GOOD AFTERNOON EVERYONE AND
WELCOME TO THE COVID-19
SCIENTIFIC INTEREST GROUP
SEMINAR SERIES.
WE ARE HAVING OUR SECOND SEMINAR
OF THE NEW 2024-25 SEASON TODAY.
AND AS YOU MAY HAVE NOTICED FROM
LAST SEMINAR AND TODAY'S SEMINAR
AND MANY OF OUR FUTURE SEMINARS,
WILL BE FOCUSED ON LONG COVID
WHICH IS LIKELY TO BECOME A REAL
PROBLEM FOR US IN THE HEALTHCARE
SYSTEM, NOT JUST IN THE U.S. BUT
ALSO GLOBALLY.
SO WE ARE REALLY FORTUNATE TODAY
TO HAVE 1 OF THE LEADING
SCIENTISTS-PHYSICIANS AND
EPIDEMIOLOGIST WHO HAS BEEN
STUDYING LONG COVID D
R. ZIYAD AL-ALY, DR. AL-ALY IS
THE CHIEF OF THE CLINICAL
EPIDEMIOLOGY CENTER AND SERVES
AS DIRECTOR FOR THE ST. LOUIS
HEALTHCARE SYSTEM AT THE VA.
HE IS A SENIOR CLINICAL
EPIDEMIOLOGIST AT WASH-U IN
ST. LOUIS.
DR. AL-ALY IS KNOWN FOR LEADING
THE SYSTEMATIC CHARACTERIZATION
OF LONG COVID AND SUBSEQUENT
OBSERVED INCREASED RISKS OF
CARDIOVASCULAR DISEASE,
NEUROLOGICAL DISEASE, DIABETES,
KIDNEY DISEASE, GI DISORDERS IN
PATIENTS FOLLOWING SARS-COV-2
INFECTION, HIS LABORATORY WAS
ALSO THE FIRST TO PRODUCE
EVIDENT CHARACTERIZING THE
EFFECTS OF VACCINES ON LONG
COVID.
THE HEALTH CONSEQUENCES OF
REPEATED INFECTIONS WITH
SARKINGS
SARKINGS KICKOFF 2 AND THE EABT
VIRALS ON THE SHORTEN LONG-TERM
OUTCOME OF SARS-COV-2 INFECTION.
DR. AL-ALY CHAIRED THE BIDEN
HARRIS COMMITTEE THAT DEVELOPED
THE NATIONAL RESEARCH ACTION
PLAN FOR LONG COVID.
HE SERVES ON THE INTERGOVERNMENT
AGENCY LONG COVID COORDINATION
COUNCIL, A MEMBER OF THE WHITE
HOSCANCER MOONSHOT TASK FORCE
FOR DATA AND INNOVATION.
HE'S PUBLISHED MANY, MANY PAPERS
AND VERY PRESTIGIOUS MEDICAL
JOURNALS AND SCIENTIFIC JOURNALS
AND NATURE, SCIENCE, MEDICINE
AND NEW ENGLAND JOURNAL OF
MEDICINE AND OTHERS.
HIS WORK HAS BEEN CITED OVER A
HUNDRED THOUSAND TIMES.
HIS WORK IS FREQUENTLY FEATURED
IN MAJOR NATIONAL AND
INTERNATIONAL MEDIA OUTLETS
INCLUDING THE NEW YORK
SOMETIMES, WALL STREET JOURNAL,
WASHINGTON POST, NBNR, CCAND
OTHERS, WE ARE REALLY GRATEFUL
FOR HIM TO TAKE TIME OUT OF HIS
BUSY SCHEDULE TO GIVE US THIS
PRESENTATION TODAY ON LONG COVID
SIGNS, RESEARCH AND POLICY.
BEFORE I LET HIM START, I JUST
WANT TO REMIND OUR VIEWERS WHO
ARE WATCHING ON THE NIH
VIDEOCAST THAT THERE IS A SEND
LIVE FEEDBACK BUTTON, YOU WILL
SEE IF YOU WANT TO ASK ANY
QUESTIONS DURING THE TALK,
PLEASE FEEL FREE TO SUBMIT ANY
QUESTIONS.
ALL QUESTIONS AT THE END OF THIS
TALK WILL BE READ TO DR. AL-ALY
SO HE CAN HAVE AN OPPORTUNITY TO
ANSWER THEM.
SO WITHOUT FURTHER ADO, WELCOME
DR. AL-ALY AND WE LOOK FORWARD
TO YOUR TALK.
>> WELL, THANK YOU FOR HAVING ME
TODAY AND GIVING ME THE
OPPORTUNITY TO TALK ABOUT LONG
COVID AND OUR VIEW AND VANTAGE
POINT OF THE SCIENCE OF LONG
COVID AND OUR THINKING ABOUT THE
WAY FORWARD IN TERMS OF RESEARCH
AND POLICY DIRECTIONS TO ADDRESS
OR TACKLE THE CRISIS OF THE LONG
COVID.
SO IN TERMS OF DISCLOSURES, I AM
EMPLOYED BY THE VA AND OPINIONS
ARE PRESENTED HERE OR TALKING
ABOUT HERE DO NOT REPRESENT THE
VIEWS OF THE VA AND U.S.
GOVERNMENT AND REALLY GRATEFUL
OF THE SUPPORT OF THE U.S.
DEPARTMENT OF VETERAN AFFAIRS IN
FUNDING OUR WORK OVER THE PAST
SEVERAL YEARS, OUR LONG COVID
WORK AND OTHER WORK BUT REALLY
THE LONG COVID WORK.
SO WHEN WE SAY LONG COVID, WHAT
DO WE REALLY MEAN BY LONG COVID
AND TALK A BIT ABOUT SEQUELA OF
CONCERN, HOW LONG IS LONG COVID,
DISCUSS WHETHER THE RISK OF LONG
COVID HAS ACTUALLY CHANGED OVER
THE COURSE OF THE PAN
DELATWALLIC, TALK A BIT ABOUT
PREVENTION AND MECHANISMS OF
LONG COVID, IMPACTS OF LONG
COVID AND THE ROAD AHEAD IN
TERMS OF POLICY AND RESEARCH
PRIORITIES.
SO WE DID A DOCUMENTARY ON AN
IRISH KID WHO'S BEEN BATTLING
LONG COVID FOR SEVERAL YEARS,
THAT'S HER ART HERE, AND WE
WANTED TO HONOR HER
CONTRIBUTIONS BY PUTTING HER ART
HERE, IT'S REALLY REMARKABLE,
ALL OF THESE ARE THINGS THAT
WERE SET TO HER AS A PATIENT
WITH LONG COVID, BE MORE
POSITIVE, YOU LOOK HEALTHY, SO
CALLED LONG COVID.
GIVE IT TIME AND IT WILL GO
AWAY.
ALL THESE THINGS WERE SET TO HER
AS A KID WHO'S BALGTING LONG
COVID.
SO ANYWAY, BACK TO THE KEY POINT
HERE.
SO WHAT IS LONG COVID, SO WE ASK
THIS QUESTION REALLY VERY EARLY
ON IN THE PANDEMIC WHEN WE
STARTED RECEIVING REPORTS FROM
PATIENTS THAT THE TIME --
TELLING US THEY WERE NOT FULLY
AREY COVERING FROM SARS-COV-2.
THAT EVERYBODY AT THE TIME OR
WISDOM AT THE TIME WOULD HAVE IT
THAT IF YOU GET SARS-COV-2
INFECTION, ESPECIALLY IF YOU
WERE YOUNG AND HEALTHY AND DID
NOT HAVE MEDICAL PROBLEMS, YOU
WILL BOUNCE BACK AND GET RID OF
IT WITHIN A FEW DAYS AND THEN,
YOU KNOW YOU WILL TOTALLY GO
BACK TO YOUR BASE LINE HEALTH
STATUS, BUT PATIENTS WERE
TELLING US AT THE TIME AND WE
LISTENED TO THEM THAT THEY WERE
NOT FULLY RECOVERING, AND THEN
THEY STARTED CATALOGING ALL THE
SYMPTOMATOLOGY THEY WERE
EXPERIENCING INCLUDING MALAISE,
FATIGUE AND BRAIN FOG AND ALL
THESE DEFINITE THINGS AND TO
THEIR CREDIT THEY COINED THE
TERM LONG COVID AND THEY THEY
REFERRED TO THEMSELVES AS LONG
COVIDERS.
SO WHAT ARE THESE PEOPLE TALKING
ABOUT?
THEY'RE TELLING US THESE THINGS,
AND WE NEED TO UNDERSTAND WHAT
EXACTLY THEY'RE TALKING ABOUT.
SO WE DID WHAT WE TERMED AT THE
TIME OR WE SORT OF USE THE
DISCOVERY BASE APPROACH TO
UNDERSTAND SO THAT THE LONG-TERM
HEALTH CONSEQUENCES OF
SARS-COV-2 INFECTION AND REALLY
IN AN UNBIASED WAY, WE DIDN'T
WANT TO BIAS OURSELVES LOOKING
AT CARDIOVASCULAR EFFECTS OR
METABOLIC EFFECTS OR OTHER
THINGS, WE WANTED TO KEEP AN
OPEN EYE AND OPEN MIND AND DO
WHATEVER WE CALL AT THE TIME AN
UNBI ASSED APPROACH TO
CHARACTERIZE THE LONG-TERM
HEALTH EFFECTS OF SARKICKOFF 2
INFECTION, AND WE,A SEMBLED THE
COHORT AT THE TIME ABOUT 70,000
PEOPLE WHO HAD SARS-COV-2
INFECTION AND COMPARED NONE TO
MILL NEARLY 5 MILLION CONTROLS
WHO AT THE TIME DID NOT HAVE
CARS KICKOFF 2 INFECTION, THIS
IS ALL EARLY 2020 AND EARLY
PHASE OF THE PANDEMIC AND AGAIN
RESPONDING TO THE PATIENT
COMMUNITY AND TRYING TO
UNDERSTAND WHAT ARE THEY WILLING
US.
