1 00:00:05,840 --> 00:00:08,960 >> WELCOME. 2 00:00:08,960 --> 00:00:11,800 THIS IS WIN ARIAS AT THE NIH. 3 00:00:11,800 --> 00:00:13,760 AND YOU ARE MOST WELCOME TO THE 4 00:00:13,760 --> 00:00:16,800 13TH SESSION OF THE 21ST YEAR OF 5 00:00:16,800 --> 00:00:20,240 A COURSE CALLED DEMYSTIFYING 6 00:00:20,240 --> 00:00:21,640 MEDICINE, WHICH SEEKS TO BRIDGE 7 00:00:21,640 --> 00:00:24,360 THE EXCITING DEVELOPMENTS IN 8 00:00:24,360 --> 00:00:28,280 BIOLOGY AND ENGINEERING WITH 9 00:00:28,280 --> 00:00:28,760 MEDICINE. 10 00:00:28,760 --> 00:00:32,520 MANY OF OUR TOPICS HAVE 11 00:00:32,520 --> 00:00:34,320 PARTICULAR INTEREST TO SOMEWHAT 12 00:00:34,320 --> 00:00:37,720 SMALLER GROUPS OF INDIVIDUALS. 13 00:00:37,720 --> 00:00:40,520 BUT TODAY'S TOPIC, CHRONIC 14 00:00:40,520 --> 00:00:43,600 COVID, OR LONG HAUL COVID, IS OF 15 00:00:43,600 --> 00:00:46,400 INTEREST TO EVERYONE. 16 00:00:46,400 --> 00:00:48,200 IN FACT, TO THE WORLD 17 00:00:48,200 --> 00:00:49,520 SO AS I MENTIONED, THIS IS 18 00:00:49,520 --> 00:00:51,840 REALLY A COURSE IN 19 00:00:51,840 --> 00:00:54,680 BRIDGE-BUILDING, AND IN THIS 20 00:00:54,680 --> 00:01:00,680 CASE TODAY, WE ARE BRIDGING THE 21 00:01:00,680 --> 00:01:04,440 ENTIRE AREA THE CHRONIC COVID. 22 00:01:04,440 --> 00:01:06,160 PARTICULARLY I WOULD EMPHASIZE 23 00:01:06,160 --> 00:01:08,080 THE NEUROLOGIC AND THE MENTAL 24 00:01:08,080 --> 00:01:12,640 DISEASE ASPECT OF IT. 25 00:01:12,640 --> 00:01:17,040 AND THAT PUTS 'S WHAT THE TWO 26 00:01:17,040 --> 00:01:18,240 GENTLEMEN ON THE CATWALK ARE 27 00:01:18,240 --> 00:01:18,760 DISCUSSING. 28 00:01:18,760 --> 00:01:20,040 THEY ARE BRIDGING BETWEEN 29 00:01:20,040 --> 00:01:21,400 BROOKLYN AND NEW YORK, AND 30 00:01:21,400 --> 00:01:23,840 LIKEWISE, WE WILL BE BRIDGING TO 31 00:01:23,840 --> 00:01:26,840 LEARN MORE ABOUT CHRONIC COVID 32 00:01:26,840 --> 00:01:32,480 AND WHERE WE STAND. 33 00:01:32,480 --> 00:01:34,920 NOW WHAT IS POST-COVID PROBLEMS 34 00:01:34,920 --> 00:01:35,360 ANYWAY? 35 00:01:35,360 --> 00:01:37,760 AND THIS SLIDE LISTS A BUNCH OF 36 00:01:37,760 --> 00:01:39,040 THEM, AND YOU'RE GOING TO HEAR 37 00:01:39,040 --> 00:01:40,800 MORE DISCUSSION AND DETAIL OF 38 00:01:40,800 --> 00:01:42,280 THEM. 39 00:01:42,280 --> 00:01:46,040 THEY RANGE FROM RESPIRATORY 40 00:01:46,040 --> 00:01:49,360 SHORTNESS OF BREATH/COUGH, 41 00:01:49,360 --> 00:01:50,800 MEMORY, CONCENTRATION, SLEEP 42 00:01:50,800 --> 00:01:53,760 PROBLEMS, CARDIOVASCULAR, 43 00:01:53,760 --> 00:01:54,640 PALPITATIONS, LOSS OF SMELL OR 44 00:01:54,640 --> 00:01:57,360 TASTE, WHICH WAS RECOGNIZED VERY 45 00:01:57,360 --> 00:01:58,320 EARLY IN THE COURSE OF THE 46 00:01:58,320 --> 00:02:00,640 DISEASE. 47 00:02:00,640 --> 00:02:02,360 AND OF COURSE, SUBSTANTIAL 48 00:02:02,360 --> 00:02:05,440 INCREASE IN DEPRESSION AND 49 00:02:05,440 --> 00:02:07,840 ANXIETY, BROUGHT ABOUT BY THE 50 00:02:07,840 --> 00:02:09,480 ISOLATION THAT IS IMPOSED BY THE 51 00:02:09,480 --> 00:02:11,360 VIRAL INFECTION. 52 00:02:11,360 --> 00:02:13,720 AND FEVER AND DIZZINESS. 53 00:02:13,720 --> 00:02:16,720 AND THEN THERE ARE RARE TRUE 54 00:02:16,720 --> 00:02:19,240 ORGAN DAMAGES, WHERE PATHOLOGY 55 00:02:19,240 --> 00:02:22,000 HAS BEEN SHOWN, THE RARE 56 00:02:22,000 --> 00:02:24,840 MULTISYSTEM INFLAMMATORY 57 00:02:24,840 --> 00:02:26,320 SYNDROME, KAWASAKI'S, MAINLY IN 58 00:02:26,320 --> 00:02:28,920 VERY YOUNG CHILDREN AND YOUNG 59 00:02:28,920 --> 00:02:31,800 ADULTS, CARDIOVASCULAR, KIDNEY, 60 00:02:31,800 --> 00:02:36,160 CLOT FORMATION, STROKES, AND THE 61 00:02:36,160 --> 00:02:39,440 GUILLAIN-BARRE SYNDROME. 62 00:02:39,440 --> 00:02:40,960 ALL HAVE OCCURRED, ARE RARE, AND 63 00:02:40,960 --> 00:02:42,080 WHETHER THEY ARE DIRECT RESULTS 64 00:02:42,080 --> 00:02:44,520 OF THE COVID VIRUS INFECTION IS 65 00:02:44,520 --> 00:02:48,800 ONE OF THE TOPICS THAT WILL BE 66 00:02:48,800 --> 00:02:54,840 DISCUSSED TODAY. 67 00:02:54,840 --> 00:02:58,040 AN ARTIST CAPTURED THE ENTIRE 68 00:02:58,040 --> 00:02:58,640 PANORAMA. 69 00:02:58,640 --> 00:03:04,120 THIS IS FROM THE COVER OF "CELL" 70 00:03:04,120 --> 00:03:04,560 MAGAZINE, MARCH 3RD. 71 00:03:04,560 --> 00:03:06,080 IN THE REARVIEW MIRROR AT THE 72 00:03:06,080 --> 00:03:07,840 BOTTOM OF THE SLIDE IS WHAT 73 00:03:07,840 --> 00:03:08,280 WE'VE PASSED. 74 00:03:08,280 --> 00:03:12,880 THAT IS, THE VIRUS. 75 00:03:12,880 --> 00:03:15,240 BUT WHAT'S AHEAD IS A LONG AND 76 00:03:15,240 --> 00:03:17,680 COMPLICATED ROAD, AND IT'S NOT 77 00:03:17,680 --> 00:03:20,440 CLEAR WHEN AND HOW IT REACHES 78 00:03:20,440 --> 00:03:22,240 THE ACTUAL SUNSHINE. 79 00:03:22,240 --> 00:03:27,200 AND IT'S THIS AREA OF 80 00:03:27,200 --> 00:03:27,840 UNCERTAINTY AND CHALLENGE THAT 81 00:03:27,840 --> 00:03:29,160 WILL BE DISCUSSED TODAY, AND WE 82 00:03:29,160 --> 00:03:36,560 ARE MOST FORTUNATE TO HAVE TWO 83 00:03:36,560 --> 00:03:37,920 INDIVIDUALS WHO HAVE PLAYED AND 84 00:03:37,920 --> 00:03:40,760 ARE PLAYING A MAJOR ROLE IN 85 00:03:40,760 --> 00:03:43,840 TRYING TO UNRAVEL THE PROBLEMS 86 00:03:43,840 --> 00:03:46,240 OF CHRONIC COVID, PARTICULARLY 87 00:03:46,240 --> 00:03:50,040 FROM THE STANDPOINT OF NEUROLOGY 88 00:03:50,040 --> 00:03:50,720 AND MENTAL HEALTH. 89 00:03:50,720 --> 00:03:58,040 SO EACH IS A DIRECTOR OF THE 90 00:03:58,040 --> 00:04:00,720 NATIONAL INSTITUTE AND NATIONAL NATIONAL 91 00:04:00,720 --> 00:04:01,440 INSTITUTES OF HEALTH. 92 00:04:01,440 --> 00:04:03,640 OUR FIRST SPEAKER, JOSH GORDON, 93 00:04:03,640 --> 00:04:09,280 HAS HIS DEGREE, M.D. AND PH.D., 94 00:04:09,280 --> 00:04:11,440 WORKED FOR MANY YEARS AT 95 00:04:11,440 --> 00:04:13,440 COLUMBIA UNIVERSITY AND THE 96 00:04:13,440 --> 00:04:15,960 PSYCHIATRIC INSTITUTE ASSOCIATED 97 00:04:15,960 --> 00:04:19,840 WITH IT, AND CAME IN 2016 TO BE 98 00:04:19,840 --> 00:04:22,640 THE DIRECTOR OF THE NATIONAL 99 00:04:22,640 --> 00:04:23,280 INSTITUTE OF MENTAL HEALTH, 100 00:04:23,280 --> 00:04:27,000 WHICH YOU SHOULD KNOW OVERSEES 101 00:04:27,000 --> 00:04:32,520 OVER $2 BILLION IN RESEARCH. 102 00:04:32,520 --> 00:04:34,880 RESEARCH AND PUBLIC OUTREACH ON 103 00:04:34,880 --> 00:04:37,240 THE PANDEMIC'S EFFECT ON MENTAL 104 00:04:37,240 --> 00:04:37,560 HEALTH. 105 00:04:37,560 --> 00:04:39,040 JOSH IS A MEMBER OF THE NATIONAL 106 00:04:39,040 --> 00:04:42,640 ACADEMY OF MEDICINE, AND HIS OWN 107 00:04:42,640 --> 00:04:47,440 INDIVIDUAL RESEARCH IS IN 108 00:04:47,440 --> 00:04:48,640 APPLYING NEUROSCIENCE TECHNIQUES 109 00:04:48,640 --> 00:04:52,840 FROM IN VIVO IMAGING, BEHAVIORAL 110 00:04:52,840 --> 00:04:58,040 RECORDINGS, OPT THOUGH , USING THESE TO ST UDY 111 00:04:58,040 --> 00:04:59,480 IN PATIENTS SCHIZOPHRENIA, 112 00:04:59,480 --> 00:05:00,840 ANXIETY AND, OF COURSE, 113 00:05:00,840 --> 00:05:03,640 DEPRESSION. 114 00:05:03,640 --> 00:05:06,240 SO DR. GORDON WILL BE OUR FIRST 115 00:05:06,240 --> 00:05:10,000 SPEAKER, AND THEN OUR SECOND 116 00:05:10,000 --> 00:05:14,240 SPEAKER IS WALTER KOROSHETZ, WHO 117 00:05:14,240 --> 00:05:18,480 TRAINED IN NEUROLOGY AND 118 00:05:18,480 --> 00:05:19,400 NEUROSCIENCES LARGELY AT 119 00:05:19,400 --> 00:05:21,680 HARVARD, WHERE HE WAS AT THE 120 00:05:21,680 --> 00:05:24,320 MASSACHUSETTS GENERAL HOSPITAL 121 00:05:24,320 --> 00:05:30,880 FOR MANY YEARS, CAME TO THE NIH 122 00:05:30,880 --> 00:05:32,560 AS DEPUTY DIRECTOR OF THE 123 00:05:32,560 --> 00:05:34,840 NATIONAL INSTITUTE OF NEUROLOGIC 124 00:05:34,840 --> 00:05:37,280 DISEASES, AND IN 2015, HE WAS 125 00:05:37,280 --> 00:05:39,680 MADE THE DIRECTOR. 126 00:05:39,680 --> 00:05:42,760 THAT INSTITUTE OVERSEES IN 127 00:05:42,760 --> 00:05:45,600 EXCESS OF $2.5 BILLION FOR 128 00:05:45,600 --> 00:05:51,920 RESEARCH IN NEUROLOGIC DISEASES. 129 00:05:51,920 --> 00:05:54,040 IT IS ALSO A PRIMARY FUNDER OF 130 00:05:54,040 --> 00:05:55,640 COVID-19 RESEARCH DUE TO 131 00:05:55,640 --> 00:05:58,480 SARS-COV-2 VIRUS, AND ITS EFFECT 132 00:05:58,480 --> 00:06:00,800 ON THE BRAIN AND THE NERVOUS 133 00:06:00,800 --> 00:06:01,440 SYSTEM. 134 00:06:01,440 --> 00:06:04,040 WALTER IS ALSO A MEMBER OF THE 135 00:06:04,040 --> 00:06:05,600 NATIONAL ACADEMY OF MEDICINE, 136 00:06:05,600 --> 00:06:09,760 AND HIS INDIVIDUAL RESEARCH IS 137 00:06:09,760 --> 00:06:13,800 ON EXYITOTOXICITY AS A CAUSE OF 138 00:06:13,800 --> 00:06:14,840 NEURONAL CELL DEATH. 139 00:06:14,840 --> 00:06:17,840 SO DR. GORDON WILL SPEAK FIRST, 140 00:06:17,840 --> 00:06:19,240 HE'LL BE FOLLOWED BY 141 00:06:19,240 --> 00:06:19,920 DR. KOROSHETZ. 142 00:06:19,920 --> 00:06:24,360 WE ENCOURAGE YOU TO SUBMIT 143 00:06:24,360 --> 00:06:25,240 QUESTIONS DURING THESE 144 00:06:25,240 --> 00:06:25,920 PRESENTATIONS, AND THEN THEY 145 00:06:25,920 --> 00:06:29,080 WILL BE DISCUSSED IN A Q & A 146 00:06:29,080 --> 00:06:31,280 PERIOD AT THE CONCLUSION OF 147 00:06:31,280 --> 00:06:33,680 DR. KOROSHETZ' TALK. 148 00:06:33,680 --> 00:06:37,800 SO PLEASE, DR. GORDON. 149 00:06:37,800 --> 00:06:40,080 >> THANKS, WIN. 150 00:06:40,080 --> 00:06:41,480 APPRECIATE THE INTRODUCTION. 151 00:06:41,480 --> 00:06:42,880 AND I WAS LOOKING FORWARD TO 152 00:06:42,880 --> 00:06:44,440 SPEAKING WITH YOU ALL ABOUT 153 00:06:44,440 --> 00:06:46,400 COVID-19 AND MENTAL HEALTH. 154 00:06:46,400 --> 00:06:48,200 AND I TITLED THIS "THE SHORT AND 155 00:06:48,200 --> 00:06:49,600 THE LONG OF IT." 156 00:06:49,600 --> 00:06:50,560 HOPEFULLY IT WILL BE A LITTLE ON 157 00:06:50,560 --> 00:06:51,520 THE SHORTER SIDE 158 00:06:51,520 --> 00:06:53,240 FIRST I HAVE NO DISCLOSURES, AND 159 00:06:53,240 --> 00:06:55,200 THE OBJECTIVES ARE LISTED HERE. 160 00:06:55,200 --> 00:06:56,400 TO UNDERSTAND MENTAL HEALTH 161 00:06:56,400 --> 00:06:58,040 IMPACTS OF THE PANDEMIC AND 162 00:06:58,040 --> 00:07:00,440 UNDERSTAND THE BIDIRECTIONAL 163 00:07:00,440 --> 00:07:01,360 RELATIONSHIP BETWEEN COVID-19 164 00:07:01,360 --> 00:07:01,960 AND MENTAL HEALTH. 165 00:07:01,960 --> 00:07:04,480 AND IF WE'RE GOING TO TALK ABOUT 166 00:07:04,480 --> 00:07:06,920 LONG COVID OR CHRONIC COVID OR 167 00:07:06,920 --> 00:07:09,320 THE POST-ACUTE SEQUELAE OF COVID 168 00:07:09,320 --> 00:07:10,800 INFECTION, IN THE CONTEXT OF 169 00:07:10,800 --> 00:07:11,520 MENTAL ILLNESS, IT'S REALLY 170 00:07:11,520 --> 00:07:13,800 IMPORTANT TO UNDERSTAND THAT 171 00:07:13,800 --> 00:07:14,960 LONG COVID IS NOT TAKING PLACE 172 00:07:14,960 --> 00:07:18,480 IN A VACUUM, IT'S TAKING PLACE 173 00:07:18,480 --> 00:07:20,360 IN THE CONTEXT OF TREMENDOUS 174 00:07:20,360 --> 00:07:21,440 MENTAL HEALTH IMPACTS OF THE 175 00:07:21,440 --> 00:07:22,960 PANDEMIC ON THE GENERAL 176 00:07:22,960 --> 00:07:24,080 POPULATION, AS WELL AS IMPACTS 177 00:07:24,080 --> 00:07:25,960 OF THE PANDEMIC ON THOSE WITH 178 00:07:25,960 --> 00:07:27,680 PRE-EXISTING MENTAL ILLNESSES. 179 00:07:27,680 --> 00:07:28,920 THOSE COMPLICATE OUR ABILITY TO 180 00:07:28,920 --> 00:07:30,960 STUDY THE PERSISTENT MENTAL 181 00:07:30,960 --> 00:07:31,760 HEALTH EFFECTS OF COVID 182 00:07:31,760 --> 00:07:32,520 INFECTION ITSELF. 183 00:07:32,520 --> 00:07:34,280 SO I'LL TAKE YOU THROUGH THOSE 184 00:07:34,280 --> 00:07:35,080 FIRST TWO POINTS BEFORE WE 185 00:07:35,080 --> 00:07:36,880 ACTUALLY GET INTO THE DISCUSSION 186 00:07:36,880 --> 00:07:43,760 OF LONG COVID PER SE. 187 00:07:43,760 --> 00:07:50,880 SO WHAT HAVE BEEN IMPACTS OF THE 188 00:07:50,880 --> 00:07:52,920 PANDEMIC -- FIRST AND FOREMOST 189 00:07:52,920 --> 00:07:55,160 WE KNOW WHAT TO EXPECT IN THE 190 00:07:55,160 --> 00:07:56,600 CONTEXT OF DISASTERS AND OTHER 191 00:07:56,600 --> 00:07:57,560 EMERGENCIES FROM REALLY DECADES 192 00:07:57,560 --> 00:07:58,440 OF RESEARCH. 193 00:07:58,440 --> 00:07:59,920 MOST WHO ARE EXPOSED TO 194 00:07:59,920 --> 00:08:02,960 TRAUMATIC EXPERIENCES WILL HAVE 195 00:08:02,960 --> 00:08:03,800 SOME INITIAL SYMPTOMS, AND FOR 196 00:08:03,800 --> 00:08:05,160 MOST OF THOSE, THOSE SYMPTOMS 197 00:08:05,160 --> 00:08:08,080 WILL IMPROVE WITH TIME. 198 00:08:08,080 --> 00:08:09,480 SOME, THOUGH, WILL HAVE LONG 199 00:08:09,480 --> 00:08:10,720 TERM OR CHRONIC EXPERIENCES WITH 200 00:08:10,720 --> 00:08:11,760 MENTAL ILLNESS IN THE AFTERMATH 201 00:08:11,760 --> 00:08:13,680 OF SUCH AN EMERGENCY. 202 00:08:13,680 --> 00:08:18,360 LOTS OF FACTORS PREDISPOSE 203 00:08:18,360 --> 00:08:19,920 TOWARDS THOSE LONGER TERM 204 00:08:19,920 --> 00:08:21,000 EXPERIENCES INCLUDING SOCIAL 205 00:08:21,000 --> 00:08:22,360 INEQUITIES, DISPARITIES WITH 206 00:08:22,360 --> 00:08:24,440 REGARD TO TRAUMA EXPOSURE 207 00:08:24,440 --> 00:08:26,560 ITSELF, AND SUBSEQUENT MENTAL 208 00:08:26,560 --> 00:08:27,480 HEALTHCARE VULNERABILITY. 209 00:08:27,480 --> 00:08:29,560 BUT ONE OF THE STRONGEST FACTORS 210 00:08:29,560 --> 00:08:34,040 PREDICTING CROW CHRONICITY AND 211 00:08:34,040 --> 00:08:37,000 SEVERITY IS IMMEDIATE EXPOSURE 212 00:08:37,000 --> 00:08:38,200 TO THE TRAUMATIC EVENT. 213 00:08:38,200 --> 00:08:40,160 LET'S SAY YOU HAVE PSYCHIATRIC 214 00:08:40,160 --> 00:08:41,320 SYMPTOMS IN THE AFTERMATH OF 215 00:08:41,320 --> 00:08:41,920 LONG COVID. 216 00:08:41,920 --> 00:08:44,200 IS THAT DUE TO THE TRAUMATIC 217 00:08:44,200 --> 00:08:45,880 EXPERIENCE OF THE INFECTION AND 218 00:08:45,880 --> 00:08:47,720 OF BEING IN THE HOSPITAL AND OF 219 00:08:47,720 --> 00:08:49,160 BEING SEPARATED FROM LOVED ONES? 220 00:08:49,160 --> 00:08:52,840 OR IS IT DUE DIRECTLY TO A 221 00:08:52,840 --> 00:08:54,600 BIOLOGICAL CONSEQUENCE OF THE 222 00:08:54,600 --> 00:08:55,240 INFECTION? 223 00:08:55,240 --> 00:08:56,240 WE'LL TALK MORE ABOUT THAT AS 224 00:08:56,240 --> 00:08:59,120 TIME MOVES ON. 225 00:08:59,120 --> 00:09:00,920 IN ADDITION TO THESE RISK 226 00:09:00,920 --> 00:09:01,720 FACTORS I'VE MENTIONED, THERE 227 00:09:01,720 --> 00:09:03,440 ARE OTHER INDIVIDUAL DIFFERENCES 228 00:09:03,440 --> 00:09:04,680 INCLUDING HISTORY OF PRIOR 229 00:09:04,680 --> 00:09:06,520 TRAUMA OR MENTAL ILLNESS, 230 00:09:06,520 --> 00:09:08,160 ONGOING STRESSORS INCLUDING 231 00:09:08,160 --> 00:09:10,080 OCCUPATIONAL/FINANCIAL STRAIN, 232 00:09:10,080 --> 00:09:11,680 SUBSTANCE ABUSE, BEING FEMALE OR 233 00:09:11,680 --> 00:09:13,360 NON-WHITE, AND HAVING FEW SOCIAL 234 00:09:13,360 --> 00:09:13,640 SUPPORTS. 235 00:09:13,640 --> 00:09:15,640 OF COURSE THESE INDIVIDUAL 236 00:09:15,640 --> 00:09:18,040 DIFFERENCES ALSO ARE 237 00:09:18,040 --> 00:09:19,440 INTERACTING, NUMBER ONE, AND 238 00:09:19,440 --> 00:09:20,880 NUMBER TWO, MAY BE ACTUALLY 239 00:09:20,880 --> 00:09:22,280 REFLECTIVE OF ONE OR MORE OF THE 240 00:09:22,280 --> 00:09:23,280 OTHER ONES. 241 00:09:23,280 --> 00:09:25,360 SO THE POINT HERE IS NOT TO TRY 242 00:09:25,360 --> 00:09:27,400 TO CONVINCE YOU OF INDIVIDUAL 243 00:09:27,400 --> 00:09:28,760 RISK FACTORS, BUT TO SAY THAT 244 00:09:28,760 --> 00:09:30,560 THERE'S NO SINGLE VARIABLE THAT 245 00:09:30,560 --> 00:09:31,680 DETERMINES INDIVIDUAL OUTCOMES 246 00:09:31,680 --> 00:09:33,200 IN THE SETTING OF AN EMERGENCY. 247 00:09:33,200 --> 00:09:34,640 AND IT'S QUITE AN EMERGENCY 248 00:09:34,640 --> 00:09:36,920 WE'VE BEEN FACING OVER THE LAST 249 00:09:36,920 --> 00:09:37,360 TWO YEARS. 250 00:09:37,360 --> 00:09:38,880 I KNOW I DON'T HAVE TO TELL YOU 251 00:09:38,880 --> 00:09:39,680 ALL. 252 00:09:39,680 --> 00:09:40,960 BUT THE REASON WHY WE'RE VIRTUAL 253 00:09:40,960 --> 00:09:42,360 AND NOT IN BUILDING 50 RIGHT NOW 254 00:09:42,360 --> 00:09:43,480 IS SHOWN RIGHT HERE ON THIS 255 00:09:43,480 --> 00:09:45,240 GRAPH, WHICH IS A GRAPH OF THE 256 00:09:45,240 --> 00:09:47,640 DAILY CASES OF COVID OVER THE 257 00:09:47,640 --> 00:09:49,040 LAST TWO YEARS, WITH THE 258 00:09:49,040 --> 00:09:50,480 PROMINENT OMICRON SPIKE RIGHT 259 00:09:50,480 --> 00:09:54,160 THERE IN THE EARLY 2022. 260 00:09:54,160 --> 00:09:56,320 EVEN EARLY IN THE PANDEMIC, IT 261 00:09:56,320 --> 00:09:58,160 WAS RECOGNIZED THAT THE PANDEMIC 262 00:09:58,160 --> 00:10:00,080 AND/OR THE MITIGATION MEASURES 263 00:10:00,080 --> 00:10:01,720 AND THE ECONOMIC IMPACTS HAVE 264 00:10:01,720 --> 00:10:03,160 HAD SUBSTANTIAL EFFECTS ON 265 00:10:03,160 --> 00:10:05,120 MENTAL HEALTH IN THE GENERAL 266 00:10:05,120 --> 00:10:06,560 POPULATION. 267 00:10:06,560 --> 00:10:09,040 THE EARLIEST REPORT WAS IN THE 268 00:10:09,040 --> 00:10:11,000 SUMMER OF 2020, TAKING DATA 269 00:10:11,000 --> 00:10:16,160 THROUGH LATE JUNE OF 2020. 270 00:10:16,160 --> 00:10:16,800 BASICALLY THE FIRST SPRING OF 271 00:10:16,800 --> 00:10:18,040 THE PANDEMIC SHOWING THE 272 00:10:18,040 --> 00:10:19,240 DOUBLING OF THE RATE AT WHICH 273 00:10:19,240 --> 00:10:22,080 U.S. ADULTS REPORTED STRUGGLING 274 00:10:22,080 --> 00:10:23,000 THROUGH MENTAL HEALTH ACROSS A 275 00:10:23,000 --> 00:10:26,360 RANGE OF DIFFERENT FACTORS. 276 00:10:26,360 --> 00:10:27,960 THAT INCREASE PERSISTED AND 277 00:10:27,960 --> 00:10:29,280 ACTUALLY EVEN ROSE THROUGH THE 278 00:10:29,280 --> 00:10:35,400 FALL OF 2020 AND INTO EARLY 279 00:10:35,400 --> 00:10:38,240 2021, WITH APPROXIMATELY 35 TO 280 00:10:38,240 --> 00:10:42,840 40% OF AMERICANS SELF-REPORTING 281 00:10:42,840 --> 00:10:44,440 SYMPTOMS OF AN ANXIETY OR 282 00:10:44,440 --> 00:10:44,960 DEPRESSIVE DISORDER. 283 00:10:44,960 --> 00:10:46,760 THESE ARE SUBSTANTIALLY HIGHER 284 00:10:46,760 --> 00:10:48,520 NUMBERS THAN WE WOULD EXPECT AT 285 00:10:48,520 --> 00:10:53,160 BASELINE. 286 00:10:53,160 --> 00:10:55,440 ANOTHER INDICATION, A LITTLE BIT 287 00:10:55,440 --> 00:10:59,040 HARDER DATA, IS AN INCREASE IN 288 00:10:59,040 --> 00:11:00,120 THE RATES AT WHICH INDIVIDUALS 289 00:11:00,120 --> 00:11:03,080 WERE SEEKING PRESCRIPTION 290 00:11:03,080 --> 00:11:04,600 MEDICATION OR RECEIVING COUNSEL 291 00:11:04,600 --> 00:11:06,560 EGG OR THERAPY FOR MENTAL HEALTH 292 00:11:06,560 --> 00:11:08,360 SYMPTOMS BUT ALL POINT TO THE 293 00:11:08,360 --> 00:11:09,200 TREMENDOUS EFFECTS OF THE 294 00:11:09,200 --> 00:11:09,640 PANDEMIC. 295 00:11:09,640 --> 00:11:10,840 NOW ONE COULD SAY, OH, MAYBE 296 00:11:10,840 --> 00:11:12,600 IT'S JUST MILD OR MODERATE 297 00:11:12,600 --> 00:11:13,920 SYMPTOMS THAT PEOPLE ARE 298 00:11:13,920 --> 00:11:15,360 REPORTING BUT IN FACT ACROSS A 299 00:11:15,360 --> 00:11:16,880 BROAD RANGE OF SEVERITY, YOU'RE 300 00:11:16,880 --> 00:11:19,240 SEEING MORE PEOPLE AFTER COVID 301 00:11:19,240 --> 00:11:20,360 THAN BEFORE COVID REPORTING IN 302 00:11:20,360 --> 00:11:22,320 THIS CASE DEPRESSION SYMPTOMS, 303 00:11:22,320 --> 00:11:24,400 WHETHER THEY BE CLASSIFIED AS 304 00:11:24,400 --> 00:11:26,040 NON-MILD, MODERATE, MODERATELY 305 00:11:26,040 --> 00:11:26,920 SEVERE OR SEVERE. 306 00:11:26,920 --> 00:11:28,280 SO WE'RE SEEING INCREASES EVEN 307 00:11:28,280 --> 00:11:30,800 AT THE SEVERE END OF THE 308 00:11:30,800 --> 00:11:31,080 SPECTRUM. 309 00:11:31,080 --> 00:11:32,560 ONE PIECE OF GOOD NEWS IN THIS 310 00:11:32,560 --> 00:11:34,360 IS THAT WE ARE SEEING WHAT WE 311 00:11:34,360 --> 00:11:39,840 MIGHT EXPECT TO SEE, THAT IS, 312 00:11:39,840 --> 00:11:41,320 CASES -- THE CURRENT CASES IN 313 00:11:41,320 --> 00:11:43,440 RED OF COVID THROUGH THE COURSE 314 00:11:43,440 --> 00:11:47,160 OF THIS CASE, 2020, ROUGHLY 315 00:11:47,160 --> 00:11:50,800 CORRESPOND TO PEAKS AND VALLEYS 316 00:11:50,800 --> 00:11:52,840 IN REPORTS OF ANXIETY AND 317 00:11:52,840 --> 00:11:53,360 DEPRESSION. 318 00:11:53,360 --> 00:11:55,760 SO ON THE ONE HAND, WORSENING 319 00:11:55,760 --> 00:11:57,560 SEVERITY OF THE PANDEMIC, 320 00:11:57,560 --> 00:11:59,320 WORSENED SYMPTOMS IN THE GENERAL 321 00:11:59,320 --> 00:11:59,720 POPULATION. 322 00:11:59,720 --> 00:12:02,480 ON THE OTHER HAND, AS THE 323 00:12:02,480 --> 00:12:04,200 PANDEMIC ABATES, AS PREDICTED WE 324 00:12:04,200 --> 00:12:06,600 CAN EXPECT FOR MOST INDIVIDUALS, 325 00:12:06,600 --> 00:12:07,600 THOSE SYMPTOMS THEMSELVES WILL 326 00:12:07,600 --> 00:12:08,920 ABATE AS WELL. 327 00:12:08,920 --> 00:12:14,720 NOW, THERE ARE SOME SPECIFIC 328 00:12:14,720 --> 00:12:15,600 ISSUES WE'RE MOST CONCERNED 329 00:12:15,600 --> 00:12:24,960 ABOUT WITH ANY PE DICK ANY EPIDEMIC, 330 00:12:24,960 --> 00:12:27,440 POST-TRAUMATIC STRESS DISORDER 331 00:12:27,440 --> 00:12:28,960 AND WE CAN SEE AN INCREASE IN 332 00:12:28,960 --> 00:12:30,960 THE PREVALENCE OF POST-TRAUMATIC 333 00:12:30,960 --> 00:12:35,240 STRESS DISORDER IN THE CORN TEXT CON 334 00:12:35,240 --> 00:12:39,400 DEMIBGS, BE SARS, COVID-19 OR 335 00:12:39,400 --> 00:12:40,160 OTHER PANDEMICS. 336 00:12:40,160 --> 00:12:44,080 AMOUNTING TO A .1 TO .3 FOLD 337 00:12:44,080 --> 00:12:46,040 INCREASE, SO 10 TO 30% HIGHER 338 00:12:46,040 --> 00:12:48,880 RATES OF PTSD IN THE CONTEXT OF 339 00:12:48,880 --> 00:12:50,080 PANDEMICS, AND AS YOU CAN SEE 340 00:12:50,080 --> 00:12:51,400 FROM THIS PARTICULAR SET OF 341 00:12:51,400 --> 00:12:52,920 STUDY, FROM THE META-ANALYSIS, 342 00:12:52,920 --> 00:12:56,920 THAT'S TRUE FOR COVID-19 AS IT 343 00:12:56,920 --> 00:13:01,640 WAS FOR EBOLA AND SARS. 344 00:13:01,640 --> 00:13:03,840 HOW DO WE HELP PREVENT THE ONSET 345 00:13:03,840 --> 00:13:05,560 OF PTSD AND OTHER CHRONIC MENTAL 346 00:13:05,560 --> 00:13:06,680 HEALTH PROBLEMS IN THE CONTEXT 347 00:13:06,680 --> 00:13:07,760 OF PANDEMIC? 348 00:13:07,760 --> 00:13:09,400 A LOT OF IT IS WHAT WE HAVE BEEN 349 00:13:09,400 --> 00:13:12,440 DOING IN THE CONTEXT OF COVID. 350 00:13:12,440 --> 00:13:13,560 WE'VE BEEN TRYING TO MEET THE 351 00:13:13,560 --> 00:13:14,960 IMMEDIATE NEEDS OF PEOPLE FOR 352 00:13:14,960 --> 00:13:16,720 FOOD, HOUSING -- FOR FOOD, 353 00:13:16,720 --> 00:13:19,720 SHELTER AND CLOTHING. 