COVID news and more 6/10/23

Jun 11, 2023

Hi all,

The good news is that overall levels of the SARS-CoV-2 virus are low in wastewater across the United States. We are seeing descendent variants of XBB that are putting pressure on XBB 1.5, but none of them is taking over which reassures us that the newer variants will not cause a big wave soon. Hospitalizations and emergency room visits for COVID are also very low now. There was a bit of a scare in New York City this week as reported wastewater showed a very high concentration of virus, but it turns out that this was because of an accidental misinterpretation of wastewater data from a site that recently had significantly increased their sensitivity. So, NYC wastewater levels were low like most of the U.S.

Despite this, three different people this week told me that they had avoided COVID for the last three years, but they caught it recently because they let their guard down. They thought the pandemic was over and that they could not get COVID. But the virus is still circulating, and they got it, especially when they did not wear masks indoors. If you get a “summer cold”, I would recommend that you test to make sure that it’s not actually COVID.

As Dr. Akiko Iwasaki recently said, “We are not done with COVID. Not even close.” The latest, subvariants of XBB are very contagious. If you test positive on a rapid antigen test, then you are still contagious and need to quarantine. PCR tests will stay positive sometimes for many months because they are so sensitive, but home rapid antigen tests are only positive if you have enough virus to be contagious.

Metformin, an old drug that is cheap, safe and readily available, has become an important weapon in the fight against COVID. A recent study showed that during an acute COVID infection, people with a BMI of 30 or greater that took Metformin had reduced emergency room visits, hospitalizations, and deaths from COVID. A newly reported randomized controlled trial shows that giving Metformin especially by day three of an acute COVID infection reduces the SARS-CoV-2 viral load by 3.6 fold. These antiviral properties of Metformin were shown to decrease the risk of Long COVID by 42% to 68% depending on the group. Metformin truly is an amazing drug with anti-viral properties against COVID.

In other COVID news, 26% of blood donors sampled were found to have COVID antibodies only against the vaccine, meaning that those 26% never had a COVID infection. Europe plans to update their fall COVID booster using XBB strains and the US has said that they plan to do something similar for fall boosters.

COVID and the Brain

Eric Topol wrote an article on two recent studies from Germany, which show persistent viral antigen (spike protein) seen in the bone marrow of the skull and in the meninges long after COVID infection which could be driving neuroinflammation. Follow up brain scans one year after mild to moderate COVID infection showed white matter abnormalities associated with neuroinflammation on MRI, but cognitive function was normal. Long term effects are unknown.

A new article adds to the data on SARS-CoV-2 and the brain. In a petri dish, neurons that are infected with SARS-CoV-2 cause syncytia- meaning the cells fuse together. We have seen fusion of cells or syncytia caused by SARS-CoV-2 in lung epithelial cells, but this is different. In the brain organoids, the virus causes neurons to fuse 90% of the time between their axons and dendrites which is unexpected. Lung cells fuse by their cell bodies (somas). Strangely, the fused neurons hooked together by axons/dendrites were able to exchange large organelles such as mitochondria back-and-forth between the neurons across these axon/dendrite bridges. The problem is, the fused neurons were found to fire all at the same time, somewhat like what would happen during a seizure, instead of firing individually. The 10% of neurons fused by their cell bodies were found to not be able fire at all. Fusion of brain neurons by their axons and dendrites could be causing Long COVID “brain fog”, cognitive impairment and headaches, but this would need to be studied in animals and humans to be certain.

Children

A new study in JAMA of more than 300,000 households showed that 70% of household COVID spread initially started with a child, especially when school was in session. Children were noted to be important “viral vectors''. This reinforces that protecting children from COVID infections with vaccination and other mitigation techniques such as masks when virus levels are high can help to reduce spread of the virus through families. It is especially important to protect children against Omicron infection as a new study in the Journal of Pediatrics showed that 12% to 16% of children with Omicron infections had Long COVID at three and six months for both kids who had COVID for the first time and those who had a COVID reinfection with Omicron.

