1 00:00:05,328 --> 00:00:06,262 GOOD AFTERNOON EVERYONE AND 2 00:00:06,262 --> 00:00:09,298 WELCOME TO THE COVID-19 3 00:00:09,298 --> 00:00:12,201 SCIENTIFIC INTEREST GROUP 4 00:00:12,201 --> 00:00:13,002 SEMINAR SERIES. 5 00:00:13,002 --> 00:00:17,940 WE ARE HAVING OUR SECOND SEMINAR 6 00:00:17,940 --> 00:00:20,476 OF THE NEW 2024-25 SEASON TODAY. 7 00:00:20,476 --> 00:00:24,747 AND AS YOU MAY HAVE NOTICED FROM 8 00:00:24,747 --> 00:00:26,482 LAST SEMINAR AND TODAY'S SEMINAR 9 00:00:26,482 --> 00:00:29,452 AND MANY OF OUR FUTURE SEMINARS, 10 00:00:29,452 --> 00:00:32,722 WILL BE FOCUSED ON LONG COVID 11 00:00:32,722 --> 00:00:40,830 WHICH IS LIKELY TO BECOME A REAL 12 00:00:40,830 --> 00:00:43,800 PROBLEM FOR US IN THE HEALTHCARE 13 00:00:43,800 --> 00:00:47,770 SYSTEM, NOT JUST IN THE U.S. BUT 14 00:00:47,770 --> 00:00:48,237 ALSO GLOBALLY. 15 00:00:48,237 --> 00:00:50,807 SO WE ARE REALLY FORTUNATE TODAY 16 00:00:50,807 --> 00:00:57,246 TO HAVE 1 OF THE LEADING 17 00:00:57,246 --> 00:00:57,780 SCIENTISTS-PHYSICIANS AND 18 00:00:57,780 --> 00:01:01,918 EPIDEMIOLOGIST WHO HAS BEEN 19 00:01:01,918 --> 00:01:07,056 STUDYING LONG COVID D 20 00:01:07,056 --> 00:01:09,125 R. ZIYAD AL-ALY, DR. AL-ALY IS 21 00:01:09,125 --> 00:01:11,828 THE CHIEF OF THE CLINICAL 22 00:01:11,828 --> 00:01:14,397 EPIDEMIOLOGY CENTER AND SERVES 23 00:01:14,397 --> 00:01:16,165 AS DIRECTOR FOR THE ST. LOUIS 24 00:01:16,165 --> 00:01:17,433 HEALTHCARE SYSTEM AT THE VA. 25 00:01:17,433 --> 00:01:21,204 HE IS A SENIOR CLINICAL 26 00:01:21,204 --> 00:01:24,106 EPIDEMIOLOGIST AT WASH-U IN 27 00:01:24,106 --> 00:01:24,607 ST. LOUIS. 28 00:01:24,607 --> 00:01:28,878 DR. AL-ALY IS KNOWN FOR LEADING 29 00:01:28,878 --> 00:01:29,612 THE SYSTEMATIC CHARACTERIZATION 30 00:01:29,612 --> 00:01:31,881 OF LONG COVID AND SUBSEQUENT 31 00:01:31,881 --> 00:01:34,884 OBSERVED INCREASED RISKS OF 32 00:01:34,884 --> 00:01:35,685 CARDIOVASCULAR DISEASE, 33 00:01:35,685 --> 00:01:37,453 NEUROLOGICAL DISEASE, DIABETES, 34 00:01:37,453 --> 00:01:40,957 KIDNEY DISEASE, GI DISORDERS IN 35 00:01:40,957 --> 00:01:42,725 PATIENTS FOLLOWING SARS-COV-2 36 00:01:42,725 --> 00:01:43,492 INFECTION, HIS LABORATORY WAS 37 00:01:43,492 --> 00:01:46,162 ALSO THE FIRST TO PRODUCE 38 00:01:46,162 --> 00:01:47,230 EVIDENT CHARACTERIZING THE 39 00:01:47,230 --> 00:01:49,265 EFFECTS OF VACCINES ON LONG 40 00:01:49,265 --> 00:01:49,699 COVID. 41 00:01:49,699 --> 00:01:51,567 THE HEALTH CONSEQUENCES OF 42 00:01:51,567 --> 00:01:52,368 REPEATED INFECTIONS WITH 43 00:01:52,368 --> 00:01:54,370 SARKINGS 44 00:01:54,370 --> 00:01:56,739 SARKINGS KICKOFF 2 AND THE EABT 45 00:01:56,739 --> 00:02:00,509 VIRALS ON THE SHORTEN LONG-TERM 46 00:02:00,509 --> 00:02:04,714 OUTCOME OF SARS-COV-2 INFECTION. 47 00:02:04,714 --> 00:02:07,016 DR. AL-ALY CHAIRED THE BIDEN 48 00:02:07,016 --> 00:02:08,317 HARRIS COMMITTEE THAT DEVELOPED 49 00:02:08,317 --> 00:02:09,352 THE NATIONAL RESEARCH ACTION 50 00:02:09,352 --> 00:02:10,853 PLAN FOR LONG COVID. 51 00:02:10,853 --> 00:02:13,556 HE SERVES ON THE INTERGOVERNMENT 52 00:02:13,556 --> 00:02:15,024 AGENCY LONG COVID COORDINATION 53 00:02:15,024 --> 00:02:17,460 COUNCIL, A MEMBER OF THE WHITE 54 00:02:17,460 --> 00:02:18,527 HOSCANCER MOONSHOT TASK FORCE 55 00:02:18,527 --> 00:02:21,731 FOR DATA AND INNOVATION. 56 00:02:21,731 --> 00:02:25,501 HE'S PUBLISHED MANY, MANY PAPERS 57 00:02:25,501 --> 00:02:26,802 AND VERY PRESTIGIOUS MEDICAL 58 00:02:26,802 --> 00:02:28,971 JOURNALS AND SCIENTIFIC JOURNALS 59 00:02:28,971 --> 00:02:30,473 AND NATURE, SCIENCE, MEDICINE 60 00:02:30,473 --> 00:02:32,675 AND NEW ENGLAND JOURNAL OF 61 00:02:32,675 --> 00:02:33,576 MEDICINE AND OTHERS. 62 00:02:33,576 --> 00:02:36,112 HIS WORK HAS BEEN CITED OVER A 63 00:02:36,112 --> 00:02:36,812 HUNDRED THOUSAND TIMES. 64 00:02:36,812 --> 00:02:38,781 HIS WORK IS FREQUENTLY FEATURED 65 00:02:38,781 --> 00:02:41,550 IN MAJOR NATIONAL AND 66 00:02:41,550 --> 00:02:42,351 INTERNATIONAL MEDIA OUTLETS 67 00:02:42,351 --> 00:02:43,853 INCLUDING THE NEW YORK 68 00:02:43,853 --> 00:02:47,089 SOMETIMES, WALL STREET JOURNAL, 69 00:02:47,089 --> 00:02:50,026 WASHINGTON POST, NBNR, CCAND 70 00:02:50,026 --> 00:02:51,661 OTHERS, WE ARE REALLY GRATEFUL 71 00:02:51,661 --> 00:02:53,729 FOR HIM TO TAKE TIME OUT OF HIS 72 00:02:53,729 --> 00:02:57,566 BUSY SCHEDULE TO GIVE US THIS 73 00:02:57,566 --> 00:02:59,101 PRESENTATION TODAY ON LONG COVID 74 00:02:59,101 --> 00:03:00,937 SIGNS, RESEARCH AND POLICY. 75 00:03:00,937 --> 00:03:02,571 BEFORE I LET HIM START, I JUST 76 00:03:02,571 --> 00:03:04,807 WANT TO REMIND OUR VIEWERS WHO 77 00:03:04,807 --> 00:03:06,642 ARE WATCHING ON THE NIH 78 00:03:06,642 --> 00:03:09,078 VIDEOCAST THAT THERE IS A SEND 79 00:03:09,078 --> 00:03:09,779 LIVE FEEDBACK BUTTON, YOU WILL 80 00:03:09,779 --> 00:03:12,648 SEE IF YOU WANT TO ASK ANY 81 00:03:12,648 --> 00:03:21,924 QUESTIONS DURING THE TALK, 82 00:03:21,924 --> 00:03:26,729 PLEASE FEEL FREE TO SUBMIT ANY 83 00:03:26,729 --> 00:03:27,029 QUESTIONS. 84 00:03:27,029 --> 00:03:28,431 ALL QUESTIONS AT THE END OF THIS 85 00:03:28,431 --> 00:03:31,400 TALK WILL BE READ TO DR. AL-ALY 86 00:03:31,400 --> 00:03:35,538 SO HE CAN HAVE AN OPPORTUNITY TO 87 00:03:35,538 --> 00:03:36,772 ANSWER THEM. 88 00:03:36,772 --> 00:03:40,176 SO WITHOUT FURTHER ADO, WELCOME 89 00:03:40,176 --> 00:03:41,944 DR. AL-ALY AND WE LOOK FORWARD 90 00:03:41,944 --> 00:03:43,045 TO YOUR TALK. 91 00:03:43,045 --> 00:03:44,347 >> WELL, THANK YOU FOR HAVING ME 92 00:03:44,347 --> 00:03:46,048 TODAY AND GIVING ME THE 93 00:03:46,048 --> 00:03:47,216 OPPORTUNITY TO TALK ABOUT LONG 94 00:03:47,216 --> 00:03:49,051 COVID AND OUR VIEW AND VANTAGE 95 00:03:49,051 --> 00:03:50,653 POINT OF THE SCIENCE OF LONG 96 00:03:50,653 --> 00:03:52,154 COVID AND OUR THINKING ABOUT THE 97 00:03:52,154 --> 00:03:54,590 WAY FORWARD IN TERMS OF RESEARCH 98 00:03:54,590 --> 00:03:55,858 AND POLICY DIRECTIONS TO ADDRESS 99 00:03:55,858 --> 00:04:00,029 OR TACKLE THE CRISIS OF THE LONG 100 00:04:00,029 --> 00:04:00,429 COVID. 101 00:04:00,429 --> 00:04:03,299 SO IN TERMS OF DISCLOSURES, I AM 102 00:04:03,299 --> 00:04:07,203 EMPLOYED BY THE VA AND OPINIONS 103 00:04:07,203 --> 00:04:08,137 ARE PRESENTED HERE OR TALKING 104 00:04:08,137 --> 00:04:09,605 ABOUT HERE DO NOT REPRESENT THE 105 00:04:09,605 --> 00:04:10,973 VIEWS OF THE VA AND U.S. 106 00:04:10,973 --> 00:04:11,974 GOVERNMENT AND REALLY GRATEFUL 107 00:04:11,974 --> 00:04:13,976 OF THE SUPPORT OF THE U.S. 108 00:04:13,976 --> 00:04:15,611 DEPARTMENT OF VETERAN AFFAIRS IN 109 00:04:15,611 --> 00:04:19,682 FUNDING OUR WORK OVER THE PAST 110 00:04:19,682 --> 00:04:20,716 SEVERAL YEARS, OUR LONG COVID 111 00:04:20,716 --> 00:04:27,523 WORK AND OTHER WORK BUT REALLY 112 00:04:27,523 --> 00:04:29,725 THE LONG COVID WORK. 113 00:04:29,725 --> 00:04:31,827 SO WHEN WE SAY LONG COVID, WHAT 114 00:04:31,827 --> 00:04:33,996 DO WE REALLY MEAN BY LONG COVID 115 00:04:33,996 --> 00:04:42,304 AND TALK A BIT ABOUT SEQUELA OF 116 00:04:42,304 --> 00:04:44,473 CONCERN, HOW LONG IS LONG COVID, 117 00:04:44,473 --> 00:04:46,175 DISCUSS WHETHER THE RISK OF LONG 118 00:04:46,175 --> 00:04:47,109 COVID HAS ACTUALLY CHANGED OVER 119 00:04:47,109 --> 00:04:48,677 THE COURSE OF THE PAN 120 00:04:48,677 --> 00:04:50,479 DELATWALLIC, TALK A BIT ABOUT 121 00:04:50,479 --> 00:04:52,782 PREVENTION AND MECHANISMS OF 122 00:04:52,782 --> 00:04:54,617 LONG COVID, IMPACTS OF LONG 123 00:04:54,617 --> 00:04:56,685 COVID AND THE ROAD AHEAD IN 124 00:04:56,685 --> 00:05:06,629 TERMS OF POLICY AND RESEARCH 125 00:05:06,629 --> 00:05:07,396 PRIORITIES. 126 00:05:07,396 --> 00:05:13,402 SO WE DID A DOCUMENTARY ON AN 127 00:05:13,402 --> 00:05:15,271 IRISH KID WHO'S BEEN BATTLING 128 00:05:15,271 --> 00:05:16,972 LONG COVID FOR SEVERAL YEARS, 129 00:05:16,972 --> 00:05:19,675 THAT'S HER ART HERE, AND WE 130 00:05:19,675 --> 00:05:20,743 WANTED TO HONOR HER 131 00:05:20,743 --> 00:05:22,178 CONTRIBUTIONS BY PUTTING HER ART 132 00:05:22,178 --> 00:05:23,913 HERE, IT'S REALLY REMARKABLE, 133 00:05:23,913 --> 00:05:26,749 ALL OF THESE ARE THINGS THAT 134 00:05:26,749 --> 00:05:28,684 WERE SET TO HER AS A PATIENT 135 00:05:28,684 --> 00:05:30,319 WITH LONG COVID, BE MORE 136 00:05:30,319 --> 00:05:34,190 POSITIVE, YOU LOOK HEALTHY, SO 137 00:05:34,190 --> 00:05:34,723 CALLED LONG COVID. 138 00:05:34,723 --> 00:05:36,092 GIVE IT TIME AND IT WILL GO 139 00:05:36,092 --> 00:05:36,459 AWAY. 140 00:05:36,459 --> 00:05:39,895 ALL THESE THINGS WERE SET TO HER 141 00:05:39,895 --> 00:05:41,730 AS A KID WHO'S BALGTING LONG 142 00:05:41,730 --> 00:05:41,964 COVID. 143 00:05:41,964 --> 00:05:44,366 SO ANYWAY, BACK TO THE KEY POINT 144 00:05:44,366 --> 00:05:44,700 HERE. 145 00:05:44,700 --> 00:05:48,370 SO WHAT IS LONG COVID, SO WE ASK 146 00:05:48,370 --> 00:05:49,205 THIS QUESTION REALLY VERY EARLY 147 00:05:49,205 --> 00:05:51,107 ON IN THE PANDEMIC WHEN WE 148 00:05:51,107 --> 00:05:53,943 STARTED RECEIVING REPORTS FROM 149 00:05:53,943 --> 00:05:55,344 PATIENTS THAT THE TIME -- 150 00:05:55,344 --> 00:05:57,446 TELLING US THEY WERE NOT FULLY 151 00:05:57,446 --> 00:05:58,614 AREY COVERING FROM SARS-COV-2. 152 00:05:58,614 --> 00:05:59,782 THAT EVERYBODY AT THE TIME OR 153 00:05:59,782 --> 00:06:01,183 WISDOM AT THE TIME WOULD HAVE IT 154 00:06:01,183 --> 00:06:03,953 THAT IF YOU GET SARS-COV-2 155 00:06:03,953 --> 00:06:04,687 INFECTION, ESPECIALLY IF YOU 156 00:06:04,687 --> 00:06:06,288 WERE YOUNG AND HEALTHY AND DID 157 00:06:06,288 --> 00:06:07,923 NOT HAVE MEDICAL PROBLEMS, YOU 158 00:06:07,923 --> 00:06:09,225 WILL BOUNCE BACK AND GET RID OF 159 00:06:09,225 --> 00:06:11,093 IT WITHIN A FEW DAYS AND THEN, 160 00:06:11,093 --> 00:06:12,495 YOU KNOW YOU WILL TOTALLY GO 161 00:06:12,495 --> 00:06:15,030 BACK TO YOUR BASE LINE HEALTH 162 00:06:15,030 --> 00:06:16,065 STATUS, BUT PATIENTS WERE 163 00:06:16,065 --> 00:06:17,366 TELLING US AT THE TIME AND WE 164 00:06:17,366 --> 00:06:18,334 LISTENED TO THEM THAT THEY WERE 165 00:06:18,334 --> 00:06:22,738 NOT FULLY RECOVERING, AND THEN 166 00:06:22,738 --> 00:06:26,242 THEY STARTED CATALOGING ALL THE 167 00:06:26,242 --> 00:06:28,878 SYMPTOMATOLOGY THEY WERE 168 00:06:28,878 --> 00:06:30,379 EXPERIENCING INCLUDING MALAISE, 169 00:06:30,379 --> 00:06:31,413 FATIGUE AND BRAIN FOG AND ALL 170 00:06:31,413 --> 00:06:32,781 THESE DEFINITE THINGS AND TO 171 00:06:32,781 --> 00:06:34,683 THEIR CREDIT THEY COINED THE 172 00:06:34,683 --> 00:06:38,187 TERM LONG COVID AND THEY THEY 173 00:06:38,187 --> 00:06:40,289 REFERRED TO THEMSELVES AS LONG 174 00:06:40,289 --> 00:06:40,589 COVIDERS. 175 00:06:40,589 --> 00:06:42,358 SO WHAT ARE THESE PEOPLE TALKING 176 00:06:42,358 --> 00:06:42,691 ABOUT? 177 00:06:42,691 --> 00:06:43,893 THEY'RE TELLING US THESE THINGS, 178 00:06:43,893 --> 00:06:46,061 AND WE NEED TO UNDERSTAND WHAT 179 00:06:46,061 --> 00:06:48,030 EXACTLY THEY'RE TALKING ABOUT. 180 00:06:48,030 --> 00:06:50,332 SO WE DID WHAT WE TERMED AT THE 181 00:06:50,332 --> 00:06:52,968 TIME OR WE SORT OF USE THE 182 00:06:52,968 --> 00:06:55,337 DISCOVERY BASE APPROACH TO 183 00:06:55,337 --> 00:06:59,275 UNDERSTAND SO THAT THE LONG-TERM 184 00:06:59,275 --> 00:07:00,543 HEALTH CONSEQUENCES OF 185 00:07:00,543 --> 00:07:01,944 SARS-COV-2 INFECTION AND REALLY 186 00:07:01,944 --> 00:07:03,445 IN AN UNBIASED WAY, WE DIDN'T 187 00:07:03,445 --> 00:07:05,314 WANT TO BIAS OURSELVES LOOKING 188 00:07:05,314 --> 00:07:06,649 AT CARDIOVASCULAR EFFECTS OR 189 00:07:06,649 --> 00:07:07,716 METABOLIC EFFECTS OR OTHER 190 00:07:07,716 --> 00:07:11,520 THINGS, WE WANTED TO KEEP AN 191 00:07:11,520 --> 00:07:13,222 OPEN EYE AND OPEN MIND AND DO 192 00:07:13,222 --> 00:07:15,524 WHATEVER WE CALL AT THE TIME AN 193 00:07:15,524 --> 00:07:17,493 UNBI ASSED APPROACH TO 194 00:07:17,493 --> 00:07:19,461 CHARACTERIZE THE LONG-TERM 195 00:07:19,461 --> 00:07:20,663 HEALTH EFFECTS OF SARKICKOFF 2 196 00:07:20,663 --> 00:07:22,298 INFECTION, AND WE,A SEMBLED THE 197 00:07:22,298 --> 00:07:25,601 COHORT AT THE TIME ABOUT 70,000 198 00:07:25,601 --> 00:07:27,570 PEOPLE WHO HAD SARS-COV-2 199 00:07:27,570 --> 00:07:32,775 INFECTION AND COMPARED NONE TO 200 00:07:32,775 --> 00:07:33,642 MILL NEARLY 5 MILLION CONTROLS 201 00:07:33,642 --> 00:07:35,711 WHO AT THE TIME DID NOT HAVE 202 00:07:35,711 --> 00:07:38,147 CARS KICKOFF 2 INFECTION, THIS 203 00:07:38,147 --> 00:07:39,415 IS ALL EARLY 2020 AND EARLY 204 00:07:39,415 --> 00:07:41,283 PHASE OF THE PANDEMIC AND AGAIN 205 00:07:41,283 --> 00:07:41,884 RESPONDING TO THE PATIENT 206 00:07:41,884 --> 00:07:42,484 COMMUNITY AND TRYING TO 207 00:07:42,484 --> 00:07:44,853 UNDERSTAND WHAT ARE THEY WILLING 208 00:07:44,853 --> 00:07:45,020 US. 209 00:07:45,020 --> 00:07:46,889 THEY TELL US THEY HAVE ALL THESE 210 00:07:46,889 --> 00:07:47,890 PROBLEMS, HEALTH PROBLEMS AND 211 00:07:47,890 --> 00:07:49,925 YOU KNOW AT THE TIME PUBLISHED 212 00:07:49,925 --> 00:07:52,628 REALLY A WONDERFUL SURVEY, YOU 213 00:07:52,628 --> 00:07:55,130 KNOW CATALOGING THE BREDTH OF 214 00:07:55,130 --> 00:07:55,864 SYMPTOMATOLOGY, OF WHAT