THEY TELL US THEY HAVE ALL THESE
PROBLEMS, HEALTH PROBLEMS AND
YOU KNOW AT THE TIME PUBLISHED
REALLY A WONDERFUL SURVEY, YOU
KNOW CATALOGING THE BREDTH OF
SYMPTOMATOLOGY, OF WHAT THEY'RE
EXPERIENCING SO IT WAS AN
UNCONTROLLED EXPERIMENT, SO WE
WANT TO DO THE CONTROL
EXPERIMENT TO TRY TO UNDERSTAND
HERE AND WHEN YOU HAVE A CONTROL
GROUP, AND THEN MEASURE CENTER
FOR EXCELLENCE ON AGINGS AFTER
SARKINGS KICKOFF 2 INFEC, YOU
CAN CATALOG THE BREDTH OF
PROBLEMS THESE PEOPLE ARE
EXPERIENCING AND THEN TO THEIR
CREDIT, THEY WERE RIGHT, THEY
WERE RIGHT ALL LONG, THEY WERE
RIGHT FROM THE BEGINNING, SARS
ON KICKOFF 2 INFECTION CAN LEAD
TO HEALTH PROBLEMS AND MANY
ORGAN SYSTEMS INCLUDING THE
NERVOUS SYSTEM, METABOLIC
SYSTEM, GI SYSTEM, KIDNEYS,
RESPIRATORY SYSTEM,
CARDIOVASCULAR SYSTEM, SO THEY
WERE RIGHT WHEN THEY WERE
TELLING US THEY HAVE ALL THESE
PROBLEMS AND MULTIPLE ORGAN
SYSTEMS, IT CERTAINLY CLEARLY
PANNED OUT IN THE DAT AND VERY
NICELY AND WELL CONTROLLED
EXPERIMENT DATING BACK TO 2020,
VERY CLEARLY PANS OUT.
SO THAT'S SORT OF, AND A LOT OF
OTHER WORK SORT OF LED US TO --
AND NOW I'M REALLY DELIGHTED
THIS APPROACH HAS BEEN ENCORED
BY THE NATIONAL ACADEMY OF
SCIENCES AND ENGINEERING AND
MEDICINE, 1 REPORT CATALOGING
HEALTH EFFECTS OF COVID-19 AND
THIS REPORT FOCUSING ON LONG
COVID AND IT ENCOMPASSES ALL THE
LONG-TERM HEALTH EFFECTS OF
SARS-COV-2 INFEC, IT'S NOT ONLY
MALARIA, BRAIN FOG, FATIGUE,
IT'S ALL THE EFFECTS THAT ARE
CAUSED BY SARS-COV-2 INFECTION
AND I THINK THAT'S REALLY
IMPORTANT AND WE FEEL WE GOT IT
RIGHT, WE FEEL THEY GOT IT RIGHT
AND NASEM GOT IT RIGHT IN DOING
AN ALL-INCLUSIVE APPROACH TO
DEFINING LONG COVID AND
CATALOGING THE BREDTH OF HEALTH
EFFECTS THAT ARE CAUSED BY
COVID-19.
AND THEN, SO, ASK NOW, OKAY,
WELL, LIKE THIS IS THE CONCEPT
OF LONG COVID AND HOW MUCH OF IT
IS OUT THERE AND WE FEEL THAT
THE END OF 2023 IN THE WORLD
GLOBALLY, THERE WERE ABOUT
CUMULATIVELY ABOUT 400 MILLION
PEOPLE WHO HAVE BEEN AFFECTED IN
SOME WAY BY LONG COVID.
CAN THAT'S REALLY IMPORTANT
BECAUSE IT'S SORT OF REALLY NOT
A SMALL NUMBER, JUST A HUGE
NUMBER OF INDIVIDUALS.
AND THESE NUMBERS ARE TAKEN INTO
ACCOUNT THE CHANGES OF COVID-19.
YOU KNOW FROM THE ANCESTRAL
STRAIN TO DELTA TO OMICRON, THE
CHANGING OF COVID AND CHANGES IN
COVID-19 AND THE EFFECTIVE
VACCINATION, SO ALL OF THOSE
WERE INKORCHERATED AT THE
MODELING APPROACH THAT THEN LED
US TO ESTIMATE THAT AT THE END
OF 2023, THERE ARE ABOUT
400 MILLION PEOPLE IN THE WORLD
WHO HAVE BEEN AFFECTED IN SOME
WAY BY LONG COVID.
AND WE ALSO WANTED TO SORT OF
GIVE AN ECONOMIC DIMENSION
BECAUSE IT'S REALLY ALSO
IMPORTANT WHEN YOU TALK TO
STAKEHOLDERS AND WHEN WE TALK TO
GOVERNMENTS AND OTHER -- OTHER
PEOPLE WHO ARE INTERESTED IN
UNDERSTANDING THE IMPACT OF LONG
COVID, SO WE ESTIMATE THAT BASED
ON MULTIPLE DIFFERENT METRICS
INCLUDING METRICS FROM OTHER
REPORTS THAT LONG COVID AFFECTS
THE ECONOMY TO THE TUNE OF 1
BILLION DOLLARS A YEAR.
THIS ESTIMATE IS FROM 2024, IT
MAY CHANGE IN THE FUTURE BUT
THAT'S SORT OF OUR BEST ESTIMATE
IN 2024.
THIS SHOULD GIVE YOU A BETTER OF
A PERSPECTIVE OF WHAT A
1 TRILLION-DOLLAR IS, IT'S
EQUIVALENT TO $1 TRILLION OF
GDP, GROSS DOMESTIC PRODUCT.
THAT'S REALLY A SIZABLE CHUNK.
ONE% OF OUR OVERALL GLOBAL
PRODUCTIVITY IS REALLY WIPED
AWAY OR YOU KNOW TAKEN AWAY BY
LONG COVID AND THAT'S REALLY A
SIGNIFICANT DRAG ON GLOBAL
ECONOMIC GROWTH.
WE WANT AS HUMANITY AS HUMAN
CIVILIZATIONS AND AS 8 BILLION
PEOPLE,A ROUND THE WORLD, WE
WANT TO CONTINUE TO PROGRESS AND
DO BETTER AND GROW AND THAT IS A
OPINION% DRAG ON OUR GLOBAL
PRODUCTIVITY AS A RESULT OF LONG
COVID AND THAT'S REALLY SIZABLE,
IT'S NOT A SMALL DRAG ON OUR
PUSH TO MOVE CIVILIZATION
FORWARD.
SO VERY EARLY ON, WE WANTED TO
REALLY CONTEXTUALIZE AND
UNDERSTAND SARS-COV-2 AND WE
THOUGHT AT THE TIME THAT THE
BEST WAY TO CONTEXTUALIZE THAT
IS TO TRY TO UNDERSTAND WHAT
SARS-COV-2 DOES IN TERMS OF
LONG-TERM HEALTH EFFECT VERSUS
SEASONAL INFLUENZA, BECAUSE
WE'VE KNOWN ARGUABLY SEASONAL
INFLUENZA IS A WELL KNOWN VIRUS,
CHARACTERIZED, SHORT-TERM
EFFECTS, WE ALSO KNOW IMONG HERM
EFFECTS SO WE WANTED TO COMPARE
AND CONTRAST IF YOU WILL OR DO A
COMPETITIVE ASSESSMENT OF
COVID-19 VERSUS SEASONAL
INFLUENZA AND OUR RESULT AT THE
TIME SHOWED THAT MAGNITUDE OF
RISK WAS HIGHER THAN SEASONAL
INFLUENZA, THAT CERTAINLY THE
BREDTH OF ORGAN DYSFUNCTION IS
MUCH MORE EXTENSIVE IN COVID-19
VERSUS SEASONAL INFLUENZA AND WE
AT THE TIME INCLUDED THAT IT'S A
DIFFERENT KIND OF POST VIRAL
SYNDROME, SO FOLLOWING THIS
SPRM, WE DID ABOUT AN 18 MONTH
EXPERIMENT IN THE INFECT YOWZ
DISEASES, ABOUT A YEAR OR SO
AGO, YOU KNOW SHOWING MORE OF
THE SAME THINGS THAT THE BURDEN
OF POST ACUTE SEQUELA AND MUCH
HIGHER THAN THE BURDEN OF POST
SEQUELA, AND NOT THAT THE FLU IS
BENIGN, IT'S A MIGHTY VIRUS THAT
ACTUALLY STILL KILLS THOUSANDS
OF AMERICANS YOU KNOW FOUND
EVERY YEAR, AND THE RESULT ALSO
LONG-TERM ILLNESS AND MANY, MANY
INDIVIDUALS BUT COMPARATIVELY
SPEAKING, YOU KNOW COVID-19 IS
ACTUALLY WORSE AND I KNOW WE
DON'T WANT THE RISK TO BE TRUE
BUT THAT'S REALLY THE TRUTH AND
A LOT OF PEOPLE COMPARE COVID-19
TO SEASONAL INFLUENZA AND IT'S
AN IMPORTANT METRIC.
COVID-19 IN 2024 IS STILL THE
BURDEN OF INFECTION DISEASE,
HOSPITALIZATION AND LONG COVID
OR LONG-TERM SEQUELA IS HIGHER
THAN WITH SEASONAL INFLUENZA, I
WISH THAT WASN'T THE TRUE, ABOUT
YOU THAT'S THE DATA AND
EVERYTHING ELSE IS OPINION IN MY
WORLD DOESN'T RADIOLE LOAMACYY
HAVE A LOT OF VALUE.
DATA IS IMPORTANT, OPINION IS
NOT IN MY -- IN THE WAY WE THINK
ABOUT REALITY.
SO WHAT WE ALSO SAW THAT THE
RISK OF POST ACUTE SEQUELA EVEN
IN PEOPLE WHO HAD MILD DISEASE
AND THAT'S VERY IMPORTANT
BECAUSE MOST PEOPLE WHEN THEY
GET COVID-19 ACTUALLY EVEN IN
2020, EVEN WHEN THERE WAS NO
ANTIVIRALS AND NO VACCINATION,
MOST PEOPLE WHEN THEY GET
SARS-COV-2 INFEC, THEY HAVE MILD
SARS-COV-2 INFECTION, DOESN'T
NEED HOSPITALIZATION ISSUE
DOESN'T REALLY RESULT IN SEVERE
DISEASE AND THOSE PEOPLE, YOU
KNOW STILL WERE MANIFESTING WITH
LONG-TERM SEQUELA OR LONG-TERM
COMPLICATIONS ON HEALTH EFFECTS.
THE RISK HOWEVER INCREASES
ACCORDING TO THE SEVERE MITRAL
ERITY OF ACUTE INFEC, SO CLEARLY
THE POST ACUTE PROBLEM IS PEOPLE
IN HIGHER HELPIZED, HIGHER IN
PEOPLE WHO NEED ICU CARE BUT
STILL EVIDENT, VERY, VERY
CLEARLY EVIDENT AMONG
INDIVIDUALS WHO DID NOT NEED ICU
CARE AND DID NOT NEED TO BE
HOSPITALIZED AND HAD MILD
DISEASE OR VERY MILD DISEASE.
