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"We know that reinfection with COVID-19 is not a notional possibility, but the rule. People in frontline positions, including teachers and healthcare workers, have reported being infected three, four or five times. Each bout with COVID-19 can progressively damage major organ systems, including the immune system, the brain and the circulatory system. In other words, allowing COVID-19 to circulate freely steadily increases the population that Fauci describes as vulnerable".

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"We know that reinfection with COVID-19 is not a notional possibility, but the rule. People in frontline positions, including teachers and healthcare workers, have reported being infected three, four or five times. Each bout with COVID-19 can progressively damage major organ systems, including the immune system, the brain and the circulatory system. In other words, allowing COVID-19 to circulate freely steadily increases the population that Fauci describes as vulnerable".

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https://www.wsws.org/en/articles/2023/09/01/gqnt-s01.html

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This week, Dr. Anthony Fauci, the former director of the National Institute of Allergy and Infectious Diseases, gave an interview to the BBC in which he declared that older people, the ill and disabled "will fall by the wayside" in the current surge of COVID-19. Fauci was not warning about what would happen unless urgent action was taken. Rather, he was seeking to justify the Biden administration's policy of inaction and cover-up in the face of a new surge of the disease.

Fauci's comments reiterate the declaration in January 2022 by Centers for Disease Control and Prevention (CDC) Director Rochelle Walensky that the fact that COVID-19 predominantly kills people who are "unwell to begin with" is "encouraging news." The statements by both Walensky and Fauci implied that the lives of chronically ill and disabled people were less valuable than healthy ones.

Three years ago, Fauci would hardly have imagined that he could make such statements. In accepting a policy of simply letting the vulnerable die, he has suffered a complete moral collapse. He is capitulating to the fascist ideologues who have long advocated allowing the coronavirus to spread without limit.

More significant than his own personal evolution, however, is what his statements say about the Biden administration, which has adopted an unstated but nonetheless deliberate policy of social murder, targeting older, chronically ill, and disabled people. It amounts to a form of homicidal eugenics, reminiscent of the Nazi regime's policy of murdering handicapped people.

Fauci was speaking under conditions in which wastewater data indicates that COVID-19 cases have more than tripled over the course of the past two months, while COVID-19 hospital admissions have more than doubled. This is the first surge after the Biden administration rescinded the COVID-19 public health emergency (PHE) declaration and stopped counting cases on May 11, with the aim of reducing public knowledge of the spread of the disease, leaving the United States essentially flying blind into the ongoing pandemic.

Asked, "How serious could it get again," Fauci sought to downplay the dangers by asserting that he believes, but does not know for certain, that the present surge of COVID-19 will see fewer hospitalizations and deaths than in the past.

Fauci claimed, "96 percent or more of the population has some degree of immunity, either through prior infection or through vaccines, or both." He continued:

I doubt very seriously whether you're going to see the hospital and death surge that we've seen in the past, even if we get a surge of infections. Because there's enough fundamental community-level protection, that even though you'll find the vulnerable will fall by the wayside, they'll get infected, they'll get hospitalized and some will die, it's not going to be the tsunami of cases that we've seen.

Who are these "vulnerable" people, who will be left to die on the side of the road?

In the United States, approximately 45.4 percent of the population are at heightened risk of complications from COVID-19 due to having at least one of six comorbidities, including cardiovascular disease, chronic obstructive pulmonary disease (COPD), diabetes, asthma, hypertension and/or cancer. When factors exacerbating the risk from COVID-19, like autoimmune diseases, obesity, and organ transplant, and being over 65, are added, the list of groups that will be left to "fall by the wayside" grows to significantly more than half of the population and approaches two-thirds.

Fauci, who had for years been a target of fascist attacks for having advocated during the Trump administration for measures to mitigate the spread of COVID-19, has embraced the doctrine of "herd immunity." This is the conception advocated by Trump in 2020 that if enough people get COVID-19, the virus will go away, and that the deaths of older people, the ill, and the disabled are an acceptable cost of preserving the profit interests of major corporations.

The greatest argument against the proponents of "herd immunity" is the actual experience of the COVID-19 pandemic, which confirms the warnings made by the World Health Organization (WHO) in October 2020 that "herd immunity" is not a scientifically viable response to the COVID-19 pandemic.

"Herd immunity is achieved by protecting people from a virus, not by exposing them to it," WHO Director-General Tedros Adhanom Ghebreyesus said at that time. "Never in the history of public health has herd immunity been used as a strategy for responding to an outbreak, let alone a pandemic. It is scientifically and ethically problematic."

To bolster his claim, the WHO director raised the prospect-at that time hypothetical-that people might become ill with COVID-19 twice, as well as mounting reports of what he said is "now being described as Long COVID."

Three years after these statements were made, we know that reinfection with COVID-19 is not a notional possibility, but the rule. People in frontline positions, including teachers and health care workers, have reported being infected three, four, or five times.

Each bout with COVID-19 can progressively damage major organ systems, including the immune system, brain, and circulatory system. In other words, by allowing COVID-19 to circulate freely, the population that Fauci describes as vulnerable is steadily increasing.

COVID, Capitalism, and Class War: A Social and Political Chronology of the Pandemic

A compilation of the World Socialist Web Site's coverage of this global crisis, available in epub and print formats.

Finally, when Dr. Ghebreyesus made these warnings, the ability of COVID-19 to mutate to overcome existing immunity was largely hypothetical. Over the next three years, a sea of new COVID-19 variants have shown that no amount of "population immunity" will prevent significant new surges of COVID-19.

Advocates of mass infection have repeatedly increased the share of the population that must be infected to allow the disease to return to "manageable" levels. First it was 50 percent, then it was 70 percent, then 80 percent, then 90 percent. Now, with Fauci declaring that virtually the entire population-96 percent-has "immunity" to COVID-19, schools in the US are being shut down not as a preventive precaution, but because too many staff are ill to keep them open.

Shamefully, the WHO itself has repudiated its own condemnation of governments' mass infection policy, ending its COVID-19 public health emergency declaration in May, and this week shutting down its weekly COVID-19 briefings.

The ruling class's strategy of "forever COVID" has produced a disaster. In the United States alone, over 1.1 million people are officially dead, and over 20 million more have had their health significantly damaged by Long COVID. Now, COVID-19 cases and hospitalizations are surging, while the new, highly-mutated BA.2.86 "Pirola" variant has begun to circulate globally.

For more than a year, the population has been told by the Biden administration, world governments and the media that the pandemic is over, that they can take off their masks and stop worrying about being infected. It will come as a shock that now, amidst a new surge in infections, they are being told that they should simply accept that they or their loved ones could get severely ill or die.

But this is the logic of the ruling-class response to the pandemic, which is based on the subordination of public health to profit.

This policy of mass death and perpetual infection must be stopped! In every country, the demand must be raised for emergency measures to halt the spread of COVID-19, and to reject the position that it is endemic.

Health care professionals and scientists have a responsibility to speak out against this catastrophic policy. The population, which has been disarmed by the relentless propaganda of the ruling class, must be informed about the ongoing threat and mobilized to fight for a policy of global elimination and eradication.

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Dr. Anthony Fauci says many will "fall by the wayside" in new COVID-19 surge

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This week, Dr. Anthony Fauci gave an interview to the BBC in which he declared that older people, the ill, and disabled people "will fall by the wayside" in the current surge of COVID-19.

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“Now is the time for us to be practicing good respiratory etiquette. Now is the time for us to remind ourselves to think about our own individual health status and those individuals that we may be around".

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“Now is the time for us to be practicing good respiratory etiquette. Now is the time for us to remind ourselves to think about our own individual health status and those individuals that we may be around".

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It seems like everyone has Covid-19. Here’s why this wave is probably worse than official data suggests

https://www.cnn.com/2023/09/01/health/covid-case-data-wave

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It seems like everyone has Covid-19. Here's why this wave is probably worse than official data suggests | CNN

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Covid-19 certainly didn't take a vacation this summer. Virus levels in the US have been on the rise for weeks, but it's hard to know exactly how widely it's spreading.

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"So Covid is still a leading cause of death, yet some of the most powerful medical figures in the country are telling us to ignore it.  Shouldn’t that disconnect be a bigger deal"?

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"So Covid is still a leading cause of death, yet some of the most powerful medical figures in the country are telling us to ignore it.  Shouldn’t that disconnect be a bigger deal"?

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https://www.thenation.com/article/society/covid-surge-response-ignored/

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(Tang Ming Tung / Getty Images)

September 18/25, 2023 issue, with the headline "The 'You Do You' Pandemic."
Several weeks ago, two op-eds appeared in The Boston Globe-one by President Biden's former Covid czar, Ashish Jha, and the other by Jerome Adams, President Trump's surgeon general. The occasion was the clear increase in Covid-19 cases this summer. Jha, who is back at his old gig as the dean of the Brown University School of Public Health, made a case for, in his words, "ignoring" Covid. This is an old refrain of his by now: We have the tools. If you're vaccinated and have access to Paxlovid, why worry? Jha briefly acknowledged that some people may be more vulnerable, but apart from that, he played his biggest hit: Don't worry, be happy. It's what got him to the White House, and he's not changing his tune now.

It fell to Adams to provide the kind of reality check that too many Democrats (along with virtually the entire Republican Party) appear to be avoiding. He pointed out that while we may have "the tools," millions of people either lack access to those tools or have been abandoned by governments eager to pretend that Covid has disappeared. It was a stirring example of how one should lead with equity in the pandemic response, something the Biden administration said it would do but hasn't.

Despite what Jha says, it is still prudent to protect yourself and those you love from infection, particularly since community-level protections are gone and widespread environmental upgrades that could have minimized the spread (such as indoor ventilation) were never implemented. Yes, things are far better than in 2020, but the virus is still here, and you don't want to get it.

But Jha's "nothing to see here" response is, in many ways, the logical outcome of Biden's decision to essentially throw in the towel when it comes to Covid. Thanks to the official ending of the Covid public health emergency, millions-particularly low-income people-are now on their own in terms of access to the ubiquitous-in-Jha's-mind-only tools of Democratic lore. So why bother telling anyone to worry when they might not be able to get the help they need? Instead, better to tell them that everything's fine, that masks don't need to be in the picture-or even that they "don't need to know what virus they have and don't need to be buying tests all the time," as Shira Doron, the chief infection-control officer for the Tufts Medicine health care network in Massachusetts, told The Washington Post.

Jha and Doron and their ilk can speak so soothingly because they are part of the class that is much more insulated from the worst effects of Covid. People like them-the ones with money and access-can afford the expensive Covid tests. They can ensure that Paxlovid reaches their door quickly. They'll be first in line for the new boosters. Some of them even have a concierge physician on speed dial for when things get hairy. Meanwhile, they offer the rest of the country the policy equivalent of "You do you" and "Let them eat cake."

While too many people who should know better are downplaying the ongoing public health risk from Covid, others are trying to signal the peril of our current moment. The New York Times recently reported on new estimates from researchers that Covid might lead to at least 45,000 deaths between September and April-and that's the best-case scenario. "Based on these projections, Covid is likely to remain in the leading causes of death in the United States for the foreseeable future," Justin Lessler, an epidemiologist at the UNC Gillings School of Global Public Health, told the Times.

Current Issue

So Covid is still a leading cause of death, yet some of the most powerful medical figures in the country are telling us to ignore it. Shouldn't that disconnect be a bigger deal?

Jha and Biden's other defenders will call this realpolitik: What's doable right now is to do little, and people like me are naïve dreamers. I think that's a cop-out, particularly from people who took an oath to do no harm. I know about navigating political constraints-this is not my first time at the rodeo after more than 30 years of living with the AIDS epidemic-but I won't make post hoc rationalizations for our failure to do more to prevent the continuing spread of another deadly virus.

In his 1992 book The Culture of Contentment, a series of essays that ring very true today, the late economist John Kenneth Galbraith wrote that "individuals and communities that are favored in their economic, social and political condition attribute social virtue and political durability to that which they themselves enjoy. That attribution, in turn, is made to apply even in the face of commanding evidence to the contrary."

This is the exact problem we face now: a favored class that sees its own comfort as a sign that everything's fine. As a result, the members of the Church of the Contented Establishment-from the White House to Jha and his Brown colleague Emily Oster, to David Leonhardt at The New York Times and Leana Wen at The Washington Post, to even infectious-disease doctors like Monica Gandhi at the University of California San Francisco-are pushing a narrative about Covid and our public health that, thanks to its influence within elite circles, is more subtly corrupting and poisonous than anything that outright Covid denialists like Ron DeSantis have come up with.