THEY'RE 215 00:07:55,864 --> 00:07:57,733 EXPERIENCING SO IT WAS AN 216 00:07:57,733 --> 00:07:58,400 UNCONTROLLED EXPERIMENT, SO WE 217 00:07:58,400 --> 00:07:59,501 WANT TO DO THE CONTROL 218 00:07:59,501 --> 00:08:00,202 EXPERIMENT TO TRY TO UNDERSTAND 219 00:08:00,202 --> 00:08:03,872 HERE AND WHEN YOU HAVE A CONTROL 220 00:08:03,872 --> 00:08:04,473 GROUP, AND THEN MEASURE CENTER 221 00:08:04,473 --> 00:08:06,175 FOR EXCELLENCE ON AGINGS AFTER 222 00:08:06,175 --> 00:08:08,811 SARKINGS KICKOFF 2 INFEC, YOU 223 00:08:08,811 --> 00:08:10,346 CAN CATALOG THE BREDTH OF 224 00:08:10,346 --> 00:08:11,280 PROBLEMS THESE PEOPLE ARE 225 00:08:11,280 --> 00:08:12,881 EXPERIENCING AND THEN TO THEIR 226 00:08:12,881 --> 00:08:14,617 CREDIT, THEY WERE RIGHT, THEY 227 00:08:14,617 --> 00:08:15,718 WERE RIGHT ALL LONG, THEY WERE 228 00:08:15,718 --> 00:08:17,853 RIGHT FROM THE BEGINNING, SARS 229 00:08:17,853 --> 00:08:19,421 ON KICKOFF 2 INFECTION CAN LEAD 230 00:08:19,421 --> 00:08:21,290 TO HEALTH PROBLEMS AND MANY 231 00:08:21,290 --> 00:08:22,825 ORGAN SYSTEMS INCLUDING THE 232 00:08:22,825 --> 00:08:24,326 NERVOUS SYSTEM, METABOLIC 233 00:08:24,326 --> 00:08:27,663 SYSTEM, GI SYSTEM, KIDNEYS, 234 00:08:27,663 --> 00:08:28,364 RESPIRATORY SYSTEM, 235 00:08:28,364 --> 00:08:28,998 CARDIOVASCULAR SYSTEM, SO THEY 236 00:08:28,998 --> 00:08:29,932 WERE RIGHT WHEN THEY WERE 237 00:08:29,932 --> 00:08:31,467 TELLING US THEY HAVE ALL THESE 238 00:08:31,467 --> 00:08:32,835 PROBLEMS AND MULTIPLE ORGAN 239 00:08:32,835 --> 00:08:34,336 SYSTEMS, IT CERTAINLY CLEARLY 240 00:08:34,336 --> 00:08:36,405 PANNED OUT IN THE DAT AND VERY 241 00:08:36,405 --> 00:08:40,476 NICELY AND WELL CONTROLLED 242 00:08:40,476 --> 00:08:41,644 EXPERIMENT DATING BACK TO 2020, 243 00:08:41,644 --> 00:08:44,046 VERY CLEARLY PANS OUT. 244 00:08:44,046 --> 00:08:46,815 SO THAT'S SORT OF, AND A LOT OF 245 00:08:46,815 --> 00:08:48,684 OTHER WORK SORT OF LED US TO -- 246 00:08:48,684 --> 00:08:51,020 AND NOW I'M REALLY DELIGHTED 247 00:08:51,020 --> 00:08:53,322 THIS APPROACH HAS BEEN ENCORED 248 00:08:53,322 --> 00:08:55,090 BY THE NATIONAL ACADEMY OF 249 00:08:55,090 --> 00:08:57,159 SCIENCES AND ENGINEERING AND 250 00:08:57,159 --> 00:08:59,194 MEDICINE, 1 REPORT CATALOGING 251 00:08:59,194 --> 00:09:01,230 HEALTH EFFECTS OF COVID-19 AND 252 00:09:01,230 --> 00:09:03,599 THIS REPORT FOCUSING ON LONG 253 00:09:03,599 --> 00:09:05,467 COVID AND IT ENCOMPASSES ALL THE 254 00:09:05,467 --> 00:09:08,537 LONG-TERM HEALTH EFFECTS OF 255 00:09:08,537 --> 00:09:13,075 SARS-COV-2 INFEC, IT'S NOT ONLY 256 00:09:13,075 --> 00:09:14,243 MALARIA, BRAIN FOG, FATIGUE, 257 00:09:14,243 --> 00:09:16,445 IT'S ALL THE EFFECTS THAT ARE 258 00:09:16,445 --> 00:09:17,212 CAUSED BY SARS-COV-2 INFECTION 259 00:09:17,212 --> 00:09:18,681 AND I THINK THAT'S REALLY 260 00:09:18,681 --> 00:09:20,549 IMPORTANT AND WE FEEL WE GOT IT 261 00:09:20,549 --> 00:09:25,421 RIGHT, WE FEEL THEY GOT IT RIGHT 262 00:09:25,421 --> 00:09:28,457 AND NASEM GOT IT RIGHT IN DOING 263 00:09:28,457 --> 00:09:30,192 AN ALL-INCLUSIVE APPROACH TO 264 00:09:30,192 --> 00:09:31,794 DEFINING LONG COVID AND 265 00:09:31,794 --> 00:09:33,062 CATALOGING THE BREDTH OF HEALTH 266 00:09:33,062 --> 00:09:36,098 EFFECTS THAT ARE CAUSED BY 267 00:09:36,098 --> 00:09:36,565 COVID-19. 268 00:09:36,565 --> 00:09:38,200 AND THEN, SO, ASK NOW, OKAY, 269 00:09:38,200 --> 00:09:39,601 WELL, LIKE THIS IS THE CONCEPT 270 00:09:39,601 --> 00:09:41,870 OF LONG COVID AND HOW MUCH OF IT 271 00:09:41,870 --> 00:09:44,206 IS OUT THERE AND WE FEEL THAT 272 00:09:44,206 --> 00:09:46,842 THE END OF 2023 IN THE WORLD 273 00:09:46,842 --> 00:09:49,445 GLOBALLY, THERE WERE ABOUT 274 00:09:49,445 --> 00:09:50,212 CUMULATIVELY ABOUT 400 MILLION 275 00:09:50,212 --> 00:09:51,447 PEOPLE WHO HAVE BEEN AFFECTED IN 276 00:09:51,447 --> 00:09:54,316 SOME WAY BY LONG COVID. 277 00:09:54,316 --> 00:09:55,217 CAN THAT'S REALLY IMPORTANT 278 00:09:55,217 --> 00:09:58,620 BECAUSE IT'S SORT OF REALLY NOT 279 00:09:58,620 --> 00:10:00,756 A SMALL NUMBER, JUST A HUGE 280 00:10:00,756 --> 00:10:03,058 NUMBER OF INDIVIDUALS. 281 00:10:03,058 --> 00:10:05,060 AND THESE NUMBERS ARE TAKEN INTO 282 00:10:05,060 --> 00:10:07,096 ACCOUNT THE CHANGES OF COVID-19. 283 00:10:07,096 --> 00:10:09,631 YOU KNOW FROM THE ANCESTRAL 284 00:10:09,631 --> 00:10:13,602 STRAIN TO DELTA TO OMICRON, THE 285 00:10:13,602 --> 00:10:15,104 CHANGING OF COVID AND CHANGES IN 286 00:10:15,104 --> 00:10:17,039 COVID-19 AND THE EFFECTIVE 287 00:10:17,039 --> 00:10:19,007 VACCINATION, SO ALL OF THOSE 288 00:10:19,007 --> 00:10:20,743 WERE INKORCHERATED AT THE 289 00:10:20,743 --> 00:10:22,378 MODELING APPROACH THAT THEN LED 290 00:10:22,378 --> 00:10:24,213 US TO ESTIMATE THAT AT THE END 291 00:10:24,213 --> 00:10:25,814 OF 2023, THERE ARE ABOUT 292 00:10:25,814 --> 00:10:26,682 400 MILLION PEOPLE IN THE WORLD 293 00:10:26,682 --> 00:10:28,951 WHO HAVE BEEN AFFECTED IN SOME 294 00:10:28,951 --> 00:10:30,586 WAY BY LONG COVID. 295 00:10:30,586 --> 00:10:32,888 AND WE ALSO WANTED TO SORT OF 296 00:10:32,888 --> 00:10:34,289 GIVE AN ECONOMIC DIMENSION 297 00:10:34,289 --> 00:10:34,890 BECAUSE IT'S REALLY ALSO 298 00:10:34,890 --> 00:10:36,625 IMPORTANT WHEN YOU TALK TO 299 00:10:36,625 --> 00:10:39,795 STAKEHOLDERS AND WHEN WE TALK TO 300 00:10:39,795 --> 00:10:40,729 GOVERNMENTS AND OTHER -- OTHER 301 00:10:40,729 --> 00:10:46,268 PEOPLE WHO ARE INTERESTED IN 302 00:10:46,268 --> 00:10:47,569 UNDERSTANDING THE IMPACT OF LONG 303 00:10:47,569 --> 00:10:49,405 COVID, SO WE ESTIMATE THAT BASED 304 00:10:49,405 --> 00:10:57,780 ON MULTIPLE DIFFERENT METRICS 305 00:10:57,780 --> 00:10:59,381 INCLUDING METRICS FROM OTHER 306 00:10:59,381 --> 00:11:01,016 REPORTS THAT LONG COVID AFFECTS 307 00:11:01,016 --> 00:11:02,651 THE ECONOMY TO THE TUNE OF 1 308 00:11:02,651 --> 00:11:03,719 BILLION DOLLARS A YEAR. 309 00:11:03,719 --> 00:11:05,621 THIS ESTIMATE IS FROM 2024, IT 310 00:11:05,621 --> 00:11:06,789 MAY CHANGE IN THE FUTURE BUT 311 00:11:06,789 --> 00:11:09,458 THAT'S SORT OF OUR BEST ESTIMATE 312 00:11:09,458 --> 00:11:09,892 IN 2024. 313 00:11:09,892 --> 00:11:13,095 THIS SHOULD GIVE YOU A BETTER OF 314 00:11:13,095 --> 00:11:15,597 A PERSPECTIVE OF WHAT A 315 00:11:15,597 --> 00:11:17,566 1 TRILLION-DOLLAR IS, IT'S 316 00:11:17,566 --> 00:11:19,768 EQUIVALENT TO $1 TRILLION OF 317 00:11:19,768 --> 00:11:21,970 GDP, GROSS DOMESTIC PRODUCT. 318 00:11:21,970 --> 00:11:24,173 THAT'S REALLY A SIZABLE CHUNK. 319 00:11:24,173 --> 00:11:26,375 ONE% OF OUR OVERALL GLOBAL 320 00:11:26,375 --> 00:11:27,643 PRODUCTIVITY IS REALLY WIPED 321 00:11:27,643 --> 00:11:30,579 AWAY OR YOU KNOW TAKEN AWAY BY 322 00:11:30,579 --> 00:11:33,015 LONG COVID AND THAT'S REALLY A 323 00:11:33,015 --> 00:11:34,450 SIGNIFICANT DRAG ON GLOBAL 324 00:11:34,450 --> 00:11:35,717 ECONOMIC GROWTH. 325 00:11:35,717 --> 00:11:38,487 WE WANT AS HUMANITY AS HUMAN 326 00:11:38,487 --> 00:11:39,555 CIVILIZATIONS AND AS 8 BILLION 327 00:11:39,555 --> 00:11:40,856 PEOPLE,A ROUND THE WORLD, WE 328 00:11:40,856 --> 00:11:42,691 WANT TO CONTINUE TO PROGRESS AND 329 00:11:42,691 --> 00:11:44,760 DO BETTER AND GROW AND THAT IS A 330 00:11:44,760 --> 00:11:47,329 OPINION% DRAG ON OUR GLOBAL 331 00:11:47,329 --> 00:11:48,864 PRODUCTIVITY AS A RESULT OF LONG 332 00:11:48,864 --> 00:11:50,699 COVID AND THAT'S REALLY SIZABLE, 333 00:11:50,699 --> 00:11:55,103 IT'S NOT A SMALL DRAG ON OUR 334 00:11:55,103 --> 00:11:58,373 PUSH TO MOVE CIVILIZATION 335 00:11:58,373 --> 00:11:58,607 FORWARD. 336 00:11:58,607 --> 00:12:01,743 SO VERY EARLY ON, WE WANTED TO 337 00:12:01,743 --> 00:12:03,579 REALLY CONTEXTUALIZE AND 338 00:12:03,579 --> 00:12:04,279 UNDERSTAND SARS-COV-2 AND WE 339 00:12:04,279 --> 00:12:06,381 THOUGHT AT THE TIME THAT THE 340 00:12:06,381 --> 00:12:07,349 BEST WAY TO CONTEXTUALIZE THAT 341 00:12:07,349 --> 00:12:09,751 IS TO TRY TO UNDERSTAND WHAT 342 00:12:09,751 --> 00:12:11,587 SARS-COV-2 DOES IN TERMS OF 343 00:12:11,587 --> 00:12:14,590 LONG-TERM HEALTH EFFECT VERSUS 344 00:12:14,590 --> 00:12:16,525 SEASONAL INFLUENZA, BECAUSE 345 00:12:16,525 --> 00:12:18,727 WE'VE KNOWN ARGUABLY SEASONAL 346 00:12:18,727 --> 00:12:21,730 INFLUENZA IS A WELL KNOWN VIRUS, 347 00:12:21,730 --> 00:12:22,297 CHARACTERIZED, SHORT-TERM 348 00:12:22,297 --> 00:12:23,499 EFFECTS, WE ALSO KNOW IMONG HERM 349 00:12:23,499 --> 00:12:25,467 EFFECTS SO WE WANTED TO COMPARE 350 00:12:25,467 --> 00:12:28,370 AND CONTRAST IF YOU WILL OR DO A 351 00:12:28,370 --> 00:12:31,340 COMPETITIVE ASSESSMENT OF 352 00:12:31,340 --> 00:12:32,741 COVID-19 VERSUS SEASONAL 353 00:12:32,741 --> 00:12:34,343 INFLUENZA AND OUR RESULT AT THE 354 00:12:34,343 --> 00:12:35,978 TIME SHOWED THAT MAGNITUDE OF 355 00:12:35,978 --> 00:12:38,313 RISK WAS HIGHER THAN SEASONAL 356 00:12:38,313 --> 00:12:39,481 INFLUENZA, THAT CERTAINLY THE 357 00:12:39,481 --> 00:12:40,916 BREDTH OF ORGAN DYSFUNCTION IS 358 00:12:40,916 --> 00:12:43,785 MUCH MORE EXTENSIVE IN COVID-19 359 00:12:43,785 --> 00:12:45,954 VERSUS SEASONAL INFLUENZA AND WE 360 00:12:45,954 --> 00:12:49,591 AT THE TIME INCLUDED THAT IT'S A 361 00:12:49,591 --> 00:12:51,460 DIFFERENT KIND OF POST VIRAL 362 00:12:51,460 --> 00:12:52,394 SYNDROME, SO FOLLOWING THIS 363 00:12:52,394 --> 00:12:54,663 SPRM, WE DID ABOUT AN 18 MONTH 364 00:12:54,663 --> 00:12:56,064 EXPERIMENT IN THE INFECT YOWZ 365 00:12:56,064 --> 00:12:58,467 DISEASES, ABOUT A YEAR OR SO 366 00:12:58,467 --> 00:13:01,970 AGO, YOU KNOW SHOWING MORE OF 367 00:13:01,970 --> 00:13:04,473 THE SAME THINGS THAT THE BURDEN 368 00:13:04,473 --> 00:13:10,379 OF POST ACUTE SEQUELA AND MUCH 369 00:13:10,379 --> 00:13:18,353 HIGHER THAN THE BURDEN OF POST 370 00:13:18,353 --> 00:13:20,656 SEQUELA, AND NOT THAT THE FLU IS 371 00:13:20,656 --> 00:13:23,358 BENIGN, IT'S A MIGHTY VIRUS THAT 372 00:13:23,358 --> 00:13:24,593 ACTUALLY STILL KILLS THOUSANDS 373 00:13:24,593 --> 00:13:28,564 OF AMERICANS YOU KNOW FOUND 374 00:13:28,564 --> 00:13:32,868 EVERY YEAR, AND THE RESULT ALSO 375 00:13:32,868 --> 00:13:35,404 LONG-TERM ILLNESS AND MANY, MANY 376 00:13:35,404 --> 00:13:36,371 INDIVIDUALS BUT COMPARATIVELY 377 00:13:36,371 --> 00:13:37,539 SPEAKING, YOU KNOW COVID-19 IS 378 00:13:37,539 --> 00:13:39,675 ACTUALLY WORSE AND I KNOW WE 379 00:13:39,675 --> 00:13:41,209 DON'T WANT THE RISK TO BE TRUE 380 00:13:41,209 --> 00:13:42,844 BUT THAT'S REALLY THE TRUTH AND 381 00:13:42,844 --> 00:13:45,847 A LOT OF PEOPLE COMPARE COVID-19 382 00:13:45,847 --> 00:13:47,382 TO SEASONAL INFLUENZA AND IT'S 383 00:13:47,382 --> 00:13:48,750 AN IMPORTANT METRIC. 384 00:13:48,750 --> 00:13:52,354 COVID-19 IN 2024 IS STILL THE 385 00:13:52,354 --> 00:13:55,724 BURDEN OF INFECTION DISEASE, 386 00:13:55,724 --> 00:13:57,893 HOSPITALIZATION AND LONG COVID 387 00:13:57,893 --> 00:14:01,330 OR LONG-TERM SEQUELA IS HIGHER 388 00:14:01,330 --> 00:14:03,865 THAN WITH SEASONAL INFLUENZA, I 389 00:14:03,865 --> 00:14:04,967 WISH THAT WASN'T THE TRUE, ABOUT 390 00:14:04,967 --> 00:14:07,669 YOU THAT'S THE DATA AND 391 00:14:07,669 --> 00:14:09,605 EVERYTHING ELSE IS OPINION IN MY 392 00:14:09,605 --> 00:14:10,272 WORLD DOESN'T RADIOLE LOAMACYY 393 00:14:10,272 --> 00:14:12,007 HAVE A LOT OF VALUE. 394 00:14:12,007 --> 00:14:15,377 DATA IS IMPORTANT, OPINION IS 395 00:14:15,377 --> 00:14:19,881 NOT IN MY -- IN THE WAY WE THINK 396 00:14:19,881 --> 00:14:20,382 ABOUT REALITY. 397 00:14:20,382 --> 00:14:25,120 SO WHAT WE ALSO SAW THAT THE 398 00:14:25,120 --> 00:14:27,623 RISK OF POST ACUTE SEQUELA EVEN 399 00:14:27,623 --> 00:14:28,890 IN PEOPLE WHO HAD MILD DISEASE 400 00:14:28,890 --> 00:14:29,625 AND THAT'S VERY IMPORTANT 401 00:14:29,625 --> 00:14:31,360 BECAUSE MOST PEOPLE WHEN THEY 402 00:14:31,360 --> 00:14:32,894 GET COVID-19 ACTUALLY EVEN IN 403 00:14:32,894 --> 00:14:34,830 2020, EVEN WHEN THERE WAS NO 404 00:14:34,830 --> 00:14:36,231 ANTIVIRALS AND NO VACCINATION, 405 00:14:36,231 --> 00:14:38,433 MOST PEOPLE WHEN THEY GET 406 00:14:38,433 --> 00:14:41,737 SARS-COV-2 INFEC, THEY HAVE MILD 407 00:14:41,737 --> 00:14:42,571 SARS-COV-2 INFECTION, DOESN'T 408 00:14:42,571 --> 00:14:43,705 NEED HOSPITALIZATION ISSUE 409 00:14:43,705 --> 00:14:45,874 DOESN'T REALLY RESULT IN SEVERE 410 00:14:45,874 --> 00:14:47,909 DISEASE AND THOSE PEOPLE, YOU 411 00:14:47,909 --> 00:14:50,912 KNOW STILL WERE MANIFESTING WITH 412 00:14:50,912 --> 00:14:52,581 LONG-TERM SEQUELA OR LONG-TERM 413 00:14:52,581 --> 00:14:54,516 COMPLICATIONS ON HEALTH EFFECTS. 414 00:14:54,516 --> 00:14:55,517 THE RISK HOWEVER INCREASES 415 00:14:55,517 --> 00:14:57,753 ACCORDING TO THE SEVERE MITRAL 416 00:14:57,753 --> 00:15:00,155 ERITY OF ACUTE INFEC, SO CLEARLY 417 00:15:00,155 --> 00:15:02,257 THE POST ACUTE PROBLEM IS PEOPLE 418 00:15:02,257 --> 00:15:03,659 IN HIGHER HELPIZED, HIGHER IN 419 00:15:03,659 --> 00:15:06,795 PEOPLE WHO NEED ICU CARE BUT 420 00:15:06,795 --> 00:15:08,463 STILL EVIDENT, VERY, VERY 421 00:15:08,463 --> 00:15:09,364 CLEARLY EVIDENT AMONG 422 00:15:09,364 --> 00:15:11,566 INDIVIDUALS WHO DID NOT NEED ICU 423 00:15:11,566 --> 00:15:13,201 CARE AND DID NOT NEED TO BE 424 00:15:13,201 --> 00:15:15,671 HOSPITALIZED AND HAD MILD 425 00:15:15,671 --> 00:15:17,305 DISEASE OR VERY MILD DISEASE. 