1 00:00:05,040 --> 00:00:08,400 >>WELCOME TO THE FINAL 2 00:00:08,400 --> 00:00:11,320 PRESENTATION OF THIS YEAR'S 3 00:00:11,320 --> 00:00:14,080 COVID-19 SCIENTIFIC INTEREST 4 00:00:14,080 --> 00:00:14,760 GROUP LECTURE SERIES. 5 00:00:14,760 --> 00:00:16,320 WE'VE MARKED A NUMBER OF SENIOR 6 00:00:16,320 --> 00:00:19,600 INVESTIGATOR IN THE NHLBI'S 7 00:00:19,600 --> 00:00:20,240 EPITHELIAL SYSTEMS BIOLOGY 8 00:00:20,240 --> 00:00:23,120 LABORATORY AND I'M HAPPY TO BE 9 00:00:23,120 --> 00:00:26,400 INTRODUCING TODAY'S SPEAKER 10 00:00:26,400 --> 00:00:27,440 ZIYAD AL-ALY, WHOSE RESEARCH 11 00:00:27,440 --> 00:00:30,040 GROUP HAS PUBLISHED ABSOLUTELY 12 00:00:30,040 --> 00:00:31,440 EITHER SHAKING EPIDEMIOLOGICAL 13 00:00:31,440 --> 00:00:32,640 STUDIES ON LONG ASHING OVER THE 14 00:00:32,640 --> 00:00:33,480 PAST YEAR. TODAY'S 15 00:00:33,480 --> 00:00:35,800 PRESENTATION IS THE LAST IN OUR 16 00:00:35,800 --> 00:00:38,800 COVID LECTURE SERIES BEFORE THE 17 00:00:38,800 --> 00:00:41,000 SUMMER GREAT. 18 00:00:41,000 --> 00:00:41,600 COVID-19 SCIENTIFIC INTEREST 19 00:00:41,600 --> 00:00:42,840 GROUP WITH MEMBERS THROUGHOUT 20 00:00:42,840 --> 00:00:46,760 THE NIH AND FDA SCIENTIFIC 21 00:00:46,760 --> 00:00:50,680 COMMUNITY BEGAN THESE LECTURES 22 00:00:50,680 --> 00:00:53,080 BACK IN APRIL 2020 AND EACH 23 00:00:53,080 --> 00:00:54,400 LECTURE HAS BEEN ABSOLUTELY 24 00:00:54,400 --> 00:00:58,800 STELLAR AND TODAY'S WILL BE NO 25 00:00:58,800 --> 00:00:59,040 EXCEPTION. 26 00:00:59,040 --> 00:01:00,440 TODAY'S TOPIC LONG COVID HAS 27 00:01:00,440 --> 00:01:04,400 BEEN TO MANY OF US A MYSTERIOUS 28 00:01:04,400 --> 00:01:07,760 AND UNEXPECTED ASPECT OF THE 29 00:01:07,760 --> 00:01:08,640 PANDEMIC, PROTEIN COMPLEXION AND 30 00:01:08,640 --> 00:01:09,600 NATURE AND LIKELY TO COMMAND 31 00:01:09,600 --> 00:01:11,920 MORE AND MORE OF OUR HEALTHCARE 32 00:01:11,920 --> 00:01:14,280 RESOURCES IN THE COMING YEARS, 33 00:01:14,280 --> 00:01:16,880 NO 1 IS BETTER SUITED TO TELL US 34 00:01:16,880 --> 00:01:21,240 WHERE WE STAND WITH LONG COVID 35 00:01:21,240 --> 00:01:23,960 THAN ZIYAD, AL-ALY, HE IS A 36 00:01:23,960 --> 00:01:25,720 PHYSICIAN SCIENTIST WHO HIS 37 00:01:25,720 --> 00:01:28,760 FIRST AND FOREMOST KIDNEY 38 00:01:28,760 --> 00:01:30,360 RESEARCHER, HE'S A MEMBER OF THE 39 00:01:30,360 --> 00:01:34,960 RENAL FAC ALL THEY AT WASHINGTON 40 00:01:34,960 --> 00:01:37,200 UNIVERSITY IN ST. LOUIS, WORKING 41 00:01:37,200 --> 00:01:39,200 AT THE VA HEALTHCARE SYSTEM, 42 00:01:39,200 --> 00:01:41,160 WHERE HE'S DIRECTOR OF THE 43 00:01:41,160 --> 00:01:42,600 CLINICAL EPIDEMIOLOGY CENTER, 44 00:01:42,600 --> 00:01:44,200 HIS PRECOVID RESEARCH WAS 45 00:01:44,200 --> 00:01:45,720 CHIEFLY ABOUT CHRONIC KIDNEY 46 00:01:45,720 --> 00:01:47,920 DISEASE AND FACTORS THAT HAVE 47 00:01:47,920 --> 00:01:49,280 CONTRIBUTED TO THE CHRONIC 48 00:01:49,280 --> 00:01:51,000 KIDNEY DISEASE EPIDEMIC THAT WE 49 00:01:51,000 --> 00:01:53,080 EXPERIENCED OVER THE LAST COUPLE 50 00:01:53,080 --> 00:01:54,560 OF DECADES. 51 00:01:54,560 --> 00:01:56,800 AMONG THE MOST INTERESTING 52 00:01:56,800 --> 00:02:00,160 ASPECTS OF THIS IS HIS WORK ON 53 00:02:00,160 --> 00:02:01,680 THE ROLE OF AIR POLLUTION IN 54 00:02:01,680 --> 00:02:04,080 CHRONIC KIDNEY DISEASE AND 55 00:02:04,080 --> 00:02:05,760 DIABETES. 56 00:02:05,760 --> 00:02:07,200 NOT IN CONSEQUENTIALLY, HE'S 57 00:02:07,200 --> 00:02:09,080 BEEN A MAJOR PLAYER IN THE 58 00:02:09,080 --> 00:02:12,280 GLOBAL BURDEN OF DISEASE STUDY 59 00:02:12,280 --> 00:02:12,560 PROJECT. 60 00:02:12,560 --> 00:02:14,400 SO THEN COVID HAPPENED AND HE 61 00:02:14,400 --> 00:02:19,360 WAS ABLE TO MARSHAL HIS 62 00:02:19,360 --> 00:02:20,280 SUBSTANTIAL EXPERTISE IN 63 00:02:20,280 --> 00:02:22,120 EPIDEMIOLOGY TO TACKLE THE 64 00:02:22,120 --> 00:02:26,080 PROBLEM OF POST ACUTE SEQUELA OF 65 00:02:26,080 --> 00:02:27,640 SARS KICKOFF 2 INFECTION, SO 66 00:02:27,640 --> 00:02:32,280 CALLED LONG COVID, THE TOPIC OF 67 00:02:32,280 --> 00:02:32,720 TODAY'S LECTURE. 68 00:02:32,720 --> 00:02:34,240 NOW ZIYAD RECEIVED HIS 69 00:02:34,240 --> 00:02:35,200 UNDERGRADUATE DEGREE FROM 70 00:02:35,200 --> 00:02:36,600 BIOLOGY IN THE AMERICAN 71 00:02:36,600 --> 00:02:37,840 UNIVERSITY OF BEIRUT, FOLLOWED 72 00:02:37,840 --> 00:02:41,600 BY A MEDICAL DEGREE ALSO IN 73 00:02:41,600 --> 00:02:42,680 BEIRUT IN 1999. 74 00:02:42,680 --> 00:02:46,280 AFTER AN INTERNSHIP IN BEIRUT, 75 00:02:46,280 --> 00:02:48,560 ZIYAD ACCEPTED A RESIDENCY AT 76 00:02:48,560 --> 00:02:49,120 ST. LOUIS UNIVERSITY. 77 00:02:49,120 --> 00:02:53,920 THIS WAS FOLLOWED BY A SERIES OF 78 00:02:53,920 --> 00:02:56,840 FELLOWSHIPS, THERE AND AT NEARBY 79 00:02:56,840 --> 00:02:58,240 WASHINGTON UNIVERSITY. 80 00:02:58,240 --> 00:03:00,640 AT 2006, HE BECAME A STAFF 81 00:03:00,640 --> 00:03:02,760 PHYSICIAN IN THE RENAL SECTION 82 00:03:02,760 --> 00:03:07,400 OF THE ST. LOUIS DA IN 2013, HE 83 00:03:07,400 --> 00:03:11,840 ASSUMED THE DIRECTORSHIP OF THE 84 00:03:11,840 --> 00:03:12,880 CLINICAL EPIDEMIOLOGY CENTER AND 85 00:03:12,880 --> 00:03:15,280 ALSO BECAME CHIEF OF THE 86 00:03:15,280 --> 00:03:16,600 RESEARCH AND DEVELOPMENT SERVICE 87 00:03:16,600 --> 00:03:17,960 AT THE VA. 88 00:03:17,960 --> 00:03:19,760 AMONG HIS OTHER ACTIVITIES IN 89 00:03:19,760 --> 00:03:21,440 THE KID ME WORLD HE'S A KEY 90 00:03:21,440 --> 00:03:23,800 MEMBER OF THE EDITORIAL TEAM OF 91 00:03:23,800 --> 00:03:25,920 THE JOURNAL OF THE AMERICAN 92 00:03:25,920 --> 00:03:27,680 SOCIETY OF NEPHROLOGY, THE 93 00:03:27,680 --> 00:03:31,320 WORLD'S TOP KIDNEY RESEARCH 94 00:03:31,320 --> 00:03:31,720 JOURNAL. 95 00:03:31,720 --> 00:03:34,560 MOST PERTINENT FOR TODAY'S TALK 96 00:03:34,560 --> 00:03:37,080 ZIYAD SITS ON THE WHITE HOUSE 97 00:03:37,080 --> 00:03:37,800 INTERAGENCY APPROXIMATELY SEE 98 00:03:37,800 --> 00:03:39,320 COMMITTEE ON LONG COVID AND CO 99 00:03:39,320 --> 00:03:41,360 CHAIRS THE COMMITTEE FOR 100 00:03:41,360 --> 00:03:42,640 DEVELOPING A LONG ASHING 101 00:03:42,640 --> 00:03:44,640 NATIONAL RESEARCH ACTION PLAN. 102 00:03:44,640 --> 00:03:50,280 THE TITLE OF HIS TALK TODAY IS 103 00:03:50,280 --> 00:03:51,480 LONG COVID, A BRIEF OVERVIEW. 104 00:03:51,480 --> 00:03:53,560 ZIYAD, WELCOME TO THE NIH AND 105 00:03:53,560 --> 00:03:54,520 THANK YOU FOR JOINING US. 106 00:03:54,520 --> 00:03:55,640 >>THANK YOU VERY 107 00:03:55,640 --> 00:03:57,240 MUCH FOR THE WARM DISTRIBUTION 108 00:03:57,240 --> 00:03:58,920 AND DELIGHTED TO BE WITH YOU 109 00:03:58,920 --> 00:04:01,720 TODAY FOR THE LONG ASHING 110 00:04:01,720 --> 00:04:02,160 REVIEW. 111 00:04:02,160 --> 00:04:07,240 IT'S A REALLY BRIEF OVERVIEW OF 112 00:04:07,240 --> 00:04:10,480 LONG COVID, AND ENCOMPASS MORE 113 00:04:10,480 --> 00:04:12,440 LITERATURE THAT WE HAVE AMASSED 114 00:04:12,440 --> 00:04:13,600 FOR LONG COVID AND OUR 115 00:04:13,600 --> 00:04:14,840 PERSPECTIVE WHAT WE THINK IS 116 00:04:14,840 --> 00:04:16,000 GOING ON HERE, AND I WOULD LIKE 117 00:04:16,000 --> 00:04:18,440 TO LEAVE AMPLE TIME FOR Q, ANDA 118 00:04:18,440 --> 00:04:19,280 AND A DISCUSSION. 119 00:04:19,280 --> 00:04:22,480 HOPEFULLY THAT'S SORT OF AN 120 00:04:22,480 --> 00:04:23,080 ACTIVE DISCUSSION WILL BE 121 00:04:23,080 --> 00:04:26,480 INTERESTING TO YOU ALL. 122 00:04:26,480 --> 00:04:30,520 SO DUE TO DISCLOSURES, I'VE 123 00:04:30,520 --> 00:04:31,840 CONDULTED FOR GILLIAD AND TONICS 124 00:04:31,840 --> 00:04:36,640 AND I WOULD LIKE TO SAY THAT THE 125 00:04:36,640 --> 00:04:40,080 OPINIONS EXPRESSED IN THIS 126 00:04:40,080 --> 00:04:44,680 PRESENTATION ARE MY OWN AND NOT 127 00:04:44,680 --> 00:04:47,560 THOSE OF THE UNITED STATES 128 00:04:47,560 --> 00:04:48,040 GOVERNMENT. 129 00:04:48,040 --> 00:04:51,240 SEVERAL OF MY MENTEES IN THE LAB 130 00:04:51,240 --> 00:04:54,520 HAVE ALSO RECEIVED GENEROUS 131 00:04:54,520 --> 00:04:56,080 SOCIETY AND AS MARK MENTIONED WE 132 00:04:56,080 --> 00:05:03,560 DO A LOT OF KIDNEY DISEASE 133 00:05:03,560 --> 00:05:08,360 RESEARCH AND NECESSARILY WORKING 134 00:05:08,360 --> 00:05:18,960 FOR SEVERAL OF MY ARTICLES 135 00:05:18,960 --> 00:05:19,880 TODAY. 136 00:05:19,880 --> 00:05:21,040 --PIVOTED AND STARTED STUDYING 137 00:05:21,040 --> 00:05:22,240 LONG COVID, I WOULD LIKE TO GIVE 138 00:05:22,240 --> 00:05:24,760 A BROAD OVERVIEW OF LONG COVID, 139 00:05:24,760 --> 00:05:27,720 WHAT WE THINK LONG COVID IS AND 140 00:05:27,720 --> 00:05:29,480 SPECIFICALLY DELVE DEEPER INTO 141 00:05:29,480 --> 00:05:32,320 THE CARDIOVASCULAR OUTCOMES AND 142 00:05:32,320 --> 00:05:34,080 KIDNEY OUTCOMES, DIABETES, AND 143 00:05:34,080 --> 00:05:36,080 MENTAL HEALTH OUTCOMES IN PEOPLE 144 00:05:36,080 --> 00:05:36,400 WITH COVID-19. 145 00:05:36,400 --> 00:05:38,520 IF I CAN BRIEFLY TOUCH UPON THE 146 00:05:38,520 --> 00:05:40,600 EFFECTIVE VACCINATION ON RISK OF 147 00:05:40,600 --> 00:05:43,240 LONG COVID, AND THEN PUT IT 148 00:05:43,240 --> 00:05:47,400 UP--AND THEN PUT IT ALL IN 149 00:05:47,400 --> 00:05:48,920 PERSPECTIVE, YOU KNOW DISCUSSING 150 00:05:48,920 --> 00:05:51,240 IMPLICATIONS FOR HEALTH SYSTEMS 151 00:05:51,240 --> 00:05:51,600 AND COMMUNITIES. 152 00:05:51,600 --> 00:05:54,120 AND THEN I WILL PROVIDE A 153 00:05:54,120 --> 00:05:57,400 SUMMARY AND THEN WE WILL OPEN IT 154 00:05:57,400 --> 00:06:00,480 UP FOR Q&A. 155 00:06:00,480 --> 00:06:01,480 SOPHISTICATED VERY EARLY ON IN 156 00:06:01,480 --> 00:06:03,280 THE PANDEMIC WHEN THE PANDEMIC 157 00:06:03,280 --> 00:06:05,400 HIT IN MARCH 2020 IT WAS REALLY 158 00:06:05,400 --> 00:06:06,240 AN ENORMOUSLY STRESSFUL TIME FOR 159 00:06:06,240 --> 00:06:08,520 ALL OF US HERE, MYSELF AND MY 160 00:06:08,520 --> 00:06:09,880 TEAM MEMBERS, YOU KNOW ALL OF A 161 00:06:09,880 --> 00:06:14,200 SUDDEN OUR LIFE WAS UPSIDE DOWN. 162 00:06:14,200 --> 00:06:15,960 YOU KNOW, THINGS WERE REALLY, 163 00:06:15,960 --> 00:06:17,160 REALLY VERY DIFFERENT AND REALLY 164 00:06:17,160 --> 00:06:21,360 IN 1 OR 2 DAYS, YOU KNOW THINGS 165 00:06:21,360 --> 00:06:23,400 SWITCHED SWITCHED PRETTY 166 00:06:23,400 --> 00:06:23,760 DYNAMICALLY. 167 00:06:23,760 --> 00:06:25,800 SO WE STARPTED THINKING HOW DO 168 00:06:25,800 --> 00:06:30,200 WE DO, WHAT DO WE DO AS CLINICAL 169 00:06:30,200 --> 00:06:31,880 EPIDEMIOLOGISTS HOW DO WE DO OUR 170 00:06:31,880 --> 00:06:33,240 PART TO HELP FIGHT AGAINST 171 00:06:33,240 --> 00:06:33,520 COVID-19. 172 00:06:33,520 --> 00:06:36,000 AT THAT TIME WE DID NOT KNOW 173 00:06:36,000 --> 00:06:38,160 THAT LONG COVID EXISTED OR THAT 174 00:06:38,160 --> 00:06:42,160 IT COULD LEAD TO LONG-TERM 175 00:06:42,160 --> 00:06:43,640 SEQUELA OR LONG-TERM SEQUENCES, 176 00:06:43,640 --> 00:06:45,000 WE HAD THIS FORCE WITHIN US THAT 177 00:06:45,000 --> 00:06:47,200 WE NEED TO DO SOMETHING HERE TO 178 00:06:47,200 --> 00:06:49,320 HELP THE NATION DEVELOP A 179 00:06:49,320 --> 00:06:51,920 RESPONSE TO LONG COVID--TO 180 00:06:51,920 --> 00:06:52,920 COVID. 181 00:06:52,920 --> 00:06:55,040 AT THAT TIME, MYSELF AS A 182 00:06:55,040 --> 00:06:56,400 CLINICIAN, WITH THE FRONT LINE 183 00:06:56,400 --> 00:06:59,320 AND WORK IN THE ICU AND WORK ON 184 00:06:59,320 --> 00:07:00,520 RENAL SERVICE, ET CETERA, ET 185 00:07:00,520 --> 00:07:02,280 CETERA, SO WE DID THAT, BUT A 186 00:07:02,280 --> 00:07:05,480 LOT OF US IN MY TEAM ARE 187 00:07:05,480 --> 00:07:07,640 ACTUALLY JUST REALLY--NOT JUST 188 00:07:07,640 --> 00:07:10,200 CLINICAL EPIDEMIOLOGISTS SO WE 189 00:07:10,200 --> 00:07:11,080 STARTED BRAINSTORMING ABOUT YOU 190 00:07:11,080 --> 00:07:13,480 KNOW AVENUES WE COULD DO, THINGS 191 00:07:13,480 --> 00:07:17,120 WE COULD DO TO CONTRIBUTE IN THE 192 00:07:17,120 --> 00:07:18,160 FIGHT AGAINST COVID-19. 193 00:07:18,160 --> 00:07:20,560 WE STARTED BRAINSTORMING A LOT 194 00:07:20,560 --> 00:07:22,000 AND UNANIMOUSLY. 195 00:07:22,000 --> 00:07:22,840 UNANIMOUSLY, THE RESPONSE FROM 196 00:07:22,840 --> 00:07:25,680 MY TEAM WAS WE DO WHAT WE DO 197 00:07:25,680 --> 00:07:25,880 BEST. 198 00:07:25,880 --> 00:07:26,520 WE IDENTIFY RESOURCE QUESTIONS 199 00:07:26,520 --> 00:07:29,520 THAT ARE IMPORTANT TO THE NATION 200 00:07:29,520 --> 00:07:30,800 THAT REALLY CONSEQUENTIAL IN OUR 201 00:07:30,800 --> 00:07:33,200 FIGHT AGAINST COVID-19 AND WE 202 00:07:33,200 --> 00:07:34,680 ADDRESS THEM USING OUR DATA AND 203 00:07:34,680 --> 00:07:36,800 TOOLS, SO THAT WAS REALLY 204 00:07:36,800 --> 00:07:38,840 UNANIMOUS ANSWER OR UNANIMOUS 205 00:07:38,840 --> 00:07:40,280 RESPONSE ACROSS THE BOARD HAD IT 206 00:07:40,280 --> 00:07:43,840 FROM ALL MY TEAM MEMBERS. 207 00:07:43,840 --> 00:07:45,640 THAT'S WHAT WE HAVE TO DO. 208 00:07:45,640 --> 00:07:47,240 WE HAVE TO FIGURE OUT HOW WE 209 00:07:47,240 --> 00:07:48,120 CONTRIBUTE SCIENCE HERE TO TRY 210 00:07:48,120 --> 00:07:50,920 TO ADVANCE OUR UNDERSTANDING OF 211 00:07:50,920 --> 00:07:54,840 COVID AND THEN HELP TO FIGHT 212 00:07:54,840 --> 00:07:55,800 AGAINST COVID-19. 213 00:07:55,800 --> 00:07:58,360 AT THAT TIME, WE DID NOT KNOW 214 00:07:58,360 --> 00:07:59,640 ANYTHING ABOUT LONG COVID AND 215 00:07:59,640 --> 00:08:01,280 THEN, YOU KNOW SO 1 TECHNOLOGY 216 00:08:01,280 --> 00:08:02,720 TRANSFER LED TO ANOTHER AND IN 217 00:08:02,720 --> 00:08:04,840 THE EARLY REPORT WE GOT, WAS NOT 218 00:08:04,840 --> 00:08:07,280 A CASE REPORT UNUSUAL MEDICINE 219 00:08:07,280 --> 00:08:10,240 OR ANYTHING ELSE, WAS REALLY AN 220 00:08:10,240 --> 00:08:13,560 UPEDGE PIECE BY THE NEW YORK 221 00:08:13,560 --> 00:08:16,960 TIMES BY FIONA, LOWENSTEIN AND I 222 00:08:16,960 --> 00:08:18,440 REMEMBER READ THANKSGIVING ON MY 223 00:08:18,440 --> 00:08:19,760 COUCH IN THE LIVING ROOM, AND 224 00:08:19,760 --> 00:08:21,880 THINKING TO MYSELF, THIS IS 225 00:08:21,880 --> 00:08:23,080 REALLY BIZARRE, THIS IS--YOU 226 00:08:23,080 --> 00:08:25,240 KNOW SHE WAS TELLING US HER 227 00:08:25,240 --> 00:08:27,320 STORY, YOUNG AND HEALTHY, 228 00:08:27,320 --> 00:08:30,160 PREVIOUSLY HEALTHY, DID NOT HAVE 229 00:08:30,160 --> 00:08:31,760 ANY MEDICAL PROBLEMS, NO 230 00:08:31,760 --> 00:08:34,840 CO-MORBIDITIES AT ALL, SHE GETS 231 00:08:34,840 --> 00:08:36,400 COVID-19 OR SARS KICKOFF 2 232 00:08:36,400 --> 00:08:37,560 INFECTION, WEEKS DOWN THE ROAD 233 00:08:37,560 --> 00:08:39,200 SHE'S LEFT WITH LINGERING 234 00:08:39,200 --> 00:08:40,960 SYMPTOMS AND THAT'S INTERNAL 235 00:08:40,960 --> 00:08:42,640 AUDIT DEXTRAN SULFATE CASE OR AN 236 00:08:42,640 --> 00:08:42,840 EQUAL 1. 237 00:08:42,840 --> 00:08:44,640 AND KUDOS TO HER AND THE PATIENT 238 00:08:44,640 --> 00:08:46,120 COMMUNITY AROUND HERE AND THEY 239 00:08:46,120 --> 00:08:49,520 GENERATED A LOT OF RESPONSE FROM 240 00:08:49,520 --> 00:08:50,480 THE PATIENT COMPLIEWNT. 