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The new Covid policy: Let them eat cake.

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"A new study has found that many people with post-COVID syndrome who suffer from fatigue six months after a coronavirus infection are still severely physically impaired up to 20 months afterward ". 

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"A new study has found that many people with post-COVID syndrome who suffer from fatigue six months after a coronavirus infection are still severely physically impaired up to 20 months afterward ". 

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https://scitechdaily.com/long-haul-ahead-the-prolonged-impact-of-severe-long-covid/

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SciTechDaily - Science, Space and Technology News 2024

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"However, several of our collaborative teams are working to begin even more SARS-CoV-2 reservoir clinical trials of antivirals, monoclonal antibodies, or other therapeutics in Long COVID" says paper first author Amy Proal, President of PolyBio Research Foundation". 

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"However, several of our collaborative teams are working to begin even more SARS-CoV-2 reservoir clinical trials of antivirals, monoclonal antibodies, or other therapeutics in Long COVID" says paper first author Amy Proal, President of PolyBio Research Foundation". 

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https://finance.yahoo.com/news/scientists-detail-current-evidence-long-100000532.html?guccounter=1&guce_referrer=aHR0cHM6Ly9wYWRsZXQuY29tLw&guce_referrer_sig=AQAAAA_uZ48MIfavnVIb1UuFapqPP_Wn5xrR5QzELt_tENjG8Y6Vg4GyyBPWSIckhxjUMeYlCUsLGXACA7MPu6tn-ZszppHN1p1cuaqzOM4roxmM9aZZ9_78NazXa1kp1oS-wOMOb6s5ePYA-D0EQueiKVSWAjKkDK376nNDkIQNtUyo

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MEDFORD, Mass. , /PRNewswire/ -- PolyBio Research Foundation is excited to announce a new publication in the journal Nature Immunology. The paper - written by 33 scientists - is titled "SARS-CoV-2 reservoir in post-acute sequelae of COVID-19 (PASC)." It represents one of the largest academic collaborations in the PASC (Long COVID) space, with scientists from institutions including PolyBio Research Foundation, Harvard Medical School, and the University of Pennsylvania Perelman School Medicine all serving as authors.

The paper reviews evidence showing that some patients with Long COVID - and more surprisingly, some with no symptoms - do not fully clear the SARS-CoV-2 virus after initial infection. Instead, the virus can persist in patient organ tissue as a "reservoir" - such as in the gut or lungs. These reservoirs could be one of the primary drivers of the Long COVID disease process. For example, coauthors Michael Peluso MD and team at UCSF recently found SARS-CoV-2 in Long COVID colon tissue up to 676 days following initial infection.

The paper also details mechanisms by which a SARS-CoV-2 reservoir could contribute to immune, coagulation, and neuroimmune abnormalities, microbiome imbalances, autoimmunity, or other issues in Long COVID. Importantly, the authors emphasize that antivirals or other drugs should be tested in clinical trials with the goal of clearing SARS-CoV-2 reservoirs in Long COVID patients. Multiple clinical trials of the antiviral Paxlovid are already underway. "However, several of our collaborative teams are working to begin even more SARS-CoV-2 reservoir clinical trials of antivirals, monoclonal antibodies, or other therapeutics in Long COVID" says paper first author Amy Proal, President of PolyBio Research Foundation.

Publication of the paper makes it clear that top researchers in the Long COVID space are taking SARS-CoV-2 persistence seriously. "A new and important review of the persistence of SARS-CoV-2 in tissue as a reservoir, a key underpinning of LongCovid", writes Eric Topol MD, director of the Scripps Research Translational Institute on Twitter/X. Indeed, as the paper emphasizes, the study of SARS-CoV-2 reservoir in Long COVID may inform the identification of disease mechanisms, biomarkers, and therapeutics for other chronic conditions now being tied to persistent viral infection including ME/CFS, Alzheimer's disease, and multiple sclerosis.

Contact: Amy Proal, PolyBio Research Foundation ( info@polybio.org).

View original content: https://www.prnewswire.com/news-releases/scientists-detail-current-evidence-that-long-covid-is-caused-by-persistent-sars-cov-2-viral-reservoirs-301920123.html

SOURCE PolyBio Research Foundation

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Scientists detail current evidence that Long COVID is caused by persistent SARS-CoV-2 viral reservoirs

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PolyBio Research Foundation is excited to announce a new publication in the journal Nature Immunology. The paper - written by 33 scientists - is titled "SARS-CoV-2 reservoir in post-acute sequelae of COVID-19 (PASC)."

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"In addition to the complications that can occur during the acute phase of a Covid infection, there appears to be an increased risk of heart attacks, strokes and other problems up to a year after an infection". 

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"In addition to the complications that can occur during the acute phase of a Covid infection, there appears to be an increased risk of heart attacks, strokes and other problems up to a year after an infection". 

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Three years into the pandemic, the short- and long-term risks are becoming more clear.

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"I've never doubted it — people are suffering," says Harlan Krumholz, a cardiologist at Yale University who's involved in long COVID research. "But we're now seeing imaging evidence, biopsy evidence, physiologic testing evidence of derangements in people who have long COVID."

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"I've never doubted it — people are suffering," says Harlan Krumholz, a cardiologist at Yale University who's involved in long COVID research. "But we're now seeing imaging evidence, biopsy evidence, physiologic testing evidence of derangements in people who have long COVID."

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https://www.npr.org/sections/health-shots/2023/09/09/1198342040/long-covid-causes-treatment-research

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For people suffering from long COVID's often disabling symptoms, including intense fatigue, breathing troubles, cognitive issues and heart palpitations, the list of scientific unknowns may sound defeating. There's still no validated treatment or diagnostic test specifically for the condition, although there are many candidates.

Clinicians who treat long COVID are acutely aware of the unsettled nature of the field. "You do sort of feel like you're out in the wilderness," says Dr. Rasika Karnik, medical director of UChicago Medicine's post-COVID clinic.

Karnik first began seeing long COVID patients in the fall of 2020. There's more information to work with now, she says, but doctors' approach still comes down to treating individual symptoms, rather than the underlying cause of the illness. "It's hard to look a patient in the eyes and say 'we're not quite sure yet' and to keep repeating that," she says.

But researchers are making progress in the field, and they presented their recent findings at one of the first major gatherings dedicated to sharing emerging evidence about the possible root cause of long COVID and implications for treatment.

"I know there's been a lot of frustration that there haven't been faster answers," says Dr. Catherine Blish, a professor of medicine at Stanford University and one of the organizers of the conference, held by the nonprofit Keystone Symposia in Santa Fe, N.M., in late August.

"But in all honesty, we are so much further ahead at this relative point than for any other major disease in my lifetime as an infectious disease specialist," she says.

The meeting underscored that scientists have made headway in developing evidence of a clear biological basis for what patients have been reporting for years.

"I've never doubted it - people are suffering," says Harlan Krumholz, a cardiologist at Yale University who's involved in long COVID research. "But we're now seeing imaging evidence, biopsy evidence, physiologic testing evidence of derangements in people who have long COVID."

Here are some of the new findings and promising lines of research highlighted during the three-day gathering.

Narrowing in on some key suspects behind the disease

If long COVID were a crime scene, authorities would have no shortage of leads.

They've pinpointed a handful of possible reasons why patients suffer from an array of chronic symptoms. The tricky thing is disentangling which mechanisms are bystanders and which are actually doing the damage.

"At this point, we have hints and correlative data," says Blish. "We can say we see this finding in a subset of people, but that doesn't mean it's the cause of their problems."

Take the theory of viral persistence: There's now strong evidence that protein and genetic material from SARS-CoV-2 persist in the blood and tissue of some long COVID patients well after their initial illness. Scientists believe these "viral reservoirs" could be driving many of the problems in long COVID patients, although it isn't yet clear exactly how this is happening - and whether the virus itself is replicating.

Dr. Michael Peluso, an infectious disease specialist at the University of California, San Francisco, told conference attendees that his team is now confident in their data showing pieces of viral antigen in the blood of people anywhere from six months to more than a year after they've had COVID-19.

They compared these blood samples to ones collected years before the pandemic to verify their conclusions. "That's a very, very important finding, showing that this is indeed real," he says.

But the story gets more messy from there because these viral reservoirs may not be the primary culprit.

While they are more likely to find viral persistence in the most symptomatic long COVID patients, not everyone with long COVID has it, Peluso notes, "And then really importantly, we're also seeing this in some people who feel totally fine - and we don't know what that means."

Finding activated T cells where they shouldn't be

Other leads have come from imaging technology that traces the activity of T cells, a type of white blood cell, which are part of the body's main antiviral immune response.

"We saw some very unexpected findings," says Dr. Timothy Henrich, an associate professor of medicine at the University of California, San Francisco.

His lab has found activated T cells in the gut wall, lung tissue, certain lymph nodes, the bone marrow, the spinal cord and the brainstem, long after someone's initial infection.

"You really shouldn't have activated T cells in the spinal cord or the brainstem," he says. "We are seeing evidence of this immune response in areas we don't typically see in the setting of an acute viral infection."

Here too the immunological detective work opens up even more questions: This T cell activity is also present in people who've recovered from an infection and have no long COVID symptoms, although Henrich notes the levels appear to be higher in certain tissues of people with long COVID.

So what does this immune response actually indicate about the underlying cause of the disease?

Henrich says T cell activity could be evidence that the immune system is trying to purge the viral reservoirs, or that the immune response has gone awry, possibly in the form of an autoimmune response, and is "doing damage to people, even if the virus has been cleared or is not replicating in those tissues," he says.

Similar questions bedevil researchers pursuing another theory.

Research shows that people with long COVID have high levels of Epstein-Barr antibodies and that an acute COVID infection can trigger reactivation of the virus.

Akiko Iwasaki, a professor of immunobiology at Yale University, says it's well known that this herpesvirus can lead to a "long COVID-like syndrome," but whether or not the reactivation is driving long COVID symptoms - or just an indication of a dysregulated immune system - remains to be seen.

All of those involved in research stress that they don't expect just one answer to long COVID. It's likely that many of these theories about its underlying cause are interrelated. And certain mechanisms may only be causing symptoms in some patients and not others.

Microclots could point the way to treatment

Early in the pandemic, it was recognized that COVID-19 can wreak havoc on the vascular system, in particular causing inflammation and damage to the inner lining of blood vessels, known as endothelial cells.

Resia Pretorius, a medical researcher at Stellenbosch University in South Africa, says the clotting and hyperactivation of platelets in long COVID is essentially a "persistent continuation" of what happens during an acute infection within the blood vessels.

Her research has focused on the role of tiny, harmful blood clots she's seeing in the blood of long COVID patients that appear to have "trapped inflammatory molecules that you might expect inside the blood if you have inflamed [or] damaged endothelial layers."

"It's not unique to long COVID, but long COVID has so much more of these inflammatory molecules in circulation," says Pretorius. "And what makes it so interesting is that the spike protein drives these microclots to form."

As the clots accumulate, they may choke off blood flow, preventing oxygen from reaching tissue.

In Santa Fe, Pretorius shared preliminary data from her team showing that so-called "triple therapy" - a combination of three medications - targeting clotting and platelet hyperactivation could benefit some long COVID patients. The preprint showed that this regime resolved symptoms in the majority of the 91 patients who were followed, although the results are not yet peer-reviewed and the study was not a clinical trial.

The approach is not without risk; many patients reported bruising, some had nosebleeds and one reported a gastrointestinal bleed.

Pretorius says microclots are not necessarily the root cause of long COVID, though.

It could be that viral reservoirs are actually helping trigger this vascular mayhem in the first place. These microclots, if left untreated, could also tie into other problems seen in long COVID patients, perhaps leading some to develop autoimmunity, says Pretorius. "That is a problem to solve because we know autoimmune diseases are notorious for being so, so difficult to treat."

Sex differences may play a role in long COVID risk

In general, males tend to do worse during an acute bout of COVID-19, but studies show that long COVID appears to be more prevalent among females. Yale's Iwasaki says this is also the case for other " post-acute infection syndromes."