426 00:15:17,305 --> 00:15:18,473 AND I'M SHOWING THIS PICTURE 427 00:15:18,473 --> 00:15:20,909 HERE AND I REALLY LIKE TO SHOW 428 00:15:20,909 --> 00:15:23,512 IT, TO SORT OF ILLUSTRATE HOW 429 00:15:23,512 --> 00:15:25,881 COMPLEX LONG COVID IS. 430 00:15:25,881 --> 00:15:28,050 THIS REALLY DOESN'T EVEN ACCOUNT 431 00:15:28,050 --> 00:15:29,484 FOR THE SEQUELA OF LONG COVID, 432 00:15:29,484 --> 00:15:30,552 THIS ACCOUNTS FOR ABOUT 30 OF 433 00:15:30,552 --> 00:15:31,753 THEM ONLY AND IF YOU LOOK AT 434 00:15:31,753 --> 00:15:33,422 THIS HEAT MAP AND SAY, OH MY GOD 435 00:15:33,422 --> 00:15:35,490 THIS IS REALLY ALL OVER THE 436 00:15:35,490 --> 00:15:37,659 PLACE, YOU KNOW THERE IS NO 437 00:15:37,659 --> 00:15:39,494 REALLY CLEAR PATTERN HERE, YOU 438 00:15:39,494 --> 00:15:42,631 CAME TO THE RIGHT CONCLUSION, 439 00:15:42,631 --> 00:15:43,265 CONGRATULATIONS, AND THIS IS 440 00:15:43,265 --> 00:15:45,033 XABLGLY WHAT I WANTED TO SEE -- 441 00:15:45,033 --> 00:15:46,968 EXACTLY WHAT I WANTED TO SEE 442 00:15:46,968 --> 00:15:49,871 HERE, THIS LONG COVID ARE NOT 443 00:15:49,871 --> 00:15:50,172 MONOLITHIC. 444 00:15:50,172 --> 00:15:52,007 THESE ARE ALL SEQUELA THAT ARE 445 00:15:52,007 --> 00:15:53,775 -- YOU KNOW THAT ARE DERIVING 446 00:15:53,775 --> 00:15:56,378 THEIR RISK OR BURDEN OF THE 447 00:15:56,378 --> 00:15:59,848 SEQUELA ACCORDING TO AGE, RACE, 448 00:15:59,848 --> 00:16:00,582 SEX, ETHNICITY AND 449 00:16:00,582 --> 00:16:02,084 CO-MORBIDITIES AT BASE LINE AND 450 00:16:02,084 --> 00:16:03,618 EVERY SEQUELA HAS A DIFFERENT 451 00:16:03,618 --> 00:16:05,520 DIRECTION MEANING THAT YOU KNOW 452 00:16:05,520 --> 00:16:08,457 LONG COVID IS NOT 1 THING, LONG 453 00:16:08,457 --> 00:16:11,660 COVID ASK COMPOSED OF MANY, MANY 454 00:16:11,660 --> 00:16:12,728 SEQUELA AND WE TOUTED ABOUT 30 455 00:16:12,728 --> 00:16:14,629 AND SOME OF THEM MORE EXPRESSED 456 00:16:14,629 --> 00:16:17,299 IN YOUNGER ADULLS, SOME OF THEM 457 00:16:17,299 --> 00:16:18,834 ARE MORE ABUNDANTLY EXPRESSED IN 458 00:16:18,834 --> 00:16:20,569 OLDER ADULLS, SOME OF THEM ARE 459 00:16:20,569 --> 00:16:21,870 MORE EXPRESSED IN WOMEN OR 460 00:16:21,870 --> 00:16:25,774 FEMALES AND SOME OF THEM ARE 461 00:16:25,774 --> 00:16:26,775 MORE EXPRESSED IN MEN. 462 00:16:26,775 --> 00:16:29,444 SO IT'S NOT MONOLEATHIC THING, 463 00:16:29,444 --> 00:16:31,480 ALWAYS RESIST THE URGE TO SORT 464 00:16:31,480 --> 00:16:33,115 OF SIMPLIFY LONG COVID AND 465 00:16:33,115 --> 00:16:35,417 COMPLEX CONDITION WITH MULTIPLE 466 00:16:35,417 --> 00:16:36,918 SEQUELA AND MANY ORGAN SYSTEMS 467 00:16:36,918 --> 00:16:39,554 AND 1 SENTENCE SAYING WHAT LONG 468 00:16:39,554 --> 00:16:41,957 COVID IS, MORE FREQUENT IN YOUNG 469 00:16:41,957 --> 00:16:43,825 WOMEN OR MORE FREQUENT IN YOUNG 470 00:16:43,825 --> 00:16:48,163 ADULTS OR MORE FREQUENT IN OLD 471 00:16:48,163 --> 00:16:49,965 ADULTS SO THAT 472 00:16:49,965 --> 00:16:52,200 OVERSIMPLIFICATION DOESN'T DO IT 473 00:16:52,200 --> 00:16:52,467 JUSTICE. 474 00:16:52,467 --> 00:16:54,402 THE TRUTH IS, THE TRUTH IS 475 00:16:54,402 --> 00:16:56,138 SCIENTIFICALLY THAT LONG COVID 476 00:16:56,138 --> 00:16:59,007 IS COMPOSED OF MULTIPLE SEQUELA 477 00:16:59,007 --> 00:16:59,941 IN MANY MULTIPLE ORGAN SYSTEMS 478 00:16:59,941 --> 00:17:03,478 AND THEY DO NOT ALL BEHAVE THE 479 00:17:03,478 --> 00:17:05,714 SAME WAY WITH RELATION TO AGE, 480 00:17:05,714 --> 00:17:09,484 SEX, STATUS, HEALTH, AND IT'S 481 00:17:09,484 --> 00:17:13,288 TRULY, TRULY, THE NON MONOLITHIC 482 00:17:13,288 --> 00:17:13,522 DISEASE. 483 00:17:13,522 --> 00:17:15,157 AND RESIST THE URGE TO SIMPLIFY 484 00:17:15,157 --> 00:17:17,159 BECAUSE THAT'S NOT CLOSER TO THE 485 00:17:17,159 --> 00:17:19,060 TRUTH, AND WHEN YOU SIMPLIFY 486 00:17:19,060 --> 00:17:20,328 THINGS, YOU'RE MOVINGA, WAY FROM 487 00:17:20,328 --> 00:17:23,198 THE TRUTH NOT CLOSER TOO IT. 488 00:17:23,198 --> 00:17:24,833 SO THE SEQUELA THAT CONCERNS ALL 489 00:17:24,833 --> 00:17:26,701 OF US QUITE A BIT ARE THOSE THAT 490 00:17:26,701 --> 00:17:27,903 ARE CHRONIC CONDITIONS THAT ARE 491 00:17:27,903 --> 00:17:29,337 LIKELY TO IMPACT PEOPLE, YOU 492 00:17:29,337 --> 00:17:33,542 KNOW AND IMPACT THEIR LIFE SPAN 493 00:17:33,542 --> 00:17:35,010 AND IMPACT HEALTHCARE 494 00:17:35,010 --> 00:17:37,679 UTILIZATION, ET CETERA, AND 495 00:17:37,679 --> 00:17:40,315 THOSE INCLUDE CARDIOVASCULAR 496 00:17:40,315 --> 00:17:43,618 DISORDERS, KIDNEY DISEASE, 497 00:17:43,618 --> 00:17:45,220 NEUROLOGIC MANIFESTATION ANDS 498 00:17:45,220 --> 00:17:45,787 GASTROINTESTINAL DISORDERS. 499 00:17:45,787 --> 00:17:47,022 I WILL GO THROUGH THIS QUICKLY 500 00:17:47,022 --> 00:17:48,156 BECAUSE I WANT TO DEDICATE THE 501 00:17:48,156 --> 00:17:50,158 LAST PART OF THE TALK TO 502 00:17:50,158 --> 00:17:51,226 DISCUSSING MORE SORT OF THE 503 00:17:51,226 --> 00:17:53,195 FORWARD DIRECTION BUT WE CAN DO 504 00:17:53,195 --> 00:17:54,362 Q&A AND IF YOU HAVE ANY 505 00:17:54,362 --> 00:17:55,797 QUESTIONS ABOUT THESE THINGS BUT 506 00:17:55,797 --> 00:17:57,599 VERY CLEARLY, YOU KNOW THERE IS 507 00:17:57,599 --> 00:18:00,135 INCREASE OF CARDIO VASCULARY 508 00:18:00,135 --> 00:18:00,869 DISEASE AFTER SARS-COV-2 509 00:18:00,869 --> 00:18:02,838 INFECTION AND IN THIS STUDY, WE 510 00:18:02,838 --> 00:18:04,172 EVALUATED THE RISK IN ABOUT A 511 00:18:04,172 --> 00:18:06,675 HUNDRED AND 50,000 PEOPLE AT THE 512 00:18:06,675 --> 00:18:07,709 TIME HAD SARS-COV-2 INFECTION 513 00:18:07,709 --> 00:18:09,744 AND 2 CONTROL GROUPS. 514 00:18:09,744 --> 00:18:11,379 ONE CONTEMPORARY CONTROL GROUP 515 00:18:11,379 --> 00:18:12,314 ABOUT 5 MILLION PEOPLE AT THE 516 00:18:12,314 --> 00:18:16,084 TIME DID NOT HAVE SARS-COV-2 517 00:18:16,084 --> 00:18:18,019 INFECTION AND HISTORICALLY ABOUT 518 00:18:18,019 --> 00:18:18,553 5 MILLION PEOPLE, AND THE 519 00:18:18,553 --> 00:18:20,689 CONTROL GROUP THAT COULD NOT 520 00:18:20,689 --> 00:18:22,257 HAVE HAD SARS-COV-2 BECAUSE 521 00:18:22,257 --> 00:18:25,260 THOSE WERE ENROLL INDEED 2016, 522 00:18:25,260 --> 00:18:28,163 2017, 2018 AND AT THE TIME THERE 523 00:18:28,163 --> 00:18:30,098 WAS LITERALLY NO SARS-COV-2 ON 524 00:18:30,098 --> 00:18:34,169 EARTH THAT HAD INFECTED HUMANS 525 00:18:34,169 --> 00:18:43,078 AND CLEARLY WE SEE INCREASE OF 526 00:18:43,078 --> 00:18:45,780 RISK OF DISREGHT MIAS OR 527 00:18:45,780 --> 00:18:48,717 ABNORMAL RHYTHM OF THE HEART, 528 00:18:48,717 --> 00:18:53,021 ATRI OLDER PEOPLE 529 00:18:53,021 --> 00:18:53,855 FIBROLIEWLINGS, TACHYCARDIA, 530 00:18:53,855 --> 00:18:54,856 MYOCARDIAL INFARCTION, HEART 531 00:18:54,856 --> 00:19:00,095 FAILURE AND THROMBOLLIC DISEASE, 532 00:19:00,095 --> 00:19:01,496 MEANING A PULMONARY EMBOLISM, SO 533 00:19:01,496 --> 00:19:03,231 YOU CAN APPRECIATE HERE THE LACK 534 00:19:03,231 --> 00:19:07,669 OF SPECIFICITY, IT'S NOT 1 THING 535 00:19:07,669 --> 00:19:12,107 IT'S NOT ONLY MI, BUT THERE'S 536 00:19:12,107 --> 00:19:17,746 ARRHYTHMIA, STROKES, VTE OR VINO 537 00:19:17,746 --> 00:19:18,680 THROMBOW EMBOLIC DISEASE, THERE 538 00:19:18,680 --> 00:19:24,819 WERE LOTS IN THE CARDIOVASCULAR 539 00:19:24,819 --> 00:19:26,121 SIZE, AND AND YOU HAVE SEEN THE 540 00:19:26,121 --> 00:19:27,856 RESULTS NOW, THIS IS OUR FIRST 541 00:19:27,856 --> 00:19:29,557 TALKING ABOUT THE INCREASE RISK 542 00:19:29,557 --> 00:19:33,295 OF DIABETES IN PEOPLE AFTER 543 00:19:33,295 --> 00:19:35,597 SARS-COV-2 INFECTION, THIS HAS 544 00:19:35,597 --> 00:19:46,107 BEEN PRODUCED FENT 20 TIMES -- 545 00:19:57,519 --> 00:20:01,056 THERE'S CLEARLY METABOLIC 546 00:20:01,056 --> 00:20:02,390 SIGNALLURE, WHEN WE FIRST YOU 547 00:20:02,390 --> 00:20:04,059 KNOW DID THIS STUDY, I REMEMBER 548 00:20:04,059 --> 00:20:08,163 TELLING MY TEAM, WE GOT IT 549 00:20:08,163 --> 00:20:09,497 WRONG, THIS CANNOT BE TRUE, WE 550 00:20:09,497 --> 00:20:15,770 WILL NOT PUBLISH THIS, BECAUSE 551 00:20:15,770 --> 00:20:17,472 HOW CAN SARS-COV-2 552 00:20:17,472 --> 00:20:18,707 [INDISCERNIBLE] DIABETES, THE 553 00:20:18,707 --> 00:20:29,250 RESULTS DON'T MAKE ANY SENSE -- 554 00:20:32,220 --> 00:20:34,022 IT WAS THE FIRST AND REALLY GLAD 555 00:20:34,022 --> 00:20:36,624 TO REPORT THERE'S BEEN MORE THAN 556 00:20:36,624 --> 00:20:40,795 20 STUDIES EXACTLY THE SAME 557 00:20:40,795 --> 00:20:42,330 THING THAT LEADING TO INCREASED 558 00:20:42,330 --> 00:20:46,201 RISK OF DIABETES, INCREASED RISK 559 00:20:46,201 --> 00:20:49,971 OF HYPE DEEMIA, AND ALSO PRODUCE 560 00:20:49,971 --> 00:20:58,013 MULTIPLE STUDIES INCLUDING A 561 00:20:58,013 --> 00:20:59,881 REALLY WONDERFUL STUDY IN IN THE 562 00:20:59,881 --> 00:21:01,616 SWISS MILITARY, I DIDN'T KNOW 563 00:21:01,616 --> 00:21:04,352 THE SWISS HAVE A MILITARY BUT 564 00:21:04,352 --> 00:21:05,487 APPARENTLY THEY DO, THEY HAVE 565 00:21:05,487 --> 00:21:06,388 SWISSED ARMED FORCES AND I DID 566 00:21:06,388 --> 00:21:09,491 NOT KNOW THAT EXISTED BUT 567 00:21:09,491 --> 00:21:11,459 ANYWAY, THEY DO, AND MILITARY 568 00:21:11,459 --> 00:21:12,660 RECRUITS IN SWITZERLAND IS VERY 569 00:21:12,660 --> 00:21:14,629 CLEARLY THE SAME THING, AFTER 570 00:21:14,629 --> 00:21:16,831 THEY GET SARS-COV-2 INFEC, THEY 571 00:21:16,831 --> 00:21:19,034 ACTUALLY MANIFEST WITH DECREASED 572 00:21:19,034 --> 00:21:21,369 HDL, AND INCREASED LDL AND 573 00:21:21,369 --> 00:21:25,607 TRIGLYCERIDES, SO THERE IS A 574 00:21:25,607 --> 00:21:26,541 METABOLIC SIGNATURE OF 575 00:21:26,541 --> 00:21:27,475 SARS-COV-2 INFECTION THAT WE 576 00:21:27,475 --> 00:21:29,144 NEED TO MAY ATTENTION TO IT, AND 577 00:21:29,144 --> 00:21:30,245 I THINK THE BEAUTY ABOUT STUDIES 578 00:21:30,245 --> 00:21:32,280 IN THE PREOF THEINE AREA AND THE 579 00:21:32,280 --> 00:21:33,681 VERY EARLY PHASE OF THE 580 00:21:33,681 --> 00:21:36,017 PANDEMIC, IS IT GAVE US A WINDOW 581 00:21:36,017 --> 00:21:37,419 TO UNDERSTAND WHAT SARS-COV-2 IS 582 00:21:37,419 --> 00:21:39,654 DOING, NOW THE PICTURE IS MUCH 583 00:21:39,654 --> 00:21:40,655 MORE MUDDIED BECAUSE PEOPLE ARE 584 00:21:40,655 --> 00:21:42,690 NOT TESTING AND THERE'S NO 585 00:21:42,690 --> 00:21:44,993 CLARITY ABOUT THE SEQUENCE OF 586 00:21:44,993 --> 00:21:46,961 SARS-COV-2 NOW BECAUSE THERE'S A 587 00:21:46,961 --> 00:21:48,963 LOT OF MUDDIED PICTURE BUT 588 00:21:48,963 --> 00:21:50,532 AGAIN, THE BEAUTY ABOUT GETTING 589 00:21:50,532 --> 00:21:53,101 THIS WINDOW TO REALLY MORE 590 00:21:53,101 --> 00:21:53,968 DEEPLY UNDERSTAND WHAT 591 00:21:53,968 --> 00:21:55,904 SARS-COV-2 IS DOING TO PEOPLE'S 592 00:21:55,904 --> 00:21:57,639 HEALTH IN A VERY FIRST YEAR AND 593 00:21:57,639 --> 00:22:00,141 THE SECOND YEAR OF THE PANDEMIC 594 00:22:00,141 --> 00:22:01,209 AND REALLY WONDERFUL AND AGAIN, 595 00:22:01,209 --> 00:22:03,311 THIS WORK HAS BEEN PRODUCED 596 00:22:03,311 --> 00:22:04,412 MULTIPLE TIMES, WE HEAR IN THE 597 00:22:04,412 --> 00:22:10,285 STUDY, WE SORT OF CATALOG THE 598 00:22:10,285 --> 00:22:11,486 KIDNEY DYSFUNCTION AFTER 599 00:22:11,486 --> 00:22:12,520 SARS-COV-2 INFECTION, AND WHAT I 600 00:22:12,520 --> 00:22:18,293 WANTED TO SHOW HERE IS THIS EGFR 601 00:22:18,293 --> 00:22:20,662 TRAJECTORY, IT'S A QUANTITATIVE 602 00:22:20,662 --> 00:22:24,899 MARKER OF KIDNEY FUNCTION AND 603 00:22:24,899 --> 00:22:26,201 AND YOU CAN APPRECIATE HERE ALL 604 00:22:26,201 --> 00:22:28,603 THE LINES ARE GOING DOWN. 605 00:22:28,603 --> 00:22:30,538 AND TO PUT IT IN PERSPECTIVE 606 00:22:30,538 --> 00:22:33,775 WHAT WE SAW HERE IN PEOPLE, WHO 607 00:22:33,775 --> 00:22:35,110 HAD SARS-COV-2 INFECTION, EVEN 608 00:22:35,110 --> 00:22:39,013 MILD KICKOFF 2 INFECTION, TO 609 00:22:39,013 --> 00:22:40,048 EXPERIENCE ABOUT 2-4-MILLIMETER 610 00:22:40,048 --> 00:22:43,151 DECLINE IN THEIR EGFR, AND THE 611 00:22:43,151 --> 00:22:44,752 YEAR THAT FOLLOWS THE INFECTION. 612 00:22:44,752 --> 00:22:47,155 YOU SHOULD BE ASKING ME NOW, 613 00:22:47,155 --> 00:22:49,757 WHAT DID THIS REALLY MEAN? 614 00:22:49,757 --> 00:22:52,360 WHAT DOES IT MEAN IN GFR REALLY 615 00:22:52,360 --> 00:22:57,432 MEANS, THAT MEANS THAT THE 616 00:22:57,432 --> 00:22:58,233 KIDNEYS AGED ABOUT 4 YEARS IN 617 00:22:58,233 --> 00:23:00,768 THE SPAN OF JUST 1, SO NORMALLY 618 00:23:00,768 --> 00:23:02,170 KIDNEYS AGE, JUST NORMAL AGING 619 00:23:02,170 --> 00:23:04,405 AND THEN WITH NORMAL AGING THE 620 00:23:04,405 --> 00:23:06,274 KIDNEY LOSES ABOUT 1 LITER PER 621 00:23:06,274 --> 00:23:08,776 MINUTE WITH 1 YEAR OF AGING, A 622 00:23:08,776 --> 00:23:11,112 LOSS OF ABOUT 4 LITER 623 00:23:11,112 --> 00:23:12,380 PERMINUTE IN EGFR TRANSLATES 624 00:23:12,380 --> 00:23:16,017 INTO THIS KIDNEY AGED ABOUT 4 625 00:23:16,017 --> 00:23:19,320 YEARS AFTER INFECTION WITH SAVS 626 00:23:19,320 --> 00:23:20,388 KICKOFF 2 INSTEAD OF JUST 1. 