241 00:08:50,480 --> 00:08:52,360 THEY WERE AROUND HERE AND 242 00:08:52,360 --> 00:08:53,520 LITERALLY WITHIN 48 HOURS HER 243 00:08:53,520 --> 00:08:55,480 INBOX WAS FLOOD WIDE A LOT OF 244 00:08:55,480 --> 00:08:57,040 MESSAGES FROM PEOPLE SHARING, OH 245 00:08:57,040 --> 00:08:59,920 ME TOO, THAT'S MY STORY TOO, I 246 00:08:59,920 --> 00:09:02,160 WAS ALSO DIAGNOSED WITH COVID-19 247 00:09:02,160 --> 00:09:04,880 OR SARS KICKOFF 2 INFECTION IN 248 00:09:04,880 --> 00:09:06,680 MARCH 2020 AND IN APRIL, 249 00:09:06,680 --> 00:09:09,320 PREVENTIVUOUSLY YOUNG AND 250 00:09:09,320 --> 00:09:10,720 HEALTHY, NOW STILL HAVING ALL 251 00:09:10,720 --> 00:09:12,240 THESE PROBLEMS, ET CETERA. 252 00:09:12,240 --> 00:09:12,640 ET CETERA. 253 00:09:12,640 --> 00:09:15,640 SO THAT WAS LIKE THE INDEX OR 254 00:09:15,640 --> 00:09:17,600 THE INDEX CASE IN MY 255 00:09:17,600 --> 00:09:20,200 CONSCIOUSNESS AND OUR SORT OF, 256 00:09:20,200 --> 00:09:22,480 YOU KNOW UNDERSTANDING AS TO 257 00:09:22,480 --> 00:09:24,440 THINGS MAY BE HAPPENING IN 258 00:09:24,440 --> 00:09:26,680 PEOPLE WITH SARS KICKOFF 2 THAT 259 00:09:26,680 --> 00:09:28,160 ARE LINGERING FOR A LONGER 260 00:09:28,160 --> 00:09:30,960 PERIOD OF TIME OR LINGERING FOR 261 00:09:30,960 --> 00:09:33,640 YOU KNOW BEYOND THE ACUTE 262 00:09:33,640 --> 00:09:34,880 INFECTION AND AGAIN, REALLY 263 00:09:34,880 --> 00:09:36,560 KUDOS TO THE PATIENT COMMUNITY. 264 00:09:36,560 --> 00:09:38,480 THIS IS REALLY A--I ARGUE THAT 265 00:09:38,480 --> 00:09:40,840 THIS IS REALLY A REMARKABLE 266 00:09:40,840 --> 00:09:42,160 POINT IN HISTORY OF MEDICINE 267 00:09:42,160 --> 00:09:43,800 WHERE PATIENTS, YOU KNOW 268 00:09:43,800 --> 00:09:46,600 REPORTED THEMSELVES, NOT DOCTORS 269 00:09:46,600 --> 00:09:48,160 REPORTED ON PATIENTS, PATIENTS 270 00:09:48,160 --> 00:09:49,440 REPORTED THEMSELVES IN THE FORM 271 00:09:49,440 --> 00:09:52,080 OF AN UP EDGE PIECE, THE 272 00:09:52,080 --> 00:09:56,040 EXISTENCE OF A POTENTIALLY 273 00:09:56,040 --> 00:09:58,480 LONG-TERM OR POST SEQUELA 2 274 00:09:58,480 --> 00:09:59,520 INFECTION, AND THEY FORM WHAT 275 00:09:59,520 --> 00:10:02,160 THEY CALL NOW THE PATIENT LED 276 00:10:02,160 --> 00:10:03,480 RESEARCH COLLABORATIVE. 277 00:10:03,480 --> 00:10:04,760 REALLY AN AMAZING ENTERPRISE OF 278 00:10:04,760 --> 00:10:07,520 REALLY YOUNG PEOPLE WHO ARE 279 00:10:07,520 --> 00:10:09,120 PATIENTS AND AT THE SAME TIME 280 00:10:09,120 --> 00:10:11,400 ALSO, YOU KNOW ENGAGED IN 281 00:10:11,400 --> 00:10:12,800 RESEARCH, GAVE US REALLY THE 282 00:10:12,800 --> 00:10:15,560 FIRST CLUES AS TO WHAT SORT OF 283 00:10:15,560 --> 00:10:17,440 THE POST ACUTE SEQUELA MIGHT 284 00:10:17,440 --> 00:10:19,120 LOOK LIKE SO THEY ORGANIZE 285 00:10:19,120 --> 00:10:21,480 THEMSELVES INTO THE PATIENT LED 286 00:10:21,480 --> 00:10:22,160 RESEARCH COLLABORATIVE. 287 00:10:22,160 --> 00:10:24,480 AND THEY PUBLISHED IN AN 288 00:10:24,480 --> 00:10:25,240 UNCONTROLLED STUDY, UNCONTROLLED 289 00:10:25,240 --> 00:10:27,480 STUDY THIS IS NOT THE GOLD 290 00:10:27,480 --> 00:10:28,280 STANDARD SCIENTIFIC INSTRUMENT 291 00:10:28,280 --> 00:10:31,480 BUT IT REALLY PROVIDED US WITH 292 00:10:31,480 --> 00:10:33,080 CLUES THAT THESE--YOU KNOW THESE 293 00:10:33,080 --> 00:10:35,400 PATIENTS WERE HAVING A WHOLE LOT 294 00:10:35,400 --> 00:10:38,080 OF SYMPTOMS THAT EITHER COULD 295 00:10:38,080 --> 00:10:41,000 EXIST OR ARISE IN YOU AFTER THE 296 00:10:41,000 --> 00:10:47,560 ACUTE PHASE OF THE DISEASE. 297 00:10:47,560 --> 00:10:49,680 THOSE INVOLVE WEAKNESS, FATIGUE, 298 00:10:49,680 --> 00:10:50,800 WEAKNESS, PAIN AND TO THEIR 299 00:10:50,800 --> 00:10:53,080 CREDIT AS WELL, THIS IS NOT THE 300 00:10:53,080 --> 00:10:53,880 PATIENT LED MOVEMENT OR 301 00:10:53,880 --> 00:10:55,440 COLLABORATIVE BUT TO THE CREDIT 302 00:10:55,440 --> 00:10:57,280 IT THEY COINED THE TERM LONG 303 00:10:57,280 --> 00:10:57,920 COVID. 304 00:10:57,920 --> 00:10:58,920 THEY GAVE THE DISEASE OOGHTS 305 00:10:58,920 --> 00:11:02,000 NAME AND STARTED TO REFERRING TO 306 00:11:02,000 --> 00:11:04,400 THEMSELVES AS LONG HAULERS. 307 00:11:04,400 --> 00:11:05,920 SO I THINK THIS IS INTERESTING 308 00:11:05,920 --> 00:11:07,120 IN THE HISTORY OF SCIENCE AND 309 00:11:07,120 --> 00:11:10,120 MEDICINE THIS IS REALLY 310 00:11:10,120 --> 00:11:11,120 REMARKABLE THAT PATIENTS 311 00:11:11,120 --> 00:11:13,520 THEMSELVES CONTRIBUTED TO 312 00:11:13,520 --> 00:11:15,960 ALERTING THE WORLD ABOUT THE 313 00:11:15,960 --> 00:11:18,120 EXISTENCE OF POST ACUTE SEQUELA 314 00:11:18,120 --> 00:11:20,880 OF SARS KICKOFF 2, GENERALLY THE 315 00:11:20,880 --> 00:11:23,400 INITIAL CASE REPORT AND FORM OF 316 00:11:23,400 --> 00:11:25,640 OPED PIECE AND SUBSEQUENTLY IT 317 00:11:25,640 --> 00:11:29,200 REALLY AN EYE OPENING REPORT 318 00:11:29,200 --> 00:11:30,840 ALBIET UNCONTROLLED, THIS IS NOT 319 00:11:30,840 --> 00:11:32,080 A CONTROLLED STUDY. 320 00:11:32,080 --> 00:11:34,280 UNCONTROLLED SURVEY OF THE 321 00:11:34,280 --> 00:11:36,240 MEMBERSHIP, JUST LOGGING THE 322 00:11:36,240 --> 00:11:36,880 BREDTHS OF PROBLEMS THEY'RE 323 00:11:36,880 --> 00:11:38,680 EXPERIENCING IN THE POST ACUTE 324 00:11:38,680 --> 00:11:41,320 STAGE OF THE DISEASE, THOSE ARE 325 00:11:41,320 --> 00:11:45,440 SYMPTOMS THAT EITHER PERSISTED 326 00:11:45,440 --> 00:11:46,920 OR MANIFESTED IN YOU IN THE POST 327 00:11:46,920 --> 00:11:47,920 ACUTE PHASE OF THE DISEASE. 328 00:11:47,920 --> 00:11:49,120 SO WITH THAT BACKGROUND AND 329 00:11:49,120 --> 00:11:52,760 REMEMBER THIS IS ALL LIKE YOU 330 00:11:52,760 --> 00:11:55,000 KNOW MARCH, APRIL, MAY OF 2020. 331 00:11:55,000 --> 00:11:56,880 YOU KNOW, WITH THAT BACKGROUND 332 00:11:56,880 --> 00:11:58,600 WE STARTED THINKING, ME AND MY 333 00:11:58,600 --> 00:11:59,640 GROUP LIKE WHAT'S HAPPENING HERE 334 00:11:59,640 --> 00:12:02,800 THIS, IS AN UNCONTROLLED STUDY, 335 00:12:02,800 --> 00:12:03,840 IS THIS REALLY REAL? 336 00:12:03,840 --> 00:12:05,160 THEY DIDN'T HAVE A CONTROL 337 00:12:05,160 --> 00:12:05,520 GROUP? 338 00:12:05,520 --> 00:12:06,800 SOME PEOPLE HAVE FATIGUE HERE 339 00:12:06,800 --> 00:12:08,680 BUT WHAT'S THE BASE LINE FATIGUE 340 00:12:08,680 --> 00:12:09,520 IN THE GENERAL POPULATION, DID 341 00:12:09,520 --> 00:12:11,520 IT LEAD TO LOCK DOWNS AND BEING 342 00:12:11,520 --> 00:12:12,760 AT HOME AND NOT EXERCISING AND 343 00:12:12,760 --> 00:12:15,440 ALL THE OTHER THINGS, YOU KNOW, 344 00:12:15,440 --> 00:12:16,920 A SURVEY CAN ONLY TELL YOU SO 345 00:12:16,920 --> 00:12:20,120 MUCH, GIVE YOU A WATO LOOK BUT 346 00:12:20,120 --> 00:12:22,640 NOT TD EVIDENCE THAT LONG COVID 347 00:12:22,640 --> 00:12:24,400 ACTUALLY EXISTS OR IS A SAYING 348 00:12:24,400 --> 00:12:25,720 IN THE MANIFESTATION, SO WE 349 00:12:25,720 --> 00:12:27,040 STARTED ASKING THE QUESTION, THE 350 00:12:27,040 --> 00:12:28,440 SIMPLE QUESTION, WHAT IS LONG 351 00:12:28,440 --> 00:12:28,800 OVENG. 352 00:12:28,800 --> 00:12:30,280 THESE PEOPLE ARE TALKING TO US 353 00:12:30,280 --> 00:12:32,440 ABOUT LONG ASHING, YOU KNOW, MY 354 00:12:32,440 --> 00:12:33,480 E-MAIL STARTED SORT OF GETTING A 355 00:12:33,480 --> 00:12:43,960 LOT OF THESE THINGS AND WE ASKED 356 00:12:43,960 --> 00:12:45,000 WHAT IS LONG COVID? 357 00:12:45,000 --> 00:12:48,480 SO WE DECIDED TO TAKE A HIGH 358 00:12:48,480 --> 00:12:48,920 DIMENSION APPROACH. 359 00:12:48,920 --> 00:12:51,800 LEAVE NO STONE UNTURNED AND TAKE 360 00:12:51,800 --> 00:12:53,800 THIS HIGH DIMENSIONAL WAY TO 361 00:12:53,800 --> 00:12:55,600 CHARACTERIZE THE POST ACUTE 362 00:12:55,600 --> 00:12:57,960 SEQUELA OF SARS KICKOFF 2, OR 363 00:12:57,960 --> 00:12:59,360 POST ACUTE SEQUELA OF COVID-19. 364 00:12:59,360 --> 00:13:03,640 AND WHAT WE DID HERE IS WE 365 00:13:03,640 --> 00:13:05,520 AMASSED THIS WONDERFUL, 366 00:13:05,520 --> 00:13:07,640 WONDERFUL MAGZ NATIONAL 367 00:13:07,640 --> 00:13:09,480 RESOURCE, NATIONAL TREASURE OF 368 00:13:09,480 --> 00:13:09,920 VA DATA. 369 00:13:09,920 --> 00:13:12,720 THE VA OPERATES THE LARGEST 370 00:13:12,720 --> 00:13:13,520 NATIONALLY INTEGRATED HEALTHCARE 371 00:13:13,520 --> 00:13:14,280 SYSTEM IN THE U.S. 372 00:13:14,280 --> 00:13:15,440 DOESN'T GET A LOT OF CREDIT BUT 373 00:13:15,440 --> 00:13:17,560 I'M GOING TO TOOT THAT HORN NOW. 374 00:13:17,560 --> 00:13:19,920 LIKE THE VA IS THE LARGEST 375 00:13:19,920 --> 00:13:20,560 NATIONALLY INTEGRATED HELT CARE 376 00:13:20,560 --> 00:13:23,920 SYSTEM IN THE U.S., WITH THE 377 00:13:23,920 --> 00:13:25,560 FIRST TO PIONEER THE DEVELOPMENT 378 00:13:25,560 --> 00:13:27,160 AND IMPLEMENTATION AND USE OF 379 00:13:27,160 --> 00:13:28,320 ELECTRONIC HEALTH RECORDS AND AS 380 00:13:28,320 --> 00:13:32,200 A RESULT, IT WAS REALLY THIS 381 00:13:32,200 --> 00:13:34,080 AMAZING AND WONDERFUL, REALLY 382 00:13:34,080 --> 00:13:34,800 NATIONALLY INTEGRATED HEALTH 383 00:13:34,800 --> 00:13:36,280 RECORD ON MILLIONS OF VETERANS 384 00:13:36,280 --> 00:13:39,720 SO VERY EARLY ON IN THE 385 00:13:39,720 --> 00:13:41,440 PANDEMIC, WE YOU KNOW 386 00:13:41,440 --> 00:13:43,040 STARTED,--MADE USE OF THE DATA 387 00:13:43,040 --> 00:13:45,280 AND CATALOGED THIS COHORT OF 388 00:13:45,280 --> 00:13:49,160 PEOPLE BUT MORE THAN 74,000 389 00:13:49,160 --> 00:13:51,120 PEOPLE HERE ARE VETERANS WHO HAD 390 00:13:51,120 --> 00:13:52,560 SARS KICKOFF 2 INFECTION 391 00:13:52,560 --> 00:13:53,240 COMPARED TO SEVERAL CONTROL 392 00:13:53,240 --> 00:13:54,800 GROUPS AND THEN WE FOLLOW THEM 393 00:13:54,800 --> 00:13:56,040 FOR AT LEAST 6 MONTHS. 394 00:13:56,040 --> 00:13:57,280 SO WHAT WE'VE DONE HERE IS WE'VE 395 00:13:57,280 --> 00:14:01,320 DONE WHAT WE CALL A HIGH 396 00:14:01,320 --> 00:14:01,960 DIMENSIONAL CHARACTERIZATION OF 397 00:14:01,960 --> 00:14:02,840 SARS KICKOFF 2. 398 00:14:02,840 --> 00:14:04,640 SO WE DIDN'T LOOK AT LUNGS AND 399 00:14:04,640 --> 00:14:05,480 HEART, WE LOOKEDDA THE 400 00:14:05,480 --> 00:14:06,760 EVERYTHING, TO TRY TO UNDERSTAND 401 00:14:06,760 --> 00:14:08,720 AND USING A COUNTER FACTUAL 402 00:14:08,720 --> 00:14:09,600 APPROACH IN EPIDEMIOLOGY, USING 403 00:14:09,600 --> 00:14:12,760 IT AS SORT OF A WELL DEFINED 404 00:14:12,760 --> 00:14:15,880 CONTROL, WHAT IS THE RISK OF 405 00:14:15,880 --> 00:14:16,800 POST ACUTE SEQUELA, ON ANSWERING 406 00:14:16,800 --> 00:14:18,480 THE QUESTION, WHAT ARE THE RISKS 407 00:14:18,480 --> 00:14:21,080 OF POST ACUTE SEQUELA AND PEOPLE 408 00:14:21,080 --> 00:14:23,000 WHO ARE EXPOSED TO SARS KICKOFF 409 00:14:23,000 --> 00:14:24,600 2 INFECTION VERSUS A WELL 410 00:14:24,600 --> 00:14:26,480 DEFINED CONTROL GROUP THAT DID 411 00:14:26,480 --> 00:14:30,320 NOT HAVE ANY INFECTION AT ALL, 412 00:14:30,320 --> 00:14:33,360 OR HAD NO KNOWN INFECTION WITH 413 00:14:33,360 --> 00:14:35,000 SARS-ON 2 AND THE RESULTS WERE 414 00:14:35,000 --> 00:14:36,680 REALLY EYE OPENING AND AT THE 415 00:14:36,680 --> 00:14:39,520 TIME VERY JARRING AND THEY 416 00:14:39,520 --> 00:14:41,240 REMAIN HERE OR SO MORE THAN A 417 00:14:41,240 --> 00:14:44,840 YEAR AFTERWARDS AFTER WE 418 00:14:44,840 --> 00:14:45,840 PUBLISHED THIS PAPER, I FEEL 419 00:14:45,840 --> 00:14:47,240 THAT AFTER WE LOOK AT THESE 420 00:14:47,240 --> 00:14:50,440 SLIDES AND THE BREDTH OF 421 00:14:50,440 --> 00:14:51,240 DISFUNCHES, THAT IS--THAT IS 422 00:14:51,240 --> 00:14:54,920 EXPERIENCED BY PEOPLE WITH 423 00:14:54,920 --> 00:14:55,920 COVID-19 IS REALLY IT REMAINS 424 00:14:55,920 --> 00:14:57,320 JARRING, SO WHAT WE'VE SEEN, 425 00:14:57,320 --> 00:14:59,360 WE'VE SEEN INCREASE RISK OF 426 00:14:59,360 --> 00:15:02,920 MENTAL HEALTH DISORDERS AND 427 00:15:02,920 --> 00:15:04,040 INCLUDE ANXIETY, DEPRESSION, 428 00:15:04,040 --> 00:15:05,560 SLEEP PROBLEM, SUBSTANCE ABUSE 429 00:15:05,560 --> 00:15:06,240 PROBLEMS. 430 00:15:06,240 --> 00:15:08,040 NERVOUS SYSTEM DISORDERS 431 00:15:08,040 --> 00:15:10,760 INCLUDING INCREASE RISK OF 432 00:15:10,760 --> 00:15:12,160 STROKES, EPISODIC DISORDERS LIKE 433 00:15:12,160 --> 00:15:13,800 HEADACHES AND SEIZURES, MEMORY 434 00:15:13,800 --> 00:15:19,600 PROBLEMS, BRAIN FOG, YOU KNOW 435 00:15:19,600 --> 00:15:21,320 SMELL PROBLEMS, DIABETES, 436 00:15:21,320 --> 00:15:22,840 HYPOLIPIDEMMIA, INCREASED RISK 437 00:15:22,840 --> 00:15:25,440 OF GI PROBLEMS, CONSIPATION, 438 00:15:25,440 --> 00:15:27,880 DISCIPLINARY RIA, ACID REFLUX 439 00:15:27,880 --> 00:15:28,680 DISEASE, SKIN DISORDERS 440 00:15:28,680 --> 00:15:31,600 INCLUDING RISK OF AIR LOSS AND 441 00:15:31,600 --> 00:15:34,160 RASH, COAGULATION DISORDERS AND 442 00:15:34,160 --> 00:15:36,720 THIS WAS SUBSTANTIAL BECAUSE OF 443 00:15:36,720 --> 00:15:37,920 BLOOD CLOTTING IN PEOPLE WITH 444 00:15:37,920 --> 00:15:40,320 COVID-19 AND A WHOLE HOST OF 445 00:15:40,320 --> 00:15:42,960 CARDIOVASCULAR CONDITIONS 446 00:15:42,960 --> 00:15:46,840 INCLUDING KID SYNDROME, HEART 447 00:15:46,840 --> 00:15:48,280 PALITATIONS, ARRHYTHMIA, 448 00:15:48,280 --> 00:15:49,400 RESPIRATORY SYMPTOMS, SHORTNESS 449 00:15:49,400 --> 00:15:51,800 OF BREATH, LOW BLOOD OXYGEN, 450 00:15:51,800 --> 00:15:54,640 ACUTE AND CHRONIC KIDNEY 451 00:15:54,640 --> 00:15:56,200 DISEASE, MUSK LO SKELETAL FORM 452 00:15:56,200 --> 00:15:58,480 IN THE FORM OF PAIN AND 453 00:15:58,480 --> 00:15:59,800 WEAKNESS, MALAISE, PROFOUND 454 00:15:59,800 --> 00:16:02,720 FATIGUE AND IN SOME PATIENTS 455 00:16:02,720 --> 00:16:04,960 REALLY DEBILITATING FATIGUE THAT 456 00:16:04,960 --> 00:16:07,320 REALLY ALMOST, IT'S ALMOST 457 00:16:07,320 --> 00:16:08,360 INCAPACITATING AND LEAVES THISEM 458 00:16:08,360 --> 00:16:10,080 IN BED FOR A LOT OF DAYS, A LOT 459 00:16:10,080 --> 00:16:14,640 OF HOURS IN THE DAY AND ALSO 460 00:16:14,640 --> 00:16:15,360 ANEMIA. 461 00:16:15,360 --> 00:16:17,520 SO WITH THIS BACKGROUND, WE ASK 462 00:16:17,520 --> 00:16:18,840 YOURSELF LIKE, WELL, THIS REALLY 463 00:16:18,840 --> 00:16:22,160 HAPPENING, YOU KNOW VERSUS THE 464 00:16:22,160 --> 00:16:23,200 CONTROL GROUP. 465 00:16:23,200 --> 00:16:25,480 SO HOW DOES THE PICTURE COMPARE 466 00:16:25,480 --> 00:16:27,200 WHEN WE EVALUATE PEOPLE WITH 467 00:16:27,200 --> 00:16:29,960 COVID-19 VERSUS ANOTHER VIRUS, 468 00:16:29,960 --> 00:16:31,040 ANOTHER WELL CHARACTEREDDIZED 469 00:16:31,040 --> 00:16:31,920 RESPIRATORY VIRUS HAS BEEN WITH 470 00:16:31,920 --> 00:16:35,080 US AT LEAST A HUNDRED YEARS 471 00:16:35,080 --> 00:16:36,560 THAT'S SEASONAL INFLUENZA, SO 472 00:16:36,560 --> 00:16:38,560 WE'VE DID A COMPARATIVE 473 00:16:38,560 --> 00:16:40,600 EVALUATION OF COVID VERSUS FLU, 474 00:16:40,600 --> 00:16:42,320 TRIED TO GET A DEEPER 475 00:16:42,320 --> 00:16:42,920 UNDERSTANDING OF WHETHER, YOU 476 00:16:42,920 --> 00:16:45,600 KNOW ALL OF THOSE THINGS THAT WE 477 00:16:45,600 --> 00:16:47,120 SHOWED YOU THAT THEY ARE 478 00:16:47,120 --> 00:16:49,360 MANIFESTING HERE ARE THESE SORT 479 00:16:49,360 --> 00:16:51,040 OF--DO PEOPLE GET THESE WITH ANY 480 00:16:51,040 --> 00:16:53,160 POST VIRAL IN THIS, ANY POST 481 00:16:53,160 --> 00:16:54,720 VIRAL IN THIS, FOR THE PEOPLE 482 00:16:54,720 --> 00:16:56,880 AND EXPOSE THEM TO RISK OF ALL 483 00:16:56,880 --> 00:16:59,760 THESE COMPLICATIONS, OR IS THERE 484 00:16:59,760 --> 00:17:00,760 SOMETHING SPECIFIC ABOUT SARS 485 00:17:00,760 --> 00:17:01,360 KICKOFF 2. 