This background led Iwasaki's lab to look into sex differences in the immune profiles of long COVID patients, in hopes of finding another path to understanding what could be driving the illness. She says they've found that reactivation of Epstein-Barr virus and the activation of T cells are more prevalent among females, whereas males have different "immune signatures."

"We're already starting to see sex differences in long COVID symptoms, as well as potentially the autoimmunity more associated with female patients," she says. "This insight is critical going forward because now we can separate out long COVID into different clusters. And depending on the driver of the disease, we can start targeting it with proper medicine."

Iwasaki's lab has also zeroed in on the role of hormones.

At the conference, she shared evidence of reduced cortisol levels in long COVID patients and shared a separate, unpublished finding that female long COVID patients tend to have reduced testosterone levels and that males have reduced estradiol levels.

Those who had lower testosterone (compared to the controls who don't have long COVID symptoms) also have higher activation of T cells, whether they're males or females, says Julio Silva, a graduate student in Iwasaki's lab who presented the new findings on testosterone. And this was "associated with higher neurological symptoms and overall higher symptom burden," says Silva.

The impetus to look at testosterone was, in part, because of "anecdotes from trans individuals who were informing us that while on testosterone therapy, their symptoms had improved dramatically," says Silva. While the results are preliminary and need to be replicated, he says they at least raise the question "could hormonal therapy help?"

Taken together, Iwasaki says their data strongly suggest there could be problems in the area of the brain that's responsible for regulating these hormones.

Viral persistence offers one possible target for treating long COVID

In the absence of a clear roadmap for treating long COVID, doctors and patients have taken to trying all kinds of therapies - from antivirals to drugs approved for treating addiction.

"All of this research is so critical to understanding the underlying mechanisms of long COVID," says Lisa McCorkell, co-founder of the advocacy group Patient-Led Research Collaborative. "We need to pair that with focusing on clinical trials. We have enough evidence right now to at least try some things."

In Santa Fe, UCSF's Peluso outlined how his team had just launched a small trial using monoclonal antibodies to target the coronavirus spike protein in long COVID patients - one vehicle for testing whether viral persistence is the underlying cause of at least some patients' symptoms. Meanwhile, Iwasaki and Krumholz, both at Yale, have started a clinical trial testing whether a 15-day course of Paxlovid can help alleviate symptoms.

Stanford's Blish points out that as more clinical trials start up, their success will hinge on being deliberate about which patients should be enrolled, since long COVID is a catch-all term for what may be multiple different illnesses.

"We need to understand in detail who's most likely to benefit from those trials, because if we just take everyone, that trial will fail," she says.

Many o ther trials are in the works, too, but Dr. Jennifer Curtin says those will inevitably take time to produce evidence that trickles down to patient care.

"It's that tough sort of in-between status right now," says Curtin, co-founder of the telehealth clinic RTHM that treats long COVID and other overlapping conditions like myalgic encephalomyelitis/chronic fatigue syndrome, or ME/CFS for short. "So what do you do for the people who are sick and suffering now until we get that data?"

Curtin, who has lived with ME/CFS herself, says their clinic's approach is to perform intensive workups, draw lots of blood and try to identify which symptoms they can treat.

"Treatment is very much individually tailored," she says. "Right now it's a journey that you take with your patients. You're going through this together. You're both learning on this road and it can be tough."

Always in the backdrop at the Santa Fe gathering was the question of whether there would be enough funding - be it from the U.S. Congress or the pharmaceutical industry - to advance the research agenda toward treatments.

"What we really need here is industry engagement. We need funding for clinical trials. And that, to me, is something that's missing," says McCorkell.

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Unraveling long COVID: Here's what scientists who study the illness want to find out

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At a recent medical gathering, researchers presented their latest hypotheses about what causes - and what could treat - the lingering disease.

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"Paul Sax, MD, clinical director of the infectious disease clinic at Brigham and Women’s Hospital in Boston, Massachusetts, acknowledged an absence of clinical trial data on vaccines for people with long COVID. But he said the COVID and flu shots may benefit people with the condition".

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"Paul Sax, MD, clinical director of the infectious disease clinic at Brigham and Women’s Hospital in Boston, Massachusetts, acknowledged an absence of clinical trial data on vaccines for people with long COVID. But he said the COVID and flu shots may benefit people with the condition".

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https://www.medscape.com/viewarticle/996286

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The first thing up on the Dartmouth Hitchcock Medical Center website in late August was a question: Are you up to date with your vaccines?

For people living with long COVID and other chronic conditions, the answer may not be so clear.

Three shots are coming on line this fall, including a new vaccine for respiratory syncytial virus (RSV). With flu season approaching, as well a pending update to the COVID-19 shot, people with long COVID will have to make some choices.

The Centers for Disease Control and Prevention (CDC) advises everyone to get the COVID vaccine and a flu shot. The RSV vaccine is recommended for those over 60 and with weakened immune systems, and federal health experts suggest younger individuals, pregnant women, parents, and others talk to their doctors about the pros and cons of receiving the RSV vaccine.

But the CDC is not specifically saying whether long COVID patients should get the new COVID boosters, flu shots, or RSV vaccines. A CDC spokesperson said the agency could make no one available to discuss whether long COVID patients should get a COVID vaccine, and the Food and Drug Administration (FDA) referred similar questions to the CDC.

Last fall, federal health officials urged people to get their COVID booster and flu shot at the same time - but in separate arms.

In terms of vaccine guidelines, some professional medical groups, like the American Academy of Family Physicians, defer to the CDC. The FDA's label for the RSV vaccine makes no mention of long COVID. Long COVID is not on the CDC's list of vaccine contraindications.

Despite the lack of clear guidelines from the CDC, some experts and healthcare organizations say people with long COVID should get the new COVID booster and the flu shot, and should talk with their doctors about whether the RSV vaccine is right for them.

At Oregon Health and Science University (OHSU), Portland, for instance, researchers have created a guide to educate primary care doctors on how to recognize and treat long COVID. Eric Herman, MD, who helped set up the OHSU long COVID program in 2021, recommends the flu, COVID, and RSV vaccines to individuals with long COVID.

Paul Sax, MD, clinical director of the infectious disease clinic at Brigham and Women's Hospital in Boston, Massachusetts, acknowledged an absence of clinical trial data on vaccines for people with long COVID. But he said the COVID and flu shots may benefit people with the condition.

"People with long COVID may be susceptible to postinfectious, prolonged fatigue illnesses, and these are more likely with the severity of the illness," he said in an email. "Since the vaccines reduce disease severity (and initially prevent infection), anything that mitigates disease severity would be beneficial to them."

On the RSV vaccine, he agrees with the (FDA) that this is a shot that benefits "shared decision making" - a doctor and a patient weighing risks and benefits before proceeding. He would only recommend RSV to "people at the extremes of older age, immunocompromised, or with multiple other medical problems," he wrote.

Jeffrey Parsonnet, MD, co-director of Dartmouth Hitchcock's Post-Acute COVID Syndrome Clinic in Lebanon, New Hampshire, said nothing in the medical literature raises concerns about vaccines for people with long COVID. However, he said it is reasonable for some people to be cautious and to talk to their doctors about the pros and cons before making a decision.

Parsonnet said he's not getting many questions about the flu or RSV vaccines from his patients with long COVID, as neither one has rolled out yet. But he gets a lot of questions about the COIVD boosters. He added that many of his patients who contracted long COVID did so after a second infection.

He tells those already vaccinated to skip the current boosters if they had a bad reaction in the past. The vaccines are great at preventing death and hospitalization, he said. "I've had every vaccine right on time and I've had it twice," he said.

If the new vaccine booster due this month proves effective, he said, he would be likely to recommend the shot.

The fall COVID-19 vaccines are an improvement on the exiting vaccine, but the virus is mutating quickly. In late August, President Joe Biden called for another update.

For anyone who is vaccine hesitant, Parsonnet advises a wait-and-see approach on RSV. Until recently, RSV was considered a childhood disease, he said, but a growing death rate among older adults led to a vaccine. He said he qualifies by age and will be getting it.

His general advice: "I think doctors should follow the recommendations of our public health authorities," he said. "That's what I would do."

Advocates for people with long COVID and other chronic health conditions have complained that there is little research into how vaccines impact their health. For years, people with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), which is common among people with long COVID, have been reporting both improvement and declines after vaccines or infections.

A recent Mayo Clinic study of about 500 patients found that vaccination lowered the risk for long COVID and reduced the severity when it did occur. Vaccinated patients are less likely to report loss of smell, chest pain, dizziness, numbness, shortness of breath, and weakening.

Herman, with Oregon Health and Science University, noted that most people get their vaccines from primary care doctors, which is why OHSU's long COVID program created a guide for primary care doctors who need help treating a new condition.

"The OHSU Long COVID-19 Program generally recommends that patients experiencing chronic COVID-19 symptoms obtain all preventative vaccinations (including flu, COVID, and RSV) for which they are eligible, while also recommending that patients directly discuss any questions or concerns they may have about vaccination with their health care provider," he said.

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Should Long COVID Patients Get Flu, RSV and New COVID Shots?

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Are your patients up to date with their vaccines? For people living with long COVID and other chronic conditions, the answer may not be so clear.

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"One of the biggest misperceptions is that vaccination or prior infection protects you, or that you’ll react the same to every COVID infection".  Hannah Davis, co-founder of the Patient-Led Research Collaborative

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"One of the biggest misperceptions is that vaccination or prior infection protects you, or that you’ll react the same to every COVID infection".  Hannah Davis, co-founder of the Patient-Led Research Collaborative

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https://cen.acs.org/biological-chemistry/infectious-disease/Long-COVID-hunt-causes-cures/101/i30

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Hannah Davis misses her old self. Like so many people around the world, she has seen her life upended by long COVID, which has made many once-routine activities impossible. The 32-year-old has stopped working at her job in the field of machine learning and generative models. It's too cognitively taxing; the lights from display monitors are disorienting. Merely standing up from a sitting position causes her heart rate to shoot to 170 beats per minute, the equivalent of doing a good jog.

"A phone that doesn't hold a charge" is how Davis describes how she feels. "Keep plugging it in and keep plugging it in, and then it'll just last 20 minutes."

There are multiple terms for what Davis experiences: postacute sequelae of SARS-CoV-2, post-COVID conditions, chronic COVID, and long COVID-the most popular name. She is one of an estimated 65 million people worldwide still suffering from COVID-19's fallout weeks to months after their initial infection with the virus SARS-CoV-2.

Potential drivers of long COVID Viral persistence and reemergence Immune system dysregulation Clotting Mitochondrial issues

About 10% of those who contract the virus end up with several of long COVID-19's 200 documented symptoms. The most debilitating of these include the prolonged physical exhaustion known as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS); cognitive impairment; and postural orthostatic tachycardia syndrome(POTS), which involves the dysregulation of the body's background systems, such as heart rate. Some eventually recover fully, but many are still grappling with the aftereffects.

As disruptive as her long COVID is, Davis hasn't looked back, and she is taking charge of her own fate. Just months after the start of the pandemic, she and others with long COVID founded the Patient-Led Research Collaborative, an advocacy and research organization that seeks to accelerate new findings on long COVID and spread awareness about the latest treatment options.

So far, no treatment has been approved specifically for long COVID. And the syndrome is still an enigma to many researchers because of the sweeping physiological changes that accompany it. "There are so many different syndromes underneath that lead me to believe that there might be multiple underlying causes," says physician William Q. Pittman, assistant director of the Long COVID Program at UCLA Health, part of the University of California, Los Angeles.

But thanks to tireless efforts by scientists and patients such as Davis, researchers are starting to illuminate the biological underpinnings of the disease, and candidate treatments are already advancing through the clinic. Over 300 long-COVID studies from research institutions and drug companies alike populate the US government clinical trial registry. Those trials should provide more clues to how long COVID wreaks havoc in the body and how it might one day be countered.

Viruses all the way down

One hypothesis for a root cause of long COVID is a lingering viral presence in the body after an infection. Studies have reported viral flotsam, such as RNA and protein fragments, in the respiratory tract, blood, gut, poop, and extracellular vesicles of long-COVID patients. Autopsies of people who died weeks to months after contracting COVID-19 also found viral detritus in the brain, muscles, reproductive organs, eyes, and lungs ( Nature 2022, DOI: 10.1038/s41586-022-05542-y). In a recent report, researchers uncovered viral traces in the tongues of people who had lost their sense of taste for months after infection. But it isn't clear whether these are long-term leftovers or evidence of a persistent infection.