627 00:23:20,388 --> 00:23:21,823 SO CAN YOU CHARACTERIZE AN 628 00:23:21,823 --> 00:23:23,024 INFECTION OR AHEAD IN THE EARLY 629 00:23:23,024 --> 00:23:27,061 YEARS OF THE PANDEMIC AS ALMOST 630 00:23:27,061 --> 00:23:28,163 A TANTAMOUNT OUTSIDE OF AGING 631 00:23:28,163 --> 00:23:32,000 THAT PUSHED THAT BODY FROM 632 00:23:32,000 --> 00:23:36,871 BEING, YOU KNOW 50, 54, OR 54-68 633 00:23:36,871 --> 00:23:39,040 OR 66, SORT OF A FORMFUL 634 00:23:39,040 --> 00:23:39,607 ACCELERATED AGING. 635 00:23:39,607 --> 00:23:42,143 YOU KNOW HERE WE LOOKED AT THE 636 00:23:42,143 --> 00:23:44,345 NEUROLOGIC DYSFUNCTION AFTER 637 00:23:44,345 --> 00:23:46,848 SARS-COV-2 INFECTION AND VERY 638 00:23:46,848 --> 00:23:47,582 CLEARLY, DYSFUNCTION ISSUE YOU 639 00:23:47,582 --> 00:23:49,184 MIGHT HAVE HEARD OF BRAIN FOG 640 00:23:49,184 --> 00:23:52,387 BEFORE AND THAT IS 1 OF THE 641 00:23:52,387 --> 00:23:53,221 CARDINAL MANIFESTATIONS OF LONG 642 00:23:53,221 --> 00:23:55,290 COVID AND THAT'S DEFINITELY 643 00:23:55,290 --> 00:23:56,391 TRUE. 644 00:23:56,391 --> 00:23:59,894 SO VERY CLEARLY, A BRAIN FOG OR 645 00:23:59,894 --> 00:24:00,328 COGNITIVE CHANGES. 646 00:24:00,328 --> 00:24:02,163 BUT ALSO MORE THAN THAT, THERE 647 00:24:02,163 --> 00:24:05,166 IS INCREASED RISK OF STROKE AS 648 00:24:05,166 --> 00:24:07,135 DISCUSSED BEFORE, INCREASED RISK 649 00:24:07,135 --> 00:24:09,237 OF SEIZURES, HEADACHES, SLEEP 650 00:24:09,237 --> 00:24:11,105 PROBLEMS, VARIOUS DISORDERS, 651 00:24:11,105 --> 00:24:11,906 VARIOUS NEUROLOGIC DISORDERS, 652 00:24:11,906 --> 00:24:14,108 NOT ONLY BRAIN FOG BUT NOT ONLY 653 00:24:14,108 --> 00:24:24,652 COGNITIVE DISFUNCTION BUT THAT'S 654 00:24:25,086 --> 00:24:26,054 REALLY IMPORTANT AND -- AND 655 00:24:26,054 --> 00:24:27,589 AGAIN LACK THE NOTE OF 656 00:24:27,589 --> 00:24:28,623 SPECIFICITY HERE, IT'S NOT 1 657 00:24:28,623 --> 00:24:31,259 THING, IT'S NOT LIKE A -- YOU 658 00:24:31,259 --> 00:24:36,764 KNOW KIND OF LIKE EBVV, CAUSES 659 00:24:36,764 --> 00:24:40,134 MULTIPLE SCLEROSIS, IT'S 1 THING 660 00:24:40,134 --> 00:24:43,871 THAT'S VERY DEFINED THAT CAUSES 661 00:24:43,871 --> 00:24:46,174 EPSTEIN BARR, OR MULTIPLE 662 00:24:46,174 --> 00:24:47,675 SCLEROSIS, THERE'S A BROAD RANGE 663 00:24:47,675 --> 00:24:49,477 OF THINGS FROM AUTONOMIC 664 00:24:49,477 --> 00:24:52,714 DYSFUNCTION, HEADACHES, SLEEP 665 00:24:52,714 --> 00:24:55,950 PROBLEMS, STROKES, ET CETERA AND 666 00:24:55,950 --> 00:24:56,651 OTHER NEUROLOGIC MANIFESTATIONS 667 00:24:56,651 --> 00:24:58,253 AND THEN HERE, SORT OF A FOLLOW 668 00:24:58,253 --> 00:25:00,388 UP STUDY TO TRY TO UNDERSTAND 669 00:25:00,388 --> 00:25:05,793 THE GI MANIFESTATIONS AND 670 00:25:05,793 --> 00:25:06,728 CLEARLY AFTER SARS-COV-2 671 00:25:06,728 --> 00:25:07,862 INFECTION WITH THE POST ACUTE 672 00:25:07,862 --> 00:25:09,163 PHASE COME BACK TO THE CLINICS 673 00:25:09,163 --> 00:25:16,471 WITH ALL SORT OF PROBLEMS 674 00:25:16,471 --> 00:25:18,773 INCLUDING CONSTIPATION, 675 00:25:18,773 --> 00:25:19,707 DIARRHEA, INFLAMMATORY BOWEL 676 00:25:19,707 --> 00:25:20,642 SYNDROME, ET CETERA, ET CETERA. 677 00:25:20,642 --> 00:25:21,943 AND IN THIS WE WANT TO 678 00:25:21,943 --> 00:25:22,910 UNDERSTAND THE INFECTION ON 679 00:25:22,910 --> 00:25:24,946 PEOPLE, AND THE DESIGN HERE IS 680 00:25:24,946 --> 00:25:26,314 ACTUALLY QUITE INTERESTING, WE 681 00:25:26,314 --> 00:25:29,017 SORT OF FEEL THAT AMERICA DID 682 00:25:29,017 --> 00:25:31,185 NOT, OR MANY PEOPLE IN THE PRESS 683 00:25:31,185 --> 00:25:34,856 DID NOT REALLY FULLY REPORT ON 684 00:25:34,856 --> 00:25:35,556 THIS STUDY ACCURATELY. 685 00:25:35,556 --> 00:25:38,159 SO THIS IS A COUNTER FACTUAL 686 00:25:38,159 --> 00:25:39,827 APPROACH TO TRY TO UNDERSTAND 687 00:25:39,827 --> 00:25:40,762 EFFECTIVELY INFECTION. 688 00:25:40,762 --> 00:25:45,700 WE ANALYZE THE SEQUENCES OF 689 00:25:45,700 --> 00:25:46,901 INFECTION VERSUS [INDISCERNIBLE] 690 00:25:46,901 --> 00:25:49,437 INFECTION, WE SAW 2 INFECTIONS, 691 00:25:49,437 --> 00:25:50,705 IT ACTUALLY WORSENED JUST HAVING 692 00:25:50,705 --> 00:25:51,839 1 AND THE SEQUENCES OR HEALTH 693 00:25:51,839 --> 00:25:52,507 CENTER FOR EXCELLENCE ON AGINGS 694 00:25:52,507 --> 00:25:56,311 OF HAVING 3 INFECTIONS ARE 695 00:25:56,311 --> 00:25:57,545 WORSES THAN 2. 696 00:25:57,545 --> 00:26:02,050 SO VERY CLIERLY THE INFECTION IS 697 00:26:02,050 --> 00:26:03,117 CONSEQUENTIAL OF NO INFECTION, 698 00:26:03,117 --> 00:26:04,285 AND 1 THING WE DISCOVERED WHEN 699 00:26:04,285 --> 00:26:06,354 WE DID THE PAPER, IS THAT 700 00:26:06,354 --> 00:26:08,456 AMERICA DOES NOT LIKE COUNTER 701 00:26:08,456 --> 00:26:09,590 FACTUAL THINKING, THE PRESS, 702 00:26:09,590 --> 00:26:11,492 THEY DON'T LIKE COUNTER FACTUAL 703 00:26:11,492 --> 00:26:13,561 THINKING, MUCH OF THIS WAS 704 00:26:13,561 --> 00:26:14,128 MISINTERPRETED BUT THE POINT 705 00:26:14,128 --> 00:26:16,264 THAT IS VERY CLEAR AND THIS HAS 706 00:26:16,264 --> 00:26:19,534 ACTUALLY NOW BEEN REPRODUCED BY 707 00:26:19,534 --> 00:26:21,002 WORK FROM CHINA AND THE WORK 708 00:26:21,002 --> 00:26:25,206 FROM THE U.S., WORK FROM 709 00:26:25,206 --> 00:26:26,908 CANADIAN STUDIES, WORK BY THE 710 00:26:26,908 --> 00:26:27,375 PATIENT LED RESEARCH 711 00:26:27,375 --> 00:26:29,043 COLLABORATIVE IN THE U.S., MANY, 712 00:26:29,043 --> 00:26:33,147 MANY PAPERS, YOU KNOW SHOWING OR 713 00:26:33,147 --> 00:26:35,950 CATALOGING THE REPEATED 714 00:26:35,950 --> 00:26:38,319 INFECTIONS OF SARS-COV-2. 715 00:26:38,319 --> 00:26:39,387 REINFECTION CAN TRIGGER DE NOVO 716 00:26:39,387 --> 00:26:44,158 LONG COVID, MEANING THIS PERSON 717 00:26:44,158 --> 00:26:45,126 MAY HAVE IMMERSED UNSCATHED 718 00:26:45,126 --> 00:26:47,562 AFTER THE FIRST INFECTION AND 719 00:26:47,562 --> 00:26:49,197 DID NOT HAVE LONG COVID AFTER 720 00:26:49,197 --> 00:26:50,798 THE FIRST INFECTION BUT THEN NOW 721 00:26:50,798 --> 00:26:52,734 DEVELOP LONG COVID AFTER THE 722 00:26:52,734 --> 00:26:54,202 SECOND INFECTION OR THIRD 723 00:26:54,202 --> 00:26:56,904 INFECTION, THAT'S DE NOVO LONG 724 00:26:56,904 --> 00:26:59,307 COVID AFTER INFECTION OR 725 00:26:59,307 --> 00:27:00,141 EXACERBATION OF UNDERLYING LONG 726 00:27:00,141 --> 00:27:01,342 COVID AND THAT'S FAIRLY COMMON. 727 00:27:01,342 --> 00:27:02,510 YOU SEE PEOPLE WITH LONG COVID 728 00:27:02,510 --> 00:27:05,346 IN THE CLINIC AND THEN FOR 1 729 00:27:05,346 --> 00:27:06,414 REASON OR ANOTHER, THEY TRAVEL 730 00:27:06,414 --> 00:27:08,583 SOMEWHERE AND THEN THEY GOT 731 00:27:08,583 --> 00:27:14,155 INFECT EXCLUDE UPON REINFECTION, 732 00:27:14,155 --> 00:27:17,759 THE LONG COVID IS TRIGGERED ALL 733 00:27:17,759 --> 00:27:19,160 OVER AGAIN, EXACERBATED, SO 734 00:27:19,160 --> 00:27:20,628 EXACERBATE UNDERLYING LONG COVID 735 00:27:20,628 --> 00:27:25,299 OR CAUSES DE NOVO OR NEW LONG 736 00:27:25,299 --> 00:27:25,933 COVID UPON REINFECTION. 737 00:27:25,933 --> 00:27:27,435 SO HOW LONG IS LONG COVID AND WE 738 00:27:27,435 --> 00:27:29,737 REALLY THINK THAT PATIENTS ARE 739 00:27:29,737 --> 00:27:30,671 REALLY PROPHETIC AND BECAUSE 740 00:27:30,671 --> 00:27:32,540 THEY -- WHEN THEY TURNED IT LONG 741 00:27:32,540 --> 00:27:34,208 COVID AND THEY START TALKING 742 00:27:34,208 --> 00:27:36,778 ABOUT THE LONG HAWF HAUL, I 743 00:27:36,778 --> 00:27:38,346 GUESS THEY KNEW OR FELT THEY 744 00:27:38,346 --> 00:27:41,315 SENSED THEY HAD THIS SORT OF 745 00:27:41,315 --> 00:27:44,585 PROPHETIC WAY OF THINKING ABOUT 746 00:27:44,585 --> 00:27:46,754 YOU KNOW THE TRAJECTORY OF LONG 747 00:27:46,754 --> 00:27:48,456 COVID AND IT IS REALLY LONG. 748 00:27:48,456 --> 00:27:50,992 THIS IS A STUDY CATALOGING THE 749 00:27:50,992 --> 00:27:52,493 RISK OF INCIDENT DEC AFTER 750 00:27:52,493 --> 00:27:54,328 INITIAL INFECTION AND WE CAN, 751 00:27:54,328 --> 00:27:56,063 YOU KNOW THE GOOD NEWS HERE IS 752 00:27:56,063 --> 00:27:58,032 THAT FOR MOST OF THE SEQUELA, 753 00:27:58,032 --> 00:28:00,902 THERE IS NO NEW INCIDENT DISEASE 754 00:28:00,902 --> 00:28:02,937 AFTER THE FIRST YEAR BUT, BUT, 755 00:28:02,937 --> 00:28:05,173 FOR ABOUT ONE-THIRD OF SEQUELA 756 00:28:05,173 --> 00:28:09,277 WE CATALOGED IN THE STUDY AND WE 757 00:28:09,277 --> 00:28:11,212 CATALOG ABOUT 8-0, PEOPLE WERE 758 00:28:11,212 --> 00:28:13,514 MANIFESTED WITH NEW ONSET 759 00:28:13,514 --> 00:28:13,848 DISEASE. 760 00:28:13,848 --> 00:28:15,349 NEW ONSET DISEASE IN THE SECOND 761 00:28:15,349 --> 00:28:17,084 YEAR AFTER INITIAL INFECTION. 762 00:28:17,084 --> 00:28:18,886 AND THAT'S REALLY REMARKABLE, 763 00:28:18,886 --> 00:28:20,421 THAT'S REALLY REMARKABLE AND 764 00:28:20,421 --> 00:28:23,391 THAT DECLINES ALSO IN THE THIRD 765 00:28:23,391 --> 00:28:25,960 YEAR, AND 3 YEARS AFTER 766 00:28:25,960 --> 00:28:26,694 SARS-COV-2 INFECTION, PEOPLE 767 00:28:26,694 --> 00:28:28,429 WERE MANIFESTING WITH THE NEW 768 00:28:28,429 --> 00:28:30,298 ONSET DEC CAN THAT RELATED TO 769 00:28:30,298 --> 00:28:31,833 INFECTION THAT I HAD 3 YEARS 770 00:28:31,833 --> 00:28:33,501 AGO, SO YES, YES, YOU MAY HAVE 771 00:28:33,501 --> 00:28:36,737 FORGOTTEN THAT YOU HAD 772 00:28:36,737 --> 00:28:38,639 SARS-COV-2, 2 OR 3 YORES AGO, 773 00:28:38,639 --> 00:28:40,875 BUT IT'S POSSIBLE, IT'S POSSIBLE 774 00:28:40,875 --> 00:28:42,343 THAT SARS-COV-2 DID NOT FORGET 775 00:28:42,343 --> 00:28:46,881 ABOUT YOU AND IT'S STILL 776 00:28:46,881 --> 00:28:48,950 WREAKING HAVOC IN BODY SYSTEMS 777 00:28:48,950 --> 00:28:50,518 AND RESULTING IN NEW INCIDENT 778 00:28:50,518 --> 00:28:55,256 DISEASE OVERALL STRATEGY AFTER 779 00:28:55,256 --> 00:28:56,057 AN INFEC. 780 00:28:56,057 --> 00:28:59,827 I THINK IT'S REALLY SORT OF OUT 781 00:28:59,827 --> 00:29:00,862 DATED, REALLY 20th CENTURY 782 00:29:00,862 --> 00:29:02,430 IDEA AS A 18th OR 19th 783 00:29:02,430 --> 00:29:05,366 CENTURY IDEA THAT IS NOT REALLY 784 00:29:05,366 --> 00:29:07,401 COMPATIBLE WITH ACTUAL REAL 785 00:29:07,401 --> 00:29:10,738 EVIDENCE THAT WE SEE IN REALITY. 786 00:29:10,738 --> 00:29:11,806 SO THAT'S REALLY THE KIND OF 787 00:29:11,806 --> 00:29:13,908 THINKING THAT NEEDS TO BE 788 00:29:13,908 --> 00:29:15,510 LITERALLY PROBABLY GO TO THE 789 00:29:15,510 --> 00:29:17,879 SMITHSONIAN AND BE SORT OF 790 00:29:17,879 --> 00:29:19,647 FRAMED THERE AS A REEL 791 00:29:19,647 --> 00:29:20,982 KEEPSAKESSIC OF REALLY OLD IDEAS 792 00:29:20,982 --> 00:29:23,084 THAT WORK FOR SOMETIME BUT NO 793 00:29:23,084 --> 00:29:25,520 LONGER REALLY TRUE, NO LONGER 794 00:29:25,520 --> 00:29:27,455 REFLECT REALITY, SO THIS SORT OF 795 00:29:27,455 --> 00:29:28,990 DIVISION BETWEEN ACUTE AND 796 00:29:28,990 --> 00:29:30,691 CHRONIC, IT'S REALLY NAIVE 797 00:29:30,691 --> 00:29:33,561 CONCEPT THAT DOESN'T REALLY -- 798 00:29:33,561 --> 00:29:34,896 THAT LITERALLY DOESN'T RECONCILE 799 00:29:34,896 --> 00:29:35,429 WITH REALITY. 800 00:29:35,429 --> 00:29:36,931 THE REALITY IS, THE REALITY IS, 801 00:29:36,931 --> 00:29:39,567 WE SEE VERY CLIERLY EPIDEMIOLOGY 802 00:29:39,567 --> 00:29:41,369 IN THE DATA, THAT AND IT'S 803 00:29:41,369 --> 00:29:44,405 LITERALLY, HUNDREDS OF THOUSANDS 804 00:29:44,405 --> 00:29:45,806 OF PEOPLE FOLLOWED FOR A LONG 805 00:29:45,806 --> 00:29:48,442 PERIOD OF TIME AND EVEN IN ACUTE 806 00:29:48,442 --> 00:29:51,212 INFECTION CAN RESULT IN 807 00:29:51,212 --> 00:29:53,814 LONG-TERM HEALTH EECHGHTS 2 OR 3 808 00:29:53,814 --> 00:29:55,516 YEARS AFTER THE INITIAL 809 00:29:55,516 --> 00:29:57,385 INFECTION, NOW THE GOOD NEWS IS 810 00:29:57,385 --> 00:29:58,619 THIS IS FROM [INDISCERNIBLE], 811 00:29:58,619 --> 00:30:00,621 YOU CAN APPRECIATE HERE THAT THE 812 00:30:00,621 --> 00:30:02,290 LION'S SHARE OF DEC AND BURDEN 813 00:30:02,290 --> 00:30:03,591 IN THIS ABILITY, HAPPENS IN THE 814 00:30:03,591 --> 00:30:04,992 FIRST YEARS, IN THE RED BARS AND 815 00:30:04,992 --> 00:30:06,427 LESS SO IN THE SECOND AND THIRD 816 00:30:06,427 --> 00:30:10,631 YEAR BUT IT'S NOT 0. 817 00:30:10,631 --> 00:30:11,566 BUT IT'S CERTAINLY NOT 0. 818 00:30:11,566 --> 00:30:14,068 NOW HAS THE RISK OF LONG COVID 819 00:30:14,068 --> 00:30:15,570 REALLY CHANGED OVER TIME? 820 00:30:15,570 --> 00:30:17,305 AND THE -- THE FACT IS THAT YES 821 00:30:17,305 --> 00:30:19,040 IT DID EMPLOY YES IT DID. 822 00:30:19,040 --> 00:30:21,809 SO THIS IS SORT OF DATA ALSO 823 00:30:21,809 --> 00:30:25,846 FROM OUR TEAM, PUBLISHED 824 00:30:25,846 --> 00:30:27,014 RECENTLY ABOUT MAYBE 2 MONTHS 825 00:30:27,014 --> 00:30:28,749 AGO, SOMETHING LIKE THAT, IN 826 00:30:28,749 --> 00:30:34,255 JULY, AND AUGUST, SORRY. 827 00:30:34,255 --> 00:30:36,657 SHOWING THAT THE RISK HAS 828 00:30:36,657 --> 00:30:37,925 DECLINED OVERTIME, FROM THE VERY 829 00:30:37,925 --> 00:30:39,927 EARLY ERA OF THE PANDEMIC, WE 830 00:30:39,927 --> 00:30:43,598 CALL THIS SORT OF PREDELTA ERA 831 00:30:43,598 --> 00:30:44,966 AMONG UNVACCINATED INDIVIDUALS 832 00:30:44,966 --> 00:30:49,837 ABOUT 10% AT THAT TIME TO ABOUT 833 00:30:49,837 --> 00:30:51,272 3.5% AMONG VACCINATED EVENT IN 834 00:30:51,272 --> 00:30:53,474 INDIVIDUALS IN THE OMICRON ERA, 835 00:30:53,474 --> 00:30:56,143 SO THATIA A SIGNIFICANT DECLINE 836 00:30:56,143 --> 00:30:57,745 OVERTIME BETWEEN THE PREDELTA, 837 00:30:57,745 --> 00:30:59,480 DELTA AND OMI CRON ERAS, NOTICE 838 00:30:59,480 --> 00:31:02,617 HERE THE GREEN LINE, THE GREEN 839 00:31:02,617 --> 00:31:05,519 LINE THAT REPRESENTS VEKINATED 840 00:31:05,519 --> 00:31:05,953 INDIVIDUALS. 