486 00:17:01,360 --> 00:17:02,440 AND REALLY 1 OF THE WAYS YOU GD 487 00:17:02,440 --> 00:17:04,320 BE DO THIS IS ESTABLISH, YOU 488 00:17:04,320 --> 00:17:08,480 KNOW AS CLOSE AS AN APPLES 489 00:17:08,480 --> 00:17:10,560 TOANELS COMPARISON, EVALUATING 490 00:17:10,560 --> 00:17:12,320 POST ACUTE SEQUELA AND SARS 491 00:17:12,320 --> 00:17:14,880 KICKOFF 2 INFECTION VERSUS POST 492 00:17:14,880 --> 00:17:19,240 SEQUELA IN PEOPLE WITH FLU, 493 00:17:19,240 --> 00:17:19,680 SEASONAL INFLUENZA. 494 00:17:19,680 --> 00:17:20,520 SO THE SHORT BRIEF ANSWER HERE 495 00:17:20,520 --> 00:17:25,840 IS THAT THERE ARE 2 MAIN OR KEY 496 00:17:25,840 --> 00:17:27,560 DIFFERENCES IN PEOPLE WITH SARS 497 00:17:27,560 --> 00:17:31,200 KICKOFF 2 VERSUS SEASONAL 498 00:17:31,200 --> 00:17:32,360 INFLUENZA, 1 KEY DIFFERENCE IS 499 00:17:32,360 --> 00:17:34,520 THE MAGNITUDE OF RISK OF ALL 500 00:17:34,520 --> 00:17:38,960 THESE SEQUELA IS MUCH HIGHER IN 501 00:17:38,960 --> 00:17:40,320 COVID-19 VERSUS CEASEONAL INFLU 502 00:17:40,320 --> 00:17:41,440 EANS AND 2, REALLY VERY 503 00:17:41,440 --> 00:17:43,680 IMPORTANT IS THE BREDTH OF ORGAN 504 00:17:43,680 --> 00:17:46,920 DYSFUNCTION, THE BREDTH OF 505 00:17:46,920 --> 00:17:49,520 ORGANS THAT ARE INVOLVED AND MAN 506 00:17:49,520 --> 00:17:51,640 TEST WITH SEQUELA IS MUCH, MUCH, 507 00:17:51,640 --> 00:17:54,080 LARGER AND EXTENSIVE IN PEOPLE 508 00:17:54,080 --> 00:17:56,080 WITH SARS KICKOFF 2 VERSUS 509 00:17:56,080 --> 00:17:57,560 SEASONAL INFLUENZA, YOU KNOW THE 510 00:17:57,560 --> 00:17:59,440 BROADER CONDITION HEAT IS A 1 OF 511 00:17:59,440 --> 00:18:02,680 THE POST VIRAL INDROAM OR POST 512 00:18:02,680 --> 00:18:04,840 VIRAL CONDITION. 513 00:18:04,840 --> 00:18:06,680 BUT SARS KICKOFF 2 REALLY 514 00:18:06,680 --> 00:18:07,440 PRESENTED DIFFERENT FORM OR 515 00:18:07,440 --> 00:18:10,680 DIFFERENT KIND OF A POST VIRAL 516 00:18:10,680 --> 00:18:11,320 SYNDROME. 517 00:18:11,320 --> 00:18:12,680 AGAIN, IN DIFFERENTIATING ITSELF 518 00:18:12,680 --> 00:18:14,920 IN 2 DIFFERENT KEY FEATURES, THE 519 00:18:14,920 --> 00:18:16,680 MAGNITUDE OF RISK IS MUCH 520 00:18:16,680 --> 00:18:18,480 HIGHER, MUCH MORE PRONOUNCED AND 521 00:18:18,480 --> 00:18:21,080 THE BREDTH OF ORGAN DYSFUNCTION 522 00:18:21,080 --> 00:18:23,960 IS REALLY MUCH MORE EXTENSIVE. 523 00:18:23,960 --> 00:18:25,600 AND THEN WE ASK THE QUESTION 524 00:18:25,600 --> 00:18:28,880 HERE, WELL, WE ALSO KNOW THAT 525 00:18:28,880 --> 00:18:30,600 PEOPLE WHO REALLY SPEND TIME ON 526 00:18:30,600 --> 00:18:32,040 THE ICU ON A VENTILATOR OR 527 00:18:32,040 --> 00:18:33,720 PEOPLE WHO HAD BEEN IN THE 528 00:18:33,720 --> 00:18:36,320 HOSPITAL FOR A LONG TIME COULD 529 00:18:36,320 --> 00:18:38,000 BECOME DECONDITIONED AND HAVE A 530 00:18:38,000 --> 00:18:40,200 LOT OF MANIFESTATIONS, 531 00:18:40,200 --> 00:18:41,160 DESCRIBED, YOU KNOW FATIGUE, 532 00:18:41,160 --> 00:18:42,840 MUSCLE PAIN, WEAKNESS AND 533 00:18:42,840 --> 00:18:43,640 POTENTIALLY ANEMIA AND A LOT OF 534 00:18:43,640 --> 00:18:46,960 THESE THINGS THAT CAN HAPPEN IN 535 00:18:46,960 --> 00:18:48,040 THE POST HOSPITALIZATION COURSE 536 00:18:48,040 --> 00:18:49,480 AND PEOPLE WHO HAD SPENT SOME 537 00:18:49,480 --> 00:18:51,240 TIME IN THE HOSPITAL OR MORE SO 538 00:18:51,240 --> 00:18:54,400 SPENT TIME IN THE ICU, OF COURSE 539 00:18:54,400 --> 00:18:55,080 ICU SYNDROME, ESPECIALLY IF THEY 540 00:18:55,080 --> 00:18:57,960 WERE ON A VENTILATOR FOR A 541 00:18:57,960 --> 00:18:59,160 PERIOD OF TIME. 542 00:18:59,160 --> 00:19:00,320 SO WE'VE DONE THIS TO TRY TO 543 00:19:00,320 --> 00:19:02,000 UNDERSTAND THE LEVEL OF RISK IN 544 00:19:02,000 --> 00:19:03,160 DIFFERENT POPULATIONS WITH SARS 545 00:19:03,160 --> 00:19:05,960 KICKOFF 2 INCLUDING THOSE WHO 546 00:19:05,960 --> 00:19:06,960 ARE NOT HOSPITALIZED YOU KNOW 547 00:19:06,960 --> 00:19:08,640 PEOPLE WHO WERE HOSPITALIZED AND 548 00:19:08,640 --> 00:19:10,960 THEN PEOPLE WHO WERE IN THE ICU 549 00:19:10,960 --> 00:19:16,480 DURING THE ACUTE PHASE OF SARS 550 00:19:16,480 --> 00:19:16,920 KICKOFF 2 INFECTION. 551 00:19:16,920 --> 00:19:18,640 WHAT WE FOUND IS THAT THE RISK 552 00:19:18,640 --> 00:19:21,520 OF EVIDENT EVEN AMONG THE 553 00:19:21,520 --> 00:19:22,560 NONHOSPITALLIZED PEOPLE, THAT'S 554 00:19:22,560 --> 00:19:23,960 A KEY FEATURE AND VERY IMPORTANT 555 00:19:23,960 --> 00:19:24,680 BECAUSE A MAJORITY OF PEOPLE IN 556 00:19:24,680 --> 00:19:26,920 THE U.S. AND GLOBAL WITH SARS 557 00:19:26,920 --> 00:19:28,440 KICKOFF 2 INFECTION ARE 558 00:19:28,440 --> 00:19:29,640 NONHOSPITALLIZED SO LONG COVID 559 00:19:29,640 --> 00:19:32,720 OR THE POST ACUTE SEQUELA OF 560 00:19:32,720 --> 00:19:34,440 COVID-19 WERE EVIDENT EVEN AMONG 561 00:19:34,440 --> 00:19:35,840 NONHOSPITALLIZED TO A LESSER 562 00:19:35,840 --> 00:19:39,160 DEGREE THOUGH, TO A LESSER 563 00:19:39,160 --> 00:19:39,880 DEGREE BUT CERTAINLY EVIDENT, 564 00:19:39,880 --> 00:19:40,640 THEY WERE COMPARED TO THE 565 00:19:40,640 --> 00:19:42,640 CONTROL GROUP AND THE RISK 566 00:19:42,640 --> 00:19:44,200 INCREASES, ACCORDING TO THE 567 00:19:44,200 --> 00:19:46,400 SEVERITY OF THAT ACUTE 568 00:19:46,400 --> 00:19:47,840 INFECTION, MEANING THE RISK 569 00:19:47,840 --> 00:19:48,880 WAS--COMPARED TO THE 570 00:19:48,880 --> 00:19:51,440 NONHOSPITALLIZED RISK WAS HIGHER 571 00:19:51,440 --> 00:19:53,400 WHEN HOSPITALIZED AND HIGHEST IN 572 00:19:53,400 --> 00:19:55,880 PEOPLE WHO WERE IN THE ICU 573 00:19:55,880 --> 00:19:57,320 DURING THE ACUTE PHASE OF THE 574 00:19:57,320 --> 00:19:57,760 INFECTION. 575 00:19:57,760 --> 00:20:00,440 AND THIS IS BY THE WAY SORT OF 576 00:20:00,440 --> 00:20:03,720 LIKE ALMOST LIKE A UNIVERSAL 577 00:20:03,720 --> 00:20:04,840 STUDIES THAT REPRODUCED IN 578 00:20:04,840 --> 00:20:06,080 MULTIPLE OTHER STTDS AND THE 579 00:20:06,080 --> 00:20:07,560 SEVERITY OF THE ACUTE INFECTION 580 00:20:07,560 --> 00:20:08,560 REALLY MATTERS. 581 00:20:08,560 --> 00:20:10,600 IT DOES NOT MEAN THAT WE DON'T 582 00:20:10,600 --> 00:20:12,600 HAVE PEOPLE WITH LONG COVID OUT 583 00:20:12,600 --> 00:20:14,840 THERE WHO HAD ASYMPTOMATIC ACUTE 584 00:20:14,840 --> 00:20:16,240 INFECTION OR PEOPLE WITH LONG 585 00:20:16,240 --> 00:20:19,480 COVID OUT THERE WHO HAD REALLY 586 00:20:19,480 --> 00:20:21,440 MILD ACUTE INFECTION WITH SARS 587 00:20:21,440 --> 00:20:22,880 KICKOFF 2 THAT PUT THEM IN THE 588 00:20:22,880 --> 00:20:24,280 HOSPITAL, WE'RE NOT SAYING THAT, 589 00:20:24,280 --> 00:20:27,880 LONG COVID IN THESE PATIENTS 590 00:20:27,880 --> 00:20:28,720 ABSOLUTELY EXISTS AND WE 591 00:20:28,720 --> 00:20:29,960 RECOGNIZE IT AND REALIZE IT BUT 592 00:20:29,960 --> 00:20:34,560 WE'RE SAYING HERE THAT THE 593 00:20:34,560 --> 00:20:37,240 MAGNITUDE OF RISK POST ACUTE 594 00:20:37,240 --> 00:20:39,120 SEQUELA IS HIGHER IN PEOPLE WHO 595 00:20:39,120 --> 00:20:40,400 WERE HOSPITALLED AND HIGHEST IN 596 00:20:40,400 --> 00:20:43,880 PEOPLE WHO SPENT TIME ON AN ICU, 597 00:20:43,880 --> 00:20:44,880 ESPECIALLY IN A VENTILATOR 598 00:20:44,880 --> 00:20:48,920 DURING THE ACUTE PHASE OF SARS 599 00:20:48,920 --> 00:20:50,080 COV 2 INFECTION. 600 00:20:50,080 --> 00:20:52,000 YOU SHOULD BE ASKING, WELL THIS 601 00:20:52,000 --> 00:20:54,640 IS ALL FINE BUT WHOSE AT RISK 602 00:20:54,640 --> 00:20:57,560 HERE OR ON DO WE KNOW? 603 00:20:57,560 --> 00:20:59,760 AND IT'S LONG COVID ISN'T LIKELY 604 00:20:59,760 --> 00:21:00,760 TO BE 1 THING. 605 00:21:00,760 --> 00:21:03,480 SO WE SORT OF LUMP ALL OF THESE 606 00:21:03,480 --> 00:21:05,080 THINGS UNDER THE UMBELLA TO LONG 607 00:21:05,080 --> 00:21:07,400 COVID AND ACTUALLY, YOU KNOW, 608 00:21:07,400 --> 00:21:12,080 OTHERS, I THINK NIH CALLS IT 609 00:21:12,080 --> 00:21:14,520 POST ACUTE SEQUELA SARS COV2 AND 610 00:21:14,520 --> 00:21:15,960 OUR DEFINITION OF LONG COVID IS 611 00:21:15,960 --> 00:21:18,960 PRETTY MUCH ALINE WIDE WHAT MOST 612 00:21:18,960 --> 00:21:23,000 NIH CALLED P A SCS ARER OR POST 613 00:21:23,000 --> 00:21:27,000 ACUTE SEQUELA OF SARS COV 2, AND 614 00:21:27,000 --> 00:21:28,440 IN THE DISEASE, EITHER PERSISTS 615 00:21:28,440 --> 00:21:32,280 FROM THE ACUTE PHASE OR AND THE 616 00:21:32,280 --> 00:21:34,000 POST ACUTE PHASE OF THE DISEASE. 617 00:21:34,000 --> 00:21:36,760 THOSE CAN INVOLVE MULTIPLE ORGAN 618 00:21:36,760 --> 00:21:38,360 SYSTEMS WE DISCUSSED AND IT'S 619 00:21:38,360 --> 00:21:42,440 UNLIKELY AT THE END OF THE DAY 620 00:21:42,440 --> 00:21:43,920 WHEN WE FULLY UNDERSTAND LONG 621 00:21:43,920 --> 00:21:46,760 COVID AND HOPEFULLY SOON BUT 622 00:21:46,760 --> 00:21:48,040 WHEN WE FULLY UNDERSTAND IT, YOU 623 00:21:48,040 --> 00:21:50,880 KNOW LONG COVID HAS TO BE 624 00:21:50,880 --> 00:21:58,040 MULTIPLE ENTITIES AND NOT 1 625 00:21:58,040 --> 00:21:59,720 SYMBOL OR DISEASE, IT HAS IT'S 626 00:21:59,720 --> 00:22:02,040 OWN SET OF RISK FACTORS, HEALTH 627 00:22:02,040 --> 00:22:02,760 TRANSLATIONAL RESEARCH JECTORS 628 00:22:02,760 --> 00:22:03,680 AND OUTCOMES. 629 00:22:03,680 --> 00:22:05,960 SOA THIS POINT WE CATALOG THE 630 00:22:05,960 --> 00:22:08,880 MAIN FEATURES OF SARS COV 2, AND 631 00:22:08,880 --> 00:22:09,760 MAIN CONDITIONS, 30 OF THEM. 632 00:22:09,760 --> 00:22:14,720 AND ASKED THE QUESTION, ARE 633 00:22:14,720 --> 00:22:16,680 THOSE REALLY HIGHER IN MALES OR 634 00:22:16,680 --> 00:22:16,920 FEMALES? 635 00:22:16,920 --> 00:22:19,720 HIGHER IN PEOPLE WHO HAD IN 636 00:22:19,720 --> 00:22:22,720 BLACK INDIVIDUALS OR WHITE 637 00:22:22,720 --> 00:22:23,000 INDIVIDUALS? 638 00:22:23,000 --> 00:22:24,880 WERE THEY HIGHER IN PEOPLE HAD 639 00:22:24,880 --> 00:22:27,600 IN OLDER ADULTS OR YOUNGER 640 00:22:27,600 --> 00:22:29,360 ADULTS, OR ACCORDING TO BASE 641 00:22:29,360 --> 00:22:30,560 LINE HEALTH STATUS. 642 00:22:30,560 --> 00:22:32,080 AND IF--IF YOU CAN SEE 1 THING 643 00:22:32,080 --> 00:22:33,800 FROM THIS HEAT MAP, IT'S REALLY 644 00:22:33,800 --> 00:22:36,880 ALL OVER THE PLACE. 645 00:22:36,880 --> 00:22:37,960 IF YOUR BRAIN WENT TO THE 646 00:22:37,960 --> 00:22:39,240 CONCLUSION THAT OH MY GOD THIS, 647 00:22:39,240 --> 00:22:41,440 IS REALLY ALL OVER THE PLACE, 648 00:22:41,440 --> 00:22:44,240 YOU'RE ABSOLUTELY RIGHT ON 649 00:22:44,240 --> 00:22:44,720 POINT. 650 00:22:44,720 --> 00:22:46,280 THAT'S EXACTLY WHY LONG COVID IS 651 00:22:46,280 --> 00:22:47,520 NOT REALLY 1 THING. 652 00:22:47,520 --> 00:22:48,880 SOME FEATURES OF LONG COVID, 653 00:22:48,880 --> 00:22:51,120 SOME OF THOSE POST ACUTE 654 00:22:51,120 --> 00:22:52,320 SEQUELA, ACTUALLY THE RISK IS 655 00:22:52,320 --> 00:22:53,520 HIGHER IN YOUNGER ADULTS, SOME 656 00:22:53,520 --> 00:22:55,120 OF THEM ARE ACTUALLY HIGHER OR 657 00:22:55,120 --> 00:22:56,960 THE BURDEN IS MUCH, MUCH, HIGHER 658 00:22:56,960 --> 00:22:57,760 IN OLDER ADULTS WITH THE 659 00:22:57,760 --> 00:23:01,840 EVIDENCE THAT SOME OF IT ALSO 660 00:23:01,840 --> 00:23:02,880 UNEQUALLY DISTRIBUTED ACCORDING 661 00:23:02,880 --> 00:23:04,760 TO RACE, AND SOME UNEQUALLY 662 00:23:04,760 --> 00:23:06,040 DISTRIBUTED ACCORDING TO SEX. 663 00:23:06,040 --> 00:23:07,800 SOME OF THE SEQUENCES OF LONG 664 00:23:07,800 --> 00:23:10,640 ASHING OR THE POST ACUTE SEQUELA 665 00:23:10,640 --> 00:23:17,480 OF SARS COV 2 ARE MORE EXPRESSD 666 00:23:17,480 --> 00:23:19,320 FEMALE, SOME MORE IN MALES. 667 00:23:19,320 --> 00:23:20,880 UNIVERSALLY THOUGH IN THIS 668 00:23:20,880 --> 00:23:23,640 PAPER, YOU KNOW AGAIN FROM MY 669 00:23:23,640 --> 00:23:25,120 TEAM, REALLY CONVINCINGLY SHOWED 670 00:23:25,120 --> 00:23:30,600 AGAIN THAT THE RISK AND BURDEN 671 00:23:30,600 --> 00:23:33,560 ACCORDING TO THE SEVERITY OF THE 672 00:23:33,560 --> 00:23:35,400 INFECTION, THAT'S CONSISTENT OUT 673 00:23:35,400 --> 00:23:37,800 THERE, THAT'S REALLY VERY 674 00:23:37,800 --> 00:23:39,520 IMPORTANT, CONSISTENT FOR ALL 675 00:23:39,520 --> 00:23:44,040 THESE PAPERS THAT THE RISK SEEMS 676 00:23:44,040 --> 00:23:45,640 TO INCREASE GRADUALLY, IN A 677 00:23:45,640 --> 00:23:47,840 RELATED WAY ACCORDING TO THE 678 00:23:47,840 --> 00:23:49,840 THIS VERY ACUTE INFECTION, BUT 679 00:23:49,840 --> 00:23:51,720 WHEN YOU ANALYZE THE INDIVIDUAL 680 00:23:51,720 --> 00:23:53,120 COMPONENTS ACCORDING TO AGE, 681 00:23:53,120 --> 00:23:54,800 RACE, SEX AND BASED ON HEALTH 682 00:23:54,800 --> 00:23:56,560 STATUS, HAVE YOU SOMETHING LIKE 683 00:23:56,560 --> 00:23:57,120 THIS. 684 00:23:57,120 --> 00:23:58,440 YOU GET LIKE OH, IT'S ALL OVER 685 00:23:58,440 --> 00:23:59,920 THE PLACE, SOME CONDITIONS ARE 686 00:23:59,920 --> 00:24:01,960 HIGHENER MALES, SOME HIGHER IN 687 00:24:01,960 --> 00:24:03,440 FEMALES, ET CETERA, ET CETERA. 688 00:24:03,440 --> 00:24:10,720 SO REALLY THE CONCLUSION IT'S 689 00:24:10,720 --> 00:24:12,160 NOT ALL THE SAME WAY, WHEN YOU 690 00:24:12,160 --> 00:24:15,040 READ IN THE PRESS OR OTHER 691 00:24:15,040 --> 00:24:17,440 PLACES THROUGH GENERALIZATION, 692 00:24:17,440 --> 00:24:19,360 LONG COVID IS MORE EXPRESSED OR 693 00:24:19,360 --> 00:24:20,920 HIGHER IN FEMALES, WELL, ASK 694 00:24:20,920 --> 00:24:23,080 THEM, WHAT'S YOUR DEFINITION OF 695 00:24:23,080 --> 00:24:25,280 LONG COVID, WHICH SEQUELA ARE 696 00:24:25,280 --> 00:24:27,120 YOU TALKING ABOUT, FATIGUE, 697 00:24:27,120 --> 00:24:29,040 BRAIN FOG, METABOLIC SEQUENCES 698 00:24:29,040 --> 00:24:32,720 OF LONG COVID, DERMA TO LOGIC 699 00:24:32,720 --> 00:24:33,600 MANIFESTATIONS OF LONG COVID SO 700 00:24:33,600 --> 00:24:35,760 WHAT ARE YOU TALKING ABOUT WHEN 701 00:24:35,760 --> 00:24:38,800 YOU GENERALIZE THESE BROAD VERY, 702 00:24:38,800 --> 00:24:40,240 SWEEPING STATEMENTS ABOUT LONG 703 00:24:40,240 --> 00:24:41,320 ASHING BEING HIGHENER 1 AGE 704 00:24:41,320 --> 00:24:43,600 GROUP OR ANOTHER AGE GROUP OR 1 705 00:24:43,600 --> 00:24:46,320 SEX GROUP OR ANOTHER SEX GROUP. 