There was a very interesting development regarding the Multisystem Inflammatory Syndrome in children (MIS-C). MIS-C is a serious and potentially fatal post-infectious syndrome in some children that happens weeks after they have a SARS-CoV-2 infection. Molecular mimicry triggers an abnormal autoimmune response which appears to cause MIS-C. There are identical areas on both the SNX8 protein expressed on human immune cells and on the N protein of the SARS-CoV-2 virus. Children who had MIS-C were found to have autoantibodies to SNX8 and also had T cells that were cross-reactive to both the self-protein SNX8 and the SARS-CoV-2 N protein.

Long COVID

Two techniques allow for the evaluation of microvasculature. Some groups are using Capillaroscopy to examine tiny blood vessels just under the nail bed of the fingers of people with Long COVID. Another group used Retinal Vessel Analysis (RVA) in the retina of the eye and found that prolonged endothelial dysfunction seen on RVA is a hallmark of Long COVID. RVA and capillaroscopy could possibly be used as clinical biomarkers to help diagnose and to follow treatment progress for Long COVID.

Long COVID can be devastating and can cause healthy people to become bedridden even after a very mild initial COVID infection. A concerning new study from the UK shows that Long COVID patients are functionally impaired more than stroke patients and similarly to Parkinson’s patients, have a quality of life that is worse than some stage IV cancer patients, and have fatigue worse than other diseases such as stroke, inflammatory bowel disease, end stage renal disease and even anemic cancer patients. Possible treatments for Long COVID need to be tested in clinical trials as soon as possible.

The Patient Led Research Collaborative put out their first journal with patient-led hypotheses on Long COVID mechanisms. People with the condition reviewed possible causes of Long COVID symptoms that they feel should be investigated further including the relationship between free glycan sugar chains and brain fog, the use of doxycycline as a matrix metalloproteinase inhibitor, eye floaters as a risk factor for Long COVID and ME/CFS and other topics.

Dr. Bhupesh Prusty, a virologist in Germany, did a podcast and a talk at the IIMEC15 where he discussed that acute COVID infection causes a decrease in IgM in most people. However, in people with Long COVID, the low IgM does not recover. His lab also found that Long COVID patients have elevated levels of Fibronectin 1. We await the paper on his lab's results.

Dr. Prusty has previously written a paper on HHV-6 reactivation in ME/CFS patients. A UCSF study shows that reactivation of EBV increases the risk of Long COVID. Chronic EBV viral infection was associated with Long COVID fatigue. A review in eLife looks at immune mechanisms underlying COVID-19 pathology and Long COVID. They looked at complex immune system reactions to COVID infection and possible causes of immune dysregulation leading to PASC.

There were articles this week on the difficulties of getting disability pay with Long COVID and how with each COVID infection we may be playing “disability roulette”. An article in the New England Journal of Medicine discussed how healthcare providers can best help with workplace accommodations for people suffering from Long COVID. The CDC COCA will have a webinar on June 15th to discuss evaluating and supporting patients with Long COVID in returning to work.

And in non-COVID news: Wishing a happy 1000th birthday to Mont St. Michel in France, a nice surprise regarding the top social media influencers in Ob/Gyn on Twitter, antibody-drug conjugate (ADC) Elahere significantly improved survival for patients with folate receptor alpha-positive platinum-resistant ovarian cancer, and a sweeping scientific analysis shows that early skin-to-skin contact or kangaroo mother care significantly improves the odds of survival for premature and low-birth-weight babies.

A fan could not get tickets to Taylor Swift's Eras Tour, so he got a job as a security guard so he could see the shows. Here is a joyous video of South African firefighters singing and dancing in the Canadian airport upon their arrival there to help combat the wildfires.

Have a good rest of your weekend,

Ruth Ann Crystal MD

Twitter: https://twitter.com/CatchTheBaby

In other news:

5/21/23 Nashville resident couldn't get tickets to Taylor Swift's Eras Tour, so he got a job as a security guard and attended anyway | CNN https://buff.ly/3N1xThF

5/25/23 JAMA: County-Level Maternal Vulnerability and Preterm Birth (PTB) in the US https://buff.ly/45IsiFr

The Maternal Vulnerability Index (MVI) “is a county-level index that quantifies maternal vulnerability to adverse health outcomes associated with preterm births through 43 indicators that reflect physical, social and health care landscapes.”
MVI was associated with PTB even after adjustment for individual-level confounders.

5/31/23 Truth, trust, and hope. Where to start? https://buff.ly/3OO37v6

Excellent article by Katelyn Jetelina on mis/disinformation that will only get worse with AI unless we do something about it.