AND I'M SHOWING THIS PICTURE
HERE AND I REALLY LIKE TO SHOW
IT, TO SORT OF ILLUSTRATE HOW
COMPLEX LONG COVID IS.
THIS REALLY DOESN'T EVEN ACCOUNT
FOR THE SEQUELA OF LONG COVID,
THIS ACCOUNTS FOR ABOUT 30 OF
THEM ONLY AND IF YOU LOOK AT
THIS HEAT MAP AND SAY, OH MY GOD
THIS IS REALLY ALL OVER THE
PLACE, YOU KNOW THERE IS NO
REALLY CLEAR PATTERN HERE, YOU
CAME TO THE RIGHT CONCLUSION,
CONGRATULATIONS, AND THIS IS
XABLGLY WHAT I WANTED TO SEE --
EXACTLY WHAT I WANTED TO SEE
HERE, THIS LONG COVID ARE NOT
MONOLITHIC.
THESE ARE ALL SEQUELA THAT ARE
-- YOU KNOW THAT ARE DERIVING
THEIR RISK OR BURDEN OF THE
SEQUELA ACCORDING TO AGE, RACE,
SEX, ETHNICITY AND
CO-MORBIDITIES AT BASE LINE AND
EVERY SEQUELA HAS A DIFFERENT
DIRECTION MEANING THAT YOU KNOW
LONG COVID IS NOT 1 THING, LONG
COVID ASK COMPOSED OF MANY, MANY
SEQUELA AND WE TOUTED ABOUT 30
AND SOME OF THEM MORE EXPRESSED
IN YOUNGER ADULLS, SOME OF THEM
ARE MORE ABUNDANTLY EXPRESSED IN
OLDER ADULLS, SOME OF THEM ARE
MORE EXPRESSED IN WOMEN OR
FEMALES AND SOME OF THEM ARE
MORE EXPRESSED IN MEN.
SO IT'S NOT MONOLEATHIC THING,
ALWAYS RESIST THE URGE TO SORT
OF SIMPLIFY LONG COVID AND
COMPLEX CONDITION WITH MULTIPLE
SEQUELA AND MANY ORGAN SYSTEMS
AND 1 SENTENCE SAYING WHAT LONG
COVID IS, MORE FREQUENT IN YOUNG
WOMEN OR MORE FREQUENT IN YOUNG
ADULTS OR MORE FREQUENT IN OLD
ADULTS SO THAT
OVERSIMPLIFICATION DOESN'T DO IT
JUSTICE.
THE TRUTH IS, THE TRUTH IS
SCIENTIFICALLY THAT LONG COVID
IS COMPOSED OF MULTIPLE SEQUELA
IN MANY MULTIPLE ORGAN SYSTEMS
AND THEY DO NOT ALL BEHAVE THE
SAME WAY WITH RELATION TO AGE,
SEX, STATUS, HEALTH, AND IT'S
TRULY, TRULY, THE NON MONOLITHIC
DISEASE.
AND RESIST THE URGE TO SIMPLIFY
BECAUSE THAT'S NOT CLOSER TO THE
TRUTH, AND WHEN YOU SIMPLIFY
THINGS, YOU'RE MOVINGA, WAY FROM
THE TRUTH NOT CLOSER TOO IT.
SO THE SEQUELA THAT CONCERNS ALL
OF US QUITE A BIT ARE THOSE THAT
ARE CHRONIC CONDITIONS THAT ARE
LIKELY TO IMPACT PEOPLE, YOU
KNOW AND IMPACT THEIR LIFE SPAN
AND IMPACT HEALTHCARE
UTILIZATION, ET CETERA, AND
THOSE INCLUDE CARDIOVASCULAR
DISORDERS, KIDNEY DISEASE,
NEUROLOGIC MANIFESTATION ANDS
GASTROINTESTINAL DISORDERS.
I WILL GO THROUGH THIS QUICKLY
BECAUSE I WANT TO DEDICATE THE
LAST PART OF THE TALK TO
DISCUSSING MORE SORT OF THE
FORWARD DIRECTION BUT WE CAN DO
Q&A AND IF YOU HAVE ANY
QUESTIONS ABOUT THESE THINGS BUT
VERY CLEARLY, YOU KNOW THERE IS
INCREASE OF CARDIO VASCULARY
DISEASE AFTER SARS-COV-2
INFECTION AND IN THIS STUDY, WE
EVALUATED THE RISK IN ABOUT A
HUNDRED AND 50,000 PEOPLE AT THE
TIME HAD SARS-COV-2 INFECTION
AND 2 CONTROL GROUPS.
ONE CONTEMPORARY CONTROL GROUP
ABOUT 5 MILLION PEOPLE AT THE
TIME DID NOT HAVE SARS-COV-2
INFECTION AND HISTORICALLY ABOUT
5 MILLION PEOPLE, AND THE
CONTROL GROUP THAT COULD NOT
HAVE HAD SARS-COV-2 BECAUSE
THOSE WERE ENROLL INDEED 2016,
2017, 2018 AND AT THE TIME THERE
WAS LITERALLY NO SARS-COV-2 ON
EARTH THAT HAD INFECTED HUMANS
AND CLEARLY WE SEE INCREASE OF
RISK OF DISREGHT MIAS OR
ABNORMAL RHYTHM OF THE HEART,
ATRI OLDER PEOPLE
FIBROLIEWLINGS, TACHYCARDIA,
MYOCARDIAL INFARCTION, HEART
FAILURE AND THROMBOLLIC DISEASE,
MEANING A PULMONARY EMBOLISM, SO
YOU CAN APPRECIATE HERE THE LACK
OF SPECIFICITY, IT'S NOT 1 THING
IT'S NOT ONLY MI, BUT THERE'S
ARRHYTHMIA, STROKES, VTE OR VINO
THROMBOW EMBOLIC DISEASE, THERE
WERE LOTS IN THE CARDIOVASCULAR
SIZE, AND AND YOU HAVE SEEN THE
RESULTS NOW, THIS IS OUR FIRST
TALKING ABOUT THE INCREASE RISK
OF DIABETES IN PEOPLE AFTER
SARS-COV-2 INFECTION, THIS HAS
BEEN PRODUCED FENT 20 TIMES --
THERE'S CLEARLY METABOLIC
SIGNALLURE, WHEN WE FIRST YOU
KNOW DID THIS STUDY, I REMEMBER
TELLING MY TEAM, WE GOT IT
WRONG, THIS CANNOT BE TRUE, WE
WILL NOT PUBLISH THIS, BECAUSE
HOW CAN SARS-COV-2
[INDISCERNIBLE] DIABETES, THE
RESULTS DON'T MAKE ANY SENSE --
IT WAS THE FIRST AND REALLY GLAD
TO REPORT THERE'S BEEN MORE THAN
20 STUDIES EXACTLY THE SAME
THING THAT LEADING TO INCREASED
RISK OF DIABETES, INCREASED RISK
OF HYPE DEEMIA, AND ALSO PRODUCE
MULTIPLE STUDIES INCLUDING A
REALLY WONDERFUL STUDY IN IN THE
SWISS MILITARY, I DIDN'T KNOW
THE SWISS HAVE A MILITARY BUT
APPARENTLY THEY DO, THEY HAVE
SWISSED ARMED FORCES AND I DID
NOT KNOW THAT EXISTED BUT
ANYWAY, THEY DO, AND MILITARY
RECRUITS IN SWITZERLAND IS VERY
CLEARLY THE SAME THING, AFTER
THEY GET SARS-COV-2 INFEC, THEY
ACTUALLY MANIFEST WITH DECREASED
HDL, AND INCREASED LDL AND
TRIGLYCERIDES, SO THERE IS A
METABOLIC SIGNATURE OF
SARS-COV-2 INFECTION THAT WE
NEED TO MAY ATTENTION TO IT, AND
I THINK THE BEAUTY ABOUT STUDIES
IN THE PREOF THEINE AREA AND THE
VERY EARLY PHASE OF THE
PANDEMIC, IS IT GAVE US A WINDOW
TO UNDERSTAND WHAT SARS-COV-2 IS
DOING, NOW THE PICTURE IS MUCH
MORE MUDDIED BECAUSE PEOPLE ARE
NOT TESTING AND THERE'S NO
CLARITY ABOUT THE SEQUENCE OF
SARS-COV-2 NOW BECAUSE THERE'S A
LOT OF MUDDIED PICTURE BUT
AGAIN, THE BEAUTY ABOUT GETTING
THIS WINDOW TO REALLY MORE
DEEPLY UNDERSTAND WHAT
SARS-COV-2 IS DOING TO PEOPLE'S
HEALTH IN A VERY FIRST YEAR AND
THE SECOND YEAR OF THE PANDEMIC
AND REALLY WONDERFUL AND AGAIN,
THIS WORK HAS BEEN PRODUCED
MULTIPLE TIMES, WE HEAR IN THE
STUDY, WE SORT OF CATALOG THE
KIDNEY DYSFUNCTION AFTER
SARS-COV-2 INFECTION, AND WHAT I
WANTED TO SHOW HERE IS THIS EGFR
TRAJECTORY, IT'S A QUANTITATIVE
MARKER OF KIDNEY FUNCTION AND
AND YOU CAN APPRECIATE HERE ALL
THE LINES ARE GOING DOWN.
AND TO PUT IT IN PERSPECTIVE
WHAT WE SAW HERE IN PEOPLE, WHO
HAD SARS-COV-2 INFECTION, EVEN
MILD KICKOFF 2 INFECTION, TO
EXPERIENCE ABOUT 2-4-MILLIMETER
DECLINE IN THEIR EGFR, AND THE
YEAR THAT FOLLOWS THE INFECTION.
YOU SHOULD BE ASKING ME NOW,
WHAT DID THIS REALLY MEAN?
WHAT DOES IT MEAN IN GFR REALLY
MEANS, THAT MEANS THAT THE
KIDNEYS AGED ABOUT 4 YEARS IN
THE SPAN OF JUST 1, SO NORMALLY
KIDNEYS AGE, JUST NORMAL AGING
AND THEN WITH NORMAL AGING THE
KIDNEY LOSES ABOUT 1 LITER PER
MINUTE WITH 1 YEAR OF AGING, A
LOSS OF ABOUT 4 LITER
PERMINUTE IN EGFR TRANSLATES
INTO THIS KIDNEY AGED ABOUT 4
YEARS AFTER INFECTION WITH SAVS
KICKOFF 2 INSTEAD OF JUST 1.
