDUCTION, DEVELOPMENT AND
EDUCATION OF KIDS WITH COVID,
THEY WILL HAVE BROAD AND
ECONOMIC COMPLICATIONS.
WE DON'T SEE THIS, THIS IS
BENEATH THE ICEBERG, WE CONTINUE
TO FECUS ON HOSPITALIZED AND
DEATHS, WE SHOULD FOCUS ON THE
LONG HAUL AND WHAT'S BEENEATH
AND A LOT MORE AND WILL LIKELY
ELLIPSE THAT THE TIP OF THE
ICEBERG.
SO IN SUMMARY, I HOPE I CONVEYED
TO YOU THAT LONG ASHING IS A
MULTIFACETED DISEASE THAT CAN
AFFECT NEARLY EVERY ORGAN
SYSTEM, THE BURDEN IS BETWEEN
4-7%, GOVERNMENT AND HEALTH
SYSTEMS MUST ADAPT QUICKLY AND
ESTABLISH POST COVID CARE
STRATEGIES.
REALLY WANTED TO HIGHLIGHT, YOU
KNOW THE KEY PEOPLE WHO
CONTRIBUTE TO A LOT OF THIS WORK
YAN XIE, AMAZING, AMAZING,
AMAZING GUY FROM MY TEAM WHO LED
A LOT OF THIS WORK I PRESENTED
TODAY.
BENJAMIN BOWE, EVAN XU FROM MY
TEAM, KEY MEMBERS HERE INCLUDE
MIAO CAI, ANDREW GIBSON,
TAEYOING CHOI, AND OTHERS.
GRATEFUL FROM THE FUNDING FROM
THE U.S. DEPARTMENT OF VETERANS
AFFAIRS AND TO THE SUPPORT OF MY
MENTEES BY THE AMERICAN SOCIETY
OF NEPHROLOGY AND THE SUPPORT AT
THE VI AND MOST IMPORTANTLY THE
LONG HAULER WHO IS INSPIRED US
AND CONTINUE TO INSPIRE US TO DO
THIS WORK.
I WAS HOPING TO LEAVE 10 MINUTES
FOR QUESTIONS BUT WE HAVE LESS
THAN 5 MINUTES.
WOULD BE DELIGHTED, DELIGHTED TO
HAVE QUESTIONS FROM THE
AUDIENCE.
>> THANK YOU SO MUCH DOCTOR.
SO HELLO EVERYBODY, I'M AN
INFECT YOWZ DISEASE DOCTOR AT
NAID AND I WILL RELAY YOUR
QUESTIONS TO DR. ALAS LY, SO
FIRST OF ALL I WOULD LIKE TO
THANK YOU SO MUCH FOR THIS
FASCINATING TALK AND FOR SHARING
WITH US THE IMPORTANT WORK THAT
YOU DO AND THAT YOU'VE DONE AND
ALSO FOR SHOWING US THE WEALTH
OF INFORMATION THAT THE VA
HEALTH SYSTEM COLLECTS AND THE
SOPHISTICATED WORK THAT CAN BE
DONE WITH IT.
SO TO GET STARTED, THE FIRST
QUESTION HAS TO DO WITH ACE 2
RECEPTORS AND THE QUESTION IS
WHAT HOLE DOES THE SARS COV 2
VIRUS BINDING TO ACE 2 RECEPTORS
IN THE PATHOLOGY OF
CARDIOVASCULAR AND KIDNEY
DISEASE SEQUELA IN THE PATIENTS
YOU HAVE BEEN FOLLOWING TO US
ABOUT AND AS A FOLLOW UP TO
THAT, COULD IT BE THAT THE
DIFFERENT NUMBERS OF RECEPTORS
ON DIFFERENT CELLS PLACENTA I A
ROLE IN THAT.
>> THIS IS ABSOLUTELY
FASCINATING SO CERTAINLY THERE
IS A HYPOTHESIS OUT THERE THAT
SPIKE PROTEIN INTERACTION WITH
AN AGE 2 RECEPTOR WITH SERL CELL
TYPES INCLUDING CARDIOVASCULAR
CELLS AND KIDNEY CELLS MIGHT
LEAD OR EXPLAIN THE PATHOGENESIS
OR THE ORGAN INJURY IN THESE
CELLS.
I HAVE TO SAY THAT THE DATA ON
THIS OR THE MECHANISTIC DATA ON
THIS IS STILL EVOLVING, YOU KNOW
WITH THE OTHER DATA LIKE
NEWSPAPER AND CELLS THAT ARGUE
THAT THAT MIGHT BE THE CASE.
SO THE LITERATURE ON THIS IS
EVOLVING BUT IT'S A VIABLE AND
IMPORTANT HYPOTHESIS.