354 00:13:19,720 --> 00:13:21,120 ONE STUDY, FOR EXAMPLE, HAS 355 00:13:21,120 --> 00:13:23,840 SHOWN THAT THOSE IN COMMUNITIES 356 00:13:23,840 --> 00:13:25,440 WHO'VE RECEIVED FREE GROCERIES 357 00:13:25,440 --> 00:13:27,920 OR MEALS COMPARED TO THOSE WHO 358 00:13:27,920 --> 00:13:29,880 DIDN'T RECEIVE FREE GROCERY OR 359 00:13:29,880 --> 00:13:32,040 MEALS HAD LOWER LEVELS OF A 360 00:13:32,040 --> 00:13:32,560 VARIETY OF MENTAL HEALTH 361 00:13:32,560 --> 00:13:33,360 COMPLAINTS. 362 00:13:33,360 --> 00:13:34,480 OTHER THINGS THAT WE CAN DO IS 363 00:13:34,480 --> 00:13:36,880 TO PRACTICE HEALTHY COPING 364 00:13:36,880 --> 00:13:38,600 STRATEGIES, SOMETHING NIMH AND 365 00:13:38,600 --> 00:13:40,520 NIH AND THE CDC HAVE ALL BEEN 366 00:13:40,520 --> 00:13:43,440 ACTIVE IN PROMOTING. 367 00:13:43,440 --> 00:13:44,760 WHETHER THAT BE ENGAGING 368 00:13:44,760 --> 00:13:46,160 SOCIALLY WITH OTHERS, SLEEPING 369 00:13:46,160 --> 00:13:50,120 AND EATING WELL, AND SEEKING 370 00:13:50,120 --> 00:13:52,040 HELP WHEN YOU NEED IT, 371 00:13:52,040 --> 00:13:55,480 PRACTICING HEALTHY COPING 372 00:13:55,480 --> 00:13:56,240 STRATEGIES CAN HELP. 373 00:13:56,240 --> 00:13:57,320 FINDING WAYS TO HELP OTHERS IN 374 00:13:57,320 --> 00:13:58,720 THE CONTEXT OF AN EMERGENCY 375 00:13:58,720 --> 00:14:01,480 PROMOTES A SENSE OF 376 00:14:01,480 --> 00:14:04,120 SELF-EFFICACY, PROMOTES CONNECT 377 00:14:04,120 --> 00:14:06,080 IFNESS AND CAN FORESTALL THE 378 00:14:06,080 --> 00:14:07,960 WORST EFFECTS OF TRAUMATIC 379 00:14:07,960 --> 00:14:08,240 EXPERIENCES. 380 00:14:08,240 --> 00:14:13,360 FLAD TO THE 381 00:14:13,360 --> 00:14:13,760 EXPERIENCES. 382 00:14:13,760 --> 00:14:15,400 THE IMPACT ON INDIVIDUALS WITH 383 00:14:15,400 --> 00:14:16,280 PRE-EXISTING MENTAL ILLNESSES 384 00:14:16,280 --> 00:14:19,000 HAVE, AS WE MIGHT HAVE EXPECTED, 385 00:14:19,000 --> 00:14:19,440 BEEN SIGNIFICANT. 386 00:14:19,440 --> 00:14:20,640 ONE OF THE THINGS THAT WAS 387 00:14:20,640 --> 00:14:24,040 UNEXPECTED OR AT LEAST NOT CLEAR 388 00:14:24,040 --> 00:14:25,560 THAT WE WOULD SEE WAS REVEALED 389 00:14:25,560 --> 00:14:31,520 ACTUALLY BY OUR COLLEAGUE, NORA 390 00:14:31,520 --> 00:14:32,800 VOLKOW, DIRECTOR THE NIDA, AND 391 00:14:32,800 --> 00:14:34,880 OTHERS WHO LOOKED AT ELECTRONIC 392 00:14:34,880 --> 00:14:35,880 HEALTHCARE DATA AND SAW THAT 393 00:14:35,880 --> 00:14:36,960 INDIVIDUALS WITH MENTAL 394 00:14:36,960 --> 00:14:38,960 ILLNESSES HAD INCREASED RATES OF 395 00:14:38,960 --> 00:14:40,280 CONTRACTING COVID-19, OF GETTING 396 00:14:40,280 --> 00:14:41,920 THE INFECTION EARLY ON IN THE 397 00:14:41,920 --> 00:14:42,560 PANDEMIC. 398 00:14:42,560 --> 00:14:43,880 THIS DATA IS FROM I THINK 399 00:14:43,880 --> 00:14:46,600 THROUGH THE SUMMER OF 2020. 400 00:14:46,600 --> 00:14:52,360 THAT INCLUDED DIAGNOSES OF ADHD, 401 00:14:52,360 --> 00:14:54,760 BIPOLAR DISORDER, DEPRESSION AND 402 00:14:54,760 --> 00:14:59,400 SCHIZOPHRENIA. 403 00:14:59,400 --> 00:15:02,480 THE LIKELIHOOD, A TENFOLD 404 00:15:02,480 --> 00:15:03,680 INCREASED RISK IF YOU HAVE A 405 00:15:03,680 --> 00:15:05,360 SERIOUS MENTAL ILLNESS COMPARED 406 00:15:05,360 --> 00:15:08,360 TO IF YOU DON'T. 407 00:15:08,360 --> 00:15:09,040 MOREOVER, IF YOU HAVE A 408 00:15:09,040 --> 00:15:10,000 PSYCHIATRIC DIAGNOSIS, YOU'RE 409 00:15:10,000 --> 00:15:11,480 MORE LIKELY TO DIE FROM COVID 410 00:15:11,480 --> 00:15:12,760 THAN IF YOU DO NOT HAVE A 411 00:15:12,760 --> 00:15:14,120 PSYCHIATRIC DIAGNOSIS, AND 412 00:15:14,120 --> 00:15:15,520 THAT'S ESPECIALLY TRUE FOR 413 00:15:15,520 --> 00:15:16,960 INDIVIDUALS WITH SCHIZOPHRENIA, 414 00:15:16,960 --> 00:15:18,680 WHO HAVE APPROXIMATELY A THREE 415 00:15:18,680 --> 00:15:20,440 FOLD INCREASE IN RISK, EVEN 416 00:15:20,440 --> 00:15:22,520 AFTER YOU ACCOUNT FOR 417 00:15:22,520 --> 00:15:26,200 COMORBIDITIES THAT ARE PRESENT 418 00:15:26,200 --> 00:15:29,280 IN SCHIZOPHRENIA LIKE HEART 419 00:15:29,280 --> 00:15:31,360 FAILURE, MYOCARDIAL INFARCTION 420 00:15:31,360 --> 00:15:31,760 AND DIABETES. 421 00:15:31,760 --> 00:15:33,880 SO EVEN CONTROLLING FOR THESE 422 00:15:33,880 --> 00:15:34,800 DEMOGRAPHIC VARIABLES WHICH 423 00:15:34,800 --> 00:15:37,560 RAISE YOUR RISK FOR DEATH FROM 424 00:15:37,560 --> 00:15:39,440 COVID, YOU HAVE AN INCREASED 425 00:15:39,440 --> 00:15:41,080 LIKELIHOOD OF DEATH IF YOU HAVE 426 00:15:41,080 --> 00:15:42,120 SERIOUS MENTAL ILLNESS LIKE 427 00:15:42,120 --> 00:15:42,960 SCHIZOPHRENIA. 428 00:15:42,960 --> 00:15:44,920 AND THAT ASSOCIATION WITH 429 00:15:44,920 --> 00:15:46,360 MORTALITY HAS BEEN BORNE OUT IN 430 00:15:46,360 --> 00:15:47,560 A META-ANALYSIS COVERING A WIDE 431 00:15:47,560 --> 00:15:49,320 RANGE OF MENTAL ILLNESSES, AND 432 00:15:49,320 --> 00:15:50,400 IT'S ESPECIALLY SEEN IN THE 433 00:15:50,400 --> 00:15:53,400 STUDIES THAT INCLUDED OR FOCUSED 434 00:15:53,400 --> 00:15:54,800 ON SCHIZOPHRENIA ACROSS A WIDE 435 00:15:54,800 --> 00:15:56,560 RANGE OF DIFFERENT LOCALITIES, 436 00:15:56,560 --> 00:15:58,680 WITH AN ODDS RATIO SLIGHTLY LESS 437 00:15:58,680 --> 00:16:00,960 THAN THAT ONE STUDY IN THE U.S. 438 00:16:00,960 --> 00:16:03,160 WOULD SUGGEST OF AROUND NEARLY 439 00:16:03,160 --> 00:16:04,960 2. 440 00:16:04,960 --> 00:16:06,400 THAT ODDS RATIO IS ENHANCED IF 441 00:16:06,400 --> 00:16:07,840 YOU'RE A MEMBER OF A MINORITY 442 00:16:07,840 --> 00:16:09,160 CLASS, WHICH ARE ALREADY AT 443 00:16:09,160 --> 00:16:11,680 INCREASED RISK OF SERIOUS 444 00:16:11,680 --> 00:16:12,880 CONSEQUENCE OF COVID. 445 00:16:12,880 --> 00:16:14,280 FOR EXAMPLE, AFRICAN AMERICANS 446 00:16:14,280 --> 00:16:15,840 WITH SCHIZOPHRENIA HAVE ABOUT A 447 00:16:15,840 --> 00:16:17,040 TWOFOLD INCREASE IN RISK 448 00:16:17,040 --> 00:16:19,360 COMPARED TO WHITES WITH 449 00:16:19,360 --> 00:16:20,320 SCHIZOPHRENIA, OF DYING FROM 450 00:16:20,320 --> 00:16:23,160 COVID IF THEY GET IT. 451 00:16:23,160 --> 00:16:24,600 AND THERE ARE SIMILAR 452 00:16:24,600 --> 00:16:26,160 DISPARITIES IN THE PREVALENCE OF 453 00:16:26,160 --> 00:16:28,200 A WIDE RANGE OF MENTAL HEALTH 454 00:16:28,200 --> 00:16:29,960 SYMPTOMS IN THE CONTEXT OF THE 455 00:16:29,960 --> 00:16:30,760 PANDEMIC, IN THE GENERAL 456 00:16:30,760 --> 00:16:32,200 POPULATION AS WELL, POINTING TO 457 00:16:32,200 --> 00:16:33,680 THE FACT THAT THE PANDEMIC HAS 458 00:16:33,680 --> 00:16:35,560 NOT BEEN KIND, IN FACT, IT'S 459 00:16:35,560 --> 00:16:37,280 BEEN PARTICULARLY BRUTAL ON 460 00:16:37,280 --> 00:16:38,840 MINORITY POPULATIONS IN THE 461 00:16:38,840 --> 00:16:43,440 UNITED STATES. 462 00:16:43,440 --> 00:16:44,880 WHAT ARE WE DOING ABOUT IT? 463 00:16:44,880 --> 00:16:46,800 I CAN TALK A LOT ABOUT THE 464 00:16:46,800 --> 00:16:48,760 RESEARCH THAT NIMH HAS SUPPORTED 465 00:16:48,760 --> 00:16:50,440 BUT I WANTED TO MENTION, ONE, 466 00:16:50,440 --> 00:16:51,720 BECAUSE IT'S SORT OF RELEVANT TO 467 00:16:51,720 --> 00:16:53,120 THE KIND OF INTERVENTIONS WE'RE 468 00:16:53,120 --> 00:16:55,920 HOPING TO TEST IN LONG COVID. 469 00:16:55,920 --> 00:16:57,360 THIS ONE AWARD THAT NIMH GAVE 470 00:16:57,360 --> 00:17:00,440 OUT, IT SEEKS TO UNDERSTAND THE 471 00:17:00,440 --> 00:17:04,280 ROLE OF GETTING MOBILE HEALTH -- 472 00:17:04,280 --> 00:17:05,760 MOBILE MENTAL HEALTHCARE TO 473 00:17:05,760 --> 00:17:08,840 INDIVIDUALS AT RISK FOR MENTAL 474 00:17:08,840 --> 00:17:10,360 HEALTH ISSUES IN THE CONTEXT OF 475 00:17:10,360 --> 00:17:11,480 THE COVID-19 PANDEMIC. 476 00:17:11,480 --> 00:17:13,000 AND IN PARTICULAR, IT'S FOCUSED 477 00:17:13,000 --> 00:17:14,560 ON DELIVERING THIS CARE TO 478 00:17:14,560 --> 00:17:16,400 BLACK, LATINX AND AMERICAN 479 00:17:16,400 --> 00:17:16,840 INDIAN INDIVIDUALS. 480 00:17:16,840 --> 00:17:19,560 IT TESTS THIS MOBILE APP THAT 481 00:17:19,560 --> 00:17:21,200 CAN REDUCE ANXIETY AND 482 00:17:21,200 --> 00:17:21,760 DEPRESSIVE SYMPTOMS IN THE 483 00:17:21,760 --> 00:17:22,880 CONTEXT OF COVID-19. 484 00:17:22,880 --> 00:17:27,120 AND THE APP INCLUDES A NUMBER OF 485 00:17:27,120 --> 00:17:28,000 EVIDENCE-BASED APPROACHES TO 486 00:17:28,000 --> 00:17:29,400 TREATING SUCH SYMPTOMS INCLUDING 487 00:17:29,400 --> 00:17:31,040 SYMPTOM MONITORING, EXPOSURE 488 00:17:31,040 --> 00:17:32,600 MANAGEMENT, WHICH IS AIMED AT 489 00:17:32,600 --> 00:17:34,680 POST-TRAUMATIC STRESS DISORDER 490 00:17:34,680 --> 00:17:36,080 LIKE SYMPTOMS, AS WELL AS 491 00:17:36,080 --> 00:17:38,480 EDUCATION ON THE STRESS AND 492 00:17:38,480 --> 00:17:41,920 COPING STRATEGIES. 493 00:17:41,920 --> 00:17:43,360 SO THAT'S JUST A LITTLE ON THE 494 00:17:43,360 --> 00:17:47,160 MENTAL HEALTH EFFECTS OF COVID 495 00:17:47,160 --> 00:17:49,360 ON THE PANDEMIC AND MENTAL 496 00:17:49,360 --> 00:17:49,920 ILLNESSES. 497 00:17:49,920 --> 00:17:52,400 IT COMPLICATES OUR ABILITY TO 498 00:17:52,400 --> 00:17:54,160 LOOK AT THE PERSISTENT MENTAL 499 00:17:54,160 --> 00:17:55,040 HEALTH EFFECTS BUT NONETHELESS 500 00:17:55,040 --> 00:17:56,160 WE CAN DO IT WITH THE RIGHT 501 00:17:56,160 --> 00:17:56,560 CONTROLS. 502 00:17:56,560 --> 00:18:00,960 SO EARLY ON, THIS WAS PUBLISHED 503 00:18:00,960 --> 00:18:02,040 IN 2021 BUT IT WAS ACTUALLY 504 00:18:02,040 --> 00:18:03,120 PRE-PRINT IN THE FALL OF 2020. 505 00:18:03,120 --> 00:18:04,200 EARLY ON IT WAS RECOGNIZED THAT 506 00:18:04,200 --> 00:18:06,080 THERE ARE NEUROLOGIC AND 507 00:18:06,080 --> 00:18:07,400 PSYCHIATRIC OUTCOMES AMONGST 508 00:18:07,400 --> 00:18:10,160 SURVIVORS OF COVID-19 AS LATE AS 509 00:18:10,160 --> 00:18:14,920 SIX MONTHS AFTER THE INITIAL 510 00:18:14,920 --> 00:18:15,160 INFECTION. 511 00:18:15,160 --> 00:18:16,480 NOW, HOW DO YOU LOOK FOR 512 00:18:16,480 --> 00:18:18,000 INCREASED RATES OF MOOD, ANXIETY 513 00:18:18,000 --> 00:18:23,160 OR SIGH TO TICK DISORDERS IN PSYCHOTIC DI SORDERS WHEN 514 00:18:23,160 --> 00:18:24,240 YOU'RE ALSO SEEING INCREASED 515 00:18:24,240 --> 00:18:25,200 RATES IN THE GENERAL POPULATION 516 00:18:25,200 --> 00:18:26,760 AND I CREASED MENTAL HEALTH 517 00:18:26,760 --> 00:18:27,680 CONSEQUENCES IN THE CONTEXT OF 518 00:18:27,680 --> 00:18:30,640 THE TRAUMATIC EXPOSURE? 519 00:18:30,640 --> 00:18:32,440 THE WAY THIS PARTICULAR GROUP 520 00:18:32,440 --> 00:18:33,760 LED BY PAUL HARRISON TRIED TO DO 521 00:18:33,760 --> 00:18:35,080 THAT WAS COMPARE THE RATES OF 522 00:18:35,080 --> 00:18:37,360 SUCH SYMPTOMS IN INDIVIDUALS 523 00:18:37,360 --> 00:18:38,760 HOSPITALIZED FOR COVID-19 524 00:18:38,760 --> 00:18:39,640 COMPARED TO INDIVIDUALS 525 00:18:39,640 --> 00:18:40,840 HOSPITALIZED FOR OTHER 526 00:18:40,840 --> 00:18:42,400 RESPIRATORY TRACT INFECTIONS, SO 527 00:18:42,400 --> 00:18:45,960 OTHER SERIOUS HOSPITALIZED 528 00:18:45,960 --> 00:18:47,760 RESPIRATORY TRACT INFECTIONS 529 00:18:47,760 --> 00:18:48,600 LIKE INFLUENZA AND THE LIKE. 530 00:18:48,600 --> 00:18:50,000 WHAT YOU CAN SEE IS, EVEN FOR 531 00:18:50,000 --> 00:18:51,240 CONTROLLING FOR THOSE WHO HAVE 532 00:18:51,240 --> 00:18:52,600 BEEN EXPOSED TO THE TRAUMA OF A 533 00:18:52,600 --> 00:18:53,920 HOSPITALIZATION FOR A 534 00:18:53,920 --> 00:18:54,560 RESPIRATORY INFECTION, YOU CAN 535 00:18:54,560 --> 00:18:56,880 SEE INCREASED RATES OF MOOD, 536 00:18:56,880 --> 00:19:01,040 ANXIETY OR SIGH TO PSYCHOTIC DISORDERS 537 00:19:01,040 --> 00:19:02,480 IN INDIVIDUALS WHO WERE INFECTED 538 00:19:02,480 --> 00:19:03,360 WITH COVID-19 COMPARED TO 539 00:19:03,360 --> 00:19:04,960 INFECTED WITH OTHER INFECTIOUS 540 00:19:04,960 --> 00:19:10,960 AGENTS CAUSING RESPIRATORY TRACT 541 00:19:10,960 --> 00:19:11,280 INFECTIONS. 542 00:19:11,280 --> 00:19:14,040 ONE CLUE TO THE ETIOLOGY DOES 543 00:19:14,040 --> 00:19:15,760 SUGGEST IT HAS TO DO WITH THE 544 00:19:15,760 --> 00:19:16,440 SEVERITY AND LOCUS OF THAT 545 00:19:16,440 --> 00:19:17,040 ILLNESS. 546 00:19:17,040 --> 00:19:18,640 SO IF YOU LOOK AT THE RATES OF 547 00:19:18,640 --> 00:19:24,840 MOOD, ANXIETY OR SIGH PSYCHOTIC 548 00:19:24,840 --> 00:19:27,240 DISORDER SYMPTOMS AND SEPARATE 549 00:19:27,240 --> 00:19:29,240 INDIVIDUALS WITH COVID-19 NO 550 00:19:29,240 --> 00:19:31,960 INTO COVID-19 NOOPT 551 00:19:31,960 --> 00:19:34,360 A HOSPITALIZED GROUP, 552 00:19:34,360 --> 00:19:36,440 HOSPITALIZED PLUS ENCEPHALOPATHY 553 00:19:36,440 --> 00:19:37,440 GROUP HERE IN THE DARK RED AS 554 00:19:37,440 --> 00:19:41,560 COMPARED TO A HOSPITALIZATION 555 00:19:41,560 --> 00:19:43,440 ALONE OR MATCHED COHORT THAT 556 00:19:43,440 --> 00:19:44,880 DIDN'T RECEIVE -- DIDN'T HAVE 557 00:19:44,880 --> 00:19:45,760 COVID-19 THAT WERE HOSPITALIZED 558 00:19:45,760 --> 00:19:47,400 WITH OR WITHOUT ENCEPHALOPATHY, 559 00:19:47,400 --> 00:19:49,480 YOU CAN SEE THAT WHAT IT SEEMS 560 00:19:49,480 --> 00:19:52,480 TO BE IS THAT COVID-19 PLUS 561 00:19:52,480 --> 00:19:53,400 ENCEPHALOPATHY RAISES YOUR RISK 562 00:19:53,400 --> 00:19:57,160 FOR LONG LASTING PSYCHIATRIC 563 00:19:57,160 --> 00:19:58,040 SYMPTOMS, AND THAT RISK 564 00:19:58,040 --> 00:20:00,040 CONTINUES TO INCREASE THROUGH 565 00:20:00,040 --> 00:20:00,920 THE FIRST SIX MONTHS AFTER 566 00:20:00,920 --> 00:20:02,440 INFECTION WITH COVID-19. 567 00:20:02,440 --> 00:20:06,800 SO IT DOES APPEAR THAT THERE IS 568 00:20:06,800 --> 00:20:10,080 A CONJOINT SEVERITY BY COVID-19 569 00:20:10,080 --> 00:20:11,320 EFFECT WHICH RAISES YOUR RISK 570 00:20:11,320 --> 00:20:12,720 FOR MENTAL ILLNESS SYMPTOMS. 571 00:20:12,720 --> 00:20:16,120 NOW WE CANNOT DEFINITIVELY POINT 572 00:20:16,120 --> 00:20:17,960 TO THE BIOLOGY OF COVID-19 LIKE 573 00:20:17,960 --> 00:20:20,360 THIS, BUT IT DOES STRONGLY 574 00:20:20,360 --> 00:20:21,160 IMPLICATE THE FACT THAT THERE'S 575 00:20:21,160 --> 00:20:22,000 SOMETHING SPECIAL ABOUT COVID-19 576 00:20:22,000 --> 00:20:23,640 COMPARED TO OTHER INFECTIOUS 577 00:20:23,640 --> 00:20:25,400 AGENTS, AND SOMETHING SPECIAL 578 00:20:25,400 --> 00:20:27,720 ABOUT COVID-19 SEVERE ENOUGH TO 579 00:20:27,720 --> 00:20:28,440 INDUCE ENCEPHALOPATHY THAT 580 00:20:28,440 --> 00:20:29,640 RAISES YOUR RISK FOR THESE 581 00:20:29,640 --> 00:20:34,240 DISORDERS. 582 00:20:34,240 --> 00:20:36,440 I'LL JUST POINT OUT THAT THIS IS 583 00:20:36,440 --> 00:20:37,840 NOT THE ONLY STUDY TO SHOW THIS. 584 00:20:37,840 --> 00:20:39,480 THIS IS ANOTHER STUDY LOOKING AT 585 00:20:39,480 --> 00:20:41,360 LARGE NUMBER OF INDIVIDUALS 586 00:20:41,360 --> 00:20:42,200 TREATED FOR COVID-19 IN THE 587 00:20:42,200 --> 00:20:43,960 CONTEXT OF THE VETERANS' 588 00:20:43,960 --> 00:20:45,160 ADMINISTRATION HOSPITAL SYSTEM, 589 00:20:45,160 --> 00:20:46,720 AND YOU CAN SEE INCREASED RISK 590 00:20:46,720 --> 00:20:50,320 OF A WIDE RANGE OF PSYCHIATRIC 591 00:20:50,320 --> 00:20:53,400 SYMPTOMS INCLUDING ANXIETY 592 00:20:53,400 --> 00:20:55,200 DISORDERS, DEPRESSIVE DISORDERS 593 00:20:55,200 --> 00:20:55,880 AND PTSD. 594 00:20:55,880 --> 00:20:59,680 THESE ARE HAZARD RATIOS TO THE 595 00:20:59,680 --> 00:21:01,640 DIAGNOSIS IN THE PRESENCE OF 596 00:21:01,640 --> 00:21:03,160 SUICIDAL IDEATION WITH INCREASE 597 00:21:03,160 --> 00:21:06,040 IN RISK OF ABOUT 30 TO 40% 598 00:21:06,040 --> 00:21:11,280 INCREASES. 599 00:21:11,280 --> 00:21:12,880 ALSO IN THE PRESENCE OF THIS 600 00:21:12,880 --> 00:21:14,200 LARGE STUDY OF ELECTRONIC HEALTH 601 00:21:14,200 --> 00:21:16,280 RECORDS, THEY COULD LOOK AT THE 602 00:21:16,280 --> 00:21:17,840 PRESCRIPTION USE OF 603 00:21:17,840 --> 00:21:18,680 ANTIDEPRESSANTS, THE 604 00:21:18,680 --> 00:21:20,600 PRESCRIPTION USE OR MISUSE OF 605 00:21:20,600 --> 00:21:22,760 OPIOIDS AND OTHER SUBSTANCES, 606 00:21:22,760 --> 00:21:24,760 AND SLEEP DISORDERS IN THAT SAME 607 00:21:24,760 --> 00:21:27,120 POPULATION ALL HAVE INCREASED 608 00:21:27,120 --> 00:21:28,680 RISKS IN THE AFTERMATH OF 609 00:21:28,680 --> 00:21:30,120 COVID-19 FROM THESE EHRs. 610 00:21:30,120 --> 00:21:31,960 NOW HERE WE'RE NOT SHOWING 611 00:21:31,960 --> 00:21:34,040 NECESSARILY CONTROLS RELATIVE TO 612 00:21:34,040 --> 00:21:35,240 OTHER RESPIRATORY TRACT 613 00:21:35,240 --> 00:21:36,240 INFECTIONS BUT WE'RE 614 00:21:36,240 --> 00:21:37,400 DEMONSTRATING IN THE CONTEXT OF 615 00:21:37,400 --> 00:21:38,800 PANDEMIC, IN THOSE WHO HAVE BEEN 616 00:21:38,800 --> 00:21:39,800 INFECTED COMPARED TO THOSE WHO 617 00:21:39,800 --> 00:21:40,920 HAVEN'T, WE'RE SEEING INCREASES 618 00:21:40,920 --> 00:21:42,880 IN RISK FOR A WIDE RANGE OF 619 00:21:42,880 --> 00:21:43,440 PSYCHIATRIC SYMPTOMATOLOGY. 620 00:21:43,440 --> 00:21:45,040 AND THAT'S REFLECTED HERE IN THE 621 00:21:45,040 --> 00:21:47,240 OVERALL DATA FROM THIS STUDY, 622 00:21:47,240 --> 00:21:49,280 SHOWING ABOUT A 50% INCREASE IN 623 00:21:49,280 --> 00:21:51,040 THE LIKELIHOOD OF HAVING ANY 624 00:21:51,040 --> 00:21:53,720 MENTAL HEALTH DIAGNOSIS, ANY 625 00:21:53,720 --> 00:21:54,640 MENTAL HEALTH DIAGNOSIS TREATED 626 00:21:54,640 --> 00:21:57,600 BUT WITH A DRUG OR ANY MENTAL 627 00:21:57,600 --> 00:21:59,960 HEALTH DIAGNOSIS TREATED WITH 628 00:21:59,960 --> 00:22:01,720 EITHER ONE, SORRY, DIAGNOSIS, 629 00:22:01,720 --> 00:22:05,000 DRUG, OR BOTH. 630 00:22:05,000 --> 00:22:07,160 SO WITH THAT, I'M GOING TO TURN 631 00:22:07,160 --> 00:22:08,760 IT OVER TO WALTER WITH THIS 632 00:22:08,760 --> 00:22:11,960 BRIEF INTRODUCTION, AND THAT IS 633 00:22:11,960 --> 00:22:13,680 THAT IN COLLABORATION ACROSS A 634 00:22:13,680 --> 00:22:14,960 NUMBER OF DIFFERENT NIH 635 00:22:14,960 --> 00:22:18,280 INSTITUTES, BUT REALLY LED 636 00:22:18,280 --> 00:22:20,920 WALTER'S 637 00:22:20,920 --> 00:22:23,160 WALTER'S INSTITUTE, THE NIH 638 00:22:23,160 --> 00:22:24,360 RECOVERY INITIATIVES WHICH HE'LL 639 00:22:24,360 --> 00:22:28,120 TELL YOU MORE ABOUT IS SEEKING 640 00:22:28,120 --> 00:22:32,240 TO UNDERSTAND CHRONIC COVID AND 641 00:22:32,240 --> 00:22:33,560 TO DEVELOP INTERVENTIONS THAT 642 00:22:33,560 --> 00:22:34,360 WILL REDUCE ITS IMPACT. 643 00:22:34,360 --> 00:22:35,760 WITH THAT, I'LL TURN IT OVER TO 644 00:22:35,760 --> 00:22:36,080 WALTER. 645 00:22:36,080 --> 00:22:37,360 THANKS FOR LISTENING, AND I'LL 646 00:22:37,360 --> 00:22:38,440 BE HAPPY TO TAKE YOUR QUESTIONS 647 00:22:38,440 --> 00:22:42,040 AT THE END. 648 00:22:42,040 --> 00:22:45,800 >> THANKS SO MUCH, JOSH. 649 00:22:45,800 --> 00:22:46,960 AS JOSH MENTIONED, I'M GOING TO 650 00:22:46,960 --> 00:22:48,480 TALK A LITTLE BIT ABOUT -- MAYBE 651 00:22:48,480 --> 00:22:49,560 IT'S MORE ABOUT WHAT WE DON'T 652 00:22:49,560 --> 00:22:56,240 KNOW ABOUT POST-ACUTE SEQUELAE 653 00:22:56,240 --> 00:22:57,440 OF COVID AS OPPOSE DOLLARS TO 654 00:22:57,440 --> 00:23:00,160 WHAT OPPOSED TO WHAT WE 655 00:23:00,160 --> 00:23:02,320 DO KNOW, AND THEN TALK ABOUT HOW 656 00:23:02,320 --> 00:23:04,320 NIH IS ATTEMPTING TO TRY TO GET 657 00:23:04,320 --> 00:23:07,600 ANSWERS TO SOME OF THESE 658 00:23:07,600 --> 00:23:13,840 QUESTIONS. 659 00:23:13,840 --> 00:23:15,800 SO THE PROBLEM IS THE CONDITION 660 00:23:15,800 --> 00:23:18,880 THAT IS CALLED LONG COVID NOW IS 661 00:23:18,880 --> 00:23:25,520 A SYMPTOMATIC LIST OF THINGS, 662 00:23:25,520 --> 00:23:27,320 AND PEOPLE WHO HAVE THESE 663 00:23:27,320 --> 00:23:29,120 PERSISTENT SYMPTOMS AFTER THE 664 00:23:29,120 --> 00:23:30,280 ACUTE INFECTION TEND TO HAVE 665 00:23:30,280 --> 00:23:34,200 MULTIPLE BUT NOT NECESSARILY ALL 666 00:23:34,200 --> 00:23:35,120 THAT BEGS THE QUESTION OF 667 00:23:35,120 --> 00:23:37,440 WHETHER THERE ARE SUBSETS IN 668 00:23:37,440 --> 00:23:42,160 THIS GROUP OF FOLKS. 669 00:23:42,160 --> 00:23:47,040 THE SYMPTOMS AND THE EFFECT OF 670 00:23:47,040 --> 00:23:48,240 COVID POINT TO POTENTIAL 671 00:23:48,240 --> 00:23:50,200 TROUBLES IN MULTIPLE DIFFERENT 672 00:23:50,200 --> 00:23:52,960 ORGAN SYSTEMS IN THE BODY, SO WE 673 00:23:52,960 --> 00:23:55,320 CAN'T REALLY FOCUS IN ON ANY 674 00:23:55,320 --> 00:23:55,520 ONE. 675 00:23:55,520 --> 00:24:04,320 WE HAVE TO LOOK AT ALL THE ORGAN 676 00:24:04,320 --> 00:24:05,640 SYSTEMS AND HOW THEY MIGHT 677 00:24:05,640 --> 00:24:06,520 CONTRIBUTE TO SYMPTOMS PEOPLE 678 00:24:06,520 --> 00:24:08,560 HAVE AFTER ACUTE COVID 679 00:24:08,560 --> 00:24:09,440 INFECTION. 680 00:24:09,440 --> 00:24:11,160 ALSO I'D POINT OUT THAT WE NEED 681 00:24:11,160 --> 00:24:15,480 TO SET UP TO LOOK AT HOW THE 682 00:24:15,480 --> 00:24:20,520 ACUTE COVID INFECTION, WHICH IS 683 00:24:20,520 --> 00:24:22,120 AFFECTING UP TO 76 MILLION 684 00:24:22,120 --> 00:24:23,320 PEOPLE IN THE U.S., BUT GOING TO 685 00:24:23,320 --> 00:24:26,880 AFFECT THEIR FUTURE HEALTH OVER 686 00:24:26,880 --> 00:24:28,160 TIME, THOSE ARE POTENTIAL 687 00:24:28,160 --> 00:24:29,480 INCREASES OR MAYBE DECREASES 688 00:24:29,480 --> 00:24:31,120 HOPEFULLY IN RARE CONDITIONS OR 689 00:24:31,120 --> 00:24:32,640 COMMON CONDITIONS. 690 00:24:32,640 --> 00:24:35,040 SO A LOT OF QUESTIONS OUT THERE 691 00:24:35,040 --> 00:24:40,280 TO BE STUDIED. 692 00:24:40,280 --> 00:24:41,480 WHAT IS THE PREVALENCE? 