SO CAN YOU CHARACTERIZE AN
INFECTION OR AHEAD IN THE EARLY
YEARS OF THE PANDEMIC AS ALMOST
A TANTAMOUNT OUTSIDE OF AGING
THAT PUSHED THAT BODY FROM
BEING, YOU KNOW 50, 54, OR 54-68
OR 66, SORT OF A FORMFUL
ACCELERATED AGING.
YOU KNOW HERE WE LOOKED AT THE
NEUROLOGIC DYSFUNCTION AFTER
SARS-COV-2 INFECTION AND VERY
CLEARLY, DYSFUNCTION ISSUE YOU
MIGHT HAVE HEARD OF BRAIN FOG
BEFORE AND THAT IS 1 OF THE
CARDINAL MANIFESTATIONS OF LONG
COVID AND THAT'S DEFINITELY
TRUE.
SO VERY CLEARLY, A BRAIN FOG OR
COGNITIVE CHANGES.
BUT ALSO MORE THAN THAT, THERE
IS INCREASED RISK OF STROKE AS
DISCUSSED BEFORE, INCREASED RISK
OF SEIZURES, HEADACHES, SLEEP
PROBLEMS, VARIOUS DISORDERS,
VARIOUS NEUROLOGIC DISORDERS,
NOT ONLY BRAIN FOG BUT NOT ONLY
COGNITIVE DISFUNCTION BUT THAT'S
REALLY IMPORTANT AND -- AND
AGAIN LACK THE NOTE OF
SPECIFICITY HERE, IT'S NOT 1
THING, IT'S NOT LIKE A -- YOU
KNOW KIND OF LIKE EBVV, CAUSES
MULTIPLE SCLEROSIS, IT'S 1 THING
THAT'S VERY DEFINED THAT CAUSES
EPSTEIN BARR, OR MULTIPLE
SCLEROSIS, THERE'S A BROAD RANGE
OF THINGS FROM AUTONOMIC
DYSFUNCTION, HEADACHES, SLEEP
PROBLEMS, STROKES, ET CETERA AND
OTHER NEUROLOGIC MANIFESTATIONS
AND THEN HERE, SORT OF A FOLLOW
UP STUDY TO TRY TO UNDERSTAND
THE GI MANIFESTATIONS AND
CLEARLY AFTER SARS-COV-2
INFECTION WITH THE POST ACUTE
PHASE COME BACK TO THE CLINICS
WITH ALL SORT OF PROBLEMS
INCLUDING CONSTIPATION,
DIARRHEA, INFLAMMATORY BOWEL
SYNDROME, ET CETERA, ET CETERA.
AND IN THIS WE WANT TO
UNDERSTAND THE INFECTION ON
PEOPLE, AND THE DESIGN HERE IS
ACTUALLY QUITE INTERESTING, WE
SORT OF FEEL THAT AMERICA DID
NOT, OR MANY PEOPLE IN THE PRESS
DID NOT REALLY FULLY REPORT ON
THIS STUDY ACCURATELY.
SO THIS IS A COUNTER FACTUAL
APPROACH TO TRY TO UNDERSTAND
EFFECTIVELY INFECTION.
WE ANALYZE THE SEQUENCES OF
INFECTION VERSUS [INDISCERNIBLE]
INFECTION, WE SAW 2 INFECTIONS,
IT ACTUALLY WORSENED JUST HAVING
1 AND THE SEQUENCES OR HEALTH
CENTER FOR EXCELLENCE ON AGINGS
OF HAVING 3 INFECTIONS ARE
WORSES THAN 2.
SO VERY CLIERLY THE INFECTION IS
CONSEQUENTIAL OF NO INFECTION,
AND 1 THING WE DISCOVERED WHEN
WE DID THE PAPER, IS THAT
AMERICA DOES NOT LIKE COUNTER
FACTUAL THINKING, THE PRESS,
THEY DON'T LIKE COUNTER FACTUAL
THINKING, MUCH OF THIS WAS
MISINTERPRETED BUT THE POINT
THAT IS VERY CLEAR AND THIS HAS
ACTUALLY NOW BEEN REPRODUCED BY
WORK FROM CHINA AND THE WORK
FROM THE U.S., WORK FROM
CANADIAN STUDIES, WORK BY THE
PATIENT LED RESEARCH
COLLABORATIVE IN THE U.S., MANY,
MANY PAPERS, YOU KNOW SHOWING OR
CATALOGING THE REPEATED
INFECTIONS OF SARS-COV-2.
REINFECTION CAN TRIGGER DE NOVO
LONG COVID, MEANING THIS PERSON
MAY HAVE IMMERSED UNSCATHED
AFTER THE FIRST INFECTION AND
DID NOT HAVE LONG COVID AFTER
THE FIRST INFECTION BUT THEN NOW
DEVELOP LONG COVID AFTER THE
SECOND INFECTION OR THIRD
INFECTION, THAT'S DE NOVO LONG
COVID AFTER INFECTION OR
EXACERBATION OF UNDERLYING LONG
COVID AND THAT'S FAIRLY COMMON.
YOU SEE PEOPLE WITH LONG COVID
IN THE CLINIC AND THEN FOR 1
REASON OR ANOTHER, THEY TRAVEL
SOMEWHERE AND THEN THEY GOT
INFECT EXCLUDE UPON REINFECTION,
THE LONG COVID IS TRIGGERED ALL
OVER AGAIN, EXACERBATED, SO
EXACERBATE UNDERLYING LONG COVID
OR CAUSES DE NOVO OR NEW LONG
COVID UPON REINFECTION.
SO HOW LONG IS LONG COVID AND WE
REALLY THINK THAT PATIENTS ARE
REALLY PROPHETIC AND BECAUSE
THEY -- WHEN THEY TURNED IT LONG
COVID AND THEY START TALKING
ABOUT THE LONG HAWF HAUL, I
GUESS THEY KNEW OR FELT THEY
SENSED THEY HAD THIS SORT OF
PROPHETIC WAY OF THINKING ABOUT
YOU KNOW THE TRAJECTORY OF LONG
COVID AND IT IS REALLY LONG.
THIS IS A STUDY CATALOGING THE
RISK OF INCIDENT DEC AFTER
INITIAL INFECTION AND WE CAN,
YOU KNOW THE GOOD NEWS HERE IS
THAT FOR MOST OF THE SEQUELA,
THERE IS NO NEW INCIDENT DISEASE
AFTER THE FIRST YEAR BUT, BUT,
FOR ABOUT ONE-THIRD OF SEQUELA
WE CATALOGED IN THE STUDY AND WE
CATALOG ABOUT 8-0, PEOPLE WERE
MANIFESTED WITH NEW ONSET
DISEASE.
NEW ONSET DISEASE IN THE SECOND
YEAR AFTER INITIAL INFECTION.
AND THAT'S REALLY REMARKABLE,
THAT'S REALLY REMARKABLE AND
THAT DECLINES ALSO IN THE THIRD
YEAR, AND 3 YEARS AFTER
SARS-COV-2 INFECTION, PEOPLE
WERE MANIFESTING WITH THE NEW
ONSET DEC CAN THAT RELATED TO
INFECTION THAT I HAD 3 YEARS
AGO, SO YES, YES, YOU MAY HAVE
FORGOTTEN THAT YOU HAD
SARS-COV-2, 2 OR 3 YORES AGO,
BUT IT'S POSSIBLE, IT'S POSSIBLE
THAT SARS-COV-2 DID NOT FORGET
ABOUT YOU AND IT'S STILL
WREAKING HAVOC IN BODY SYSTEMS
AND RESULTING IN NEW INCIDENT
DISEASE OVERALL STRATEGY AFTER
AN INFEC.
I THINK IT'S REALLY SORT OF OUT
DATED, REALLY 20th CENTURY
IDEA AS A 18th OR 19th
CENTURY IDEA THAT IS NOT REALLY
COMPATIBLE WITH ACTUAL REAL
EVIDENCE THAT WE SEE IN REALITY.
SO THAT'S REALLY THE KIND OF
THINKING THAT NEEDS TO BE
LITERALLY PROBABLY GO TO THE
SMITHSONIAN AND BE SORT OF
FRAMED THERE AS A REEL
KEEPSAKESSIC OF REALLY OLD IDEAS
THAT WORK FOR SOMETIME BUT NO
LONGER REALLY TRUE, NO LONGER
REFLECT REALITY, SO THIS SORT OF
DIVISION BETWEEN ACUTE AND
CHRONIC, IT'S REALLY NAIVE
CONCEPT THAT DOESN'T REALLY --
THAT LITERALLY DOESN'T RECONCILE
WITH REALITY.
THE REALITY IS, THE REALITY IS,
WE SEE VERY CLIERLY EPIDEMIOLOGY
IN THE DATA, THAT AND IT'S
LITERALLY, HUNDREDS OF THOUSANDS
OF PEOPLE FOLLOWED FOR A LONG
PERIOD OF TIME AND EVEN IN ACUTE
INFECTION CAN RESULT IN
LONG-TERM HEALTH EECHGHTS 2 OR 3
YEARS AFTER THE INITIAL
INFECTION, NOW THE GOOD NEWS IS
THIS IS FROM [INDISCERNIBLE],
YOU CAN APPRECIATE HERE THAT THE
LION'S SHARE OF DEC AND BURDEN
IN THIS ABILITY, HAPPENS IN THE
FIRST YEARS, IN THE RED BARS AND
LESS SO IN THE SECOND AND THIRD
YEAR BUT IT'S NOT 0.
BUT IT'S CERTAINLY NOT 0.
NOW HAS THE RISK OF LONG COVID
REALLY CHANGED OVER TIME?
AND THE -- THE FACT IS THAT YES
IT DID EMPLOY YES IT DID.
SO THIS IS SORT OF DATA ALSO
FROM OUR TEAM, PUBLISHED
RECENTLY ABOUT MAYBE 2 MONTHS
AGO, SOMETHING LIKE THAT, IN
JULY, AND AUGUST, SORRY.