706 00:24:46,320 --> 00:24:50,040 SO REALLY LONG COVID IS NOT A 707 00:24:50,040 --> 00:24:51,960 MODERNISTIC ENTITY, IT DOES NOT 708 00:24:51,960 --> 00:24:58,720 ALL BEHAVE IN THE SAME WAY. 709 00:24:58,720 --> 00:25:00,400 THE COMPONENTS OF WHICH ARE 710 00:25:00,400 --> 00:25:01,840 ACROSS AGE, RACE, SEX AND BASED 711 00:25:01,840 --> 00:25:03,680 ON HEALTH STATUS AND THAT LEADS 712 00:25:03,680 --> 00:25:05,960 US HERE TO THE--STILL SORT OF 713 00:25:05,960 --> 00:25:07,720 THE BROAD UMBRELLA TERM TO LONG 714 00:25:07,720 --> 00:25:10,400 COVID, FOR WHAT WE THINK WE ARE 715 00:25:10,400 --> 00:25:12,640 INTERESTED IN AND WHAT WE THINK 716 00:25:12,640 --> 00:25:14,160 ARE CONSEQUENTIAL SEQUELA THAT 717 00:25:14,160 --> 00:25:15,000 MIGHT CLASH FOR SOME PEOPLE FOR 718 00:25:15,000 --> 00:25:17,160 A LONG TIME AND THOSE INCLUDE, 719 00:25:17,160 --> 00:25:19,600 OR THE SEQUELA OF CONCERNS, TO 720 00:25:19,600 --> 00:25:23,440 US, AND THAT'S REALLY, YOU KNOW 721 00:25:23,440 --> 00:25:26,000 OBVIOUSLY SORT OF DEBATABLE, ARE 722 00:25:26,000 --> 00:25:26,600 THE CARDIOVASCULAR DISORDERS 723 00:25:26,600 --> 00:25:28,640 PEOPLE CAN GET AFTER SARS 724 00:25:28,640 --> 00:25:30,640 KICKOFF INFECTION, THE INCREASES 725 00:25:30,640 --> 00:25:33,520 OF DIABETES, SARS KICKOFF 2 726 00:25:33,520 --> 00:25:34,480 INFECTION, INCREASED RISK OF 727 00:25:34,480 --> 00:25:36,920 KIDNEY DISEASE AND THE INCREASED 728 00:25:36,920 --> 00:25:38,760 RISK OF NEUROLOGIC MENTAL HEALTH 729 00:25:38,760 --> 00:25:41,600 DISORDERS SO I WILL DIVE A BIT 730 00:25:41,600 --> 00:25:43,920 DEEPER INTO EACH 1 OF THOSE IN A 731 00:25:43,920 --> 00:25:45,360 SLIDE OR TBO AND THEN SORT OF 732 00:25:45,360 --> 00:25:49,280 TRANSITION TO THE NEXT PART OF 733 00:25:49,280 --> 00:25:49,560 THE TALK. 734 00:25:49,560 --> 00:25:51,280 SO WHAT WE'VE DONE HERE IS 735 00:25:51,280 --> 00:25:52,480 EVALUATE THE LONG-TERM OUTCOMES 736 00:25:52,480 --> 00:25:54,280 OF PEOPLE WITH SARS COV 2 737 00:25:54,280 --> 00:25:56,640 ENFEKS, SO AGAIN TBR AN 738 00:25:56,640 --> 00:25:57,280 EPIDEMIOLOGIC PERSPECTIVE, THE 739 00:25:57,280 --> 00:26:00,240 BEST WAY IS TO DEVELOP A COHORT 740 00:26:00,240 --> 00:26:02,640 OF PEOPLE WITH KNOWN SARS COV 2 741 00:26:02,640 --> 00:26:05,240 INFECTION AND COMPARE THEM TO 742 00:26:05,240 --> 00:26:08,080 CONTROL GROUPS WITH NO KNOWN 743 00:26:08,080 --> 00:26:09,880 INFECTION, NO KNOWN SARS COV 2 744 00:26:09,880 --> 00:26:12,280 INFECTION AND THIS ANALYSIS, WE 745 00:26:12,280 --> 00:26:14,120 REALLY ELECTED TO FOCUS ON 2 746 00:26:14,120 --> 00:26:16,560 CONTROL GROUPS, 1 WE CALL IT 747 00:26:16,560 --> 00:26:18,240 CONTEMPORARY COHORT, OR 748 00:26:18,240 --> 00:26:19,200 CONTEMPORARY CONTROL, PEOPLE WHO 749 00:26:19,200 --> 00:26:22,920 LIVE IN THE SAME TIME PERIOD 750 00:26:22,920 --> 00:26:25,320 DURING THE PAN DEMIC, MEANING 751 00:26:25,320 --> 00:26:26,760 THEY'RE EXPOSED TO SAME BROADER 752 00:26:26,760 --> 00:26:29,480 CONDITIONS OF THE PANDEMIC, SOME 753 00:26:29,480 --> 00:26:31,000 SARS COV 2 WITHOUT INFECTION AND 754 00:26:31,000 --> 00:26:33,440 A SOLE CONTROL GROUP OF PEOPLE 755 00:26:33,440 --> 00:26:35,080 WHO LIVE IN AN ERA THATY 756 00:26:35,080 --> 00:26:40,600 PRACTICES DATES THE PANDEMIC, A 757 00:26:40,600 --> 00:26:42,040 PREPANDEMIC ERASO COMPARED TO 758 00:26:42,040 --> 00:26:43,440 THESE CONTROL GROUPS WE FOUND 759 00:26:43,440 --> 00:26:46,280 PEOPLE WITH SARS INFECTION, WERE 760 00:26:46,280 --> 00:26:48,120 MANIFESTING OF HIGHER RISK UP TO 761 00:26:48,120 --> 00:26:50,840 A YEAR AFTER SARS COV 2 762 00:26:50,840 --> 00:26:52,240 DIAGNOSIS AND CARDIOVASCULAR 763 00:26:52,240 --> 00:26:56,400 CONDITIONS THAT WERE EVIDENT 764 00:26:56,400 --> 00:26:57,720 ACTUALLY SPANNED FOR 765 00:26:57,720 --> 00:26:59,000 CARDIOVASCULAR DISEASE AND THESE 766 00:26:59,000 --> 00:27:01,840 ARE DISORDERS AND STROKES AND 767 00:27:01,840 --> 00:27:03,880 TIA, DISRYTH METRICSA AND 768 00:27:03,880 --> 00:27:06,440 INFLAMMATORY HEART DISEASE THAT 769 00:27:06,440 --> 00:27:08,480 INCLUDES PERICARDITEIS AND MY O 770 00:27:08,480 --> 00:27:09,440 CARDITEIS AND ESCHEMIC HEART 771 00:27:09,440 --> 00:27:11,440 DISEASE AND SEVERAL CARDIAC 772 00:27:11,440 --> 00:27:14,680 DISORDERS INCLUDING HEART 773 00:27:14,680 --> 00:27:17,520 FAILURE AND THROMBOTIC 774 00:27:17,520 --> 00:27:19,920 DISORDERS, THOSE INCLUDE DEEP 775 00:27:19,920 --> 00:27:21,720 VAIN THOMBOSIS AND THE ORGANS OR 776 00:27:21,720 --> 00:27:25,760 THE BREDTH OF CARDIOVASCULAR 777 00:27:25,760 --> 00:27:26,880 MANIFESTATIONS IS REALLY--IS 778 00:27:26,880 --> 00:27:27,960 EXTENSIVE, AND THIS IS WHAT MAKE 779 00:27:27,960 --> 00:27:29,520 ITS HARD FROM MECHANISTIC 780 00:27:29,520 --> 00:27:30,800 PATHWAY AND I UNDERSTAND A LOT 781 00:27:30,800 --> 00:27:34,200 OF YOU GUYS ARE, YOU KNOW BASIC 782 00:27:34,200 --> 00:27:35,240 SCIENTISTS AND MECHANISMS 783 00:27:35,240 --> 00:27:37,600 DRIVING BIOLOGY OF THE DISEASE, 784 00:27:37,600 --> 00:27:40,160 IT MAKES IT REALLY HARD TO SORT 785 00:27:40,160 --> 00:27:42,840 OF HAVE A 1 UNIFYING HYPOTHESIS 786 00:27:42,840 --> 00:27:44,080 THAT EXPLAINS ALL OF THESE 787 00:27:44,080 --> 00:27:45,040 MANIFESTATIONS AND THIS IS 788 00:27:45,040 --> 00:27:47,320 REALLY SORT OF A--IN DIFFERENT 789 00:27:47,320 --> 00:27:51,440 VASCULAR BEDS AND SORT OF 790 00:27:51,440 --> 00:27:54,120 DIFFERENT, YOU KNOW LITERALLY 791 00:27:54,120 --> 00:27:55,400 HAVE DIFFERENT BUT BIOLOGIC 792 00:27:55,400 --> 00:27:57,160 MECHANISMS SO IT'S UNLIKELY THAT 793 00:27:57,160 --> 00:27:59,440 1 SORT OF UNIFYING MECHANISM, 794 00:27:59,440 --> 00:28:02,560 CAN EXPLAIN ALL OF THIS. 795 00:28:02,560 --> 00:28:04,800 SOPHISTICATED AND FROM AN 796 00:28:04,800 --> 00:28:05,640 EPIDEMIOLOGIC PERSPECTIVE HERE, 797 00:28:05,640 --> 00:28:06,720 THE FINDINGS WERE CLEAR THAT 798 00:28:06,720 --> 00:28:11,120 WHEN WE COMPARE THEM TO ABOUT 799 00:28:11,120 --> 00:28:12,440 5 MILLION PEOPLE, WHO HAD LIVED 800 00:28:12,440 --> 00:28:14,600 DURING THE SAME TIME PERIOD BUT 801 00:28:14,600 --> 00:28:16,760 DID NOT HAVE SARS COV 2 802 00:28:16,760 --> 00:28:19,680 INFECTION, SO IN TOTAL MORE THAN 803 00:28:19,680 --> 00:28:21,400 10 MILLION CONTROLS THROUGH THE 804 00:28:21,400 --> 00:28:24,920 ADCO VASEY OF PEOPLE WITH SARS 805 00:28:24,920 --> 00:28:27,520 COVID INFECTION HAD A MUCH 806 00:28:27,520 --> 00:28:28,720 LARGER HIGHER CARDIOVASCULAR 807 00:28:28,720 --> 00:28:30,560 RISK WITH THE SEQUELA. 808 00:28:30,560 --> 00:28:32,200 WE GO BACK TO THIS AGAIN AND 809 00:28:32,200 --> 00:28:34,160 AGAIN, THE RISK WAS HIGHER TO 810 00:28:34,160 --> 00:28:36,040 PEOPLE IN HOSPITALIZED AND 811 00:28:36,040 --> 00:28:37,000 COMPARED TO NONHOSPITALLIZED AND 812 00:28:37,000 --> 00:28:39,960 HIGHEST IN PEOPLE WHO NEEDED ICU 813 00:28:39,960 --> 00:28:40,880 CARE DURING THE ACUTE PHASE OF 814 00:28:40,880 --> 00:28:41,200 THE DISEASE. 815 00:28:41,200 --> 00:28:44,440 AND YOU CAN SEE THAT THE GREEN 816 00:28:44,440 --> 00:28:46,720 BARS ARE BARELY VISIBLE AND 817 00:28:46,720 --> 00:28:47,640 THAT'S ACTUALLY GOOD. 818 00:28:47,640 --> 00:28:49,280 THAT MEANS HOSPITALIZED THE RISK 819 00:28:49,280 --> 00:28:51,120 IS THERE, IT'S EVIDENT BUT 820 00:28:51,120 --> 00:28:51,600 ACTUALLY QUITE SMALL. 821 00:28:51,600 --> 00:28:53,920 SO WHEN YOU TALK TO PEOPLE, MORE 822 00:28:53,920 --> 00:28:56,760 THAN 80 OR 90% OF THE PEOPLE OF 823 00:28:56,760 --> 00:28:58,320 SARS COV 2, VERY FEW OF THEM 824 00:28:58,320 --> 00:28:59,440 WILL GO TO TO DEVELOP HEART 825 00:28:59,440 --> 00:29:01,560 DISEASE AND OTHER SARS COV 2, SO 826 00:29:01,560 --> 00:29:03,120 THE BURDEN HERE IS ACTUALLY 827 00:29:03,120 --> 00:29:04,360 QUITE SMALL, IT'S NOT A VISUAL, 828 00:29:04,360 --> 00:29:08,080 IT'S NOT 0, IT'S NOT TRIVIAL, 829 00:29:08,080 --> 00:29:09,760 BUT IT'S QUITE SMALL, REAH 830 00:29:09,760 --> 00:29:13,320 SURINGLY SMALL SO THIS IS LIKE A 831 00:29:13,320 --> 00:29:16,480 SILVER LINING THAT THE FEW THAT 832 00:29:16,480 --> 00:29:18,280 HAD--NEEDED ICU CARE OR WHAT 833 00:29:18,280 --> 00:29:19,560 HOSPITALIZED EXPRESSED THE 834 00:29:19,560 --> 00:29:21,720 HIGHER RISK AND THE MAJORITY WHO 835 00:29:21,720 --> 00:29:22,920 ARE NOT HOSPITALIZED ACTUALLY 836 00:29:22,920 --> 00:29:26,200 HAVE YOU KNOW THE LOWEST RISK 837 00:29:26,200 --> 00:29:26,520 HERE. 838 00:29:26,520 --> 00:29:31,720 LET ME ASK THE QUESTION, ARE 839 00:29:31,720 --> 00:29:32,560 THESE CARDIOVASCULAR 840 00:29:32,560 --> 00:29:33,840 MANIFESTATIONS DOES IT SPED ANY 841 00:29:33,840 --> 00:29:35,640 SPECIFIC GROUP, SO WE DID 842 00:29:35,640 --> 00:29:39,880 ANALYSIS BY AGE, RACE, SEX, 843 00:29:39,880 --> 00:29:42,120 OBESITY, SMOKING, HYPERTENSION, 844 00:29:42,120 --> 00:29:45,160 DIABETES, CHRONIC KIDNEY 845 00:29:45,160 --> 00:29:46,280 DISEASE, HYPOLIP DEEMIA AND 846 00:29:46,280 --> 00:29:48,040 CARDIOVASCULAR DISEASE AND THE 847 00:29:48,040 --> 00:29:49,120 MORAL OF THE STORY OR THE SHORT 848 00:29:49,120 --> 00:29:51,120 OF THE SLIDE IS, IT DOESN'T 849 00:29:51,120 --> 00:29:52,800 MATTER IF PEOPLE WERE YOUNG OR 850 00:29:52,800 --> 00:29:54,000 OLD, IT DIDN'T MATTER IF THEY 851 00:29:54,000 --> 00:29:56,920 WERE BLACK OR WHITE, FEMALE OR 852 00:29:56,920 --> 00:29:58,600 MALE, THEY HAD OBISITY OR DIDN'T 853 00:29:58,600 --> 00:30:02,480 HAVE OBESITY, IF THEY SMOKED OR 854 00:30:02,480 --> 00:30:04,200 NOT, OTHER CARDIOVASCULAR RISK 855 00:30:04,200 --> 00:30:05,400 FACTORS INCLUDING HYPERTENSION, 856 00:30:05,400 --> 00:30:08,480 DIABETES, CHRONIC KIDNEY 857 00:30:08,480 --> 00:30:09,800 DISEASE, HYPER LIPIDEMIA, ANY 858 00:30:09,800 --> 00:30:10,400 PRIOR CARDIOVASCULAR DISEASE, 859 00:30:10,400 --> 00:30:13,080 NONE OF THIS MATTERS, LIKE, 860 00:30:13,080 --> 00:30:15,480 THEY--IF THEY GOT SARS COV 2 861 00:30:15,480 --> 00:30:16,840 INFECTION, THEY STILL MANIFESTED 862 00:30:16,840 --> 00:30:20,320 WITH INCREASED RISK OF 863 00:30:20,320 --> 00:30:22,320 CARDIOVASCULAR RISK OF SEQUELA, 864 00:30:22,320 --> 00:30:23,960 AND WE WENT INTO THIS THINKING 865 00:30:23,960 --> 00:30:25,640 THAT THOSE ARE GOING TO BE 866 00:30:25,640 --> 00:30:28,520 HAPPENING IN PEOPLE WHO HAD 867 00:30:28,520 --> 00:30:30,280 PRIOR CARDIOVASCULAR RISKS, 868 00:30:30,280 --> 00:30:32,440 PEOPLE HAD HYPER LIP DEEMIA I 869 00:30:32,440 --> 00:30:33,920 JUST TALKED WITH, PEOPLE WITH 870 00:30:33,920 --> 00:30:35,920 OBISITY, PEOPLE WHO SMOKED A LOT 871 00:30:35,920 --> 00:30:37,200 OR PEOPLE WHO DIDN'T EXERCISE 872 00:30:37,200 --> 00:30:39,600 MUCH, PEOPLE WHO HAD PRIOR 873 00:30:39,600 --> 00:30:40,840 DIABETES OR SOME METABOLIC 874 00:30:40,840 --> 00:30:41,840 DYSFUNCTION AND THAT PUT THEM AT 875 00:30:41,840 --> 00:30:43,520 A HIGH RISK OF VARDIO CASKULAR 876 00:30:43,520 --> 00:30:45,880 DEC AND WE THOUGHT, YOU KNOW 877 00:30:45,880 --> 00:30:47,800 BEFORE--BEFORE GETTING THESE 878 00:30:47,800 --> 00:30:49,320 RESULTS WE THOUGHT THAT THOSE 879 00:30:49,320 --> 00:30:51,200 PEOPLE AT HIGH RISK TO START 880 00:30:51,200 --> 00:30:53,280 WITH, BEFORE GETTING SARS COV 2, 881 00:30:53,280 --> 00:30:56,000 THEY GOT HIT WITH SARS COV 2 AND 882 00:30:56,000 --> 00:30:59,000 THEY CAN GET THEM OVER THE EDGE 883 00:30:59,000 --> 00:31:00,520 TO MANIFEST WITH THE DISEASE. 884 00:31:00,520 --> 00:31:02,080 BUT IT WAS CLEAR HERE THAT EVEN 885 00:31:02,080 --> 00:31:03,520 PEOPLE AT LOW RISK, PEOPLE WHO 886 00:31:03,520 --> 00:31:07,080 HAD NO PRIOR RISK FACTORS, KNOW 887 00:31:07,080 --> 00:31:08,080 DIABETES, NO HYPERTENSION, NONE 888 00:31:08,080 --> 00:31:10,000 OF THIS STILL ALSO MANIFESTED 889 00:31:10,000 --> 00:31:11,920 WITH INCREASED RISK OF 890 00:31:11,920 --> 00:31:13,360 CARDIOVASCULAR CONDITION AND 891 00:31:13,360 --> 00:31:15,000 THAT'S REALLY IMPORTANT BECAUSE 892 00:31:15,000 --> 00:31:15,760 MECHANISTICALLY 2 THINGS COULD 893 00:31:15,760 --> 00:31:19,800 BE AT PLAY HERE, 1 THING COULD 894 00:31:19,800 --> 00:31:22,160 BE THAT SARS COV 2 MIGHT 895 00:31:22,160 --> 00:31:23,800 ACCELERATE UNDERLYING RISK SO 896 00:31:23,800 --> 00:31:25,120 SOMEONE HAD PRIOR ENDOTHELIAL 897 00:31:25,120 --> 00:31:30,360 DYSFUNCTION OR SOME SORT OF FORM 898 00:31:30,360 --> 00:31:32,200 OF DISEASE BECAUSE OF SMOKING OR 899 00:31:32,200 --> 00:31:33,680 SMOKING FOR A LONG TIENL, THOSE 900 00:31:33,680 --> 00:31:36,960 PEOPLE WHEN THEY GET THE 901 00:31:36,960 --> 00:31:38,160 SARS-COV 2-INFECTION AND IT PUTS 902 00:31:38,160 --> 00:31:40,080 THEM OVER THE EDGE AND THEY 903 00:31:40,080 --> 00:31:41,640 MANIFEST WITH CLINICAL DISEASE 904 00:31:41,640 --> 00:31:43,120 AND THEN 2, WHAT MAY BE 905 00:31:43,120 --> 00:31:44,880 HAPPENING IS SARS MAY BE 906 00:31:44,880 --> 00:31:47,160 PROVOKING THE DE NOVO INJURY 907 00:31:47,160 --> 00:31:48,080 THAT MIGHT CASCADE DOWN WITHIN 908 00:31:48,080 --> 00:31:50,040 THE SPAN OF A YEAR, THIS IS A 909 00:31:50,040 --> 00:31:53,800 YEAR FOLLOW UP COHORT TO 910 00:31:53,800 --> 00:31:55,800 MANIFEST WITH CARDIO LASKULAR 911 00:31:55,800 --> 00:31:56,600 CONDITIONS AND DISEASE. 912 00:31:56,600 --> 00:31:59,160 SO WE ALSO TURN OUR ATTENTION, 913 00:31:59,160 --> 00:32:01,720 WE ARE NEPHROLOGIST, WE DO A LOT 914 00:32:01,720 --> 00:32:02,840 OF KIDNEY DISEASE WORK PRIOR TO 915 00:32:02,840 --> 00:32:03,960 THE PANDEMIC AND WE WANT TO SORT 916 00:32:03,960 --> 00:32:06,560 OF LEAD THE KIDNEY UNATTENDED TO 917 00:32:06,560 --> 00:32:08,200 WHEN WE ARE EVALUATING LONG 918 00:32:08,200 --> 00:32:10,680 COVID, WE ALSO LOOK AT KIDNEY 919 00:32:10,680 --> 00:32:11,760 MANIFESTATIONS OR THE RISK OF 920 00:32:11,760 --> 00:32:13,280 KIDNEY DISEASE IN PEOPLE WITH 921 00:32:13,280 --> 00:32:14,480 LONG ASHING AND REALLY THE SHORT 922 00:32:14,480 --> 00:32:16,920 OF IT HERE THAT PEOPLE WITH SARS 923 00:32:16,920 --> 00:32:18,200 KICKOFF 2 INFECTION, YOU KNOW 924 00:32:18,200 --> 00:32:20,040 CAN HAVE UP TO A YEAR LATER CAN 925 00:32:20,040 --> 00:32:22,720 HAVE AN INCREASED RISK OF YOU 926 00:32:22,720 --> 00:32:25,160 KNOW ACUTE KIDNEY INJURY END 927 00:32:25,160 --> 00:32:26,760 STAGE KIDNEY DISEASE, WHAT WE 928 00:32:26,760 --> 00:32:28,280 CALL MAKE OR MAJOR ADVERSE 929 00:32:28,280 --> 00:32:30,320 KIDNEY EVENTS AND THOSE INCLUDE 930 00:32:30,320 --> 00:32:32,440 END STAGE KIDNEY DISEASE, ALL 931 00:32:32,440 --> 00:32:34,680 CAUSE MORTALITY OR EGF ARE 932 00:32:34,680 --> 00:32:36,920 DECLINED MORE THAN 30%. 933 00:32:36,920 --> 00:32:39,080 THAT'S QUITE SUBSTANTIAL DECLINE 934 00:32:39,080 --> 00:32:44,440 IN EGFR OR A MARKER OF KIDNEY 935 00:32:44,440 --> 00:32:44,800 FUNCTION. 936 00:32:44,800 --> 00:32:49,600 ESTIMATED RATE, THE MARKER OF 937 00:32:49,600 --> 00:32:50,520 KIDNEY FUNCTION. 938 00:32:50,520 --> 00:32:51,880 AND REALLY, YOU KNOW THIS IS 939 00:32:51,880 --> 00:32:54,960 WORK LED BY BENIA MIN BOLT FROM 940 00:32:54,960 --> 00:32:58,400 MY LAB, THE AMAZING THAT ALL THE 941 00:32:58,400 --> 00:32:59,560 ANALYSIS, ALSO BY CARE SETTING 942 00:32:59,560 --> 00:33:02,800 AND PEOPLE WHO ARE REALLY NOT 943 00:33:02,800 --> 00:33:03,600 HOSPITALIZED, HOSPITALIZED BUT 944 00:33:03,600 --> 00:33:08,080 DID NOT HAVE AKI DURING THE 945 00:33:08,080 --> 00:33:10,000 ACUTE PHASE AND ALSO 946 00:33:10,000 --> 00:33:12,040 HOSPITALIZED AND HAD AKI ACUTE 947 00:33:12,040 --> 00:33:15,240 PHASE, AND FOR THOSE THAT WERE 948 00:33:15,240 --> 00:33:16,480 HOSPITALIZED AND AKI MANIFEST 949 00:33:16,480 --> 00:33:17,840 WIDE A HIGHER RISK BUT AGAIN 950 00:33:17,840 --> 00:33:18,960 EVEN PEOPLE WHO WERE NOT 951 00:33:18,960 --> 00:33:21,800 HOSPITALIZED AT ALL DURING THE 952 00:33:21,800 --> 00:33:23,280 ACUTE PHASE STILL MANIFESTED 953 00:33:23,280 --> 00:33:24,800 LATER ON WITH INCREASED RISK OF 954 00:33:24,800 --> 00:33:28,840 AKI IN THE POST ACUTE PHASE, 955 00:33:28,840 --> 00:33:33,400 INCREASES RISK OF ESKD AND 956 00:33:33,400 --> 00:33:34,400 INCREASED KIDNEY DISUSE AND 957 00:33:34,400 --> 00:33:36,640 INCREASED RISK OF MAJOR ADVERSE 958 00:33:36,640 --> 00:33:37,160 KIDNEY EVENT. 