Some researchers theorize that SARS-CoV-2 may remain in the body and continue to replicate long after the acute infection has passed. There's precedent for such behavior. For example, the Ebola virus takes cover in sanctuary tissue, only to reemerge later. In one patient, researchers found a high concentration of RNA strands, which suggests that the virus might be replicating in semen.

Although viral replication of SARS-CoV-2 has not been directly observed in long-COVID patients, some researchers are not ruling it out. "The whole idea is that, likely, it's deeply hidden," says Linda Geng, a primary care physician at Stanford Health Care. "In living human beings, it's difficult [for researchers] to access a lot of deeper tissues" to find these viruses, she explains. The autopsy studies demonstrate the pervasiveness of viral particles and give researchers reason to suspect that viruses could lurk throughout the body.

The possible presence of viral squatters that continue to drive infection has motivated researchers to investigate whether antivirals can treat long COVID. In an anecdotal report of four patients taking Paxlovid, Pfizer's combination drug of ritonavir and the antiviral nirmatrelvir, three reported improvement in chronic symptoms ( Pathogens Immun. 2022, DOI: 10.20411/pai.v7i1.518). Four clinical trials in the US and Europe are underway to investigate whether Paxlovid can ameliorate long-COVID symptoms and potentially improve quality of life.

"There is some evidence that Paxlovid decreases development of long COVID," says Jai Marathe, an infectious disease specialist at Boston Medical Center, in an email to C&EN. Marathe isn't involved in any of the clinical studies involving the drug.

If long COVID's symptoms are elicited not by the replicating SARS-CoV-2 virus but by its RNA rubble, then going after these fragments makes for a sensible therapeutic strategy. Resolve Therapeutics has a drug candidate with this mechanism of action. RSLV-132 consists of an antibody-straddling ribonuclease that patrols the bloodstream to chew up any loose nucleic acids outside the cell, viral or not. It completed Phase 2 clinical trials for long COVID in March.

But a bulky protein drug has an obvious limitation: it's too big to enter a cell. "If you want to degrade a particular RNA inside the cell, that approach would not work," says Gonçalo Bernardes, a chemical biologist at the University of Cambridge.

His team's solution is to give RNA busters a small-molecule makeover. The researchers discovered that a lightweight imidazole group is sufficient to initiate a degradation sequence on any RNA it covalently tags ( ACS Cent. Sci. 2020, DOI: 10.1021/acscentsci.0c01094). To make sure the compound leaves other nucleic acids alone, the researchers attach their imidazole warhead to binder ligands with a penchant for structural motifs on the RNA of SARS-CoV-2.

Bernardes's team has demonstrated that its molecule can decrease the viral load in COVID-infected mice models. Now, the researchers are continuing their drug optimization and development efforts through a company in stealth mode. Their goal is a drug that can one day treat both acute infection and long COVID.

Long COVID could also involve more than one virus. Some researchers suggest that the syndrome stems from the reactivation of viruses that had infected the body previously. Common bugs such as human herpes viruses stay dormant in the body until another infection reawakens them. A COVID-19 infection could weaken the immune system to the extent that the body can no longer keep the preexisting viruses in check.

"Acute COVID illness is a little bit like a tsunami," says Michael VanElzakker, a neuroscientist at Harvard Medical School. Just as a tsunami can level human-made structures and drastically reshape the landscape it inundates, so SARS-CoV-2 infection can change the milieu of the host, he says.

Before the pandemic, the Epstein-Barr virus (EBV) was linked to ME/CFS in a subset of patients. Researchers studying ME/CFS have found EBV-related antibodies in newly diagnosed individuals. In anonymized and placebo-controlled studies, the antiviral valganciclovir, which targets the herpes virus and the EBV, improved fatigue levels and cognitive function in patients with ME/CFS ( J. Med. Virol. 2013, DOI: 10.1002/jmv.23713). Since ME/CFS is a hallmark of long COVID and previous infection with EBV is one of the risk factors for it, EBV could be the common culprit.

Last year, the biotechnology company Virios Therapeutics initiated clinical studies on a different antiviral, valacyclovir, for long COVID. The open-label study demonstrated that the drug improved symptoms of fatigue, pain, and autonomic dysfunction among its 22 enrollees, all of whom were female.

A forever war inside the body

Long COVID's indications also include elevated levels of immune signaling proteins and a lack of naïve T and B immune cells ( Nat. Immunol.2022, DOI: 10.1038/s41590-021-01113-x). People diagnosed with long COVID often have an immune system on constant high alert.

A study showed that 60% of 55 ong-COVID patients carried inflammatory biomarkers in their bloodstream ( Nat. Commun. 2023, DOI: 10.1038/s41467-023-38682-4). In one mouse study, the authors found that spike proteins from the virus facilitated infiltration past the blood-brain barrier. The chronic neuroinflammation in the wake of the virus's pillaging may explain long COVID's hallmarks of memory and attention loss ( Brain, Behav., Immun. 2023, DOI: 10.1016/j.bbi.2023.01.010).

It could be that the body's defenses are simply not turning off, as if the immune system is still shadowboxing a viral ghost. Alternatively, the virus may still be present and driving inflammation, in line with the viral persistence theory. Either way, the constant immune activity contributes to debilitating malaise and can significantly cramp a person's quality of life.

"When people talk about this large immune response, I usually use the word inefficient, rather than exaggerated, because . . . it's not working," VanElzakker says.

Immune dysregulation points toward another suspect behind long COVID: autoantibodies. These defense proteins are often found in the blood of people with severe or long COVID ( Nature 2022, DOI: 10.1038/s41586-022-05273-0; J. Transl. Autoimmun. 2021, DOI: 10.1016/j.jtauto.2021.100100). Autoantibodies turn against the host they're supposed to protect; while researchers don't think they are the lone drivers of long COVID, they may be coconspirators, working in unison with inflammatory cofactors to bring about biological bedlam.

If so, anti-inflammatory medication may address long-COVID symptoms by quieting the overactive immune response. "It's possible that in some cases, or even many cases, what you want is to get the immune system to relax and say . . . 'Let's just call a truce.' " VanElzakker says.

Enter naltrexone. While the drug is best known as an opioid antagonist, when given at low doses it reduces the levels of cytokines originating in the central nervous system and decreases neuroinflammation ( Eur. Heart J.: Cardiovasc. Pharmacother. 2022, DOI: 10.1093/ehjcvp/pvac014). Before the pandemic, physicians prescribed naltrexone to treat chronic pain and ME/CFS, conditions that overlap with long COVID. "This has been a known treatment for [ME/CFS] for a long time," UCLA's Pittman says. Although the exact biological mechanism still isn't known, he calls efforts to repurpose the drug for long COVID "very reasonable."

In one study, 36 long-COVID patients taking naltrexone reported improvements in their symptoms, including higher energy levels and better sleep ( Brain Behav. Immun. Health 2022, DOI: 10.1016/j.bbih.2022.100485). The drug is also undergoing a 160-person Phase 2 clinical study to gauge its efficacy for alleviating post-COVID fatigue.

Another promising candidate for long COVID is aripiprazole, an antipsychotic drug approved for schizophrenia. The medication interacts strongly with dopamine and serotonin receptors in the brain to mediate neural signaling pathways. Like naltrexone, it can promote anti-​inflammatory activity in the brain by elevating the levels of temperate cytokines over the combative kinds.

Aripiprazole has also already demonstrated some promise for treating ME/CFS: a retrospective study out of Stanford University showed that 77 of 101 patients self-reported improvement in fatigue, brain fog, and postexertional malaise after taking aripiprazole daily for several months ( J. Transl. Med. 2021, DOI: 10.1186/s12967-021-02721-9). While no long-COVID-specific clinical trials of the drug are underway, physicians have prescribed it off label-that is, outside its officially approved use.

It's in the veins

Persistent inflammation in the blood vessels may also lead to another insidious effect: microclots made from clumps of fibrinogen and amyloid and reinforced with antiplasmin. Some researchers think these clots drive long COVID by clogging capillaries and starving tissues of oxygen-thus leading to fatigue, increased risk of stroke, and body aches. Antiplasmin gives microclots their abnormal longevity by preventing their natural solubilization. Adding fuel to the fire, hyperactive platelets prowl the bloodstream, boosting opportunities for microclot mischief by glomming onto the walls of blood vessels and restricting flow.

Researchers say microclots aren't necessarily a primary cause of long COVID but rather a downstream consequence of viral remnants. "We're not saying that thrombotic endotheliitis is the beginning and the end, but we are saying it is a prominent and specific part of the reason why we see long-COVID symptoms," says Resia Pretorius, a professor in the physiological sciences at Stellenbosch University.

Pretorius was part of a team that inspected microclots for their composition. Inflammation from SARS-CoV-2's spike proteins commonly results in endothelial damage, which leads to pathologic clotting. Clotting in turn can perpetuate further inflammation and blood vessel damage. Drugs that disrupt at any stage of this vicious cycle, such as by preventing clot formation, could let tissues heal once and for all.

Because COVID-19 increases the risk of thrombosis among patients in the hospital, they often receive anticoagulants such as heparin during their stay. In an open-label, placebo-controlled trial with 318 participants, researchers in Brazil investigated whether the practice should be continued after patients are discharged. They found that a daily dose of the anticoagulant rivaroxaban for 35 days posthospitalization led to a lower rate of thrombosis ( Lancet 2022, DOI: 10.1016/S0140-6736(21)02392-8).

The study didn't name long COVID per se, but research is already underway to cement the connection between blood clots and the condition and its treatability. STIMULATE-ICP, a 4,500-patient study focused on long COVID and sponsored by University College London, aims to examine the efficacy of drugs that have gained a foothold in the patient community but without clinical data to show for it. Those drugs include rivaroxaban. The researchers will announce their first results by the end of this month.

Some researchers are pushing a more drastic "triple therapy" to weed out clots. In 2021, Pretorius's team tested a monthlong regimen of double antiplatelets and the anticoagulant apixaban among 24 people with long COVID. According to a preprint, all the participants found complete relief from their fatigue.

As promising as they sound, blood thinners have inherent risks. "Anticoagulants can have a side effect of bleeding, which can be very dangerous," says Petter Brodin, a pediatrician and immunologist at the Karolinska Institute and Imperial College London. "We need to be very careful and make sure that we know what we're doing."

Restoring energy levels

A growing body of research also suggests that COVID-19 may also be a disease of mitochondria, of metabolic homeostasis gone awry. "Mitochondrial dysfunction can explain a lot of the symptoms" of long COVID, says Akiko Iwasaki, an immunobiologist at Yale University. "It's literally like not fueling your battery."

The damage that SARS-CoV-2 inflicts on the vital organelles is manifold: it can hijack mitochondria to inhibit gene expression, reduce membrane potential, toggle them to a sluggish metabolic pathway, inhibit energy transduction, and eventually cause organelle death. In the aftermath of an acute infection, the detritus of free-floating mitochondrial DNA circulates in the blood like scattered bank notes at a crime scene.

Mitochondria aren't just the energy reactors of the cell but gatekeepers of the immune system. They are hubs of metabolic processes that inadvertently generate reactive oxygen species, but they also produce key enzymes to neutralize those harmful oxidizers and limit their damage before they pinball around the cell. As SARS-CoV-2 tampers with these abilities, the body careens toward constant inflammation and a diminished ability to generate energy.

Mitochondria's role in long COVID is still somewhat speculative, and the treatments that target these organelles are even more so. But several mitochondria-mitigating molecules have been observed to reduce the severity of COVID-19 infection. They are also a good starting point for developing potential treatments for long COVID.

Coenzyme Q10 (CoQ10), or ubiquinone, an antioxidant that occurs naturally in the body, has been explored as a supplement for people with ME/CFS. The compound has also found its way into long-COVID studies, but a 121-person study in Denmark found that a 6-week regimen of CoQ10 did not significantly improve fatigue levels compared with the placebo ( Lancet Reg. Health. Eur. 2023, DOI: 10.1016/j.lanepe.2022.100539).

Recognizing the overlapping biology at play, the biotech firm Axcella Therapeutics recently pivoted from treating nonalcoholic steatohepatitis liver disease to addressing chronic fatigue in long COVID. Axcella's investigational supplement, AXA1125, is a concoction of six amino acids in concentrations higher than those found in the average protein shake. While their exact mechanism is still unknown, these endogenous metabolic modulators purportedly regulate various biological processes after the body metabolizes them into diverse compounds that modify multiple pathways.