5/29/23 Nature: Polygenic prediction of preeclampsia and gestational hypertension https://buff.ly/441AQFR

18 independent loci associated with preeclampsia/eclampsia and/or gestational hypertension were identified, 12 of which are new.
Identified loci highlight the role of natriuretic peptide signaling, angiogenesis, renal glomerular function, trophoblast development and immune dysregulation.
Low dose aspirin in pregnancy could be offered to people who carry these genes.

6/2/23 The Top Social Media Influencers in Obstetrics and Gynecology on Twitter - Archives of Gynecology and Obstetrics https://buff.ly/45OuF9w

Congrats Amanda Williams and Jane Van Dis. I was surprised to be number 5.

6/5/23 MedCity News: ‘We’ve Already Made Changes’ to the System: How Doulas Are Advancing Maternal Health Outcomes https://buff.ly/43mUCvi

Doula services may be covered by Medicaid soon.

6/5/23 AP: California insurance market rattled by withdrawal of major companies https://buff.ly/3qoiXCh

Increasing wildfire risk and high construction costs have prompted State Farm and Allstate insurance companies to stop writing new policies in California.

6/5/23 AP: France's spectacular abbey Mont-Saint-Michel celebrates 1,000th birthday https://buff.ly/3MRfuDW

6/5/23 MedCity News: How Data for ImmunoGen Drug Could Change the Way Doctors Treat Ovarian Cancer https://buff.ly/45RQ7e3

Elahere (mirvetuximab soravtansine) targets folate receptor alpha (FRa), a protein abundant on the surface of ovarian cancer cells.
In Phase 3 trial, Elahere shrunk tumors and helped ovarian cancer patients live longer compared to chemotherapies in patients with folate receptor alpha-positive platinum-resistant ovarian cancer.

ELAHERE (mirvetuximab soravtansine-gynx) for Injection https://buff.ly/3WQTRrQ

Elahere is a type of treatment called an antibody-drug conjugate (ADC). ADCs are different from traditional chemotherapies and are designed to treat cancer in a targeted and less toxic way.

6/7/23 Healio: SGLT2 inhibitors may reduce cancer risks among adults with diabetes https://buff.ly/3NdCrTb

“Adults with diabetes who use SGLT2 inhibitors have lower risks for developing most types of cancer compared with nonusers, though the risk for pancreatic cancer is higher among SGLT2 users.”

6/8/23 Washington Post: Early skin-to-skin contact or kangaroo mother care appears to significantly improve the odds of survival for premature or low-birth-weight babies, according to a sweeping scientific analysis https://buff.ly/3WU13Uk

6/8/23 BMJ: Kangaroo mother care (KMC) for preterm or low birth weight infants: a systematic review and meta-analysis https://buff.ly/43OoyQN

Review of 31 clinical trials involving 15,559 infants concludes KMC for preterm or low birth weight infants should start within 24hrs of birth and continue for 8 hours per day if possible.
Compared with conventional care, KMC reduces mortality to 28 days of age and reduces severe infection.
Reduction in mortality was noted irrespective of gestational age or weight at enrolment, time of initiation, and place of initiation of KMC (hospital or community).
The mortality benefits were greater when the daily duration of KMC was at least 8 hours per day than with shorter-duration KMC.
Studies comparing early vs late-initiated KMC demonstrated a reduction in neonatal mortality and a probable decrease in clinical sepsis until 28-days following early initiation of KMC.

6/8/23 South African firefighters arrive in Canada to help fight wildfires. Upon arrival, they greeted Canada with a special song and dance (CLICK HERE TO WATCH THE VIDEO)

COVID news:

WHO Weekly Epidemiological Updates: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports

US Variant tracker: https://covid.cdc.gov/covid-data-tracker/#variant-proportions

Continued rise of XBB.1.16 and other XBB recombinants, without new variants showing up. Stable picture.