959 00:33:37,160 --> 00:33:39,560 AND HE DID A WONDERFUL, 960 00:33:39,560 --> 00:33:42,080 WONDERFUL MATH MALICAL MODELING 961 00:33:42,080 --> 00:33:44,120 OF THE EGFR DECLINE IN THESE 962 00:33:44,120 --> 00:33:46,640 PATIENTS, WE APPRECIATE IT EVEN 963 00:33:46,640 --> 00:33:48,560 AMONG THOSE HOSPITALIZED 964 00:33:48,560 --> 00:33:49,880 ILLUSTRATED HERE IN RED, 965 00:33:49,880 --> 00:33:51,280 SIGNIFICANT DECLINE IN GFR OVER 966 00:33:51,280 --> 00:33:53,080 THE SPAN OF A YEAR. 967 00:33:53,080 --> 00:33:54,320 IT'S ABOUT, YOU KNOW BETWEEN 2 968 00:33:54,320 --> 00:33:56,840 AND 3, IT'S ABOUT LIKE 3 LITER 969 00:33:56,840 --> 00:33:59,120 PER MINUTE AND THATIA REALLY 970 00:33:59,120 --> 00:34:01,680 ALMOST LIKE A COVID OF AGING 2-3 971 00:34:01,680 --> 00:34:03,760 YEARS, IN THE SPAN OF 1 YEAR. 972 00:34:03,760 --> 00:34:07,960 THAT'S REALLY SORT OF A REALLY 973 00:34:07,960 --> 00:34:09,480 CONSEQUENCIAL THING SO 2 LITER 974 00:34:09,480 --> 00:34:11,080 PERMINUTE PER YEAR IS NOT A 975 00:34:11,080 --> 00:34:11,600 WHOLE LOT. 976 00:34:11,600 --> 00:34:13,880 IT'S ACTUALLY A WHOLE LOT ON TOP 977 00:34:13,880 --> 00:34:14,560 OF NORMALIGING AND 978 00:34:14,560 --> 00:34:15,800 ERESPONSIBLELY IF THIS WERE TO 979 00:34:15,800 --> 00:34:17,800 PERSIST FOR A LONGER TOWARD OF 980 00:34:17,800 --> 00:34:18,000 TIME. 981 00:34:18,000 --> 00:34:19,760 WE ARE DOING ANALYSIS TO TRY TO 982 00:34:19,760 --> 00:34:20,920 TRACK THESE PATIENTS FOR 2IERS 983 00:34:20,920 --> 00:34:22,480 TO GET A DEEPER UNDERSTANDING 984 00:34:22,480 --> 00:34:24,880 WHETHER THAT'S SORT OF DECLINE 985 00:34:24,880 --> 00:34:26,240 MELLOWS DOWN. 986 00:34:26,240 --> 00:34:27,400 THIS FIGURE SUGGIESTS IT MIGHT 987 00:34:27,400 --> 00:34:28,480 SO WE'RE VERY, VERY INTERESTED 988 00:34:28,480 --> 00:34:30,680 IN NEW DATA TO TRY TO SORT OF 989 00:34:30,680 --> 00:34:34,240 GET A DEEPER PERSPECTIVE AND HOW 990 00:34:34,240 --> 00:34:35,960 CHRONIC OR HOW REALLY--WHETHER 991 00:34:35,960 --> 00:34:39,880 THE DECLINE WILL CONTINUE TO GO 992 00:34:39,880 --> 00:34:40,560 ON OR NOT. 993 00:34:40,560 --> 00:34:43,760 AND THEN WE DID SOME STUDIES TO 994 00:34:43,760 --> 00:34:44,720 UNDERSTAND DEEPER TO UNDERSTAND 995 00:34:44,720 --> 00:34:47,000 THE RISK OF DIABETES IN PEOPLE 996 00:34:47,000 --> 00:34:48,480 WITH SARS COV 2 INFECTION IN THE 997 00:34:48,480 --> 00:34:50,440 POST ACUTE PHASE OF THE DISEASE. 998 00:34:50,440 --> 00:34:52,160 AND THE RISK OF DIABETES WAS 999 00:34:52,160 --> 00:34:53,720 EVIDENT, IT WAS NOT ONLY THAT 1000 00:34:53,720 --> 00:34:55,160 PEOPLE GOT DIAGNOSED WITH 1001 00:34:55,160 --> 00:34:57,600 DIABETES BASED ON HEMOGLOBIN AC1 1002 00:34:57,600 --> 00:35:00,680 C CRITERIA, BUT ALSO GOT 1003 00:35:00,680 --> 00:35:02,000 INITTIAITED ON THE HYPER 1004 00:35:02,000 --> 00:35:02,800 GLYCEMIC THERAPY AND THAT'S 1005 00:35:02,800 --> 00:35:04,200 IMPORTANT BECAUSE THIS IS JUST 1006 00:35:04,200 --> 00:35:07,640 NOT A DIAGNOSIS PEOPLE THOUGHT 1007 00:35:07,640 --> 00:35:09,120 OR PHYSICIANS, PROVIDERS THOUGHT 1008 00:35:09,120 --> 00:35:13,280 THAT THIS DIABETES IS,--IS TRUE, 1009 00:35:13,280 --> 00:35:19,640 IT'S IMPORTANT ENOUGH FOR THEM 1010 00:35:19,640 --> 00:35:21,160 TO BE INITIATED TREATMENT. 1011 00:35:21,160 --> 00:35:25,000 AND OUR THEME HERE TO PRODUCE 1012 00:35:25,000 --> 00:35:26,360 MULTIPLE TIMES THAT THERE IS A 1013 00:35:26,360 --> 00:35:27,440 GREATER ASSOCIATION OF RISK IN 1014 00:35:27,440 --> 00:35:31,080 THE SENSE OF PEOPLE WHO WOULD 1015 00:35:31,080 --> 00:35:32,280 ADMIT INTENSIVE CARE FOR THE 1016 00:35:32,280 --> 00:35:34,280 HIGHEST RISK OR THE HIGHEST 1017 00:35:34,280 --> 00:35:34,800 RISK. 1018 00:35:34,800 --> 00:35:35,840 IT DOESN'T ABSOLUTE RISK HERE, 1019 00:35:35,840 --> 00:35:37,720 SO THEY GIVE YOU APPRECIATION OF 1020 00:35:37,720 --> 00:35:39,120 THE MAGNITUDE OF THE ABSOLUTE 1021 00:35:39,120 --> 00:35:40,920 RISK IN THESE THINGS, YOU KNOW 1022 00:35:40,920 --> 00:35:44,000 HERE IS ABOUT 1-2%, SO 1-2% OF 1023 00:35:44,000 --> 00:35:46,120 PEOPLE, OF PEOPLE WHO WERE 1024 00:35:46,120 --> 00:35:48,080 EXPOSED TO SARS COV 2 MIGHT GO 1025 00:35:48,080 --> 00:35:50,120 ON TO DEVELOP DIABETES IN OUR 1026 00:35:50,120 --> 00:35:52,080 COHORT, AND 1 MAY SAY WELL, LIKE 1027 00:35:52,080 --> 00:35:56,240 1-2% IS NOT A WHOLE LOT, YOU 1028 00:35:56,240 --> 00:35:58,440 KNOW IF YOU MULTIPLY THAT BY THE 1029 00:35:58,440 --> 00:36:00,160 SIGNIFICANT NUMBER OF SARS COV2 1030 00:36:00,160 --> 00:36:01,680 IN THE U.S., THAT WAS 1031 00:36:01,680 --> 00:36:03,040 TRANCEALATED TO A SIGNIFICANT 1032 00:36:03,040 --> 00:36:03,560 BUMP IN DIABETES. 1033 00:36:03,560 --> 00:36:05,560 BUT IT ALSO MAKE ITS HARD TO 1034 00:36:05,560 --> 00:36:06,440 DETECT CLINICALLY BECAUSE YOU 1035 00:36:06,440 --> 00:36:08,480 CAN SEE HUNDRED PATIENTS WITH 1036 00:36:08,480 --> 00:36:10,440 SARS COV 2 AND ONLY 1 OF THEM 1037 00:36:10,440 --> 00:36:12,480 WILL ACTUALLY HAVE DIABETES AS A 1038 00:36:12,480 --> 00:36:14,360 RESULT OF SARS, A-THERE'S NO 1039 00:36:14,360 --> 00:36:15,200 BIOMARKER TO DIFFERENTIATE THAT 1040 00:36:15,200 --> 00:36:17,400 DIABETES FROM AND OTHER THINGS. 1041 00:36:17,400 --> 00:36:19,400 AND 1 OUT OF A HUNDRED IS ALMOST 1042 00:36:19,400 --> 00:36:21,240 LIKE A NEEDLE IN THE HAY STACK 1043 00:36:21,240 --> 00:36:23,200 SO IT MAKES IT REAL ACTUALLY, 1044 00:36:23,200 --> 00:36:28,200 IT'S SORT OF EASY FOR US TO SEE 1045 00:36:28,200 --> 00:36:30,040 IT VERY LARGE COLOSSAL DATA 1046 00:36:30,040 --> 00:36:31,440 APPROACH, USING OUR DATA AND 1047 00:36:31,440 --> 00:36:32,800 TOOLS, MUCH HARDER TO SEE IT IN 1048 00:36:32,800 --> 00:36:34,600 THE FRONT LINE WHEN YOU ARE 1049 00:36:34,600 --> 00:36:36,080 REALLY LOOKING FOR THAT 1 IN A 1050 00:36:36,080 --> 00:36:37,080 HUNDRED PATIENTS WITH COVID-19 1051 00:36:37,080 --> 00:36:38,600 COMING BA BEING TO THE CLINIC 1052 00:36:38,600 --> 00:36:40,440 AND ONLY 1 WILL HAVE METABOLIC 1053 00:36:40,440 --> 00:36:43,080 DYSFUNCTION AS A RESULT OF SARS 1054 00:36:43,080 --> 00:36:44,560 COV 2 ESPECIALLY IN THE ABSENCE 1055 00:36:44,560 --> 00:36:46,720 OF BIOMARKERS OR THE THING THAT 1056 00:36:46,720 --> 00:36:49,800 COULD DEFERENTIATE IT FROM 1057 00:36:49,800 --> 00:36:50,160 EVERYTHING ELSE. 1058 00:36:50,160 --> 00:36:51,760 AND I HAVE TO SAY HERE, LET'S GO 1059 00:36:51,760 --> 00:36:53,840 BACK TO THIS THAT THE REST OF 1060 00:36:53,840 --> 00:36:59,600 THE PAPER HERE AGAIN LED BY YAN 1061 00:36:59,600 --> 00:37:04,920 XIE, IN MY TEAM, BRILLIANT MAN 1062 00:37:04,920 --> 00:37:06,760 FROM MY TEAM, BUT THE RISK WAS 1063 00:37:06,760 --> 00:37:08,560 EVIDENT FOR THOSE THAT HAD NO 1064 00:37:08,560 --> 00:37:09,880 PRIOR RISK FOR DIABETES AT ALL 1065 00:37:09,880 --> 00:37:12,480 AND THAT'S AN IMPORTANT 1066 00:37:12,480 --> 00:37:14,920 COMPONENT HERE THAT MAYBE IN 1067 00:37:14,920 --> 00:37:17,440 THOSE INSTANCES SARS COV 2 IS 1068 00:37:17,440 --> 00:37:19,560 RESULTING IN DE NOVO DISEASE 1069 00:37:19,560 --> 00:37:20,160 ALTOGETHER, DIDN'T NECESSARILY 1070 00:37:20,160 --> 00:37:23,960 HEAD TO PEOPLE WHO HAD PRIOR 1071 00:37:23,960 --> 00:37:27,160 METABOLIC DYSFUNCTION OR PRIOR 1072 00:37:27,160 --> 00:37:28,080 PREDELICATION OR DIABETES, BUT 1073 00:37:28,080 --> 00:37:29,520 IT ALSO CAN AFFECT PEOPLE WHO 1074 00:37:29,520 --> 00:37:31,000 HAD NO PRIOR RISK FACTOR FOR 1075 00:37:31,000 --> 00:37:31,520 DIABETES AT ALL. 1076 00:37:31,520 --> 00:37:32,760 AND THEN WE TURN OUR ATTENTION 1077 00:37:32,760 --> 00:37:35,240 TO TRY TO UNDERSTAND THE RISK OF 1078 00:37:35,240 --> 00:37:37,360 MENTAL HEALTH OUTCOMES, THIS IS 1079 00:37:37,360 --> 00:37:41,120 ALSO WORK LED BY THE AMAZING YAN 1080 00:37:41,120 --> 00:37:47,000 XIE AND MY TEAM, CATALOGING THE 1081 00:37:47,000 --> 00:37:47,960 BREDTH OF MANIFESTATIONS THAT 1082 00:37:47,960 --> 00:37:50,720 CAN HAPPEN IN PEOPLE WITH SARS 1083 00:37:50,720 --> 00:37:52,240 COV 2 INFECTIONS UP TO A YEAR 1084 00:37:52,240 --> 00:37:55,080 LATER, SO THIS IS AGAIN A GROUP 1085 00:37:55,080 --> 00:37:58,400 COMPARED TO NEARLY MORE THAN 1086 00:37:58,400 --> 00:37:58,840 10 MILLION CONTROLS. 1087 00:37:58,840 --> 00:38:00,160 ONE CONTROL GROUP IN THE 1088 00:38:00,160 --> 00:38:01,560 CONTEMPORARY ERA, MEANING THERE 1089 00:38:01,560 --> 00:38:03,240 WERE EXPOSED TO THE SAME BROADER 1090 00:38:03,240 --> 00:38:08,080 CONDITIONS OF THE PANDEMIC LOCK 1091 00:38:08,080 --> 00:38:09,440 DOWN, NO GYM, NO STARBUCKS FOR 1092 00:38:09,440 --> 00:38:11,040 YOU AND ALL THESE STRESSORS THAT 1093 00:38:11,040 --> 00:38:13,880 AFFECTED OUR LIVES ALL OF A 1094 00:38:13,880 --> 00:38:15,800 SUDDEN STARTING MARCH 2020 AND 1095 00:38:15,800 --> 00:38:18,440 THEN FOLLOW THEM FOR A YEAR AND 1096 00:38:18,440 --> 00:38:21,240 THEN ALSO HISTORICAL CONTROL 1097 00:38:21,240 --> 00:38:22,040 GROUP PREPANDEMIC ERATHOSE 1098 00:38:22,040 --> 00:38:23,640 PEOPLE WERE NOT EVEN EXPERIENCE 1099 00:38:23,640 --> 00:38:26,680 THE PANDEMIC AT ALL AND WHAT YAN 1100 00:38:26,680 --> 00:38:30,760 SHOWS HERE REALLY WONDERFUL, 1101 00:38:30,760 --> 00:38:32,840 EARLIER THIS YEAR THAT YOU KNOW 1102 00:38:32,840 --> 00:38:34,720 I SHOULD PREFACE THIS BY SAYING 1103 00:38:34,720 --> 00:38:35,800 THAT WE'VE KNOWN ALL ALONG THAT 1104 00:38:35,800 --> 00:38:40,920 ALL OF US, ALL OF US DURING THIS 1105 00:38:40,920 --> 00:38:42,680 PANDEMIC, MOST OF US DURING THE 1106 00:38:42,680 --> 00:38:45,680 PANDEMIC EXPERIENCED SOME SORT 1107 00:38:45,680 --> 00:38:45,960 OF STRESS. 1108 00:38:45,960 --> 00:38:46,720 INCLUDING MYSELF, I WAS STRESS 1109 00:38:46,720 --> 00:38:48,400 TD OUT A LOT, MY TEAM WAS 1110 00:38:48,400 --> 00:38:51,200 STRESSED OUT IT WAS AN ENORMOUS, 1111 00:38:51,200 --> 00:38:53,120 IT A CHALLENGING TIME FOR ALL OF 1112 00:38:53,120 --> 00:38:53,680 US HERE. 1113 00:38:53,680 --> 00:38:56,600 SO WE KNEW THAT A LOT OF THE 1114 00:38:56,600 --> 00:38:57,720 POPULATION MNCHT HAVEOME 1115 00:38:57,720 --> 00:39:00,040 STRESS BUT WE ASKED THE QUESTION 1116 00:39:00,040 --> 00:39:03,160 HERE, DO PEOPLE WITH SARCOV 2 1117 00:39:03,160 --> 00:39:04,680 INFECTION HAVE IT WORSE? 1118 00:39:04,680 --> 00:39:06,760 DO PEOPLE WITH SARS COV 2 1119 00:39:06,760 --> 00:39:09,240 INFECTION EXHIBIT A HIGHER RISK 1120 00:39:09,240 --> 00:39:11,840 THAN [INDISCERNIBLE] WHO DID NOT 1121 00:39:11,840 --> 00:39:13,600 GET SARS COV2 INFECTION, DID 1122 00:39:13,600 --> 00:39:15,160 THEY EXHIBIT HIGHER RISK OF 1123 00:39:15,160 --> 00:39:17,520 MENTAL HEALTH PROBLEMS AND THE 1124 00:39:17,520 --> 00:39:19,560 ANSWER IS ABSOLUTELY, ABSOLUTELY 1125 00:39:19,560 --> 00:39:23,040 YES, PEOPLE WITH SARS COV 2 1126 00:39:23,040 --> 00:39:25,240 INFECTION, HAVE HIGHER ANXIETY 1127 00:39:25,240 --> 00:39:25,920 DISORDERS, DEPRESSIVE DISORDERS, 1128 00:39:25,920 --> 00:39:27,280 STRESS AND,A JUSTMENT DISORDERS 1129 00:39:27,280 --> 00:39:30,840 AND NOT ONLY DIAGNOSIS, PEOPLE 1130 00:39:30,840 --> 00:39:32,160 THOUGHT OF THESE ACTUALLY 1131 00:39:32,160 --> 00:39:32,800 CONSEQUENTIAL AND IMPORTANT 1132 00:39:32,800 --> 00:39:35,840 ENOUGH TO START THEM ON MEDICAL 1133 00:39:35,840 --> 00:39:36,800 THERAPY INCLUDING SSVIs 1134 00:39:36,800 --> 00:39:38,760 ACCIDENT BENZO DIAZ PENES, ET 1135 00:39:38,760 --> 00:39:40,520 CETERA, ET CETERA. 1136 00:39:40,520 --> 00:39:41,800 AN ALARMING FIEBDING IN OUR DAT 1137 00:39:41,800 --> 00:39:43,080 WE FIND THAT SOME PEOPLE ARE 1138 00:39:43,080 --> 00:39:44,760 COMING BACK TO THE CLINIC FOR A 1139 00:39:44,760 --> 00:39:47,520 VARIETY OF REASONS BUT PRIMARILY 1140 00:39:47,520 --> 00:39:49,240 PAIN, AMONG PEOPLE WITH SARS 1141 00:39:49,240 --> 00:39:51,600 COV2 AND HAVE LONG COVID ARE 1142 00:39:51,600 --> 00:39:52,880 BEING PRESCRIBED OPIOIDS AND WE 1143 00:39:52,880 --> 00:39:56,280 SEE AN INCREASED RISK OF OPIOID 1144 00:39:56,280 --> 00:39:57,560 UTILIZATION IN THIS POPULATION 1145 00:39:57,560 --> 00:39:58,400 AND HIGHLIGHTING BECAUSE WE ALL 1146 00:39:58,400 --> 00:40:00,360 NEED TO PAY ATTENTION IT, ALL OF 1147 00:40:00,360 --> 00:40:04,280 US LIVE THROUGH THE HORROR OF 1148 00:40:04,280 --> 00:40:05,640 THE OPIOID EPIDEMIC AND WE'VE 1149 00:40:05,640 --> 00:40:08,400 ALL THOUGHT THAT WE ARE TRYING 1150 00:40:08,400 --> 00:40:10,600 TO CURVETILIZATION AND P IT TO E 1151 00:40:10,600 --> 00:40:12,080 IT AND SUPPRESS IT AND WE'VE 1152 00:40:12,080 --> 00:40:14,240 DONE ACTUALLY QUITE A GOOD JOB 1153 00:40:14,240 --> 00:40:16,120 BEFORE THE PANDEMIC AND THE 1154 00:40:16,120 --> 00:40:18,600 PANDEMIC HIT AND WE'VE SEEN OUR 1155 00:40:18,600 --> 00:40:20,040 SIGNALS NOW ARE DATA, I HOPE 1156 00:40:20,040 --> 00:40:22,360 THIS DOES NOT CONTINUE. 1157 00:40:22,360 --> 00:40:24,760 THESE ARE EARLY SIGNALS OF 1158 00:40:24,760 --> 00:40:25,800 RESURGENCE OF OPIOID USE 1159 00:40:25,800 --> 00:40:28,760 SPECIFICALLY IN PEOPLE WITH SARS 1160 00:40:28,760 --> 00:40:29,600 COV2 INFECTION, THAT DEMANDS 1161 00:40:29,600 --> 00:40:31,880 ATTENTION TO NIP IT IN THE BUD 1162 00:40:31,880 --> 00:40:33,440 AND CURVE IT AGAIN TO PREVENT IT 1163 00:40:33,440 --> 00:40:36,920 FROM CASCADING DOWN TO ANOTHER 1164 00:40:36,920 --> 00:40:38,880 OPIOID EPIDEMIC TO LEAD DOWN TO 1165 00:40:38,880 --> 00:40:39,600 MAYBE MAJOR PROBLEMS. 1166 00:40:39,600 --> 00:40:41,920 WE SEE INCREASED RISK OF 1167 00:40:41,920 --> 00:40:43,360 SUBSTANCE USE DISORDERS, 1168 00:40:43,360 --> 00:40:44,720 NEUROCOGNITIVE DECLINE AND SLEEP 1169 00:40:44,720 --> 00:40:46,480 PROBLEMS, SO REALLY, IT REALLY 1170 00:40:46,480 --> 00:40:48,720 SPANS THE GAMUT HERE WHEN YOU 1171 00:40:48,720 --> 00:40:50,360 TALK ABOUT CLINICAL HEALTH 1172 00:40:50,360 --> 00:40:51,640 DISORDERS. 1173 00:40:51,640 --> 00:40:52,640 AND AGAIN, NOT TOO SPEND TOO 1174 00:40:52,640 --> 00:40:54,560 MUCH TIME ON THIS SLIDE THERE 1175 00:40:54,560 --> 00:40:56,360 THE RISK IS A GREAT ASSOCIATION 1176 00:40:56,360 --> 00:41:02,120 WITH CARE SETTING AT BASE LINE. 1177 00:41:02,120 --> 00:41:03,880 EXCUSE ME, I USED TO ASK NOW, 1178 00:41:03,880 --> 00:41:05,280 WELL, DO THESE PEOPLE, YOU KNOW 1179 00:41:05,280 --> 00:41:07,200 CAN YOU SORT OF GET US A LITTLE 1180 00:41:07,200 --> 00:41:11,280 BIT OF AN UNDERSTANDING HOW DOES 1181 00:41:11,280 --> 00:41:13,080 SARS COV2 BEHAVE VIS A VIS 1182 00:41:13,080 --> 00:41:14,360 SEASONAL INFLUENZA SO WE DID 1183 00:41:14,360 --> 00:41:15,960 ANALYSIS TO TRY TO DEEMERGING 1184 00:41:15,960 --> 00:41:17,360 HERE ARE THESE INCREASED RISKS 1185 00:41:17,360 --> 00:41:20,480 REALLY SPECIFIC TO SCARS COV2 OR 1186 00:41:20,480 --> 00:41:22,120 CAN THEY BE PRESCRIBING WENT ANY 1187 00:41:22,120 --> 00:41:23,240 VIRAL ILLNESS AND AGAIN HERE IN 1188 00:41:23,240 --> 00:41:25,840 OUR WORK, WHEN WE AM CO PAIR IT 1189 00:41:25,840 --> 00:41:28,400 HEAD-TO-HEAD OR APPLES TO 1190 00:41:28,400 --> 00:41:29,440 HAPPENLES COMPARISON AS NEAR TO 1191 00:41:29,440 --> 00:41:32,440 IT AS WE CAN DO IT, IT'S VERY, 1192 00:41:32,440 --> 00:41:34,840 VERY CLEAR PEOPLE WITH SARS COV 1193 00:41:34,840 --> 00:41:37,800 2 INFECTION HAVE A HIGHER RISK 1194 00:41:37,800 --> 00:41:38,880 OF THESE DISORDS. 