693 00:24:41,480 --> 00:24:42,920 WELL, IT KIND OF DEPENDS ON HOW 694 00:24:42,920 --> 00:24:45,160 YOU DEFINE IT AND WHAT YOUR 695 00:24:45,160 --> 00:24:48,240 STUDY IS SET UP TO DO. 696 00:24:48,240 --> 00:24:50,240 THE BEST DATA I COULD SEE IS 697 00:24:50,240 --> 00:24:54,680 FROM 698 00:24:54,680 --> 00:24:58,840 FROM THE U.K. OFFICE FOR 699 00:24:58,840 --> 00:25:00,240 NATIONAL STATISTICS IS TRYING TO 700 00:25:00,240 --> 00:25:03,120 LOOK SERIOUSLY AT WHAT THE LEVEL 701 00:25:03,120 --> 00:25:04,720 OF PREVALENCE AND INCIDENCE IS. 702 00:25:04,720 --> 00:25:08,000 SO IF YOU TRACK SYMPTOMS IN A 703 00:25:08,000 --> 00:25:09,680 GROUP OF PEOPLE AND LOOK FOR 704 00:25:09,680 --> 00:25:11,320 SYMPTOMS THAT ARE PERSISTENT 705 00:25:11,320 --> 00:25:16,440 AFTER 12 WEEKS OF ACUTE 706 00:25:16,440 --> 00:25:18,400 INFECTION, THE DATA YOU GET IS 707 00:25:18,400 --> 00:25:19,600 ABOUT 3% IF YOU'RE DOING A 708 00:25:19,600 --> 00:25:22,240 CAREFUL TRACKING, IF YOU'RE 709 00:25:22,240 --> 00:25:23,520 LOOKING ON JUST HOW PEOPLE 710 00:25:23,520 --> 00:25:25,400 CLASSIFY THEMSELVES, IT GOES UP 711 00:25:25,400 --> 00:25:31,720 TO 11.7%. 712 00:25:31,720 --> 00:25:35,760 IN THE U.K., AMONG THOSE 713 00:25:35,760 --> 00:25:38,320 STUDIED, 5% REPORTED ANY OF THE 714 00:25:38,320 --> 00:25:40,480 12 COMMON SYMPTOMS, 12 TO 16 715 00:25:40,480 --> 00:25:41,240 WEEKS AFTER INFECTION. 716 00:25:41,240 --> 00:25:43,640 HOWEVER, THE PREVALENCE OF THESE 717 00:25:43,640 --> 00:25:44,640 COMMON SYMPTOMS THAT I SHOWED 718 00:25:44,640 --> 00:25:47,880 YOU ON THE PREVIOUS SLIDE IS 719 00:25:47,880 --> 00:25:48,960 3.4% IN THE CONTROL GROUP WHO 720 00:25:48,960 --> 00:25:50,160 NEVER HAD COVID. 721 00:25:50,160 --> 00:25:52,560 SO YOU HAVE TO BE A LITTLE BIT 722 00:25:52,560 --> 00:25:54,320 CAREFUL IN ATTRIBUTING THESE 723 00:25:54,320 --> 00:25:56,160 VERY COMMON SYMPTOMS TO THE 724 00:25:56,160 --> 00:25:57,920 INFECTION ITSELF. 725 00:25:57,920 --> 00:26:00,440 HOWEVER, IF YOU LOOK AT PEOPLE 726 00:26:00,440 --> 00:26:03,120 WHO HAVE CONSISTENTLY SUFFERED 727 00:26:03,120 --> 00:26:05,920 FROM THESE SYMPTOMS IN A 728 00:26:05,920 --> 00:26:07,000 CONTINUOUS PERIOD FOR AT LEAST 729 00:26:07,000 --> 00:26:09,080 12 WEEKS FROM THE INFECTION, 730 00:26:09,080 --> 00:26:15,640 THEN YOU SEE THE INCIDENCE IS 3% 731 00:26:15,640 --> 00:26:16,720 VERSUS 0.5% IN THE CONTROL 732 00:26:16,720 --> 00:26:16,920 GROUP. 733 00:26:16,920 --> 00:26:19,360 SO THIS MIGHT BE THE BEST GOLD 734 00:26:19,360 --> 00:26:22,760 STANDARD DATA WE HAVE SO FAR. 735 00:26:22,760 --> 00:26:25,040 IF YOU GO TO SELF-REPORTED LONG 736 00:26:25,040 --> 00:26:26,680 COVID AND YOU ASK THEM, YOU 737 00:26:26,680 --> 00:26:28,240 KNOW, ARE YOU FEELING WELL OR 738 00:26:28,240 --> 00:26:32,120 NOT, IT GOES UP MUCH HIGHER. 739 00:26:32,120 --> 00:26:34,240 THE DATA FROM THE U.K. SAID THE 740 00:26:34,240 --> 00:26:35,440 PREVALENCE WAS HIGHER IN 741 00:26:35,440 --> 00:26:37,520 FEMALES, HIGHER IN ADULTS 50 TO 742 00:26:37,520 --> 00:26:37,680 69. 743 00:26:37,680 --> 00:26:40,120 SOME STUDIES HAVE SHOWN THAT 744 00:26:40,120 --> 00:26:42,640 MAYBE IT'S HIGHER IN PEOPLE A 745 00:26:42,640 --> 00:26:43,640 LITTLE YOUNGER THAN THIS, IT'S 746 00:26:43,640 --> 00:26:47,920 ALWAYS MIER HIGHER IN PEOPLE WITH 747 00:26:47,920 --> 00:26:48,560 PRE-EXISTING HEALTH CONDITIONS 748 00:26:48,560 --> 00:26:50,520 AND ALWAYS HIGHER IN PEOPLE WHO 749 00:26:50,520 --> 00:26:51,680 HAVE HIGH VIRAL LOAD AT THE TIME 750 00:26:51,680 --> 00:26:52,800 OF INFECTION OR MORE SEVERE 751 00:26:52,800 --> 00:27:08,480 INFECTION. 752 00:27:08,480 --> 00:27:11,160 THIS IS A STUDY FROM THE VETERAN 753 00:27:11,160 --> 00:27:11,720 ADMINISTRATION'S ELECTRONIC 754 00:27:11,720 --> 00:27:14,720 HEALTH RECORDS LOOKING AT 755 00:27:14,720 --> 00:27:17,160 153,000 COVID-POSITIVE SUBJECTS, 756 00:27:17,160 --> 00:27:21,720 5-POINT , 757 00:27:21,720 --> 00:27:22,200 5.86 MILLION CONTROLS. 758 00:27:22,200 --> 00:27:24,320 WHAT YOU SEE ON THE SCREEN IS 759 00:27:24,320 --> 00:27:25,920 PEOPLE WHO WERE NEVER 760 00:27:25,920 --> 00:27:27,360 HOSPITALIZED, THEIR RISK OF 761 00:27:27,360 --> 00:27:29,160 STROKE, TIA, THIS IS THE 762 00:27:29,160 --> 00:27:30,000 CARDIOVASCULAR SIDE OF THINGS. 763 00:27:30,000 --> 00:27:31,120 THE RED IS PEOPLE WHO WERE IN 764 00:27:31,120 --> 00:27:32,840 THE HOSPITAL, DIDN'T REALLY 765 00:27:32,840 --> 00:27:35,480 REQUIRE ICU LEVEL CARE, AND THE 766 00:27:35,480 --> 00:27:36,680 PURPLE ARE THE PEOPLE WHO 767 00:27:36,680 --> 00:27:37,960 REQUIRED ICU LEVEL CARE. 768 00:27:37,960 --> 00:27:40,600 YOU CAN SEE THAT MANY THINGS, 769 00:27:40,600 --> 00:27:41,800 EVEN IF YOU DIDN'T GO IN THE 770 00:27:41,800 --> 00:27:42,920 HOSPITAL, THERE WAS AN INCREASED 771 00:27:42,920 --> 00:27:45,760 RISK OF THESE 772 00:27:45,760 --> 00:27:48,600 CARDIOVASCULAR/STROKE 773 00:27:48,600 --> 00:27:49,920 COMPLICATIONS AT THIS -- I THINK 774 00:27:49,920 --> 00:27:52,320 THIS WAS OUT BEYOND 30 DAYS 775 00:27:52,320 --> 00:27:56,120 GOING OUT TO ABOUT SIX MONTHS 776 00:27:56,120 --> 00:28:03,120 AFTER THE ACUTE INFECTION. 777 00:28:03,120 --> 00:28:04,760 SO A SIGN HERE THAT SOMETHING'S 778 00:28:04,760 --> 00:28:06,440 GOING ON EVEN IF YOU WEREN'T 779 00:28:06,440 --> 00:28:07,000 HOSPITALIZED, CLEARLY THOSE 780 00:28:07,000 --> 00:28:09,880 PEOPLE IN THE HOSPITAL HAVE 781 00:28:09,880 --> 00:28:11,440 GREATER RISKS FOR 782 00:28:11,440 --> 00:28:12,160 CARDIOVASCULAR. 783 00:28:12,160 --> 00:28:15,720 IN ANEAR ANOTHER STUDY OF HEALTH 784 00:28:15,720 --> 00:28:22,600 RECORDS OUT OF BOSTON, LOOKING 785 00:28:22,600 --> 00:28:23,800 AT 97,000 PEOPLE WHO TESTED 786 00:28:23,800 --> 00:28:26,080 POSITIVE FOR COVID, AND THEN 787 00:28:26,080 --> 00:28:28,920 LOOKING AT WHO DEVELOPED A NEW 788 00:28:28,920 --> 00:28:32,560 DIAGNOSIS IN THEIR ELECTRONIC 789 00:28:32,560 --> 00:28:38,680 HEALTH RECORD STARTING LIKE 790 00:28:38,680 --> 00:28:40,520 THREE MONTHS AFTER THEIR COVID 791 00:28:40,520 --> 00:28:41,840 DIAGNOSIS, THREE TO SIX MONTHS 792 00:28:41,840 --> 00:28:42,480 AFTER THEIR COVID DIAGNOSIS, 793 00:28:42,480 --> 00:28:45,280 THEN THEY ACTUALLY FOLLOWED IT 794 00:28:45,280 --> 00:28:47,360 OUT SIX TO NINE MONTHS, AND THEY 795 00:28:47,360 --> 00:28:51,440 DEVELOPED SCORING THAT GIVES YOU 796 00:28:51,440 --> 00:28:52,840 THE STRENGTH OF THE ASSOCIATION 797 00:28:52,840 --> 00:28:55,040 OF THESE DIFFERENT SYMPTOMS WITH 798 00:28:55,040 --> 00:28:58,400 WHAT THEY CALL A POST-ACUTE 799 00:28:58,400 --> 00:29:00,400 SEQUELAE OF COVID, AND SO THINGS 800 00:29:00,400 --> 00:29:04,120 LIKE ALOPECIA ARE VERY SPECIFIC. 801 00:29:04,120 --> 00:29:07,280 IT'S A STRESS-RELATED RESPONSE, 802 00:29:07,280 --> 00:29:13,080 CHEST PAIN, PALPITATIONS, 803 00:29:13,080 --> 00:29:15,480 PROTEINURIA, AND FATIGUE IS DOWN 804 00:29:15,480 --> 00:29:19,880 HERE, BUT AT THE AFTER 6 TO 9 MONTHS, 805 00:29:19,880 --> 00:29:22,120 IT GOES BACK UP TO BE SECOND 806 00:29:22,120 --> 00:29:26,600 ONLY TO TROUBLE WITH SMELL AND 807 00:29:26,600 --> 00:29:28,840 TASTE. 808 00:29:28,840 --> 00:29:30,280 SO YOU CAN SEE HOW THINGS CHANGE 809 00:29:30,280 --> 00:29:32,520 OVER TIME, BUT THERE IS CLEARLY, 810 00:29:32,520 --> 00:29:35,920 UNFORTUNATELY, IN MOST OF THESE 811 00:29:35,920 --> 00:29:37,680 STUDY, PEOPLE HAVE PERSISTENT 812 00:29:37,680 --> 00:29:42,600 TROUBLE OUT PAST SIX MONTHS 813 00:29:42,600 --> 00:29:44,680 AFTER THE ACUTE INFECTION. 814 00:29:44,680 --> 00:29:45,880 PEOPLE GET BETTER OVER THE FIRST 815 00:29:45,880 --> 00:29:46,840 COUPLE MONTHS, THEN THERE'S A 816 00:29:46,840 --> 00:29:48,560 SLOWING DOWN OF THE IMPROVEMENT 817 00:29:48,560 --> 00:29:53,520 AROUND THAT SIX-MONTH PERIOD. 818 00:29:53,520 --> 00:29:54,400 THAT'S VERY CONCERNING BECAUSE A 819 00:29:54,400 --> 00:29:58,640 LOT OF THESE SYMPTOMS, WHAT WE 820 00:29:58,640 --> 00:30:01,720 SEE IN ADDITION, MYALGIA, 821 00:30:01,720 --> 00:30:05,320 ENCEPHALITIS, CHRONIC FATIGUE 822 00:30:05,320 --> 00:30:06,520 SYNDROME, THOSE PEOPLE OFTEN 823 00:30:06,520 --> 00:30:07,400 PRESENTED WITH SOME TYPE OF A 824 00:30:07,400 --> 00:30:08,520 VIRAL INFECTION AND NEVER GOT 825 00:30:08,520 --> 00:30:10,360 BETTER, BUT THEY CAN BE SICK FOR 826 00:30:10,360 --> 00:30:10,920 DECADES. 827 00:30:10,920 --> 00:30:15,360 SO THAT'S REALLY THE WORST FEAR, 828 00:30:15,360 --> 00:30:19,760 IS THAT THOUSANDS, EVEN A 829 00:30:19,760 --> 00:30:21,520 MILLION PEOPLE COULD GO ON TO 830 00:30:21,520 --> 00:30:24,640 THAT VERY TRAGIC CONDITION 831 00:30:24,640 --> 00:30:27,200 UNLESS WE UNDERSTAND HOW TO 832 00:30:27,200 --> 00:30:31,120 PREVENT THAT OR IF THIS IS 833 00:30:31,120 --> 00:30:34,840 SOMEHOW GOING TO PEETER OUT OVER 834 00:30:34,840 --> 00:30:37,040 A LONGER PERIOD OF TIME. 835 00:30:37,040 --> 00:30:38,240 NOW, WHAT'S AT THE BOTTOM OF 836 00:30:38,240 --> 00:30:38,720 THIS? 837 00:30:38,720 --> 00:30:42,920 WE REALLY DON'T KNOW WHAT THE 838 00:30:42,920 --> 00:30:44,360 BIOLOGICAL DRIVERS ARE. 839 00:30:44,360 --> 00:30:47,080 I TALKED TO YOU ABOUT THREE 840 00:30:47,080 --> 00:30:47,720 MAJOR HYPOTHESES. 841 00:30:47,720 --> 00:30:53,720 ONE IS THAT THERE'S A 842 00:30:53,720 --> 00:30:55,360 DISTURBANCE IN THE IMMUNE SYSTEM 843 00:30:55,360 --> 00:30:56,360 THAT OCCURS DURING COVID, AND 844 00:30:56,360 --> 00:30:58,520 THAT DOESN'T RESET AND THAT 845 00:30:58,520 --> 00:31:00,320 CAUSES PERSISTENT SYMPTOMS. 846 00:31:00,320 --> 00:31:02,640 THE SECOND ONE IS THAT THERE IS 847 00:31:02,640 --> 00:31:04,760 A AUTOIMMUNITY THAT DEVELOPS DUE 848 00:31:04,760 --> 00:31:06,600 TO THE SURGE IN IMMUNE RESPONSE 849 00:31:06,600 --> 00:31:09,920 TO THE VIRUS WITH THE IMMUNE 850 00:31:09,920 --> 00:31:12,760 RESPONSE OVERSPILLING AND 851 00:31:12,760 --> 00:31:14,520 ATTACKING SELF-ANTIGENS SO YOU 852 00:31:14,520 --> 00:31:15,640 GET AN AUTOIMMUNE DISORDER. 853 00:31:15,640 --> 00:31:17,280 THERE ARE SOME INCREASES OF, 854 00:31:17,280 --> 00:31:23,920 SAY, LUPUS AFTER COVID, CLASSIC 855 00:31:23,920 --> 00:31:26,600 AUTOIMMUNE DISORDER, AND THE 856 00:31:26,600 --> 00:31:27,880 LAST ONE, POTENTIAL PERSISTENT 857 00:31:27,880 --> 00:31:29,080 VIRUS IN THE BODY THAT IS 858 00:31:29,080 --> 00:31:30,160 CONTINUING TO STIMULATE THE 859 00:31:30,160 --> 00:31:31,360 IMMUNE SYSTEM, SO YOU STILL HAVE 860 00:31:31,360 --> 00:31:33,320 THOSE SYMPTOMS THAT YOU HAD WHEN 861 00:31:33,320 --> 00:31:35,320 YOU FIRST GOT INFECTED. 862 00:31:35,320 --> 00:31:37,080 SO THIS IS A PAPER THAT RECENTLY 863 00:31:37,080 --> 00:31:38,600 CAME OUT IN "CELL." 864 00:31:38,600 --> 00:31:40,760 THEY LOOKED AT 309 PATIENTS, AND 865 00:31:40,760 --> 00:31:43,400 THEY TRIED TO LOOK AT EVERYTHING 866 00:31:43,400 --> 00:31:46,440 THEY COULD, SINGLE CELL 867 00:31:46,440 --> 00:31:47,720 MULTI-YOE MIX IN THE WHITE 868 00:31:47,720 --> 00:31:53,560 CELLS, PLASMA -- AUTO 869 00:31:53,560 --> 00:31:58,920 ANTIBODIES, AND RNAEMIA, AND 870 00:31:58,920 --> 00:32:00,920 ALSO VIREMIA DUE TO EPSTEIN-BARR 871 00:32:00,920 --> 00:32:02,960 VIRUS. 872 00:32:02,960 --> 00:32:05,920 WHAT THEY FOUND WAS THAT THERE 873 00:32:05,920 --> 00:32:07,720 WERE FOUR -- IN THE ACUTE STAGE, 874 00:32:07,720 --> 00:32:09,120 THERE WERE FOUR THINGS THAT 875 00:32:09,120 --> 00:32:10,920 ANTICIPATED YOU WERE GOING TO 876 00:32:10,920 --> 00:32:12,920 GET POST-ACUTE SEQUELAE OF 877 00:32:12,920 --> 00:32:13,560 COVID. 878 00:32:13,560 --> 00:32:20,040 THOSE WERE TYPE 2 DIABETES, HIGH 879 00:32:20,040 --> 00:32:21,880 RNAEMIA FROM YOUR COVID-19 880 00:32:21,880 --> 00:32:24,400 VIRUS, AND HIGH VIREMIA DUE TO 881 00:32:24,400 --> 00:32:26,920 ACTIVATION OF EPSTEIN-BARR 882 00:32:26,920 --> 00:32:28,440 VIRUS, AND THEN SPECIFIC AUTO 883 00:32:28,440 --> 00:32:28,960 ANTIBODIES. 884 00:32:28,960 --> 00:32:30,640 I JUST WANTED TO MENTION THAT 885 00:32:30,640 --> 00:32:33,040 EPSTEIN-BARR VIRUS IS A VIRUS 886 00:32:33,040 --> 00:32:35,680 THAT INFECTS PRETTY MUCH ALL OF 887 00:32:35,680 --> 00:32:37,320 US, WHEN IT CAUSES AN ILLNESS, 888 00:32:37,320 --> 00:32:41,320 IT'S CALLED INFECTIOUS 889 00:32:41,320 --> 00:32:42,520 MONONUCLEOSIS, MOSTLY IN 890 00:32:42,520 --> 00:32:44,520 TEENAGER, YOUNG 20s WHO GET 891 00:32:44,520 --> 00:32:46,960 THIS INFECTION, BUT PRETTY MUCH 892 00:32:46,960 --> 00:32:48,720 EVERYBODY GETS EPSTEIN-BARR 893 00:32:48,720 --> 00:32:50,680 VIRUS, AND IT IS PERSISTENT IN 894 00:32:50,680 --> 00:32:51,160 THE BODY. 895 00:32:51,160 --> 00:32:57,160 AND WHEN YOU HAVE A MAJOR IMMUNE 896 00:32:57,160 --> 00:32:58,640 CHALLENGE, WHATEVER IS HOLDING 897 00:32:58,640 --> 00:33:01,120 DOWN THE EPSTEIN-BARR VIRUS IN 898 00:33:01,120 --> 00:33:04,080 YOUR BODY LOSES ITS 899 00:33:04,080 --> 00:33:05,360 EFFECTIVENESS AND THE 900 00:33:05,360 --> 00:33:06,800 EPSTEIN-BARR VIRUS STARTS TO 901 00:33:06,800 --> 00:33:07,520 REPLICATE, SO THIS IS SOMETHING 902 00:33:07,520 --> 00:33:12,280 THAT YOU WOULD SEE IN MANY 903 00:33:12,280 --> 00:33:15,400 DIFFERENT IMMUNE INSULTS. 904 00:33:15,400 --> 00:33:17,120 NOW THE PROBLEM WITH THE STUDY 905 00:33:17,120 --> 00:33:18,040 IS THAT EVERYBODY DIDN'T HAVE 906 00:33:18,040 --> 00:33:19,800 THE SAME THING AND THEN THEY 907 00:33:19,800 --> 00:33:22,640 STARTED TO LOOK FOR DIFFERENT 908 00:33:22,640 --> 00:33:24,600 SUBGROUPS OF PATIENTS, AND THEY 909 00:33:24,600 --> 00:33:30,640 DIVIDED IT INTO SYMPTOMS AND 910 00:33:30,640 --> 00:33:31,800 RESPIRATORY NEURO, G.I. 911 00:33:31,800 --> 00:33:33,120 ESTIMATES AND CLAIMED THAT COULD 912 00:33:33,120 --> 00:33:34,200 FIND CERTAIN PATTERNS MORE 913 00:33:34,200 --> 00:33:36,360 ASSOCIATED WITH THE RESPIRATORY 914 00:33:36,360 --> 00:33:38,360 AND THE G.I. AND THE NEURO. 915 00:33:38,360 --> 00:33:40,480 SO THAT, YOU KNOW, THAT REALLY 916 00:33:40,480 --> 00:33:43,400 HAS TO BE VALIDATED. 917 00:33:43,400 --> 00:33:48,680 YOU START TO DROP INTO 918 00:33:48,680 --> 00:33:49,080 SUBGROUP-SPECIFIC 919 00:33:49,080 --> 00:33:50,000 CHARACTERISTICS, YOU RUN INTO 920 00:33:50,000 --> 00:33:53,520 TROUBLE WITH MULTIPLE 921 00:33:53,520 --> 00:33:53,840 COMPARISONS. 922 00:33:53,840 --> 00:33:54,960 SO THIS REALLY HAS TO BE LOOKED 923 00:33:54,960 --> 00:33:55,400 AT. 924 00:33:55,400 --> 00:33:58,240 WHAT THEY FOUND WAS THAT THERE 925 00:33:58,240 --> 00:34:02,400 WAS A PARTICULAR T-CELL PATTERN 926 00:34:02,400 --> 00:34:07,280 IN THOSE PEOPLE WHO DEVELOPED 927 00:34:07,280 --> 00:34:07,880 GASTROINTESTINAL SYMPTOMS IN 928 00:34:07,880 --> 00:34:12,480 THEIR POST-COVID STATE. 929 00:34:12,480 --> 00:34:16,720 THEY FOUND THAT THERE WERE 930 00:34:16,720 --> 00:34:17,320 IMMUNOLOGIC ASSOCIATIONS BETWEEN 931 00:34:17,320 --> 00:34:19,240 DIFFERENT FACTORS, WHETHER THEY 932 00:34:19,240 --> 00:34:21,480 BE CYTOKINES OR T-CELL SUBSETS 933 00:34:21,480 --> 00:34:28,240 OR AUTO ANTIBODIES, AND THOSE 934 00:34:28,240 --> 00:34:28,920 ASSOCIATIONS WERE PRETTY TIGHT 935 00:34:28,920 --> 00:34:31,840 IN THE ACUTE STAGE AND MAYBE AT 936 00:34:31,840 --> 00:34:34,480 THREE MONTHS, BUT THEN THEY 937 00:34:34,480 --> 00:34:35,800 SEPARATED OUT BY SIX MONTHS AND 938 00:34:35,800 --> 00:34:37,800 DIDN'T REALLY HANG TOGETHER 939 00:34:37,800 --> 00:34:40,720 ANYMORE. 940 00:34:40,720 --> 00:34:44,400 SO THE EMPHASIS WAS ON THE IDEA 941 00:34:44,400 --> 00:34:48,920 THAT THE BEST PREDICT TORES OF 942 00:34:48,920 --> 00:34:53,320 WHETHER YOU GET PASC ARE 943 00:34:53,320 --> 00:34:54,720 MEASURES DURING THE ACUTE 944 00:34:54,720 --> 00:34:55,160 INFECTION. 945 00:34:55,160 --> 00:34:56,840 OF COURSE THAT'S A PROBLEM IF WE 946 00:34:56,840 --> 00:34:58,040 DON'T UNDERSTAND THAT RIGHT 947 00:34:58,040 --> 00:35:00,000 AWAY, HOPEFULLY ACUTE INFECTIONS 948 00:35:00,000 --> 00:35:01,240 WILL START DROPPING OUT, BUT 949 00:35:01,240 --> 00:35:02,640 IT'S GOING TO BE A LOT HARDER TO 950 00:35:02,640 --> 00:35:06,120 GO BACKWARDS FROM SOMEBODY WHO'S 951 00:35:06,120 --> 00:35:07,360 SIX MONTHS OUT TO TRY AND FIGURE 952 00:35:07,360 --> 00:35:09,720 OUT WHAT IS THE MAJOR DRIVER. 953 00:35:09,720 --> 00:35:11,840 SO JUST AN EXAMPLE. 954 00:35:11,840 --> 00:35:13,920 THERE'S ANOTHER EXAMPLE, THE 955 00:35:13,920 --> 00:35:15,880 STUDY WAS FROM SWITZERLAND, AND 956 00:35:15,880 --> 00:35:20,480 IT'S A SMALL NUMBER AGAIN, ONLY 957 00:35:20,480 --> 00:35:20,800 175 PATIENTS. 958 00:35:20,800 --> 00:35:23,200 WHAT THEY'RE SHOWING HERE IS 959 00:35:23,200 --> 00:35:29,240 THAT IF YOU GET COVID-19, YOU 960 00:35:29,240 --> 00:35:34,040 GENERALLY ELEVATE YOUR LEVELS OF 961 00:35:34,040 --> 00:35:36,000 IG3, AND THEY GO UP IN MILD 962 00:35:36,000 --> 00:35:39,960 DISEASE, THEY GO UP HIGHER IN 963 00:35:39,960 --> 00:35:46,720 SEVERE DISEASE, WHERE THE GROUPS 964 00:35:46,720 --> 00:35:50,720 THAT DEVELOP -- YOU DON'T SEE 965 00:35:50,720 --> 00:35:52,400 THAT SAME OF IG3. 966 00:35:52,400 --> 00:35:55,560 PATIENTS WHO HAD BOTH HIGH IGM 967 00:35:55,560 --> 00:36:00,520 AND HIGH IG3 WERE LESS LIKELY TO 968 00:36:00,520 --> 00:36:04,000 DEVELOP POST SEQUELAE. 969 00:36:04,000 --> 00:36:07,080 THERE'S AN INTERESTING CUT 970 00:36:07,080 --> 00:36:08,920 DEPENDING ON WHETHER YOUR 971 00:36:08,920 --> 00:36:12,760 IG3 LEVEL WAS LOW OR NOT. 972 00:36:12,760 --> 00:36:14,120 SIMILARLY, THEY LOOK ALMOST 973 00:36:14,120 --> 00:36:15,640 IDENTICAL WHEN YOU LOOK AT 974 00:36:15,640 --> 00:36:17,120 IG3 AND A CUT BETWEEN THOSE WHO 975 00:36:17,120 --> 00:36:20,440 HAVE HIGH I GM LEVELS OR LOW IGM 976 00:36:20,440 --> 00:36:21,320 LEVELS. 977 00:36:21,320 --> 00:36:25,120 THAT COMBINATION SOMEHOW IS 978 00:36:25,120 --> 00:36:25,520 INTERACTING. 979 00:36:25,520 --> 00:36:29,040 AGAIN, THESE KIND OF THINGS HAVE 980 00:36:29,040 --> 00:36:32,560 TO BE VALIDATED AND THEN THE 981 00:36:32,560 --> 00:36:33,600 NUMBERS ARE SMALL AND THE 982 00:36:33,600 --> 00:36:34,960 QUESTION IS, ARE THERE A SUBSET, 983 00:36:34,960 --> 00:36:38,360 YOU CAN SEE THIS TREMENDOUS 984 00:36:38,360 --> 00:36:41,440 OVERLAP HERE PATTERNS. 985 00:36:41,440 --> 00:36:42,520 NEXT ONE IS A PAPER THAT'S NOT 986 00:36:42,520 --> 00:36:49,160 YET PUBLISHED LOOKING AT IL-1 987 00:36:49,160 --> 00:36:58,400 BETA, IL-6, TNF ALPHA. 988 00:36:58,400 --> 00:37:00,520 258 PEOPLE AFTER MOSTLY MILD 989 00:37:00,520 --> 00:37:03,560 INFECTION FROM A TOWN IN 990 00:37:03,560 --> 00:37:05,640 GERMANY, AND POST-ACUTE SEQUELAE 991 00:37:05,640 --> 00:37:09,320 REPORTED IN 40% OF CASES AT SIX 992 00:37:09,320 --> 00:37:11,480 MONTHS, SO THIS IS SELF-REPORTED 993 00:37:11,480 --> 00:37:14,680 NUMBERS. 994 00:37:14,680 --> 00:37:16,960 NOT ONLY FATIGUE, SHORTNESS OF 995 00:37:16,960 --> 00:37:17,920 BREATH, TROUBLE WITH 996 00:37:17,920 --> 00:37:18,920 CONCENTRATION. 997 00:37:18,920 --> 00:37:22,640 BUT THEY LOOKED AT JUST 998 00:37:22,640 --> 00:37:27,240 ANTIBODIES, THE NUMBER OF AUTO 999 00:37:27,240 --> 00:37:28,720 ANTIBODIES, YOU GET A BIG 1000 00:37:28,720 --> 00:37:30,040 INCREASE, I THINK IN THE CONTROL 1001 00:37:30,040 --> 00:37:32,120 GROUP, IT WAS ZERO. 1002 00:37:32,120 --> 00:37:35,440 SO IF YOU HAVE PASC, YOUR CHANCE 1003 00:37:35,440 --> 00:37:37,920 OF DEVELOPING AUTO ANTIBODIES 1004 00:37:37,920 --> 00:37:39,680 GOES REALLY HIGH, I THINK UP TO 1005 00:37:39,680 --> 00:37:39,920 30%. 1006 00:37:39,920 --> 00:37:43,400 IF YOU HAVE NO PASC, THEY DIDN'T 1007 00:37:43,400 --> 00:37:45,720 REALLY -- IF ANYTHING, WITHOUT 1008 00:37:45,720 --> 00:37:47,320 DEVELOPING POST-ACUTE SEQUELAE 1009 00:37:47,320 --> 00:37:49,520 HAD A HIGHER CHANCE OF HAVING 1010 00:37:49,520 --> 00:37:50,600 AUTO ANTIBODIES THAN THE PEOPLE 1011 00:37:50,600 --> 00:37:53,760 WHO ARE PASC. 1012 00:37:53,760 --> 00:37:55,440 SO YOU'RE NOT SEEING A 1013 00:37:55,440 --> 00:37:56,400 ASSOCIATION THERE WITH WHETHER 1014 00:37:56,400 --> 00:37:58,280 YOU HAVE AUTO ANTIBODIES OR NOT, 1015 00:37:58,280 --> 00:38:00,120 THAT BEGS THE QUESTION OF 1016 00:38:00,120 --> 00:38:01,520 WHETHER SPECIFIC AUTO ANTIBODIES 1017 00:38:01,520 --> 00:38:03,120 ARE CAUSING THE TROUBLE, THAT'S 1018 00:38:03,120 --> 00:38:04,920 NOT SOMETHING THAT THEY GOT 1019 00:38:04,920 --> 00:38:05,520 INTO. 1020 00:38:05,520 --> 00:38:11,040 IF YOU LOOK AT THE PROBABILITY 1021 00:38:11,040 --> 00:38:14,040 OF PASC WITH DIFFERENT CYTOKINE 1022 00:38:14,040 --> 00:38:15,680 LEVELS THEN YOU CAN SEE FAIRLY 1023 00:38:15,680 --> 00:38:16,880 SIGNIFICANT ASSOCIATION WITH 1024 00:38:16,880 --> 00:38:26,320 HIGH CYTOKINE LEVELS OF TNF 1025 00:38:26,320 --> 00:38:30,200 ALPHA, -- A DIFFERENT SUBSET OF 1026 00:38:30,200 --> 00:38:32,280 CYTOKINES. 1027 00:38:32,280 --> 00:38:35,240 THEY ALSO SAID DEVELOPING -- 1028 00:38:35,240 --> 00:38:41,360 GETTING A VACCINE AFTER YOU'RE 1029 00:38:41,360 --> 00:38:42,560 INFECTED DID NOT AFFECT YOUR 1030 00:38:42,560 --> 00:38:44,080 CHANCE OF GETTING PASC. 1031 00:38:44,080 --> 00:38:46,120 THERE WAS A STORY THAT PEOPLE 1032 00:38:46,120 --> 00:38:48,320 WHO HAVE PASC, THEY GOT 1033 00:38:48,320 --> 00:38:49,840 VACCINATED, THEY FELT BETTER. 1034 00:38:49,840 --> 00:38:51,280 THERE'S BEEN SOME STUDY THAT 1035 00:38:51,280 --> 00:38:52,560 DOESN'T SEEM LIKE A STRONG 1036 00:38:52,560 --> 00:38:53,760 EFFECT SIZE, THESE FOLKS DIDN'T 1037 00:38:53,760 --> 00:38:55,520 SEE IT AT ALL. 1038 00:38:55,520 --> 00:38:57,720 HIGH PERCENTAGE OF THE PEOPLE 1039 00:38:57,720 --> 00:39:00,440 WITH COVID-19 HAVE AUTO 1040 00:39:00,440 --> 00:39:01,040 ANTIBODIES BUT NOT ASSOCIATED 1041 00:39:01,040 --> 00:39:03,920 WITH PASC, BROAD RANGE OF 1042 00:39:03,920 --> 00:39:04,920 CYTOKINES DISREGULATED LONG 1043 00:39:04,920 --> 00:39:05,320 AFTER INFECTION. 1044 00:39:05,320 --> 00:39:07,000 SO THE QUESTION IS, IS THIS 1045 00:39:07,000 --> 00:39:09,040 CYTOKINE PATTERN SOMETHING THAT 1046 00:39:09,040 --> 00:39:12,440 WOULD MAKE YOU FEEL FATIGUE, 1047 00:39:12,440 --> 00:39:14,520 TROUBLE WITH CONCENTRATION? 1048 00:39:14,520 --> 00:39:19,000 THAT'S POSSIBLE, BUT NEEDS TO BE 1049 00:39:19,000 --> 00:39:20,560 PURSUED FURTHER. 