"We don't have a precise target," says Margaret Koziel, Axcella's former chief medical officer. "We're going after multiple pathways at the same time."

A multipronged therapeutic approach may be fitting for such a multifaceted disease. A 41-person randomized Phase 2a trial showed that while the supplement failed to improve the biological markers for mitochondrial health, participants reported feeling less fatigued ( eClinicalMedicine 2023, DOI: 10.1016/j.eclinm.2023.101946). Axcella is now getting ready for a follow-up Phase 2b study.

Like microclots, mitochondrial mayhem may be a downstream driver of long COVID but not its root cause. "Whether or not these supplements can restore the function of mitochondria is unclear," Yale's Iwasaki says. "You might have a transient improvement, but this is not going to be a solution long term."

Prevention over cures

Some research has demonstrated that reducing the severity of COVID-19 at the height of infection aids in preventing long COVID down the line. Treating people with antivirals or other drugs when the symptoms appear may help with both present and future conditions. Ziyad Al-Aly, a clinical epidemiologist at the Veterans Affairs St. Louis Health Care System, calls it "hitting the virus hard and early with antivirals," just like "suppressing a fire."

A retrospective study identified that people who took Paxlovid within 5 days of a positive test were 26% less likely-or had a 4.5% reduction in absolute risk-to become COVID-19 long-haulers than those who went without. The antiviral also whittled the odds of hospitalization and death when the patients were in the throes of a viral assault.

One nonantiviral drug seems to work similarly, by reducing illness and warding off long COVID. Metformin, a diabetes drug, made its way into the world of COVID-19 when researchers at the University of Minnesota Medical Center studied whether it could improve infection outcomes among hospitalized people.

The researchers later rolled their study into a Phase 3 trial for long-COVID prevention by following up with participants for 300 days. They found that metformin reduced long-COVID incidence by 41% and absolute risk by 4.1% among people who took the drug after the onset of symptoms. Previous research had also found that metformin inhibited SARS-CoV-2 replication in cell cultures and reduced viral load in patients ( Virus Res. 2022, DOI: 10.1016/j.virusres.2022.199010; Biomed. Pharmacother. 2022, DOI: 10.1016/j.biopha.2022.113223). Whatever the mechanism, experts agree that the best thing about metformin is that it's cheap and proven safe.

Arguably, the best tool for preventing long COVID is our all-around best protection against COVID-19: vaccines. Multiple studies have shown that a vaccinated person who later catches COVID-19 has a lower chance of developing chronic symptoms. Moreover, the vaccine's preventative power increases with booster shots. But the data is split on whether or not receiving a vaccine after infection can ease long-COVID symptoms.

Just as vaccinated people are susceptible to breakthrough infections, so vaccines don't fully shield against long COVID. Even if a person gets away scot-free after the first infection, they still face the risk of long COVID if they're reinfected. People with mild COVID-19 can also develop chronic symptoms later. "One of the biggest misperceptions is that vaccination or prior infection protects you, or that you'll react the same to every COVID infection," Davis warns. "That's not true."

No preventative therapy eliminates the risk of developing chronic symptoms after a viral attack. The surest safeguard is to not get infected in the first place. "There's no long COVID without COVID," Al-Aly says.

A long shot

Work continues to find long COVID's causes and cures. But for now, patients get by with over-the-counter drugs that provide symptomatic relief. For example, antihistamines, a common allergy medication, may tackle inflammation and alleviate some discomfort. Long-hauler Davis also takes beta-blockers to deal with POTS. She says they are effective at alleviating some of her symptoms, but she knows that she'll pay for her relief-her energy levels will crash in a few hours, making her feel worse than before.

"They're a Band-Aid," Davis says, "not cures." And they often come with barriers in cost and coverage. In her own experience, she adds, "insurers will generally put up a fight."

People can't always count on clinical trials to get the latest cutting-edge treatment. For example, geographical access to trials can be a challenge. Even those who live near a clinical site have to muster their limited energy to show up. Davis says some people don't bother registering for clinical trials because of their placebo-​controlled and blinded format. No one wants to be in the group receiving a dud, she says. Instead, she advocates for crossover trials, in which all participants will rotate into the treatment cohort and eventually receive the therapy under investigation.

Without approved treatments or official diagnostics available, doctors have to rely on their experience and discussions with colleagues to provide care to long-COVID patients. For example, UCLA's Pittman says he has prescribed the blood pressure medicine guanfacine for treating brain fog. His judgment stems from anecdotal evidence from Yale Medicine that the drug brought improvement among the hospital's own patients with similar conditions ( Neuroimmunol. Rep. 2023, DOI: 10.1016/j.nerep.2022.100154).

Al-Aly at Veterans Affairs argues that treatment-seeking efforts could be more organized and systematic. "I think it's kind of like the Wild West," he says. "There is really no coherent approach."

For some researchers, the scattershot strategy has advantages, especially for stirring up creativity and out-of-the-box thinking. But open-mindedness needs to be grounded in a scientific rationale and be backed by scientific rigor. "I don't recommend anyone, doctor or patient, to just try things left and right," Brodin at Karolinska Institute Brodin warns. "There's a huge risk of possible side effects that might actually do more harm than good."

The lack of a definition for long COVID also makes it challenging to find treatments. "That inability to have a uniform definition means we can't know who the proper patients are to get treated," says Panagis Galiatsatos, a pulmonary physician at Johns Hopkins Medicine. The vague terminology only highlights the lack of clarity around the disease pathology, which results in what he calls a "shooting from the hips" approach in both treatment and clinical studies.

The workaround is to define the target population very narrowly, stipulating the symptoms, time of infection, persistence of the condition, infection severity, and vaccination status in the eligibility criteria for an experimental treatment. If a treatment succeeds in clinical trials, doctors can say then who it is best suited to.

Some large-scale efforts are underway to understand the full-picture pathology of long COVID. They include the COVID Human Genetic Effort, a research consortium that aims to parse the genomic and immunological secrets behind why only some people get critically infected or develop long COVID.

The RECOVER Initiative by the US National Institutes of Health aims to demystify long COVID in the name of basic research and clinical care. The program has received $1 billion in funding and boasts a large, diverse patient enrollment, but it has drawn criticism for its glacial progress.

Meanwhile, long COVID patients are taking action themselves-documenting their symptoms and collating research on their conditions. Amplifying these individual efforts are patient-led initiatives like the one Davis leads, so that the wealth of lived experiences can reach medical researchers and funders.

"What makes this postviral illness different from other ones is the scale and speed of communication" among the patient community, Davis says. Many people are living with the illness, and they would rather not sit around and wait.

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# data[].attributes.attachment_link.title
Long COVID: The hunt for causes and cures

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With so many treatment candidates, researchers work to gain more clarity

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"Stories like Zimmerman’s—illness, improvement, exercise, crash—are common in the Long COVID world.  And they highlight what many researchers, patients, and advocates say is one of the most powerful tools for managing, and potentially even preventing, Long COVID: rest".

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"Stories like Zimmerman’s—illness, improvement, exercise, crash—are common in the Long COVID world.  And they highlight what many researchers, patients, and advocates say is one of the most powerful tools for managing, and potentially even preventing, Long COVID: rest".

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https://time.com/6215346/covid-19-rest-helps/

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Why You Should Rest-a Lot-If You Have COVID-19

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Resting a lot when you have COVID-19 may help prevent Long COVID. Rest and pacing can also help manage Long COVID symptoms.

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"What we found is really undeniable: It’s very clear in our data that reinfection contributes additional risk of long Covid".

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"What we found is really undeniable: It’s very clear in our data that reinfection contributes additional risk of long Covid".

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ore than three years into the coronavirus pandemic, fewer and fewer people are experiencing their first Covid-19 infections. But as cases climb, those who've had the virus before may wonder: What are their chances of developing long Covid - and does the risk increase with each reinfection?

Fatigue and brain fog may be the first post-infection symptoms that come to mind for long Covid, but lists compiled by the Centers for Disease Control and Prevention and by the World Health Organization also include musculoskeletal pain, shortness of breath, gastrointestinal disorders, and dysautonomia, the disruptions in heart rate, blood pressure, sweating, and other functions our bodies carry out without our control. We still can't predict, prevent, or cure long Covid - or understand why it affects some people and not others.

There is, however, a lot of research underway exploring the many still-unanswered questions about long Covid. Ziyad Al-Aly, chief of research at the VA St. Louis Healthcare System and clinical epidemiologist at Washington University in St. Louis, talked with STAT about what we understand about long Covid so far, and what scientists are still trying to figure out. (One of his studies, for example, showed that vaccination appears to lower, but not eliminate, the risk of long Covid.)

This interview has been edited and condensed for clarity.
Let's set the stage: What did you learn about Covid reinfection in your study What does that mean for patients? based on the What if you already have long Covid? U.S. Department of Veterans Affairs' national health care database So each time you are infected with Covid, you are rolling the dice on long Covid, whether it's a first infection or second or third or so on? Does that risk add up, or does each roll of the dice stand alone? ?
We compared people who have a reinfection to people who have no reinfection - not comparing the severity of infection versus the first. What we found is really undeniable: It's very clear in our data that reinfection contributes additional risk of long Covid.

If you've had Covid previously and dodged a bullet and did not get long Covid the first time around and you're getting another infection now, you're pretty much trying your luck again. People need to understand that you can get long Covid the second time, even if you dodged the bullet the first time. You can get long Covid the third time.
Do people get over long Covid?
If you had long Covid before, upon reinfection there is a risk of worsening problems. You may have had brain fog and fatigue but not dysautonomia or other manifestations. Long Covid is a broad basket of conditions. Even if you've had it before, you're also trying your luck again.

That's correct.
Where should research be focusing?
This is really hard to answer. I can give you my speculation: There are two opposing forces at play here. It could be that prior infection may have primed the immune system in a way resulting in subclinical damage that people are not even aware that they have. The second infection sort of surfaces it and makes it more clinically evident and diagnosable, and they start feeling fatigue and brain fog and all of that.

In the other, opposing pathway, the immune system has seen this virus before on the first infection in a particular individual, and when they get a second infection, the immune system would say, "I've seen this virus before. I know how to deal with it, I'm going to clear it better" and they may have actually even milder disease.

This is why long Covid is so complex: These two things can happen in different directions.

Anecdotally, from the clinics we know that some people come back and say, "I feel better" or "I feel I improved." If you dig a little bit deeper, they did not get back to their baseline; they adjusted their baseline. They used to be able to walk the dog three blocks out of the house and now they only do a half a block. Or they used to garden Saturday or Sunday and now they feel exhausted just watering.

Recovery, unfortunately - for fatigue and dysautonomia and all that - is actually quite rare.

Long Covid does not seem to be self-resolving, in the sense of spontaneous recovery or recovery in the absence of a cure or a treatment that's been validated. It further raises the importance of finding treatment because this is not going to go away.

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Does the risk of getting long Covid increase each time you get reinfected?

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Do odds of getting long Covid go up with more coronavirus infections? It's "clear in our data that reinfection contributes additional risk."

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"The political declaration, first, does not appropriately and thoroughly address the best practices to prevent the ongoing spread and evolution of SARS-CoV-2 and the potential spread of emerging pathogens of concern. In addition, this political declaration does not address Long Covid, one of the most mass-disabling events in history".

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"The political declaration, first, does not appropriately and thoroughly address the best practices to prevent the ongoing spread and evolution of SARS-CoV-2 and the potential spread of emerging pathogens of concern. In addition, this political declaration does not address Long Covid, one of the most mass-disabling events in history".

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https://www.pandemies.org/final-letter-un-political-declaration/
The World Health Organization (WHO), the United Nations (UN), Heads of State and Government: Pandemic Prevention, Preparedness and Response

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The World Health Organization (WHO), the United Nations (UN), Heads of State and Government, are about to sign a " political declaration " attached to the next United Nations General Assembly High-level Meeting (HLM) on Pandemic Prevention, Preparedness and Response, which will take place on September 20th, 2023 in New York.