1195 00:41:38,880 --> 00:41:40,280 THERE'S ALSO HIGHER RISK FOR 1196 00:41:40,280 --> 00:41:41,520 HOSPITALIZED FOR ANY OTHER 1197 00:41:41,520 --> 00:41:44,800 CAUSE, MEANING WHEN WE COMPARE 1198 00:41:44,800 --> 00:41:47,120 PEOPLE WHO ARE HOSPITALIZED FOR 1199 00:41:47,120 --> 00:41:49,360 SARS COV 2, VERSUS HOSPITALIZED 1200 00:41:49,360 --> 00:41:52,560 FOR AND OTHER CAUSE THOSE 1201 00:41:52,560 --> 00:41:53,560 HOSPITALIZED FOR SARCOV2 EXHIBIT 1202 00:41:53,560 --> 00:41:55,760 A HIGHER RISK OF MENTAL HEALTH 1203 00:41:55,760 --> 00:41:56,360 DISORDERS. 1204 00:41:56,360 --> 00:41:58,000 THERE'S SOMETHING ABOUT SARS 1205 00:41:58,000 --> 00:41:59,680 COV2 OR SPECIFICITY TO IT 1206 00:41:59,680 --> 00:42:01,320 RESULTING IN ALL THESE POST 1207 00:42:01,320 --> 00:42:05,080 ACUTE SEQUELA WE'VE SEEN IN 1208 00:42:05,080 --> 00:42:05,840 EPIDEMIOLOGIC ANALYSIS. 1209 00:42:05,840 --> 00:42:07,960 THIS IS FRESH OFF THE PRESS, 1210 00:42:07,960 --> 00:42:12,360 THIS WAS PUBLISHED LAST WEEK IN 1211 00:42:12,360 --> 00:42:15,280 NATURE MEDICINE. 1212 00:42:15,280 --> 00:42:20,160 EVALUATING THE RISK OF POST 1213 00:42:20,160 --> 00:42:21,880 ACUTE SEQUELA IN BREAK THROUGH 1214 00:42:21,880 --> 00:42:24,200 SARS COV-2, THESE PEOPLE ARE 1215 00:42:24,200 --> 00:42:26,760 PREVIOUSLY VACCINATED AND 1216 00:42:26,760 --> 00:42:28,760 SUBSEQUENTLY GOT BREAK THROUGH 1217 00:42:28,760 --> 00:42:30,960 SARS COV2 AFTER COMPLETING A 1218 00:42:30,960 --> 00:42:34,480 SERIES OF VACCINATION YOU KNOW 1219 00:42:34,480 --> 00:42:35,600 FOR COVID-19. 1220 00:42:35,600 --> 00:42:37,840 SKI ASKED 2 KEY QUESTIONS, WE 1221 00:42:37,840 --> 00:42:39,400 WANTED A-UNDERSTAND PEOPLE WITH 1222 00:42:39,400 --> 00:42:41,360 PEOPLE WITH SARS COV2 INFECTION 1223 00:42:41,360 --> 00:42:42,040 GET LONG COVID? 1224 00:42:42,040 --> 00:42:45,880 AND THE ANSWER IS ABSOLUTELY 1225 00:42:45,880 --> 00:42:46,480 YES. 1226 00:42:46,480 --> 00:42:48,360 QUALITATIVELY, IT IS NOT 1227 00:42:48,360 --> 00:42:49,800 DIFFERENT THAN POST ACUTE 1228 00:42:49,800 --> 00:42:50,600 SEQUELA OR LONG ASHING THAT 1229 00:42:50,600 --> 00:42:52,520 HAPPENS IN PEOPLE WHO ARE 1230 00:42:52,520 --> 00:42:53,840 UNVACCINATED IN THE SENSE THEY 1231 00:42:53,840 --> 00:42:56,840 GET BRAIN FOG, FATIGUE, MUSCLE 1232 00:42:56,840 --> 00:43:01,360 PAIN, YOU KNOW, IT'S 1233 00:43:01,360 --> 00:43:02,000 INDISTINGUISHABLE QUALITATIVELY. 1234 00:43:02,000 --> 00:43:06,400 FROM LONG COVID OR POST ACUTE 1235 00:43:06,400 --> 00:43:08,320 SEQUELA HAPPEN IN UNVACCINATED 1236 00:43:08,320 --> 00:43:09,080 INDIVIDUALS. 1237 00:43:09,080 --> 00:43:10,160 AND THEN 2, QUESTION 2 THAT WE 1238 00:43:10,160 --> 00:43:14,000 WANT TO ANSWER IN THIS PAPER WAS 1239 00:43:14,000 --> 00:43:15,920 THAT YOU KNOW DOES VACCINATION 1240 00:43:15,920 --> 00:43:16,920 DO ANYTHING? 1241 00:43:16,920 --> 00:43:17,760 DOES VACCINATION HELP? 1242 00:43:17,760 --> 00:43:19,480 AND THE SHORT ANSWER IS IT 1243 00:43:19,480 --> 00:43:22,400 ACTUALLY DOES BUT NOT REALLY NOT 1244 00:43:22,400 --> 00:43:23,920 A WHOLE LOT, OVERALL WHEN WE 1245 00:43:23,920 --> 00:43:25,960 ANALYZE THE RISK OF ANY POST 1246 00:43:25,960 --> 00:43:27,520 ACUTE SIGNIFY QUELLA VACCINATION 1247 00:43:27,520 --> 00:43:30,560 REDUCES THE RISK BY ONLY 15%, 1248 00:43:30,560 --> 00:43:30,840 1-5. 1249 00:43:30,840 --> 00:43:32,920 HOWEVER RISK REDUCTION IS 1250 00:43:32,920 --> 00:43:34,640 VARIABLE ACROSS DIFFERENT ORGAN 1251 00:43:34,640 --> 00:43:36,400 SYSTEM, IT'S MOST PRONOUNCED 1252 00:43:36,400 --> 00:43:38,080 RISK REDUCTION IS MOST 1253 00:43:38,080 --> 00:43:39,240 PRONOUNCED MOST EVIDENT, MOST 1254 00:43:39,240 --> 00:43:42,720 CLEAR IN 2 ORGAN SYSTEMS, 1255 00:43:42,720 --> 00:43:43,440 A-COAGULATION DISORDERS THAT 1256 00:43:43,440 --> 00:43:45,320 BLOCK CLOTS THAT I TOLD YOU 1257 00:43:45,320 --> 00:43:49,560 ABOUT THAT WE SEE PEOPLE IN THE 1258 00:43:49,560 --> 00:43:52,400 SARS COV2 INFECTION, PULMONARY 1259 00:43:52,400 --> 00:43:53,920 DISORDERS AND CARDIO DISORDERS, 1260 00:43:53,920 --> 00:43:55,960 THESE 2 SEEM TO BE MOST AFFECTED 1261 00:43:55,960 --> 00:43:57,600 BY VACCINATION AND THE RISK IS 1262 00:43:57,600 --> 00:44:01,560 MOST EVIDENT IN THESE 2 SPECIFIC 1263 00:44:01,560 --> 00:44:01,960 DOMAINS. 1264 00:44:01,960 --> 00:44:03,760 THIS IS A SLIDE ABOUT MECHANISMS 1265 00:44:03,760 --> 00:44:04,840 AND THESE ARE MECHANISMS WE 1266 00:44:04,840 --> 00:44:06,560 DON'T REALLY KNOW WHY PEOPLE, 1267 00:44:06,560 --> 00:44:08,480 WHY SOME PEOPLE WITH SARS GO ON 1268 00:44:08,480 --> 00:44:11,360 TOO FAST WITH POST ACUTE SEQUELA 1269 00:44:11,360 --> 00:44:13,160 OF SARS COV 2, BUT THERE ARE 1270 00:44:13,160 --> 00:44:13,840 SEVERAL HYPOTHESIS HERE, YOU 1271 00:44:13,840 --> 00:44:18,040 KNOW THIS IS REALLY FROM 1272 00:44:18,040 --> 00:44:20,640 [INDISCERNIBLE] IN SCIENCE, NOT 1273 00:44:20,640 --> 00:44:22,120 SO LONG AGO, WONDERFUL LUCID 1274 00:44:22,120 --> 00:44:24,360 THINKING ABOUT THE POST ACUTE 1275 00:44:24,360 --> 00:44:25,600 SARS COV 2 AND POTENTIAL 1276 00:44:25,600 --> 00:44:27,560 HYPOTHESIS LEADING TO THAT. 1277 00:44:27,560 --> 00:44:32,800 ONE IS REALLY AUTOIMMUNITY AND 2 1278 00:44:32,800 --> 00:44:34,920 IS MICRO BIOME DISBIOSS, SARS 1279 00:44:34,920 --> 00:44:37,720 COV 2 IN THE ACUTE PHASE 1280 00:44:37,720 --> 00:44:38,600 DISTURBS THE MICROBIOME, AND 1281 00:44:38,600 --> 00:44:39,920 THIS IS SPHBL FOR EXPHELGT 1282 00:44:39,920 --> 00:44:41,960 DISEASE CAN SORT OF TRIGGER 1283 00:44:41,960 --> 00:44:42,960 INFLAMMATION, ET CETERA, ET 1284 00:44:42,960 --> 00:44:44,760 CETERA, LEADING TO SOME OF THE 1285 00:44:44,760 --> 00:44:46,080 MANIFESTATION WE SEE IN THE POST 1286 00:44:46,080 --> 00:44:47,920 ACUTE PHASE OF THE DISEASE. 1287 00:44:47,920 --> 00:44:48,880 ONE OTHER HYPOTHESIS AND YOU 1288 00:44:48,880 --> 00:44:51,280 KNOW STILL REMAINS TO BE REFUTED 1289 00:44:51,280 --> 00:44:52,680 OR PROVEN, IS THE IDEA OF THE 1290 00:44:52,680 --> 00:44:55,680 PRESENCE OF A VIRAL RESERVOIR OR 1291 00:44:55,680 --> 00:44:58,000 REMNANTS OF VIRUS IN 1292 00:44:58,000 --> 00:44:58,880 QUOTE-UNQUOTE IMMUNE SIZE, THEY 1293 00:44:58,880 --> 00:45:00,080 ARE NOT ACCESSIBLE TO THE IMMUNE 1294 00:45:00,080 --> 00:45:02,560 SYSTEM AND THE PERSISTENCE OF 1295 00:45:02,560 --> 00:45:04,480 THE VIRUS OR ITSELF FRAGMENTS 1296 00:45:04,480 --> 00:45:07,720 AND THOSE SITES WILL ILLICIT AND 1297 00:45:07,720 --> 00:45:10,000 PROLONG THE LOW GRADE BUT 1298 00:45:10,000 --> 00:45:13,160 LONG-TERM INFLAMMATION THAT MAY 1299 00:45:13,160 --> 00:45:14,000 RESULT IN ORGAN INJURY. 1300 00:45:14,000 --> 00:45:15,760 SOME OF THE MANIFESTATIONS WE 1301 00:45:15,760 --> 00:45:18,360 SEE IN SARS COV-2 BEYOND THE 1302 00:45:18,360 --> 00:45:20,000 ACUTE PHASE AND THE LAST 1 IS 1303 00:45:20,000 --> 00:45:21,400 REALLY TISSUE DAMAGE THAT CAN 1304 00:45:21,400 --> 00:45:23,640 HAPPEN IN THE ACUTE PHASE AND 1305 00:45:23,640 --> 00:45:25,720 MAYBE THE BODY'S ON ITS WAY TO 1306 00:45:25,720 --> 00:45:28,040 REPAIRING IT OR, YOU KNOW SORT 1307 00:45:28,040 --> 00:45:32,000 OF THAT TISSUE DAMAGE MAY THEN 1308 00:45:32,000 --> 00:45:33,440 SUBSEQUENTLY RESULT IN POST 1309 00:45:33,440 --> 00:45:34,520 ACUTE SEQUELA, I HAVE TO SAY 1310 00:45:34,520 --> 00:45:38,520 THESE ARE SORT OF ALL MECHANISMS 1311 00:45:38,520 --> 00:45:39,680 OF THE DISEASE AND 1312 00:45:39,680 --> 00:45:40,520 [INDISCERNIBLE], THIS IS A 1313 00:45:40,520 --> 00:45:44,520 LITTLE BIT OF A SORT OF THE WHY 1314 00:45:44,520 --> 00:45:45,360 NEUROLOGIC MANIFESTATIONS HAPPEN 1315 00:45:45,360 --> 00:45:47,840 IN PEOPLE WITH SARS COV2, BUT 1316 00:45:47,840 --> 00:45:49,560 IT'S MISUNDERSTOOD BUT IT'S FROM 1317 00:45:49,560 --> 00:45:52,360 NIH, FROM THE [INDISCERNIBLE] AT 1318 00:45:52,360 --> 00:45:54,160 NIH AND SERIES POINTSA 1319 00:45:54,160 --> 00:45:58,080 [INDISCERNIBLE] FROM YALE, AND 1320 00:45:58,080 --> 00:46:01,520 RECENTLY IN SCIENCE, WONDERFUL 1321 00:46:01,520 --> 00:46:03,240 WONDERFUL LUCID THINKING ABOUT 1322 00:46:03,240 --> 00:46:04,000 NEUROLOGIC MANIFESTATIONS AND 1323 00:46:04,000 --> 00:46:05,880 PEOPLE WITH POST COVID CONDITION 1324 00:46:05,880 --> 00:46:08,800 OR P A, C AND THIS IS THEIR 1325 00:46:08,800 --> 00:46:10,120 HYPOTHESIS THAT THIS SCHEMATIC 1326 00:46:10,120 --> 00:46:12,080 FOR WHAT'S POTENTIALLY GOING ON, 1327 00:46:12,080 --> 00:46:13,640 AND THE SHORT ANSWER IS THAT WE 1328 00:46:13,640 --> 00:46:15,360 DON'T FULLY UNDERSTAND, THESE 1329 00:46:15,360 --> 00:46:17,160 ARE PUTATIVE MECHANISMS OF 1330 00:46:17,160 --> 00:46:18,800 DISEASE, THAT INVOLVES THE 1331 00:46:18,800 --> 00:46:20,200 RECRUITMENT OF OTHER CELLS AND 1332 00:46:20,200 --> 00:46:23,920 INFLAMMA ARE TOY CELLS, 1333 00:46:23,920 --> 00:46:25,920 SUBSEQUENT CYTOKINES AND CELLS 1334 00:46:25,920 --> 00:46:26,640 AND ACTIVATION OF MICROGLUE 1335 00:46:26,640 --> 00:46:30,360 MARIOUSA IN THE BRAIN AND 1336 00:46:30,360 --> 00:46:33,720 ENDOTHEL YIETIS THAT MIGHT 1337 00:46:33,720 --> 00:46:36,480 PROVOKE COAGULATION LEADING TO 1338 00:46:36,480 --> 00:46:38,280 MICROCLOTS OR MICROBLEEDS 1339 00:46:38,280 --> 00:46:39,880 EXPLAINING THE MINISTROKES OR 1340 00:46:39,880 --> 00:46:41,240 STROKES OR BRAIN DISTORTION OR 1341 00:46:41,240 --> 00:46:42,320 BRAIN FOG OR OTHER 1342 00:46:42,320 --> 00:46:42,960 MANIFESTATIONS OF THE DISEASE 1343 00:46:42,960 --> 00:46:46,520 THAT WE SEE IN PEOPLE WITH SARS 1344 00:46:46,520 --> 00:46:47,920 COV 2 INFECTION AND I HAVE TO 1345 00:46:47,920 --> 00:46:49,880 CAVEAT THIS BY THIS IS A LOT OF, 1346 00:46:49,880 --> 00:46:51,040 YOU KNOW SPECULATION, AT LEAST 1347 00:46:51,040 --> 00:46:52,400 OUR MECHANISMS THAT ARE BEING 1348 00:46:52,400 --> 00:46:54,280 WORKED ON BY A LOT OF PEOPLE 1349 00:46:54,280 --> 00:46:55,240 THROUGHOUT THE WORLD, BUT NONE 1350 00:46:55,240 --> 00:46:58,880 OF THEM REALLY IS ESTABLISHED AS 1351 00:46:58,880 --> 00:47:01,600 A PROVEN MECHANISM THAT EXPLAINS 1352 00:47:01,600 --> 00:47:03,800 THE POST ACUTE MANIFESTATION OF 1353 00:47:03,800 --> 00:47:04,320 SARS COV 2. 1354 00:47:04,320 --> 00:47:06,040 SO WHEN WE TALK ABOUT LONG 1355 00:47:06,040 --> 00:47:07,440 ASHING, IT'S REALLY AN UMBRELLA 1356 00:47:07,440 --> 00:47:12,520 TERM AND I HOPE, WE ALL HAVE AN 1357 00:47:12,520 --> 00:47:13,960 AAPPRECIATION THAT PEOPLE WHO 1358 00:47:13,960 --> 00:47:14,880 GET HOSPITALIZED ESPECIALLY IF 1359 00:47:14,880 --> 00:47:17,520 THEY SPEND TIME IN THE HOSPITAL 1360 00:47:17,520 --> 00:47:19,600 ISSUE GOOD TIME IN THE HOSPITAL 1361 00:47:19,600 --> 00:47:21,520 OR IN THE ICU, THEY ACTUALLY 1362 00:47:21,520 --> 00:47:23,240 HAVE A POST ICU SYNDROME AND 1363 00:47:23,240 --> 00:47:25,000 LONG ASHING SOME OF THE FEATURES 1364 00:47:25,000 --> 00:47:27,760 ACTUALLY OVERLAP WITH POST ICU 1365 00:47:27,760 --> 00:47:28,360 AND HOSPITALIZATION SYNDROME. 1366 00:47:28,360 --> 00:47:30,880 AND ALSO NEEDS TO BE UNDERSTAND 1367 00:47:30,880 --> 00:47:33,280 WITHIN SORT OF BROADER POST 1368 00:47:33,280 --> 00:47:36,200 VIRAL ILLNESS AND YOU KNOW WE 1369 00:47:36,200 --> 00:47:37,560 HAVEN'T DONE A LOT CHARACTERIZED 1370 00:47:37,560 --> 00:47:39,320 IN DETAIL WHAT HAPPENS IN THE 1371 00:47:39,320 --> 00:47:40,600 POST FLU CONDITION BUT TO BE 1372 00:47:40,600 --> 00:47:42,120 VERY CLEAR THAT YOU KNOW 1373 00:47:42,120 --> 00:47:43,600 ACTUALLY PEOPLE WITH FLU ALSO 1374 00:47:43,600 --> 00:47:46,160 SOME OF THEM EXPERIENCE, YOU 1375 00:47:46,160 --> 00:47:48,840 KNOW POST ACUTE SEQUELA AND THIS 1376 00:47:48,840 --> 00:47:49,800 WAS REALLY EVIDENT EVEN A 1377 00:47:49,800 --> 00:47:52,320 HUNDRED YEARS AGO AND THAT TIME 1378 00:47:52,320 --> 00:47:55,880 IT WAS CALLED ENSIEVE LIGHTIS OR 1379 00:47:55,880 --> 00:48:00,440 SICKNESS OR POST ENCEPHALETTIC 1380 00:48:00,440 --> 00:48:02,880 PARKINNISM, MEASLES COULD ALSO 1381 00:48:02,880 --> 00:48:05,680 PRODUCE POST ACUTE SEQUELA AND 1382 00:48:05,680 --> 00:48:07,960 ALSO PAN-ENCEPHALITIS, WE 1383 00:48:07,960 --> 00:48:09,800 LEARNED THAT EVV CAN BE LINKED 1384 00:48:09,800 --> 00:48:11,360 TO MULTIPLE SCLEROSIS DOWN THE 1385 00:48:11,360 --> 00:48:15,320 ROAD THAT IS THE POST EBOLA 1386 00:48:15,320 --> 00:48:20,160 SYNDROME AND POST POLIO 1387 00:48:20,160 --> 00:48:21,440 SYNDROME, SO ME/CFS AND THERE 1388 00:48:21,440 --> 00:48:25,520 ARE A LOT OF SIMILARITIES AND 1389 00:48:25,520 --> 00:48:28,440 DIFFERENCES WEAN ME/CFS OR THE P 1390 00:48:28,440 --> 00:48:30,240 A SC. 1391 00:48:30,240 --> 00:48:32,120 SO AS WE DELVE DEEPER INTO 1392 00:48:32,120 --> 00:48:34,320 BRAINSTORMING AND RESEARCHING 1393 00:48:34,320 --> 00:48:40,320 AND AIMS AND HYPOTHESIS FOR THE 1394 00:48:40,320 --> 00:48:42,360 MOST COVID CONDITION, LONG COVID 1395 00:48:42,360 --> 00:48:45,040 OR P A SC, IT'S IMPORTANT TO PUT 1396 00:48:45,040 --> 00:48:46,440 THAT IN THE CONDITION AND 1397 00:48:46,440 --> 00:48:48,240 OVERLAP WITH THE [INDISCERNIBLE] 1398 00:48:48,240 --> 00:48:48,560 OF ICU. 1399 00:48:48,560 --> 00:48:50,920 SHOULD BE ASKING NOW, IS LONG 1400 00:48:50,920 --> 00:48:52,440 COVID RARE? 1401 00:48:52,440 --> 00:48:52,880 IT'S NOT RARE. 1402 00:48:52,880 --> 00:48:54,880 ALTHOUGH THE FIGURES FROM OUR 1403 00:48:54,880 --> 00:48:55,880 REPORTS ALMOST ALL UNIVERSALLY 1404 00:48:55,880 --> 00:48:59,600 IN THE SINGLE DIGIT, AND WE PUT 1405 00:48:59,600 --> 00:49:02,160 IT OUT BETWEEN 4 AND 7% BUT 1406 00:49:02,160 --> 00:49:04,560 BECAUSE THE SCALE OF THE PEOPLE 1407 00:49:04,560 --> 00:49:06,840 INFEC WIDE SARS IN THE U.S. AND 1408 00:49:06,840 --> 00:49:08,440 GLOBAL 4-7% OF POPULATION IS 1409 00:49:08,440 --> 00:49:10,840 REALLY, REALLY A HUGE NUMBER. 1410 00:49:10,840 --> 00:49:12,160 SO PEOPLE HAVE A HIGHER FIGURE 1411 00:49:12,160 --> 00:49:15,480 AND OUR FIGURES IS REALLY AROUND 1412 00:49:15,480 --> 00:49:16,760 47%, SO WHAT ARE THE 1413 00:49:16,760 --> 00:49:18,560 IMPLICATIONS FOR HEALTH SYSTEMS, 1414 00:49:18,560 --> 00:49:20,640 I THINK THE BURDEN IS LIKELY 1415 00:49:20,640 --> 00:49:20,960 SUBSTANTIAL. 1416 00:49:20,960 --> 00:49:22,520 IN OUR WORK WE THINK WHRRP 1417 00:49:22,520 --> 00:49:24,560 BETWEEN 4 AND 7%, AGAIN THAT'S 1418 00:49:24,560 --> 00:49:25,680 MUCH, MUCH, LESS THAN WHAT YOU 1419 00:49:25,680 --> 00:49:27,720 READ IN THE PRESS OR IN THE NEWS 1420 00:49:27,720 --> 00:49:30,920 AND OTHER REPORTS UNCONTROLLED 1421 00:49:30,920 --> 00:49:31,160 REPORTS. 