1050 00:39:20,560 --> 00:39:22,200 AND THEIR POINT WAS THAT THESE 1051 00:39:22,200 --> 00:39:24,720 CYTOKINES ARE BASICALLY COMING 1052 00:39:24,720 --> 00:39:28,320 FROM THE MACROPHAGES THAT ARE 1053 00:39:28,320 --> 00:39:29,880 BEING ACTIVATED IN THE LUNG 1054 00:39:29,880 --> 00:39:38,160 DURING THE ACUTE INFECTION. 1055 00:39:38,160 --> 00:39:40,160 THIS IS THE NEXT KIND OF THING 1056 00:39:40,160 --> 00:39:41,120 THAT WORRIES ME THE MOST, IS 1057 00:39:41,120 --> 00:39:42,280 THAT THERE MAY BE EVIDENCE THAT 1058 00:39:42,280 --> 00:39:47,200 THE VIRUS, ALTHOUGH THE ACUTE 1059 00:39:47,200 --> 00:39:48,920 INFECTION IS OVER, THE VIRUS IS 1060 00:39:48,920 --> 00:39:50,120 STILL HIDING IN YOUR BODY. 1061 00:39:50,120 --> 00:39:51,840 SO WE TALKED A LITTLE BIT ABOUT 1062 00:39:51,840 --> 00:39:52,920 THAT WITH REGARD TO EBV. 1063 00:39:52,920 --> 00:39:56,320 THE QUESTION IS, COULD THAT BE 1064 00:39:56,320 --> 00:39:56,960 TRUE WITH COVID-19? 1065 00:39:56,960 --> 00:39:59,800 SO THIS STUDY FROM MICHELLE'S 1066 00:39:59,800 --> 00:40:07,480 LAB AT ROCKEFELLER BASICALLY DID 1067 00:40:07,480 --> 00:40:08,440 INTESTINAL BIOPSIES FROM 1068 00:40:08,440 --> 00:40:10,640 ASYMPTOMATIC INDIVIDUALS FOR 1069 00:40:10,640 --> 00:40:12,360 FOUR MONTHS AND REVEALED 1070 00:40:12,360 --> 00:40:16,200 PERSISTENCE OF NUCLEAR ACIDS 1071 00:40:16,200 --> 00:40:17,720 FROM COVID-19 IN 7 OF 14 PEOPLE, 1072 00:40:17,720 --> 00:40:19,920 AND THEN THEY LOOKED AT MEMORY B 1073 00:40:19,920 --> 00:40:21,040 CELL RESPONSES OVER TIME, AND 1074 00:40:21,040 --> 00:40:23,120 THEY SEE THE CHANGES THAT ARE 1075 00:40:23,120 --> 00:40:26,120 OCCURRING IN PEOPLE CONSISTENT 1076 00:40:26,120 --> 00:40:26,800 WITH CONTINUED ANTIGEN 1077 00:40:26,800 --> 00:40:27,600 PERSISTENCE. 1078 00:40:27,600 --> 00:40:30,440 SO THIS WAS THE FIRST THING THAT 1079 00:40:30,440 --> 00:40:31,400 I'VE SEEN THAT SUGGESTED THAT 1080 00:40:31,400 --> 00:40:33,600 THE VIRUS IS STILL PRESENT, 1081 00:40:33,600 --> 00:40:37,400 STILL ACTIVE IN THE IMMUNE 1082 00:40:37,400 --> 00:40:40,960 SYSTEM. 1083 00:40:40,960 --> 00:40:42,200 THESE WERE NOT NECESSARILY PAST 1084 00:40:42,200 --> 00:40:44,480 PATIENTS SO IT DOESN'T GET YOU 1085 00:40:44,480 --> 00:40:45,680 AT PASC, SO CERTAINLY IF THE 1086 00:40:45,680 --> 00:40:47,200 VIRUS IS STILL PRESENT, THAT 1087 00:40:47,200 --> 00:40:51,400 THAT'S GOING TO BRING THAT AS A 1088 00:40:51,400 --> 00:40:53,240 HIGH DRIVER OF THE SYMPTOMS. 1089 00:40:53,240 --> 00:40:54,520 THEN THERE'S THIS PAPER COMING 1090 00:40:54,520 --> 00:41:00,200 OUT OF THE NCI GROUP, AUTOPSIES 1091 00:41:00,200 --> 00:41:03,080 ON 44 COVID-19 PATIENTS, OVER 1092 00:41:03,080 --> 00:41:04,400 SEVEN MONTHS FOLLOWING SYMPTOM 1093 00:41:04,400 --> 00:41:05,920 ONSET AND CLAIMING THAT 1094 00:41:05,920 --> 00:41:09,280 SARS-COV-2 IS ACTUALLY 1095 00:41:09,280 --> 00:41:10,160 EVERYWHERE IN THE BODY, EVEN 1096 00:41:10,160 --> 00:41:12,120 THOSE WHO DIED WITH ASYMPTOMATIC 1097 00:41:12,120 --> 00:41:13,760 OR MILD INFECTION, AND EVEN AT 1098 00:41:13,760 --> 00:41:15,120 LATE TIME PERIODS. 1099 00:41:15,120 --> 00:41:17,120 THEY'RE CLAIMING THE REPLICATION 1100 00:41:17,120 --> 00:41:22,120 IS PRESENT IN BOTH THE PULMONARY 1101 00:41:22,120 --> 00:41:24,240 ANNEX -- HARDER TO SEE LAYERS 1102 00:41:24,240 --> 00:41:25,920 BUT THEY CLAIM IT'S STILL THERE 1103 00:41:25,920 --> 00:41:28,160 IN MULTIPLE ANATOMIC SITES 1104 00:41:28,160 --> 00:41:29,720 INCLUDE THE BRAIN FOR UP TO 230 1105 00:41:29,720 --> 00:41:31,040 DAYS, THAT'S THE LATEST THEY 1106 00:41:31,040 --> 00:41:39,040 LOOKED, AND THEY SEE -- 1107 00:41:39,040 --> 00:41:39,800 PATHOLOGY EXCEPT FOR IN THE 1108 00:41:39,800 --> 00:41:40,680 LUNG. 1109 00:41:40,680 --> 00:41:42,960 SO THIS IS NOT YET PUBLISHED BUT 1110 00:41:42,960 --> 00:41:44,280 I THINK IT'S BEEN ACCEPTED, SO 1111 00:41:44,280 --> 00:41:47,320 THIS REALLY RAISES THE QUESTION 1112 00:41:47,320 --> 00:41:50,240 ABOUT PERSISTENT VIRUS AND, OF 1113 00:41:50,240 --> 00:41:52,200 COURSE, IT WOULD LEAD PEOPLE TO 1114 00:41:52,200 --> 00:41:53,520 THINK, WELL, IF THAT'S WHAT'S 1115 00:41:53,520 --> 00:41:56,360 DRIVING SOME OF THESE SYMPTOMS 1116 00:41:56,360 --> 00:41:58,640 AND THAT POTENTIALLY AN 1117 00:41:58,640 --> 00:42:01,520 ANTIVIRAL AGENT MAY WORK, THE 1118 00:42:01,520 --> 00:42:04,680 VACCINE DOESN'T SEEM TO HAVE THE 1119 00:42:04,680 --> 00:42:07,400 EFFECT SIZE, REPEATING 1120 00:42:07,400 --> 00:42:10,360 VACCINATION, BUT POTENTIALLY THE 1121 00:42:10,360 --> 00:42:13,520 ANTIVIRUS -- IF WE GO INTO THE 1122 00:42:13,520 --> 00:42:14,200 NERVOUS SYSTEM, PEOPLE MAY HAVE 1123 00:42:14,200 --> 00:42:20,880 SEEN THIS BEFORE, DR. -- LAB 1124 00:42:20,880 --> 00:42:21,960 INITIALLY SHOWED THERE'S NOT A 1125 00:42:21,960 --> 00:42:23,280 LOT OF VIRUS THAT HE COULD FIND 1126 00:42:23,280 --> 00:42:25,320 IN THE NERVE CELLS, BUT THE 1127 00:42:25,320 --> 00:42:28,200 VIRUS IS BASICALLY -- ATTACKS 1128 00:42:28,200 --> 00:42:30,600 THE ACE 2 RECEPTOR WHICH IS 1129 00:42:30,600 --> 00:42:32,440 PRESENT ON ENDOTHELIAL CELLS 1130 00:42:32,440 --> 00:42:34,440 THAT LINE THE BLOOD VESSELS, SO 1131 00:42:34,440 --> 00:42:38,120 YOU SEE BLOOD VESSEL PATHOLOGY. 1132 00:42:38,120 --> 00:42:47,160 YOU SEE LEAKAGE HERE IN GREEN OF 1133 00:42:47,160 --> 00:42:49,000 DYES, BLOOD PRODUCTS, BLOOD 1134 00:42:49,000 --> 00:42:50,760 PROTEINS LEAKING THROUGH THE 1135 00:42:50,760 --> 00:42:54,400 BLOOD-BRAIN BARRIER, WE SEE 1136 00:42:54,400 --> 00:42:55,120 BRAIN SUBSTANCE WHICH SHOULDN'T 1137 00:42:55,120 --> 00:42:55,560 BE THERE. 1138 00:42:55,560 --> 00:42:57,560 WE SEE LOSS OF EXTRACELLULAR 1139 00:42:57,560 --> 00:43:03,800 MEMBRANE ALONG BLOOD VESSELS. 1140 00:43:03,800 --> 00:43:05,120 THEN YOU SEE INFLAMMATION THAT 1141 00:43:05,120 --> 00:43:06,880 STARTS TO SURROUND THESE BLOOD 1142 00:43:06,880 --> 00:43:07,960 VESSELS, WHICH YOU WOULD EXPECT 1143 00:43:07,960 --> 00:43:10,080 TO SEE IF THERE'S LEAK OF 1144 00:43:10,080 --> 00:43:10,920 SUBSTANCES FROM THE BLOODSTREAM 1145 00:43:10,920 --> 00:43:12,920 INTO THE BRAIN SUBSTANCE. 1146 00:43:12,920 --> 00:43:16,720 AND THEN THERE'S AN INFLAMMATORY 1147 00:43:16,720 --> 00:43:18,720 RESPONSE WHICH IS POTENTIALLY A 1148 00:43:18,720 --> 00:43:20,720 DRIVER OF SOME OF THE NEUROLOGIC 1149 00:43:20,720 --> 00:43:22,760 SYMPTOMS IN THE ACUTE COVID 1150 00:43:22,760 --> 00:43:27,920 CASE, SO IF YOU LOOK AT RISK 1151 00:43:27,920 --> 00:43:30,960 FACTORS IN THE SPINAL FLUID, 1152 00:43:30,960 --> 00:43:32,400 PEOPLE WHO HAVE COGNITIVE 1153 00:43:32,400 --> 00:43:33,720 TROUBLE AFTER MILD COVID, AGAIN, 1154 00:43:33,720 --> 00:43:38,480 VERY SMALL STUDY, BUT THIS ONE 1155 00:43:38,480 --> 00:43:43,560 SHOWED THAT 9 OF 13 MONO CLONL 1156 00:43:43,560 --> 00:43:45,800 BANDS IN THE SPINAL FLUID, SO 1157 00:43:45,800 --> 00:43:48,120 THEY'RE BANDS OF IMMUNOGLOBULINS 1158 00:43:48,120 --> 00:43:49,520 ASSOCIATED WITH PARTICULAR 1159 00:43:49,520 --> 00:43:55,120 ANTIGENS, ANTIGENS ARE NOT 1160 00:43:55,120 --> 00:43:58,640 DEFINED, BUT IT'S A FAIRLY LOW 1161 00:43:58,640 --> 00:43:59,160 PREVALENCE IN NORMAL 1162 00:43:59,160 --> 00:43:59,520 INDIVIDUALS. 1163 00:43:59,520 --> 00:44:03,960 SO THIS INDICATES SOME TYPE OF 1164 00:44:03,960 --> 00:44:05,840 PRODUCTION OF ANTIBODIES IN THE 1165 00:44:05,840 --> 00:44:09,960 CENTRAL NERVOUS SYSTEM. 1166 00:44:09,960 --> 00:44:11,840 IN STUDIES OF ACUTE COVID CASES, 1167 00:44:11,840 --> 00:44:14,680 THERE'S A LOT OF BRAIN INJURY 1168 00:44:14,680 --> 00:44:16,720 LIKE WE TALKED ABOUT IN 1169 00:44:16,720 --> 00:44:18,920 BLOOD-BRAIN BARRIER BREAK DOWNS 1170 00:44:18,920 --> 00:44:20,920 AND WHAT YOU SEE IS A LEAKAGE OF 1171 00:44:20,920 --> 00:44:29,200 CERTAIN PROTEINS, NEUROFILAMENT 1172 00:44:29,200 --> 00:44:32,120 LIGHT, FIBRILLARY ACIDIC 1173 00:44:32,120 --> 00:44:33,120 PROTEIN, AND THESE WERE ELEVATED 1174 00:44:33,120 --> 00:44:35,040 IN THE ACUTE PHASE BUT THEY 1175 00:44:35,040 --> 00:44:35,920 NORMALIZED BY SIX MONTHS. 1176 00:44:35,920 --> 00:44:38,720 AND THEY FOUND NO CORRELATION 1177 00:44:38,720 --> 00:44:43,320 BETWEEN SYMPTOMS AND THESE CNS 1178 00:44:43,320 --> 00:44:44,880 BIOMARKERS OF LEAKAGE. 1179 00:44:44,880 --> 00:44:47,000 BUT THERE IS DEFINITELY LEAKAGE 1180 00:44:47,000 --> 00:44:48,440 SO THERE IS EVIDENCE OF CELLULAR 1181 00:44:48,440 --> 00:44:50,320 INJURY IN THE ACUTE PHASE WITH 1182 00:44:50,320 --> 00:44:53,920 SEVERE ILLNESS. 1183 00:44:53,920 --> 00:44:55,120 MAYBE NOT THAT SURPRISING. 1184 00:44:55,120 --> 00:44:57,720 OTHER STUDIES LOOKING AT SPINAL 1185 00:44:57,720 --> 00:45:02,720 FLUID SHOW T-CELL ACTIVATION IN 1186 00:45:02,720 --> 00:45:05,040 THE SPINAL FLUID. 1187 00:45:05,040 --> 00:45:07,360 THE CYTOKINE RESPONSE IN THE 1188 00:45:07,360 --> 00:45:13,280 CNS, THE T-CELLS PATTERN YOU SEE 1189 00:45:13,280 --> 00:45:14,240 IS DIFFERENT THAN WHAT YOU SEE 1190 00:45:14,240 --> 00:45:15,880 IN THE BLOOD, SO THERE'S 1191 00:45:15,880 --> 00:45:16,800 SOMETHING PARTICULAR GOING ON IN 1192 00:45:16,800 --> 00:45:22,000 THE NERVOUS SYSTEM, AND THIS IS 1193 00:45:22,000 --> 00:45:29,800 ANOTHER STUDY LOOKING AT THE 1194 00:45:29,800 --> 00:45:36,840 INJURY MARKER BUT ALSO CYTOKINES 1195 00:45:36,840 --> 00:45:40,520 IN THE SPINAL FLUID OF PATIENTS 1196 00:45:40,520 --> 00:45:42,480 WITH NEUROLOGICAL COMPLICATIONS, 1197 00:45:42,480 --> 00:45:43,760 ACUTE COVID. 1198 00:45:43,760 --> 00:45:46,680 WHAT ARE PROBLEMS, FATIGUE IS 1199 00:45:46,680 --> 00:45:48,880 PROBABLY THE MOST COMMON AND THE 1200 00:45:48,880 --> 00:45:50,680 MOST DISABLING. 1201 00:45:50,680 --> 00:45:51,920 THE OTHER ONE THAT'S DISABLING 1202 00:45:51,920 --> 00:45:53,240 IS TROUBLE WITH CONCENTRATION. 1203 00:45:53,240 --> 00:45:57,480 SO THIS IS A STUDY FROM THE 1204 00:45:57,480 --> 00:45:58,360 U.K., A REALLY LARGE STUDY. 1205 00:45:58,360 --> 00:46:05,240 THEY HAVE THESE COMPUTERIZED 1206 00:46:05,240 --> 00:46:07,320 TESTS OF WORD SPAN, RARE WORD 1207 00:46:07,320 --> 00:46:09,120 DEFINITION, AND THEY TESTED 1208 00:46:09,120 --> 00:46:10,720 81,000 PEOPLE AND THEY LOOKED AT 1209 00:46:10,720 --> 00:46:12,280 PEOPLE WHO HAD COVID BEFORE 1210 00:46:12,280 --> 00:46:14,120 COMPARED TO NORMALS. 1211 00:46:14,120 --> 00:46:15,960 WHAT THEY SEE IS THAT THERE IS 1212 00:46:15,960 --> 00:46:18,360 SOME DEFICITS THAT YOU CAN 1213 00:46:18,360 --> 00:46:21,680 MEASURE AT THIS POPULATION LEVEL 1214 00:46:21,680 --> 00:46:23,520 IN PEOPLE WHO HAVE HAD COVID. 1215 00:46:23,520 --> 00:46:25,240 IT'S VERY SMALL EFFECT SIZE IF 1216 00:46:25,240 --> 00:46:27,560 YOU HAD SYMPTOMS OF COVID BUT 1217 00:46:27,560 --> 00:46:31,080 DIDN'T HAVE REALLY TROUBLE WITH 1218 00:46:31,080 --> 00:46:31,360 RESPIRATION. 1219 00:46:31,360 --> 00:46:33,920 IF YOU HAD SHORTNESS OF BREATH 1220 00:46:33,920 --> 00:46:35,120 AND STAYED AT HOME, IT'S A 1221 00:46:35,120 --> 00:46:35,560 LITTLE WORSE. 1222 00:46:35,560 --> 00:46:37,280 IF YOU NEEDED MEDICAL ASSISTANCE 1223 00:46:37,280 --> 00:46:39,160 AT HOME, YOUR SCORE IS ACTUALLY 1224 00:46:39,160 --> 00:46:40,480 A LITTLE WORSE THAN THAT. 1225 00:46:40,480 --> 00:46:42,680 IF YOU WENT TO A HOSPITAL NOT ON 1226 00:46:42,680 --> 00:46:44,200 A VENTILATOR, THEY'RE 1227 00:46:44,200 --> 00:46:46,720 SIGNIFICANTLY WORSE, AND THEN ON 1228 00:46:46,720 --> 00:46:50,720 A VENTILATOR, THEY'RE THE WORST. 1229 00:46:50,720 --> 00:46:55,520 SO THIS IS A LARGE POPULATION 1230 00:46:55,520 --> 00:46:58,160 STUDY SHOWING COGNITIVE CHANGES 1231 00:46:58,160 --> 00:46:59,680 RELATED TO COVID WHETHER OR NOT 1232 00:46:59,680 --> 00:47:02,520 YOU WENT INTO THE HOSPITAL BUT 1233 00:47:02,520 --> 00:47:04,840 CERTAINLY THE WORST, MORE SEVERE 1234 00:47:04,840 --> 00:47:05,600 ILLNESSES. 1235 00:47:05,600 --> 00:47:07,000 THAT THEME HAS BEEN REPEATED 1236 00:47:07,000 --> 00:47:08,760 OVER AND OVER AGAIN IN THE 1237 00:47:08,760 --> 00:47:16,640 POST-ACUTE SEQUELAE OF COVID. 1238 00:47:16,640 --> 00:47:17,880 NOW, IN TERMS OF THE CENTRAL 1239 00:47:17,880 --> 00:47:19,040 NERVOUS SYSTEM, WE'RE TALKING 1240 00:47:19,040 --> 00:47:21,920 MOSTLY ABOUT FATIGUE, SLEEP 1241 00:47:21,920 --> 00:47:24,720 TROUBLES, TROUBLE WITH 1242 00:47:24,720 --> 00:47:25,080 CONCENTRATION. 1243 00:47:25,080 --> 00:47:27,560 IN THE PERIPHERAL NERVOUS SYSTEM 1244 00:47:27,560 --> 00:47:30,120 WE OFTEN TALK ABOUT PAIN AND 1245 00:47:30,120 --> 00:47:37,080 DISOUGHT NOME 1246 00:47:37,080 --> 00:47:37,520 DISAUTONOMIA. 1247 00:47:37,520 --> 00:47:42,680 THOUGHT TO COME TO SMALL NERVE 1248 00:47:42,680 --> 00:47:44,440 FIBERS. 1249 00:47:44,440 --> 00:47:50,120 THEY EVALUATED A VERY -- THIS IS 1250 00:47:50,120 --> 00:47:52,120 NOT AN UNBIASED GROUP. 1251 00:47:52,120 --> 00:47:53,320 THESE ARE PEOPLE WHO HAD SOME 1252 00:47:53,320 --> 00:47:58,440 KIND OF SYMPTOMS OF LONG COVID, 1253 00:47:58,440 --> 00:48:00,520 THAT GOT THEM TO SEE A 1254 00:48:00,520 --> 00:48:05,160 PERIPHERAL NERVE DOCTOR. 1255 00:48:05,160 --> 00:48:09,680 THEY DID FIND 57% HAD NEUROPATHY 1256 00:48:09,680 --> 00:48:11,120 FROM THEIR SYMPTOM CHECKLIST AND 1257 00:48:11,120 --> 00:48:12,320 THEIR TESTING WAS SIGNIFICANT 1258 00:48:12,320 --> 00:48:13,800 WITH A SMALL FIBER NEUROPATHY. 1259 00:48:13,800 --> 00:48:15,880 SO THESE ARE THE NERVE FIBERS 1260 00:48:15,880 --> 00:48:17,160 THAT DON'T HAVE MYELIN AROUND 1261 00:48:17,160 --> 00:48:19,720 THEM, THEY GO TO THE SKIN. 1262 00:48:19,720 --> 00:48:22,960 THEY'RE BASICALLY PAIN FIBERS, 1263 00:48:22,960 --> 00:48:28,240 TEMPERATURE FIBERS PRIMARILY. 1264 00:48:28,240 --> 00:48:30,400 THE SUGGESTION WAS THAT THIS IS 1265 00:48:30,400 --> 00:48:33,120 AN INFECTION TRIGGERED IMMUNE 1266 00:48:33,120 --> 00:48:35,880 DYSREGULATION THAT GIVES RISE TO 1267 00:48:35,880 --> 00:48:40,400 THE SMALL -- NEWER NEUROPATHY SIMILAR 1268 00:48:40,400 --> 00:48:42,600 TO GILLIAN BARRE EXCEPT GILLIAN 1269 00:48:42,600 --> 00:48:44,320 BARRE AFFECTS MOSTLY MYELIN, BUT 1270 00:48:44,320 --> 00:48:47,200 THERE ARE FORMS OF VERY 1271 00:48:47,200 --> 00:48:49,440 AUTOIMMUNE POST INFECTIOUS 1272 00:48:49,440 --> 00:48:50,320 CONDITIONS WHERE THE TARGET IS 1273 00:48:50,320 --> 00:48:51,720 NOT THE MYELIN, BUT IT'S THE 1274 00:48:51,720 --> 00:48:54,360 SMALL FIBERS, AND THAT'S WHAT IT 1275 00:48:54,360 --> 00:48:55,480 LOOKS LIKE WE'RE SEEING HERE. 1276 00:48:55,480 --> 00:48:58,880 THAT WILL ALSO GIVE YOU 1277 00:48:58,880 --> 00:49:01,320 AUTONOMIC TROUBLE. 1278 00:49:01,320 --> 00:49:02,480 THERE'S ACTUALLY AN INTERESTING 1279 00:49:02,480 --> 00:49:04,880 STUDY THAT WAS PUBLISHED LOOKING 1280 00:49:04,880 --> 00:49:07,600 AT THE NERVE FIBERS IN THE 1281 00:49:07,600 --> 00:49:07,920 CORNEA. 1282 00:49:07,920 --> 00:49:10,320 SO THIS IS SOMETHING THAT 1283 00:49:10,320 --> 00:49:11,880 POTENTIALLY COULD BE A GOOD BIO 1284 00:49:11,880 --> 00:49:14,360 MARKER WHERE YOU CAN SEE HERE'S 1285 00:49:14,360 --> 00:49:17,880 THE NORMAL, HERE'S SOMEBODY WHO 1286 00:49:17,880 --> 00:49:21,640 HAD COVID AND HAVING TROUBLE, 1287 00:49:21,640 --> 00:49:23,320 AND HERE'S SOMEBODY WHO HAD 1288 00:49:23,320 --> 00:49:24,520 COVID AND NOT HAVING TROUBLE, 1289 00:49:24,520 --> 00:49:27,840 AND YOU CAN CERTAINLY SEE SEVERE 1290 00:49:27,840 --> 00:49:29,240 ABNORMALITY IN THE SMALL NERVE 1291 00:49:29,240 --> 00:49:34,080 FIBERS OF THE CORNEA IN THIS 1292 00:49:34,080 --> 00:49:37,600 PATIENT, A SMALL 1293 00:49:37,600 --> 00:49:37,960 FIBRONEUROPATHY. 1294 00:49:37,960 --> 00:49:38,520 THERE'S AN INTERESTING PAPER 1295 00:49:38,520 --> 00:49:40,160 THAT CAME OUT THAT GOT A LOT OF 1296 00:49:40,160 --> 00:49:44,120 PRESS IN NATURE FROM THE U.K., 1297 00:49:44,120 --> 00:49:46,240 WHERE THEY HAVE A BIOBANK AND 1298 00:49:46,240 --> 00:49:47,640 THEY DO MRI SCANS ON PEOPLE IN 1299 00:49:47,640 --> 00:49:50,640 THE STUDY, AND THE STUDY STARTED 1300 00:49:50,640 --> 00:49:53,120 BEFORE COVID, SO THEY ACTUALLY 1301 00:49:53,120 --> 00:49:55,200 HAD MRI SCANS BEFORE COVID AND 1302 00:49:55,200 --> 00:49:58,160 AFTER COVID, AND THEY COULD FIND 1303 00:49:58,160 --> 00:50:01,200 CHANGES WHICH ARE PRIMARILY 1304 00:50:01,200 --> 00:50:03,720 DECREASES IN CORTICAL THICKNESS 1305 00:50:03,720 --> 00:50:07,360 IN DIFFERENT AREAS OF BRAIN, AND 1306 00:50:07,360 --> 00:50:12,280 MOST OF THEM ARE ASSOCIATED WITH 1307 00:50:12,280 --> 00:50:17,000 THE LIMBIC SYSTEM, WHICH IS 1308 00:50:17,000 --> 00:50:18,640 SIGNIFICANTLY ASSOCIATED WITH 1309 00:50:18,640 --> 00:50:20,920 THE OLFACTORY SYSTEM. 1310 00:50:20,920 --> 00:50:28,680 SO PIRIFORM CORTEX -- ALL LIMBIC 1311 00:50:28,680 --> 00:50:35,720 SYSTEM AREAS, AND SO THEY SHOW 1312 00:50:35,720 --> 00:50:37,000 DEFINITE THINNING OF CORTEX IN 1313 00:50:37,000 --> 00:50:37,680 THESE AREAS. 1314 00:50:37,680 --> 00:50:38,680 IT'S VERY CLEAR THAT THAT'S THE 1315 00:50:38,680 --> 00:50:38,960 CASE. 1316 00:50:38,960 --> 00:50:42,360 AND THE QUESTION IS, WHY? 1317 00:50:42,360 --> 00:50:43,800 YOU MIGHT ASSUME, WELL, IT'S DUE 1318 00:50:43,800 --> 00:50:45,120 TO INFECTION, BUT THERE IS A 1319 00:50:45,120 --> 00:50:48,720 CAVEAT HERE, AND THAT IS THAT IF 1320 00:50:48,720 --> 00:50:49,920 YOU LOSE YOUR SENSE OF SMELL, 1321 00:50:49,920 --> 00:50:51,200 YOU SEE CHANGES IN A LOT OF 1322 00:50:51,200 --> 00:50:53,040 THESE SAME REGIONS. 1323 00:50:53,040 --> 00:50:54,360 THIS IS A STUDY THAT HAD NOTHING 1324 00:50:54,360 --> 00:50:58,840 TO DO WITH COVID, JUST PEOPLE AS 1325 00:50:58,840 --> 00:51:00,520 THEY GET OLDER, THEY LOSE THEIR 1326 00:51:00,520 --> 00:51:04,960 SENSE OF SMELL, SO THEY DIDN'T 1327 00:51:04,960 --> 00:51:07,720 EVEN HAVE BEFORE AND AFTERs. 1328 00:51:07,720 --> 00:51:10,000 SO THE SAME THINGS IN THE SAME 1329 00:51:10,000 --> 00:51:12,840 AREAS, SAME THING OF CORE TECT, 1330 00:51:12,840 --> 00:51:15,120 CLEARLY MUCH MORE ROBUST WHEN 1331 00:51:15,120 --> 00:51:17,680 YOU HAVE BEFORE AND AFTER MRI, 1332 00:51:17,680 --> 00:51:18,760 SO THE ANSWER TO THE QUESTION 1333 00:51:18,760 --> 00:51:22,920 COULD BE, IT HAS NOTHING TO DO 1334 00:51:22,920 --> 00:51:24,920 WITH THAT SECTION OF THE BRAIN 1335 00:51:24,920 --> 00:51:26,760 AT ALL OR IMMUNE RESPONSE OF THE 1336 00:51:26,760 --> 00:51:28,520 BRAIN BR MORE RELATED TO HAVING 1337 00:51:28,520 --> 00:51:31,920 LOST YOUR SENSE OF SMELL AND 1338 00:51:31,920 --> 00:51:32,720 PLASTICITY [INAUDIBLE]. 1339 00:51:32,720 --> 00:51:35,400 JUST TO MENTION THAT PEOPLE HAVE 1340 00:51:35,400 --> 00:51:36,520 LOOKED AT THE VACCINATION STORY 1341 00:51:36,520 --> 00:51:40,120 AND CERTAINLY IF YOU HAVE BEEN 1342 00:51:40,120 --> 00:51:40,960 VACCINATED, YOUR CHANCE OF 1343 00:51:40,960 --> 00:51:46,520 GETTING POST-ACUTE SCE LAY SEQUELAE OF 1344 00:51:46,520 --> 00:51:47,400 COVID IS DECREASED. 1345 00:51:47,400 --> 00:51:48,600 SO THAT'S WHAT I WANTED TO JUST 1346 00:51:48,600 --> 00:51:49,680 MENTION WHERE WE ARE IN TERMS OF 1347 00:51:49,680 --> 00:51:50,920 WHAT THE STUDIES ARE THAT ARE 1348 00:51:50,920 --> 00:51:51,320 OUT THERE. 1349 00:51:51,320 --> 00:51:53,200 AS YOU CAN SEE, THERE'S LOTS OF 1350 00:51:53,200 --> 00:51:55,840 SMALL STUDIES, THEY'RE ALL 1351 00:51:55,840 --> 00:51:59,440 PLANNING TO SEE SOME 1352 00:51:59,440 --> 00:51:59,960 ASSOCIATIONS, POTENTIALLY 1353 00:51:59,960 --> 00:52:01,160 INTERESTING WITH REGARD TO 1354 00:52:01,160 --> 00:52:05,000 CAUSATION, BUT NO CAUSATION. 1355 00:52:05,000 --> 00:52:06,520 SO THE RECOVERY INITIATIVE IS 1356 00:52:06,520 --> 00:52:08,080 ENGINEERED TO KIND OF, AT THE 1357 00:52:08,080 --> 00:52:10,560 END OF THE THING, GIVE THE 1358 00:52:10,560 --> 00:52:12,320 ANSWERS IF IT'S POSSIBLE, WE'RE 1359 00:52:12,320 --> 00:52:16,160 GOING TO GET THEM THROUGH THE 1360 00:52:16,160 --> 00:52:20,520 RECOVERY INITIATIVE. 1361 00:52:20,520 --> 00:52:23,360 IF THAT -- IF A SMALL STUDY OR 1362 00:52:23,360 --> 00:52:24,160 INVESTIGATOR-INITIATED SMALL 1363 00:52:24,160 --> 00:52:25,760 GROUP GETS TOGETHER, FIGURES IT 1364 00:52:25,760 --> 00:52:27,200 ALL OUT, THAT WOULD BE FINE, WE 1365 00:52:27,200 --> 00:52:29,520 CAN CLOSE TO IT DOWN. 1366 00:52:29,520 --> 00:52:30,600 BUT THE GUESS IS THAT THIS IS 1367 00:52:30,600 --> 00:52:32,960 GOING TO BE A HARD PROBLEM. 1368 00:52:32,960 --> 00:52:33,640 AND ONE REASON I THINK IT'S 1369 00:52:33,640 --> 00:52:35,400 GOING TO BE A HARD PROBLEM IS 1370 00:52:35,400 --> 00:52:39,680 BECAUSE DEALING WITH DEALING 1371 00:52:39,680 --> 00:52:42,040 WITH CHRONIC FATIGUE SYNDROME 1372 00:52:42,040 --> 00:52:46,920 FOR YEARS, WE HAVEN'T MADE ANY 1373 00:52:46,920 --> 00:52:48,360 PROGRESS FOREVER, AND SOME OF 1374 00:52:48,360 --> 00:52:49,880 THESE PEOPLE HAVE BEEN BED BOUND 1375 00:52:49,880 --> 00:52:51,000 FOR DECADES. 1376 00:52:51,000 --> 00:52:52,520 SO THIS GOVERNMENT INITIATIVE IS 1377 00:52:52,520 --> 00:52:56,560 FUNDED TO THE TUNE OF 1378 00:52:56,560 --> 00:52:57,120 $1.15 BILLION BY CONGRESS. 1379 00:52:57,120 --> 00:52:59,200 THE GOAL IS TO UNDERSTAND THE 1380 00:52:59,200 --> 00:53:05,200 BIOLOGY UNDERLYING RECOVERY OVER 1381 00:53:05,200 --> 00:53:11,000 TIME, UNDERSTANDING RISK 1382 00:53:11,000 --> 00:53:13,160 TYPES, -- TO STUDY THE 1383 00:53:13,160 --> 00:53:15,040 PATHOGENESIS OVER TIME AND TO 1384 00:53:15,040 --> 00:53:16,240 IDENTIFY INTERVENTIONS TO TREAT 1385 00:53:16,240 --> 00:53:17,920 AND PREVENT POST-ACUTE SEQUELAE 1386 00:53:17,920 --> 00:53:19,120 OF COVID. 