WHETHER THE SPIKE PROTEIN WITH A
RECEPTOR ON SEVERAL CELL TYPES,
MEDIATE INJURY.
AND WHETHER ALSO LIKE, THE
ABUNDANCE OF ACE 2 RECEPTOR THIS
THESE CELLS WAS REALLY SORT OF 1
OF THE RISK FACTORS OR 1 OF THE
MECHANISMS LEADING TO INJURY IN
THOSE CELLS.
I THINK THE JURY ON THIS IS
STILL OUT.
THERE WAS A LOT OF TALK EARLY
ON, ABOUT ACE INHIBITORS, I
THINK THE JURY ON THIS IS STILL
OUT BUT IT'S A POSSIBLE
HYPOTHESIS FOR SURE.
>> THANK YOU.
SO THE NEXT QUESTION IS THE
SYMPTOMS OF LONG COVID ARE
SIMILAR TO THOSE THAT PATIENTS
WITH FIBROMYALGIA HAVE AND I'M
CITING FOR YEARS WITH NO OR
VARIED RECOGNITION FROM THE
MEDICAL COMMUNITY.
WHY DO YOU THINK IT IS THAT LONG
COVID HAS BEEN RECOGNIZED AS A
TRUE SYNDROME WHERE FIBRO MIRROR
IMAGEIALGIA IS NOT
AS--FIBROMYALGIA IS NOT
RECOGNIZED AS MUCH IN THE
COMMUNITY?
>> I THINK A LOT OF FACTORS.
MULTIPLE SORT OF LIKE RESEARCH
PROGECS TRY TO EVEN UNDERSTAND
LIKE HOW DO WE BEGIN TO ANSWER
THIS QUESTION.
SO I THINK IT'S MULTIFACTORIAL.
I TRIBUTE A LOT OF THIS FROM THE
ADVOCACY EARLY ON AND THEY
ORGANIZED EARLY ON, AND REALLY
LEVERAGED SOCIAL MEDIA, LIKE
THERE ARE--AND THE WIND BEHIND
THEM LIKE SORT OF ALSO IN A
COMPLEX OF A PANDEMIC, YOU KNOW
LOOKING FOR WHAT SARS COV2 IS
DOING TO PEOPLE, SO I THINK ALL
OF THAT, SORT OF, YOU KNOW SORT
OF ALL THESE FACTORS TOGETHER
CONTRIBUTED TO PROMOTING
AWARENESS OF LONG COVID AND IN A
VERY, VERY IMPORTANT WAY THAN
SAY FIBROMYALGIA OR EMS, YOU CAN
SPEND 30 YEARSA ADVOCATING FOR
THE DISEASE TO BE VISIBLE IN THE
NATIONAL SPOTLIGHT AND I HAVE TO
ATTRIBUTE THIS THERE'S QUITE A
BIT OF MEDIA ATTENTION THAT, YOU
KNOW THIS IS AGAIN, THE PATIENT
ADVOCACY AND THE POWER OF
PATIENT ADVOCABULARY KASP A R
EXPE KNOWING THE RIGHT LEVERS TO
PUSH.
I KNOW IT'S LIKE A LOT OF, YOU
KNOW JOURNALISTS SPECIFICALLY
INTERESTED IN LONG COVID HAVE AN
INTEREST IN IT.
YOU KNOW NEW YORK TIMES, WALL
STREET JOURNAL, THAT REALLY
HELPS, LIKE THE PATIENT
COMMUNITY CONNECTING WITH THOSE
KEY STAKEHOLDERS AND LEVERAGING
THOSE LETTERS OF POWER IN THE
MEDIA, AND CONGRESS AND IN
SENATE AND THE HOUSE, AND
ACADEMIA TO REALLY PROMOTE THEIR
CAUSE, I THINK THAT ALL HAD SORT
OF A--LED TO THIS REALLY--THIS
REALLY MOMENT WHERE WE RECOGNIZE
LONG COVID AS A MAJOR PROBLEM
AND A LOT OF RESEARCH ON IT, AND
NIH RECOVER INITIATIVES, THE
WHITE HOUSE IS LOOKING AT THIS
ON NEARLY ALMOST A DAILY BASIS,
SORT OF AN INTEREST IN LONG
ASHING SO IT'S QUITE REMARKABLE
WITH THE LEVERAGE OF INTEREST IN
THIS DISEASE.
>> THANK YOU.
IN YOUR TALK YOU MENTION THAD
PATIENTS WITH LONG COVID
EXPERIENCE CARDIOVASCULAR
DISEASE UP TO A YEAR POST
INFECTION, WHICH IMPLIES THESE
SYMPTOMS RESOLVE AFTER A CERTAIN
TIME.