1422 00:49:31,160 --> 00:49:33,640 IT'S POSSIBLE WE ARE 1423 00:49:33,640 --> 00:49:34,920 UNDERESTIMATING THE PROBLEM, BUT 1424 00:49:34,920 --> 00:49:37,560 EVEN 4 TO 7-% OF PEOPLE WHO ARE 1425 00:49:37,560 --> 00:49:39,800 INFECT WIDE SARS COVR 2 HAVING 1426 00:49:39,800 --> 00:49:45,840 LONG COVID COULD REALLY HAVE 1427 00:49:45,840 --> 00:49:47,160 LONG SERIOUS APPLICATION ON OUR 1428 00:49:47,160 --> 00:49:47,800 LIFE. 1429 00:49:47,800 --> 00:49:49,480 IT IS A DEC THAT CAN AFFECT 1430 00:49:49,480 --> 00:49:50,640 NEARLY EVERY ORGAN SYSTEM AND WE 1431 00:49:50,640 --> 00:49:53,000 THINK BECAUSE IT AFFECTS, YOU 1432 00:49:53,000 --> 00:49:54,840 KNOW AT LEAST INCREASES 1433 00:49:54,840 --> 00:49:56,840 DIABETES, CHRONIC KIDNEY 1434 00:49:56,840 --> 00:49:58,400 DISEASE, MENTAL HEALTH 1435 00:49:58,400 --> 00:49:59,120 DISORDERS, CARDIOVASCULAR 1436 00:49:59,120 --> 00:49:59,880 DISEASE, THAT WOULD LEAD TO A 1437 00:49:59,880 --> 00:50:02,480 RISE IN THE BURDEN OF 1438 00:50:02,480 --> 00:50:03,680 NONCOMMUNICABLE DISEASES, SO WE 1439 00:50:03,680 --> 00:50:04,920 THINK IT'S IMPORTANT, WE 1440 00:50:04,920 --> 00:50:07,360 CONTRIBUTE A RISE OF THE BURDEN 1441 00:50:07,360 --> 00:50:09,120 OF NONCOMMUNICABLE DISEASES IN 1442 00:50:09,120 --> 00:50:10,720 THE U.S. AND ELSEWHERE. 1443 00:50:10,720 --> 00:50:12,000 SO WE THINK IT'S VERY IMPORTANT 1444 00:50:12,000 --> 00:50:15,600 THAT GOVERNMENTS AND HELT 1445 00:50:15,600 --> 00:50:17,000 SYSTEMS PREPARE FOR PEOPLE WITH 1446 00:50:17,000 --> 00:50:20,400 POST COVID OR WITH LONG COVID 1447 00:50:20,400 --> 00:50:21,600 THAT NEED CARE. 1448 00:50:21,600 --> 00:50:22,840 THE [INDISCERNIBLE] HEALTH 1449 00:50:22,840 --> 00:50:24,880 SYSTEM HAS STOOD UP SEVERAL 1450 00:50:24,880 --> 00:50:26,040 CLINICS, SERL U.S. HEALTH 1451 00:50:26,040 --> 00:50:28,320 SYSTEMS ARE DOING SO, THE VA HAS 1452 00:50:28,320 --> 00:50:30,880 STEPPED UP TO THE PLATE AND DONE 1453 00:50:30,880 --> 00:50:33,160 A REMARKABLE JOB IS SETTING UP 1454 00:50:33,160 --> 00:50:34,600 POST COVID CLINICS AND THAT'S 1455 00:50:34,600 --> 00:50:36,360 THE BEST WAY TO GO FOR CARING 1456 00:50:36,360 --> 00:50:38,440 PER PEOPLE WITH LONG COVID AND 1457 00:50:38,440 --> 00:50:39,520 IT'S IMPORTANT THAT THE HEALTH 1458 00:50:39,520 --> 00:50:40,840 SYSTEM REALIZE THE IMPORTANCE OF 1459 00:50:40,840 --> 00:50:42,320 THIS AND BE PREPARED TO ADDRESS 1460 00:50:42,320 --> 00:50:45,360 THE NEEDS OF THE PATIENTS. 1461 00:50:45,360 --> 00:50:48,600 THE BEST WAY TO PREVENT LONG 1462 00:50:48,600 --> 00:50:50,600 COVID IS TO PREVENT COVID IN THE 1463 00:50:50,600 --> 00:50:51,200 FIRST PLACE. 1464 00:50:51,200 --> 00:50:53,000 IF YOU HAVEN'T ENCOUNTERED IT 1465 00:50:53,000 --> 00:50:54,800 YET, DO YOUR BEST TO PREVENT 1466 00:50:54,800 --> 00:50:56,840 YOURSELF AND YOUR LOVED 1S FROM 1467 00:50:56,840 --> 00:50:58,360 ACTUALLY HAVING COVID. 1468 00:50:58,360 --> 00:51:00,200 THE BEST WAY IS TO PREVENT COVID 1469 00:51:00,200 --> 00:51:01,440 IN THE FIRST PLACE AND OBVIOUSLY 1470 00:51:01,440 --> 00:51:03,560 THE BEST WAY WE KNOW TO PREVENT 1471 00:51:03,560 --> 00:51:04,280 SEVERE DISEASE AND 1472 00:51:04,280 --> 00:51:05,440 HOSPITALIZATION AND THAT FROM 1473 00:51:05,440 --> 00:51:07,040 ACUTE COVID IS REALLY 1474 00:51:07,040 --> 00:51:08,200 VACCINATION. 1475 00:51:08,200 --> 00:51:09,480 IT IS VERY IMPORTANT, I CAN'T 1476 00:51:09,480 --> 00:51:11,640 REALLY GIVE A TALK ON COVID OR 1477 00:51:11,640 --> 00:51:14,880 LONG COVID WITHOUT TALKING ABOUT 1478 00:51:14,880 --> 00:51:16,320 MISINFORMATION, DISINFORMATION 1479 00:51:16,320 --> 00:51:16,720 AND GAS LIGHTING. 1480 00:51:16,720 --> 00:51:17,520 SO IT'S REALLY IMPORTANT TO 1481 00:51:17,520 --> 00:51:18,760 REALIZE THAT THIS IS HAPPENING 1482 00:51:18,760 --> 00:51:21,360 IN THE PUBLIC SPHERE AND U.S. 1483 00:51:21,360 --> 00:51:22,360 AND ELSEWHERE AND EUROPE AND A 1484 00:51:22,360 --> 00:51:24,800 LOT OF OTHER PLACES AND IT'S 1485 00:51:24,800 --> 00:51:30,600 VERY IMPORTANT TO TAKE YOUR ROLE 1486 00:51:30,600 --> 00:51:32,200 VERY, VERY SERIOUSLY AND 1487 00:51:32,200 --> 00:51:34,400 ACTIVELY COMBATING GAS LIGHTING. 1488 00:51:34,400 --> 00:51:34,840 IT'S REALLY IMPORTANT. 1489 00:51:34,840 --> 00:51:36,560 WE CANNOT BE SWITTER LAND AND 1490 00:51:36,560 --> 00:51:39,080 TAKE A NEUTRAL APPROACH HERE. 1491 00:51:39,080 --> 00:51:42,000 I WOULD ARGUE WE HAVE AN 1492 00:51:42,000 --> 00:51:43,440 OBLIGATION TO STEP UP TO THE 1493 00:51:43,440 --> 00:51:46,800 PLATE AND ACTIVELY COMBAT, YOU 1494 00:51:46,800 --> 00:51:48,360 KNOW MISINFORMATION, 1495 00:51:48,360 --> 00:51:49,520 DISINFORMATION GAS LIGHTING. 1496 00:51:49,520 --> 00:51:51,560 WITH DATA, WITH SCIENCE, WITH 1497 00:51:51,560 --> 00:51:53,000 FACTS, AND TO PROMOTE PUBLIC 1498 00:51:53,000 --> 00:51:56,200 UNDERSTANDING OF THIS CONDITION. 1499 00:51:56,200 --> 00:51:58,200 AND REALLY WE CANNOT IGNORE THE 1500 00:51:58,200 --> 00:51:59,600 PATIENT ADVOCACY IN THIS TALK AS 1501 00:51:59,600 --> 00:52:01,800 LI WOULD NOT BE RESEARCHING, MY 1502 00:52:01,800 --> 00:52:03,480 GROUP WOULD NOT BE RESEARCHING 1503 00:52:03,480 --> 00:52:05,200 LONG COVID, WE WILL NOTED BE 1504 00:52:05,200 --> 00:52:08,320 KNEE DEEP BO IT HAD IT NOT BEEN 1505 00:52:08,320 --> 00:52:09,920 FOR THE WONDERFUL PATIENT 1506 00:52:09,920 --> 00:52:11,720 ADVOCACY WHO GAVE US A LOT 1507 00:52:11,720 --> 00:52:13,280 STRENGTH, THE WARMTH IN OUR 1508 00:52:13,280 --> 00:52:16,640 HEART REALLY TO PURSUE THIS AND 1509 00:52:16,640 --> 00:52:17,720 REALLY A CHALLENGING JOURNEY, 1510 00:52:17,720 --> 00:52:19,680 THIS IS NOT EASY TO DO ALL OF 1511 00:52:19,680 --> 00:52:21,840 THIS, BUT REALLY HAD IT NOT BEEN 1512 00:52:21,840 --> 00:52:26,320 FOR THEM, WE WOULD NOT BE HERE 1513 00:52:26,320 --> 00:52:26,880 TALKING ABOUT THIS. 1514 00:52:26,880 --> 00:52:28,600 WHEN WE TALK ABOUT LONG ASHING, 1515 00:52:28,600 --> 00:52:30,120 THAT'S REALLY NOW, STILL BENEATH 1516 00:52:30,120 --> 00:52:33,400 THE TIP OF THE ICEBERG, TIP OF 1517 00:52:33,400 --> 00:52:35,000 THE ICEBERG IS THE ACUTE 1518 00:52:35,000 --> 00:52:39,600 DISEASE, THIS IS DISEASE, LIFE 1519 00:52:39,600 --> 00:52:41,840 EXPECTANCY, CHANGES OR 1520 00:52:41,840 --> 00:52:44,760 REDUCTION, DEVELOPMENT AND 1521 00:52:44,760 --> 00:52:46,000 EDUCATION OF KIDS WITH COVID, 1522 00:52:46,000 --> 00:52:49,000 THEY WILL HAVE BROAD AND 1523 00:52:49,000 --> 00:52:49,760 ECONOMIC COMPLICATIONS. 1524 00:52:49,760 --> 00:52:51,840 WE DON'T SEE THIS, THIS IS 1525 00:52:51,840 --> 00:52:53,800 BENEATH THE ICEBERG, WE CONTINUE 1526 00:52:53,800 --> 00:52:55,840 TO FECUS ON HOSPITALIZED AND 1527 00:52:55,840 --> 00:52:57,560 DEATHS, WE SHOULD FOCUS ON THE 1528 00:52:57,560 --> 00:52:58,640 LONG HAUL AND WHAT'S BEENEATH 1529 00:52:58,640 --> 00:53:01,720 AND A LOT MORE AND WILL LIKELY 1530 00:53:01,720 --> 00:53:03,240 ELLIPSE THAT THE TIP OF THE 1531 00:53:03,240 --> 00:53:04,000 ICEBERG. 1532 00:53:04,000 --> 00:53:06,120 SO IN SUMMARY, I HOPE I CONVEYED 1533 00:53:06,120 --> 00:53:08,040 TO YOU THAT LONG ASHING IS A 1534 00:53:08,040 --> 00:53:09,560 MULTIFACETED DISEASE THAT CAN 1535 00:53:09,560 --> 00:53:11,000 AFFECT NEARLY EVERY ORGAN 1536 00:53:11,000 --> 00:53:12,960 SYSTEM, THE BURDEN IS BETWEEN 1537 00:53:12,960 --> 00:53:14,160 4-7%, GOVERNMENT AND HEALTH 1538 00:53:14,160 --> 00:53:16,360 SYSTEMS MUST ADAPT QUICKLY AND 1539 00:53:16,360 --> 00:53:18,040 ESTABLISH POST COVID CARE 1540 00:53:18,040 --> 00:53:18,720 STRATEGIES. 1541 00:53:18,720 --> 00:53:19,560 REALLY WANTED TO HIGHLIGHT, YOU 1542 00:53:19,560 --> 00:53:20,520 KNOW THE KEY PEOPLE WHO 1543 00:53:20,520 --> 00:53:25,240 CONTRIBUTE TO A LOT OF THIS WORK 1544 00:53:25,240 --> 00:53:26,880 YAN XIE, AMAZING, AMAZING, 1545 00:53:26,880 --> 00:53:27,960 AMAZING GUY FROM MY TEAM WHO LED 1546 00:53:27,960 --> 00:53:33,560 A LOT OF THIS WORK I PRESENTED 1547 00:53:33,560 --> 00:53:34,080 TODAY. 1548 00:53:34,080 --> 00:53:36,000 BENJAMIN BOWE, EVAN XU FROM MY 1549 00:53:36,000 --> 00:53:41,200 TEAM, KEY MEMBERS HERE INCLUDE 1550 00:53:41,200 --> 00:53:43,200 MIAO CAI, ANDREW GIBSON, 1551 00:53:43,200 --> 00:53:44,440 TAEYOING CHOI, AND OTHERS. 1552 00:53:44,440 --> 00:53:45,360 GRATEFUL FROM THE FUNDING FROM 1553 00:53:45,360 --> 00:53:48,000 THE U.S. DEPARTMENT OF VETERANS 1554 00:53:48,000 --> 00:53:50,680 AFFAIRS AND TO THE SUPPORT OF MY 1555 00:53:50,680 --> 00:53:52,280 MENTEES BY THE AMERICAN SOCIETY 1556 00:53:52,280 --> 00:53:53,720 OF NEPHROLOGY AND THE SUPPORT AT 1557 00:53:53,720 --> 00:53:55,280 THE VI AND MOST IMPORTANTLY THE 1558 00:53:55,280 --> 00:53:56,720 LONG HAULER WHO IS INSPIRED US 1559 00:53:56,720 --> 00:54:00,120 AND CONTINUE TO INSPIRE US TO DO 1560 00:54:00,120 --> 00:54:00,560 THIS WORK. 1561 00:54:00,560 --> 00:54:03,240 I WAS HOPING TO LEAVE 10 MINUTES 1562 00:54:03,240 --> 00:54:05,200 FOR QUESTIONS BUT WE HAVE LESS 1563 00:54:05,200 --> 00:54:06,840 THAN 5 MINUTES. 1564 00:54:06,840 --> 00:54:07,720 WOULD BE DELIGHTED, DELIGHTED TO 1565 00:54:07,720 --> 00:54:08,960 HAVE QUESTIONS FROM THE 1566 00:54:08,960 --> 00:54:09,840 AUDIENCE. 1567 00:54:09,840 --> 00:54:13,960 >> THANK YOU SO MUCH DOCTOR. 1568 00:54:13,960 --> 00:54:16,120 SO HELLO EVERYBODY, I'M AN 1569 00:54:16,120 --> 00:54:17,240 INFECT YOWZ DISEASE DOCTOR AT 1570 00:54:17,240 --> 00:54:19,360 NAID AND I WILL RELAY YOUR 1571 00:54:19,360 --> 00:54:21,040 QUESTIONS TO DR. ALAS LY, SO 1572 00:54:21,040 --> 00:54:22,360 FIRST OF ALL I WOULD LIKE TO 1573 00:54:22,360 --> 00:54:23,720 THANK YOU SO MUCH FOR THIS 1574 00:54:23,720 --> 00:54:24,880 FASCINATING TALK AND FOR SHARING 1575 00:54:24,880 --> 00:54:26,160 WITH US THE IMPORTANT WORK THAT 1576 00:54:26,160 --> 00:54:30,360 YOU DO AND THAT YOU'VE DONE AND 1577 00:54:30,360 --> 00:54:31,200 ALSO FOR SHOWING US THE WEALTH 1578 00:54:31,200 --> 00:54:32,720 OF INFORMATION THAT THE VA 1579 00:54:32,720 --> 00:54:33,960 HEALTH SYSTEM COLLECTS AND THE 1580 00:54:33,960 --> 00:54:36,800 SOPHISTICATED WORK THAT CAN BE 1581 00:54:36,800 --> 00:54:37,360 DONE WITH IT. 1582 00:54:37,360 --> 00:54:39,120 SO TO GET STARTED, THE FIRST 1583 00:54:39,120 --> 00:54:41,840 QUESTION HAS TO DO WITH ACE 2 1584 00:54:41,840 --> 00:54:45,920 RECEPTORS AND THE QUESTION IS 1585 00:54:45,920 --> 00:54:48,720 WHAT HOLE DOES THE SARS COV 2 1586 00:54:48,720 --> 00:54:58,640 VIRUS BINDING TO ACE 2 RECEPTORS 1587 00:54:58,640 --> 00:55:00,480 IN THE PATHOLOGY OF 1588 00:55:00,480 --> 00:55:01,560 CARDIOVASCULAR AND KIDNEY 1589 00:55:01,560 --> 00:55:03,720 DISEASE SEQUELA IN THE PATIENTS 1590 00:55:03,720 --> 00:55:04,920 YOU HAVE BEEN FOLLOWING TO US 1591 00:55:04,920 --> 00:55:06,200 ABOUT AND AS A FOLLOW UP TO 1592 00:55:06,200 --> 00:55:08,920 THAT, COULD IT BE THAT THE 1593 00:55:08,920 --> 00:55:10,520 DIFFERENT NUMBERS OF RECEPTORS 1594 00:55:10,520 --> 00:55:11,720 ON DIFFERENT CELLS PLACENTA I A 1595 00:55:11,720 --> 00:55:12,640 ROLE IN THAT. 1596 00:55:12,640 --> 00:55:13,480 >> THIS IS ABSOLUTELY 1597 00:55:13,480 --> 00:55:14,880 FASCINATING SO CERTAINLY THERE 1598 00:55:14,880 --> 00:55:16,920 IS A HYPOTHESIS OUT THERE THAT 1599 00:55:16,920 --> 00:55:18,000 SPIKE PROTEIN INTERACTION WITH 1600 00:55:18,000 --> 00:55:21,400 AN AGE 2 RECEPTOR WITH SERL CELL 1601 00:55:21,400 --> 00:55:22,040 TYPES INCLUDING CARDIOVASCULAR 1602 00:55:22,040 --> 00:55:23,880 CELLS AND KIDNEY CELLS MIGHT 1603 00:55:23,880 --> 00:55:26,440 LEAD OR EXPLAIN THE PATHOGENESIS 1604 00:55:26,440 --> 00:55:27,840 OR THE ORGAN INJURY IN THESE 1605 00:55:27,840 --> 00:55:28,040 CELLS. 1606 00:55:28,040 --> 00:55:29,840 I HAVE TO SAY THAT THE DATA ON 1607 00:55:29,840 --> 00:55:32,000 THIS OR THE MECHANISTIC DATA ON 1608 00:55:32,000 --> 00:55:33,880 THIS IS STILL EVOLVING, YOU KNOW 1609 00:55:33,880 --> 00:55:35,280 WITH THE OTHER DATA LIKE 1610 00:55:35,280 --> 00:55:36,120 NEWSPAPER AND CELLS THAT ARGUE 1611 00:55:36,120 --> 00:55:41,280 THAT THAT MIGHT BE THE CASE. 1612 00:55:41,280 --> 00:55:42,520 SO THE LITERATURE ON THIS IS 1613 00:55:42,520 --> 00:55:49,120 EVOLVING BUT IT'S A VIABLE AND 1614 00:55:49,120 --> 00:55:49,560 IMPORTANT HYPOTHESIS. 1615 00:55:49,560 --> 00:55:51,840 WHETHER THE SPIKE PROTEIN WITH A 1616 00:55:51,840 --> 00:55:54,400 RECEPTOR ON SEVERAL CELL TYPES, 1617 00:55:54,400 --> 00:55:55,960 MEDIATE INJURY. 1618 00:55:55,960 --> 00:55:57,560 AND WHETHER ALSO LIKE, THE 1619 00:55:57,560 --> 00:55:59,040 ABUNDANCE OF ACE 2 RECEPTOR THIS 1620 00:55:59,040 --> 00:56:01,040 THESE CELLS WAS REALLY SORT OF 1 1621 00:56:01,040 --> 00:56:03,760 OF THE RISK FACTORS OR 1 OF THE 1622 00:56:03,760 --> 00:56:04,880 MECHANISMS LEADING TO INJURY IN 1623 00:56:04,880 --> 00:56:05,680 THOSE CELLS. 1624 00:56:05,680 --> 00:56:07,000 I THINK THE JURY ON THIS IS 1625 00:56:07,000 --> 00:56:07,280 STILL OUT. 1626 00:56:07,280 --> 00:56:09,600 THERE WAS A LOT OF TALK EARLY 1627 00:56:09,600 --> 00:56:11,640 ON, ABOUT ACE INHIBITORS, I 1628 00:56:11,640 --> 00:56:13,080 THINK THE JURY ON THIS IS STILL 1629 00:56:13,080 --> 00:56:14,960 OUT BUT IT'S A POSSIBLE 1630 00:56:14,960 --> 00:56:17,080 HYPOTHESIS FOR SURE. 1631 00:56:17,080 --> 00:56:20,080 >> THANK YOU. 1632 00:56:20,080 --> 00:56:21,960 SO THE NEXT QUESTION IS THE 1633 00:56:21,960 --> 00:56:26,040 SYMPTOMS OF LONG COVID ARE 1634 00:56:26,040 --> 00:56:29,880 SIMILAR TO THOSE THAT PATIENTS 1635 00:56:29,880 --> 00:56:32,160 WITH FIBROMYALGIA HAVE AND I'M 1636 00:56:32,160 --> 00:56:33,880 CITING FOR YEARS WITH NO OR 1637 00:56:33,880 --> 00:56:39,440 VARIED RECOGNITION FROM THE 1638 00:56:39,440 --> 00:56:39,840 MEDICAL COMMUNITY. 1639 00:56:39,840 --> 00:56:42,440 WHY DO YOU THINK IT IS THAT LONG 1640 00:56:42,440 --> 00:56:45,320 COVID HAS BEEN RECOGNIZED AS A 1641 00:56:45,320 --> 00:56:47,360 TRUE SYNDROME WHERE FIBRO MIRROR 1642 00:56:47,360 --> 00:56:51,800 IMAGEIALGIA IS NOT 1643 00:56:51,800 --> 00:56:52,320 AS--FIBROMYALGIA IS NOT 1644 00:56:52,320 --> 00:56:53,120 RECOGNIZED AS MUCH IN THE 1645 00:56:53,120 --> 00:56:53,440 COMMUNITY? 1646 00:56:53,440 --> 00:56:56,360 >> I THINK A LOT OF FACTORS. 1647 00:56:56,360 --> 00:56:58,000 MULTIPLE SORT OF LIKE RESEARCH 1648 00:56:58,000 --> 00:56:59,520 PROGECS TRY TO EVEN UNDERSTAND 1649 00:56:59,520 --> 00:57:02,800 LIKE HOW DO WE BEGIN TO ANSWER 1650 00:57:02,800 --> 00:57:03,120 THIS QUESTION. 1651 00:57:03,120 --> 00:57:05,800 SO I THINK IT'S MULTIFACTORIAL. 