1387 00:53:19,120 --> 00:53:22,680 IT'S A NATIONAL SCALE TO BE 1388 00:53:22,680 --> 00:53:23,120 INCLUSIVE, DIVERSE 1389 00:53:23,120 --> 00:53:25,200 PARTICIPATION, AND REALLY BROAD 1390 00:53:25,200 --> 00:53:30,080 LOOK AT COVID, NOT TAKING A 1391 00:53:30,080 --> 00:53:31,320 PARTICULAR GROUP AND STUDYING 1392 00:53:31,320 --> 00:53:34,720 THEM AND FOR GETTING ABOUT SEVEN 1393 00:53:34,720 --> 00:53:36,920 OR EIGHT OTHER GROUPS THAT 1394 00:53:36,920 --> 00:53:38,600 CONSTITUTE POST-ACUTE SEQUELAE 1395 00:53:38,600 --> 00:53:42,520 OF COVID. 1396 00:53:42,520 --> 00:53:44,560 AND IT'S A LARGE STUDY WITH 30 1397 00:53:44,560 --> 00:53:48,960 HUBS AROUND THE COUNTRY, 15 1398 00:53:48,960 --> 00:53:51,000 ADULT COHORTS, TWO PREGNANCY 1399 00:53:51,000 --> 00:53:52,480 COHORTS, EIGHT PEDIATRIC 1400 00:53:52,480 --> 00:53:53,920 COHORTS, AND IMPORTANTLY WE HAVE 1401 00:53:53,920 --> 00:53:55,840 ENGINEERED IN AUTOPSIES ON 1402 00:53:55,840 --> 00:53:59,400 PEOPLE WHO HAVE SURVIVED COVID 1403 00:53:59,400 --> 00:54:02,800 TO FIND OUT WHAT ARE THE -- WHAT 1404 00:54:02,800 --> 00:54:04,120 CAN WE SEE UNDER THE MICROSCOPE 1405 00:54:04,120 --> 00:54:06,000 IN PEOPLE WHO ARE STILL 1406 00:54:06,000 --> 00:54:07,560 SUFFERING WITH POST-ACUTE 1407 00:54:07,560 --> 00:54:10,040 SEQUELAE OF COVID VERSUS THOSE 1408 00:54:10,040 --> 00:54:10,480 WHO DON'T? 1409 00:54:10,480 --> 00:54:11,560 IF ANYTHING IS GOING TO GIVE US 1410 00:54:11,560 --> 00:54:12,960 A QUICK ANSWER, IT GOING TO COME 1411 00:54:12,960 --> 00:54:15,600 OUT OF THE AUTOPSY STUDIES. 1412 00:54:15,600 --> 00:54:17,120 BUT THE OTHER ONES, THERE'S SO 1413 00:54:17,120 --> 00:54:18,320 MUCH TO LOOK AT, WE'RE GOING TO 1414 00:54:18,320 --> 00:54:19,960 SEE ASSOCIATIONS, AND THEN WE'RE 1415 00:54:19,960 --> 00:54:22,160 GOING TO HAVE TO DRILL DOWN ON 1416 00:54:22,160 --> 00:54:24,320 THOSE AND DISCARD THOSE THAT ARE 1417 00:54:24,320 --> 00:54:26,320 NOT CAUSATIVE AND REALLY TRY AND 1418 00:54:26,320 --> 00:54:29,200 KEEP WORKING UNTIL WE FIND WHAT 1419 00:54:29,200 --> 00:54:30,240 ARE THE BIOLOGICAL DRIVERS. 1420 00:54:30,240 --> 00:54:31,920 WE'RE ALSO LOOKING AT ELECTRONIC 1421 00:54:31,920 --> 00:54:33,640 HEALTH RECORDS, 50 MILLION 1422 00:54:33,640 --> 00:54:35,840 PEOPLE, AND THIS IS PARTICULARLY 1423 00:54:35,840 --> 00:54:40,720 THE LOOK OVER TIME AT CHANGES IN 1424 00:54:40,720 --> 00:54:44,280 PUBLIC HEALTH THAT ARE RELATED 1425 00:54:44,280 --> 00:54:47,240 TO THE COVID PANDEMIC. 1426 00:54:47,240 --> 00:54:54,720 WE ARE ENROLLING UP TO 40,000 1427 00:54:54,720 --> 00:54:55,160 PARTICIPANTS. 1428 00:54:55,160 --> 00:54:58,680 1,500 SO FAR, ELECTRONIC HEALTH 1429 00:54:58,680 --> 00:55:00,520 RECORD STUDIES ARE GOING, TISSUE 1430 00:55:00,520 --> 00:55:01,600 PATHOLOGY, AUTOPSY STUDY. 1431 00:55:01,600 --> 00:55:06,960 WE'RE JUST SETTING UP NOW 1432 00:55:06,960 --> 00:55:08,600 CLINICAL TRIALS IN PEOPLE WHO 1433 00:55:08,600 --> 00:55:11,520 HAVE POST SEQUELAE OF ACUTE 1434 00:55:11,520 --> 00:55:11,880 COVID. 1435 00:55:11,880 --> 00:55:13,320 NOW THAT THERE'S STILL ACUTE 1436 00:55:13,320 --> 00:55:14,920 COVID AROUND, TO TRY TO RECRUIT 1437 00:55:14,920 --> 00:55:16,800 PEOPLE WHO ARE ACUTE AND THEN TO 1438 00:55:16,800 --> 00:55:18,680 FOLLOW THEM OVER TIME TO SEE 1439 00:55:18,680 --> 00:55:20,520 WHAT'S DIFFERENT IN THOSE PEOPLE 1440 00:55:20,520 --> 00:55:21,720 WHO RECOVER WELL VERSUS THOSE 1441 00:55:21,720 --> 00:55:24,800 WHO DON'T. 1442 00:55:24,800 --> 00:55:25,760 THIS IS THE OPPORTUNITY TO DO 1443 00:55:25,760 --> 00:55:27,200 THAT, AND THEY SAID HOPEFULLY A 1444 00:55:27,200 --> 00:55:29,520 YEAR OR TWO LATER, THE PANDEMIC 1445 00:55:29,520 --> 00:55:30,560 WILL BE OVER, YOU'RE NOT GOING 1446 00:55:30,560 --> 00:55:34,520 TO GET THAT OPPORTUNITY AGAIN. 1447 00:55:34,520 --> 00:55:36,360 AND THE HOPE IS WE CAN GET INTO 1448 00:55:36,360 --> 00:55:38,320 CLINICAL TRIALS, I THINK IN THE 1449 00:55:38,320 --> 00:55:43,480 BEGINNING THEY'LL BE BASED ON 1450 00:55:43,480 --> 00:55:49,920 SYMPTOMATIC THERAPY, LIKE WHAT 1451 00:55:49,920 --> 00:55:51,680 DOES IT TAKE TO TREAT THEIR PAIN 1452 00:55:51,680 --> 00:55:54,520 OR THEIR AUTONOMIC TROUBLE OR 1453 00:55:54,520 --> 00:55:57,680 DEPRESSION OR ANXIETY DISORDERS? 1454 00:55:57,680 --> 00:55:59,160 THEY MAY BE JUST LIKE EVERYBODY 1455 00:55:59,160 --> 00:56:00,920 ELSE WHO HAS THOSE TROUBLE, THEY 1456 00:56:00,920 --> 00:56:02,440 MIGHT BE QUITE UNIQUE. 1457 00:56:02,440 --> 00:56:06,920 SO GETTING SYMPTOM ATTENUATION 1458 00:56:06,920 --> 00:56:08,640 WOULD BE THE FIRST STEP IN 1459 00:56:08,640 --> 00:56:09,040 TRIALS. 1460 00:56:09,040 --> 00:56:10,880 BUT THEN IF WE UNDERSTAND SOME 1461 00:56:10,880 --> 00:56:12,120 OF THE BIOLOGICAL DRIVERS, FOR 1462 00:56:12,120 --> 00:56:13,600 INSTANCE, WE TALKED ABOUT 1463 00:56:13,600 --> 00:56:16,120 PERSISTENT VIRUS, THEN 1464 00:56:16,120 --> 00:56:17,320 ANTIVIRALS WOULD BE THERAPY 1465 00:56:17,320 --> 00:56:19,720 THAT'S DESIGNED TO GET RIGHT AT 1466 00:56:19,720 --> 00:56:24,960 THE ROOT CAUSE OF THE TROUBLE. 1467 00:56:24,960 --> 00:56:25,960 SO THAT'S WHAT I WANTED TO TALK 1468 00:56:25,960 --> 00:56:26,520 ABOUT. 1469 00:56:26,520 --> 00:56:32,200 I THINK WE'RE EMBARKING ON AN 1470 00:56:32,200 --> 00:56:33,360 UNBELIEVABLY LARGE AND WELL 1471 00:56:33,360 --> 00:56:34,160 ENGINEERED STUDY, AND IT 1472 00:56:34,160 --> 00:56:37,120 CERTAINLY HAS TAKEN TIME TO SET 1473 00:56:37,120 --> 00:56:38,720 IT ALL UP, BUT I THINK IT'S 1474 00:56:38,720 --> 00:56:41,520 GOING TO LEAVE NO STONE UNTURNED 1475 00:56:41,520 --> 00:56:45,360 AND HOPEFULLY WE GET ANSWERS, 1476 00:56:45,360 --> 00:56:46,720 HOPEFULLY SOONER THAN LATER. 1477 00:56:46,720 --> 00:56:52,320 SO THANKS VERY MUCH. 1478 00:56:52,320 --> 00:56:53,320 >> THANK YOU VERY, VERY MUCH, 1479 00:56:53,320 --> 00:56:59,480 BOTH OF YOU, FOR REALLY 1480 00:56:59,480 --> 00:57:03,320 STIMULATING AN AND INFORMATIVE 1481 00:57:03,320 --> 00:57:03,720 PRESENTATIONS. 1482 00:57:03,720 --> 00:57:08,760 WE HAVE A BARRAGE OF QUESTIONS, 1483 00:57:08,760 --> 00:57:09,880 AND I'M GOING TO TRY AND 1484 00:57:09,880 --> 00:57:10,720 CONDENSE SOME OF THEM. 1485 00:57:10,720 --> 00:57:14,360 BUT LET ME BEGIN BY THIS ONE. 1486 00:57:14,360 --> 00:57:22,560 ANTIPERHAPS AND PERHAPS YOU WANT TO RESPON D 1487 00:57:22,560 --> 00:57:23,880 OR DISCUSS IT AMONGST 1488 00:57:23,880 --> 00:57:26,520 YOURSELVES. 1489 00:57:26,520 --> 00:57:29,240 SO KIRA SUBMITS A MESSAGE. 1490 00:57:29,240 --> 00:57:31,880 SHE SAYS, THIS HAS BEEN 1491 00:57:31,880 --> 00:57:34,480 FANTASTIC, THANK YOU! 1492 00:57:34,480 --> 00:57:38,640 HOWEVER, IN A CLINICAL SETTING, 1493 00:57:38,640 --> 00:57:40,800 IF THE BIOMARKERS ARE 1494 00:57:40,800 --> 00:57:41,920 DIMINISHING BY 6 MONTHS AND 1495 00:57:41,920 --> 00:57:43,440 EVIDENCE SUGGESTS THAT LONG 1496 00:57:43,440 --> 00:57:46,680 COVID SYMPTOMS CAN LAST WELL 1497 00:57:46,680 --> 00:57:48,720 BEYOND 6 MONTHS, HOW DO YOU 1498 00:57:48,720 --> 00:57:50,560 EVALUATE NEUROLOGIC SYMPTOMS FOR 1499 00:57:50,560 --> 00:57:51,120 CAUSE? 1500 00:57:51,120 --> 00:57:56,120 FOR EXAMPLE, IF AN ADOLESCENT 1501 00:57:56,120 --> 00:57:57,960 PATIENT DEVELOPS SOME RARE 1502 00:57:57,960 --> 00:58:02,800 NEUROLOGIC SYMPTOM OR MAIBL A OR MAYBE A 1503 00:58:02,800 --> 00:58:04,320 SEIZURE APPROXIMATELY 6 WEEKS 1504 00:58:04,320 --> 00:58:06,440 FOLLOWING A MILD COVID 1505 00:58:06,440 --> 00:58:07,160 INFECTION, IT WOULD SEEM 1506 00:58:07,160 --> 00:58:09,240 PHYSICIANS ARE MORE LIKELY TO 1507 00:58:09,240 --> 00:58:10,600 EVALUATE OTHER SOURCES BEFORE 1508 00:58:10,600 --> 00:58:14,520 THEY LOOK AT COVID WHEN IT COMES 1509 00:58:14,520 --> 00:58:16,600 TO ANY ASPECT OF TREATMENT. 1510 00:58:16,600 --> 00:58:20,320 SO ARE THESE SYMPTOMS THEN 1511 00:58:20,320 --> 00:58:21,520 TREATED DIFFERENTLY IF COVID IS 1512 00:58:21,520 --> 00:58:22,160 THE CAUSE? 1513 00:58:22,160 --> 00:58:26,320 AND I GUESS UNDERNEATH IT ALL IS 1514 00:58:26,320 --> 00:58:27,520 HOW DO YOU DETERMINE WHETHER 1515 00:58:27,520 --> 00:58:30,080 COVID IS THE CAUSE OR RELATED TO 1516 00:58:30,080 --> 00:58:32,920 THE OCCURRENCE OF NEUROLOGICAL 1517 00:58:32,920 --> 00:58:36,280 SYMPTOMS DURING THIS PERIOD WHEN 1518 00:58:36,280 --> 00:58:39,800 THE BIOMARKERS HAVE DIMINISHING 1519 00:58:39,800 --> 00:58:45,440 BUT VARIOUS SYMPTOMS NOW APPEAR? 1520 00:58:45,440 --> 00:58:47,920 >> I'LL TAKE A STAB AT IT AND 1521 00:58:47,920 --> 00:58:49,480 THEN WALTER IF YOU WANT TO ADD 1522 00:58:49,480 --> 00:58:49,640 ON. 1523 00:58:49,640 --> 00:58:51,760 FIRST YOU HAVE TO DISTINGUISH 1524 00:58:51,760 --> 00:58:52,560 BETWEEN STATISTICAL CLINIC 1525 00:58:52,560 --> 00:58:53,760 EFFECTS AND THE BIOMARKERS. 1526 00:58:53,760 --> 00:58:55,400 SO LET'S TAKE THE CASE THAT YOU 1527 00:58:55,400 --> 00:58:58,560 SUGGEST, OR REALLY ANY CASE OF A 1528 00:58:58,560 --> 00:59:01,200 SYMPTOM OR A SYNDROME THAT 1529 00:59:01,200 --> 00:59:03,080 HAPPENS AFTER COVID. 1530 00:59:03,080 --> 00:59:04,120 YOU HAVE TO LOOK AT THE BASE 1531 00:59:04,120 --> 00:59:06,360 RATE OF THAT SYMPTOM IN A 1532 00:59:06,360 --> 00:59:07,120 SIMILAR CONTROL POPULATION. 1533 00:59:07,120 --> 00:59:08,440 THAT'S WHY WE NEED A VERY LARGE 1534 00:59:08,440 --> 00:59:11,200 STUDY TO UNDERSTAND WHAT ARE THE 1535 00:59:11,200 --> 00:59:13,160 CONSEQUENCES OF COVID 1536 00:59:13,160 --> 00:59:13,480 THEREAFTER? 1537 00:59:13,480 --> 00:59:14,680 NOW EVEN IF YOU ESTABLISH THAT 1538 00:59:14,680 --> 00:59:16,320 THERE'S A HIGHER RATE OF 1539 00:59:16,320 --> 00:59:17,720 SEIZURES IN THE SIX MONTHS AFTER 1540 00:59:17,720 --> 00:59:19,160 COVID, IT'S QUITE POSSIBLE THAT 1541 00:59:19,160 --> 00:59:20,720 IT'S NOT DUE TO COVID, IT'S DUE 1542 00:59:20,720 --> 00:59:22,320 TO SOMETHING ELSE, SO THEN YOU 1543 00:59:22,320 --> 00:59:23,920 NEED TO DO YOUR TYPICAL 1544 00:59:23,920 --> 00:59:25,920 DIFFERENTIAL DIAGNOSIS AS A 1545 00:59:25,920 --> 00:59:26,720 CLINICIAN, BUT NONETHELESS, IF 1546 00:59:26,720 --> 00:59:28,720 YOU WANT TO KNOW COULD SOMETHING 1547 00:59:28,720 --> 00:59:30,040 LIKELY BE CONSEQUENT TO COVID, 1548 00:59:30,040 --> 00:59:32,840 WE HAVE TO COMPARE THE RATES OF 1549 00:59:32,840 --> 00:59:36,000 THOSE EFFECTS IN AFTERMATH OF 1550 00:59:36,000 --> 00:59:38,320 COVID COMPARED TO CONTROL GROUP. 1551 00:59:38,320 --> 00:59:39,920 I THINK FOR A LOT OF THESE 1552 00:59:39,920 --> 00:59:41,800 THINGS, IT'S GOING TO BE 1553 00:59:41,800 --> 00:59:43,320 CHALLENGING ESPECIALLY WITH LOW 1554 00:59:43,320 --> 00:59:45,120 BASE RATE CONDITIONS. 1555 00:59:45,120 --> 00:59:46,480 AND THE QUESTION IS HOW DO YOU 1556 00:59:46,480 --> 00:59:48,000 TREAT IT? 1557 00:59:48,000 --> 00:59:51,800 THERE, WALTER -- AS WALTER SAID, 1558 00:59:51,800 --> 00:59:54,000 RIGHT NOW, ALL THAT WE CAN DO IS 1559 00:59:54,000 --> 00:59:55,120 TREAT THE SYMPTOMS, SO IN THE 1560 00:59:55,120 --> 00:59:57,520 CASE OF SEIZURE, YOU'RE GOING TO 1561 00:59:57,520 --> 00:59:59,800 TREAT THEM WITH ANTIEPILEPTIC IF 1562 00:59:59,800 --> 01:00:00,800 IT'S INDICATED. 1563 01:00:00,800 --> 01:00:02,120 AND THAT'S WHAT YOU'RE GOING TO 1564 01:00:02,120 --> 01:00:02,640 DO. 1565 01:00:02,640 --> 01:00:06,040 BUT IF WE CAN UNDERSTAND THE 1566 01:00:06,040 --> 01:00:08,120 DIFFERENCE IN CAUSALITY, THEN WE 1567 01:00:08,120 --> 01:00:11,720 WOULD TRY TO TARGET THE 1568 01:00:11,720 --> 01:00:14,000 MECHANISM UNDERLYING SEIZURES IN 1569 01:00:14,000 --> 01:00:15,120 THE AFTERMATH OF COVID WHICH 1570 01:00:15,120 --> 01:00:16,840 MIGHT BE DIFFERENT THAN THE 1571 01:00:16,840 --> 01:00:19,120 MECHANISM OF OTHER FORMS OF 1572 01:00:19,120 --> 01:00:20,320 EPILEPTIC ACTIVITY IN 1573 01:00:20,320 --> 01:00:21,120 ADOLESCENT. 1574 01:00:21,120 --> 01:00:22,960 FINALLY WITH REGARD TO THE 1575 01:00:22,960 --> 01:00:23,960 BIOMARKERS, I THINK IT'S REALLY 1576 01:00:23,960 --> 01:00:25,800 IMPORTANT TO SAY, NUMBER ONE, WE 1577 01:00:25,800 --> 01:00:26,920 DO NOT KNOW WHETHER THE 1578 01:00:26,920 --> 01:00:28,440 BIOMARKERS WILL BE GONE AFTER 1579 01:00:28,440 --> 01:00:29,520 6 MONTHS AT THIS POINT. 1580 01:00:29,520 --> 01:00:31,080 WE'RE TALKING ABOUT VERY SMALL 1581 01:00:31,080 --> 01:00:34,000 STUDY, WEAR WE'RE TALKING ABOUT 1582 01:00:34,000 --> 01:00:35,960 NEUROIMAGING STUDIES WHICH ARE 1583 01:00:35,960 --> 01:00:37,080 NOTORIOUSLY CHALLENGING, AND 1584 01:00:37,080 --> 01:00:38,640 WE'RE TALKING ABOUT BIOMARKER 1585 01:00:38,640 --> 01:00:40,520 STUDIES THAT DON'T LOOK AT TREUL 1586 01:00:40,520 --> 01:00:41,680 MECHANISM AT THIS POINT. 1587 01:00:41,680 --> 01:00:44,520 SO I THINK IT'S TOO EARLY TO SAY 1588 01:00:44,520 --> 01:00:46,720 WHETHER THE BIOMARKERS ARE, 1589 01:00:46,720 --> 01:00:47,320 QUOTE-UNQUOTE, DIMINISHING BY 1590 01:00:47,320 --> 01:00:49,040 SIX MONTHS, AND THEN IN TERMS OF 1591 01:00:49,040 --> 01:00:50,120 THE EVIDENCE SUGGESTING THAT 1592 01:00:50,120 --> 01:00:53,720 LONG COVID SYSTEMS CAN PERSIST 1593 01:00:53,720 --> 01:00:54,680 PAST 6 MONTHS, AGAIN, WALTER 1594 01:00:54,680 --> 01:00:55,720 SHOWED YOU THE DATA. 1595 01:00:55,720 --> 01:00:57,600 THEY'RE NOT TERRIBLY CONVINCING. 1596 01:00:57,600 --> 01:00:59,120 WE'RE TALKING ABOUT RELATIVELY 1597 01:00:59,120 --> 01:01:01,040 LOW RATES OF SYMPTOMS PERSISTING 1598 01:01:01,040 --> 01:01:01,880 OUT BEYOND SIX MONTHS IF YOU 1599 01:01:01,880 --> 01:01:03,400 LOOK IN CAREFULLY CONTROLLED 1600 01:01:03,400 --> 01:01:03,720 STUDIES. 1601 01:01:03,720 --> 01:01:05,360 SO ANOTHER REASON WHY WE NEED 1602 01:01:05,360 --> 01:01:06,680 THOSE LARGE STUDIES. 1603 01:01:06,680 --> 01:01:07,920 SO I THINK THE ANSWER TO ALL 1604 01:01:07,920 --> 01:01:09,720 THESE QUESTIONS IS, RIGHT NOW, 1605 01:01:09,720 --> 01:01:11,480 YOU TREAT SYMPTOMATICALLY, YOU 1606 01:01:11,480 --> 01:01:12,840 TRY TO DO A DIFFERENTIAL 1607 01:01:12,840 --> 01:01:13,920 DIAGNOSIS AND IN THE FUTURE, 1608 01:01:13,920 --> 01:01:14,920 HOPEFULLY WE'LL UNDERSTAND 1609 01:01:14,920 --> 01:01:15,960 SOMETHING ABOUT THE TRUE 1610 01:01:15,960 --> 01:01:17,120 PREVALENCE OF THESE CONSEQUENCES 1611 01:01:17,120 --> 01:01:19,600 AND OF THEIR MECHANISM. 1612 01:01:19,600 --> 01:01:21,000 >> WALTER, DO YOU WANT TO 1613 01:01:21,000 --> 01:01:25,840 COMMENT ABOUT THAT? 1614 01:01:25,840 --> 01:01:27,520 >> WELL, I THINK IT'S A REALLY 1615 01:01:27,520 --> 01:01:27,920 GOOD QUESTION. 1616 01:01:27,920 --> 01:01:30,920 I THINK THAT RIGHT NOW, WE'RE 1617 01:01:30,920 --> 01:01:32,480 KIND OF LOOKING UNDER THE LAMP 1618 01:01:32,480 --> 01:01:34,920 POST SO WE HAVE A LOT OF DATA 1619 01:01:34,920 --> 01:01:38,640 FROM ACUTE INFECTION STANDPOINT. 1620 01:01:38,640 --> 01:01:42,840 AND SO WHAT WE KNOW IS, WHAT WE 1621 01:01:42,840 --> 01:01:44,640 USED TO SAY IN INTENSIVE CARE 1622 01:01:44,640 --> 01:01:47,200 RESEARCH, IT ALL BOILS DOWN TO 1623 01:01:47,200 --> 01:01:50,320 SICK PEOPLE DON'T DO WELL. 1624 01:01:50,320 --> 01:01:54,680 SO I THINK WHAT WE SEE HERE IS 1625 01:01:54,680 --> 01:01:59,040 THAT THE WORSE YOUR INFECTION 1626 01:01:59,040 --> 01:02:01,120 WAS, IT INCREASES YOUR CHANCES 1627 01:02:01,120 --> 01:02:02,640 OF DEVELOPING PERSISTENT TROUBLE 1628 01:02:02,640 --> 01:02:04,080 LATER ON, AND THEN THERE ARE 1629 01:02:04,080 --> 01:02:08,520 PATTERNS THAT OCCUR IN THE ACUTE 1630 01:02:08,520 --> 01:02:12,560 STAGE THAT AGAIN PREDICT 1631 01:02:12,560 --> 01:02:13,560 POTENTIALLY -- THESE ARE SMALL 1632 01:02:13,560 --> 01:02:17,280 STUDIES NOW, BUT THAT THEY 1633 01:02:17,280 --> 01:02:18,120 PREDICT THAT YOU'RE GOING TO 1634 01:02:18,120 --> 01:02:21,720 HAVE TROUBLE WITH POST-ACUTE 1635 01:02:21,720 --> 01:02:22,920 SEQUELAE OF COVID. 1636 01:02:22,920 --> 01:02:24,280 NOW THAT DOESN'T MEAN THAT THOSE 1637 01:02:24,280 --> 01:02:28,200 MARKERS ARE ACTUALLY THE CAUSE 6 MONTHS LA TER. 1638 01:02:28,200 --> 01:02:30,040 THEY'RE JUST A PATTERN THAT WAS 1639 01:02:30,040 --> 01:02:35,520 IDENTIFIED ACUTELY, AND THERE'S 1640 01:02:35,520 --> 01:02:38,840 SOME OTHER DRIVER AT THE 6 MONTH 1641 01:02:38,840 --> 01:02:39,160 PERIOD. 1642 01:02:39,160 --> 01:02:40,560 SO THE OTHER QUESTION IS WHAT 1643 01:02:40,560 --> 01:02:42,680 ELSE IS IN THAT PATTERN THAT 1644 01:02:42,680 --> 01:02:44,720 DOESN'T GO AWAY, AND THAT'S 1645 01:02:44,720 --> 01:02:47,520 GOING TO TAKE SOME TIME. 1646 01:02:47,520 --> 01:02:50,120 SO EXAMPLE OF THE SEIZURES, SO 1647 01:02:50,120 --> 01:02:52,320 EVERYBODY GETS AUTO ANTIBODIES 1648 01:02:52,320 --> 01:02:56,120 AFTER COVID, AND THAT PROBABLY 1649 01:02:56,120 --> 01:02:57,240 IS NOT GOING TO BE ASSOCIATED 1650 01:02:57,240 --> 01:03:02,600 WITH SEIZURES, BULL IF ONE OF 1651 01:03:02,600 --> 01:03:05,120 THOSE AUTO ANTIBODIES IS AN MMDA 1652 01:03:05,120 --> 01:03:06,120 RECEPTOR, YOU'RE GOING TO HAVE 1653 01:03:06,120 --> 01:03:07,400 SEIZURES AND YOU'RE GOING TO 1654 01:03:07,400 --> 01:03:07,920 HAVE PSYCHOSIS. 1655 01:03:07,920 --> 01:03:08,960 AND THAT'S BEEN SEEN ALREADY IN 1656 01:03:08,960 --> 01:03:09,720 COVID. 1657 01:03:09,720 --> 01:03:13,760 SO I WOULD SAY WHAT WE'RE SEEING 1658 01:03:13,760 --> 01:03:15,000 NOW IS KIND OF LIKE THE CLOUD 1659 01:03:15,000 --> 01:03:16,200 AND YOU HAVE TO KIND OF GET INTO 1660 01:03:16,200 --> 01:03:20,560 THE CLOUD AND SEE THE DROPLETS 1661 01:03:20,560 --> 01:03:25,160 OF THE MOISTURE, AND GET MORE 1662 01:03:25,160 --> 01:03:26,840 DRILLED DOWN INTO WHAT THE 1663 01:03:26,840 --> 01:03:27,800 CAUSATION IS. 1664 01:03:27,800 --> 01:03:33,600 SO I WOULDN'T THROW IT OUT, BUT 1665 01:03:33,600 --> 01:03:35,240 I AGREE WITH THE QUESTION, IT'S 1666 01:03:35,240 --> 01:03:37,720 NOT SOLVING OUR PROBLEM. 1667 01:03:37,720 --> 01:03:39,840 IT JUST STARTING TO OPEN THE 1668 01:03:39,840 --> 01:03:44,280 DOOR TO RESEARCH. 1669 01:03:44,280 --> 01:03:50,720 >> THERE'S A COUPLE QUESTIONS 1670 01:03:50,720 --> 01:03:53,280 REGARDING WHEN INDIVIDUALS ARE 1671 01:03:53,280 --> 01:03:54,080 DIAGNOSED WITH ONE MANIFESTATION 1672 01:03:54,080 --> 01:03:58,320 OR ANOTHER OF CHRONIC COVID, ARE 1673 01:03:58,320 --> 01:04:01,320 THEY INFECTIOUS? 1674 01:04:01,320 --> 01:04:03,120 ARE MANY OF THEM INFECTIOUS? 1675 01:04:03,120 --> 01:04:05,400 ARE THEY CARRYING THE VIRUS? 1676 01:04:05,400 --> 01:04:07,440 >> WE DON'T THINK THEY'RE 1677 01:04:07,440 --> 01:04:09,680 INFECTIOUS, NO. 1678 01:04:09,680 --> 01:04:11,440 >> ARE THEY CARRYING THE VIRUS? 1679 01:04:11,440 --> 01:04:13,400 >> THE VIRUS COULD BE PRESENT. 1680 01:04:13,400 --> 01:04:15,400 THERE MIGHT BE VIRUS PRESENT, 1681 01:04:15,400 --> 01:04:17,520 YOU KNOW, IN SOME CELLS IN THE 1682 01:04:17,520 --> 01:04:19,920 BODY, THERE'S NO EVIDENCE THAT 1683 01:04:19,920 --> 01:04:24,000 PEOPLE ARE INFECTIOUS. 1684 01:04:24,000 --> 01:04:25,840 MOST OF THE INFECTION IS COMING 1685 01:04:25,840 --> 01:04:28,360 OUT OF RESPIRATORY DROPLETS, AND 1686 01:04:28,360 --> 01:04:29,120 THESE PEOPLE DO NOT HAVE ANY 1687 01:04:29,120 --> 01:04:31,080 VIRUS IN THEIR RESPIRATORY TRACT 1688 01:04:31,080 --> 01:04:33,920 THAT YOU CAN MEASURE COMING OUT. 1689 01:04:33,920 --> 01:04:43,520 SO THEY'RE NOT INFECTIOUS. 1690 01:04:43,520 --> 01:04:44,680 >> ANOTHER GROUP OF QUESTIONS 1691 01:04:44,680 --> 01:04:50,720 CONCERNED WHETHER THE TYPE OF 1692 01:04:50,720 --> 01:04:53,800 SYMPTOMATOLOGY ASSOCIATED WITH 1693 01:04:53,800 --> 01:04:58,080 CHRONIC COVID HAS BEEN OBSERVED 1694 01:04:58,080 --> 01:04:59,720 WITH OTHER CORONA VIRAL 1695 01:04:59,720 --> 01:05:00,800 INFECTIONS AND OTHERS HAVE 1696 01:05:00,800 --> 01:05:02,560 POINTED OUT THAT THOSE ARE VERY 1697 01:05:02,560 --> 01:05:06,640 SIMILAR TO SOME OF THE SYMPTOMS 1698 01:05:06,640 --> 01:05:13,920 OF INFECTIOUS MONONUCLEOSIS, AND 1699 01:05:13,920 --> 01:05:19,320 ALSO INFLUENZA. 1700 01:05:19,320 --> 01:05:21,160 DO YOU WANT TO DISSECT OUT SOME 1701 01:05:21,160 --> 01:05:22,800 OF THOSE DIFFERENCES AS TO WHAT 1702 01:05:22,800 --> 01:05:26,640 WE KNOW AND DON'T KNOW? 1703 01:05:26,640 --> 01:05:28,600 COULD THEY ALL BE PART OF SOME 1704 01:05:28,600 --> 01:05:32,000 COMMON UNDERLYING MECHANISM OR 1705 01:05:32,000 --> 01:05:34,640 WOULD YOU JUST COMMENT ABOUT 1706 01:05:34,640 --> 01:05:37,160 THIS DILEMMA? 1707 01:05:37,160 --> 01:05:39,360 >> FROM A MENTAL ILLNESS 1708 01:05:39,360 --> 01:05:40,240 PERSPECTIVE, I SORT OF 1709 01:05:40,240 --> 01:05:41,120 TELEGRAPHED THAT IN MY 1710 01:05:41,120 --> 01:05:41,640 PRESENTATION, RIGHT? 1711 01:05:41,640 --> 01:05:43,480 I MEAN, YES, WE SEE INCREASED 1712 01:05:43,480 --> 01:05:46,200 RATES OF ANXIETY AND DEPRESSION 1713 01:05:46,200 --> 01:05:49,360 AND PSYCHOSIS AFTER 1714 01:05:49,360 --> 01:05:50,320 HOSPITALIZATION FOR COVID, BUT 1715 01:05:50,320 --> 01:05:51,840 WE SEE THAT ALSO AFTER 1716 01:05:51,840 --> 01:05:52,720 HOSPITALIZATION FOR OTHER 1717 01:05:52,720 --> 01:05:54,680 RESPIRATORY TRACT INFECTIONS, 1718 01:05:54,680 --> 01:05:56,560 AND THERE COULD BE BIOLOGICAL 1719 01:05:56,560 --> 01:06:00,160 CAUSES RELATED TO THE 1720 01:06:00,160 --> 01:06:01,800 CORONAVIRUS, BUT THERE ALSO ARE 1721 01:06:01,800 --> 01:06:02,920 CONTRIBUTORS HAVING TO DO WITH 1722 01:06:02,920 --> 01:06:06,640 ICU STAYS WHICH CAUSE -- CAN 1723 01:06:06,640 --> 01:06:08,480 CAUSE LONG LASTING MENTAL HEALTH 1724 01:06:08,480 --> 01:06:10,640 COMPLICATIONS AS WELL. 1725 01:06:10,640 --> 01:06:14,640 SO I THINK A LOT OF THAT IS FROM 1726 01:06:14,640 --> 01:06:15,800 MY PERSPECTIVE, THE MENTAL 1727 01:06:15,800 --> 01:06:16,680 HEALTH AREA, IS UNKNOWN AT THIS 1728 01:06:16,680 --> 01:06:17,680 POINT. 1729 01:06:17,680 --> 01:06:21,920 I THINK THE FACT THAT SARS-COV-2 1730 01:06:21,920 --> 01:06:25,640 IS NEW, THAT COVID-19 IS A NEW 1731 01:06:25,640 --> 01:06:26,840 ILLNESS, RAISES THE POSSIBILITY 1732 01:06:26,840 --> 01:06:29,480 THAT IT'S SPECIAL, AND WE NEED 1733 01:06:29,480 --> 01:06:31,520 STUDIES TO KNOW HOW SPECIAL AND 1734 01:06:31,520 --> 01:06:33,080 HOW DIFFERENT IT REALLY IS FROM 1735 01:06:33,080 --> 01:06:38,120 OTHER CORONAVIRUSs. 