SHOWING THAT THE RISK HAS
DECLINED OVERTIME, FROM THE VERY
EARLY ERA OF THE PANDEMIC, WE
CALL THIS SORT OF PREDELTA ERA
AMONG UNVACCINATED INDIVIDUALS
ABOUT 10% AT THAT TIME TO ABOUT
3.5% AMONG VACCINATED EVENT IN
INDIVIDUALS IN THE OMICRON ERA,
SO THATIA A SIGNIFICANT DECLINE
OVERTIME BETWEEN THE PREDELTA,
DELTA AND OMI CRON ERAS, NOTICE
HERE THE GREEN LINE, THE GREEN
LINE THAT REPRESENTS VEKINATED
INDIVIDUALS.
VACCINATED INDIVIDUALS ALWAYS
HAD LESS RISK OF ENCOUNTERED OR
HAVING UNVACCINATED INDIVIDUALS
AND EVEN PEOPLE WHO ARE
VACCINATED, THE RISK CAN
ACTUALLY DROPPED TO ABOUT 3.5
AMONG THOSE WHO ARE VACCINATED
IN THE OMICRON ERA, THERE'S 2
KEY DRIVERS HERE.
IF I THINK ABOUT IT, 2 KEY
DRIVERS FOR THIS DECLINE.
ONE IS THE EVOLUTION OF SORTING
SIGNALSS KICKOFF 2 TODAY.
SORTING SIGNALSS KICKOFF 2 TODAY
IS NOT THE SAME OF MARCH IN
2020.
THAT'S THE REALITY.
IT'S NOT THE SAME AND 2, TONINGS
MORE PEOPLE ARE VACCINATED IN
2022, 2023, 2024 THAN AND THERE
WAS NOBODY, LITERALLY NOBODY, 0
IN 2020.
SO THESE 2 KEY DRIVERS RESULT
INDEED A SIGNIFICANT DECLINE IN
THE RISK OF LONG COVID OVER
TIME, HOWEVER, HOWEVER, EVEN
WITH THIS DECLINE, THE RISK IS
NOT 0.
SO YES IT'S MUCH LOWER THAN IT
WAS BEFORE, MUCH LOWER THAN IT
WAS IN 2020 AMONG UNVACCINATED
INDIVIDUALS BUT STILL, 3.5% IS
REALLY IMPORTANT.
AND I KNOW SOME PEOPLE MAY BE,
THIS IS A GROUP THAT ALSO
INCLUDES THE FDA, AND IT'S ALSO
IMPORTANT FOR VACCINE POLICY
BECAUSE WE CAN ACTUALLY SAY
THAT, YOU KNOW WHAT LONG COVID
IS NO LONGER A BIG, BIG PROBLEM
BECAUSE OF VACCINES, BECAUSE
PEOPLE ARE VACCINATED AND THEN
IN THE NEXT SENTENCE SAY
ABANDON, THE VACCINES THAT
ACTUALLY GOT US TO THIS POINT,
RIGHT?
SO I THINK IT'S VERY, VERY
IMPORTANT TO REALIZE THAT, YOU
KNOW THE VACCINE HAVE IT ALL AND
REDUCING THE RISK OF DEATH AND
HOSPITALIZATION AND ACUTE PHASE
AND ALSO REDUCING THE RISK OF
LONG COVID AND THAT'S VERY, VERY
KEY AND VERY IMPORTANT IN THE
DATA.
SO WHAT ABOUT PREVENTION.
WE JUST TALKED ABOUT IT VERY,
VERY BRIEFLY, VACCINES WORK AND
VACCINES REDUCE THE RISK OF
HOSPITAL RISATION AND IN AN
ACUTE PHASE, AND ALSO REDUCE THE
RISK OF LONG COVID, THE RISK OF
REDUCTION IN LONG COVID, IS NOT
REALLY COMPLETE, BUT IT IS
THERE, AND BUT ALSO HOE IN THE
DATA THAT IT'S VARIABLE ACROSS
THE ORGAN SYSTEMS, SO IT'S NOT
THE SAME FOR THIS NEVERTHELESS,
YOU CAN SEE ALL THIS HERE, ON
ALL THEE BARS ARE GREEN AND ON
THE RIGHT SIDE OF HISTORY, SO
RISK OF REDUCTION AND RISK, SO
WE ALSO SEE AND THIS HAS BEEN
CORROBORATED BY AN RCT THAT WAS
PUBLISHED IN LANCET INFECTIOUS
DISEASES, AND ANTIVIRALS WHEN
THEY TAKEN IN THE ACUTE PHASE
AMONG THOSE ELIGIBLE FOR
ANTIVIRALS, ADVANCE AGE,
PRESENCE OF CORMORBIDITYS THAT
PUT PEOPLE AT HIGH RISK OF
SEVERE ILLNESS AND DEATH, AND
THAT SUBSET OF PEOPLE, THAT'S
THOT EVERYONE AND THAT SUBSET OF
PEOPLE THAT WILL QUALIFY FOR
ANTIVIRALS WITH P A XLOVE D
REDUCES THE RISK OF P A SC, THE
EFFECTS ARE WEAK BUT IT'S NOT 0,
NOT NULL, AND WE SEE THAT
CLEARLY IN [INDISCERNIBLE], THIS
HAS BEEN PRODUCED BY THE
PANORAMIC TRIAL, OR PEOPLE WHO
HAD BEEN TREATED OR RABD ORDER
OF MICRONSIZED WITH
[INDISCERNIBLE], VERSUS USUAL
CARE AND THE 6 MONTH FOLLOW UP
AND THE FOLLOW UP THE PAN O
RAMMIC CAME UP PROBABLY A MONTH
AGO AND INFECTIOUS DISEASES AND
SHOWING CLEARLY A REDUCTION IN
RISK OF LONG COVID, AMONG PEOPLE
WHO WERE TREATED IN ACUTE PHASE
OF [INDISCERNIBLE].
THE REDUCTION WAS ALSO MODEST,
WEAK EFFECT BUT NOT 0, SO
ANTIVIRALS AND ACUTE PHASE
REDUCE TO SOME EXTENT BUT NOT
REALLY, YOU KNOW DO NOT
COMPLETELY ABROGATE THE RISK OF
LONG COVID.
SO, WHY DOES LONG COVID HAPPEN?
AND THE SHORT ANSWER IS THAT,
THE LIKELY MULTIPLE MECH NICHES
AT PLAY AND I DON'T WANT US TO
PUT OUR EGGS IN 1 BASKET AND
DIVIDE UP RESISTANCE OR THE
MICROBIOME, DISBIOSEIS, THESE
ARE ALL IN MY VIEW, EQUALLY
PLAUSIBLE HYPOTHESIS OR
MECHANISMS THAT COULD
POTENTIALLY EXPAND LONG COVID.
ONE OF THEM IS CLEARLY VIRAL
PERSISTENCE, THE IDEA THAT THE
VIRUS MIGHT PERSIST IN THE BODY
AFTER LONG ACUTE INFECTION, IT
DOESN'T HAVE TO THE VIRUS,
COMPLETE FRAGMENTS OF THE VIRUS,
PROTEIN FRAG M-TEBURKEULOSEISS
OR AND THEY WERE HIDING IN
TISSUES AND NOW THEY'RE BEING
DEGRADED, YOU KNOW, IMMUNE
DISREGULATION, THAT'S VERY CLEAR
NOW, THERE'S ABUNDANT DATA,
SHOWING THE LIKELIHOOD THAT
IMMUNE DISRESSULATION MAY
EXPLAIN SOME OF THE MECHANISMS
OF LONG COVID, MICROBIOME
DISBIOSEIS IS VERY PLAUSIBLE,
THE IDEA OF ENDOTHELIAL
INFLAMMATION IS VERY IMPORTANT
INCLUDING COMPLEMENT
DISREGULATIONULATION, COTING,
RED CELL LYSIS, IMPAIRED TISSUE
PROFUSION, OR DISTAL TISSUE
PROFUSION, VERY CLEARLY NEURONAL
INFLAMMATION, WE WILL TALK ABOUT
IT IN THE NEXT SLIDE, AND
MITOCHONDRIA DYSFUNCTION MAY
PLAY A ROLE EMPLOY SO WE DID
THIS PIECE TO TRY TO SORT OF
DIVE A BIT MORE DEEPER INTO THE
MECHANISM AND MAY EXPLAIN
NEUROLOGIC DISFUNCTION OR MAY
SPLEAN THE NEUROLOGIC
INVOLVEMENT IN LONG COVID.
YOU KNOW, YOU GUYS ARE PROBABLY
AMONG YOU IS THE PEOPLE WOULD
REALLY PRODUCE, ARE THE PEOPLE
WHO PRODUCE EVIDENCE OF THE
PRESENCE OF SARS-COV-2 IN THE
BRAIN OF PEOPLE SO THAT'S
REALLY, THAT'S POSSIBLE.
OBVIOUSLY IN EVERYONE, THAT'S
POTENTIA WILY 1 MECHANISM THAT
MAY EXPLAIN THIS, GLIAL CELL
ACTIVATION, THERE ARE SORT OF
PEOPLE SORT OF PROPOSED THE IDEA
THAT THERE IS POTENTIALLY MAYBE,
TO THE ADREENA DYSFUNCTION WITH
LOW CORTISOL.
THAT DATA NEEDS TO BE SORT OF
FURTHER FLESHED OUT.
YOU KNOW THE IDEA OF
MITOCHONDRIA DYSFUNCTION CAN
ALSO BE PLAUSIBLE HERE, AND THE
DISBIOSEIS CAN ALSO BE DRIVERS
OR MECHANISTIC PATHWAYS THAT
EXPLAIN LONG COVID.
THE IMPACTS OF LONG COVID, WE
WORRY ABOUT IMPACT ON
INDIVIDUALS AND COMMUNITIES A
LOT AND AGAIN, I WANT TO SORT OF
GO BACK TO THE -- TO ROSIE'S
ART, ROSIE DID THIS IRISH KID
WHO HAS BEEN SUFFERING FROM LONG
COVID FOR THE PAST SEVERAL YEARS
AND REALLY SORT OF TRIES TO DEAL
WITH IT BY PAINTING AND THIS IS
1 OF HER PAINTINGS WHERE SHE
PAINTS HERSELF AND LOOK AT THE
EYES, LOOK AT THE MOUTH, LIKE
UNSEEN AND UNHEARD, SO SHE DOES
NOT REALLY FEEL THAT PEOPLE ARE
SEE HER, PEOPLE AREN'T HEARING
WHAT SHE SAYS, THEY'RE SAYING
ALL THESE THINGS TO HER, GIVE IT
TIME, MAN UP, YOU LOOK HEALTHY.