CDC COVID data tracker: https://covid.cdc.gov/covid-data-tracker/index.html#datatracker-home

CDC COVID Hospitalizations (blue) and Emergency Room (orange) visits tracker: https://covid.cdc.gov/covid-data-tracker/index.html#trends_weeklyhospitaladmissions_7dayeddiagnosed_00

US Wastewater Monitoring:

CDC Wastewater Monitor https://covid.cdc.gov/covid-data-tracker/#wastewater-surveillance

Iowa COVID tracker from Sarah Anne Willette shows wastewater virus levels from NWSS and Biobot in a US map format:

https://iowacovid19tracker.org/

“Fantastic resource for WW (wastewater). Allows charting of individual states.” @JPWeiland

Biobot: https://biobot.io/data/

Sewer Coronavirus Alert Network (SCAN) project by Stanford University:

FE.1 variant in Brazil and Ireland. A descendant of XBB.

6/9/23 Katelyn Jetelina: Wildfire smoke, COVID-19, and striking comparisons https://buff.ly/3oYcgGT

New York City PM2.5 measurements. Red dotted line indicates unhealthy levels

Masks: Use N95. N95’s filter both wildfire smoke and respiratory droplets from COVID.
Politicalization, risk communication, climate change is forcing animals and humans to move together, indoor air quality.
“Politicizing masks makes as much sense as politicizing gravity.” Bill Hanage.

Step by step instructions on how to build a Corsi-Rosenthal Cube https://buff.ly/3qAMOaU

UC Davis: How to Build a Corsi-Rosenthal Box https://buff.ly/3oSspO5

Adding a fan “shroud” to the outlet fan can decrease noise and power usage.

6/7/23 Science: Could fused neurons explain COVID-19’s ‘brain fog’? https://buff.ly/3oStfuc

SARS-CoV-2 causes syncytia (fusing of cells together):
- Lung cells fuse their cell bodies
- Neuronal syncytia in the lab dishes and brain organoids fused dendrites and axons, disrupting communication.
  - Neurons typically fire independently, propagating signals throughout the brain.
  - But 90% of the fused neurons fired at the same time, whereas the remaining 10% stayed silent. This massive amount of synchronous activity “is almost like a seizure,”
Need to study next in animal models and then humans (autopsies).

Mouse neurons (in magenta) fuse (yellow) when they express the SARS-CoV-2 protein and its receptor.

6/7/23 Science (Ramon Martinez-Marmol et al): SARS-CoV-2 infection and viral fusogens cause neuronal and glial fusion that compromises neuronal activity https://buff.ly/3WS5orb

Mouse and human brain organoids and hESC-derived neurons were studied.
Viral fusogens cause neuron-neuron, neuron-glia, and glia-glia fusion.
In most tissues like the lung, syncytia are normally formed at the level of the cell bodies (soma).
- But, with SARS-CoV-2 infection, neuronal fusion occurred 10% between the somas, and 90% between the neurites (axons or dendrites).
Neuronal fusion can easily be missed if searching for classical multinucleated syncytia.
Fused neurons form long neuronal bridges and exchange large organelles including mitochondria back and forth.

Fused neurons had compromised neuronal activity:

90% fused neuron axon/dendrite to neuron axon/dendrite: caused synchronized firing instead of firing individually like neurons should.
10% fused neuron (soma) to neuron (soma): with complete loss of neural activity.
Neuron-Glia fusions also had a complete loss of neuronal activity.

(h/t Wolfgang Hagen- Thanks)

Capillaroscopy can show microvascular changes which are being seen in some Long COVID patients.

Metformin reduces viral load.

“The phase 3 trial — considered the gold standard in research — revealed that metformin could reduce the risk of #LongCovid by up to 63% among participants who started treatment within four days of their initial COVID diagnosis.” SF Chronicle

6/7/23 MedRxiV: Metformin reduces SARS-CoV-2 in a Phase 3 Randomized Placebo Controlled Clinical Trial https://buff.ly/3NhWOhY

Metformin reduces SARS-CoV-2 viral load by 3.6-fold as compared to placebo.
In vitro, metformin has antiviral activity against RNA viruses including SARS-CoV-2.
In the COVID-OUT phase 3, randomized, placebo-controlled trial of outpatient treatment of COVID-19, metformin had a
- 42% reduction in ER visits/hospitalizations/death through 14 days;
- 58% reduction in hospitalizations/death through 28 days,
- 42% reduction in Long COVID through 10 months.
"Our results demonstrate … that a safe, widely available, well-tolerated, and inexpensive oral medication, metformin, can be repurposed to significantly reduce SARS-CoV-2 viral load."