SO, SO THIS AUDIENCE MEMBER IS
WONDERING HOW THIS IS POSSIBLE,
ONCE THE DAMAGE IS IN
CARDIOVASCULAR DISEASE IS A
PROGRESSIVE KIND OF DISEASE,
WOULDN'T THE IMPACT OF THIS
DAMAGE KEEP PROGRESSING THROUGH
A LIFETIME AND IF NOT, SHOULD
THIS GIVE US HOPE OR WOULD THIS
SUGGEST THAT THESE SYMPTOMS
WOULD EVENTUALLY DISAPPEAR OR
GET BETTER.
>> THIS IS VERY, VERY CLEAR LONG
COVID IS A LOT OF DIFFERENT
THINGS.
SO IN THE CARDIOVASCULAR
MANIFESTATION CHEST PAIN COULD
RESOLVE WITH PAIN, PEOPLE COULD
WAKE UP AND IT'S ALL GONE AND
NEVER HAVE IT AGAIN BUT IT'S
ALSO VERY, VERY CLEAR THAT SOME
MAN IF HE FELTATIONS ARE CHRONIC
DISEASE STATES THAT WILL LAST
FOR A LIFETIME WHEN WE TALK
ABOUT KIDNEY DISEASE OR CHRONIC
ACUTE SYNDROME OH HEART FAILURE,
THEY DON'T WAKE UP TOMORROW CAN
DON'T HAVE CHRONIC KIDNEY
DISEASE.
PEOPLE HAVE HEART FAILURE AS A
RESULT OF SARS COV 2 INFECTION,
THEY DON'T WAKE UP AND THEN
HEART FAILURE IS GONE.
THEY ARE TREATABLE, MANAGEABLE
BUT THEY'RE NOT CURABLE
CONDITIONS, MEANING THAT THEY'RE
LIKELY TO STICK WITH PEOPLE FOR
A LIFETIME.
WHEN WE TALK ABOUT NEW ONSET
DIABETES, AS A RESULT OF SARS
COVERY 2 INFECTION, ONLY 1-2% IN
OUR DATA AND SO WE CAN DISCOVER
THE NEEDLE IN THE HAY STACK BUT
DIABETES GENERALLY A CHRONIC
DISEASE STATE.
IT'S NOT SOMETHING THAT YOU WAKE
UP AND GO OH I NO LONGER HAVE
DIABETES NOW, WE STILL NEED TO
DO FOLLOW UP STUDIES ON THESE
PATIENTS, DO 3 YEAR 4, YEAR
STUDIES TO GET A DEEPER
UNDERSTANDING OF THE TRAJECTORY
OF THESE PATIENTS BUT IT'S CLEAR
THAT WE LUMP EVERYTHING INTO
LONG COVID OR P A SC AND IT'S
REALLY A HETEROGEANIOUS MIX OF A
LOT, LOT OF DIFFERENT THINGS,
SOME OF THEM LIKE FATIGUE OR
MAYBE, YOU KNOW CHEST PAIN AND
CHEST PRESSURE THOSE MIGHT
IMPROVE WITH TIME OR GO AWAY
TOTAL WITH TIME BUT SOME ARE
LIKELY TO BE PERMANENT OR LIFE
LONG KONG DITIONS THAT WILL
STICK WITH PEOPLE
LIFETIME.
>> THANK YOU DO ANTIVIRALS OR
ANY OTHER INTERVENTIONS HAVE ANY
EFFECT ON THE RISK OF LONG
COVID?
>> OH THIS IS ABSOLUTELY
NASAA.COMINATING.
YOU GUYS ARE AMAZING THIS IS
ABSOLUTELY FASCINATING THIS IS A
QUESTION OF THE MOMENT.
IF YOU HAVE AN ANSWER, YOU GET A
UNUSUAL [INDISCERNIBLE] PAPER,
SO WE ARE WORKING ON IT.
WE DON'T KNOW THE ANSWER TO THIS
YE.
THE CHIEF CANDIDATE HERE FOR
POTENTIAL IS [INDISCERNIBLE],
THAT REALLY AMELIORATED THE RISK
OF LONG ASHING.
I DON'T KNOW THE ANSWER TO THIS.
WE ARE WORKING ON IT.
A LOT OF OTHER FROWPS ARE
WORKING ON IT AND KUDOS TO THE
PEOPLE WHO FINISH FIRST AND ABLE
TO GIVE US THE ANSWER.
>> IS THERE A DIFFERENCE IN THE
LONG COVID SYMPTOMS OR
PREVALENCE OF THEM BETWEEN
INDIVIDUALS INFECT WIDE
DIFFERENT SARS COV2 VARIANTS?