841 00:31:05,953 --> 00:31:06,554 VACCINATED INDIVIDUALS ALWAYS 842 00:31:06,554 --> 00:31:12,660 HAD LESS RISK OF ENCOUNTERED OR 843 00:31:12,660 --> 00:31:13,294 HAVING UNVACCINATED INDIVIDUALS 844 00:31:13,294 --> 00:31:14,662 AND EVEN PEOPLE WHO ARE 845 00:31:14,662 --> 00:31:16,063 VACCINATED, THE RISK CAN 846 00:31:16,063 --> 00:31:18,099 ACTUALLY DROPPED TO ABOUT 3.5 847 00:31:18,099 --> 00:31:20,635 AMONG THOSE WHO ARE VACCINATED 848 00:31:20,635 --> 00:31:23,070 IN THE OMICRON ERA, THERE'S 2 849 00:31:23,070 --> 00:31:23,704 KEY DRIVERS HERE. 850 00:31:23,704 --> 00:31:26,474 IF I THINK ABOUT IT, 2 KEY 851 00:31:26,474 --> 00:31:30,778 DRIVERS FOR THIS DECLINE. 852 00:31:30,778 --> 00:31:37,151 ONE IS THE EVOLUTION OF SORTING 853 00:31:37,151 --> 00:31:39,086 SIGNALSS KICKOFF 2 TODAY. 854 00:31:39,086 --> 00:31:40,021 SORTING SIGNALSS KICKOFF 2 TODAY 855 00:31:40,021 --> 00:31:42,023 IS NOT THE SAME OF MARCH IN 856 00:31:42,023 --> 00:31:42,390 2020. 857 00:31:42,390 --> 00:31:42,957 THAT'S THE REALITY. 858 00:31:42,957 --> 00:31:44,625 IT'S NOT THE SAME AND 2, TONINGS 859 00:31:44,625 --> 00:31:48,863 MORE PEOPLE ARE VACCINATED IN 860 00:31:48,863 --> 00:31:51,098 2022, 2023, 2024 THAN AND THERE 861 00:31:51,098 --> 00:31:53,234 WAS NOBODY, LITERALLY NOBODY, 0 862 00:31:53,234 --> 00:31:54,702 IN 2020. 863 00:31:54,702 --> 00:31:56,537 SO THESE 2 KEY DRIVERS RESULT 864 00:31:56,537 --> 00:31:57,505 INDEED A SIGNIFICANT DECLINE IN 865 00:31:57,505 --> 00:31:59,774 THE RISK OF LONG COVID OVER 866 00:31:59,774 --> 00:32:00,808 TIME, HOWEVER, HOWEVER, EVEN 867 00:32:00,808 --> 00:32:04,345 WITH THIS DECLINE, THE RISK IS 868 00:32:04,345 --> 00:32:05,279 NOT 0. 869 00:32:05,279 --> 00:32:06,847 SO YES IT'S MUCH LOWER THAN IT 870 00:32:06,847 --> 00:32:09,650 WAS BEFORE, MUCH LOWER THAN IT 871 00:32:09,650 --> 00:32:12,153 WAS IN 2020 AMONG UNVACCINATED 872 00:32:12,153 --> 00:32:13,287 INDIVIDUALS BUT STILL, 3.5% IS 873 00:32:13,287 --> 00:32:13,888 REALLY IMPORTANT. 874 00:32:13,888 --> 00:32:15,089 AND I KNOW SOME PEOPLE MAY BE, 875 00:32:15,089 --> 00:32:17,091 THIS IS A GROUP THAT ALSO 876 00:32:17,091 --> 00:32:19,060 INCLUDES THE FDA, AND IT'S ALSO 877 00:32:19,060 --> 00:32:20,428 IMPORTANT FOR VACCINE POLICY 878 00:32:20,428 --> 00:32:22,229 BECAUSE WE CAN ACTUALLY SAY 879 00:32:22,229 --> 00:32:23,631 THAT, YOU KNOW WHAT LONG COVID 880 00:32:23,631 --> 00:32:25,866 IS NO LONGER A BIG, BIG PROBLEM 881 00:32:25,866 --> 00:32:27,835 BECAUSE OF VACCINES, BECAUSE 882 00:32:27,835 --> 00:32:29,170 PEOPLE ARE VACCINATED AND THEN 883 00:32:29,170 --> 00:32:31,639 IN THE NEXT SENTENCE SAY 884 00:32:31,639 --> 00:32:33,007 ABANDON, THE VACCINES THAT 885 00:32:33,007 --> 00:32:35,142 ACTUALLY GOT US TO THIS POINT, 886 00:32:35,142 --> 00:32:35,376 RIGHT? 887 00:32:35,376 --> 00:32:38,145 SO I THINK IT'S VERY, VERY 888 00:32:38,145 --> 00:32:39,213 IMPORTANT TO REALIZE THAT, YOU 889 00:32:39,213 --> 00:32:43,517 KNOW THE VACCINE HAVE IT ALL AND 890 00:32:43,517 --> 00:32:45,886 REDUCING THE RISK OF DEATH AND 891 00:32:45,886 --> 00:32:47,288 HOSPITALIZATION AND ACUTE PHASE 892 00:32:47,288 --> 00:32:48,456 AND ALSO REDUCING THE RISK OF 893 00:32:48,456 --> 00:32:50,091 LONG COVID AND THAT'S VERY, VERY 894 00:32:50,091 --> 00:32:51,292 KEY AND VERY IMPORTANT IN THE 895 00:32:51,292 --> 00:32:51,826 DATA. 896 00:32:51,826 --> 00:32:52,893 SO WHAT ABOUT PREVENTION. 897 00:32:52,893 --> 00:32:54,729 WE JUST TALKED ABOUT IT VERY, 898 00:32:54,729 --> 00:32:56,530 VERY BRIEFLY, VACCINES WORK AND 899 00:32:56,530 --> 00:32:58,499 VACCINES REDUCE THE RISK OF 900 00:32:58,499 --> 00:32:59,867 HOSPITAL RISATION AND IN AN 901 00:32:59,867 --> 00:33:02,069 ACUTE PHASE, AND ALSO REDUCE THE 902 00:33:02,069 --> 00:33:04,071 RISK OF LONG COVID, THE RISK OF 903 00:33:04,071 --> 00:33:08,476 REDUCTION IN LONG COVID, IS NOT 904 00:33:08,476 --> 00:33:11,078 REALLY COMPLETE, BUT IT IS 905 00:33:11,078 --> 00:33:12,546 THERE, AND BUT ALSO HOE IN THE 906 00:33:12,546 --> 00:33:14,882 DATA THAT IT'S VARIABLE ACROSS 907 00:33:14,882 --> 00:33:21,956 THE ORGAN SYSTEMS, SO IT'S NOT 908 00:33:21,956 --> 00:33:28,763 THE SAME FOR THIS NEVERTHELESS, 909 00:33:28,763 --> 00:33:31,499 YOU CAN SEE ALL THIS HERE, ON 910 00:33:31,499 --> 00:33:32,700 ALL THEE BARS ARE GREEN AND ON 911 00:33:32,700 --> 00:33:39,507 THE RIGHT SIDE OF HISTORY, SO 912 00:33:39,507 --> 00:33:41,375 RISK OF REDUCTION AND RISK, SO 913 00:33:41,375 --> 00:33:43,911 WE ALSO SEE AND THIS HAS BEEN 914 00:33:43,911 --> 00:33:47,915 CORROBORATED BY AN RCT THAT WAS 915 00:33:47,915 --> 00:33:52,553 PUBLISHED IN LANCET INFECTIOUS 916 00:33:52,553 --> 00:33:53,454 DISEASES, AND ANTIVIRALS WHEN 917 00:33:53,454 --> 00:33:56,524 THEY TAKEN IN THE ACUTE PHASE 918 00:33:56,524 --> 00:33:58,392 AMONG THOSE ELIGIBLE FOR 919 00:33:58,392 --> 00:34:00,361 ANTIVIRALS, ADVANCE AGE, 920 00:34:00,361 --> 00:34:01,629 PRESENCE OF CORMORBIDITYS THAT 921 00:34:01,629 --> 00:34:04,365 PUT PEOPLE AT HIGH RISK OF 922 00:34:04,365 --> 00:34:05,432 SEVERE ILLNESS AND DEATH, AND 923 00:34:05,432 --> 00:34:07,268 THAT SUBSET OF PEOPLE, THAT'S 924 00:34:07,268 --> 00:34:08,903 THOT EVERYONE AND THAT SUBSET OF 925 00:34:08,903 --> 00:34:10,905 PEOPLE THAT WILL QUALIFY FOR 926 00:34:10,905 --> 00:34:15,609 ANTIVIRALS WITH P A XLOVE D 927 00:34:15,609 --> 00:34:18,279 REDUCES THE RISK OF P A SC, THE 928 00:34:18,279 --> 00:34:20,147 EFFECTS ARE WEAK BUT IT'S NOT 0, 929 00:34:20,147 --> 00:34:28,756 NOT NULL, AND WE SEE THAT 930 00:34:28,756 --> 00:34:31,025 CLEARLY IN [INDISCERNIBLE], THIS 931 00:34:31,025 --> 00:34:35,629 HAS BEEN PRODUCED BY THE 932 00:34:35,629 --> 00:34:37,565 PANORAMIC TRIAL, OR PEOPLE WHO 933 00:34:37,565 --> 00:34:41,635 HAD BEEN TREATED OR RABD ORDER 934 00:34:41,635 --> 00:34:43,704 OF MICRONSIZED WITH 935 00:34:43,704 --> 00:34:44,939 [INDISCERNIBLE], VERSUS USUAL 936 00:34:44,939 --> 00:34:46,006 CARE AND THE 6 MONTH FOLLOW UP 937 00:34:46,006 --> 00:34:48,609 AND THE FOLLOW UP THE PAN O 938 00:34:48,609 --> 00:34:51,912 RAMMIC CAME UP PROBABLY A MONTH 939 00:34:51,912 --> 00:34:53,214 AGO AND INFECTIOUS DISEASES AND 940 00:34:53,214 --> 00:34:54,715 SHOWING CLEARLY A REDUCTION IN 941 00:34:54,715 --> 00:34:56,884 RISK OF LONG COVID, AMONG PEOPLE 942 00:34:56,884 --> 00:35:01,155 WHO WERE TREATED IN ACUTE PHASE 943 00:35:01,155 --> 00:35:02,056 OF [INDISCERNIBLE]. 944 00:35:02,056 --> 00:35:04,325 THE REDUCTION WAS ALSO MODEST, 945 00:35:04,325 --> 00:35:07,228 WEAK EFFECT BUT NOT 0, SO 946 00:35:07,228 --> 00:35:08,262 ANTIVIRALS AND ACUTE PHASE 947 00:35:08,262 --> 00:35:09,897 REDUCE TO SOME EXTENT BUT NOT 948 00:35:09,897 --> 00:35:12,099 REALLY, YOU KNOW DO NOT 949 00:35:12,099 --> 00:35:13,234 COMPLETELY ABROGATE THE RISK OF 950 00:35:13,234 --> 00:35:15,769 LONG COVID. 951 00:35:15,769 --> 00:35:17,605 SO, WHY DOES LONG COVID HAPPEN? 952 00:35:17,605 --> 00:35:19,874 AND THE SHORT ANSWER IS THAT, 953 00:35:19,874 --> 00:35:21,175 THE LIKELY MULTIPLE MECH NICHES 954 00:35:21,175 --> 00:35:22,810 AT PLAY AND I DON'T WANT US TO 955 00:35:22,810 --> 00:35:25,779 PUT OUR EGGS IN 1 BASKET AND 956 00:35:25,779 --> 00:35:28,349 DIVIDE UP RESISTANCE OR THE 957 00:35:28,349 --> 00:35:29,016 MICROBIOME, DISBIOSEIS, THESE 958 00:35:29,016 --> 00:35:32,586 ARE ALL IN MY VIEW, EQUALLY 959 00:35:32,586 --> 00:35:34,321 PLAUSIBLE HYPOTHESIS OR 960 00:35:34,321 --> 00:35:36,023 MECHANISMS THAT COULD 961 00:35:36,023 --> 00:35:37,291 POTENTIALLY EXPAND LONG COVID. 962 00:35:37,291 --> 00:35:39,526 ONE OF THEM IS CLEARLY VIRAL 963 00:35:39,526 --> 00:35:41,362 PERSISTENCE, THE IDEA THAT THE 964 00:35:41,362 --> 00:35:43,530 VIRUS MIGHT PERSIST IN THE BODY 965 00:35:43,530 --> 00:35:45,599 AFTER LONG ACUTE INFECTION, IT 966 00:35:45,599 --> 00:35:48,469 DOESN'T HAVE TO THE VIRUS, 967 00:35:48,469 --> 00:35:51,105 COMPLETE FRAGMENTS OF THE VIRUS, 968 00:35:51,105 --> 00:35:51,739 PROTEIN FRAG M-TEBURKEULOSEISS 969 00:35:51,739 --> 00:35:53,107 OR AND THEY WERE HIDING IN 970 00:35:53,107 --> 00:35:56,844 TISSUES AND NOW THEY'RE BEING 971 00:35:56,844 --> 00:35:59,113 DEGRADED, YOU KNOW, IMMUNE 972 00:35:59,113 --> 00:36:00,981 DISREGULATION, THAT'S VERY CLEAR 973 00:36:00,981 --> 00:36:05,519 NOW, THERE'S ABUNDANT DATA, 974 00:36:05,519 --> 00:36:08,322 SHOWING THE LIKELIHOOD THAT 975 00:36:08,322 --> 00:36:08,889 IMMUNE DISRESSULATION MAY 976 00:36:08,889 --> 00:36:10,791 EXPLAIN SOME OF THE MECHANISMS 977 00:36:10,791 --> 00:36:12,559 OF LONG COVID, MICROBIOME 978 00:36:12,559 --> 00:36:15,729 DISBIOSEIS IS VERY PLAUSIBLE, 979 00:36:15,729 --> 00:36:17,464 THE IDEA OF ENDOTHELIAL 980 00:36:17,464 --> 00:36:19,066 INFLAMMATION IS VERY IMPORTANT 981 00:36:19,066 --> 00:36:26,073 INCLUDING COMPLEMENT 982 00:36:26,073 --> 00:36:28,108 DISREGULATIONULATION, COTING, 983 00:36:28,108 --> 00:36:30,511 RED CELL LYSIS, IMPAIRED TISSUE 984 00:36:30,511 --> 00:36:32,279 PROFUSION, OR DISTAL TISSUE 985 00:36:32,279 --> 00:36:33,514 PROFUSION, VERY CLEARLY NEURONAL 986 00:36:33,514 --> 00:36:34,415 INFLAMMATION, WE WILL TALK ABOUT 987 00:36:34,415 --> 00:36:38,552 IT IN THE NEXT SLIDE, AND 988 00:36:38,552 --> 00:36:39,119 MITOCHONDRIA DYSFUNCTION MAY 989 00:36:39,119 --> 00:36:40,421 PLAY A ROLE EMPLOY SO WE DID 990 00:36:40,421 --> 00:36:43,757 THIS PIECE TO TRY TO SORT OF 991 00:36:43,757 --> 00:36:45,826 DIVE A BIT MORE DEEPER INTO THE 992 00:36:45,826 --> 00:36:47,594 MECHANISM AND MAY EXPLAIN 993 00:36:47,594 --> 00:36:49,096 NEUROLOGIC DISFUNCTION OR MAY 994 00:36:49,096 --> 00:36:50,331 SPLEAN THE NEUROLOGIC 995 00:36:50,331 --> 00:36:52,099 INVOLVEMENT IN LONG COVID. 996 00:36:52,099 --> 00:36:53,500 YOU KNOW, YOU GUYS ARE PROBABLY 997 00:36:53,500 --> 00:36:55,269 AMONG YOU IS THE PEOPLE WOULD 998 00:36:55,269 --> 00:36:56,537 REALLY PRODUCE, ARE THE PEOPLE 999 00:36:56,537 --> 00:36:58,505 WHO PRODUCE EVIDENCE OF THE 1000 00:36:58,505 --> 00:36:59,573 PRESENCE OF SARS-COV-2 IN THE 1001 00:36:59,573 --> 00:37:02,576 BRAIN OF PEOPLE SO THAT'S 1002 00:37:02,576 --> 00:37:03,477 REALLY, THAT'S POSSIBLE. 1003 00:37:03,477 --> 00:37:08,315 OBVIOUSLY IN EVERYONE, THAT'S 1004 00:37:08,315 --> 00:37:10,150 POTENTIA WILY 1 MECHANISM THAT 1005 00:37:10,150 --> 00:37:13,420 MAY EXPLAIN THIS, GLIAL CELL 1006 00:37:13,420 --> 00:37:15,489 ACTIVATION, THERE ARE SORT OF 1007 00:37:15,489 --> 00:37:16,924 PEOPLE SORT OF PROPOSED THE IDEA 1008 00:37:16,924 --> 00:37:19,326 THAT THERE IS POTENTIALLY MAYBE, 1009 00:37:19,326 --> 00:37:22,930 TO THE ADREENA DYSFUNCTION WITH 1010 00:37:22,930 --> 00:37:23,530 LOW CORTISOL. 1011 00:37:23,530 --> 00:37:28,635 THAT DATA NEEDS TO BE SORT OF 1012 00:37:28,635 --> 00:37:29,203 FURTHER FLESHED OUT. 1013 00:37:29,203 --> 00:37:31,238 YOU KNOW THE IDEA OF 1014 00:37:31,238 --> 00:37:32,172 MITOCHONDRIA DYSFUNCTION CAN 1015 00:37:32,172 --> 00:37:39,346 ALSO BE PLAUSIBLE HERE, AND THE 1016 00:37:39,346 --> 00:37:41,849 DISBIOSEIS CAN ALSO BE DRIVERS 1017 00:37:41,849 --> 00:37:43,250 OR MECHANISTIC PATHWAYS THAT 1018 00:37:43,250 --> 00:37:44,318 EXPLAIN LONG COVID. 1019 00:37:44,318 --> 00:37:46,820 THE IMPACTS OF LONG COVID, WE 1020 00:37:46,820 --> 00:37:48,122 WORRY ABOUT IMPACT ON 1021 00:37:48,122 --> 00:37:49,056 INDIVIDUALS AND COMMUNITIES A 1022 00:37:49,056 --> 00:37:50,891 LOT AND AGAIN, I WANT TO SORT OF 1023 00:37:50,891 --> 00:37:55,262 GO BACK TO THE -- TO ROSIE'S 1024 00:37:55,262 --> 00:37:56,764 ART, ROSIE DID THIS IRISH KID 1025 00:37:56,764 --> 00:37:58,832 WHO HAS BEEN SUFFERING FROM LONG 1026 00:37:58,832 --> 00:38:00,768 COVID FOR THE PAST SEVERAL YEARS 1027 00:38:00,768 --> 00:38:04,071 AND REALLY SORT OF TRIES TO DEAL 1028 00:38:04,071 --> 00:38:05,606 WITH IT BY PAINTING AND THIS IS 1029 00:38:05,606 --> 00:38:08,008 1 OF HER PAINTINGS WHERE SHE 1030 00:38:08,008 --> 00:38:09,209 PAINTS HERSELF AND LOOK AT THE 1031 00:38:09,209 --> 00:38:12,746 EYES, LOOK AT THE MOUTH, LIKE 1032 00:38:12,746 --> 00:38:14,148 UNSEEN AND UNHEARD, SO SHE DOES 1033 00:38:14,148 --> 00:38:17,451 NOT REALLY FEEL THAT PEOPLE ARE 1034 00:38:17,451 --> 00:38:20,354 SEE HER, PEOPLE AREN'T HEARING 1035 00:38:20,354 --> 00:38:21,755 WHAT SHE SAYS, THEY'RE SAYING 1036 00:38:21,755 --> 00:38:24,892 ALL THESE THINGS TO HER, GIVE IT 1037 00:38:24,892 --> 00:38:27,194 TIME, MAN UP, YOU LOOK HEALTHY. 1038 00:38:27,194 --> 00:38:29,696 PEOPLE ARE TELLING HER, THIS 1039 00:38:29,696 --> 00:38:31,198 SO-CALLED LONG COVID, AND ALL 1040 00:38:31,198 --> 00:38:33,700 THESE THINGS THAT REALLY 1041 00:38:33,700 --> 00:38:35,836 REPRESENT IN OUR VIEW, GAS 1042 00:38:35,836 --> 00:38:37,037 LIGHTING OF THE EXPERIENCE OR 1043 00:38:37,037 --> 00:38:38,205 LIVED EXPERIENCES OF PEOPLE WHO 1044 00:38:38,205 --> 00:38:40,607 ARE IMPACT WIDE LONG COVID. 1045 00:38:40,607 --> 00:38:43,177 A VERY POWERFUL ART IN MY 1046 00:38:43,177 --> 00:38:46,180 OPINION IN MANY CASES WHAT 1047 00:38:46,180 --> 00:38:51,151 PATIENTS ARE FEELING WITH LONG 1048 00:38:51,151 --> 00:38:52,352 COVID. 