6/7/23 BMJ: Impact of fatigue as the primary determinant of functional limitations among patients with post-COVID-19 syndrome (PCC, Long COVID): a cross-sectional observational study https://buff.ly/43slU3D

People with Long COVID at 19 national COVID clinics in the UK were found to have “striking levels of functional impairment and low health-related quality of life (HRQoL) . This impairment is mainly driven by their fatigue level."
Functional impairment for LC was worse than in patients who had a stroke and comparable to patients with Parkinson’s disease.
LC patients reported worse quality of life than people with advanced/metastatic cancers such as stage IV lung cancer.
Fatigue was the strongest predictor of functional impairment and HRQoL.
LC patients reported worse fatigue than patients with stroke, inflammatory bowel disease, end stage renal disease and even anemic cancer patients.
In addition to severe fatigue, people with LC also reported breathlessness, anxiety, depression and cognitive dysfunction.

6/7/23 For Many Long COVID Patients, Qualifying for Disability Is Half the Battle | KQED https://buff.ly/3WYshJf

“If I didn’t have the support of my family, I’d be out on the streets,”

6/7/23 Annals of Internal Medicine: Effectiveness of COVID-19 Treatment With Nirmatrelvir–Ritonavir or Molnupiravir Among U.S. Veterans: Target Trial Emulation Studies With One-Month and Six-Month Outcomes https://buff.ly/45TyTwy

Nirmatrelvir-ritonavir and molnupiravir were each “associated with a 77% reduced risk for death, and nirmatrelvir-ritonavir was associated with a 27% reduced risk for hospitalization.”

6/6/23 European Medicines Agency: EMA and ECDC statement on updating COVID-19 vaccines to target new SARS-CoV-2 virus variants https://buff.ly/42y11CO

The WHO and EMA recommend updating vaccines to target XBB strains for Fall boosters since XBB is now dominant in Europe and other parts of the world.

6/5/23 CMS Withdraws COVID-19 Vaccine Mandate for Healthcare Workers https://buff.ly/3WRRK7c

6/5/23 JAMA: Discontinuation of Universal Admission Testing for SARS-CoV-2 and Hospital-Onset SARS-CoV-2 Infections in England and Scotland https://buff.ly/3Nd982Z

Stopping universal admission testing in the national health systems of 2 countries (England and Scotland) was associated with significant increases in hospital-onset SARS-CoV-2 infections relative to community-onset infections.

FYI: Iowa COVID tracker follows wastewater from NWSS and Biobot in a US map format:

https://iowacovid19tracker.org/

“Fantastic resource for WW (wastewater). Allows charting of individual states.” @JPWeiland

6/4/23 Tweet thread by Marc Johnson on one person with a cryptic lineage of SARS-CoV-2 in Columbus, Ohio who does not know that they are shedding tons of virus.

Trying to solve a mystery: finding the person who may not know that they are very sick with a chronic COVID infection.
“First, the signal is almost always present in the Columbus Southerly sewershed, but not always at Washington Court House. I assume this means the person lives in Columbus and travels to WCH, presumably for work.”

6/4/23 Face masks to return at Tour de France to limit COVID-19 cases in the peloton https://buff.ly/3CaLVbJ

6/3/23 NEJM: Approving Workplace Accommodations for Patients with Long Covid — Advice for Clinicians https://buff.ly/3oLqPxh

ICD-10 code for Long Covid is U09.9.
Clinicians can document the experience of patients whose symptoms render them unable to work without accommodations, focusing on functional impairment rather than diagnostic testing.
"Completing forms thoughtfully and persuasively can change the minds that matter, render the suffering of patients with Long COVID socially legitimate and visible, and make theoretical legal protections a reality."

6/2/23 CDC MMWR: Estimates of SARS-CoV-2 Seroprevalence and Incidence of Primary SARS-CoV-2 Infections Among Blood Donors, by COVID-19 Vaccination Status — United States, April 2021–September 2022 https://buff.ly/3J1vke3

By Sept 2022, in a longitudinal blood donor cohort:
- 96.4% had SARS-CoV-2 antibodies from previous infection or vaccination, including
  - 23% from infection alone
  - 26% from vaccination alone (i.e. never had a COVID infection)
  - 48% had hybrid immunity (antibodies from infection and from vaccination)
Hybrid immunity prevalence was lowest among adults aged ≥65 years.