The political declaration, first, does not appropriately and thoroughly address the best practices to prevent the ongoing spread and evolution of SARS-CoV-2 and the potential spread of emerging pathogens of concern. In addition, this political declaration does not address Long Covid, one of the most mass-disabling events in history. The fact that the ongoing spread of SARS-CoV-2 accelerates the collapse of healthcare systems, and impedes safe accessibility to such systems for large sectors of the population, including clinically vulnerable people, is also made invisible.

We ask the UN to thoroughly and appropriately mention Long Covid in the political declaration on Pandemic Prevention, Preparedness and Response, and to consider all the following points:

Long Covid should be considered as an emergency, and be part of any emergency plans. We must have concrete measures to prevent and treat the massive sequelae of SARS-CoV-2 infection and related disabilities, already harming the health of at least 65 million people worldwide - including children.

Clean air appears to be quoted only once in the document, in a very vague way. However, clean air should be a key part of the prevention of any airborne epidemics, which are likely to multiply in the future.

There appears not to be any mention of respirators/masks at all (or any other adequate mitigation measure for the airborne spread of pathogens, including SARS-CoV-2). Yet, high quality masks/respirators are the only way to ensure immediate, safe, universal accessibility in essential public spaces such as healthcare, schools, workplaces, and transport.

There is insufficient mention of the alarming impact on hospitals, which SARS-CoV-2 creates or accelerates in multiple ways - for example, by driving excess demand as well as sickness and absence of healthcare personnel. This should be a major focus, given that healthcare access and safety are decreasing in many countries.

The political declaration does not address the social consequences of making Covid "invisible", as well as the ethical issues raised by the normalization of Covid-related deaths and disabilities. There is no discussion about the exclusion of a significant proportion of the population from social life, workplaces, education, and safe healthcare. The risk of exposure to SARS-CoV-2 endured by those who are not in the position to protect themselves, including many children, can result in death, disease, forms of " social death ", stigmatization and harassment, in particular of Covid survivors, clinically vulnerable and Covid-aware people.

While this remains unclear in the political declaration, we caution that references to mental health have been used by some to justify the end of effective protections against SARS-CoV2. However, the suffering and concerns of people " evicted " from public spaces since the start of the pandemic, and of people disabled by the virus, are never appropriately mentioned. In addition, we raise again the necessity to address strongly and adequately the damage of SARS-CoV-2 infection to human health, which can target basically all organs and body systems. Similarly, the role of private companies should be further clarified, including by making clear that the health and well-being of populations are given priority over financial profits.

Moreover, we were unable to find any Long Covid or Covid-aware advocacy organization or advocate involved in the drafting of the declaration, when we consulted WHO documents, and as Long Covid is not being mentioned, it seems that none was consulted.

Many of these concerns have been raised recently to the main stakeholders, upstream of the high level meeting.

A high-level meeting about the response to pandemics should answer the questions and issues of the very people directly impacted by the ongoing SARS-CoV-2 spread.

Finally,
This declaration contains many points of concern, and its signature by Heads of State and Government, the WHO, and the United Nations, represents to us a global agreement for inaction.
-Dr Elisa Perego, MA, PhD, researcher, Long Covid advocate and patient-researcher, University College London (UCL), Italy

-Gurdasani Deepti, Associate Professor of AI in Public Health, University of New South Wales, Sydney, Australia

-Pauline Nexon, Auxiliaire de puériculture, association #ApresJ20 France

-David Church, BSc, MB, ChB, JCPTGP, ex-MRCGP, GP/Family Physician, member of MPS/DiU, past Medical Officer Special Scale to 2 Crown Health Enterprises

-Danilo Buonsenso, pediatrician, Italy

-David Kirby, retired general medical practitioner, Member of Doctors in Unite, UK.

-Louis Lebrun, MD, PhD, specialized in Public Health, France

-Melissa Smallwood, Researcher, World Health Network

-Dre Corinne Depagne, Pneumologist, France

-Desmond WHYMS, Public Health Specialist, France

-Michaël Rochoy, MD, PhD, General Practitioner, France

-Michael Collins Morton, Writer, UK

-George Carter, M. Founder/Dir, Fdn for Integrative AIDS Research (FIAR)

-Councillor Frank Adlington-Stringer, North East Derbyshire District Council (Green Party), UK

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Final letter UN political declaration - Pandémies

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"Without a treaty, the world will remain as unprepared for the next pandemic as it was for COVID-19, which killed roughly 7 million people and cost the global economy more than US$12 trillion. But there can be no compromise on one thing: there must be equity in access to vaccines, medicines and other supplies needed to save lives".

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"Without a treaty, the world will remain as unprepared for the next pandemic as it was for COVID-19, which killed roughly 7 million people and cost the global economy more than US$12 trillion. But there can be no compromise on one thing: there must be equity in access to vaccines, medicines and other supplies needed to save lives".

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https://www.nature.com/articles/d41586-023-02904-y

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Talks are stalling, but everyone benefits when the fruits of vaccine and drugs research are shared equitably.

Proclamations of equity and solidarity will be heard this week as diplomats meet at the United Nations headquarters in New York City to talk about preparing for future pandemics. But these will be hollow sentiments. In spite of a promising start to talks on the world's first treaty on pandemic prevention and preparedness, negotiations have stalled. Tensions between countries are so high that an agreement by the target date of May 2024 is now unlikely.

Compromise must be found. Without a treaty, the world will remain as unprepared for the next pandemic as it was for COVID-19, which killed roughly 7 million people and cost the global economy more than US$12 trillion. But there can be no compromise on one thing: there must be equity in access to vaccines, medicines and other supplies needed to save lives.

This issue has been the chief sticking point in the negotiations so far. To break the deadlock, countries must commit to licensing the intellectual property (IP) and sharing the knowledge needed to make vaccines and drugs with qualified manufacturers in low- and middle-income countries (LMICs) in a pandemic. Then, all regions of the world will be able to produce their own vaccines and drugs rather than relying on promises of supplies from other countries that, predictably and understandably, will prioritize protecting their own populations.

But the United States and the European Union have been reluctant to make concrete commitments that would ensure that vaccines and therapeutics are distributed more equitably. And yet, they have pushed strongly for the treaty to include a binding provision that all countries share samples and genomic sequences of pathogens.

Eswatini, on behalf of 47 African countries, has proposed a trade-off. It states that these countries would consider rules on sharing genetic data and other outbreak information provided all member states of the World Health Organization (WHO) agree on an "access and benefit sharing mechanism". It would be a system promising access to data in return for the benefits developed on the basis of those data - such as medicines and vaccines.

The logic of this proposal is compelling. Under existing international regulations, all nations must sound the alarm and share pathogen data in the event of a disease outbreak. Wealthy countries have the upper hand because they have the research and biotechnology capacity to act swiftly on the information and put it to use making lifesaving products. Countries with less capacity must wait for action by others, and then hope for goodwill.

This imbalance was on display during the COVID-19 pandemic. Take what happened in the case of the Omicron variant of the coronavirus SARS-CoV-2. South African researchers alerted the world to the emergence of Omicron and rapidly shared its genome sequence. And yet the country was unable to obtain COVID-19 vaccines made by US and European pharmaceutical companies for much of 2021.

Make access binding

To lessen the reliance on goodwill, many middle-income nations in Africa, Asia and Latin America are also pushing to make more medicines and vaccines themselves and to expand their own research-and-development capacity. One way to do this is for the pandemic treaty to contain binding stipulations around sharing patents and transferring technology during emergencies. Another way is through concrete commitments from high-income countries to help fund the building of scientific expertise and infrastructure in lower-income countries, along with funding for strengthening regulatory institutions.

A number of countries have also put forward the idea of attaching conditions to taxpayer-funded research to ensure that the results are openly available, that IP is licensed and that international collaborations are enhanced.

Predictably, opposition to all such options is fierce. The International Federation of Pharmaceutical Manufacturers and Associations, based in Geneva, Switzerland, has said it opposes any mechanism that links access to samples and genomes with the distribution of pharmaceutical products. It warns that provisions that mandate IP licensing in an emergency will hamper innovation, and stresses that agreements on drug and vaccine sharing must be voluntary.

Last year, the group created a separate, non-binding agreement called the Berlin Declaration, under which pharmaceutical and biotechnology companies promise to reserve an allocation "of real-time production of vaccines, treatments and diagnostics for priority populations in lower income countries" during a pandemic.

The United States and the European Union, which have historically backed pharmaceutical-industry positions in such negotiations, have also asserted that any effort to transfer technologies to LMICs needs to be voluntary. At pandemic-treaty negotiation meetings, the US representative at the talks, Pamela Hamamoto, has suggested that IP conditions don't belong in the pandemic treaty and are better handled by the World Trade Organization (WTO).

Such arguments show how little has been learnt from the COVID-19 pandemic, and how quickly memories are fading. South Africa and India did indeed co-lead a campaign at the WTO for IP to be relaxed during the pandemic. Although the move eventually had partial backing from the United States, the EU was opposed. And there was a voluntary mechanism, called COVAX, to ensure that vaccines and therapeutics reached poorer countries. As Nature and others reported, it largely failed because high-income countries and pharmaceutical companies did not keep their side of the bargain (Nature 592, 165-166; 2021). In addition, bilateral donations of vaccines promised by wealthy countries often showed up late and near their expiry dates, leaving low-income nations to face surges unprotected. More than one million people are estimated to have died as a result of vaccine hoarding.

A legally binding pandemic agreement is required precisely because promises of equity do not translate into equity in practice when there is a crisis. Some compromise will be necessary. There might need to be provisions that, for example, incentivize innovation by pharmaceutical companies alongside commitments to share IP. But any agreement must put protecting people - no matter where they live - at its heart. There will be another pandemic, and when it comes, the world will again be made to suffer if those who have money and research power repeat their behaviour during COVID-19.
doi: https://doi.org/10.1038/d41586-023-02904-y

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Why the pandemic treaty risks becoming COVID-19 groundhog day

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Talks are stalling, but everyone benefits when the fruits of vaccine and drugs research are shared equitably. Talks are stalling, but everyone benefits when the fruits of vaccine and drugs research are shared equitably.

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"Molnupiravir, an antiviral drug used to treat patients with COVID-19, appears to be driving SARS-CoV-2 to mutate and evolve, with some of these new viruses being transmitted onwards, a new study has shown. It is not clear, however, whether these mutated viruses pose an increased risk to patients or are able to evade the vaccine".

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"Molnupiravir, an antiviral drug used to treat patients with COVID-19, appears to be driving SARS-CoV-2 to mutate and evolve, with some of these new viruses being transmitted onwards, a new study has shown. It is not clear, however, whether these mutated viruses pose an increased risk to patients or are able to evade the vaccine".

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https://www.news-medical.net/news/20230925/COVID-drug-molnupiravir-appears-to-be-driving-SARS-CoV-2-to-mutate-and-evolve.aspx

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Molnupiravir, an antiviral drug used to treat patients with COVID-19, appears to be driving SARS-CoV-2 to mutate and evolve, with some of these new viruses being transmitted onwards, a new study has shown. It is not clear, however, whether these mutated viruses pose an increased risk to patients or are able to evade the vaccine.

The drug works by disrupting the virus's genome, causing it to develop random mutations as it replicates, weakening the virus to prevent replication, thereby enabling clearance of infection.

But in research published today in Nature, scientists have shown that in some cases, mutated forms of the virus have been able to be transmitted from patients treated with molnupiravir and spread within the community.

Molnupiravir is one of a number of drugs being used to fight COVID-19. It belongs to a class of drugs that can cause the virus to mutate so much that it is fatally weakened. But what we've found is that in some patients, this process doesn't kill all the viruses, and some mutated viruses can spread. This is important to take into account when assessing the overall benefits and risks of molnupiravir and similar drugs."

Dr Christopher Ruis, Department of Medicine, University of Cambridge

Molnupiravir, marketed under the brand name Lagevrio, is licensed for the treatment of COVID-19 in several countries, including the UK, USA and Japan. It has been used to treat the disease since late 2021.

In the body, molnupiravir is converted into a molecule that disrupts the genome of the SARS-CoV-2 virus, introducing some nucleotide mutations in its RNA - randomly changing some Cs to Ts and some Gs to As. These changes mean that as the virus replicates, its progeny get weaker, reducing how quickly the virus is able to replicate and ridding the body of the virus.

However, concern has been expressed that in some cases, a number of mutated viruses may not be killed off quickly enough and so are able to infect other individuals, potentially allowing new mutated viruses to spread.