1736 01:06:38,120 --> 01:06:39,480 WALTER, IN TERMS OF LOOKING AT 1737 01:06:39,480 --> 01:06:41,840 THE PRESENCE -- THE POTENTIAL 1738 01:06:41,840 --> 01:06:42,800 PRESENCE OF THE VIRUS IN THE 1739 01:06:42,800 --> 01:06:45,920 BRAIN OR ITS EFFECTS ON BRAIN 1740 01:06:45,920 --> 01:06:48,760 CELLS, WHETHER THERE'S DATA FROM 1741 01:06:48,760 --> 01:06:54,160 OTHER CORONAVIRUSs? 1742 01:06:54,160 --> 01:07:01,680 >> WE DID HAVE THIS INITIAL SARS 1743 01:07:01,680 --> 01:07:04,280 EPIDEMIC AND THEN MERS, AND 1744 01:07:04,280 --> 01:07:07,480 THOSE WERE SEVERE RESPIRATORY 1745 01:07:07,480 --> 01:07:14,480 VIRAL INFECTIONS, AND THOSE 1746 01:07:14,480 --> 01:07:19,200 PERSONS WERE AFFECTED FOR MANY 1747 01:07:19,200 --> 01:07:22,040 MONTHS OR YEARS. 1748 01:07:22,040 --> 01:07:24,920 SIMILAR SYMPTOMS THAT WE HAVE 1749 01:07:24,920 --> 01:07:29,240 NOW, SARS COV-2. 1750 01:07:29,240 --> 01:07:34,520 SO WE WERE SURPRISED BECAUSE THE 1751 01:07:34,520 --> 01:07:37,480 PEOPLE WITH SARS AND MERS HAD -- 1752 01:07:37,480 --> 01:07:44,320 THEY WERE VERY ILL, IN THE 1753 01:07:44,320 --> 01:07:46,080 EXPECTATION, ANYBODY THAT GOES 1754 01:07:46,080 --> 01:07:48,800 IN, DEVELOPS ARDS AND IS ON A 1755 01:07:48,800 --> 01:07:49,440 RESPIRATOR, THEY'RE LOOKING AT 1756 01:07:49,440 --> 01:07:53,160 MANY MONTHS TO YEARS OF RECOVERY 1757 01:07:53,160 --> 01:07:54,600 AFTER THAT. 1758 01:07:54,600 --> 01:07:56,800 SO THE EXPECTATION WAS THAT, 1759 01:07:56,800 --> 01:07:58,760 YEAH, THAT WAS PART AND PARCEL 1760 01:07:58,760 --> 01:08:01,360 OF GETTING SO SICK. 1761 01:08:01,360 --> 01:08:05,880 THE BIG SURPRISE WITH COVID-19 1762 01:08:05,880 --> 01:08:07,400 IS THAT WE'RE SEEING THOSE 1763 01:08:07,400 --> 01:08:10,640 SYMPTOMS IN PEOPLE WHO WERE 1764 01:08:10,640 --> 01:08:12,960 NEVER IN THE HOSPITAL AND SOME 1765 01:08:12,960 --> 01:08:14,200 PEOPLE VERY MILD, SOME PEOPLE 1766 01:08:14,200 --> 01:08:15,600 HAVEN'T HAD ANY SYMPTOMS. 1767 01:08:15,600 --> 01:08:18,640 SO INITIALLY IN THE HOSPITALS, 1768 01:08:18,640 --> 01:08:21,320 THERE WAS A RUSH INTO INTENSIVE 1769 01:08:21,320 --> 01:08:23,360 CARE UNITS, THE HOSPITALS THEN 1770 01:08:23,360 --> 01:08:26,000 STARTED TO SET UP THESE POST-ICU 1771 01:08:26,000 --> 01:08:27,600 CLINICS FOR PEOPLE COMING OUT OF 1772 01:08:27,600 --> 01:08:33,720 THE ICUs, AND THE SURPRISE WAS 1773 01:08:33,720 --> 01:08:34,720 THAT THEY WERE NEVER EVEN IN THE 1774 01:08:34,720 --> 01:08:35,480 HOSPITAL. 1775 01:08:35,480 --> 01:08:39,840 SO THAT'S KIND OF THE UNUSUAL 1776 01:08:39,840 --> 01:08:44,000 FEATURE TO THIS VIRUS, WHICH I 1777 01:08:44,000 --> 01:08:45,480 THINK DR. FAUCI MENTIONED, HE'S 1778 01:08:45,480 --> 01:08:47,280 NEVER SEEN A VIRUS WITH THIS 1779 01:08:47,280 --> 01:08:48,760 WIDE SPECTRUM OF PHENOTYPES FROM 1780 01:08:48,760 --> 01:08:50,640 PEOPLE WHO ARE COMPLETELY NORMAL 1781 01:08:50,640 --> 01:08:54,360 TO PEOPLE ON DEATH'S DOORSTEP. 1782 01:08:54,360 --> 01:08:57,200 AND THAT'S SEEMINGLY ALSO 1783 01:08:57,200 --> 01:09:01,120 OCCURRING WITH THE PERSISTENCE 1784 01:09:01,120 --> 01:09:02,240 OF THE SYMPTOMS. 1785 01:09:02,240 --> 01:09:05,840 ALTHOUGH AS WE SHOWED MANY 1786 01:09:05,840 --> 01:09:07,360 TIMES -- [INAUDIBLE] LONG TERM. 1787 01:09:07,360 --> 01:09:14,040 NOW, THE OTHER VIRUS WHICH IS -- 1788 01:09:14,040 --> 01:09:16,120 IS EPSTEIN-BARR VIRUS, SO 1789 01:09:16,120 --> 01:09:17,560 EVERYBODY GETS EPSTEIN-BARR 1790 01:09:17,560 --> 01:09:19,800 VIRUS PRETTY MUCH, EVERYBODY 1791 01:09:19,800 --> 01:09:21,360 GETS IT, MOST PEOPLE DON'T GET 1792 01:09:21,360 --> 01:09:25,200 SICK, SOME PEOPLE GET INFECTIOUS 1793 01:09:25,200 --> 01:09:25,960 MONONUCLEOSIS, AND REMEMBER 1794 01:09:25,960 --> 01:09:27,280 THOSE FOLKS, YOUNG KIDS, THEY'LL 1795 01:09:27,280 --> 01:09:29,280 MISS A WHOLE SEMESTER OF SCHOOL 1796 01:09:29,280 --> 01:09:30,920 BECAUSE OF THEIR FATIGUE AND 1797 01:09:30,920 --> 01:09:34,400 THEY JUST CAN'T GET BACK TO 1798 01:09:34,400 --> 01:09:35,600 STUDYING LIKE THEY DID BEFORE, 1799 01:09:35,600 --> 01:09:37,320 MOVING AROUND, AND THEN THEY 1800 01:09:37,320 --> 01:09:39,640 START GETTING BETTER, MAYBE EVEN 1801 01:09:39,640 --> 01:09:43,760 GO OUT A YEAR FOR SOME PEOPLE. 1802 01:09:43,760 --> 01:09:46,280 AND WE HAVE STUDIES LOOKING AT 1803 01:09:46,280 --> 01:09:48,400 THOSE FOLKS, SOME OF THOSE 1804 01:09:48,400 --> 01:09:51,400 DEVELOP CHRONIC FATIGUE 1805 01:09:51,400 --> 01:09:52,920 SYNDROME. 1806 01:09:52,920 --> 01:09:54,120 BUT THAT IS THE CLOSEST 1807 01:09:54,120 --> 01:09:57,320 PRECEDENT THAT I KNOW OF TO 1808 01:09:57,320 --> 01:09:59,280 COVID-19, WHERE IT STANDS 1809 01:09:59,280 --> 01:10:00,920 COMPLETELY ASYMPTOMATIC TO 1810 01:10:00,920 --> 01:10:05,440 INFECTIOUS PROBLEM THAT LASTS 1811 01:10:05,440 --> 01:10:06,560 WITH PERSISTENT SYMPTOMS. 1812 01:10:06,560 --> 01:10:08,320 YOU'RE NOT INFECTIOUS AFTER A 1813 01:10:08,320 --> 01:10:10,240 WHILE BUT YOU HAVE PERSISTENT 1814 01:10:10,240 --> 01:10:12,680 SYMPTOMS THAT CAN GO OUT MANY 1815 01:10:12,680 --> 01:10:15,200 MONTHS, AND THEN A SMALL 1816 01:10:15,200 --> 01:10:18,040 PROPORTION OF THOSE PEOPLE GO ON 1817 01:10:18,040 --> 01:10:18,680 TO MORE CHRONIC TROUBLE. 1818 01:10:18,680 --> 01:10:23,240 SO THAT WOULD BE THE PRECEDENT. 1819 01:10:23,240 --> 01:10:24,920 THE EPSTEIN-BARR VIRUS IS 1820 01:10:24,920 --> 01:10:28,720 PERSISTENT IN YOUR BODY AND YOUR 1821 01:10:28,720 --> 01:10:29,720 BRAIN, YOU NEVER ACTUALLY GET 1822 01:10:29,720 --> 01:10:35,400 RID OF IT. 1823 01:10:35,400 --> 01:10:36,840 >> IS THERE A RELATIONSHIP 1824 01:10:36,840 --> 01:10:39,200 BETWEEN CHRONIC COVID AND 1825 01:10:39,200 --> 01:10:47,400 VACCINATION STATUS? 1826 01:10:47,400 --> 01:10:49,760 >> AS I MENTIONED, IF YOU ARE 1827 01:10:49,760 --> 01:10:50,920 VACCINATED, THE CHANCE OF 1828 01:10:50,920 --> 01:10:51,960 GETTING SYMPTOMS THAT ARE 1829 01:10:51,960 --> 01:10:56,120 PERSISTENT IS MUCH LESS. 1830 01:10:56,120 --> 01:10:58,240 THE EVIDENCE THAT THE VACCINE 1831 01:10:58,240 --> 01:11:01,400 ACTUALLY MAKES YOU BETTER IF YOU 1832 01:11:01,400 --> 01:11:05,240 ALREADY HAD, SAY, LONG COVID, 1833 01:11:05,240 --> 01:11:06,000 THAT'S NOT CLEAR. 1834 01:11:06,000 --> 01:11:09,400 IT DOESN'T LOOK LIKE A BIG 1835 01:11:09,400 --> 01:11:14,360 EFFECT SIZE. 1836 01:11:14,360 --> 01:11:22,200 >> THERE HAVE BEEN SEVERAL 1837 01:11:22,200 --> 01:11:23,320 QUESTIONS OF PEOPLE WHO HAVE 1838 01:11:23,320 --> 01:11:26,800 ASKED ABOUT THE VACCINE, AND 1839 01:11:26,800 --> 01:11:31,320 ASKING DOES IT CAUSE PERIPHERAL 1840 01:11:31,320 --> 01:11:35,200 NEUROPATHY BY TARGETING THE 1841 01:11:35,200 --> 01:11:37,960 SPIKE PROTEIN ON ENDOTHELIAL 1842 01:11:37,960 --> 01:11:40,720 CELLS AND DOES IT DAMAGE THE 1843 01:11:40,720 --> 01:11:41,400 VASCULATURE? 1844 01:11:41,400 --> 01:11:47,200 SO DO YOU WANT TO COMMENT ABOUT 1845 01:11:47,200 --> 01:11:49,320 ANY POSSIBLE SUCH TOXICITY OF 1846 01:11:49,320 --> 01:11:50,440 THE VACCINES? 1847 01:11:50,440 --> 01:11:53,120 >> I THINK THERE HAVE BEEN A FEW 1848 01:11:53,120 --> 01:11:55,960 CASES OF GILLIAN BARRE FOLLOWING 1849 01:11:55,960 --> 01:11:57,360 THE VACCINE, BUT VERY, VERY, 1850 01:11:57,360 --> 01:11:59,440 VERY RARE, AND I DON'T THINK ANY 1851 01:11:59,440 --> 01:12:03,520 MORE THAN FOR OTHER VACCINES. 1852 01:12:03,520 --> 01:12:04,640 OTHERWISE I DON'T THINK THERE'S 1853 01:12:04,640 --> 01:12:07,520 ANY EVIDENCE OF PERIPHERAL NERVE 1854 01:12:07,520 --> 01:12:07,760 DAMAGE. 1855 01:12:07,760 --> 01:12:12,160 I'M NOT AWARE OF ANY EVIDENCE OF 1856 01:12:12,160 --> 01:12:14,600 VESSEL DAMAGE. 1857 01:12:14,600 --> 01:12:15,680 THERE ARE -- THERE'S A LOW RATE 1858 01:12:15,680 --> 01:12:17,640 OF I THINK IT'S MYOCARDITIS, 1859 01:12:17,640 --> 01:12:20,280 RIGHT, IN YOUNG MEN MOSTLY? 1860 01:12:20,280 --> 01:12:23,000 VERY LOW RATE. 1861 01:12:23,000 --> 01:12:24,120 BUT THAT -- I DON'T KNOW IF 1862 01:12:24,120 --> 01:12:25,840 THAT'S BEEN ASCRIBED TO THE 1863 01:12:25,840 --> 01:12:27,040 VASCULATURE VERSUS THE MUSCLE 1864 01:12:27,040 --> 01:12:29,200 ITSELF. 1865 01:12:29,200 --> 01:12:35,520 >> YEAH, I THINK GILLIAN BARRE, 1866 01:12:35,520 --> 01:12:38,640 MYOCARDITIS, I THINK THOSE ARE 1867 01:12:38,640 --> 01:12:39,720 AUTOIMMUNE REACTIONS, AND SO 1868 01:12:39,720 --> 01:12:41,720 WHEN YOU GET THE VACCINE, THE 1869 01:12:41,720 --> 01:12:45,720 WHOLE PURPOSE IS TO DEVELOP THIS 1870 01:12:45,720 --> 01:12:49,000 IMMUNE RESPONSE TO THE VIRUS, 1871 01:12:49,000 --> 01:12:50,200 BUT SOMETIMES, AND WE DON'T 1872 01:12:50,200 --> 01:12:53,280 UNDERSTAND WHY, THAT CAN SPILL 1873 01:12:53,280 --> 01:12:56,880 OVER TO AFFECT IMMUNE RESPONSE 1874 01:12:56,880 --> 01:12:58,080 AGAINST OTHER ANTIGENS IN YOUR 1875 01:12:58,080 --> 01:12:59,320 BODY. 1876 01:12:59,320 --> 01:13:00,960 SO GILLIAN BARRE IS THE ONE 1877 01:13:00,960 --> 01:13:04,320 THAT'S BEST STUDIED AND IT IS -- 1878 01:13:04,320 --> 01:13:05,320 IT HAS BEEN ASSOCIATED WITH 1879 01:13:05,320 --> 01:13:10,760 MULTIPLE DIFFERENT VACCINES. 1880 01:13:10,760 --> 01:13:14,560 THERE'S 1H1N1 FLU VACCINE THAT 1881 01:13:14,560 --> 01:13:17,280 HAD INCREASED INCIDENCE A COUPLE 1882 01:13:17,280 --> 01:13:21,960 YEARS AGO, AND THE STUDIES 1883 01:13:21,960 --> 01:13:24,680 FROM THE U.K., AGAIN, SHOW THAT 1884 01:13:24,680 --> 01:13:26,640 IN THE VACCINES THAT WERE 1885 01:13:26,640 --> 01:13:30,400 DELIVERED TO A VIRUS, THERE WAS 1886 01:13:30,400 --> 01:13:32,240 AN INCREASE IN GILLIAN BARRE DUE 1887 01:13:32,240 --> 01:13:33,520 TO THE VACCINE. 1888 01:13:33,520 --> 01:13:36,800 AND IN THE U.S., SIMILARLY THE 1889 01:13:36,800 --> 01:13:41,000 FDA LAST SUMMER PUT OUT A NOTICE 1890 01:13:41,000 --> 01:13:43,000 THAT THEY WERE SEEING INCREASED 1891 01:13:43,000 --> 01:13:44,480 GILLIAN BARRE IN THE J & J 1892 01:13:44,480 --> 01:13:48,280 VACCINE, WHICH IS -- NOBODY'S 1893 01:13:48,280 --> 01:13:53,280 SEEN IT IN THE MRNA VACCINES 1894 01:13:53,280 --> 01:13:53,440 YET. 1895 01:13:53,440 --> 01:13:54,960 BUT IN THE U.K. STUDY, YOUR RISK 1896 01:13:54,960 --> 01:13:57,800 OF GETTING GILLIAN BARRE AFTER 1897 01:13:57,800 --> 01:13:59,800 VACCINE IS MUCH LESS, FIVE TIMES 1898 01:13:59,800 --> 01:14:01,000 LESS THAN IT IS IF YOU GET 1899 01:14:01,000 --> 01:14:04,840 COVID. 1900 01:14:04,840 --> 01:14:06,800 SO STILL IF YOU DON'T WANT TO 1901 01:14:06,800 --> 01:14:11,320 GET GILLIAN VA RAY, THE BEST GILLIAN BARRE , THE BEST 1902 01:14:11,320 --> 01:14:14,800 THING TO DO IS STILL GET 1903 01:14:14,800 --> 01:14:15,320 VACCINATED. 1904 01:14:15,320 --> 01:14:21,800 THERE HAVE BEEN CASES REPORTED 1905 01:14:21,800 --> 01:14:23,440 AFTER THE VACCINE OF ABSOLUTELY 1906 01:14:23,440 --> 01:14:24,520 EVERY NEUROLOGIC CONDITION 1907 01:14:24,520 --> 01:14:25,520 REPORTED AFTER THE VACCINE, AND 1908 01:14:25,520 --> 01:14:28,920 IN NONE OF THEM WITH THE 1909 01:14:28,920 --> 01:14:29,760 EXCEPTION OF GILLIAN BARRE, HAS 1910 01:14:29,760 --> 01:14:31,040 ANYBODY BEEN ABLE TO SHOW WHAT 1911 01:14:31,040 --> 01:14:31,960 JOSH WAS SAYING IN THE FIRST 1912 01:14:31,960 --> 01:14:33,160 PLACE, YOU KNOW, THAT IT'S OUT 1913 01:14:33,160 --> 01:14:36,760 OF THE ORDINARY FOR WHAT WE 1914 01:14:36,760 --> 01:14:38,520 WOULD EXPECT O GIVEN THE 1915 01:14:38,520 --> 01:14:40,920 INCIDENCE OF THOSE CONDITIONS. 1916 01:14:40,920 --> 01:14:46,880 BUT AT THE NIH, THEY ARE SEEING 1917 01:14:46,880 --> 01:14:48,200 PATIENTS WHO ARE THE VACCINE WHO 1918 01:14:48,200 --> 01:14:53,000 HAVE SYMPTOMS OF USUALLY PAIN, 1919 01:14:53,000 --> 01:14:56,160 AND THEY HAVE FOUND SMALL FIBER 1920 01:14:56,160 --> 01:14:57,040 NEUROPATHY, IT'S BEEN WELL 1921 01:14:57,040 --> 01:14:58,360 MANAGED BY TREATMENT WITH 1922 01:14:58,360 --> 01:15:01,720 STEROIDS OR IVIG, BUT THEY DON'T 1923 01:15:01,720 --> 01:15:02,880 KNOW IF IT HAS ANYTHING TO DO 1924 01:15:02,880 --> 01:15:04,600 WITH THE VACCINE OR NOT. 1925 01:15:04,600 --> 01:15:07,960 CAN'T REALLY TELL. 1926 01:15:07,960 --> 01:15:08,640 FOR SURE. 1927 01:15:08,640 --> 01:15:10,160 THEY'VE LOOKED TO SEE IF THERE 1928 01:15:10,160 --> 01:15:14,560 WAS SOME KIND OF ANTIBODY THAT 1929 01:15:14,560 --> 01:15:17,280 CROSS-REACTS WITH THE NERVES AND 1930 01:15:17,280 --> 01:15:19,720 THE VIRUS. 1931 01:15:19,720 --> 01:15:23,000 BUT THEY HAVEN'T SEEN ANY. 1932 01:15:23,000 --> 01:15:24,280 SO IT'S HARD TO KNOW IF IT'S 1933 01:15:24,280 --> 01:15:30,200 CAUSAL OR IF IT'S COINCIDENTAL. 1934 01:15:30,200 --> 01:15:35,320 THE VIRUS ITSELF -- 1935 01:15:35,320 --> 01:15:38,080 DEMONSTRATED -- [INAUDIBLE]. 1936 01:15:38,080 --> 01:15:41,120 >> THERE HAVE BEEN SEVERAL 1937 01:15:41,120 --> 01:15:42,320 QUESTIONS AS TO WHETHER THERE 1938 01:15:42,320 --> 01:15:47,640 ARE ANY ANIMAL MODELS WITH LONG 1939 01:15:47,640 --> 01:15:48,880 COVID. 1940 01:15:48,880 --> 01:15:51,480 THE POINT BEING THAT WITHOUT AN 1941 01:15:51,480 --> 01:15:52,480 ANIMAL MODEL, IT'S GOING TO BE 1942 01:15:52,480 --> 01:15:58,080 THAT MUCH MORE DIFFICULT TO 1943 01:15:58,080 --> 01:15:59,160 UNDERSTAND WHAT'S GOING ON AND 1944 01:15:59,160 --> 01:16:00,600 TO DEVELOP SOME FORMS OF 1945 01:16:00,600 --> 01:16:01,120 THERAPY. 1946 01:16:01,120 --> 01:16:03,000 SO ARE THERE ANY ANIMAL MODELS? 1947 01:16:03,000 --> 01:16:04,400 AND WHAT'S THE STATUS OF THAT 1948 01:16:04,400 --> 01:16:10,120 RESEARCH? 1949 01:16:10,120 --> 01:16:12,720 >> I DON'T KNOW OF ANY ANIMAL 1950 01:16:12,720 --> 01:16:19,760 MODELS WITH LONG COVID. 1951 01:16:19,760 --> 01:16:23,360 SOME -- I DON'T KNOW IF ANY HAVE 1952 01:16:23,360 --> 01:16:29,320 STUDIED LONG-TERM EFFECTS. 1953 01:16:29,320 --> 01:16:30,720 >> JOSH IS RIGHT. 1954 01:16:30,720 --> 01:16:31,720 I SUSPECT THERE ARE PEOPLE WHO 1955 01:16:31,720 --> 01:16:33,560 ARE SMART ENOUGH TO DO THAT. 1956 01:16:33,560 --> 01:16:35,960 THERE WAS A CALL FOR GRANTS IN 1957 01:16:35,960 --> 01:16:37,400 THE RECOVERY INITIATIVE TO 1958 01:16:37,400 --> 01:16:41,280 UNDERSTAND THE PATHOBIOLOGY OF 1959 01:16:41,280 --> 01:16:42,520 LONG COVID, AND THAT INCLUDED A 1960 01:16:42,520 --> 01:16:46,720 CALL FOR ANIMAL STUDIES. 1961 01:16:46,720 --> 01:16:49,160 BUT THOSE HAVE COME IN AND WE 1962 01:16:49,160 --> 01:16:51,360 GOT A LARGE NUMBER OF 1963 01:16:51,360 --> 01:16:54,080 APPLICATIONS, AND HOPEFULLY 1964 01:16:54,080 --> 01:16:55,960 WE'LL -- I HAVEN'T SEEN THEM 1965 01:16:55,960 --> 01:16:57,160 YET, BUT HOPEFULLY THERE WILL BE 1966 01:16:57,160 --> 01:16:58,120 A FEW IN THAT SPACE. 1967 01:16:58,120 --> 01:17:00,680 I THINK THAT WOULD BE IMPORTANT. 1968 01:17:00,680 --> 01:17:01,920 OF COURSE THESE SYMPTOMS THAT 1969 01:17:01,920 --> 01:17:07,240 PATIENTS ARE REPORTING ARE A 1970 01:17:07,240 --> 01:17:11,360 LITTLE DIFFICULT TO DO HIGH 1971 01:17:11,360 --> 01:17:14,560 THROUGHPUT SCREENING IN ANIMALS. 1972 01:17:14,560 --> 01:17:20,280 -- TACHYCARDIA SYNDROME, OR 1973 01:17:20,280 --> 01:17:27,400 MUSCLE PAIN, SLEEP TROUBLE. 1974 01:17:27,400 --> 01:17:30,320 >> I THINK IF WE GO BY ANALOG TO 1975 01:17:30,320 --> 01:17:35,760 MENTAL ILLNESSES, I THINK WE 1976 01:17:35,760 --> 01:17:37,720 NEED TO HAVE BIOMARKERS THAT WE 1977 01:17:37,720 --> 01:17:39,560 CAN HANG OUR HAT ON IN ORDER TO 1978 01:17:39,560 --> 01:17:40,800 BE ABLE TO STUDY IN ANIMALS. 1979 01:17:40,800 --> 01:17:42,240 I THINK IT'S GOING TO BE REALLY 1980 01:17:42,240 --> 01:17:43,120 CHALLENGING TO DO SOME OF THESE 1981 01:17:43,120 --> 01:17:44,720 THINGS IN ANIMAL MODEL, UNTIL 1982 01:17:44,720 --> 01:17:45,840 YOU KNOW WHAT TO LOOK FOR. 1983 01:17:45,840 --> 01:17:47,120 SO FOR EXAMPLE, IF IT'S BORNE 1984 01:17:47,120 --> 01:17:51,600 OUT THAT THE SMALL VESSEL 1985 01:17:51,600 --> 01:17:54,040 PATHOLOGY IS PART OF IT, OR IF 1986 01:17:54,040 --> 01:17:55,560 THE C FIBER NEUROPATHY IS PART 1987 01:17:55,560 --> 01:17:58,640 OF IT, THEN WE CAN STUDY, YOU 1988 01:17:58,640 --> 01:18:00,320 KNOW, C FIBER NEUROPATHY IN THE 1989 01:18:00,320 --> 01:18:03,320 CONTEXT OF COVID INFECTION IN AN 1990 01:18:03,320 --> 01:18:04,200 ANIMAL MODEL. 1991 01:18:04,200 --> 01:18:07,040 BUT ABSENT SOME OF THOSE PIE 1992 01:18:07,040 --> 01:18:08,320 BIOMARKERS, IT'S REALLY HARD TO 1993 01:18:08,320 --> 01:18:14,360 TAKE A SYMPTOM-FOCUSED APPROACH. 1994 01:18:14,360 --> 01:18:16,000 GLL I THINK WE TOUCHED ON THIS, 1995 01:18:16,000 --> 01:18:17,520 BUT THERE HAVE BEEN SEVERAL 1996 01:18:17,520 --> 01:18:22,560 SPECIFIC INQUIRIES AS TO WHETHER 1997 01:18:22,560 --> 01:18:26,600 PATIENTS WHO HAVE SOME FORM OF 1998 01:18:26,600 --> 01:18:28,640 AUTOIMMUNE DISEASE, NEUROLOGICAL 1999 01:18:28,640 --> 01:18:32,080 OR NON-NEUROLOGICAL, AN THEN 2000 01:18:32,080 --> 01:18:42,040 BECOME INFECTED WITH THE VIRUS, 2001 01:18:42,040 --> 01:18:45,720 DO THINGS GET WORSE IN THEIR 2002 01:18:45,720 --> 01:18:46,920 UNDERLYING DISEASE OR ARE THESE 2003 01:18:46,920 --> 01:18:48,440 TWO NOW UNRELATED? 2004 01:18:48,440 --> 01:18:49,800 DO THEY INTERACT WITH ONE 2005 01:18:49,800 --> 01:18:50,480 ANOTHER? 2006 01:18:50,480 --> 01:18:54,000 DO WE HAVE EXPERIENCE TO COMMENT 2007 01:18:54,000 --> 01:18:59,200 ABOUT THAT? 2008 01:18:59,200 --> 01:19:00,600 >> IT'S A REALLY GOOD QUESTION 2009 01:19:00,600 --> 01:19:01,600 AND I THINK A LOT OF PEOPLE 2010 01:19:01,600 --> 01:19:02,320 WORRY ABOUT THIS. 2011 01:19:02,320 --> 01:19:06,360 I'VE BEEN FOLLOWING IT FROM THE 2012 01:19:06,360 --> 01:19:07,920 NEURO SIDE OF THINGS AND 2013 01:19:07,920 --> 01:19:09,360 MULTIPLE SCLEROSIS IS PROBABLY 2014 01:19:09,360 --> 01:19:11,200 THE MOST COMMON ONE. 2015 01:19:11,200 --> 01:19:11,840 THERE'S DEFINITELY INFORMATION 2016 01:19:11,840 --> 01:19:14,080 ON THE BRAIN AND MS AND COVID. 2017 01:19:14,080 --> 01:19:15,600 IT'S NOT BEEN -- THE GOOD NEWS 2018 01:19:15,600 --> 01:19:17,920 IS THAT WE HAVEN'T SEEN 2019 01:19:17,920 --> 01:19:22,480 SOMETHING DRAMATIC. 2020 01:19:22,480 --> 01:19:23,120 SOME SUBTLE CHANGES COULD BE 2021 01:19:23,120 --> 01:19:24,760 THERE THAT WE HAVEN'T SEEN YET, 2022 01:19:24,760 --> 01:19:26,320 BUT NOT SEEING DRAMATIC CHANGES 2023 01:19:26,320 --> 01:19:27,080 THERE. 2024 01:19:27,080 --> 01:19:33,320 I WOULD SAY, MAYBE DAN KASTNER 2025 01:19:33,320 --> 01:19:34,360 COULD TALK ABOUT THIS, BUT THERE 2026 01:19:34,360 --> 01:19:41,160 ARE REPORTS THAT -- HOPE I GET 2027 01:19:41,160 --> 01:19:42,840 THIS RIGHT -- PEOPLE WHO HAVE 2028 01:19:42,840 --> 01:19:49,560 AUTO ANTIBODIES, EVEN IF THEY'RE 2029 01:19:49,560 --> 01:19:51,960 ASYMPTOMATIC, THEY HAVE A BIG 2030 01:19:51,960 --> 01:19:55,920 CHANGE WHEN THEY GET COVID AND 2031 01:19:55,920 --> 01:19:58,520 DEVELOP CONDITIONS THAT ARE NEW, 2032 01:19:58,520 --> 01:20:01,800 LIKE LUPUS OR RHEUMATOID 2033 01:20:01,800 --> 01:20:06,200 ARTHRITIS. 2034 01:20:06,200 --> 01:20:08,920 CERTAINLY DIABETES IS 2035 01:20:08,920 --> 01:20:09,920 POTENTIALLY A DIFFERENT STORY, 2036 01:20:09,920 --> 01:20:11,920 THAT THERE IS PRETTY -- MOST OF 2037 01:20:11,920 --> 01:20:13,720 THE STUDIES ARE SHOWING THAT 2038 01:20:13,720 --> 01:20:15,160 PEOPLE -- THAT THERE'S MORE 2039 01:20:15,160 --> 01:20:17,880 DIABETES AFTER COVID. 2040 01:20:17,880 --> 01:20:19,880 NOT SURE IF THAT'S IMMUNOLOGIC 2041 01:20:19,880 --> 01:20:21,160 OR NOT. 2042 01:20:21,160 --> 01:20:24,560 BECAUSE IN COVID, THERE'S 2043 01:20:24,560 --> 01:20:30,040 INVOLVEMENT OF THE BLOOD VESSELS 2044 01:20:30,040 --> 01:20:32,160 THAT PERFUSE THE PANCREAS AND 2045 01:20:32,160 --> 01:20:33,680 THERE'S EVIDENCE OF DAMAGE TO 2046 01:20:33,680 --> 01:20:34,200 THE PANCREAS. 2047 01:20:34,200 --> 01:20:35,720 THERE COULD BE VASCULAR DAMAGE 2048 01:20:35,720 --> 01:20:37,560 THAT GETS YOU TO DIABETES. 2049 01:20:37,560 --> 01:20:39,120 IT ALSO COMPLICATED BY THE FACT 2050 01:20:39,120 --> 01:20:41,520 THAT AS WE SHOWED IN THE 2051 01:20:41,520 --> 01:20:42,960 BEGINNING, PEOPLE WITH DIABETES 2052 01:20:42,960 --> 01:20:45,120 HAVE MORE SEVERE COVID AND THEY 2053 01:20:45,120 --> 01:20:47,280 HAVE MORE TROUBLE WITH 2054 01:20:47,280 --> 01:20:55,600 POST-ACUTE SCWEA LAY SCE SCWI LAY. 2055 01:20:55,600 --> 01:20:55,880 SEQUELAE. 2056 01:20:55,880 --> 01:20:58,320 YOU COULD HAVE PEOPLE WITH 2057 01:20:58,320 --> 01:20:59,120 PRE-CLINICAL DIABETES OR 2058 01:20:59,120 --> 01:21:00,720 UNDIAGNOSED DIABETES, THEY'RE 2059 01:21:00,720 --> 01:21:02,840 GOING TO GET WORSE COVID THAN 2060 01:21:02,840 --> 01:21:07,840 OTHERS AND SO IT'S NOT COVID 2061 01:21:07,840 --> 01:21:09,120 THAT'S CAUSING THE PROBLEM BUT 2062 01:21:09,120 --> 01:21:13,360 IT'S THEIR DIABETES THAT GOT 2063 01:21:13,360 --> 01:21:18,920 THEM THE WORSE COVID. 2064 01:21:18,920 --> 01:21:21,320 THAT'S THE -- THE AUTOIMMUNE 2065 01:21:21,320 --> 01:21:21,960 SIDE. 2066 01:21:21,960 --> 01:21:23,320 >> WALTER, THANK YOU FOR RAISING 2067 01:21:23,320 --> 01:21:25,040 THAT QUESTION AND ACTUALLY I 2068 01:21:25,040 --> 01:21:28,920 DON'T KNOW OF ANY LARGE ENOUGH 2069 01:21:28,920 --> 01:21:29,720 STUDIES LOOKING AT THIS. 2070 01:21:29,720 --> 01:21:31,920 CERTAINLY IT MAKES THEORETICAL 2071 01:21:31,920 --> 01:21:35,240 SENSE ANYWAY TO THINK THAT IF 2072 01:21:35,240 --> 01:21:36,400 SOMEBODY HAS ALREADY AT LEAST 2073 01:21:36,400 --> 01:21:41,200 SOME EVIDENCE FOR AUTO 2074 01:21:41,200 --> 01:21:43,480 ANTIBODIES OR AN AUTOIMMUNE 2075 01:21:43,480 --> 01:21:44,800 PROCESS THAT SIMPLY HAVING 2076 01:21:44,800 --> 01:21:46,880 THE -- WHATEVER IT MIGHT BE 2077 01:21:46,880 --> 01:21:51,560 CALLED -- ADJUVANT EFFECT OF 2078 01:21:51,560 --> 01:21:52,640 VIRAL INFECTION COULD DO THAT, 2079 01:21:52,640 --> 01:21:53,920 BUT I DON'T KNOW THAT THERE'S 2080 01:21:53,920 --> 01:21:55,160 ENOUGH DATA REALLY TO MAKE THAT 2081 01:21:55,160 --> 01:22:01,200 CASE AT THIS POINT. 