1652 00:57:05,800 --> 00:57:08,040 I TRIBUTE A LOT OF THIS FROM THE 1653 00:57:08,040 --> 00:57:10,800 ADVOCACY EARLY ON AND THEY 1654 00:57:10,800 --> 00:57:12,400 ORGANIZED EARLY ON, AND REALLY 1655 00:57:12,400 --> 00:57:15,480 LEVERAGED SOCIAL MEDIA, LIKE 1656 00:57:15,480 --> 00:57:16,880 THERE ARE--AND THE WIND BEHIND 1657 00:57:16,880 --> 00:57:18,320 THEM LIKE SORT OF ALSO IN A 1658 00:57:18,320 --> 00:57:20,320 COMPLEX OF A PANDEMIC, YOU KNOW 1659 00:57:20,320 --> 00:57:22,240 LOOKING FOR WHAT SARS COV2 IS 1660 00:57:22,240 --> 00:57:25,160 DOING TO PEOPLE, SO I THINK ALL 1661 00:57:25,160 --> 00:57:26,760 OF THAT, SORT OF, YOU KNOW SORT 1662 00:57:26,760 --> 00:57:28,560 OF ALL THESE FACTORS TOGETHER 1663 00:57:28,560 --> 00:57:31,200 CONTRIBUTED TO PROMOTING 1664 00:57:31,200 --> 00:57:34,160 AWARENESS OF LONG COVID AND IN A 1665 00:57:34,160 --> 00:57:37,800 VERY, VERY IMPORTANT WAY THAN 1666 00:57:37,800 --> 00:57:41,280 SAY FIBROMYALGIA OR EMS, YOU CAN 1667 00:57:41,280 --> 00:57:43,520 SPEND 30 YEARSA ADVOCATING FOR 1668 00:57:43,520 --> 00:57:45,640 THE DISEASE TO BE VISIBLE IN THE 1669 00:57:45,640 --> 00:57:47,160 NATIONAL SPOTLIGHT AND I HAVE TO 1670 00:57:47,160 --> 00:57:48,280 ATTRIBUTE THIS THERE'S QUITE A 1671 00:57:48,280 --> 00:57:49,840 BIT OF MEDIA ATTENTION THAT, YOU 1672 00:57:49,840 --> 00:57:52,080 KNOW THIS IS AGAIN, THE PATIENT 1673 00:57:52,080 --> 00:57:53,480 ADVOCACY AND THE POWER OF 1674 00:57:53,480 --> 00:57:54,520 PATIENT ADVOCABULARY KASP A R 1675 00:57:54,520 --> 00:57:56,040 EXPE KNOWING THE RIGHT LEVERS TO 1676 00:57:56,040 --> 00:57:56,280 PUSH. 1677 00:57:56,280 --> 00:58:00,040 I KNOW IT'S LIKE A LOT OF, YOU 1678 00:58:00,040 --> 00:58:01,000 KNOW JOURNALISTS SPECIFICALLY 1679 00:58:01,000 --> 00:58:02,520 INTERESTED IN LONG COVID HAVE AN 1680 00:58:02,520 --> 00:58:03,200 INTEREST IN IT. 1681 00:58:03,200 --> 00:58:05,560 YOU KNOW NEW YORK TIMES, WALL 1682 00:58:05,560 --> 00:58:07,320 STREET JOURNAL, THAT REALLY 1683 00:58:07,320 --> 00:58:08,480 HELPS, LIKE THE PATIENT 1684 00:58:08,480 --> 00:58:10,200 COMMUNITY CONNECTING WITH THOSE 1685 00:58:10,200 --> 00:58:11,760 KEY STAKEHOLDERS AND LEVERAGING 1686 00:58:11,760 --> 00:58:14,480 THOSE LETTERS OF POWER IN THE 1687 00:58:14,480 --> 00:58:16,520 MEDIA, AND CONGRESS AND IN 1688 00:58:16,520 --> 00:58:19,080 SENATE AND THE HOUSE, AND 1689 00:58:19,080 --> 00:58:20,160 ACADEMIA TO REALLY PROMOTE THEIR 1690 00:58:20,160 --> 00:58:22,080 CAUSE, I THINK THAT ALL HAD SORT 1691 00:58:22,080 --> 00:58:24,680 OF A--LED TO THIS REALLY--THIS 1692 00:58:24,680 --> 00:58:26,160 REALLY MOMENT WHERE WE RECOGNIZE 1693 00:58:26,160 --> 00:58:27,720 LONG COVID AS A MAJOR PROBLEM 1694 00:58:27,720 --> 00:58:31,360 AND A LOT OF RESEARCH ON IT, AND 1695 00:58:31,360 --> 00:58:32,240 NIH RECOVER INITIATIVES, THE 1696 00:58:32,240 --> 00:58:33,560 WHITE HOUSE IS LOOKING AT THIS 1697 00:58:33,560 --> 00:58:35,520 ON NEARLY ALMOST A DAILY BASIS, 1698 00:58:35,520 --> 00:58:38,000 SORT OF AN INTEREST IN LONG 1699 00:58:38,000 --> 00:58:39,680 ASHING SO IT'S QUITE REMARKABLE 1700 00:58:39,680 --> 00:58:41,280 WITH THE LEVERAGE OF INTEREST IN 1701 00:58:41,280 --> 00:58:44,480 THIS DISEASE. 1702 00:58:44,480 --> 00:58:44,920 >> THANK YOU. 1703 00:58:44,920 --> 00:58:46,520 IN YOUR TALK YOU MENTION THAD 1704 00:58:46,520 --> 00:58:48,160 PATIENTS WITH LONG COVID 1705 00:58:48,160 --> 00:58:48,760 EXPERIENCE CARDIOVASCULAR 1706 00:58:48,760 --> 00:58:50,920 DISEASE UP TO A YEAR POST 1707 00:58:50,920 --> 00:58:52,400 INFECTION, WHICH IMPLIES THESE 1708 00:58:52,400 --> 00:58:55,360 SYMPTOMS RESOLVE AFTER A CERTAIN 1709 00:58:55,360 --> 00:58:55,760 TIME. 1710 00:58:55,760 --> 00:58:57,200 SO, SO THIS AUDIENCE MEMBER IS 1711 00:58:57,200 --> 00:58:58,320 WONDERING HOW THIS IS POSSIBLE, 1712 00:58:58,320 --> 00:59:01,440 ONCE THE DAMAGE IS IN 1713 00:59:01,440 --> 00:59:03,040 CARDIOVASCULAR DISEASE IS A 1714 00:59:03,040 --> 00:59:06,120 PROGRESSIVE KIND OF DISEASE, 1715 00:59:06,120 --> 00:59:07,560 WOULDN'T THE IMPACT OF THIS 1716 00:59:07,560 --> 00:59:08,880 DAMAGE KEEP PROGRESSING THROUGH 1717 00:59:08,880 --> 00:59:11,400 A LIFETIME AND IF NOT, SHOULD 1718 00:59:11,400 --> 00:59:15,160 THIS GIVE US HOPE OR WOULD THIS 1719 00:59:15,160 --> 00:59:17,120 SUGGEST THAT THESE SYMPTOMS 1720 00:59:17,120 --> 00:59:19,800 WOULD EVENTUALLY DISAPPEAR OR 1721 00:59:19,800 --> 00:59:20,240 GET BETTER. 1722 00:59:20,240 --> 00:59:21,440 >> THIS IS VERY, VERY CLEAR LONG 1723 00:59:21,440 --> 00:59:23,080 COVID IS A LOT OF DIFFERENT 1724 00:59:23,080 --> 00:59:24,360 THINGS. 1725 00:59:24,360 --> 00:59:26,360 SO IN THE CARDIOVASCULAR 1726 00:59:26,360 --> 00:59:29,080 MANIFESTATION CHEST PAIN COULD 1727 00:59:29,080 --> 00:59:30,080 RESOLVE WITH PAIN, PEOPLE COULD 1728 00:59:30,080 --> 00:59:31,640 WAKE UP AND IT'S ALL GONE AND 1729 00:59:31,640 --> 00:59:34,040 NEVER HAVE IT AGAIN BUT IT'S 1730 00:59:34,040 --> 00:59:35,960 ALSO VERY, VERY CLEAR THAT SOME 1731 00:59:35,960 --> 00:59:37,360 MAN IF HE FELTATIONS ARE CHRONIC 1732 00:59:37,360 --> 00:59:39,080 DISEASE STATES THAT WILL LAST 1733 00:59:39,080 --> 00:59:40,520 FOR A LIFETIME WHEN WE TALK 1734 00:59:40,520 --> 00:59:43,440 ABOUT KIDNEY DISEASE OR CHRONIC 1735 00:59:43,440 --> 00:59:45,200 ACUTE SYNDROME OH HEART FAILURE, 1736 00:59:45,200 --> 00:59:46,600 THEY DON'T WAKE UP TOMORROW CAN 1737 00:59:46,600 --> 00:59:48,320 DON'T HAVE CHRONIC KIDNEY 1738 00:59:48,320 --> 00:59:48,560 DISEASE. 1739 00:59:48,560 --> 00:59:51,000 PEOPLE HAVE HEART FAILURE AS A 1740 00:59:51,000 --> 00:59:52,560 RESULT OF SARS COV 2 INFECTION, 1741 00:59:52,560 --> 00:59:58,880 THEY DON'T WAKE UP AND THEN 1742 00:59:58,880 --> 01:00:00,360 HEART FAILURE IS GONE. 1743 01:00:00,360 --> 01:00:01,280 THEY ARE TREATABLE, MANAGEABLE 1744 01:00:01,280 --> 01:00:03,280 BUT THEY'RE NOT CURABLE 1745 01:00:03,280 --> 01:00:04,320 CONDITIONS, MEANING THAT THEY'RE 1746 01:00:04,320 --> 01:00:05,600 LIKELY TO STICK WITH PEOPLE FOR 1747 01:00:05,600 --> 01:00:06,200 A LIFETIME. 1748 01:00:06,200 --> 01:00:08,800 WHEN WE TALK ABOUT NEW ONSET 1749 01:00:08,800 --> 01:00:11,960 DIABETES, AS A RESULT OF SARS 1750 01:00:11,960 --> 01:00:14,680 COVERY 2 INFECTION, ONLY 1-2% IN 1751 01:00:14,680 --> 01:00:16,080 OUR DATA AND SO WE CAN DISCOVER 1752 01:00:16,080 --> 01:00:18,200 THE NEEDLE IN THE HAY STACK BUT 1753 01:00:18,200 --> 01:00:19,560 DIABETES GENERALLY A CHRONIC 1754 01:00:19,560 --> 01:00:19,880 DISEASE STATE. 1755 01:00:19,880 --> 01:00:21,200 IT'S NOT SOMETHING THAT YOU WAKE 1756 01:00:21,200 --> 01:00:23,480 UP AND GO OH I NO LONGER HAVE 1757 01:00:23,480 --> 01:00:26,080 DIABETES NOW, WE STILL NEED TO 1758 01:00:26,080 --> 01:00:29,240 DO FOLLOW UP STUDIES ON THESE 1759 01:00:29,240 --> 01:00:30,880 PATIENTS, DO 3 YEAR 4, YEAR 1760 01:00:30,880 --> 01:00:32,640 STUDIES TO GET A DEEPER 1761 01:00:32,640 --> 01:00:34,240 UNDERSTANDING OF THE TRAJECTORY 1762 01:00:34,240 --> 01:00:36,280 OF THESE PATIENTS BUT IT'S CLEAR 1763 01:00:36,280 --> 01:00:37,800 THAT WE LUMP EVERYTHING INTO 1764 01:00:37,800 --> 01:00:41,200 LONG COVID OR P A SC AND IT'S 1765 01:00:41,200 --> 01:00:42,520 REALLY A HETEROGEANIOUS MIX OF A 1766 01:00:42,520 --> 01:00:44,040 LOT, LOT OF DIFFERENT THINGS, 1767 01:00:44,040 --> 01:00:46,000 SOME OF THEM LIKE FATIGUE OR 1768 01:00:46,000 --> 01:00:49,360 MAYBE, YOU KNOW CHEST PAIN AND 1769 01:00:49,360 --> 01:00:50,240 CHEST PRESSURE THOSE MIGHT 1770 01:00:50,240 --> 01:00:51,920 IMPROVE WITH TIME OR GO AWAY 1771 01:00:51,920 --> 01:00:53,240 TOTAL WITH TIME BUT SOME ARE 1772 01:00:53,240 --> 01:00:54,480 LIKELY TO BE PERMANENT OR LIFE 1773 01:00:54,480 --> 01:00:55,440 LONG KONG DITIONS THAT WILL 1774 01:00:55,440 --> 01:00:57,440 STICK WITH PEOPLE 1775 01:00:57,440 --> 01:00:57,840 LIFETIME. 1776 01:00:57,840 --> 01:00:59,360 >> THANK YOU DO ANTIVIRALS OR 1777 01:00:59,360 --> 01:01:00,560 ANY OTHER INTERVENTIONS HAVE ANY 1778 01:01:00,560 --> 01:01:02,840 EFFECT ON THE RISK OF LONG 1779 01:01:02,840 --> 01:01:03,040 COVID? 1780 01:01:03,040 --> 01:01:05,360 >> OH THIS IS ABSOLUTELY 1781 01:01:05,360 --> 01:01:06,000 NASAA.COMINATING. 1782 01:01:06,000 --> 01:01:07,400 YOU GUYS ARE AMAZING THIS IS 1783 01:01:07,400 --> 01:01:09,560 ABSOLUTELY FASCINATING THIS IS A 1784 01:01:09,560 --> 01:01:10,520 QUESTION OF THE MOMENT. 1785 01:01:10,520 --> 01:01:14,840 IF YOU HAVE AN ANSWER, YOU GET A 1786 01:01:14,840 --> 01:01:15,920 UNUSUAL [INDISCERNIBLE] PAPER, 1787 01:01:15,920 --> 01:01:17,360 SO WE ARE WORKING ON IT. 1788 01:01:17,360 --> 01:01:21,480 WE DON'T KNOW THE ANSWER TO THIS 1789 01:01:21,480 --> 01:01:21,640 YE. 1790 01:01:21,640 --> 01:01:25,760 THE CHIEF CANDIDATE HERE FOR 1791 01:01:25,760 --> 01:01:30,880 POTENTIAL IS [INDISCERNIBLE], 1792 01:01:30,880 --> 01:01:32,320 THAT REALLY AMELIORATED THE RISK 1793 01:01:32,320 --> 01:01:32,800 OF LONG ASHING. 1794 01:01:32,800 --> 01:01:34,080 I DON'T KNOW THE ANSWER TO THIS. 1795 01:01:34,080 --> 01:01:34,920 WE ARE WORKING ON IT. 1796 01:01:34,920 --> 01:01:36,160 A LOT OF OTHER FROWPS ARE 1797 01:01:36,160 --> 01:01:38,120 WORKING ON IT AND KUDOS TO THE 1798 01:01:38,120 --> 01:01:39,080 PEOPLE WHO FINISH FIRST AND ABLE 1799 01:01:39,080 --> 01:01:43,040 TO GIVE US THE ANSWER. 1800 01:01:43,040 --> 01:01:45,160 >> IS THERE A DIFFERENCE IN THE 1801 01:01:45,160 --> 01:01:46,760 LONG COVID SYMPTOMS OR 1802 01:01:46,760 --> 01:01:48,960 PREVALENCE OF THEM BETWEEN 1803 01:01:48,960 --> 01:01:50,360 INDIVIDUALS INFECT WIDE 1804 01:01:50,360 --> 01:01:53,840 DIFFERENT SARS COV2 VARIANTS? 1805 01:01:53,840 --> 01:01:56,640 >> YEAH, SO WE--WE DON'T HAVE 1806 01:01:56,640 --> 01:01:58,760 DATA ON OMICRON, SO IT'S LESS 1807 01:01:58,760 --> 01:02:00,840 THAN 6 MONTHS OLD, IT'S THE LONG 1808 01:02:00,840 --> 01:02:03,640 HAUL SO WE CAN'T REALLY DEEPLY 1809 01:02:03,640 --> 01:02:04,400 CHARACTERIZE LONG COVID UNLESS 1810 01:02:04,400 --> 01:02:08,040 WE HAVE A GOOD FOLLOW UP TIME 1811 01:02:08,040 --> 01:02:12,080 AND OMEYE CRON WAS NOT ON EITHER 1812 01:02:12,080 --> 01:02:12,960 BEFORE NOVEMBER, INITIALLY 1813 01:02:12,960 --> 01:02:14,840 AFRICA OR U.S. AND NORTH AFRICA 1814 01:02:14,840 --> 01:02:15,880 DURING THE HOLIDAYS ABOUT YOU 1815 01:02:15,880 --> 01:02:17,680 FROM A PRIOR VARIANT, WE DON'T 1816 01:02:17,680 --> 01:02:20,320 REALLY SEE MUCH OF A DIFFERENCE 1817 01:02:20,320 --> 01:02:21,160 QUALITATIVELY BECAUSE OF THE 1818 01:02:21,160 --> 01:02:22,800 FEATURES OF LONG ASHING OR 1819 01:02:22,800 --> 01:02:23,960 QUANTITATIVELY BECAUSE OF THE 1820 01:02:23,960 --> 01:02:25,280 RISK DIFFERENCE OR THE MAGNITUDE 1821 01:02:25,280 --> 01:02:26,320 OF RISK. 1822 01:02:26,320 --> 01:02:28,560 YOU KNOW BETWEEN ALPHA DELTA AND 1823 01:02:28,560 --> 01:02:29,440 [INDISCERNIBLE], WE DON'T SEE 1824 01:02:29,440 --> 01:02:31,960 MUCH OF A DIFFERENCE. 1825 01:02:31,960 --> 01:02:34,960 YOU KNOW BUT A QUALITATIVELY 1826 01:02:34,960 --> 01:02:35,960 ENTER THE MAGNITUDE OF RISK. 1827 01:02:35,960 --> 01:02:37,120 BUT THE JOWRY IS STILL OUT. 1828 01:02:37,120 --> 01:02:39,880 WE DON'T KNOW ABOUT OMICRON YET, 1829 01:02:39,880 --> 01:02:42,320 IT HAS IN THE BEEN ON EARTH MORE 1830 01:02:42,320 --> 01:02:44,960 THAN 6 MONTHS SO IT STARTED IN 1831 01:02:44,960 --> 01:02:46,360 AFRICA NOVEMBER 2021 AND NOW 1832 01:02:46,360 --> 01:02:49,160 IT'S LIKE WE'RE IN EARLY 1833 01:02:49,160 --> 01:02:53,320 JUNE 2022. 1834 01:02:53,320 --> 01:02:55,120 >> YEAH AND CERTAINLY THE CASES 1835 01:02:55,120 --> 01:02:57,000 WE'VE SEEN WITH OMICRON MAY 1836 01:02:57,000 --> 01:02:58,000 AFFECT THAT AS WELL GIVEN THE 1837 01:02:58,000 --> 01:02:59,520 DATA YOU WERE TELLING US ABOUT 1838 01:02:59,520 --> 01:03:00,480 IN TERMS OF SEVERERRITY OF 1839 01:03:00,480 --> 01:03:05,520 DISEASE AND THE RISK OF LONG 1840 01:03:05,520 --> 01:03:06,000 COVID. 1841 01:03:06,000 --> 01:03:06,320 >> YEAH. 1842 01:03:06,320 --> 01:03:16,880 >> SO THERE'S ANOTHER QUESTION 1843 01:03:16,880 --> 01:03:18,280 HERE-SHOVE SO IF WE WERE TO GET 1844 01:03:18,280 --> 01:03:20,920 COVID EVERY YEAR WOULD THAT 1845 01:03:20,920 --> 01:03:22,400 CHANGE, YOU YOU KNOW IF YOU GOT 1846 01:03:22,400 --> 01:03:23,840 IT BEFORE WOULD IT CHANGE THE 1847 01:03:23,840 --> 01:03:25,080 RISK OF LONG ASHING? 1848 01:03:25,080 --> 01:03:27,640 >> YOU ARE ASKING ALL THE SUPER 1849 01:03:27,640 --> 01:03:28,720 WONDERFUL QUESTION. 1850 01:03:28,720 --> 01:03:30,520 OH WOW, SO CHARLIE IN MY TEAM IS 1851 01:03:30,520 --> 01:03:31,400 PUTTING A PAPER TOGETHER ON 1852 01:03:31,400 --> 01:03:33,200 THIS, I MEAN THE EARLIER RESULTS 1853 01:03:33,200 --> 01:03:34,320 THAT THE INFECTION REALLY 1854 01:03:34,320 --> 01:03:34,680 MATTERS. 1855 01:03:34,680 --> 01:03:37,800 AND THE QUESTION IS REALLY 1856 01:03:37,800 --> 01:03:38,560 SIGNIFICANT PUBLIC HEALTH 1857 01:03:38,560 --> 01:03:40,160 IMPORTANCE BECAUSE A LOT OF THE 1858 01:03:40,160 --> 01:03:41,840 PEOPLE IN THE U.S. HAVE ALREADY 1859 01:03:41,840 --> 01:03:43,160 BEEN INFECTED ONCE, RIGHT, LET'S 1860 01:03:43,160 --> 01:03:45,120 FACE IT THERE ARE MORE THAN 1861 01:03:45,120 --> 01:03:46,360 150 MILLION PEOPLE IN THE UNITED 1862 01:03:46,360 --> 01:03:47,640 STATES WITH AT LEAST 1 1863 01:03:47,640 --> 01:03:49,240 INFECTION, THE QUESTION IS DOES 1864 01:03:49,240 --> 01:03:50,600 IT MATTER, IS IT WORTH IT TO 1865 01:03:50,600 --> 01:03:52,440 PROTECT YOURSELF FROM A SECOND 1866 01:03:52,440 --> 01:03:53,920 INFECTION OR A THIRD 1 IF YOU 1867 01:03:53,920 --> 01:03:55,160 ALREADY HAD 2 OR MAYBE A SECOND 1868 01:03:55,160 --> 01:03:56,680 INFECTION IF YOU HAD 1, RIGHT? 1869 01:03:56,680 --> 01:03:57,960 DOES IT MATTER? 1870 01:03:57,960 --> 01:03:58,520 SHOULD YOU PROTECT? 1871 01:03:58,520 --> 01:04:00,560 SHOULD YOU GO THE EXTRA MILE TO 1872 01:04:00,560 --> 01:04:00,960 PROTECT YOURSELF? 1873 01:04:00,960 --> 01:04:02,000 DOESN'T MATTER AT ALL AND THE 1874 01:04:02,000 --> 01:04:04,960 ANSWER IS YES, THE SHORT ANSWER 1875 01:04:04,960 --> 01:04:08,360 IS YES, DATA WILL BE--CHARLIE IS 1876 01:04:08,360 --> 01:04:10,000 PUTTING A PAPER TOGETHER AND 1877 01:04:10,000 --> 01:04:11,440 HOPEFULLY WE WILL GET IT OUT AS 1878 01:04:11,440 --> 01:04:13,520 SOON AS WE CAN CAN. 1879 01:04:13,520 --> 01:04:14,880 SHORT ANSWER YES, EVERY TIME YOU 1880 01:04:14,880 --> 01:04:17,040 GET INFECTED YOU GAMLE, YOU'RE 1881 01:04:17,040 --> 01:04:19,560 LIKE THAT RUSSIAN RULET AGAIN 1882 01:04:19,560 --> 01:04:22,280 AND YOU KNOW THE BEST WAY TO 1883 01:04:22,280 --> 01:04:24,840 MINIMIZE RISK IS NOT TO GET 1884 01:04:24,840 --> 01:04:28,240 INVOLVED IN THE RUSSIAN ROWLET 1885 01:04:28,240 --> 01:04:30,040 NOT GAMBLE WITH A SECOND OR 1886 01:04:30,040 --> 01:04:30,400 THIRD INFECTION. 1887 01:04:30,400 --> 01:04:31,560 >> THANK YOU AGAIN FOR YOUR TIME 1888 01:04:31,560 --> 01:04:32,560 AND THE EXCELLENT PRESENTATION 1889 01:04:32,560 --> 01:04:33,840 AND DISCUSSION AND I WANT TO 1890 01:04:33,840 --> 01:04:35,800 THANK OUR AUDIENCE MEMBERS FOR 1891 01:04:35,800 --> 01:04:37,080 ATTENDING TODAY AND ATTENDING 1892 01:04:37,080 --> 01:04:39,200 OUR SERIES THIS PAST YEAR, SO WE 1893 01:04:39,200 --> 01:04:40,160 WISH YOU A WONDERFUL SUMMER AND 1894 01:04:40,160 --> 01:04:42,600 WE WILL SEE YOU BACK IN THE FALL 1895 01:04:42,600 --> 01:04:45,760 FOR ANOTHER FANTASTIC SERIES. 1896 01:04:45,760 --> 00:00:00,000 BYE-BYE.