During the COVID-19 pandemic, a number of countries - spearheaded by the Cambridge-led COVID-19 Genomics UK Consortium - sequenced virus samples, depositing the information in databases such as the Global Initiative on Sharing All Influenza Data (GISAID) and the International Nucleotide Sequence Database Collaboration (INSDC). This allowed scientists and public health agencies to track the evolution and spread of the virus, and in particular to look out for so-called 'variants of concern' - versions of the virus with mutations that might make them more transmissible, more lethal, or able to evade the immune system of vaccinated individuals, such as the Delta and Omicron variants.

A team of researchers from the UK and South Africa noticed a number of viral genomes that contained a large number of mutations, particularly where Cs had changed to Ts and Gs to As. While C-to-T mutations are relatively common overall in SARS-CoV-2 evolution, G-to-A mutations occur much less frequently, and a higher proportion of G-to-A mutations is associated with molnupiravir treatment.

The team then analyzed a family tree of more than 15 million SARS-CoV-2 sequences in the GISAID and INSDC databases looking for which mutations had occurred at each point in the virus's evolutionary history. They found that viruses with this signature of mutations had begun to emerge almost exclusively from 2022 onwards and in countries and age groups where molnupiravir was being widely used to treat COVID-19.

To confirm the link, the researchers examined treatment records in England and found that at least one in three of viruses showing the mutational signature involved the use of molnupiravir.

The researchers also saw small clusters of patients infected with mutated viruses, which suggests that these new viruses were being passed from one person to another. However, none of the known variants of concern has so far been linked to the use of molnupiravir.

Dr Theo Sanderson from the Francis Crick Institute, said: "COVID-19 is still having a major effect on human health, and some people have difficulty clearing the virus, so it's important we develop drugs which aim to cut short the length of infection. But our evidence shows that a specific antiviral drug, molnupiravir, also results in new mutations, increasing the genetic diversity in the surviving viral population.

"Our findings are useful for ongoing assessment of the risks and benefits of molnupiravir treatment. The possibility of persistent antiviral-induced mutations needs to be taken into account for the development of new drugs which work in a similar way."

The research was funded by Wellcome, Cancer Research UK, the Medical Research Council, National Institute for Health and Care Research, Fondation Botnar, UK Cystic Fibrosis Trust and the Oxford Martin School.

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COVID drug molnupiravir appears to be driving SARS-CoV-2 to mutate and evolve

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Molnupiravir, an antiviral drug used to treat patients with COVID-19, appears to be driving SARS-CoV-2 to mutate and evolve, with some of these new viruses being transmitted onwards, a new study has shown. It is not clear, however, whether these mutated viruses pose an increased risk to patients or are able to evade the vaccine.

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"Pfizer Inc's chief executive said on Tuesday that almost 250,000 courses of the drugmaker's oral antiviral COVID-19 treatment Paxlovid were being administered per week as cases surged in the United States".

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"Pfizer Inc's chief executive said on Tuesday that almost 250,000 courses of the drugmaker's oral antiviral COVID-19 treatment Paxlovid were being administered per week as cases surged in the United States".

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https://www.reuters.com/business/healthcare-pharmaceuticals/about-250000-courses-covid-pill-paxlovid-being-administered-per-week-pfizer-ceo-2023-09-26/

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Sept 26 (Reuters) - Pfizer Inc's (PFE.N), opens new tab chief executive said on Tuesday that almost 250,000 courses of the drugmaker's oral antiviral COVID-19 treatment Paxlovid were being administered per week as cases surged in the United States.

Speaking at the Cantor Fitzgerald Annual Healthcare Conference, Chief Executive Officer Albert Bourla said the company is still uncertain about when Paxlovid, which is currently being distributed by the government, will receive approval to be sold in the U.S. commercial market.

Paxlovid, taken for five days beginning shortly after onset of symptoms, is used to treat adults at high risk of hospitalizations and deaths from COVID-19.

Bourla, however, said Pfizer is ready to supply its COVID-19 vaccines with a smooth transition to the commercial market.

"There is enough product that has been already manufactured and we keep manufacturing," Bourla said. "We are very confident that the market will be very well supplied."

In the first week after updated COVID-19 vaccines became available in the U.S., there have been hiccups with its rollout as people have reported being turned away from pharmacies for the shots.

Pfizer has sold nearly 24 million courses of Paxlovid to the U.S. government, which has distributed only about 15 million courses so far, according to U.S. Department of Health and Human Services data.

According to IQVIA data published by research analysts, the oral antiviral COVID-19 treatment Paxlovid hit around 217,000 prescriptions in the U.S. in the week of Sept. 1, but has dropped since then.

Keep up with the latest medical breakthroughs and healthcare trends with the Reuters Health Rounds newsletter. Sign up here.

Reporting by Sriparna Roy in Bengaluru; Editing by Shweta Agarwal

Our Standards: The Thomson Reuters Trust Principles., opens new tab

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About 250,000 courses of COVID pill Paxlovid being administered per week - Pfizer CEO

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Pfizer Inc's chief executive said on Tuesday that almost 250,000 courses of the drugmaker's oral antiviral COVID-19 treatment Paxlovid were being administered per week as cases surged in the United States.

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"Long COVID patients had specific differences in immune and hormone function than other people, blood tests showed".

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"Long COVID patients had specific differences in immune and hormone function than other people, blood tests showed".

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https://www.medpagetoday.com/neurology/longcovid/106485

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Long COVID patients had specific differences in immune and hormone function than other people, blood tests showed.

Compared with matched controls, people with long COVID had marked differences in circulating myeloid and lymphocyte populations, reported Akiko Iwasaki, PhD, of Yale University in New Haven, Connecticut, and co-authors in .

Long COVID patients had exaggerated humoral responses directed against SARS-CoV-2. In addition, their antibody responses were higher against other pathogens that weren't SARS-CoV-2, especially Epstein-Barr virus (EBV).

An algorithm that incorporated blood test and self-reported survey data showed diagnostic potential with an area under the curve (AUC) of 0.94, Iwasaki and co-authors found.

"We found a number of immunological and hormonal factors that collectively are able to distinguish people with versus without long COVID at 94% accuracy," Iwasaki told MedPage Today. "This study speaks to the underlying biological causes of long COVID and provides a basis for future studies that interrogate various therapies that target the root causes of this disease."

"The reduced cortisol levels found in the long COVID patients suggest hypothalamus-pituitary-adrenal imbalance," she pointed out. "The elevated activated B cells and exhausted T cells suggest persistent antigen and potentially persistent virus infection. The EBV reactivation, which was demonstrated by others also, inform about a subset of patients who may benefit from EBV-targeting therapies."

This work is "a crucial first step towards identifying a set of biological differences between people with and without long COVID" and may lead to novel blood biomarkers for an objective diagnosis of long COVID, co-author David Putrino, PhD, of Icahn Mount Sinai in New York City, told MedPage Today.

The study "provides physicians with important insights by highlighting the fact that people with long COVID show measurable signs of hormonal and immunological dysfunction, which should serve as further irrefutable evidence that long COVID is not a functional or psychosomatic diagnosis," Putrino said.

Long COVID symptoms -- ones that lasted more than 3 months after acute infection -- affected 7.5% of U.S. adults according to 2022 CDC data. By June 2023, that percentage fell to 6%.

Symptoms of long COVID can include postexertional malaise, fatigue, brain fog, dizziness, gastrointestinal symptoms, palpitations, changes in sexual desire or capacity, loss of or change in smell or taste, thirst, chronic cough, chest pain, and abnormal movements.

In their analysis, Iwasaki and colleagues evaluated data from about 273 people with and without long COVID from Yale and two Mount Sinai locations.

The researchers looked at several groups, including people with no previous SARS-CoV-2 infection, those who had fully recovered after COVID, and those with active long COVID symptoms for 4 months or longer after COVID. The median length of symptoms in the last group was 12 months after acute infection.

Participants completed questionnaires about symptoms, medical history, and health-related quality of life, and provided blood samples. Most acute infections in the long COVID group occurred early in 2020, when parental SARS-CoV-2 strains drove most new cases.

Long COVID participants had a mean age of 46 and convalescent controls had a mean age of 38, but the two groups did not differ in sex or hospitalization for acute COVID. The aggregated medical history of the two groups did not differ in baseline prevalence of anxiety or depression.

Fatigue (87%), brain fog (78%), memory difficulty (62%), and confusion (55%) were the most common self-reported symptoms in the long COVID group. Postural orthostatic tachycardia syndrome (POTS) also was prevalent; 38% of people with long COVID in the study had formal diagnostic testing and clinical evaluation. Half of participants with long COVID reported negative effects on employment status.

Serum cortisol was the most significant predictor of long COVID status. Other biomarkers indicated abnormal T cell activity and reactivation of multiple latent viruses, including EBV and other herpesviruses.

The findings on EBV, herpesviruses, and low cortisol are especially important, observed Ziyad Al-Aly, MD, of Washington University in St. Louis and chief of research and development at the VA St. Louis Healthcare System, who wasn't involved with the research.

"They may help inform treatment trials," he told MedPage Today. "For example, whether treating EBV or cortisol replacement would ameliorate symptoms and improve outcomes would need to be considered in the light of these findings."

People with long COVID often are told the disease is "all in your head," Al-Aly noted.

"This study provides objective evidence of significant differences in the immune profiles of people with long COVID versus matched controls." he said. "I hope this puts the 'it's all in your head' idea to rest."

Judy George covers neurology and neuroscience news for MedPage Today, writing about brain aging, Alzheimer's, dementia, MS, rare diseases, epilepsy, autism, headache, stroke, Parkinson's, ALS, concussion, CTE, sleep, pain, and more. Follow

Disclosures

Primary Source

Nature

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Long COVID Blood Tests Show Distinct Immune and Hormone Function

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Algorithm may help predict who gets long COVID

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"Many people with long Covid had much lower levels of cortisol, showed signs of B-cell activation and T-cell exhaustion, other latent viruses were reactivated".

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"Many people with long Covid had much lower levels of cortisol, showed signs of B-cell activation and T-cell exhaustion, other latent viruses were reactivated".

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https://www.bloomberg.com/opinion/articles/2023-09-27/long-covid-is-real-now-the-evidence-is-piling-up

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Long Covid Is Real. Now the Evidence Is Piling Up.

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A new study finds evidence of hormone imbalances and other biomarkers that can cause symptoms to linger.

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"Our aim is to lay the foundation for a broader coalition of organizations, so that our collective efforts may ultimately serve to help improve care and outcomes across the patient populations who are coping with infection-associated chronic illnesses".

# data[].attributes.subject
"Our aim is to lay the foundation for a broader coalition of organizations, so that our collective efforts may ultimately serve to help improve care and outcomes across the patient populations who are coping with infection-associated chronic illnesses".

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https://mailchi.mp/f7a1cbfadde1/join-our-workshop-on-infection-associated-chronic-conditions-9400553?e=1737662aee

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Hello,

Join us for our national webinar to advance the development and continuation of an IACC-speciﬁc coalition, led by The Long Covid Alliance, Solve ME/CFS Initiative, COVID-19 Longhauler Advocacy Project, Dysautonomia International, and Patient-Led Research Collaborative, along with support from the CDC Foundation - on October 24th, 2023, at 12pm ET/ 9am PT.

Our aim is to lay the foundation for a broader coalition of organizations, so that our collective efforts may ultimately serve to help improve care and outcomes across the patient populations who are coping with infection-associated chronic illnesses.

If you have not already done so, please register here:
Registration link: https://bit.ly/IACCPACWebinar

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Register for the The Infection-Associated Chronic Conditions Patient Advocacy Coalition (IACCPAC) webinar

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Hello, Join us for our national webinar to advance the development and continuation of an IACC-speciﬁc coalition, led by The Long Covid Alliance, Solve ME/CFS Initiative, COVID-19 Longhauler Advocacy Project, Dysautonomia International, and Patient-Led Research Collaborative, along with support from the CDC Foundation - on October 24th, 2023, at 12pm ET/ 9am PT.