PEOPLE ARE TELLING HER, THIS
SO-CALLED LONG COVID, AND ALL
THESE THINGS THAT REALLY
REPRESENT IN OUR VIEW, GAS
LIGHTING OF THE EXPERIENCE OR
LIVED EXPERIENCES OF PEOPLE WHO
ARE IMPACT WIDE LONG COVID.
A VERY POWERFUL ART IN MY
OPINION IN MANY CASES WHAT
PATIENTS ARE FEELING WITH LONG
COVID.
WE ALSO WORRY ABOUT DISEASE IN
THIS, AND WE'RE LITERALLY
UNCERTAIN ABOUT THE DOWN STREAM
IMPLICATIONS OF ALL OF THIS.
PEOPLE WITH BRAIN FOG OR YOU
KNOW A LOT OF HEADACHE, FROM IN
LONG COVID, THEY DEVELOP SORT OF
OTHER NEUROLOGIC COMPLICATIONS
DOWN THE ROAD, LIKE EARLY
ALZHEIMER'S DISEASE, OR DEMENTIA
OR WILL WE HAVE A BUNCH OF
PEOPLE WHO ARE DEMENTED IN THEIR
30S AND 40S AND 50S 10 YEARS
FROM NOW AND I DON'T KNOW THE
ANSWER TO THAT BUT I WORRY ABOUT
THESE THINGS, I WORRY ABOUT LIFE
EXPECTANCY IN PEOPLE WITH LONG
COVID.
AND THERE ARE AT LEAST
20 MILLION AMERICANS WITH LONG
COVID SO THAT REDUCED LIFE
EXPECTANCY IN THEM WILL
CERTAINLY MAKE A HUGE DENT IN
OUR TOTAL LIFE EXPECTANCY IN THE
U.S.
WE WORRY A LOT ABOUT THAT
DEVELOPMENT EDUCATION OF KIDS
WHO ARE INVOLVED WITH LONG
COVID, WE WORRY ABOUT SORT OF
THE IMPLICATIONS ARE FOR HEALTH
SYSTEMS AND WHAT WOULD THAT DO
TO DEMAND OUR HEALTH SYSTEMS AND
ACCESS TO CARE, EQUITY OF CARE,
ALL OF THESE DIFFERENT FACTORS,
I BRIEFLY TALKED ABOUT THE
EFFECT ON THE ECONOMY AND WE
TYPED IT UP RECENTLY AND THE
TOTAL TALLY WAS ABOUT 1 MILL YEN
DOLLARS PER YEAR AND THE EFFECT
IS NOT TRIVIAL ON LABOR MARKET
AND ECONOMIC PRODUCTIVITY.
IT'S ALSO NOT TRIVIAL ON
ECONOMICS AND ALSO WOVEN INTO
THE FABRIC OF OUR SOCIETY, IT
HAS SIGNIFICANT SOCIAL
IMPLICATIONS.
SO, TO PUT LONG COVID IN TON
TEXT, I LIKE THIS SLIDE BECAUSE
I ALSO LIKE THE DELIBERATE
PLACING OF IN-CONTEXT AND BIG
FONT, SO CONTEXT MATTERS AND I
THINK SORT OF TO UNDERSTAND LONG
COVID, WE NEED TO SORT OF
UNDERSTAND THE FEATURE OF LONG
COVID AND HOW MIGHT IT OVERLAP
WITH POST HOSPITALIZATIONS FOR
EXAMPLE, THERE ARE FEATURES
THERE, THERE ARE VERY -- NOT
IDENTICAL BUT SIMILAR TO PEOPLE
WITH LONG COVID, POST CARE
SYNDROME AND THIS WHOLE
ASSOCIATION OF CHRONIC CARE AND
ILLNESSES, AS WE DISCUSS, YOU
KNOW EVEN INFLUENZA CAN LEAVE
PEOPLE WITH POST ACUTE VIRAL
ILLNESS, AND IF YOU GO BACK TO
THE HISTORY BOOK, THIS IS ALSO
NOT NEW.
YOU KNOW A LOT OF -- IT HAS
REALLY A WONDERFUL BOOK CALLED
PALE RIDER WHERE SHE CATALOGS
THE AFTEREFFECT OF THE FLU
PANDEMIC, THE 1918 FLU BAN
DEMIC, I THINK IT WAS ALSO
CALLED SPANISH FLU BUT REALLY
IT'S THE 1918 FLU PANDEMIC
EMPLOY
AND IN HER BOOK THERE ARE
ACCOUNTS OF DROVES PEOPLE
TALKING ABOUT LONG-TERM,
ENCEPHALITIS, SLEEPINESS, ET
CETERA, ET CETERA AFTER THAT
1918 FLU PANDEMIC.
TO THE POINT IT AFFECTED A WHOLE
BUNCH OF FARMERS IN NEW ZEALAND
TO THE POINT THEY WERE SO WEAK
AND THEY COULD NOT SHEER THE
WOOL OFF THE -- AND LOST
PRODUCTIVITY IN WHAT IS CALL NOW
CALLED TANZANIA IN AFRICA, THEY
ALSO HAD WHAT WE CALLED A FAMINE
BECAUSE THEY COULD NOT REALLY
CULTIVATE THEIR FIELDS, THEY
COULD NOT -- THE FARMERS THERE
WERE SO WEAK AND EN MASSE, EN
MASSE, NOT 1 OR 2, THE WHOLE
COMMUNITY OF FARMERS IN WHAT IS
CALLED TANZANIA WAS WEAK AND
MISSED ABILITY TO ACTUALLY
PLANT, ET CETERA AND IT RESULTED
IN FAMINE.
IT'S A WONDERFUL BOOK CALLED
PALE RIDER BY LAURA SPINNEY.
BRITISH WRITER WHO LIVES IN
PARIS BUT REALLY ABSOLUTELY
WONDERFUL, SO ANYWAY, THE
MEASLES CAN LEAD TO LONG-TERM
COMPLICATIONS, EBV CAN LEAD TO
MULTIPLE SCLEROSIS, FOR THOSE
WHO HAVE DEALT WITH EBOLA, YOU
KNOW, IT'S NOT JUST AN ACUTE
THING BUT A LONG-TERM
CONSEQUENCES OF EBOLA, OF POLIO,
AND THEN YOU KNOW THE BIGGENTITY
THAT'S CALLED MILE ALGORITHMSIC
ENCEPHALITIS CHRONIC FATIGUE
SYNDROME THAT BEARS A RESEMESTER
BLEL TO LONG COVID FEATURES AND
UNDERSTANDING ALL OF THOSE WILL
BE REALLY IMPORTANT TO REALLY
UNLOCK THE SEQUENCES TO WHY
ACUTE VIRUSES THAT PRESUMABLY
WILL CAUSE ACUTE INFECTION LEAVE
SOMETIMES, SOME INDIVIDUALS WITH
LONG-TERM SEQUELA AND MULTIPLE
ORGAN SYSTEMS, SO THIS IS VERY,
VERY IMPORTANT, I WILL SAYING
ALONE WILL NOT BE SUFFICIENT, WE
NEED TO UNDERSTAND THE WHOLE
THING IN CONTEXT AGAIN, THAT'S
REALLY WHY I LIKE THAT SLIDE.
SO WE NEED TO THINK ABOUT A
POLICY ROADMAP TO CHART THE WAY
AHEAD AND THAT ENTAILS
PREVENTING MORE PEOPLE FROM
HAVING LONG COVID, ACCESS
QUALITY AND EQUITY OF CARE,
PROFESSIONAL EDUCATION AND
TRAINING, PUBLIC HEALTH
COMMUNICATION, SUPPORTING
COORDINATED AREA RESEARCH AND
THAT WILL BE VERY IMPORTANT, I
AM GLAD THAT THE NIH IS THINKING
ABOUT THAT AND THAT THE NIH
COULD AND SHOULD DO MORE TO TRY
TO SPEED UP RESEARCH ON LONG
COVID AND ASSOCIATED CONDITIONS.
BUILDING CONSENSUS ON CLINICAL
END POINTS WILL BE VERY
IMPORTANT, GLOBAL COORDINATION,
WE USE PROFESSIONAL SOCIETIES
FOR LONG COVID, PROFESSIONAL
HEALTH CONSULTANTS FOR LONG
COVID AND THAT'S VERY IMPORTANT
AND ANY DISCUSSION ABOUT
PREPARING FOR THE NEXT PANDEMIC
THAT DOES NOT REALLY INVOLVE THE
IDEA, THE CORE IDEA THAT ACUTE
INFECTIONS CAN SOMETIMES ALSO
LEAD TO LONG-TERM ILLNESSES AND
LONG-TERM MANIFESTATION AND
LONG-TERM NONCOMMUNICABLE
DISEASES, ANY EFFORT LIKE THAT
THAT DOES NOT INCLUDE THAT CORE
CONCEPT, ANY EFFORT IN PANDEMIC
PREPAREDNESS THAT DOES NOT
INCLUDE THAT CORCONCEPT IS
REALLY INCOMPLETE.
IT'S INCOMPLETE.
WE NEED TO,A COUNT FOR THIS IDEA
THAT PANDEMICS LEAD TO DROVES OF
PEOPLE WITH THIS ABILITY AND
DISEASE.
YOU KNOW THE COVID-19 PAN
DEBLGIC, IT'S NOT THE FIRST,
IT'S NOT THE LAST 1, THERE WILL
BE PANDEMIC AND IF WE ARE GOING
TO MEANINGFULLY PREPARE OUR
SOCIETIES AND OUR COUNTRIES FOR
THE NEXT PANDEMIC, WE ALSO NEED
TO BE THINKING NOT ONLY ABOUT,
OH, WELL BIRD FLU IS XYZ, OR
OTHER THINGS, XYZ, BUT WE NEED
TO THINK ABOUT THE POTENTIAL FOR
THESE VIRUSES TO LEAD TO THINGS
LIKE LONG COVID, LONG VIRUS 2030
OR LONG VIRUS 2040 AND HOW DO WE
MITIGATE THAT TO THE BEST OF OUR
ABILITIES, THAT'S GOING TO BE
VERY, VERY IMPORTANT.
AND ANY PANDEMIC PREPARENESS
SAID THAT DOESN'T INCLUDE THAT
CORE CONCEPT IS REALLY
INCOMPLETE.
AND THIS RESEARCH ROADMAP, THINK
THERE'S CLEARLY A NEED FOR
TRIALS, BUT FOCUSING OHM ON
TRIALS I THINK WILL NOT YIELD,
YOU KNOW REALLY A LOT OF
PROGRESS.