>> YEAH, SO WE--WE DON'T HAVE
DATA ON OMICRON, SO IT'S LESS
THAN 6 MONTHS OLD, IT'S THE LONG
HAUL SO WE CAN'T REALLY DEEPLY
CHARACTERIZE LONG COVID UNLESS
WE HAVE A GOOD FOLLOW UP TIME
AND OMEYE CRON WAS NOT ON EITHER
BEFORE NOVEMBER, INITIALLY
AFRICA OR U.S. AND NORTH AFRICA
DURING THE HOLIDAYS ABOUT YOU
FROM A PRIOR VARIANT, WE DON'T
REALLY SEE MUCH OF A DIFFERENCE
QUALITATIVELY BECAUSE OF THE
FEATURES OF LONG ASHING OR
QUANTITATIVELY BECAUSE OF THE
RISK DIFFERENCE OR THE MAGNITUDE
OF RISK.
YOU KNOW BETWEEN ALPHA DELTA AND
[INDISCERNIBLE], WE DON'T SEE
MUCH OF A DIFFERENCE.
YOU KNOW BUT A QUALITATIVELY
ENTER THE MAGNITUDE OF RISK.
BUT THE JOWRY IS STILL OUT.
WE DON'T KNOW ABOUT OMICRON YET,
IT HAS IN THE BEEN ON EARTH MORE
THAN 6 MONTHS SO IT STARTED IN
AFRICA NOVEMBER 2021 AND NOW
IT'S LIKE WE'RE IN EARLY
JUNE 2022.
>> YEAH AND CERTAINLY THE CASES
WE'VE SEEN WITH OMICRON MAY
AFFECT THAT AS WELL GIVEN THE
DATA YOU WERE TELLING US ABOUT
IN TERMS OF SEVERERRITY OF
DISEASE AND THE RISK OF LONG
COVID.
>> YEAH.
>> SO THERE'S ANOTHER QUESTION
HERE-SHOVE SO IF WE WERE TO GET
COVID EVERY YEAR WOULD THAT
CHANGE, YOU YOU KNOW IF YOU GOT
IT BEFORE WOULD IT CHANGE THE
RISK OF LONG ASHING?
>> YOU ARE ASKING ALL THE SUPER
WONDERFUL QUESTION.
OH WOW, SO CHARLIE IN MY TEAM IS
PUTTING A PAPER TOGETHER ON
THIS, I MEAN THE EARLIER RESULTS
THAT THE INFECTION REALLY
MATTERS.
AND THE QUESTION IS REALLY
SIGNIFICANT PUBLIC HEALTH
IMPORTANCE BECAUSE A LOT OF THE
PEOPLE IN THE U.S. HAVE ALREADY
BEEN INFECTED ONCE, RIGHT, LET'S
FACE IT THERE ARE MORE THAN
150 MILLION PEOPLE IN THE UNITED
STATES WITH AT LEAST 1
INFECTION, THE QUESTION IS DOES
IT MATTER, IS IT WORTH IT TO
PROTECT YOURSELF FROM A SECOND
INFECTION OR A THIRD 1 IF YOU
ALREADY HAD 2 OR MAYBE A SECOND
INFECTION IF YOU HAD 1, RIGHT?
DOES IT MATTER?
SHOULD YOU PROTECT?
SHOULD YOU GO THE EXTRA MILE TO
PROTECT YOURSELF?
DOESN'T MATTER AT ALL AND THE
ANSWER IS YES, THE SHORT ANSWER
IS YES, DATA WILL BE--CHARLIE IS
PUTTING A PAPER TOGETHER AND
HOPEFULLY WE WILL GET IT OUT AS
SOON AS WE CAN CAN.
SHORT ANSWER YES, EVERY TIME YOU
GET INFECTED YOU GAMLE, YOU'RE
LIKE THAT RUSSIAN RULET AGAIN
AND YOU KNOW THE BEST WAY TO
MINIMIZE RISK IS NOT TO GET
INVOLVED IN THE RUSSIAN ROWLET
NOT GAMBLE WITH A SECOND OR
THIRD INFECTION.
>> THANK YOU AGAIN FOR YOUR TIME
AND THE EXCELLENT PRESENTATION
AND DISCUSSION AND I WANT TO
THANK OUR AUDIENCE MEMBERS FOR
ATTENDING TODAY AND ATTENDING
OUR SERIES THIS PAST YEAR, SO WE
WISH YOU A WONDERFUL SUMMER AND
WE WILL SEE YOU BACK IN THE FALL
FOR ANOTHER FANTASTIC SERIES.
BYE-BYE.