6/2/23 CBS: High concentrations of COVID virus detected at all 14 New York City wastewater treatment plants https://buff.ly/3MRJekh

Actually, no. See below about changing the sensitivity in wastewater (WW) testing in JP Weiland’s tweet below.

WW= wastewater

6/1/23 JAMA: Participatory Surveillance to Discern the Role of Children in Household Transmission of SARS-CoV-2 https://buff.ly/3WPFwMD

320,073 households studied
70% of household COVID spread started with a child especially when school was in session. Transmission rates dropped during school breaks.
More than 70% of US household COVID spread started with a child
Meaning These results suggest that children were important viral vectors in households during the pandemic, particularly when school was in session.

6/1/23 NY Times: An Inside Look at Covid’s Lasting Damage to the Lungs https://buff.ly/43I1XoZ

Amazing graphics show what happened to the lungs of 3 people who were deathly ill with COVID in the hospital.

5/19/23 Lancet: Respiratory sequelae of COVID-19: pulmonary and extrapulmonary origins, and approaches to clinical care and rehabilitation https://buff.ly/43m35ir

Breathlessness, pulmonary fibrosis and thromboembolic disease after COVID.

Dr. Bhupesh Prusty is a virologist at University of Wurzburg, Germany who has written papers on HHV-6 reactivation with fragmentation of mitochondria in ME/CFS patients.

Tess Falor thread on Bhupesh Prusty’s talk at #IIMEC15

6/1/23 TLC Sessions Podcast: Unveiling the Potential Biomarker for Long COVID: Exclusive Interview with Molecular Virologist Bhupesh Prusty https://buff.ly/43OzkGT

Severe ME/CFS patients have lowest IgM against Fibronectin.
Total IgM decreased with initial acute COVID infection. In Long COVID patients, it did not recover.
Circulating Fibronectin and IgM against Fibronectin levels are similar in severe Long-Covid and ME/CFS.
After acute COVID infection, Long COVID and ME/CFS patients have elevated Fibronectin 1 because their IgM to Fibronectin is low.

6/1/23 Shaney Wright tweet thread on Bhupesh Prusty’s podcast

“Natural IgM” and Fibronectin

5/31/23 BMJ (Zurich): Recovery and symptom trajectories up to two years after SARS-CoV-2 infection: population based, longitudinal cohort study https://buff.ly/3Na6riF

At 2 years, 18% of individuals who were not vaccinated before infection had post-covid-19 condition (PCC or Long COVID) as compared to controls.

5/30/23 MedRxiV: A distinct cross-reactive autoimmune response in multisystem inflammatory syndrome in children (MIS-C) https://buff.ly/3MVrcxA

MIS-C is a post-infectious syndrome in children.
Molecular mimicry noted between SNX8, a protein expressed in immune cells, and the N protein on the SARS-CoV-2 virus.
Many children with anti-SNX8 autoantibodies also have T-cells cross-reactive to both SNX8 and this distinct domain of the SARS-CoV-2 N protein.
MIS-C patients develop a distinct immune response against the SARS-CoV-2 N protein that is associated with cross reactivity to the self-protein SNX8, demonstrating a link from the infection to the inflammatory syndrome.

5/31/23

5/22/23 Research Square (preprint from Munich): Persistent endothelial dysfunction in post-COVID-19 syndrome (PCS or Long COVID) and its associations with symptom severity and chronic inflammation https://buff.ly/43xNonR

The retinal microcirculation was analyzed using Retinal Vessel Analysis (RVA) in 41 people with Long COVID compared to 204 matched controls
“Our results demonstrate that prolonged endothelial dysfunction is a hallmark of PCS (Long COVID), and impairments of the microcirculation seem to explain ongoing symptoms in patients.
As potential therapies for PCS (Long COVID) emerge, RVA parameters may become relevant as clinical biomarkers for diagnosis and therapy management.”

Retinal Vessel Analysis (RVA) of the microvessels in the eye shows that people with Long COVID have persistent endothelial dysfunction which relate to PASC symptoms.

Long COVID Support Groups

The Body Politic LC Support Group (

https://www.wearebodypolitic.com/

) closed because of lack of funding, but you can still download guides on their site.