I THINK IN CONCERT, IN PARALLEL,
YOU KNOW THE NEED TO BE A LOT
MORE RESEARCH ON UNDERSTANDING
THE MECHANISMS, DIAGNOSTICS FOR
LONG COVID, TEST THERAPEUTICS
FOR LONG COVID, EPIDEMIOLOGY OF
COURSE OF LONG COVID, CARE AND
DELIVERY OF AND HEALTH SYSTEM
RESEARCH, ECONOMIC IMPACT AND
SOCIETAL IMPACTS AND I REALLY,
REALLY HOPE, NIH GET TO RETHINK
THE WHOLE RECOVER AND EXPAND THE
PIPELINE OF INVESTIGATORS,
THAT'S NOT REALLY SORT OF A COO
COONED AND RESTRICTED TO THE
RARE PEOPLE OR FEW THAT ARE NOW
INVOLVED AND RECOVER AND SO
CLOSE SO PEOPLE LIKE US KOOBT
EVEN ACCESS THE DATA AND THAT
REALLY IN OUR VIEW SHOULD REALLY
CHANGE.
IF THE NIH IS REALLY TRULY
WANTING TO ADVANCE AND MOVE THE
BALL FORWARD ON RECOVERY AND IF
THAT'S REALLY TRUE, THEN REALLY
THE ECOSYSTEM SHOULD BE OPEN
EQUITABLY AND COMPETITIVELY TO
ALL NEW IDEAS, NOT SORT OF A --
THE FUNDS GO TO THE PEOPLE 4 OR
5 YEARS AGO AND MADE MOW
PROGRESS WITH THE FUNDS.
ANYWAY, IT DOESN'T SOUND VERY --
LONG COVID IS A MULTIFACETED
DISEASE THAT CAN AFFECT NEARLY
EVERY ORGAN SYSTEM, THE HUMAN
ICONIC TOLL OF LONG COVID IS
SIGNIFICANT AND DEMANDS A LOT OF
INTENTION.
RISK IS INCREASED BY INFECTION
AND REDUCED BY VACCINATION AND
ANTIVIRALS AND WE THINK IT NEEDS
A COORDINATE APPROACH AND
RESEARCH AND RESPONSE STRALT
EDGY.
SO YOU CAN'T GIVE THIS TALK
WITHOUT THANKING THE TEAM THAT
LED US HERE AND HELPED US DO A
LOT OF WORK ON LONG COVID,
INCLUDING YAN, SHAE, WHO IS IN
OUR CENTER AND DIRECTOR OF THE
[INDISCERNIBLE] PROGRAM, HE LED
MUCH OF THE WORK I SHOWED TODAY,
ALSO TAEYOUNG CHOI, EVAN XU,
BENJAMIN BOWE, MISO, CALL, AND
ALSO THANKFUL TO VICKI DAVIES
FROM THE VA WHO'S BEEN
ENORMOUSLY SUPPORTIVE, AND
SUPPORT FROM THE VA INCLUDING
SUSAN WOOD AND ALSO WHEN SHE WAS
HERE AT THE VA, SHE'S NOW LEFT
FOR ORD AND ALLEY SHAVER AND IF
YOU SEE THE WORK IN THE MEDIA
THAT'S THANKS TO THE WORK OF
CHRISTINA, DIANE AND JESSICA,
AND THEY DO AN ARK MAZING JOB OF
PROMOTING AWARENESS IN THE
UNITED STATES AND GLOBAL AND WE
FEEL THIS IS VERY IMPORTANT.
LAST BUT NOT LEAST IS REALLY THE
LONG HAULERS WHO INSPIRED US AND
CONTINUE TO INSPIRE US TO DO
THIS WORK AND WE WERE SORT OF
REALLY IMMERSED AND ENTRENCHED
WITH THEM FROM DAY 1 AND WE FEEL
THEY ARE THEY'VE BEEN ENORMOUSLY
HELPFUL IN INSPIRING US AND
GUIDING US IN THE RIGHT WAY.
SO GRATEFUL FOR YOU HOSTING THIS
TALK TODAY, FOR YOUR WILLINGNESS
TO LISTEN AND TALK ABOUT LONG
COVID, AND INTEREST IN LONG
COVID AND DELIGHTED TO DO QA.
>> THANK YOU FOR A WONDERFUL
TALK ON A VERY IMPORTANT TOPIC.
AS YOU CAN SEE THERE ARE LOTS OF
QUESTIONS FROM THE AUDIENCE, IN
THE TIME LEFT, I WILL SUMMARIZE
THE MANY THEMES OF THOSE
QUESTIONS, SO JUMPING TO
QUESTIONS ISSUES THE FIRST 1 IS
WHAT ACCOUNTS FOR THE HETEROGAIN
AITY OF LONG COVID, WHY SOME
PEOPLE GET IT AFTER THEY GET
INFECTION, AND OTHERS DO NOT?
DO WE KNOW THAT?
>> SO, WE DON'T COMPLETELY KNOW
WHY BUT CLEARLY THERE MAY BE,
YOU KNOW ENVIRONMENT
DETERMINANTS, MAYBE DIETARY
DENERMALITANTS, MAYBE MY ROUGH
ATOM BIOME COMPOSITION, HEALTH
DETERMINANT, GENERATED THETIC
PRIMATES DISPOSITION, THERE'S IS
STUDIES SUGGESTING THAT CERTAIN
SNPs, THERE COULD BE, THERE
COULD BE, THIS IS STILL IN
PREPRINT HAS ONLY FORMALLY BEEN
VETTED OR PEER REVIEWED AND
PUBLISHED HERE, THERE COULD BE
GENETIC PREDISPOSITION FOR WHY
PEOPLE GET LONG COVID AND WHY
SOME PEOPLE DON'T GET LONG
COVID.
BECAUSE IT'S A COMPLEX
CONDITION, I THINK ALL OF THE
ABOVE RISK FACTORS OR DRIVERS,
ENVIRONMENTAL GENERATED THETIC
DIETARY, PREEXISTING
CO-MORBIDITIES, LIFESTYLE
FACTORS, ALL OF THOSE MAY, MAY,
COALESCE TO SORT OF HEIGHTEN OR
REDUCE THE RISK OR PROBABILITY
OF SOMEBODY GETTING A SEQUELA
AND THAT'S ALL THE INTERACTION
OF THESE THESE FACTORS COMBINED
MAY BE LEADING THE PHENOTYPE OF
LONG COVID.
BUT THIS IS AN IMPORTANT
QUESTION BECAUSE WE NEED TO
UNDERSTAND EXACTLY WHY, YOU KNOW
MOST OF US, MOST PEOPLE WHEN
THEY GET SARS-COV-2 THEY DON'T
GET LONG COVID, BUT SOME PEOPLE
DO, SO WHY SOME PEOPLE DO AND
DON'T, HOW CAN WE LEVERAGE THAT
UNDERSTANDING TO POTENTIALLY
PREVEBT LONG COVID AND
POTENTIALLY EVEN TREAT LONG
COVID, SO I THINK THOSE ARE KEY,
VERY KEY QUESTIONS, VERY, VERY
IMPORTANT QUESTIONS.
>> AND SINCE WE ARE LIVING WITH
COVID NOW FOR MORE THAN 4 YEARS,
WE TEND TO GET INFECTED MULTIPLE
TIMES, SO THE EFFECTS OF
MULTIPLE INFECTIONS, SINNER
GESTIC OR MERELY ATTITUDE OR
[INDISCERNIBLE] FOR LONG COVID?
HOW DOES MULTIPLE INFECS IMPACT
LONG COVID?
>> SO WE HAD THIS PAPER IN
NATURE MEDICINE NOW A COUPLE
YEARS AGO, SORT OF WHEN WE
TALLIED UP THE RISK OF FIRST
INFECTION, SECOND INFECTION,
THIRD INFECTION, WE CLEARLY SEE
THAT THE 2 INFECTIONS ARE WORSE
THAN 1, SO, I WOULD SAY, YOU
KNOW LIKE AT LEAST, THAT'S YOU
KNOW WHEN WE HAVE SECOND AND
THIRD INFECTION, WE DON'T KNOW
WHAT HAPPENS WITH FOURTH AND
FIFTH AND SIXTH INFECTION, WE
DIDN'T DO THAT WORK SO I DON'T
KNOW, I DON'T WANT TO SORT OF
PONTIFICATE OR SPECULATE.
WE DO KNOW THAT 2 INFECTIONS ARE
WORSE THAT 1, 23 ARE WORSE THAN
2.
SO A SECOND INFECTION ADDS TO
THE RISK OR CONTRIBUTES
ADDITIONAL RISK OF LONG COVID
AND THAT COULD COME EITHER IN DE
NOVO LONG COVID OR EXACERBATING
UNDERLYING OR PREEXISTING LONG
COVID.
>> I SHOW WONDERFUL DATA FOR ALL
THIS FUNCTION, ESPECIALLY LONG
COVID PATIENTS AND THE QUESTION
S&P THIS PERMANENT OR TEMPORARY?
>> WE DON'T KNOW.
WE DON'T KNOW.
SO AGAIN, ORGAN DYSFUNCTION IS A
NONSPECIFIC TERM BUT LET'S SAY
SORT OF A WILL HEART DISEASE
AFTER SARS-COV-2, OR DURING
SARS-COV-2 INFECTION TRIGGERED
BY RISK FACTORS, AS RISULT OF
THIS INFECTION OR SAY DIABETES,
WE'RE TREATING IT IN THE SAME
WAY, WE WILL RESPOND IN THE SAME
WAY, I HAVE NOT SEEN THOSE
STUDIES AND I THINK A LOT MORE
NEEDS TO BE DONE THERE.
NOW IM PERICALLY WHEN WE SEE
THE DATA WE SEE PEOPLE
DEVELOPING DIABETES AND VERY FEW
IN A VERY SMALL PORTION OF THEM
ACTUALLY, THE A1C GETS BETTER ON
ITS OWN AND IT'S ALMOST LIKE THE
DIABETES GETS RESOLVED BUT THE
MAIORITY STAYS DIABETIC, STAYS
IN A STATE WHERE IT'S A1C IS
HIGH INITIATION OF HYPOGLEEL
CELLS SEEMIC THERAPY BUT A
LOTTER MODEL CITIZEN NEEDS TO BE
KNOWN TO CHARACTERIZE WHY SAY
SARS-COV-2 LEADS TO THINGS LIKE
DIABETES, WHY WOULD PRESUMABLY
RESPIRATORY VIRUS WITH R IN ITS
NAME AS A RES PERATTORY VIRUS
LEAD TO A CONDITION LIKE
DIABETES AND DEFINITE ORGAN
SYSTEM, AFTER SARS-COV-2 IS THE
SAME AFTER BEING OBESE FOR 20
YEARS OR SOMETHING LIKE THAT AND
WILL IT ALSO RESPOND IN THE SAME
WAY?