2082 01:22:01,200 --> 01:22:07,320 >> EARLIER IN THE COURSE, WALTER 2083 01:22:07,320 --> 01:22:10,680 HOLLAND PRESENTED A FASCINATING 2084 01:22:10,680 --> 01:22:18,120 STUDIES ON ANTICYTOKINE 2085 01:22:18,120 --> 01:22:20,440 PARTICULARLY INTERFERON 2086 01:22:20,440 --> 01:22:22,640 ANTIBODIES AS BEING SOMEWHAT 2087 01:22:22,640 --> 01:22:28,520 NEGLECTED PATHOGENIC MECHANISMS. 2088 01:22:28,520 --> 01:22:30,480 HERE IN THESE STUDIES INCLUDING 2089 01:22:30,480 --> 01:22:32,320 THE ONE THAT WALTER REFERRED TO 2090 01:22:32,320 --> 01:22:36,640 THAT WAS IN "CELL" AMONGST THOSE 2091 01:22:36,640 --> 01:22:39,680 AUTO ANTIBODIES ARE ANTIBODIES 2092 01:22:39,680 --> 01:22:42,960 AGAINST SOME OF THE CYTOKINES. 2093 01:22:42,960 --> 01:22:47,280 IT'S NOT UNIVERSAL, IT'S NOT 2094 01:22:47,280 --> 01:22:48,320 DRAMATICALLY SEPARATING ONE 2095 01:22:48,320 --> 01:22:55,200 GROUP FROM THE OTHER. 2096 01:22:55,200 --> 01:22:56,400 BUT YOU SORT OF WONDER WHETHER 2097 01:22:56,400 --> 01:22:57,800 THERE IS SOME COMMONALITY 2098 01:22:57,800 --> 01:22:59,240 INVOLVED IN THOSE AUTO 2099 01:22:59,240 --> 01:23:05,240 ANTIBODIES TO PRODUCE THE 2100 01:23:05,240 --> 01:23:05,480 DISEASE. 2101 01:23:05,480 --> 01:23:06,760 I GUESS THAT'S AN AREA OF 2102 01:23:06,760 --> 01:23:08,040 INTENSE RESEARCH NOW, NO? 2103 01:23:08,040 --> 01:23:14,680 >> YEAH, NO, I THINK THAT'S VERY 2104 01:23:14,680 --> 01:23:18,640 TRUE. 2105 01:23:18,640 --> 01:23:22,480 WHAT WE'RE HOPING IS TO COLLECT 2106 01:23:22,480 --> 01:23:23,720 BIOSAMPLE FROM TENS OF THANK THANK YOU 2107 01:23:23,720 --> 01:23:24,920 THOUSANDS OF PEOPLE AND HAVE 2108 01:23:24,920 --> 01:23:26,440 THEM STORED SO THESE KIND OF 2109 01:23:26,440 --> 01:23:30,120 THINGS CAN BE EXPLORED AND 2110 01:23:30,120 --> 01:23:31,120 HOPEFULLY GIVE US ANSWERS. 2111 01:23:31,120 --> 01:23:33,200 MAYBE IF WE DON'T GET IT RIGHT 2112 01:23:33,200 --> 01:23:35,160 AWAY, SOME SMART PERSON TWO OR 2113 01:23:35,160 --> 01:23:36,440 THREE YEARS FROM NOW WILL GO 2114 01:23:36,440 --> 01:23:41,840 BACK AND FIGURE IT OUT. 2115 01:23:41,840 --> 01:23:43,920 BUT I THINK PIECING APART WHAT 2116 01:23:43,920 --> 01:23:45,680 ARE THE -- WHAT AUTO ANTIBODIES 2117 01:23:45,680 --> 01:23:49,200 ARE REALLY DRIVING THE TROUBLE, 2118 01:23:49,200 --> 01:23:50,200 WHAT IMMUNE CHANGES ARE REALLY 2119 01:23:50,200 --> 01:23:57,320 DRIVING THE TROUBLE ARE -- I 2120 01:23:57,320 --> 01:23:58,720 THINK THEY'RE TOUGH QUESTIONS 2121 01:23:58,720 --> 01:24:00,080 BECAUSE THERE'S SO MANY -- COVID 2122 01:24:00,080 --> 01:24:02,240 IS 2123 01:24:02,240 --> 01:24:03,720 HAS SUCH A DRAMATIC EFFECT, 2124 01:24:03,720 --> 01:24:08,160 TRYING TO UNDERSTAND WHAT'S 2125 01:24:08,160 --> 01:24:09,000 CAUSATIVE GIVEN EVERYTHING 2126 01:24:09,000 --> 01:24:11,000 THAT'S GOING ON IS GOING TO BE 2127 01:24:11,000 --> 01:24:15,520 DIFFICULT. 2128 01:24:15,520 --> 01:24:16,560 THAT'S MAYBE WHERE ANIMAL 2129 01:24:16,560 --> 01:24:17,880 STUDIES WILL BE NECESSARY TO DO 2130 01:24:17,880 --> 01:24:19,440 THOSE KIND OF INTERVENTIONS. 2131 01:24:19,440 --> 01:24:22,120 >> IT SOUNDS LIKE ANOTHER 2132 01:24:22,120 --> 01:24:22,760 FRAMINGHAM-TYPE STUDY. 2133 01:24:22,760 --> 01:24:25,440 IS THAT WHAT YOU THINK MIGHT BE 2134 01:24:25,440 --> 01:24:25,680 USEFUL? 2135 01:24:25,680 --> 01:24:28,360 >> I THINK RECOVER IS KIND OF 2136 01:24:28,360 --> 01:24:29,960 LIKE A FRAMINGHAM. 2137 01:24:29,960 --> 01:24:30,680 THAT'S HOW RECOVER WAS PUT 2138 01:24:30,680 --> 01:24:31,560 TOGETHER. 2139 01:24:31,560 --> 01:24:37,720 KIND LIKE A FRAMINGHAM STUDY. 2140 01:24:37,720 --> 01:24:38,400 3,000 PEOPLE, 50 MILLION 2141 01:24:38,400 --> 01:24:38,960 ELECTRONIC HEALTH RECORDS. 2142 01:24:38,960 --> 01:24:40,600 SO IT'S A REAL BATTLESHIP TYPE 2143 01:24:40,600 --> 01:24:43,240 OF APPROACH TO THE PROBLEM. 2144 01:24:43,240 --> 01:24:46,920 BUT THAT'S NOT GOING TO GET YOU 2145 01:24:46,920 --> 01:24:50,680 THE KILLER EXPERIMENT THAT SAYS, 2146 01:24:50,680 --> 01:24:52,280 YOU KNOW, OH, IT'S THAT AUTO 2147 01:24:52,280 --> 01:24:53,120 ANTIBODY THAT'S CAUSING THE 2148 01:24:53,120 --> 01:24:53,480 TROUBLE. 2149 01:24:53,480 --> 01:24:54,680 IT WILL GET YOU ASSOCIATIONS AND 2150 01:24:54,680 --> 01:24:56,640 THEN PEOPLE WILL HAVE TO LOOK AT 2151 01:24:56,640 --> 01:25:00,000 THOSE ASSOCIATIONS AND THEN PIG 2152 01:25:00,000 --> 01:25:02,800 APART THE PATHWAYS THEY THINK 2153 01:25:02,800 --> 01:25:05,440 ARE REALLY DRIVING THE SYMPTOMS 2154 01:25:05,440 --> 01:25:11,240 OR PATHOLOGY. 2155 01:25:11,240 --> 01:25:12,880 YOU DON'T KNOW WHERE TO START. 2156 01:25:12,880 --> 01:25:14,600 YOU HAVE NO CLUE WHAT TO BEGIN 2157 01:25:14,600 --> 01:25:15,360 WITH. 2158 01:25:15,360 --> 01:25:20,080 BECAUSE I THINK THEY GIVE YOU 2159 01:25:20,080 --> 01:25:26,320 [INAUDIBLE] TO DRILL DOWN ON. 2160 01:25:26,320 --> 01:25:30,240 >> I THINK IN THE PREVIOUS GREAT 2161 01:25:30,240 --> 01:25:34,600 PANDEMICS AND EPIDEMICS 2162 01:25:34,600 --> 01:25:37,200 INCLUDING THE 2163 01:25:37,200 --> 01:25:39,200 HUNDRED-YEAR-OLD -- WE DIDN'T 2164 01:25:39,200 --> 01:25:51,080 KNOW ENOUGH TO SAVE NATISH EUS ANY NATISH ANY TISSUES 2165 01:25:51,080 --> 01:25:51,480 OR CELLS. 2166 01:25:51,480 --> 01:25:53,080 EVEN IN THE FRAMINGHAM STUDY, 2167 01:25:53,080 --> 01:25:54,280 THERE WERE SOME TISSUES THAT 2168 01:25:54,280 --> 01:25:56,000 WERE SAVED. 2169 01:25:56,000 --> 01:25:57,480 NOBODY WAS INTO DNA AT THAT 2170 01:25:57,480 --> 01:25:58,400 POINT WHEN THAT STUDY WAS 2171 01:25:58,400 --> 01:25:59,400 STARTED. 2172 01:25:59,400 --> 01:26:04,760 SO IF WE'RE GOING TO SAVE 2173 01:26:04,760 --> 01:26:08,120 THOUSANDS OF SAMPLES TODAY 2174 01:26:08,120 --> 01:26:11,440 BECAUSE WE'RE LOOKING AT 2175 01:26:11,440 --> 01:26:12,320 TOMORROW'S SCIENCE AND COMING UP 2176 01:26:12,320 --> 01:26:15,320 WITH WHAT MAY BE THE ANSWERS AT 2177 01:26:15,320 --> 01:26:16,920 THE MOMENT WE'RE TALKING ABOUT 2178 01:26:16,920 --> 01:26:19,880 THE AUTO ANTIBODY, BUT WE DON'T 2179 01:26:19,880 --> 01:26:22,360 KNOW WHAT PARTICULARLY THE 2180 01:26:22,360 --> 01:26:24,680 SYSTEMS BIOLOGISTS ARE GOING TO 2181 01:26:24,680 --> 01:26:25,320 PULL OUT. 2182 01:26:25,320 --> 01:26:30,680 ARE THERE PLANS TO ACTUALLY 2183 01:26:30,680 --> 01:26:33,840 STORE WHAT WOULD BE SUITABLE 2184 01:26:33,840 --> 01:26:34,680 SAMPLES FOR ALMOST ANYTHING THAT 2185 01:26:34,680 --> 01:26:36,360 WE CAN IMAGINE IS COMING DOWN 2186 01:26:36,360 --> 01:26:38,440 THE PIKE FROM THE STANDPOINT OF 2187 01:26:38,440 --> 01:26:43,720 SCIENCE? 2188 01:26:43,720 --> 01:26:45,720 >> YEAH, WELL, IT ALL DEPENDS ON 2189 01:26:45,720 --> 01:26:51,040 WHAT THE PATIENTS WILL GIVE US. 2190 01:26:51,040 --> 01:26:52,280 SO EVERYTHING DEPENDS ON WHAT 2191 01:26:52,280 --> 01:26:53,320 PEOPLE WILL DO. 2192 01:26:53,320 --> 01:26:58,080 SO I WANT EVERYBODY TO HAVE A -- 2193 01:26:58,080 --> 01:26:59,160 SPINAL FLUID BUT THAT DIDN'T GO 2194 01:26:59,160 --> 01:26:59,480 OVER WELL. 2195 01:26:59,480 --> 01:27:02,200 BUT I THINK THEY SHOULD HAVE IT, 2196 01:27:02,200 --> 01:27:04,600 BUT IT'S JUST NOT FEASIBLE. 2197 01:27:04,600 --> 01:27:09,680 BUT YEAH, THAT'S THE IDEA, IS TO 2198 01:27:09,680 --> 01:27:12,400 RECOVER THOSE THREE TIERS OF 2199 01:27:12,400 --> 01:27:14,320 INVESTIGATION, AND TIER 1 IS 2200 01:27:14,320 --> 01:27:17,880 PRETTY BENIGN BUT IT'S 2201 01:27:17,880 --> 01:27:18,840 BURDENSOME. 2202 01:27:18,840 --> 01:27:21,680 HERE TOO IS ALSO BURDENSOME 2203 01:27:21,680 --> 01:27:23,720 BECAUSE IT'S DRIVEN BY THE 2204 01:27:23,720 --> 01:27:24,840 SYMPTOMS, WHAT WE FOUND IS WE 2205 01:27:24,840 --> 01:27:26,360 SHOULD HAVE ANTICIPATED THIS, 2206 01:27:26,360 --> 01:27:28,960 THAT MOST OF THE PEOPLE HAVE 2207 01:27:28,960 --> 01:27:30,320 SEVEN SYMPTOMS SO THEY TRIGGER 2208 01:27:30,320 --> 01:27:33,040 THREE OR FOUR DIFFERENT TIER TWO 2209 01:27:33,040 --> 01:27:33,920 STUDIES, AND THAT'S WAY TOO 2210 01:27:33,920 --> 01:27:34,120 MUCH. 2211 01:27:34,120 --> 01:27:36,440 SO WE HAVE TO FIGURE OUT -- 2212 01:27:36,440 --> 01:27:37,320 ACTUALLY RIGHT NOW WE'RE 2213 01:27:37,320 --> 01:27:39,640 FIGURING OUT HOW TO DECREASE THE 2214 01:27:39,640 --> 01:27:41,040 BURDEN ON THE PATIENTS, AND THEN 2215 01:27:41,040 --> 01:27:42,240 THE TIER THREE STUDIES ARE THE 2216 01:27:42,240 --> 01:27:45,080 REALLY DEEP MECHANISTIC ONES. 2217 01:27:45,080 --> 01:27:46,640 AND THE IDEA IS, YES, EVERYTHING 2218 01:27:46,640 --> 01:27:49,520 WILL BE SAVED, EVERYTHING WE CAN 2219 01:27:49,520 --> 01:27:51,280 GET AHOLD OF WILL BE SAVED, AND 2220 01:27:51,280 --> 01:27:55,120 I THINK THE BEAUTY IS THAT 2221 01:27:55,120 --> 01:27:57,320 WHAT'S HAPPENED WITH THE TOOLS 2222 01:27:57,320 --> 01:28:02,920 IN SCIENCE IS THAT SOMETIMES YOU 2223 01:28:02,920 --> 01:28:05,640 DON'T NEED TO KNOW WHAT THE TOOL 2224 01:28:05,640 --> 01:28:08,480 IS GOING TO BE TO SAVE THE 2225 01:28:08,480 --> 01:28:08,920 TISSUE FOR. 2226 01:28:08,920 --> 01:28:10,520 I GUESS THE BEST EXAMPLE WE HAVE 2227 01:28:10,520 --> 01:28:14,480 FROM THE BRAIN INITIATIVE IS 2228 01:28:14,480 --> 01:28:16,120 THAT PEOPLE INVESTIGATING THESE 2229 01:28:16,120 --> 01:28:20,440 DIFFERENT CELL TYPES AND DOING 2230 01:28:20,440 --> 01:28:21,760 TRANSCRIPTOMICS OUT OF THE 2231 01:28:21,760 --> 01:28:24,800 CYTOPLASM AND GETTING PATTERNS 2232 01:28:24,800 --> 01:28:28,400 OF RNA THAT -- THE CELL, THEN 2233 01:28:28,400 --> 01:28:29,200 SOMEBODY FIGURED OUT YOU CAN GET 2234 01:28:29,200 --> 01:28:30,600 THE SAME THING FROM THE NUCLEUS, 2235 01:28:30,600 --> 01:28:32,080 AND THE GOOD NEWS ABOUT THE 2236 01:28:32,080 --> 01:28:33,600 NUCLEUS IS THAT THE WAY YOU DO 2237 01:28:33,600 --> 01:28:36,320 THAT IS YOU PUT THE BRAIN IN A 2238 01:28:36,320 --> 01:28:38,160 BLENDER AND AS SOMEBODY SAID, 2239 01:28:38,160 --> 01:28:38,840 ANY EXPERIMENT THAT STARTS WHEN 2240 01:28:38,840 --> 01:28:41,000 YOU PUT THE BRAIN IN A BLENDER 2241 01:28:41,000 --> 01:28:44,520 IS GOING TO BE VERY ROBUST. 2242 01:28:44,520 --> 01:28:46,320 SO IF YOU GET STUFF OUT OF THE 2243 01:28:46,320 --> 01:28:50,080 FLEW CLEE US AND YOU GET THAT 2244 01:28:50,080 --> 01:28:52,120 OUT OF AUTOPSY -- THE NUCLEUS IS 2245 01:28:52,120 --> 01:28:53,840 PRETTY HARDY. 2246 01:28:53,840 --> 01:28:56,960 SO YOU NEVER KNOW, BUT YEAH, 2247 01:28:56,960 --> 01:28:58,120 THROWING THINGS AWAY, IT ALWAYS 2248 01:28:58,120 --> 01:29:00,440 COMES BACK TO BITE YOU. 2249 01:29:00,440 --> 01:29:04,040 >> JUST LIKE THE LIVER. 2250 01:29:04,040 --> 01:29:06,000 YOU CAN'T PUT IT IN A BLENDER. 2251 01:29:06,000 --> 01:29:11,360 SO WE HAVE A SERIES OF QUESTIONS 2252 01:29:11,360 --> 01:29:15,920 ABOUT FREQUENCIES OF DISEASES, 2253 01:29:15,920 --> 01:29:17,240 AND MAYBE BOTH OF YOU WOULD 2254 01:29:17,240 --> 01:29:17,720 RESPOND. 2255 01:29:17,720 --> 01:29:21,720 FOR EXAMPLE, DOES COVID CAUSE OR 2256 01:29:21,720 --> 01:29:26,280 CHANGE THE INCIDENCE OF 2257 01:29:26,280 --> 01:29:28,680 MIGRAINE? 2258 01:29:28,680 --> 01:29:34,600 WHY IS ADHD A GREATER RISK FOR 2259 01:29:34,600 --> 01:29:38,320 COVID? 2260 01:29:38,320 --> 01:29:41,280 ARE PEOPLE WHO ARE CHRONICALLY 2261 01:29:41,280 --> 01:29:45,480 DISABLED, THEY SEEM TO BE MORE 2262 01:29:45,480 --> 01:29:48,000 RESILIENT IN TERMS OF BEING 2263 01:29:48,000 --> 01:29:49,120 INFECTED FROM THE DATA THAT WAS 2264 01:29:49,120 --> 01:29:58,480 SHOWN. 2265 01:29:58,480 --> 01:30:00,040 SO MAYBE, JOSH, DO YOU WANT TO 2266 01:30:00,040 --> 01:30:00,720 START WITH THOSE? 2267 01:30:00,720 --> 01:30:03,120 >> WELL, LET ME JUST -- THE ADHD 2268 01:30:03,120 --> 01:30:04,160 IS THE EASY ONE. 2269 01:30:04,160 --> 01:30:05,800 WE DON'T KNOW. 2270 01:30:05,800 --> 01:30:09,920 IT'S EASIER TO EXPLAIN -- WELL, 2271 01:30:09,920 --> 01:30:10,920 ANY SERIOUS MENTAL ILLNESS, 2272 01:30:10,920 --> 01:30:12,360 THOUGH, IS GOING TO IMPACT YOUR 2273 01:30:12,360 --> 01:30:14,200 ABILITY TO ADHERE TO MITIGATION 2274 01:30:14,200 --> 01:30:14,480 MEASURES. 2275 01:30:14,480 --> 01:30:15,320 SO THAT'S ONE POSSIBILITY. 2276 01:30:15,320 --> 01:30:16,520 SO IF YOU HAVE SCHIZOPHRENIA OR 2277 01:30:16,520 --> 01:30:18,840 DEPRESSION OR ADHD, YOU MAY BE, 2278 01:30:18,840 --> 01:30:19,720 FOR DIFFERENT REASONS, LESS 2279 01:30:19,720 --> 01:30:22,280 LIKELY TO BE ABLE TO WEAR A MASK 2280 01:30:22,280 --> 01:30:24,520 PROPERLY, LESS LIKELY TO 2281 01:30:24,520 --> 01:30:27,080 REMEMBER SOCIAL DISTANCING, 2282 01:30:27,080 --> 01:30:29,000 MAYBE YOU'RE MUCH MORE LIKELY TO 2283 01:30:29,000 --> 01:30:31,720 BE EMPLOYED IN A JOB THAT 2284 01:30:31,720 --> 01:30:33,760 DOESN'T PERMIT YOU TO WORK FROM 2285 01:30:33,760 --> 01:30:34,720 HOME. 2286 01:30:34,720 --> 01:30:36,920 SO YOU ARE MORE LIKELY TO BE 2287 01:30:36,920 --> 01:30:37,800 HOMELESS. 2288 01:30:37,800 --> 01:30:41,080 SO FOR LOTS OF DIFFERENT 2289 01:30:41,080 --> 01:30:42,480 REASONS, YOU MIGHT BE EXPOSED 2290 01:30:42,480 --> 01:30:43,040 MORE TO COVID. 2291 01:30:43,040 --> 01:30:46,720 THAT DOESN'T EXPLAIN THE 2292 01:30:46,720 --> 01:30:47,480 MORTALITY DIFFERENCES, THE 2293 01:30:47,480 --> 01:30:48,320 MORTALITY DIFFERENCES, THOUGH, 2294 01:30:48,320 --> 01:30:53,600 MAY HAVE SOMETHING TO DO WITH 2295 01:30:53,600 --> 01:30:56,320 YOUR LOWER ABILITY TO SEEK CARE 2296 01:30:56,320 --> 01:30:58,200 OR TO GET CARE WHEN YOU SEEK IT. 2297 01:30:58,200 --> 01:31:00,680 SO THERE'S BOTH SYSTEMIC REASONS 2298 01:31:00,680 --> 01:31:01,720 WHY INDIVIDUALS WITH SERIOUS 2299 01:31:01,720 --> 01:31:02,800 MENTAL ILLNESS HAVE A HARDER 2300 01:31:02,800 --> 01:31:05,720 TIME ACCESSING MEDICAL CARE, 2301 01:31:05,720 --> 01:31:07,840 THERE'S ALSO EVIDENCE OF 2302 01:31:07,840 --> 01:31:08,560 DISCRIMINATION AGAINST 2303 01:31:08,560 --> 01:31:09,320 INDIVIDUALS WITH SERIOUS MENTAL 2304 01:31:09,320 --> 01:31:10,680 ILLNESS WHEN THEY BRING UP 2305 01:31:10,680 --> 01:31:11,720 MEDICAL COMPLAINTS, THEY ARE 2306 01:31:11,720 --> 01:31:14,120 LESS OFTEN TREATED IN AN 2307 01:31:14,120 --> 01:31:14,800 EVIDENCE-BASED OR APPROPRIATE 2308 01:31:14,800 --> 01:31:15,120 MANNER. 2309 01:31:15,120 --> 01:31:16,760 SO FOR ALL THOSE REASONS, 2310 01:31:16,760 --> 01:31:18,480 REGARDLESS OF DIAGNOSIS, 2311 01:31:18,480 --> 01:31:20,720 INDIVIDUALS WITH A SERIOUS 2312 01:31:20,720 --> 01:31:22,120 MENTAL ILLNESS ARE MORE LIKELY 2313 01:31:22,120 --> 01:31:23,320 TO EXPERIENCE NEGATIVE OUTCOMES 2314 01:31:23,320 --> 01:31:25,360 OF PHYSICAL ILLNESSES. 2315 01:31:25,360 --> 01:31:31,680 MAYBE THAT EX-PLAWNS THE EXPLAINS THE 2316 01:31:31,680 --> 01:31:32,440 DIFFERENCE OF CONTRACTING COVID 2317 01:31:32,440 --> 01:31:33,400 AND DEATH BY COVID. 2318 01:31:33,400 --> 01:31:35,040 WE DON'T REALLY KNOW BUT THAT'S 2319 01:31:35,040 --> 01:31:35,600 ONE POSSIBILITY. 2320 01:31:35,600 --> 01:31:36,720 THE OTHER QUESTION HAD TO DO 2321 01:31:36,720 --> 01:31:39,200 WITH PEOPLE WITH DISABILITIES. 2322 01:31:39,200 --> 01:31:40,320 I THINK -- I SAW THAT QUESTION 2323 01:31:40,320 --> 01:31:43,120 IN THE CHAT EARLIER. 2324 01:31:43,120 --> 01:31:44,760 I THINK THE QUESTION WAS, IN 2325 01:31:44,760 --> 01:31:47,480 TERMS OF THE MITIGATION 2326 01:31:47,480 --> 01:31:49,760 MEASURES, WHICH HAVE PERHAPS 2327 01:31:49,760 --> 01:31:50,720 CONTRIBUTED TO THE RISING RATES 2328 01:31:50,720 --> 01:31:53,280 OF ANXIETY AND DEPRESSION, MIGHT 2329 01:31:53,280 --> 01:31:54,320 WE LEARN SOMETHING ABOUT 2330 01:31:54,320 --> 01:31:56,120 RESILIENCE FROM INDIVIDUALS WITH 2331 01:31:56,120 --> 01:32:00,080 DISABILITIES WHO ARE SUBJECT 2332 01:32:00,080 --> 01:32:01,240 ALMOST ALL THE TIME TO MANY OF 2333 01:32:01,240 --> 01:32:02,480 THESE MITIGATION MEASURES, AT 2334 01:32:02,480 --> 01:32:03,960 LEAST IN TERMS OF MORE LIKELY TO 2335 01:32:03,960 --> 01:32:05,360 EXPERIENCE SOCIAL ISOLATION, 2336 01:32:05,360 --> 01:32:06,640 DIFFICULTY LEAVING THEIR HOME 2337 01:32:06,640 --> 01:32:07,560 AND PARTICIPATING IN MANY 2338 01:32:07,560 --> 01:32:10,960 ASPECTS OF LIFE. 2339 01:32:10,960 --> 01:32:13,280 I DON'T KNOW THE DIRECT ANSWER 2340 01:32:13,280 --> 01:32:14,560 THE QUESTION IN TERMS OF WHAT WE 2341 01:32:14,560 --> 01:32:18,000 CAN LEARN FROM STUDYING SUCH 2342 01:32:18,000 --> 01:32:18,440 INDIVIDUALS. 2343 01:32:18,440 --> 01:32:19,400 THERE ARE LOTS OF DIFFERENT 2344 01:32:19,400 --> 01:32:24,680 REASONS WHY PEOPLE ARE RESILIENT 2345 01:32:24,680 --> 01:32:26,640 TO STRESSES, AND TO SPECIFIC 2346 01:32:26,640 --> 01:32:29,200 ASPECTS OF THE PANDEMIC, AND WE 2347 01:32:29,200 --> 01:32:30,920 ABSOLUTELY ARE STUDYING THOSE 2348 01:32:30,920 --> 01:32:33,640 RESILIENCE FACTORS. 2349 01:32:33,640 --> 01:32:34,880 SOME OF THEM, WE ALREADY KNEW, 2350 01:32:34,880 --> 01:32:36,480 THEY WERE REFLECTED IN THE 2351 01:32:36,480 --> 01:32:39,560 EARLIER POINTS OF MY 2352 01:32:39,560 --> 01:32:39,960 PRESENTATION. 2353 01:32:39,960 --> 01:32:41,120 MANY HAVE TO DO WITH YOUR 2354 01:32:41,120 --> 01:32:43,000 ABILITY TO SOCIALLY CONNECT AND 2355 01:32:43,000 --> 01:32:46,000 THAT CAN BE DOB EVEN IF DONE EVEN IF YOU ARE 2356 01:32:46,000 --> 01:32:47,000 SHUT IN THE HOME. 2357 01:32:47,000 --> 01:32:48,280 OTHER RESILIENCE FACTORS INCLUDE 2358 01:32:48,280 --> 01:32:51,760 A STRONG 2359 01:32:51,760 --> 01:32:53,200 STRONG FAMILY CONNECTIONS, 2360 01:32:53,200 --> 01:32:54,840 INCLUDE HAVING BEEN EXPOSED TO 2361 01:32:54,840 --> 01:32:55,840 HARDSHIPS IN THE PAST ARCHED 2362 01:32:55,840 --> 01:32:59,760 RESPONDING TO THEM AND DEALING 2363 01:32:59,760 --> 01:33:04,320 WITH THEM WITH SELF-EFFICACIES, 2364 01:33:04,320 --> 01:33:05,560 THEY'VE LEARNED THEY HAVE 2365 01:33:05,560 --> 01:33:07,640 SELF-EFFICACY TO COMBAT 2366 01:33:07,640 --> 01:33:08,400 CHALLENGES WHEN THEY'RE 2367 01:33:08,400 --> 01:33:08,920 CONFRONTED WITH IT. 2368 01:33:08,920 --> 01:33:10,480 SO LOTS OF DIFFERENT THINGS THAT 2369 01:33:10,480 --> 01:33:14,200 WE CAN LEARN FROM VARIOUS GROUPS 2370 01:33:14,200 --> 01:33:15,320 ABOUT RESILIENCE AND WE ARE 2371 01:33:15,320 --> 01:33:16,920 DOING THAT IN THE CONTEXT OF THE 2372 01:33:16,920 --> 01:33:17,320 PANDEMIC. 2373 01:33:17,320 --> 01:33:18,640 THERE WAS A THIRD QUESTION, 2374 01:33:18,640 --> 01:33:18,920 MIGRAINES. 2375 01:33:18,920 --> 01:33:21,080 I DON'T KNOW ABOUT THAT. 2376 01:33:21,080 --> 01:33:22,720 MAYBE WALTER KNOWS ABOUT 2377 01:33:22,720 --> 01:33:23,000 MIGRAINES. 2378 01:33:23,000 --> 01:33:25,360 >> DO YOU WANT TO COMMENT ON 2379 01:33:25,360 --> 01:33:25,640 MIGRAINE? 2380 01:33:25,640 --> 01:33:29,240 >> RIGHT. 2381 01:33:29,240 --> 01:33:31,800 SO HEADACHE IS ONE OF THE PRETTY 2382 01:33:31,800 --> 01:33:33,040 COMMON SYMPTOMS OF PEOPLE WHO 2383 01:33:33,040 --> 01:33:36,520 SUFFER FROM LONG COVID, AND 2384 01:33:36,520 --> 01:33:41,240 THOSE HEADACHES HAVE -- THEY ARE 2385 01:33:41,240 --> 01:33:42,000 MIGRAINOUS IN THEIR 2386 01:33:42,000 --> 01:33:43,240 CHARACTERISTICS. 2387 01:33:43,240 --> 01:33:46,720 PEOPLE WHO HAVE MIGRAINE TEND TO 2388 01:33:46,720 --> 01:33:48,440 HAVE WORSE HEADACHES, WORSENING 2389 01:33:48,440 --> 01:33:52,920 OF HEADACHES AFTER COVID, AND SO 2390 01:33:52,920 --> 01:33:56,400 I THINK THE ANSWER IS YES, THAT 2391 01:33:56,400 --> 01:33:57,600 COVID IN PEOPLE WITH PERSISTENT 2392 01:33:57,600 --> 01:34:02,920 SYMPTOMS OF COVID ARE HAVING 2393 01:34:02,920 --> 01:34:08,280 MIGRAINE. 2394 01:34:08,280 --> 01:34:09,800 THEY GO AWAY TWO OR THREE MONTHS 2395 01:34:09,800 --> 01:34:13,480 AFTER THE INFECTION IN MANY 2396 01:34:13,480 --> 01:34:14,080 PEOPLE. 2397 01:34:14,080 --> 01:34:15,320 MIGRAINE IS SO COMMON, IT'S HARD 2398 01:34:15,320 --> 01:34:20,080 TO KNOW IF IT'S WORSENING 2399 01:34:20,080 --> 01:34:22,240 PREDISPOSITION VERSUS TRIGGERING 2400 01:34:22,240 --> 01:34:25,320 MIGRAINE IN SOMEBODY WHO HAD 2401 01:34:25,320 --> 01:34:31,280 NEVER HAD A MIGRAINE. 2402 01:34:31,280 --> 01:34:34,640 >> THERE'S AN INTERESTING 2403 01:34:34,640 --> 01:34:40,200 QUESTION OF THE ELECTRONIC 2404 01:34:40,200 --> 01:34:44,320 HEALTH RECORD. 2405 01:34:44,320 --> 01:34:45,520 YOU MENTIONED IN YOUR SLIDE 2406 01:34:45,520 --> 01:34:49,480 SOMETHING LIKE 50 MILLION -- 2407 01:34:49,480 --> 01:34:51,040 ACCESS TO 50 MILLION ELECTRONIC 2408 01:34:51,040 --> 01:34:55,360 HEALTH RECORDS. 2409 01:34:55,360 --> 01:35:01,920 SO THE QUESTION IS, ARE THOSE IN 2410 01:35:01,920 --> 01:35:06,120 THE COUNTRY WHO HAVE GROSSLY 2411 01:35:06,120 --> 01:35:10,120 INADEQUATE HEALTHCARE AND 2412 01:35:10,120 --> 01:35:10,920 AVAILABILITY OF PUBLIC HEALTH 2413 01:35:10,920 --> 01:35:12,040 FACILITIES AND SO FORTH, SO NOW 2414 01:35:12,040 --> 01:35:20,640 WE'RE TALKING ABOUT TRULY 2415 01:35:20,640 --> 01:35:23,080 UNDERPRIVILEGED, SOME 2416 01:35:23,080 --> 01:35:24,800 MINORITIES, UNEMPLOYED, ALL OF 2417 01:35:24,800 --> 01:35:25,000 THAT. 2418 01:35:25,000 --> 01:35:26,000 ARE THEY INCLUDED IN THE 2419 01:35:26,000 --> 01:35:29,400 ELECTRONIC HEALTH RECORDS THAT 2420 01:35:29,400 --> 01:35:31,240 ARE IS STUDIED? 2421 01:35:31,240 --> 01:35:32,680 AND ARE SOME OF THE DIFFERENCES 2422 01:35:32,680 --> 01:35:36,160 THAT MAY BE OBSERVED IN THE 2423 01:35:36,160 --> 01:35:39,120 UNITED STATES AND U.K. OR 2424 01:35:39,120 --> 01:35:41,320 WESTERN EUROPE OR AUSTRALIA, DUE 2425 01:35:41,320 --> 01:35:47,080 TO THE FACT THAT IN THOSE 2426 01:35:47,080 --> 01:35:47,920 COUNTRIES, EVERYBODY IS INCLUDED 2427 01:35:47,920 --> 01:35:49,240 IN AN ELECTRONIC HEALTH RECORD. 