1049 00:38:52,352 --> 00:38:54,755 WE ALSO WORRY ABOUT DISEASE IN 1050 00:38:54,755 --> 00:38:56,790 THIS, AND WE'RE LITERALLY 1051 00:38:56,790 --> 00:38:57,858 UNCERTAIN ABOUT THE DOWN STREAM 1052 00:38:57,858 --> 00:38:59,593 IMPLICATIONS OF ALL OF THIS. 1053 00:38:59,593 --> 00:39:00,861 PEOPLE WITH BRAIN FOG OR YOU 1054 00:39:00,861 --> 00:39:07,034 KNOW A LOT OF HEADACHE, FROM IN 1055 00:39:07,034 --> 00:39:09,236 LONG COVID, THEY DEVELOP SORT OF 1056 00:39:09,236 --> 00:39:10,070 OTHER NEUROLOGIC COMPLICATIONS 1057 00:39:10,070 --> 00:39:13,040 DOWN THE ROAD, LIKE EARLY 1058 00:39:13,040 --> 00:39:14,741 ALZHEIMER'S DISEASE, OR DEMENTIA 1059 00:39:14,741 --> 00:39:17,311 OR WILL WE HAVE A BUNCH OF 1060 00:39:17,311 --> 00:39:19,346 PEOPLE WHO ARE DEMENTED IN THEIR 1061 00:39:19,346 --> 00:39:20,914 30S AND 40S AND 50S 10 YEARS 1062 00:39:20,914 --> 00:39:22,015 FROM NOW AND I DON'T KNOW THE 1063 00:39:22,015 --> 00:39:23,884 ANSWER TO THAT BUT I WORRY ABOUT 1064 00:39:23,884 --> 00:39:26,854 THESE THINGS, I WORRY ABOUT LIFE 1065 00:39:26,854 --> 00:39:28,722 EXPECTANCY IN PEOPLE WITH LONG 1066 00:39:28,722 --> 00:39:28,922 COVID. 1067 00:39:28,922 --> 00:39:30,858 AND THERE ARE AT LEAST 1068 00:39:30,858 --> 00:39:31,825 20 MILLION AMERICANS WITH LONG 1069 00:39:31,825 --> 00:39:34,328 COVID SO THAT REDUCED LIFE 1070 00:39:34,328 --> 00:39:37,264 EXPECTANCY IN THEM WILL 1071 00:39:37,264 --> 00:39:39,666 CERTAINLY MAKE A HUGE DENT IN 1072 00:39:39,666 --> 00:39:41,335 OUR TOTAL LIFE EXPECTANCY IN THE 1073 00:39:41,335 --> 00:39:41,502 U.S. 1074 00:39:41,502 --> 00:39:43,504 WE WORRY A LOT ABOUT THAT 1075 00:39:43,504 --> 00:39:45,172 DEVELOPMENT EDUCATION OF KIDS 1076 00:39:45,172 --> 00:39:46,373 WHO ARE INVOLVED WITH LONG 1077 00:39:46,373 --> 00:39:51,678 COVID, WE WORRY ABOUT SORT OF 1078 00:39:51,678 --> 00:39:52,513 THE IMPLICATIONS ARE FOR HEALTH 1079 00:39:52,513 --> 00:39:54,248 SYSTEMS AND WHAT WOULD THAT DO 1080 00:39:54,248 --> 00:39:58,485 TO DEMAND OUR HEALTH SYSTEMS AND 1081 00:39:58,485 --> 00:40:00,087 ACCESS TO CARE, EQUITY OF CARE, 1082 00:40:00,087 --> 00:40:02,856 ALL OF THESE DIFFERENT FACTORS, 1083 00:40:02,856 --> 00:40:04,024 I BRIEFLY TALKED ABOUT THE 1084 00:40:04,024 --> 00:40:08,962 EFFECT ON THE ECONOMY AND WE 1085 00:40:08,962 --> 00:40:11,298 TYPED IT UP RECENTLY AND THE 1086 00:40:11,298 --> 00:40:12,799 TOTAL TALLY WAS ABOUT 1 MILL YEN 1087 00:40:12,799 --> 00:40:14,434 DOLLARS PER YEAR AND THE EFFECT 1088 00:40:14,434 --> 00:40:18,705 IS NOT TRIVIAL ON LABOR MARKET 1089 00:40:18,705 --> 00:40:22,776 AND ECONOMIC PRODUCTIVITY. 1090 00:40:22,776 --> 00:40:26,980 IT'S ALSO NOT TRIVIAL ON 1091 00:40:26,980 --> 00:40:28,615 ECONOMICS AND ALSO WOVEN INTO 1092 00:40:28,615 --> 00:40:30,384 THE FABRIC OF OUR SOCIETY, IT 1093 00:40:30,384 --> 00:40:31,785 HAS SIGNIFICANT SOCIAL 1094 00:40:31,785 --> 00:40:32,119 IMPLICATIONS. 1095 00:40:32,119 --> 00:40:34,454 SO, TO PUT LONG COVID IN TON 1096 00:40:34,454 --> 00:40:36,690 TEXT, I LIKE THIS SLIDE BECAUSE 1097 00:40:36,690 --> 00:40:40,661 I ALSO LIKE THE DELIBERATE 1098 00:40:40,661 --> 00:40:42,496 PLACING OF IN-CONTEXT AND BIG 1099 00:40:42,496 --> 00:40:43,897 FONT, SO CONTEXT MATTERS AND I 1100 00:40:43,897 --> 00:40:45,933 THINK SORT OF TO UNDERSTAND LONG 1101 00:40:45,933 --> 00:40:47,901 COVID, WE NEED TO SORT OF 1102 00:40:47,901 --> 00:40:49,069 UNDERSTAND THE FEATURE OF LONG 1103 00:40:49,069 --> 00:40:52,239 COVID AND HOW MIGHT IT OVERLAP 1104 00:40:52,239 --> 00:40:53,073 WITH POST HOSPITALIZATIONS FOR 1105 00:40:53,073 --> 00:40:57,177 EXAMPLE, THERE ARE FEATURES 1106 00:40:57,177 --> 00:41:01,582 THERE, THERE ARE VERY -- NOT 1107 00:41:01,582 --> 00:41:04,851 IDENTICAL BUT SIMILAR TO PEOPLE 1108 00:41:04,851 --> 00:41:07,120 WITH LONG COVID, POST CARE 1109 00:41:07,120 --> 00:41:07,955 SYNDROME AND THIS WHOLE 1110 00:41:07,955 --> 00:41:10,057 ASSOCIATION OF CHRONIC CARE AND 1111 00:41:10,057 --> 00:41:12,125 ILLNESSES, AS WE DISCUSS, YOU 1112 00:41:12,125 --> 00:41:14,828 KNOW EVEN INFLUENZA CAN LEAVE 1113 00:41:14,828 --> 00:41:17,064 PEOPLE WITH POST ACUTE VIRAL 1114 00:41:17,064 --> 00:41:18,599 ILLNESS, AND IF YOU GO BACK TO 1115 00:41:18,599 --> 00:41:20,434 THE HISTORY BOOK, THIS IS ALSO 1116 00:41:20,434 --> 00:41:20,701 NOT NEW. 1117 00:41:20,701 --> 00:41:23,904 YOU KNOW A LOT OF -- IT HAS 1118 00:41:23,904 --> 00:41:27,241 REALLY A WONDERFUL BOOK CALLED 1119 00:41:27,241 --> 00:41:28,875 PALE RIDER WHERE SHE CATALOGS 1120 00:41:28,875 --> 00:41:31,979 THE AFTEREFFECT OF THE FLU 1121 00:41:31,979 --> 00:41:33,113 PANDEMIC, THE 1918 FLU BAN 1122 00:41:33,113 --> 00:41:36,650 DEMIC, I THINK IT WAS ALSO 1123 00:41:36,650 --> 00:41:40,621 CALLED SPANISH FLU BUT REALLY 1124 00:41:40,621 --> 00:41:41,755 IT'S THE 1918 FLU PANDEMIC 1125 00:41:41,755 --> 00:41:45,626 EMPLOY 1126 00:41:45,626 --> 00:41:48,161 AND IN HER BOOK THERE ARE 1127 00:41:48,161 --> 00:41:51,465 ACCOUNTS OF DROVES PEOPLE 1128 00:41:51,465 --> 00:41:53,066 TALKING ABOUT LONG-TERM, 1129 00:41:53,066 --> 00:41:53,834 ENCEPHALITIS, SLEEPINESS, ET 1130 00:41:53,834 --> 00:41:56,436 CETERA, ET CETERA AFTER THAT 1131 00:41:56,436 --> 00:41:57,170 1918 FLU PANDEMIC. 1132 00:41:57,170 --> 00:41:59,172 TO THE POINT IT AFFECTED A WHOLE 1133 00:41:59,172 --> 00:42:01,575 BUNCH OF FARMERS IN NEW ZEALAND 1134 00:42:01,575 --> 00:42:04,911 TO THE POINT THEY WERE SO WEAK 1135 00:42:04,911 --> 00:42:08,515 AND THEY COULD NOT SHEER THE 1136 00:42:08,515 --> 00:42:10,851 WOOL OFF THE -- AND LOST 1137 00:42:10,851 --> 00:42:13,820 PRODUCTIVITY IN WHAT IS CALL NOW 1138 00:42:13,820 --> 00:42:15,789 CALLED TANZANIA IN AFRICA, THEY 1139 00:42:15,789 --> 00:42:17,858 ALSO HAD WHAT WE CALLED A FAMINE 1140 00:42:17,858 --> 00:42:19,826 BECAUSE THEY COULD NOT REALLY 1141 00:42:19,826 --> 00:42:20,794 CULTIVATE THEIR FIELDS, THEY 1142 00:42:20,794 --> 00:42:23,297 COULD NOT -- THE FARMERS THERE 1143 00:42:23,297 --> 00:42:25,332 WERE SO WEAK AND EN MASSE, EN 1144 00:42:25,332 --> 00:42:27,401 MASSE, NOT 1 OR 2, THE WHOLE 1145 00:42:27,401 --> 00:42:32,105 COMMUNITY OF FARMERS IN WHAT IS 1146 00:42:32,105 --> 00:42:33,840 CALLED TANZANIA WAS WEAK AND 1147 00:42:33,840 --> 00:42:34,908 MISSED ABILITY TO ACTUALLY 1148 00:42:34,908 --> 00:42:37,477 PLANT, ET CETERA AND IT RESULTED 1149 00:42:37,477 --> 00:42:38,445 IN FAMINE. 1150 00:42:38,445 --> 00:42:40,947 IT'S A WONDERFUL BOOK CALLED 1151 00:42:40,947 --> 00:42:43,016 PALE RIDER BY LAURA SPINNEY. 1152 00:42:43,016 --> 00:42:44,318 BRITISH WRITER WHO LIVES IN 1153 00:42:44,318 --> 00:42:46,420 PARIS BUT REALLY ABSOLUTELY 1154 00:42:46,420 --> 00:42:50,624 WONDERFUL, SO ANYWAY, THE 1155 00:42:50,624 --> 00:42:52,959 MEASLES CAN LEAD TO LONG-TERM 1156 00:42:52,959 --> 00:42:55,062 COMPLICATIONS, EBV CAN LEAD TO 1157 00:42:55,062 --> 00:42:56,296 MULTIPLE SCLEROSIS, FOR THOSE 1158 00:42:56,296 --> 00:42:59,166 WHO HAVE DEALT WITH EBOLA, YOU 1159 00:42:59,166 --> 00:43:01,101 KNOW, IT'S NOT JUST AN ACUTE 1160 00:43:01,101 --> 00:43:03,870 THING BUT A LONG-TERM 1161 00:43:03,870 --> 00:43:05,172 CONSEQUENCES OF EBOLA, OF POLIO, 1162 00:43:05,172 --> 00:43:09,343 AND THEN YOU KNOW THE BIGGENTITY 1163 00:43:09,343 --> 00:43:14,147 THAT'S CALLED MILE ALGORITHMSIC 1164 00:43:14,147 --> 00:43:17,150 ENCEPHALITIS CHRONIC FATIGUE 1165 00:43:17,150 --> 00:43:19,419 SYNDROME THAT BEARS A RESEMESTER 1166 00:43:19,419 --> 00:43:20,854 BLEL TO LONG COVID FEATURES AND 1167 00:43:20,854 --> 00:43:22,122 UNDERSTANDING ALL OF THOSE WILL 1168 00:43:22,122 --> 00:43:25,359 BE REALLY IMPORTANT TO REALLY 1169 00:43:25,359 --> 00:43:27,661 UNLOCK THE SEQUENCES TO WHY 1170 00:43:27,661 --> 00:43:29,262 ACUTE VIRUSES THAT PRESUMABLY 1171 00:43:29,262 --> 00:43:33,100 WILL CAUSE ACUTE INFECTION LEAVE 1172 00:43:33,100 --> 00:43:35,469 SOMETIMES, SOME INDIVIDUALS WITH 1173 00:43:35,469 --> 00:43:36,837 LONG-TERM SEQUELA AND MULTIPLE 1174 00:43:36,837 --> 00:43:38,638 ORGAN SYSTEMS, SO THIS IS VERY, 1175 00:43:38,638 --> 00:43:40,507 VERY IMPORTANT, I WILL SAYING 1176 00:43:40,507 --> 00:43:41,675 ALONE WILL NOT BE SUFFICIENT, WE 1177 00:43:41,675 --> 00:43:42,843 NEED TO UNDERSTAND THE WHOLE 1178 00:43:42,843 --> 00:43:44,578 THING IN CONTEXT AGAIN, THAT'S 1179 00:43:44,578 --> 00:43:48,849 REALLY WHY I LIKE THAT SLIDE. 1180 00:43:48,849 --> 00:43:53,587 SO WE NEED TO THINK ABOUT A 1181 00:43:53,587 --> 00:43:55,889 POLICY ROADMAP TO CHART THE WAY 1182 00:43:55,889 --> 00:43:58,191 AHEAD AND THAT ENTAILS 1183 00:43:58,191 --> 00:44:01,128 PREVENTING MORE PEOPLE FROM 1184 00:44:01,128 --> 00:44:02,195 HAVING LONG COVID, ACCESS 1185 00:44:02,195 --> 00:44:03,463 QUALITY AND EQUITY OF CARE, 1186 00:44:03,463 --> 00:44:04,965 PROFESSIONAL EDUCATION AND 1187 00:44:04,965 --> 00:44:09,269 TRAINING, PUBLIC HEALTH 1188 00:44:09,269 --> 00:44:09,803 COMMUNICATION, SUPPORTING 1189 00:44:09,803 --> 00:44:10,537 COORDINATED AREA RESEARCH AND 1190 00:44:10,537 --> 00:44:13,306 THAT WILL BE VERY IMPORTANT, I 1191 00:44:13,306 --> 00:44:15,776 AM GLAD THAT THE NIH IS THINKING 1192 00:44:15,776 --> 00:44:17,377 ABOUT THAT AND THAT THE NIH 1193 00:44:17,377 --> 00:44:20,647 COULD AND SHOULD DO MORE TO TRY 1194 00:44:20,647 --> 00:44:22,382 TO SPEED UP RESEARCH ON LONG 1195 00:44:22,382 --> 00:44:25,986 COVID AND ASSOCIATED CONDITIONS. 1196 00:44:25,986 --> 00:44:27,354 BUILDING CONSENSUS ON CLINICAL 1197 00:44:27,354 --> 00:44:31,191 END POINTS WILL BE VERY 1198 00:44:31,191 --> 00:44:32,092 IMPORTANT, GLOBAL COORDINATION, 1199 00:44:32,092 --> 00:44:34,127 WE USE PROFESSIONAL SOCIETIES 1200 00:44:34,127 --> 00:44:36,096 FOR LONG COVID, PROFESSIONAL 1201 00:44:36,096 --> 00:44:37,030 HEALTH CONSULTANTS FOR LONG 1202 00:44:37,030 --> 00:44:38,331 COVID AND THAT'S VERY IMPORTANT 1203 00:44:38,331 --> 00:44:39,266 AND ANY DISCUSSION ABOUT 1204 00:44:39,266 --> 00:44:40,600 PREPARING FOR THE NEXT PANDEMIC 1205 00:44:40,600 --> 00:44:45,205 THAT DOES NOT REALLY INVOLVE THE 1206 00:44:45,205 --> 00:44:48,208 IDEA, THE CORE IDEA THAT ACUTE 1207 00:44:48,208 --> 00:44:49,609 INFECTIONS CAN SOMETIMES ALSO 1208 00:44:49,609 --> 00:44:51,378 LEAD TO LONG-TERM ILLNESSES AND 1209 00:44:51,378 --> 00:44:54,314 LONG-TERM MANIFESTATION AND 1210 00:44:54,314 --> 00:44:54,881 LONG-TERM NONCOMMUNICABLE 1211 00:44:54,881 --> 00:44:56,082 DISEASES, ANY EFFORT LIKE THAT 1212 00:44:56,082 --> 00:44:58,485 THAT DOES NOT INCLUDE THAT CORE 1213 00:44:58,485 --> 00:45:00,253 CONCEPT, ANY EFFORT IN PANDEMIC 1214 00:45:00,253 --> 00:45:02,222 PREPAREDNESS THAT DOES NOT 1215 00:45:02,222 --> 00:45:03,590 INCLUDE THAT CORCONCEPT IS 1216 00:45:03,590 --> 00:45:06,893 REALLY INCOMPLETE. 1217 00:45:06,893 --> 00:45:07,360 IT'S INCOMPLETE. 1218 00:45:07,360 --> 00:45:09,896 WE NEED TO,A COUNT FOR THIS IDEA 1219 00:45:09,896 --> 00:45:11,731 THAT PANDEMICS LEAD TO DROVES OF 1220 00:45:11,731 --> 00:45:13,900 PEOPLE WITH THIS ABILITY AND 1221 00:45:13,900 --> 00:45:14,367 DISEASE. 1222 00:45:14,367 --> 00:45:16,203 YOU KNOW THE COVID-19 PAN 1223 00:45:16,203 --> 00:45:17,471 DEBLGIC, IT'S NOT THE FIRST, 1224 00:45:17,471 --> 00:45:19,139 IT'S NOT THE LAST 1, THERE WILL 1225 00:45:19,139 --> 00:45:21,341 BE PANDEMIC AND IF WE ARE GOING 1226 00:45:21,341 --> 00:45:22,075 TO MEANINGFULLY PREPARE OUR 1227 00:45:22,075 --> 00:45:24,377 SOCIETIES AND OUR COUNTRIES FOR 1228 00:45:24,377 --> 00:45:26,780 THE NEXT PANDEMIC, WE ALSO NEED 1229 00:45:26,780 --> 00:45:28,915 TO BE THINKING NOT ONLY ABOUT, 1230 00:45:28,915 --> 00:45:32,385 OH, WELL BIRD FLU IS XYZ, OR 1231 00:45:32,385 --> 00:45:33,220 OTHER THINGS, XYZ, BUT WE NEED 1232 00:45:33,220 --> 00:45:35,121 TO THINK ABOUT THE POTENTIAL FOR 1233 00:45:35,121 --> 00:45:37,491 THESE VIRUSES TO LEAD TO THINGS 1234 00:45:37,491 --> 00:45:41,161 LIKE LONG COVID, LONG VIRUS 2030 1235 00:45:41,161 --> 00:45:42,796 OR LONG VIRUS 2040 AND HOW DO WE 1236 00:45:42,796 --> 00:45:44,331 MITIGATE THAT TO THE BEST OF OUR 1237 00:45:44,331 --> 00:45:45,999 ABILITIES, THAT'S GOING TO BE 1238 00:45:45,999 --> 00:45:48,201 VERY, VERY IMPORTANT. 1239 00:45:48,201 --> 00:45:49,836 AND ANY PANDEMIC PREPARENESS 1240 00:45:49,836 --> 00:45:51,471 SAID THAT DOESN'T INCLUDE THAT 1241 00:45:51,471 --> 00:45:53,907 CORE CONCEPT IS REALLY 1242 00:45:53,907 --> 00:45:54,708 INCOMPLETE. 1243 00:45:54,708 --> 00:45:55,375 INCOMPLETE. 1244 00:45:55,375 --> 00:45:55,675 INCOMPLETE. 1245 00:45:55,675 --> 00:46:02,249 AND THIS RESEARCH ROADMAP, THINK 1246 00:46:02,249 --> 00:46:03,917 THERE'S CLEARLY A NEED FOR 1247 00:46:03,917 --> 00:46:06,453 TRIALS, BUT FOCUSING OHM ON 1248 00:46:06,453 --> 00:46:09,756 TRIALS I THINK WILL NOT YIELD, 1249 00:46:09,756 --> 00:46:11,157 YOU KNOW REALLY A LOT OF 1250 00:46:11,157 --> 00:46:11,491 PROGRESS. 