WELL DOWN STREAM COMPLICATIONS
FROM DIABETES INDUCE BY
SARS-COV-2 BE SIMILAR OR
DIFFERENT?
I THINK THOSE ARE ALL GOOD
EPIDEMIOLOGIC QUESTIONS I HAVE
NOT SEEN SOLVED IN DATA.
>> SO SINCE YOU BROUGHT UP
TREATMENT, WHAT ARE THERAPEUTIC
APPROACHES TO E SOLVE THE
SYMPTOMS FROM LONG COVID AND DO
WE HAVE PLANS TO ADJUST THE
STRATEGY ACCORDING TO PERSONS
[INDISCERNIBLE], PREEXISTING
CONDITIONS OR HEALTH HISTORY?
>> YOU USE THE WORD RESOLVE.
SO CURRENTLY IN THE CLINICS, YOU
KNOW, IN THE MANAGING NONCOVID
IS REALLY SYMPTOMATIC, YOU KNOW,
I DIDN'T WANT TO SPEND TOO MUCH
TIME ON THIS IN THIS TALK,
THERE'S 0 APPROVED.
YOU HAVE PEOPLE ON THE CALL AND
THEY KNOW THERE ARE 0 APPROVED
MEDICATIONS FOR THE TREATMENT OF
LONG COVID, THERE'S NO CURE NEAR
LONG COVID.
TREATMENT IS LARGELY SIM TOMATIC
AND IT IS INDIVIDUALIZED BECAUSE
I ONCE TOLD, YOU KNOW IF YOU
HAVE SEEN 1 LONG COVID PATIENT,
YOU'VE SEEN 1 LONG COVID
PATIENT.
YES, DO SYMPTOMS INCLUDE BRAIN
FOG, FATIGUE AND POST EXERTION
AND MALAISE, YES, BUT PEOPLE
TEND TO VARY AND TREATMENT
PROTOCOL WILL HAVE TO
NECESSARILY BE INDIVIDUALIZED TO
A SPECIFIC PATIENT, FOR EXAMPLE,
SOMEBODY SHOWS UP TO THE CLINIC
WITH TACHYCARDIA ABOUT
RESPONDING TO BETA BLOCKERS BUT
THAT'S ONLY REDUCING THE HEART
RATE, BETA BLOCKERS ARE NOT
TREATING THE REASON WHY THIS
PERSON ALL OF A SUDDEN HAS
TACHYCARDIA AS A COMPONENT OF
THEIR LONG COVID AND NOT
TREATING THE UNDERLYING
PATHOGENESIS OF THAT TACHYCARDIA
IS REALLY JUST SYMPTOMATICALLY
USING BETA BLOCKERS TO LOWER THE
HEART RATE WHERE IT'S MORE
MANAGEABLE SO IT'S LESS
BURDENSOME ON THE PATIENT.
SO IT'S SYMPTOMATIC MANAGEMENT
ON THE PART OF PATIENTS BUT YOU
KNOW WE'VE SEEN REALLY WONDERFUL
SUCCESSES, I ALWAYS LIKE TO
ALSO, SEE THE GLASS HALF FULL,
YOU KNOW.
A LOT OF THESE ACTUALLY WORK AND
PATIENTS DO FEEL BETTER.
AGAIN, WE DON'T CURE THE DISEASE
BUT DEFINITELY, THERE ARE
SIGNIFICANT ARRAY OF TREATMENT
OPTIONS OR OF MANAGEMENT
OPTIONS, I SHOULD SAY TO MANAGE
THE DIFFERENT SEQUELA OR
DIFFERENT COMPONENTS OF LONG
COVID.
>> AND SO, SINCE THE SYMPTOMARY
DISEASE IS IN MOST ADULTS, THE
SYMPTOMATIC DEC IS DIFFERENT
BETWEEN CHILDREN VERSUS ARK
DULLS FOLLOWING SARS-COV-2
INFECTION.
SO DO WE KNOW, DO THE RATES OF
SEVERITY DIFFER FROM CHILDREN TO
ADULTS?
>> THE RATES, SO LONG COVID IS
ALSO IS IN KIDS AND KIDS WITH
LONG COVID, I SHOWED THE ART
WORK OF ROSIE WHO IS AN IRISH
KID WHO'S BEEN BALGING LONG
COVID FOR 3 YEARS BUT
FORTUNATELY THE PREVALENCE OF
LONG COVID IN ACE CASES MUCH
LOWER THAN THE CASES OF LONG
COVID IN ADULTS AND THERE MAY E
ALSO DIFFERENCES IN THE
PHENOTYPES OF LONG COVID, IT'S
NOT THE SAME THING, YOU KNOW THE
GENERAL FEATURES ARE THE SAME.
YOU KNOW SORT OF THE -- SOME
PECULIARITY THAT MAKES IT
SLIGHTLY DIFFERENT THAN LONG
COVID AND IN ARK DULLS AND THERE
ARE GENERALADDAGE OR WISDOM AND
IT'S WISE IN SAYING THAT KIDS
ARE NOT JUST SMALL ADULTS THEY
HAVE THEIR OWN PHYSIOLOGY AND
THE VIRUS ACTS DIFFERENTLY AND
THATIA ALSO CLEARLY SEEN IN LONG
COVID, BUT HAVING SAID THAT FOR
THE BROADER, BROADER SORT OF,
YOU KNOW IDEA THAT YOU KNOW THEY
GET AN ACUTE VIRUS AND THEY'RE
LEFT WITH LONG-TERM ILLNESS AND
REALLY CLEARLY PART OF THIS
FUNCTION LIKE BRAIN FOG AND
FATIGUE, RECAPITULATE MUCH OF
THE SYMPTOMATOLOGY WE ALSO SEE
IN ACULTINGS.
EMPLOY IN, AND YOU THERE ARE NO
VACCINES PREVENTING LONG COVID,
RIGHT IN AND DO WE HAVE DATA
SEGREGATED BY THE VACCINE
PLATFORM SO THAT DIFFERENT
VACCINE PLATFORM LIKE MRNA, LIKE
PROTEIN BASED HAVE DIFFERENT
IMPACT WHEN PREVENTING LONG
COVID.
>> WE DON'T HAVE A FACE-TO-FACE
OR HEAD-TO-HEAD TRIAL OR
HEAD-TO-HEAD STUDY, HEAD-TO-HEAD
EVALUATION WHICH WILL BE THE
BEST AND GOLD STANDARD IN
HELPING US EXACTLY ADDRESS THIS
WOBDERFUL QUESTION IS A VERY
IMPORTANT QUESTION, SO WE DON'T
HAVE HEAD-TO-HEAD EVALUATION,
THAT NEEDS TO BE DONE, WE HAVE
CLEARLY BEEN SHOWING YOU THAT
THE MAJORITY OF PEOPLE IN THE
U.S. ARE GETTING MR, INA BASED
ACSEENS AND THAT REDUCES THE
RISK OF LONG COVID.
JUST RECEIPTLY REVIEWED AND
RECENTLY PUBLISHED A BIG CHINESE
STUDY IN 1 OF THE LANCET
JOURNALS SHOWING THAT VACCINES
THERE WHICH ARE NOT MRNA BASED
ACSEENS ALSO REDUCE THE RISK OF
LONG COVID.
SO I THINK BUT AGAIN TO THE
POINT THE PERSON ASKING THE
QUESTION VERY, VERY ON POINT, I
WOULD LIKE TO SEE HEAD-TO-HEAD
COMPARISONS SO WE CAN EVALUATE
IN THE SAME SORT OF ANALYTIC
PLATFORM AND APPROACH, HOW DO
THESE VACCINES FAIR HEAD-TO-HEAD
BUT THAT'S NOT AVAILABLE.
BUT AGAIN IN U.S. AND CHINA, WE
SEE THAT THE VACCINES REDUCE THE
RISK OF LONG COVID.
IT'S NOT A HUGE REDUCTION IN
RISK BUT CERTAINLY REDUCE THE
RISK OF LONG OF COURSE.
I THINK THE KEY QUESTION GOING
FORWARD IS WHETHER REPEATED
VACCINATION SYSTEM NEEDED TO
REDUCE THE RISK OF LONG ON
COVID.
FOR EXAMPLE, WHETHER SOMEBODY IN
2026 OR 2024 OR 2028 WILL NEED
THEIR SEVENTH, EIGHTH, NINTH,
TENTH, BOOSTER OR VACCINE DOSE
IN 2027, 2028 TO REDUCE THE RISK
OF LONG COVID AND THAT WE DON'T
REALLY KNOW, WE TAKE IT FOR
GRANTED OR I THINK THAT'S REALLY
HAD NOT BEEN VALENTINED
DIADICKED IM PERICALLY THAT WE
NEED THE COVID VACCINE EVERY
YEAR BUT DO WE?
I THINK THAT'S ALSO ANOTHER
QUESTION THAT NEEDS TO BE
EVALUATED IN THE DATA?
IF I DEFINITELY THAT THE FDA
NEED TO THINK ABOUT THIS.
AGAIN I'M VERY PROVACCINE BUT I
ALSO WANT US TO ORIENT OUR
POLICY OR GUIDING OUR POLICY
WITH ACTUAL DATA AND IM PERRIC
EVALUATION OF EVIDENCE SO WE CAN
HAVE POLICY THAT'S ACTUAL TRULY,
TRULY INFORMED AND GUIDED BY
EVIDENCE.
UNFORTUNATELY, WE HAVE REACHED
THE END OF THE HOUR AND WE HAVE
SEVERAL QUESTIONS LEFT.
WE WILL CORDINATE WITH YOU
LATER.
I DO THANK YOU AND THANK YOU IF
ARE SHARING OUR FINDINGS, OTHER
FINDINGS REGARDING LONG COVID
HAD WHICH IS VERY IMPORTANT FOR
US.
THANK YOU SO MUCH.
>> THANK YOU EMPLOY THANK YOU
VERY HAVING ME.