2428 01:35:49,240 --> 01:35:52,920 IS THIS AN ISSUE IN ANALYZING 2429 01:35:52,920 --> 01:35:53,400 THE RESULTS? 2430 01:35:53,400 --> 01:36:04,120 WHAT DO YOU THINK ABOUT THAT? 2431 01:36:04,120 --> 01:36:07,800 >> I'M SURE EVERY TOOL THAT YOU 2432 01:36:07,800 --> 01:36:09,920 GET TO ASSESS HEALTH HAS ITS 2433 01:36:09,920 --> 01:36:18,280 LIMITATIONS AND ITS STRENGTHS. 2434 01:36:18,280 --> 01:36:19,160 THE ELECTRONIC HEALTH SYSTEM 2435 01:36:19,160 --> 01:36:24,760 RECORD THAT WE ARE WORKING WITH 2436 01:36:24,760 --> 01:36:26,680 IS -- ONE IS NC3 WHICH WAS SET 2437 01:36:26,680 --> 01:36:30,600 UP BY NCATS AS A COVID 2438 01:36:30,600 --> 01:36:32,840 SURVEILLANCE SYSTEM. 2439 01:36:32,840 --> 01:36:36,480 NOW WAS THAT WAS SET UP PURPOSEFULLY TO 2440 01:36:36,480 --> 01:36:38,680 GET A DIVERSE POPULATION OF 2441 01:36:38,680 --> 01:36:38,920 PEOPLE. 2442 01:36:38,920 --> 01:36:42,480 AND THE OTHER ONE WE'RE WORKING 2443 01:36:42,480 --> 01:36:44,120 WITH IS THE PATIENT-CENTERED OUT 2444 01:36:44,120 --> 01:36:51,320 COME RESEARCH INSTITUTE FOR THAT 2445 01:36:51,320 --> 01:36:52,120 MEDICAL RECORDS DATABASE, WHICH 2446 01:36:52,120 --> 01:36:55,800 AGAIN I THINK IS PRETTY -- IS 2447 01:36:55,800 --> 01:36:58,680 LARGE NUMBERS AND HAS PEOPLE 2448 01:36:58,680 --> 01:37:00,640 FROM DIVERSE BACKGROUNDS. 2449 01:37:00,640 --> 01:37:05,640 NOW THAT BEING SAID, THAT'S 2450 01:37:05,640 --> 01:37:06,400 ELECTRONIC HEALTH RECORDS, SO 2451 01:37:06,400 --> 01:37:10,320 THEY MIGHT BE THE BEST YOU CAN 2452 01:37:10,320 --> 01:37:12,400 DO, BUT STILL THE POINT REMAINS 2453 01:37:12,400 --> 01:37:18,000 THAT PEOPLE WERE LOW -- OF LOW 2454 01:37:18,000 --> 01:37:19,880 SOCIOECONOMIC STATUS ARE NOT 2455 01:37:19,880 --> 01:37:21,600 GETTING THEIR SYMPTOMS INTO THE 2456 01:37:21,600 --> 01:37:23,560 ELECTRONIC HEALTH RECORDS PLUS 2457 01:37:23,560 --> 01:37:24,680 THEY'RE NOT GETTING GOOD CARE 2458 01:37:24,680 --> 01:37:26,520 AND THEY'RE NOT SEEING DOCTORS. 2459 01:37:26,520 --> 01:37:34,080 SO WE DON'T HAVE DATA ON VAST 2460 01:37:34,080 --> 01:37:34,400 DEMOGRAPHICS. 2461 01:37:34,400 --> 01:37:35,480 THEY WERE SET UP PARTICULARLY 2462 01:37:35,480 --> 01:37:36,720 NOT TO BE BIASED. 2463 01:37:36,720 --> 01:37:38,680 BUT I COULD SAY FROM TALKING TO 2464 01:37:38,680 --> 01:37:41,800 THE DOCTORS WHO TAKE CARE OF 2465 01:37:41,800 --> 01:37:43,800 PEOPLE IN THE CLINICS, THE 2466 01:37:43,800 --> 01:37:45,880 POST-ACUTE SEQUELAE OF COVID 2467 01:37:45,880 --> 01:37:48,480 CLINICS, THEY ARE NOT DIVERSE. 2468 01:37:48,480 --> 01:37:49,720 IT'S SOMEBODY WHO HAS THE 2469 01:37:49,720 --> 01:37:52,760 WHEREWITHAL AND THE MEANS TO 2470 01:37:52,760 --> 01:37:54,560 KIND OF BREAK INTO THE 2471 01:37:54,560 --> 01:37:55,160 SUBSPECIALTY CLINICS. 2472 01:37:55,160 --> 01:37:56,760 MOST OF THEM NOW ARE SO FULL 2473 01:37:56,760 --> 01:37:58,680 THAT THEY'RE BOOKED FOR MONTHS 2474 01:37:58,680 --> 01:38:01,400 IN ADVANCE, AND SO THE BAR TO 2475 01:38:01,400 --> 01:38:05,240 GET THERE, I THINK PUTS PEOPLE 2476 01:38:05,240 --> 01:38:07,480 OF LOW SOCIOECONOMIC STATUS AT A 2477 01:38:07,480 --> 01:38:08,320 REAL DISADVANTAGE. 2478 01:38:08,320 --> 01:38:13,000 SO WE DO HAVE A PROBLEM. 2479 01:38:13,000 --> 01:38:14,440 I THINK ON THE RESEARCH SIDE OF 2480 01:38:14,440 --> 01:38:15,320 THINGS, WE'RE TRYING TO TAKE 2481 01:38:15,320 --> 01:38:15,720 CARE OF IT. 2482 01:38:15,720 --> 01:38:16,840 ON THE HEALTHCARE SIDE OF 2483 01:38:16,840 --> 01:38:18,440 THINGS, IT'S A REAL PROBLEM. 2484 01:38:18,440 --> 01:38:22,080 NOW I KNOW AT HHS, THE PEOPLE 2485 01:38:22,080 --> 01:38:23,880 WHO RUN THE FEDERAL -- THE 2486 01:38:23,880 --> 01:38:27,320 COMMUNITY HEALTH CLINICS ARE 2487 01:38:27,320 --> 01:38:30,480 TRYING TO FOCUS ON PROVIDING 2488 01:38:30,480 --> 01:38:31,120 CARE. 2489 01:38:31,120 --> 01:38:35,600 I SUSPECT THAT PEOPLE WHO DON'T 2490 01:38:35,600 --> 01:38:36,840 FREQUENT PHYSICIANS DON'T GET 2491 01:38:36,840 --> 01:38:41,120 ANY TREATMENT AND THEIR SYMPTOMS 2492 01:38:41,120 --> 01:38:42,880 ARE NEVER CODED ANYWHERE. 2493 01:38:42,880 --> 01:38:45,320 I THINK THERE'S PROBABLY LOTS OF 2494 01:38:45,320 --> 01:38:48,480 THOSE FOLKS OUT THERE. 2495 01:38:48,480 --> 01:38:50,680 I THINK ONE OF THE STRESSES ON 2496 01:38:50,680 --> 01:38:52,720 THE HEALTHCARE SYSTEM. 2497 01:38:52,720 --> 01:38:56,560 BECAUSE COVID DID ACTUALLY 2498 01:38:56,560 --> 01:38:57,680 PREFERENTIALLY HAVE BIGGER HITS 2499 01:38:57,680 --> 01:38:58,640 AGAINST AFRICAN AMERICANS AND 2500 01:38:58,640 --> 01:38:59,920 HISPANICS IN THIS COUNTRY WHO 2501 01:38:59,920 --> 01:39:03,640 TEND TO COME FROM AREAS OF 2502 01:39:03,640 --> 01:39:05,360 COMMONLY LOW SOCIOECONOMIC 2503 01:39:05,360 --> 01:39:07,360 STATUS, THAT THAT DISPARITY ON 2504 01:39:07,360 --> 01:39:11,080 THE ACUTE SIDE, THEY GOT HIT 2505 01:39:11,080 --> 01:39:12,160 WORSE, IS GOING TO FLOW OVER TO 2506 01:39:12,160 --> 01:39:13,800 THE CHRONIC SIDE TOO. 2507 01:39:13,800 --> 01:39:17,520 AND THAT'S SOMETHING THAT I 2508 01:39:17,520 --> 01:39:19,280 THINK THE COUNTRY HAS TO TAKE TO 2509 01:39:19,280 --> 01:39:21,760 MIND AND TRY TO -- 2510 01:39:21,760 --> 01:39:26,880 >> ACTUALLY EVERYTHING -- I I A 2511 01:39:26,880 --> 01:39:27,800 GREE WITH EVERYTHING WALTER 2512 01:39:27,800 --> 01:39:28,120 SAID. 2513 01:39:28,120 --> 01:39:29,440 THERE'S A MISCONCEPTION 2514 01:39:29,440 --> 01:39:30,600 INHERENTLY IN THAT QUESTION, 2515 01:39:30,600 --> 01:39:32,720 THAT UNDERRESOURCED HEALTHCARE 2516 01:39:32,720 --> 01:39:33,920 SETTINGS MIGHT NOT USE 2517 01:39:33,920 --> 01:39:35,360 HEALTHCARE RECORDS OR MIGHT NOT 2518 01:39:35,360 --> 01:39:37,000 HAVE AS GOOD HEALTHCARE RECORDS. 2519 01:39:37,000 --> 01:39:37,960 ACTUALLY THAT IS NOT TRUE. 2520 01:39:37,960 --> 01:39:39,760 SO IN FACT, UNDERRESOURCED 2521 01:39:39,760 --> 01:39:40,720 HEALTHCARE SETTINGS LIKE 2522 01:39:40,720 --> 01:39:43,560 COMMUNITY CLINICS AND MEDICAID 2523 01:39:43,560 --> 01:39:46,280 CLINIC, ET CETERA, THE EARLY 2524 01:39:46,280 --> 01:39:47,800 ADOPTERS IN THE AGE OF 2525 01:39:47,800 --> 01:39:48,640 OBAMACARE. 2526 01:39:48,640 --> 01:39:50,640 SO THE PENETRATION OF HEALTHCARE 2527 01:39:50,640 --> 01:39:52,040 RECORDS, THE ELECTRONIC 2528 01:39:52,040 --> 01:39:52,920 HEALTHCARE RECORDS IS ACTUALLY 2529 01:39:52,920 --> 01:39:54,640 LESS WHEN YOU LOOK AT SMALLER 2530 01:39:54,640 --> 01:39:55,560 PRIVATE PRACTICES, ET CETERA, 2531 01:39:55,560 --> 01:39:56,240 ALTHOUGH EVERYBODY USES THEM 2532 01:39:56,240 --> 01:39:59,080 NOW. 2533 01:39:59,080 --> 01:40:00,880 SO I DON'T THINK IT'S AN 2534 01:40:00,880 --> 01:40:01,720 ELECTRONIC HEALTHCARE ISSUE, 2535 01:40:01,720 --> 01:40:03,000 ALTHOUGH IT ABSOLUTELY IS AN 2536 01:40:03,000 --> 01:40:04,640 ACCESS TO HEALTHCARE ISSUE, AND 2537 01:40:04,640 --> 01:40:06,080 STUDIES LIKE RECOVER HAVE TO 2538 01:40:06,080 --> 01:40:08,000 WORK HARD TO RECRUIT OUTSIDE OF 2539 01:40:08,000 --> 01:40:08,880 THE NORMAL HEALTHCARE SETTINGS 2540 01:40:08,880 --> 01:40:11,400 IN ORDER TO MAKE SURE TO RECRUIT 2541 01:40:11,400 --> 01:40:17,120 A REPRESENTATIVE GROUP. 2542 01:40:17,120 --> 01:40:18,080 >> VERY INTERESTING. 2543 01:40:18,080 --> 01:40:20,160 WE HAVE -- LET'S SEE. 2544 01:40:20,160 --> 01:40:22,640 THERE'S -- AH, HERE'S A 2545 01:40:22,640 --> 01:40:29,560 QUESTION. 2546 01:40:29,560 --> 01:40:32,600 SO JORDAN ASK, HOW LONG DOES 2547 01:40:32,600 --> 01:40:40,480 COVID AFFECT LIVER ENZYMES? 2548 01:40:40,480 --> 01:40:42,120 DOES IT AFFECT THE LIVER 2549 01:40:42,120 --> 01:40:42,360 ENZYMES? 2550 01:40:42,360 --> 01:40:43,360 I PERSONALLY WAS NOT AWARE OF 2551 01:40:43,360 --> 01:40:47,400 THAT, BUT IS THIS AN ISSUE? 2552 01:40:47,400 --> 01:40:52,160 >> FREQUENTLY, YEAH. 2553 01:40:52,160 --> 01:40:53,720 FREQUENTLY, 46% OF THE -- COVID 2554 01:40:53,720 --> 01:40:56,440 PATIENTS ELEVATED ASTs, 35% 2555 01:40:56,440 --> 01:40:58,520 ELEVATED ALTs. 2556 01:40:58,520 --> 01:41:02,120 MY UNDERSTANDING, THEY TEND TO 2557 01:41:02,120 --> 01:41:05,520 GO DOWN WITHIN WEEKS TO MONTHS 2558 01:41:05,520 --> 01:41:11,640 AFTER DISCHARGE. 2559 01:41:11,640 --> 01:41:14,600 >> SO THEY GO DOWN RATHER 2560 01:41:14,600 --> 01:41:16,280 PROMPTLY. 2561 01:41:16,280 --> 01:41:16,520 IS THAT -- 2562 01:41:16,520 --> 01:41:19,920 >> OVER A MONTH. 2563 01:41:19,920 --> 01:41:23,240 >> YEAH. 2564 01:41:23,240 --> 01:41:28,200 THERE ARE ALSO A COUPLE OF 2565 01:41:28,200 --> 01:41:28,480 QUESTIONS. 2566 01:41:28,480 --> 01:41:32,080 DIABETES MELLITUS, TYPE 2, IS 2567 01:41:32,080 --> 01:41:39,520 LISTED AS A RISK FACTOR, BOTH IN 2568 01:41:39,520 --> 01:41:42,640 SEVERITY AND ALSO IN CHRONIC 2569 01:41:42,640 --> 01:41:45,000 LONG HAUL COVID. 2570 01:41:45,000 --> 01:41:53,280 WHAT ARE YOUR THOUGHTS ABOUT HOW 2571 01:41:53,280 --> 01:41:53,920 DOES THAT WORK? 2572 01:41:53,920 --> 01:41:58,160 DO WE UNDERSTAND WHAT THE 2573 01:41:58,160 --> 01:42:05,280 UNDERLYING ASSOCIATION MEANS? 2574 01:42:05,280 --> 01:42:08,040 IN BIOLOGICAL TERMS, 2575 01:42:08,040 --> 01:42:15,480 MECHANISTICALLY? 2576 01:42:15,480 --> 01:42:17,240 >> I THINK, AGAIN, THERE'S A LOT 2577 01:42:17,240 --> 01:42:20,280 OF POSSIBILITIES. 2578 01:42:20,280 --> 01:42:21,360 AND I DON'T THINK I'M THE RIGHT 2579 01:42:21,360 --> 01:42:22,640 PERSON TO ANSWER THE QUESTION, 2580 01:42:22,640 --> 01:42:26,120 BUT I'LL THROW OUT A COUPLE OF 2581 01:42:26,120 --> 01:42:26,320 IDEAS. 2582 01:42:26,320 --> 01:42:31,200 ONE IS THAT I UNDERSTAND FAT 2583 01:42:31,200 --> 01:42:37,000 TISSUE IS ENRICHED [INAUDIBLE]. 2584 01:42:37,000 --> 01:42:40,040 ALSO FAT TISSUE IS, IN SOME 2585 01:42:40,040 --> 01:42:43,000 INSTANCES, ALMOST LIKE AN 2586 01:42:43,000 --> 01:42:49,080 ENDOCRINE ORGAN THAT STIMULATES 2587 01:42:49,080 --> 01:42:50,520 ABNORMALITIES THAT AFFECT OTHER 2588 01:42:50,520 --> 01:42:56,520 BODY SYSTEMS, SORT OF METABOLIC 2589 01:42:56,520 --> 01:42:56,880 SYNDROME. 2590 01:42:56,880 --> 01:42:58,160 ONE OF THOSE IS ACTUALLY 2591 01:42:58,160 --> 01:42:58,480 INFLAMMATION. 2592 01:42:58,480 --> 01:43:02,680 SO THAT OBESITY IS ASSOCIATED 2593 01:43:02,680 --> 01:43:05,640 WITH WORSENED IMMUNE RESPONSES 2594 01:43:05,640 --> 01:43:10,440 TO A WHOLE BUNCH OF DIFFERENT 2595 01:43:10,440 --> 01:43:11,120 CONDITIONS. 2596 01:43:11,120 --> 01:43:14,600 AND THEN THERE'S THE DIABETES 2597 01:43:14,600 --> 01:43:17,000 ISSUE WHICH COULD BE SEPARATE 2598 01:43:17,000 --> 01:43:18,680 FROM OBESITY OR COULD BE ONE OF 2599 01:43:18,680 --> 01:43:19,480 THE DRIVERS. 2600 01:43:19,480 --> 01:43:21,760 THOSE ARE THE THINGS THAT I 2601 01:43:21,760 --> 01:43:22,760 WOULD THROW OUT ON THE TABLE, 2602 01:43:22,760 --> 01:43:28,240 BUT I BET YOU THERE'S A 2603 01:43:28,240 --> 01:43:29,120 DIABETOLOGIST ON THE CALL WHO 2604 01:43:29,120 --> 01:43:37,200 KNOWS THE RIGHT ANSWER. 2605 01:43:37,200 --> 01:43:38,560 >> SO JOSH, DO YOU HAVE THOUGHTS 2606 01:43:38,560 --> 01:43:40,160 ABOUT THAT? 2607 01:43:40,160 --> 01:43:42,440 >> THE OTHER THING WHICH DATA 2608 01:43:42,440 --> 01:43:43,520 COULD TELL US, I JUST DON'T KNOW 2609 01:43:43,520 --> 01:43:46,760 THE ANSWER TO IT, IS WHETHER THE 2610 01:43:46,760 --> 01:43:47,960 ASSOCIATION WITH LONG COVID AND 2611 01:43:47,960 --> 01:43:49,720 DIABETES MIGHT HAVE TO DO 2612 01:43:49,720 --> 01:43:53,680 WITH -- SORRY, MOI DOG , MY DOG IS 2613 01:43:53,680 --> 01:43:55,200 DEMANDING MY ATTENTION -- MIGHT 2614 01:43:55,200 --> 01:43:56,720 HAVE TO DO WITH THE LIKELIHOOD 2615 01:43:56,720 --> 01:43:58,360 OF MORE SEVERE COVID. 2616 01:43:58,360 --> 01:44:00,520 SO I DON'T KNOW WHEN YOU 2617 01:44:00,520 --> 01:44:01,720 STRATIFY FOR SEVERITY IF YOU 2618 01:44:01,720 --> 01:44:02,560 ALSO SEE THE DIABETES 2619 01:44:02,560 --> 01:44:09,400 ASSOCIATION. 2620 01:44:09,400 --> 01:44:10,600 >> THERE WAS AN INTERESTING 2621 01:44:10,600 --> 01:44:11,480 QUESTION OF WHETHER PEOPLE 2622 01:44:11,480 --> 01:44:14,680 INFECTED WITH COVID, THE ACTIVE 2623 01:44:14,680 --> 01:44:18,720 DISEASE OR CHRONIC, LOSE THEIR 2624 01:44:18,720 --> 01:44:26,480 CIRCADIAN RHYTHMS. 2625 01:44:26,480 --> 01:44:27,920 >> I WOULD SAY THAT SLEEP 2626 01:44:27,920 --> 01:44:33,120 DISORDERS ARE PRETTY COMMON. 2627 01:44:33,120 --> 01:44:34,600 IN POST-ACUTE SEQUELAE OF COVID. 2628 01:44:34,600 --> 01:44:41,560 AND I JUST RECALL TALKING TO ONE 2629 01:44:41,560 --> 01:44:43,920 DOC WHOSE PATIENT TOLD HIM HE 2630 01:44:43,920 --> 01:44:44,480 FORGOT HOW TO SLEEP. 2631 01:44:44,480 --> 01:44:46,280 HE WOULD GO TO BED AND HAVE NO 2632 01:44:46,280 --> 01:44:47,720 IDEA TO SLEEP, HE WAS UNABLE TO 2633 01:44:47,720 --> 01:44:50,160 SLEEP AT ALL. 2634 01:44:50,160 --> 01:44:51,920 SO THERE IS DEFINITELY IN SOME 2635 01:44:51,920 --> 01:44:53,800 PEOPLE VERY PROFOUND TROUBLE 2636 01:44:53,800 --> 01:44:54,320 WITH SLEEP. 2637 01:44:54,320 --> 01:44:57,520 AND I THINK ALSO THE PAPER IN 2638 01:44:57,520 --> 01:45:02,880 "CELL" CLAIMED THAT THERE WERE 2639 01:45:02,880 --> 01:45:05,280 PROTEINS -- PROTEINS THAT THEY 2640 01:45:05,280 --> 01:45:10,680 FOUND AN ABNORMAL PATTERN IN, IN 2641 01:45:10,680 --> 01:45:12,440 PARTICULAR NEUROLOGIC PASC, SO I 2642 01:45:12,440 --> 01:45:13,600 THINK THAT'S SOMETHING TO 2643 01:45:13,600 --> 01:45:13,840 PURSUE. 2644 01:45:13,840 --> 01:45:14,640 AND OF COURSE, YOU KNOW, IF 2645 01:45:14,640 --> 01:45:16,720 YOU'RE NOT SLEEPING, THE FATIGUE 2646 01:45:16,720 --> 01:45:19,760 IS GOING TO BE COMPOUNDED 2647 01:45:19,760 --> 01:45:22,920 DRAMATICALLY, AND IF YOU'RE 2648 01:45:22,920 --> 01:45:23,920 FATIGUED, THEN YOUR 2649 01:45:23,920 --> 01:45:28,720 CONCENTRATION IS GOING TO BE 2650 01:45:28,720 --> 01:45:32,600 AFFECTED. 2651 01:45:32,600 --> 01:45:34,960 SOME PEOPLE, MAYBE SOLVING THEIR 2652 01:45:34,960 --> 01:45:36,080 SLEEP PROBLEM MAY BE VERY 2653 01:45:36,080 --> 01:45:36,360 BENEFICIAL. 2654 01:45:36,360 --> 01:45:39,480 >> SO I GUESS THE LAST QUESTION 2655 01:45:39,480 --> 01:45:47,400 WE MIGHT ASK IS, HOW SHOULD WE 2656 01:45:47,400 --> 01:45:53,320 PREPARE FOR THE NEXT POST 2657 01:45:53,320 --> 01:45:56,560 PANDEMIC? 2658 01:45:56,560 --> 01:45:58,320 >> IN MY MIND, THE MOST 2659 01:45:58,320 --> 01:45:59,400 IMPORTANT THINGS WE CAN DO ARE 2660 01:45:59,400 --> 01:46:03,040 TO REALLY UNDERSTAND TWO 2661 01:46:03,040 --> 01:46:04,320 PHENOMENON THAT HAVE NOTHING 2662 01:46:04,320 --> 01:46:07,920 DIRECTLY TO DO WITH LONG COVID, 2663 01:46:07,920 --> 01:46:08,120 RIGHT? 2664 01:46:08,120 --> 01:46:12,320 ONE OF THEM IS, WHAT MITIGATION 2665 01:46:12,320 --> 01:46:14,840 MEASURES WORK, AND WA DON'T, AND 2666 01:46:14,840 --> 01:46:16,480 WHAT'S THE RELATIVE COST BENEFIT 2667 01:46:16,480 --> 01:46:19,960 OF THOSE MITIGATION MEASURES? 2668 01:46:19,960 --> 01:46:21,720 I THINK THERE WERE A LOT OF 2669 01:46:21,720 --> 01:46:22,720 DIFFERENT EXPERIMENTS IN THE 2670 01:46:22,720 --> 01:46:25,840 UNITED STATES ALONG THOSE LINES, 2671 01:46:25,840 --> 01:46:27,200 AND WE HOPE TO LEARN SOMETHING 2672 01:46:27,200 --> 01:46:28,320 FROM THOSE VARIANTS IN 2673 01:46:28,320 --> 01:46:32,240 MITIGATION MEASURES AND THEIR 2674 01:46:32,240 --> 01:46:33,440 ADHERENCE AS WELL AS THE EFFECTS 2675 01:46:33,440 --> 01:46:34,760 OF THOSE MITIGATION MEASURES ON 2676 01:46:34,760 --> 01:46:39,480 THINGS LIKE ECONOMIC EFFECTS ON 2677 01:46:39,480 --> 01:46:40,120 SCHOOL, ET CETERA. 2678 01:46:40,120 --> 01:46:41,520 SO ALREADY WE'VE LEARNED SOME 2679 01:46:41,520 --> 01:46:44,000 THINGS, BUT I THINK THAT'S ONE 2680 01:46:44,000 --> 01:46:45,640 THAT WILL HELP US PREPARE A LOT 2681 01:46:45,640 --> 01:46:47,280 FOR THE NEXT PANDEMIC. 2682 01:46:47,280 --> 01:46:49,760 THE SECOND THING WHICH ALSO 2683 01:46:49,760 --> 01:46:53,320 DOESN'T HAVE MUCH TO DO WITH IT 2684 01:46:53,320 --> 01:46:56,280 IS TRYING TO -- OH, IT JUST 2685 01:46:56,280 --> 01:46:57,800 FLIPPED OUT OF MY HEAD SO I'M 2686 01:46:57,800 --> 01:46:58,960 GOING TO HAND IT OVER TO WALTER 2687 01:46:58,960 --> 01:47:01,920 AND MAYBE IT WILL COME BACK WHEN 2688 01:47:01,920 --> 01:47:02,920 WALTER TRIES TO STAB IT IN THE 2689 01:47:02,920 --> 01:47:03,160 ANSWER. 2690 01:47:03,160 --> 01:47:06,240 >> I THINK FROM THE NIH POINT OF 2691 01:47:06,240 --> 01:47:15,480 VIEW, HAVING BEEN INVOLVED IN 2692 01:47:15,480 --> 01:47:27,440 THE -- IN THE BEST OF ALL 2693 01:47:27,440 --> 01:47:30,720 POSSIBLE WORLDS, THE RESEARCH 2694 01:47:30,720 --> 01:47:33,160 THAT NIH HAS FUNDED WOULD SIGN A 2695 01:47:33,160 --> 01:47:34,680 COMPACT SAYING IN THE CASE OF A 2696 01:47:34,680 --> 01:47:36,560 PANDEMIC, WE'RE ALL GOING TO BE 2697 01:47:36,560 --> 01:47:37,160 PANDEMIC RESEARCHERS AND WE'RE 2698 01:47:37,160 --> 01:47:39,480 GOING TO TAKE DIRECTION FROM THE 2699 01:47:39,480 --> 01:47:40,920 TOP DOWN AND WE'RE ALL GOING TO 2700 01:47:40,920 --> 01:47:44,080 DO IT LOCK-STEP. 2701 01:47:44,080 --> 01:47:44,920 AND THEN THINGS COULD REALLY 2702 01:47:44,920 --> 01:47:46,480 MOVE QUICKLY. 2703 01:47:46,480 --> 01:47:49,400 BUT THE WAY IT -- IT WAS QUICKER 2704 01:47:49,400 --> 01:47:50,720 THAN ANYTHING ELSE WE EVER DID, 2705 01:47:50,720 --> 01:47:51,920 BUT IT TOOK MONTHS TO GET 2706 01:47:51,920 --> 01:47:53,240 CONTRACTS SIGNED, THERE WERE 2707 01:47:53,240 --> 01:47:55,680 PEOPLE DOING MULTIPLE DIFFERENT 2708 01:47:55,680 --> 01:47:58,160 TRIALS, SOME OF THEM NIH FUNDED, 2709 01:47:58,160 --> 01:47:59,720 SOME INDUSTRY FUNDED, SOME 2710 01:47:59,720 --> 01:48:05,240 HOSPITAL FUNDED, AND I'M NOT 2711 01:48:05,240 --> 01:48:08,760 SURE THAT THAT WAS -- OUR SYSTEM 2712 01:48:08,760 --> 01:48:14,600 IS NOT BUILT TO RESPOND ON A 2713 01:48:14,600 --> 01:48:17,400 DIME TO GET A BIG HEALTH PROBLEM 2714 01:48:17,400 --> 01:48:19,360 LIKE WE GOT HIT WITH. 2715 01:48:19,360 --> 01:48:20,920 SO IF WE WANT TO LEARN A LESSON, 2716 01:48:20,920 --> 01:48:23,000 I THINK WE'D HAVE TO ORGANIZE 2717 01:48:23,000 --> 01:48:24,760 OURSELVES TO JUMP INTO A 2718 01:48:24,760 --> 01:48:27,200 DIFFERENT MODE OF ACTIVITY IN 2719 01:48:27,200 --> 01:48:33,800 THE CASE OF A PANDEMIC, AND THAT 2720 01:48:33,800 --> 01:48:34,920 WOULD -- YOU CAN'T DO THAT ON 2721 01:48:34,920 --> 01:48:36,120 THE FLY. 2722 01:48:36,120 --> 01:48:40,400 YOU'VE GOT TO BE PREPARED FOR 2723 01:48:40,400 --> 01:48:41,600 THAT, GET IT ALL SET AND 2724 01:48:41,600 --> 01:48:42,680 HOPEFULLY YOU NEVER HAVE TO 2725 01:48:42,680 --> 01:48:44,760 TRIGGER IT, BUT YOU HAVE TO TEST 2726 01:48:44,760 --> 01:48:47,040 THE SYSTEM, MAKE SURE IT'S 2727 01:48:47,040 --> 01:48:48,480 WORKING, HAVE ALL THE CONTRACTS, 2728 01:48:48,480 --> 01:48:53,240 EVERYBODY SIGNED ON, AND THERE'S 2729 01:48:53,240 --> 01:48:55,640 GOT TO BE A PENALTY IF YOU DON'T 2730 01:48:55,640 --> 01:48:58,920 PLAY BALL. 2731 01:48:58,920 --> 01:49:00,320 SO THAT'S WHAT -- A LOT OF THE 2732 01:49:00,320 --> 01:49:02,040 PEOPLE WHO HAVE BEEN INVOLVED IN 2733 01:49:02,040 --> 01:49:05,120 ACUTE TRIALS ARE TALKING ABOUT 2734 01:49:05,120 --> 01:49:07,080 THAT. 2735 01:49:07,080 --> 01:49:08,320 THAT WAS SOMETHING WE SHOULD GET 2736 01:49:08,320 --> 01:49:09,720 READY TO DO FOR THE NEXT 2737 01:49:09,720 --> 01:49:10,480 PANDEMIC, ON THE RESEARCH SIDE 2738 01:49:10,480 --> 01:49:14,320 OF THINGS. 2739 01:49:14,320 --> 01:49:15,520 >> VERY GOOD. 2740 01:49:15,520 --> 01:49:19,040 JOSH, DO YOU HAVE ANY ADDITIONAL 2741 01:49:19,040 --> 01:49:19,280 COMMENT? 2742 01:49:19,280 --> 01:49:20,800 >> I THINK THE OTHER THING WE 2743 01:49:20,800 --> 01:49:22,000 ALSO HAVE TO LEARN ABOUT IS HOW 2744 01:49:22,000 --> 01:49:23,440 TO COMMUNICATE OUR SCIENCE MORE 2745 01:49:23,440 --> 01:49:24,960 EFFECTIVELY IN A PUBLIC 2746 01:49:24,960 --> 01:49:26,720 HEALTH-RELEVANT WAY. 2747 01:49:26,720 --> 01:49:30,120 >> WELL, LISTEN, ON BEHALF OF 2748 01:49:30,120 --> 01:49:33,600 MANY, MANY, MANY PEOPLE WHO HAVE 2749 01:49:33,600 --> 01:49:36,600 LISTENED AND I'M SURE LEARNED AS 2750 01:49:36,600 --> 01:49:38,600 I HAVE, WE WANT TO THANK BOTH OF 2751 01:49:38,600 --> 01:49:38,760 YOU. 2752 01:49:38,760 --> 01:49:43,640 YOU'RE VERY BUSY PEOPLE, WE 2753 01:49:43,640 --> 01:49:44,600 FULLY UNDERSTAND AND APPRECIATE 2754 01:49:44,600 --> 01:49:46,680 VERY MUCH YOUR SHARING, YOUR 2755 01:49:46,680 --> 01:49:49,160 EXPERIENCE AND INFORMATION. 2756 01:49:49,160 --> 01:49:53,880 AND I THINK IT'S EXTRAORDINARY 2757 01:49:53,880 --> 01:49:57,680 THAT THIS IS PROBABLY -- IT IS, 2758 01:49:57,680 --> 01:49:59,880 I THINK, THE FIRST PANDEMIC, 2759 01:49:59,880 --> 01:50:02,320 WELL, MAYBE HIV WAS THE FIRST IN 2760 01:50:02,320 --> 01:50:04,920 THE MODERN ERA, WHERE THERE'S 2761 01:50:04,920 --> 01:50:10,840 THIS INCREDIBLE INVESTMENT IN 2762 01:50:10,840 --> 01:50:12,240 COMBINED COLLABORATIVE ACTIVITY, 2763 01:50:12,240 --> 01:50:14,520 A LOT OF BRIDGE-BUILDING GOING 2764 01:50:14,520 --> 01:50:17,040 ON, NOT ONLY BETWEEN DISCIPLINES 2765 01:50:17,040 --> 01:50:21,440 BUT BETWEEN COUNTRIES, BETWEEN 2766 01:50:21,440 --> 01:50:23,400 HEALTH SYSTEMS, SO THIS HAS BEEN 2767 01:50:23,400 --> 01:50:25,720 AN EXTRAORDINARY PRESENTATION 2768 01:50:25,720 --> 01:50:27,400 AND ON BEHALF OF EVERYONE, THANK 2769 01:50:27,400 --> 01:50:29,200 YOU. 2770 01:50:29,200 --> 01:50:30,400 THANK YOU VERY MUCH. 2771 01:50:30,400 --> 01:50:33,120 >> THANKS FOR HAVING US. 2772 01:50:33,120 --> 01:50:33,960 >> IT'S A PLEASURE. 2773 01:50:33,960 --> 00:00:00,000 THANK YOU.