1251 00:46:11,491 --> 00:46:13,026 I THINK IN CONCERT, IN PARALLEL, 1252 00:46:13,026 --> 00:46:17,230 YOU KNOW THE NEED TO BE A LOT 1253 00:46:17,230 --> 00:46:20,033 MORE RESEARCH ON UNDERSTANDING 1254 00:46:20,033 --> 00:46:22,669 THE MECHANISMS, DIAGNOSTICS FOR 1255 00:46:22,669 --> 00:46:24,070 LONG COVID, TEST THERAPEUTICS 1256 00:46:24,070 --> 00:46:25,539 FOR LONG COVID, EPIDEMIOLOGY OF 1257 00:46:25,539 --> 00:46:28,041 COURSE OF LONG COVID, CARE AND 1258 00:46:28,041 --> 00:46:30,043 DELIVERY OF AND HEALTH SYSTEM 1259 00:46:30,043 --> 00:46:31,111 RESEARCH, ECONOMIC IMPACT AND 1260 00:46:31,111 --> 00:46:33,446 SOCIETAL IMPACTS AND I REALLY, 1261 00:46:33,446 --> 00:46:34,881 REALLY HOPE, NIH GET TO RETHINK 1262 00:46:34,881 --> 00:46:37,717 THE WHOLE RECOVER AND EXPAND THE 1263 00:46:37,717 --> 00:46:38,685 PIPELINE OF INVESTIGATORS, 1264 00:46:38,685 --> 00:46:41,955 THAT'S NOT REALLY SORT OF A COO 1265 00:46:41,955 --> 00:46:44,658 COONED AND RESTRICTED TO THE 1266 00:46:44,658 --> 00:46:46,626 RARE PEOPLE OR FEW THAT ARE NOW 1267 00:46:46,626 --> 00:46:49,596 INVOLVED AND RECOVER AND SO 1268 00:46:49,596 --> 00:46:51,631 CLOSE SO PEOPLE LIKE US KOOBT 1269 00:46:51,631 --> 00:46:53,166 EVEN ACCESS THE DATA AND THAT 1270 00:46:53,166 --> 00:46:56,870 REALLY IN OUR VIEW SHOULD REALLY 1271 00:46:56,870 --> 00:46:57,137 CHANGE. 1272 00:46:57,137 --> 00:46:59,406 IF THE NIH IS REALLY TRULY 1273 00:46:59,406 --> 00:47:00,740 WANTING TO ADVANCE AND MOVE THE 1274 00:47:00,740 --> 00:47:02,275 BALL FORWARD ON RECOVERY AND IF 1275 00:47:02,275 --> 00:47:06,012 THAT'S REALLY TRUE, THEN REALLY 1276 00:47:06,012 --> 00:47:08,882 THE ECOSYSTEM SHOULD BE OPEN 1277 00:47:08,882 --> 00:47:09,950 EQUITABLY AND COMPETITIVELY TO 1278 00:47:09,950 --> 00:47:16,923 ALL NEW IDEAS, NOT SORT OF A -- 1279 00:47:16,923 --> 00:47:19,426 THE FUNDS GO TO THE PEOPLE 4 OR 1280 00:47:19,426 --> 00:47:20,594 5 YEARS AGO AND MADE MOW 1281 00:47:20,594 --> 00:47:22,228 PROGRESS WITH THE FUNDS. 1282 00:47:22,228 --> 00:47:23,863 ANYWAY, IT DOESN'T SOUND VERY -- 1283 00:47:23,863 --> 00:47:25,932 LONG COVID IS A MULTIFACETED 1284 00:47:25,932 --> 00:47:27,434 DISEASE THAT CAN AFFECT NEARLY 1285 00:47:27,434 --> 00:47:30,637 EVERY ORGAN SYSTEM, THE HUMAN 1286 00:47:30,637 --> 00:47:32,639 ICONIC TOLL OF LONG COVID IS 1287 00:47:32,639 --> 00:47:34,140 SIGNIFICANT AND DEMANDS A LOT OF 1288 00:47:34,140 --> 00:47:34,507 INTENTION. 1289 00:47:34,507 --> 00:47:35,942 RISK IS INCREASED BY INFECTION 1290 00:47:35,942 --> 00:47:40,347 AND REDUCED BY VACCINATION AND 1291 00:47:40,347 --> 00:47:43,450 ANTIVIRALS AND WE THINK IT NEEDS 1292 00:47:43,450 --> 00:47:44,818 A COORDINATE APPROACH AND 1293 00:47:44,818 --> 00:47:45,885 RESEARCH AND RESPONSE STRALT 1294 00:47:45,885 --> 00:47:46,119 EDGY. 1295 00:47:46,119 --> 00:47:47,621 SO YOU CAN'T GIVE THIS TALK 1296 00:47:47,621 --> 00:47:49,389 WITHOUT THANKING THE TEAM THAT 1297 00:47:49,389 --> 00:47:51,057 LED US HERE AND HELPED US DO A 1298 00:47:51,057 --> 00:47:54,527 LOT OF WORK ON LONG COVID, 1299 00:47:54,527 --> 00:47:56,596 INCLUDING YAN, SHAE, WHO IS IN 1300 00:47:56,596 --> 00:48:01,568 OUR CENTER AND DIRECTOR OF THE 1301 00:48:01,568 --> 00:48:02,802 [INDISCERNIBLE] PROGRAM, HE LED 1302 00:48:02,802 --> 00:48:09,342 MUCH OF THE WORK I SHOWED TODAY, 1303 00:48:09,342 --> 00:48:14,614 ALSO TAEYOUNG CHOI, EVAN XU, 1304 00:48:14,614 --> 00:48:16,349 BENJAMIN BOWE, MISO, CALL, AND 1305 00:48:16,349 --> 00:48:19,419 ALSO THANKFUL TO VICKI DAVIES 1306 00:48:19,419 --> 00:48:21,955 FROM THE VA WHO'S BEEN 1307 00:48:21,955 --> 00:48:22,555 ENORMOUSLY SUPPORTIVE, AND 1308 00:48:22,555 --> 00:48:24,791 SUPPORT FROM THE VA INCLUDING 1309 00:48:24,791 --> 00:48:26,192 SUSAN WOOD AND ALSO WHEN SHE WAS 1310 00:48:26,192 --> 00:48:29,629 HERE AT THE VA, SHE'S NOW LEFT 1311 00:48:29,629 --> 00:48:32,265 FOR ORD AND ALLEY SHAVER AND IF 1312 00:48:32,265 --> 00:48:34,000 YOU SEE THE WORK IN THE MEDIA 1313 00:48:34,000 --> 00:48:36,903 THAT'S THANKS TO THE WORK OF 1314 00:48:36,903 --> 00:48:40,240 CHRISTINA, DIANE AND JESSICA, 1315 00:48:40,240 --> 00:48:42,575 AND THEY DO AN ARK MAZING JOB OF 1316 00:48:42,575 --> 00:48:43,710 PROMOTING AWARENESS IN THE 1317 00:48:43,710 --> 00:48:45,679 UNITED STATES AND GLOBAL AND WE 1318 00:48:45,679 --> 00:48:46,913 FEEL THIS IS VERY IMPORTANT. 1319 00:48:46,913 --> 00:48:48,948 LAST BUT NOT LEAST IS REALLY THE 1320 00:48:48,948 --> 00:48:50,684 LONG HAULERS WHO INSPIRED US AND 1321 00:48:50,684 --> 00:48:52,552 CONTINUE TO INSPIRE US TO DO 1322 00:48:52,552 --> 00:48:56,322 THIS WORK AND WE WERE SORT OF 1323 00:48:56,322 --> 00:48:58,425 REALLY IMMERSED AND ENTRENCHED 1324 00:48:58,425 --> 00:49:00,527 WITH THEM FROM DAY 1 AND WE FEEL 1325 00:49:00,527 --> 00:49:05,598 THEY ARE THEY'VE BEEN ENORMOUSLY 1326 00:49:05,598 --> 00:49:06,533 HELPFUL IN INSPIRING US AND 1327 00:49:06,533 --> 00:49:08,401 GUIDING US IN THE RIGHT WAY. 1328 00:49:08,401 --> 00:49:10,370 SO GRATEFUL FOR YOU HOSTING THIS 1329 00:49:10,370 --> 00:49:11,871 TALK TODAY, FOR YOUR WILLINGNESS 1330 00:49:11,871 --> 00:49:14,674 TO LISTEN AND TALK ABOUT LONG 1331 00:49:14,674 --> 00:49:17,077 COVID, AND INTEREST IN LONG 1332 00:49:17,077 --> 00:49:21,581 COVID AND DELIGHTED TO DO QA. 1333 00:49:21,581 --> 00:49:25,885 >> THANK YOU FOR A WONDERFUL 1334 00:49:25,885 --> 00:49:28,221 TALK ON A VERY IMPORTANT TOPIC. 1335 00:49:28,221 --> 00:49:30,590 AS YOU CAN SEE THERE ARE LOTS OF 1336 00:49:30,590 --> 00:49:31,858 QUESTIONS FROM THE AUDIENCE, IN 1337 00:49:31,858 --> 00:49:33,293 THE TIME LEFT, I WILL SUMMARIZE 1338 00:49:33,293 --> 00:49:34,794 THE MANY THEMES OF THOSE 1339 00:49:34,794 --> 00:49:37,764 QUESTIONS, SO JUMPING TO 1340 00:49:37,764 --> 00:49:39,799 QUESTIONS ISSUES THE FIRST 1 IS 1341 00:49:39,799 --> 00:49:41,868 WHAT ACCOUNTS FOR THE HETEROGAIN 1342 00:49:41,868 --> 00:49:43,303 AITY OF LONG COVID, WHY SOME 1343 00:49:43,303 --> 00:49:44,738 PEOPLE GET IT AFTER THEY GET 1344 00:49:44,738 --> 00:49:45,672 INFECTION, AND OTHERS DO NOT? 1345 00:49:45,672 --> 00:49:48,742 DO WE KNOW THAT? 1346 00:49:48,742 --> 00:49:51,044 >> SO, WE DON'T COMPLETELY KNOW 1347 00:49:51,044 --> 00:49:53,346 WHY BUT CLEARLY THERE MAY BE, 1348 00:49:53,346 --> 00:49:55,882 YOU KNOW ENVIRONMENT 1349 00:49:55,882 --> 00:49:57,951 DETERMINANTS, MAYBE DIETARY 1350 00:49:57,951 --> 00:49:59,419 DENERMALITANTS, MAYBE MY ROUGH 1351 00:49:59,419 --> 00:50:01,287 ATOM BIOME COMPOSITION, HEALTH 1352 00:50:01,287 --> 00:50:02,489 DETERMINANT, GENERATED THETIC 1353 00:50:02,489 --> 00:50:04,858 PRIMATES DISPOSITION, THERE'S IS 1354 00:50:04,858 --> 00:50:06,392 STUDIES SUGGESTING THAT CERTAIN 1355 00:50:06,392 --> 00:50:07,594 SNPs, THERE COULD BE, THERE 1356 00:50:07,594 --> 00:50:10,063 COULD BE, THIS IS STILL IN 1357 00:50:10,063 --> 00:50:11,798 PREPRINT HAS ONLY FORMALLY BEEN 1358 00:50:11,798 --> 00:50:14,901 VETTED OR PEER REVIEWED AND 1359 00:50:14,901 --> 00:50:17,771 PUBLISHED HERE, THERE COULD BE 1360 00:50:17,771 --> 00:50:19,005 GENETIC PREDISPOSITION FOR WHY 1361 00:50:19,005 --> 00:50:20,940 PEOPLE GET LONG COVID AND WHY 1362 00:50:20,940 --> 00:50:22,342 SOME PEOPLE DON'T GET LONG 1363 00:50:22,342 --> 00:50:22,809 COVID. 1364 00:50:22,809 --> 00:50:23,743 BECAUSE IT'S A COMPLEX 1365 00:50:23,743 --> 00:50:25,278 CONDITION, I THINK ALL OF THE 1366 00:50:25,278 --> 00:50:29,382 ABOVE RISK FACTORS OR DRIVERS, 1367 00:50:29,382 --> 00:50:32,152 ENVIRONMENTAL GENERATED THETIC 1368 00:50:32,152 --> 00:50:33,520 DIETARY, PREEXISTING 1369 00:50:33,520 --> 00:50:34,053 CO-MORBIDITIES, LIFESTYLE 1370 00:50:34,053 --> 00:50:36,322 FACTORS, ALL OF THOSE MAY, MAY, 1371 00:50:36,322 --> 00:50:37,724 COALESCE TO SORT OF HEIGHTEN OR 1372 00:50:37,724 --> 00:50:39,793 REDUCE THE RISK OR PROBABILITY 1373 00:50:39,793 --> 00:50:42,095 OF SOMEBODY GETTING A SEQUELA 1374 00:50:42,095 --> 00:50:43,129 AND THAT'S ALL THE INTERACTION 1375 00:50:43,129 --> 00:50:46,633 OF THESE THESE FACTORS COMBINED 1376 00:50:46,633 --> 00:50:48,134 MAY BE LEADING THE PHENOTYPE OF 1377 00:50:48,134 --> 00:50:48,968 LONG COVID. 1378 00:50:48,968 --> 00:50:49,936 BUT THIS IS AN IMPORTANT 1379 00:50:49,936 --> 00:50:51,171 QUESTION BECAUSE WE NEED TO 1380 00:50:51,171 --> 00:50:52,372 UNDERSTAND EXACTLY WHY, YOU KNOW 1381 00:50:52,372 --> 00:50:54,440 MOST OF US, MOST PEOPLE WHEN 1382 00:50:54,440 --> 00:50:55,608 THEY GET SARS-COV-2 THEY DON'T 1383 00:50:55,608 --> 00:50:57,610 GET LONG COVID, BUT SOME PEOPLE 1384 00:50:57,610 --> 00:50:59,813 DO, SO WHY SOME PEOPLE DO AND 1385 00:50:59,813 --> 00:51:04,117 DON'T, HOW CAN WE LEVERAGE THAT 1386 00:51:04,117 --> 00:51:04,818 UNDERSTANDING TO POTENTIALLY 1387 00:51:04,818 --> 00:51:06,886 PREVEBT LONG COVID AND 1388 00:51:06,886 --> 00:51:07,720 POTENTIALLY EVEN TREAT LONG 1389 00:51:07,720 --> 00:51:10,156 COVID, SO I THINK THOSE ARE KEY, 1390 00:51:10,156 --> 00:51:12,025 VERY KEY QUESTIONS, VERY, VERY 1391 00:51:12,025 --> 00:51:12,492 IMPORTANT QUESTIONS. 1392 00:51:12,492 --> 00:51:14,194 >> AND SINCE WE ARE LIVING WITH 1393 00:51:14,194 --> 00:51:15,995 COVID NOW FOR MORE THAN 4 YEARS, 1394 00:51:15,995 --> 00:51:18,531 WE TEND TO GET INFECTED MULTIPLE 1395 00:51:18,531 --> 00:51:22,535 TIMES, SO THE EFFECTS OF 1396 00:51:22,535 --> 00:51:23,903 MULTIPLE INFECTIONS, SINNER 1397 00:51:23,903 --> 00:51:26,072 GESTIC OR MERELY ATTITUDE OR 1398 00:51:26,072 --> 00:51:27,841 [INDISCERNIBLE] FOR LONG COVID? 1399 00:51:27,841 --> 00:51:30,276 HOW DOES MULTIPLE INFECS IMPACT 1400 00:51:30,276 --> 00:51:30,710 LONG COVID? 1401 00:51:30,710 --> 00:51:32,245 >> SO WE HAD THIS PAPER IN 1402 00:51:32,245 --> 00:51:35,415 NATURE MEDICINE NOW A COUPLE 1403 00:51:35,415 --> 00:51:36,616 YEARS AGO, SORT OF WHEN WE 1404 00:51:36,616 --> 00:51:39,819 TALLIED UP THE RISK OF FIRST 1405 00:51:39,819 --> 00:51:40,587 INFECTION, SECOND INFECTION, 1406 00:51:40,587 --> 00:51:41,955 THIRD INFECTION, WE CLEARLY SEE 1407 00:51:41,955 --> 00:51:44,224 THAT THE 2 INFECTIONS ARE WORSE 1408 00:51:44,224 --> 00:51:46,392 THAN 1, SO, I WOULD SAY, YOU 1409 00:51:46,392 --> 00:51:47,827 KNOW LIKE AT LEAST, THAT'S YOU 1410 00:51:47,827 --> 00:51:49,562 KNOW WHEN WE HAVE SECOND AND 1411 00:51:49,562 --> 00:51:51,397 THIRD INFECTION, WE DON'T KNOW 1412 00:51:51,397 --> 00:51:52,232 WHAT HAPPENS WITH FOURTH AND 1413 00:51:52,232 --> 00:51:53,533 FIFTH AND SIXTH INFECTION, WE 1414 00:51:53,533 --> 00:51:54,934 DIDN'T DO THAT WORK SO I DON'T 1415 00:51:54,934 --> 00:52:04,811 KNOW, I DON'T WANT TO SORT OF 1416 00:52:04,811 --> 00:52:05,478 PONTIFICATE OR SPECULATE. 1417 00:52:05,478 --> 00:52:07,814 WE DO KNOW THAT 2 INFECTIONS ARE 1418 00:52:07,814 --> 00:52:09,549 WORSE THAT 1, 23 ARE WORSE THAN 1419 00:52:09,549 --> 00:52:09,682 2. 1420 00:52:09,682 --> 00:52:11,317 SO A SECOND INFECTION ADDS TO 1421 00:52:11,317 --> 00:52:13,386 THE RISK OR CONTRIBUTES 1422 00:52:13,386 --> 00:52:15,421 ADDITIONAL RISK OF LONG COVID 1423 00:52:15,421 --> 00:52:17,590 AND THAT COULD COME EITHER IN DE 1424 00:52:17,590 --> 00:52:21,027 NOVO LONG COVID OR EXACERBATING 1425 00:52:21,027 --> 00:52:24,197 UNDERLYING OR PREEXISTING LONG 1426 00:52:24,197 --> 00:52:24,664 COVID. 1427 00:52:24,664 --> 00:52:29,202 >> I SHOW WONDERFUL DATA FOR ALL 1428 00:52:29,202 --> 00:52:29,969 THIS FUNCTION, ESPECIALLY LONG 1429 00:52:29,969 --> 00:52:34,073 COVID PATIENTS AND THE QUESTION 1430 00:52:34,073 --> 00:52:39,145 S&P THIS PERMANENT OR TEMPORARY? 1431 00:52:39,145 --> 00:52:40,313 >> WE DON'T KNOW. 1432 00:52:40,313 --> 00:52:41,881 WE DON'T KNOW. 1433 00:52:41,881 --> 00:52:43,883 SO AGAIN, ORGAN DYSFUNCTION IS A 1434 00:52:43,883 --> 00:52:53,960 NONSPECIFIC TERM BUT LET'S SAY 1435 00:52:53,960 --> 00:52:58,698 SORT OF A WILL HEART DISEASE 1436 00:52:58,698 --> 00:53:01,601 AFTER SARS-COV-2, OR DURING 1437 00:53:01,601 --> 00:53:06,506 SARS-COV-2 INFECTION TRIGGERED 1438 00:53:06,506 --> 00:53:09,475 BY RISK FACTORS, AS RISULT OF 1439 00:53:09,475 --> 00:53:11,144 THIS INFECTION OR SAY DIABETES, 1440 00:53:11,144 --> 00:53:14,614 WE'RE TREATING IT IN THE SAME 1441 00:53:14,614 --> 00:53:16,115 WAY, WE WILL RESPOND IN THE SAME 1442 00:53:16,115 --> 00:53:17,183 WAY, I HAVE NOT SEEN THOSE 1443 00:53:17,183 --> 00:53:18,718 STUDIES AND I THINK A LOT MORE 1444 00:53:18,718 --> 00:53:21,220 NEEDS TO BE DONE THERE. 1445 00:53:21,220 --> 00:53:22,822 NOW IM PERICALLY WHEN WE SEE 1446 00:53:22,822 --> 00:53:24,891 THE DATA WE SEE PEOPLE 1447 00:53:24,891 --> 00:53:25,959 DEVELOPING DIABETES AND VERY FEW 1448 00:53:25,959 --> 00:53:30,797 IN A VERY SMALL PORTION OF THEM 1449 00:53:30,797 --> 00:53:32,865 ACTUALLY, THE A1C GETS BETTER ON 1450 00:53:32,865 --> 00:53:34,567 ITS OWN AND IT'S ALMOST LIKE THE 1451 00:53:34,567 --> 00:53:37,804 DIABETES GETS RESOLVED BUT THE 1452 00:53:37,804 --> 00:53:39,505 MAIORITY STAYS DIABETIC, STAYS 1453 00:53:39,505 --> 00:53:43,576 IN A STATE WHERE IT'S A1C IS 1454 00:53:43,576 --> 00:53:44,610 HIGH INITIATION OF HYPOGLEEL 1455 00:53:44,610 --> 00:53:45,478 CELLS SEEMIC THERAPY BUT A 1456 00:53:45,478 --> 00:53:48,748 LOTTER MODEL CITIZEN NEEDS TO BE 1457 00:53:48,748 --> 00:53:50,950 KNOWN TO CHARACTERIZE WHY SAY 1458 00:53:50,950 --> 00:53:53,252 SARS-COV-2 LEADS TO THINGS LIKE 1459 00:53:53,252 --> 00:53:55,555 DIABETES, WHY WOULD PRESUMABLY 1460 00:53:55,555 --> 00:53:58,491 RESPIRATORY VIRUS WITH R IN ITS 1461 00:53:58,491 --> 00:54:00,593 NAME AS A RES PERATTORY VIRUS 1462 00:54:00,593 --> 00:54:02,195 LEAD TO A CONDITION LIKE 1463 00:54:02,195 --> 00:54:06,399 DIABETES AND DEFINITE ORGAN 1464 00:54:06,399 --> 00:54:07,767 SYSTEM, AFTER SARS-COV-2 IS THE 1465 00:54:07,767 --> 00:54:09,068 SAME AFTER BEING OBESE FOR 20 1466 00:54:09,068 --> 00:54:12,205 YEARS OR SOMETHING LIKE THAT AND 1467 00:54:12,205 --> 00:54:15,975 WILL IT ALSO RESPOND IN THE SAME 1468 00:54:15,975 --> 00:54:16,642 WAY? 1469 00:54:16,642 --> 00:54:19,479 WELL DOWN STREAM COMPLICATIONS 1470 00:54:19,479 --> 00:54:22,715 FROM DIABETES INDUCE BY 1471 00:54:22,715 --> 00:54:25,718 SARS-COV-2 BE SIMILAR OR 1472 00:54:25,718 --> 00:54:25,985 DIFFERENT? 