Long COVID support groups via The Body Politic tweet thread
h/t Hannah Davis
Long COVID Support Group on Facebook
https://www.longcovid.org/
is LC support group in England and Wales

5/30/23 JAMA: Sleep Health Before SARS-CoV-2 Infection and Risk of Post–COVID-19 Condition https://buff.ly/43vVzkH

Healthy sleep lowers the risk of Long COVID in women.
Compared with women who had a pre pandemic sleep score of 0 or 1 (least healthy), those who scored 5 (most healthy sleep) had a 30% lower risk of PCC (Long COVID).
Women who had the healthiest pre-pandemic sleep scores saw a 30% lower risk of Long COVID.

5/26/23 eLife: Immune mechanisms underlying COVID-19 pathology and post-acute sequelae of SARS-CoV-2 infection (PASC or Long COVID) https://buff.ly/3q7BFxW

Review of complex immune system reactions to COVID infection and possible causes of immune dysregulation leading to PASC.
Innate immune system:
- Neutrophils, NETs (neutrophil extracellular traps), monocytes, macrophages and mast cells.
- Macrophages are present in multiple tissues that include brain microglia, liver Kupffer cells, lung alveolar and interstitial macrophages, and adipose tissue.
Adaptive immune system:
- T and B cells in COVID-19 and PASC

The innate immune response serves as the initial line of defense against the virus, involving the activation of immune cells such as monocytes, natural killer (NK) cells, dendritic cells, and macrophages. These cells release cytokines and chemokines to recruit other immune cells, such as T cells and neutrophils, to the site of infection.
Later in the course of the infection, the adaptive immune cells including B plasma cells release antibodies. However, the overreactive immune responses trigger inflammatory conditions that are sustained in PASC due to dysregulation of the immune system.

5/26/23 Library of Congress Launches COVID-19 American History Project https://buff.ly/3C4AFO4

“The COVID-19 project will collect, preserve and make available to the public the oral histories of healthcare workers affected by the pandemic.
The project will accept proposals from researchers to document the experiences of American frontline workers across many sectors.
The project will encourage the public to share their COVID-19 experiences with StoryCorps, a nonprofit group dedicated to preserving and sharing humanity's stories.”

5/25/23 KQED: 'Screaming Into a Void': Long COVID Patients Have Waited in Vain for Years for Treatments https://buff.ly/3qkf9Su

"The NIH has not started a clinical trial for possible treatments. One of the only official long COVID clinical trials is underway at Stanford University, to determine whether Paxlovid can be an effective treatment."
Featuring Charlie McCone, Lisa McCorkell, Dr. Steven Deeks, David Putrino, Dr. Monica Verduzco-Gutierrez
McCone and other long COVID patients and advocates have for years pushed state and federal health agencies to begin trials for long COVID treatments.

5/10/23 Journal of Pediatrics: Long COVID in Children and Youth After Infection or Reinfection with the Omicron Variant: A Prospective Observational Study https://buff.ly/43z8aDA

n =332 first-positives, n =243 reinfected and n =311 test-negative children and young people.
12-16% of children with Omicron infections experience long COVID at 3 and 6 months for both initial infections and reinfections.

5/10/23 European Society of Cardiology: Hyperbaric oxygen therapy (HBOT) improves heart function in patients with long COVID https://buff.ly/42rZ0sn

RCT 60 people with Long COVID, half of whom had reduced GLS despite normal ejection fraction.
Echocardiography was used to assess left ventricular global longitudinal strain (GLS).
Each patient had five sessions HBOT per week for 8 weeks, for a total of 40 sessions.
In the HBOT group, GLS significantly increased from -17.8% at baseline to -20.2% after the intervention (p=0.0001).
In the sham group, GLS was -17.8% at baseline and -19.1% after the sessions, with no statistically significant difference between the two measurements.

Patient-Generated Hypotheses Journal Issue 1 – Patient Led Research Collaborative https://buff.ly/3IL9zzg

CDC COCA Webinar Thursday, June 15, 2023 - Evaluating and Supporting Patients with Long COVID in Returning to Work https://buff.ly/3MGgb2J

Clinician Outreach and Communication Activity (COCA)

Physicians, Nurses, Pharmacists, Physician Assistants, Health Educators

5/28/23 Eric Topol MD: The Brain and Long Covid https://buff.ly/3WHQDa7

Reviewed 2 studies showing that there can be persistent brain neuroinflammation a year after a mild COVID infection without symptoms and without long COVID.
Persistent SARS-CoV-2 spike protein was found in the skull bone marrow and meninges and brain tissue of random asymptomatic people if they had mild COVID in the past.
Follow up brain scans 1 year after mild to moderate COVID infection showed white matter abnormalities associated with neuroinflammation, but cognitive function was normal in the Hamburg study. Long term effects are unknown.
Insightful review of different studies on COVID and the brain.

5/27/23 Wash Post: Tally of covid-19 cases after CDC conference April 24-27 climbs to 181 cases https://buff.ly/439JwK7

5/28/23 The Guardian: Immunologist Akiko Iwasaki: ‘We are not done with Covid, not even close’ https://buff.ly/3OFzzj1

Long Covid is a blanket term that likely describes multiple diseases with different causes:
SARS-CoV-2 spike protein or RNA, EBV reactivation, microclots which impair oxygen exchange, mitochondrial dysfunction.
She also talks of bullying and sexism in academic medicine.
COVID is here to stay so we need to plan for vaccines, etc.

5/28/23 Dr. Wes Ely (Boston Globe): As long COVID turns three, Americans play disability roulette https://buff.ly/3oJ0qjA

"No longer a mass death event, COVID-19 is an ongoing mass disability event.
Every seven days, 25,000 more people join the 10 million in our country suffering memory loss, heart problems, dizziness, extreme fatigue, and more owing to the virus."
Difficulties getting disability

Vanderbilt, Dr. Wes Ely Long-COVID support at CIBS: Critical Illness, Brain Dysfunction and Survivorship Center https://buff.ly/45CgFjm

Long COVID advocacy and support

5/23/23 MedRxiV (Melbourne): Hypothalamus volumes in adolescent Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): Impact of self-reported fatigue and illness duration https://buff.ly/42e9smy

ME/CFS may reflect a progressive, aberrant state of homeostasis caused by disturbances within the hypothalamus.
48 adolescents (25 ME/CFS, 23 controls)
In the ME/CFS group, a negative linear relationship between right anterior-superior volumes and fatigue severity was identified, which was absent in controls.
Findings suggest greater fatigue and longer illness duration were associated with greater right anterior-superior and superior-tubular volumes, respectively.
- These regions contain the anterior and superior divisions of the paraventricular nucleus, involved in the neuroendocrine response to stress, suggesting involvement in ME/CFS pathophysiology.

4/11/2023 Cornell to receive $9.5M grant to fund chronic fatigue syndrome research https://buff.ly/3UQu1TP

They will start with gene expression in muscle biopsies.

4/16/23 J Med Virology: Causal effects of COVID‐19 on cancer risk: A Mendelian randomization study https://buff.ly/42r1G8O

SARS-CoV-2 infection was linked with the increased risk of stomach cancer but decreased risk of head and neck cancer.
Hospitalized COVID-19 infection was linked with the increased risk for three cancers (HER2-positive breast cancer, esophageal cancer, and stomach cancer).
Critically ill COVID-19 infection was linked with the increased risk for five cancers (HER2-positive breast cancer, esophageal cancer, colorectal cancer, stomach cancer, and colon cancer).

4/20/23 Frontiers in Immunology: Long COVID: a review and proposed visualization of the complexity of long COVID https://buff.ly/44Sxgio

12/1/22 JCI (UCSF) - Chronic viral coinfections differentially affect the likelihood of developing long COVID (LC) https://buff.ly/40zkBia

EBV: At 4 months post COVID infection, LC symptoms, such as fatigue and neurocognitive dysfunction, were independently associated with serological evidence suggesting recent EBV reactivation (early antigen–diffuse IgG positivity) or high nuclear antigen (EBNA) IgG levels but not with ongoing EBV viremia. Serological evidence suggesting recent EBV reactivation (early antigen–diffuse IgG positivity) was most strongly associated with fatigue (OR = 2.12).
HIV: HIV infection was also independently associated with neurocognitive LC (OR = 2.5).
CMV: Interestingly, participants who had serologic evidence of prior CMV infection were less likely to develop neurocognitive LC (OR = 0.52).