1473 00:54:25,985 --> 00:54:28,621 I THINK THOSE ARE ALL GOOD 1474 00:54:28,621 --> 00:54:30,189 EPIDEMIOLOGIC QUESTIONS I HAVE 1475 00:54:30,189 --> 00:54:32,592 NOT SEEN SOLVED IN DATA. 1476 00:54:32,592 --> 00:54:34,127 >> SO SINCE YOU BROUGHT UP 1477 00:54:34,127 --> 00:54:35,395 TREATMENT, WHAT ARE THERAPEUTIC 1478 00:54:35,395 --> 00:54:36,496 APPROACHES TO E SOLVE THE 1479 00:54:36,496 --> 00:54:37,563 SYMPTOMS FROM LONG COVID AND DO 1480 00:54:37,563 --> 00:54:39,799 WE HAVE PLANS TO ADJUST THE 1481 00:54:39,799 --> 00:54:43,970 STRATEGY ACCORDING TO PERSONS 1482 00:54:43,970 --> 00:54:44,637 [INDISCERNIBLE], PREEXISTING 1483 00:54:44,637 --> 00:54:47,573 CONDITIONS OR HEALTH HISTORY? 1484 00:54:47,573 --> 00:54:50,276 >> YOU USE THE WORD RESOLVE. 1485 00:54:50,276 --> 00:54:53,980 SO CURRENTLY IN THE CLINICS, YOU 1486 00:54:53,980 --> 00:54:56,849 KNOW, IN THE MANAGING NONCOVID 1487 00:54:56,849 --> 00:54:59,652 IS REALLY SYMPTOMATIC, YOU KNOW, 1488 00:54:59,652 --> 00:55:02,155 I DIDN'T WANT TO SPEND TOO MUCH 1489 00:55:02,155 --> 00:55:03,723 TIME ON THIS IN THIS TALK, 1490 00:55:03,723 --> 00:55:04,390 THERE'S 0 APPROVED. 1491 00:55:04,390 --> 00:55:05,825 YOU HAVE PEOPLE ON THE CALL AND 1492 00:55:05,825 --> 00:55:07,827 THEY KNOW THERE ARE 0 APPROVED 1493 00:55:07,827 --> 00:55:09,328 MEDICATIONS FOR THE TREATMENT OF 1494 00:55:09,328 --> 00:55:11,164 LONG COVID, THERE'S NO CURE NEAR 1495 00:55:11,164 --> 00:55:12,331 LONG COVID. 1496 00:55:12,331 --> 00:55:13,699 TREATMENT IS LARGELY SIM TOMATIC 1497 00:55:13,699 --> 00:55:15,735 AND IT IS INDIVIDUALIZED BECAUSE 1498 00:55:15,735 --> 00:55:17,470 I ONCE TOLD, YOU KNOW IF YOU 1499 00:55:17,470 --> 00:55:19,338 HAVE SEEN 1 LONG COVID PATIENT, 1500 00:55:19,338 --> 00:55:21,574 YOU'VE SEEN 1 LONG COVID 1501 00:55:21,574 --> 00:55:22,508 PATIENT. 1502 00:55:22,508 --> 00:55:24,243 YES, DO SYMPTOMS INCLUDE BRAIN 1503 00:55:24,243 --> 00:55:27,513 FOG, FATIGUE AND POST EXERTION 1504 00:55:27,513 --> 00:55:29,715 AND MALAISE, YES, BUT PEOPLE 1505 00:55:29,715 --> 00:55:31,417 TEND TO VARY AND TREATMENT 1506 00:55:31,417 --> 00:55:34,821 PROTOCOL WILL HAVE TO 1507 00:55:34,821 --> 00:55:40,726 NECESSARILY BE INDIVIDUALIZED TO 1508 00:55:40,726 --> 00:55:42,628 A SPECIFIC PATIENT, FOR EXAMPLE, 1509 00:55:42,628 --> 00:55:45,932 SOMEBODY SHOWS UP TO THE CLINIC 1510 00:55:45,932 --> 00:55:46,399 WITH TACHYCARDIA ABOUT 1511 00:55:46,399 --> 00:55:48,067 RESPONDING TO BETA BLOCKERS BUT 1512 00:55:48,067 --> 00:55:50,369 THAT'S ONLY REDUCING THE HEART 1513 00:55:50,369 --> 00:55:51,704 RATE, BETA BLOCKERS ARE NOT 1514 00:55:51,704 --> 00:55:52,972 TREATING THE REASON WHY THIS 1515 00:55:52,972 --> 00:55:54,874 PERSON ALL OF A SUDDEN HAS 1516 00:55:54,874 --> 00:55:56,576 TACHYCARDIA AS A COMPONENT OF 1517 00:55:56,576 --> 00:55:58,911 THEIR LONG COVID AND NOT 1518 00:55:58,911 --> 00:55:59,979 TREATING THE UNDERLYING 1519 00:55:59,979 --> 00:56:01,314 PATHOGENESIS OF THAT TACHYCARDIA 1520 00:56:01,314 --> 00:56:03,483 IS REALLY JUST SYMPTOMATICALLY 1521 00:56:03,483 --> 00:56:05,084 USING BETA BLOCKERS TO LOWER THE 1522 00:56:05,084 --> 00:56:06,919 HEART RATE WHERE IT'S MORE 1523 00:56:06,919 --> 00:56:08,087 MANAGEABLE SO IT'S LESS 1524 00:56:08,087 --> 00:56:10,723 BURDENSOME ON THE PATIENT. 1525 00:56:10,723 --> 00:56:11,757 SO IT'S SYMPTOMATIC MANAGEMENT 1526 00:56:11,757 --> 00:56:13,659 ON THE PART OF PATIENTS BUT YOU 1527 00:56:13,659 --> 00:56:15,194 KNOW WE'VE SEEN REALLY WONDERFUL 1528 00:56:15,194 --> 00:56:16,996 SUCCESSES, I ALWAYS LIKE TO 1529 00:56:16,996 --> 00:56:19,298 ALSO, SEE THE GLASS HALF FULL, 1530 00:56:19,298 --> 00:56:21,467 YOU KNOW. 1531 00:56:21,467 --> 00:56:23,336 A LOT OF THESE ACTUALLY WORK AND 1532 00:56:23,336 --> 00:56:25,738 PATIENTS DO FEEL BETTER. 1533 00:56:25,738 --> 00:56:29,275 AGAIN, WE DON'T CURE THE DISEASE 1534 00:56:29,275 --> 00:56:30,977 BUT DEFINITELY, THERE ARE 1535 00:56:30,977 --> 00:56:31,978 SIGNIFICANT ARRAY OF TREATMENT 1536 00:56:31,978 --> 00:56:33,846 OPTIONS OR OF MANAGEMENT 1537 00:56:33,846 --> 00:56:36,048 OPTIONS, I SHOULD SAY TO MANAGE 1538 00:56:36,048 --> 00:56:37,583 THE DIFFERENT SEQUELA OR 1539 00:56:37,583 --> 00:56:40,052 DIFFERENT COMPONENTS OF LONG 1540 00:56:40,052 --> 00:56:41,654 COVID. 1541 00:56:41,654 --> 00:56:43,689 >> AND SO, SINCE THE SYMPTOMARY 1542 00:56:43,689 --> 00:56:46,926 DISEASE IS IN MOST ADULTS, THE 1543 00:56:46,926 --> 00:56:48,494 SYMPTOMATIC DEC IS DIFFERENT 1544 00:56:48,494 --> 00:56:50,596 BETWEEN CHILDREN VERSUS ARK 1545 00:56:50,596 --> 00:56:51,531 DULLS FOLLOWING SARS-COV-2 1546 00:56:51,531 --> 00:56:51,797 INFECTION. 1547 00:56:51,797 --> 00:56:58,304 SO DO WE KNOW, DO THE RATES OF 1548 00:56:58,304 --> 00:57:01,140 SEVERITY DIFFER FROM CHILDREN TO 1549 00:57:01,140 --> 00:57:01,374 ADULTS? 1550 00:57:01,374 --> 00:57:03,910 >> THE RATES, SO LONG COVID IS 1551 00:57:03,910 --> 00:57:07,513 ALSO IS IN KIDS AND KIDS WITH 1552 00:57:07,513 --> 00:57:09,148 LONG COVID, I SHOWED THE ART 1553 00:57:09,148 --> 00:57:12,552 WORK OF ROSIE WHO IS AN IRISH 1554 00:57:12,552 --> 00:57:14,487 KID WHO'S BEEN BALGING LONG 1555 00:57:14,487 --> 00:57:16,489 COVID FOR 3 YEARS BUT 1556 00:57:16,489 --> 00:57:17,190 FORTUNATELY THE PREVALENCE OF 1557 00:57:17,190 --> 00:57:19,492 LONG COVID IN ACE CASES MUCH 1558 00:57:19,492 --> 00:57:21,594 LOWER THAN THE CASES OF LONG 1559 00:57:21,594 --> 00:57:26,165 COVID IN ADULTS AND THERE MAY E 1560 00:57:26,165 --> 00:57:27,366 ALSO DIFFERENCES IN THE 1561 00:57:27,366 --> 00:57:28,334 PHENOTYPES OF LONG COVID, IT'S 1562 00:57:28,334 --> 00:57:30,536 NOT THE SAME THING, YOU KNOW THE 1563 00:57:30,536 --> 00:57:31,604 GENERAL FEATURES ARE THE SAME. 1564 00:57:31,604 --> 00:57:35,575 YOU KNOW SORT OF THE -- SOME 1565 00:57:35,575 --> 00:57:36,943 PECULIARITY THAT MAKES IT 1566 00:57:36,943 --> 00:57:37,877 SLIGHTLY DIFFERENT THAN LONG 1567 00:57:37,877 --> 00:57:44,283 COVID AND IN ARK DULLS AND THERE 1568 00:57:44,283 --> 00:57:47,253 ARE GENERALADDAGE OR WISDOM AND 1569 00:57:47,253 --> 00:57:48,654 IT'S WISE IN SAYING THAT KIDS 1570 00:57:48,654 --> 00:57:50,389 ARE NOT JUST SMALL ADULTS THEY 1571 00:57:50,389 --> 00:57:53,125 HAVE THEIR OWN PHYSIOLOGY AND 1572 00:57:53,125 --> 00:57:54,660 THE VIRUS ACTS DIFFERENTLY AND 1573 00:57:54,660 --> 00:57:56,062 THATIA ALSO CLEARLY SEEN IN LONG 1574 00:57:56,062 --> 00:57:57,496 COVID, BUT HAVING SAID THAT FOR 1575 00:57:57,496 --> 00:57:59,365 THE BROADER, BROADER SORT OF, 1576 00:57:59,365 --> 00:58:01,100 YOU KNOW IDEA THAT YOU KNOW THEY 1577 00:58:01,100 --> 00:58:03,502 GET AN ACUTE VIRUS AND THEY'RE 1578 00:58:03,502 --> 00:58:05,905 LEFT WITH LONG-TERM ILLNESS AND 1579 00:58:05,905 --> 00:58:07,373 REALLY CLEARLY PART OF THIS 1580 00:58:07,373 --> 00:58:10,209 FUNCTION LIKE BRAIN FOG AND 1581 00:58:10,209 --> 00:58:11,711 FATIGUE, RECAPITULATE MUCH OF 1582 00:58:11,711 --> 00:58:13,079 THE SYMPTOMATOLOGY WE ALSO SEE 1583 00:58:13,079 --> 00:58:17,049 IN ACULTINGS. 1584 00:58:17,049 --> 00:58:19,051 EMPLOY IN, AND YOU THERE ARE NO 1585 00:58:19,051 --> 00:58:20,186 VACCINES PREVENTING LONG COVID, 1586 00:58:20,186 --> 00:58:23,522 RIGHT IN AND DO WE HAVE DATA 1587 00:58:23,522 --> 00:58:25,124 SEGREGATED BY THE VACCINE 1588 00:58:25,124 --> 00:58:26,859 PLATFORM SO THAT DIFFERENT 1589 00:58:26,859 --> 00:58:29,395 VACCINE PLATFORM LIKE MRNA, LIKE 1590 00:58:29,395 --> 00:58:31,831 PROTEIN BASED HAVE DIFFERENT 1591 00:58:31,831 --> 00:58:32,865 IMPACT WHEN PREVENTING LONG 1592 00:58:32,865 --> 00:58:33,232 COVID. 1593 00:58:33,232 --> 00:58:35,067 >> WE DON'T HAVE A FACE-TO-FACE 1594 00:58:35,067 --> 00:58:37,503 OR HEAD-TO-HEAD TRIAL OR 1595 00:58:37,503 --> 00:58:38,904 HEAD-TO-HEAD STUDY, HEAD-TO-HEAD 1596 00:58:38,904 --> 00:58:39,839 EVALUATION WHICH WILL BE THE 1597 00:58:39,839 --> 00:58:42,174 BEST AND GOLD STANDARD IN 1598 00:58:42,174 --> 00:58:43,976 HELPING US EXACTLY ADDRESS THIS 1599 00:58:43,976 --> 00:58:45,177 WOBDERFUL QUESTION IS A VERY 1600 00:58:45,177 --> 00:58:46,946 IMPORTANT QUESTION, SO WE DON'T 1601 00:58:46,946 --> 00:58:47,680 HAVE HEAD-TO-HEAD EVALUATION, 1602 00:58:47,680 --> 00:58:49,548 THAT NEEDS TO BE DONE, WE HAVE 1603 00:58:49,548 --> 00:58:50,850 CLEARLY BEEN SHOWING YOU THAT 1604 00:58:50,850 --> 00:58:52,151 THE MAJORITY OF PEOPLE IN THE 1605 00:58:52,151 --> 00:58:53,953 U.S. ARE GETTING MR, INA BASED 1606 00:58:53,953 --> 00:58:55,788 ACSEENS AND THAT REDUCES THE 1607 00:58:55,788 --> 00:58:57,323 RISK OF LONG COVID. 1608 00:58:57,323 --> 00:58:58,824 JUST RECEIPTLY REVIEWED AND 1609 00:58:58,824 --> 00:59:00,359 RECENTLY PUBLISHED A BIG CHINESE 1610 00:59:00,359 --> 00:59:04,363 STUDY IN 1 OF THE LANCET 1611 00:59:04,363 --> 00:59:05,498 JOURNALS SHOWING THAT VACCINES 1612 00:59:05,498 --> 00:59:08,634 THERE WHICH ARE NOT MRNA BASED 1613 00:59:08,634 --> 00:59:09,869 ACSEENS ALSO REDUCE THE RISK OF 1614 00:59:09,869 --> 00:59:13,806 LONG COVID. 1615 00:59:13,806 --> 00:59:15,241 SO I THINK BUT AGAIN TO THE 1616 00:59:15,241 --> 00:59:17,710 POINT THE PERSON ASKING THE 1617 00:59:17,710 --> 00:59:19,111 QUESTION VERY, VERY ON POINT, I 1618 00:59:19,111 --> 00:59:20,980 WOULD LIKE TO SEE HEAD-TO-HEAD 1619 00:59:20,980 --> 00:59:22,281 COMPARISONS SO WE CAN EVALUATE 1620 00:59:22,281 --> 00:59:26,752 IN THE SAME SORT OF ANALYTIC 1621 00:59:26,752 --> 00:59:29,055 PLATFORM AND APPROACH, HOW DO 1622 00:59:29,055 --> 00:59:30,222 THESE VACCINES FAIR HEAD-TO-HEAD 1623 00:59:30,222 --> 00:59:38,898 BUT THAT'S NOT AVAILABLE. 1624 00:59:38,898 --> 00:59:40,866 BUT AGAIN IN U.S. AND CHINA, WE 1625 00:59:40,866 --> 00:59:42,635 SEE THAT THE VACCINES REDUCE THE 1626 00:59:42,635 --> 00:59:43,669 RISK OF LONG COVID. 1627 00:59:43,669 --> 00:59:45,204 IT'S NOT A HUGE REDUCTION IN 1628 00:59:45,204 --> 00:59:47,306 RISK BUT CERTAINLY REDUCE THE 1629 00:59:47,306 --> 00:59:48,808 RISK OF LONG OF COURSE. 1630 00:59:48,808 --> 00:59:50,443 I THINK THE KEY QUESTION GOING 1631 00:59:50,443 --> 00:59:52,078 FORWARD IS WHETHER REPEATED 1632 00:59:52,078 --> 00:59:52,678 VACCINATION SYSTEM NEEDED TO 1633 00:59:52,678 --> 00:59:55,214 REDUCE THE RISK OF LONG ON 1634 00:59:55,214 --> 00:59:55,414 COVID. 1635 00:59:55,414 --> 00:59:58,718 FOR EXAMPLE, WHETHER SOMEBODY IN 1636 00:59:58,718 --> 01:00:02,021 2026 OR 2024 OR 2028 WILL NEED 1637 01:00:02,021 --> 01:00:03,489 THEIR SEVENTH, EIGHTH, NINTH, 1638 01:00:03,489 --> 01:00:06,392 TENTH, BOOSTER OR VACCINE DOSE 1639 01:00:06,392 --> 01:00:07,660 IN 2027, 2028 TO REDUCE THE RISK 1640 01:00:07,660 --> 01:00:09,228 OF LONG COVID AND THAT WE DON'T 1641 01:00:09,228 --> 01:00:10,396 REALLY KNOW, WE TAKE IT FOR 1642 01:00:10,396 --> 01:00:12,565 GRANTED OR I THINK THAT'S REALLY 1643 01:00:12,565 --> 01:00:14,200 HAD NOT BEEN VALENTINED 1644 01:00:14,200 --> 01:00:15,368 DIADICKED IM PERICALLY THAT WE 1645 01:00:15,368 --> 01:00:16,535 NEED THE COVID VACCINE EVERY 1646 01:00:16,535 --> 01:00:17,870 YEAR BUT DO WE? 1647 01:00:17,870 --> 01:00:18,571 I THINK THAT'S ALSO ANOTHER 1648 01:00:18,571 --> 01:00:20,206 QUESTION THAT NEEDS TO BE 1649 01:00:20,206 --> 01:00:22,708 EVALUATED IN THE DATA? 1650 01:00:22,708 --> 01:00:23,909 IF I DEFINITELY THAT THE FDA 1651 01:00:23,909 --> 01:00:25,644 NEED TO THINK ABOUT THIS. 1652 01:00:25,644 --> 01:00:27,246 AGAIN I'M VERY PROVACCINE BUT I 1653 01:00:27,246 --> 01:00:30,583 ALSO WANT US TO ORIENT OUR 1654 01:00:30,583 --> 01:00:33,219 POLICY OR GUIDING OUR POLICY 1655 01:00:33,219 --> 01:00:35,054 WITH ACTUAL DATA AND IM PERRIC 1656 01:00:35,054 --> 01:00:36,822 EVALUATION OF EVIDENCE SO WE CAN 1657 01:00:36,822 --> 01:00:38,124 HAVE POLICY THAT'S ACTUAL TRULY, 1658 01:00:38,124 --> 01:00:44,096 TRULY INFORMED AND GUIDED BY 1659 01:00:44,096 --> 01:00:44,397 EVIDENCE. 1660 01:00:44,397 --> 01:00:46,165 UNFORTUNATELY, WE HAVE REACHED 1661 01:00:46,165 --> 01:00:48,167 THE END OF THE HOUR AND WE HAVE 1662 01:00:48,167 --> 01:00:48,868 SEVERAL QUESTIONS LEFT. 1663 01:00:48,868 --> 01:00:50,269 WE WILL CORDINATE WITH YOU 1664 01:00:50,269 --> 01:00:50,469 LATER. 1665 01:00:50,469 --> 01:00:52,772 I DO THANK YOU AND THANK YOU IF 1666 01:00:52,772 --> 01:00:56,075 ARE SHARING OUR FINDINGS, OTHER 1667 01:00:56,075 --> 01:00:56,909 FINDINGS REGARDING LONG COVID 1668 01:00:56,909 --> 01:00:58,210 HAD WHICH IS VERY IMPORTANT FOR 1669 01:00:58,210 --> 01:00:58,511 US. 1670 01:00:58,511 --> 01:00:59,345 THANK YOU SO MUCH. 1671 01:00:59,345 --> 01:01:00,446 >> THANK YOU EMPLOY THANK YOU 1672 01:01:00,446 --> 01:01:10,723 VERY HAVING ME.