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"Overall, the survey found that many US adults underestimate the seriousness of these respiratory diseases". Nat'l Foundation of Infectious Diseases:

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"Overall, the survey found that many US adults underestimate the seriousness of these respiratory diseases". Nat'l Foundation of Infectious Diseases:

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https://www.nfid.org/resource/2023-national-survey-attitudes-about-influenza-covid-19-respiratory-syncytial-virus-and-pneumococcal-disease/

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The National Foundation for Infectious Diseases (NFID) commissioned an annual survey to better understand beliefs about influenza (flu), COVID-19, respiratory syncytial virus (RSV), and pneumococcal disease, as well as attitudes and practices around vaccination.

Overall, the survey found that many US adults underestimate the seriousness of these respiratory diseases. As a result, many do not plan to get vaccinated and are not confident in the safety and effectiveness of vaccines. These findings underscore the need to raise awareness of the benefits of vaccines and highlight the importance of strong vaccine recommendations from healthcare professionals. The survey, conducted August 10-14, 2023, included 1,000 complete responses-913 via the web and 87 via telephone-from US adults age 18 years and older representing the 50 states and the District of Columbia.

Summary of Key Results

Attitudes and Practices around Flu Vaccination

Overall, most US adults believe annual flu vaccination is the best protection against flu, but many do not plan to get vaccinated against flu during the 2023-2024 season.

65% agree that annual flu vaccination is the best preventive measure against flu-related hospitalizations and deaths, but 43% say they do not plan to or are unsure they will get vaccinated against flu this season

72% of adults age 65 years and older plan to get a flu vaccine, compared with only 52% of adults age 18-64 years

Among those who do not plan to get a flu vaccine, top reasons cited include:¹

32% are concerned about potential side effects from the vaccine

31% do not trust vaccines

27% do not think vaccines work very well

27% are concerned about getting sick from vaccines

Only 22% of US adults are very or extremely concerned about themselves or someone in their family getting infected with flu

More than 1 in 4 US adults (28%) who are at higher risk² for flu-related complications said that they were not planning to get vaccinated this season

Sources of Information and Trust

Healthcare professionals are the primary and most trusted source of information about flu vaccines.

Most US adults (75%) trust healthcare professionals a great deal or a lot³, far more than other sources

54% of US adults trust the Centers for Disease Control and Prevention (CDC) a great deal or a lot and 47% trust state and local health departments a great deal or a lot

Adults age 18-64 years are less trusting of doctors (63%) than adults age 65 years and older are (80%)

Attitudes and Intentions around COVID-19

Only 23% of US adults are very or extremely concerned about themselves or someone in their family getting infected with COVID-19

Only 40% of US adults plan to get an updated COVID-19 vaccine

Among those who do not plan to get an updated COVID-19 vaccine, nearly half (48%) are concerned about side effects from the vaccine. Others reported that they:⁴

Do not trust vaccines (34%)

Do not think that vaccines work very well (28%)

Are concerned about getting sick from vaccines (27%)

Do not think COVID-19 is a serious illness (13%)

Attitudes and Intentions around RSV

Only 19% of US adults are very or extremely concerned about themselves or someone in their family getting infected with RSV

Among adults age 60 years and older, only 40% plan to get an RSV vaccine

Among US adults age 60 years and older who do not plan to get an RSV vaccine, top reasons cited include:⁵

Concerns about side effects from the vaccine (33%)

Do not trust vaccines (28%)

Have not been advised to get an RSV vaccine (27%)

Concerns about getting sick from the vaccine (25%)

Concerns about Flu and COVID-19 Vaccine Coadministration

Most US adults (62%) would not or are unsure about getting vaccinated against flu and COVID-19 at the same time

Only 38% of US adults would get a flu and COVID-19 vaccine at the same time, if offered

Among those who would not get a flu and COVID-19 vaccine at the same time, top reasons cited include:⁶

Concerns about the side effects from getting both vaccines at the same time (56%)

Do not think it is safe to get both at the same time (37%)

Have not been advised to get both at the same time (21%)

Do not think the vaccines will work well if received at the same time (18%)

Attitudes around Testing and Treatment for Flu, COVID-19, and RSV

2 in 3 US adults (66%) would use an at-home test, if available, that would accurately and quickly diagnose flu, COVID-19, and RSV at the same time

Approximately 3 in 4 US adults (78%) would take an antiviral medication to help reduce severe flu or COVID-19 symptoms if prescribed by a doctor or other healthcare professional

Masking Behaviors This Fall and Winter

Only about 1 in 4 US adults (26%) report they will wear a mask in healthcare settings this fall and winter

Black (39%) and Hispanic (33%) adults are more likely than White (19%) adults to wear a mask in a doctor's office, pharmacy, or hospital this season

Knowledge and Attitudes around Pneumococcal Disease

40% of those at higher risk⁷ for pneumococcal disease have been advised to get a pneumococcal vaccine, sometimes referred to as a pneumonia vaccine
Among those who have been advised to get vaccinated, the majority (79%) have received a pneumococcal vaccine

Among those who do not plan to get a pneumococcal vaccine, the top reason cited (38%) was that they have not been advised to do so

Only 22% of US adults are very or extremely concerned about themselves or someone in their family getting infected with pneumonia

Key Messages

Survey findings reinforce the importance of raising awareness and addressing misconceptions about flu, COVID-19, RSV, and pneumococcal disease, and the need for healthcare professionals to provide strong vaccine recommendations for their patients. Overall, survey findings underscore the need to build trust and dispel myths about vaccines by informing the public that even in cases when vaccination does not prevent infection completely, it can reduce the duration and severity of illness and can help prevent serious complications, including hospitalization and death.

Safe, effective vaccines are available in the US to help protect against flu, COVID-19, RSV, and pneumococcal disease

An annual flu vaccine is recommended for everyone age 6 months and older

Updated COVID-19 vaccines are now recommended for everyone age 6 months and older

New prevention tools, including vaccines and monoclonal antibodies, are now available to prevent RSV-related complications among those most at risk

Vaccination is a critical part of the routine management of older adults, patients with chronic health conditions, and pregnant women

Vaccines cannot cause the diseases they are designed to prevent

Flu vaccines contain either killed or weakened viruses, making it impossible to get the disease from the vaccine

None of the COVID-19 vaccines contain the live virus that causes COVID-19

Potential side effects associated with vaccines are uncommon and much less severe than the diseases they prevent

Vaccines are safe:

All recommended vaccines in the US are required to go through extensive safety testing before they are licensed or authorized, and all vaccines continue to undergo intensive post-licensure safety monitoring

For more than 50 years, hundreds of millions of individuals in the US have safely received seasonal flu vaccines⁸

Millions of COVID-19 vaccine doses have been given around the world, and serious adverse events are rare

It is safe to get a flu vaccine at the same time as a COVID-19 vaccine

Getting vaccinated, washing hands, wearing a mask, and staying home when you are sick can help stop the spread of flu, COVID-19, and other respiratory diseases

About the National Foundation for Infectious Diseases

Founded in 1973, the National Foundation for Infectious Diseases (NFID) is a non-profit 501(c)(3) organization dedicated to educating and engaging the public, communities, and healthcare professionals about infectious diseases across the lifespan. For more information, visit www.nfid.org

About the Survey

This NFID-sponsored survey was conducted by NORC at the University of Chicago. Data were collected using the AmeriSpeak Omnibus ®, a monthly multi-client survey using the NORC probability-based panel designed to be representative of the US household population.

Interviews for this survey were conducted between August 10 and 14, 2023, with adults age 18 years and older representing the 50 states and the District of Columbia. Randomly selected US households were sampled with a known, non-zero probability of selection from the NORC National Sample Frame and 1,000 completed the survey-913 via the web and 87 via telephone. Interviews were conducted in English. The final stage completion rate is 16.0%, the weighted household panel response rate is 20.6%, and the weighted household panel retention rate is 80.3%, for a cumulative response rate of 2.6%. The overall margin of sampling error is +/- 4.3 percentage points at the 95% confidence level, including the design effect. The margin of sampling error may be higher for subgroups.

Once the sample has been selected and fielded, and all the study data have been collected and made final, a poststratification process is used to adjust for any survey nonresponse as well as any noncoverage or under and oversampling resulting from the study specific sample design. Poststratification variables included age, gender, census division, race/ethnicity, and education. Weighting variables were obtained from the 2023 Current Population Survey. The weighted data reflect the US population of adults age 18 years and older.

¹ Top responses reflect survey respondent answers when asked to select "all that apply."

² People at higher risk for complications from flu or pneumococcal disease as defined in the survey include those age 65 years and older, adults who currently or ever smoked tobacco, and those who have or ever have had diabetes, asthma, chronic obstructive pulmonary disease (COPD), heart disease, stroke, or kidney disease.

³ Responses reflect survey respondents ranking selections on a scale of "trust a great deal/a lot," "trust somewhat," and "trust a little/not at all." Healthcare professionals include doctors, nurses, and pharmacists.

⁴ Top responses reflect survey respondent answers when asked to select "all that apply."

⁵ Top responses reflect survey respondent answers when asked to select "all that apply."

⁶ Top responses reflect survey respondent answers when asked to select "all that apply."

⁷ People at higher risk for complications from flu or pneumococcal disease as defined in the survey include those age 65 years and older, adults who currently or ever smoked tobacco, and those who have or ever have had diabetes, asthma, COPD, heart disease, stroke, or kidney disease.

⁸ Centers for Disease Control and Prevention. Flu Vaccine Safety Information: Q&A. Updated August 25, 2023. www.cdc.gov/flu/prevent/general.htm. Accessed September 15, 2023.

September 2023

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Attitudes about Influenza, COVID-19, Respiratory Syncytial Virus, and Pneumococcal Disease

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NFID 2023 national survey on flu, RSV, COVID-19, and pneumococcal disease

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"To say that this is a textbook virus, it doesn’t mean that it’s not killing people. Objectively, it’s still killing more people than any other infectious disease. What it means is that we could’ve taken action based on what we knew, rather than waiting around to prove everything and publish papers in Nature and Science talking about things we already knew".

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"To say that this is a textbook virus, it doesn’t mean that it’s not killing people. Objectively, it’s still killing more people than any other infectious disease. What it means is that we could’ve taken action based on what we knew, rather than waiting around to prove everything and publish papers in Nature and Science talking about things we already knew".

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https://www.nytimes.com/2023/10/05/opinion/covid-pandemic-michael-mina.html?smid=url-share

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Opinion | We Should Have Known So Much About Covid From the Start

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The immunologist Michael Mina says even its worst aspects should have been expected from a new pathogen for which there was no immunity.

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 “In honour of those patients, we need to ensure that we do not lose the momentum we have in long COVID research, and that we take this opportunity to build our understanding and knowledge of post-infection syndromes more generally.”

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 “In honour of those patients, we need to ensure that we do not lose the momentum we have in long COVID research, and that we take this opportunity to build our understanding and knowledge of post-infection syndromes more generally.”

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There is more to worry about than long Covid, study shows. You could get a long cold, too

https://www.cnn.com/2023/10/06/health/long-colds-study-wellness

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There is more to worry about than long Covid, study shows. You could get a long cold, too | CNN

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Even if you're on the other side of a cold, that doesn't always mean you're back to normal. Respiratory symptoms can last, a new study shows. Experts say to take that seriously.

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"Although each reinfection should theoretically be milder than the previous one for most people, doctors said, cases like Keele’s do happen. McComsey estimated that about 20% to 25% of her patients report that their reinfections are more severe".

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"Although each reinfection should theoretically be milder than the previous one for most people, doctors said, cases like Keele’s do happen. McComsey estimated that about 20% to 25% of her patients report that their reinfections are more severe".

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https://www.nbcnews.com/health/health-news/covid-5-times-people-describe-illnesses-rcna118132

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Nearly four years after Covid's emergence, plenty of people have tested positive at least twice. But an unlucky group has been hit with reinfection after reinfection.

"I've seen a few patients with five infections," said Dr. Grace McComsey, vice dean for clinical and translational research at Case Western University. "Sadly, they were immunized and they still got Covid five times."

Reanna Sunford Clark, a 47-year-old day care teacher in Portland, Oregon, says she has gotten Covid six times.

"It does make me concerned that I have this predisposition to it," Clark said.

Given that the age group she works with isn't known for clean hands, Clark added, "it makes sense that I am exposing myself to a more likely source - but on the flip side of that, I feel like I've had it so many times, I should have more immunity than I do."

After her first infection in November 2021 - which landed her in the ER with shortness of breath - Clark's subsequent illnesses mostly brought cold-like symptoms that resolved within three or four days, she said.

"Every time I've gotten it, I've had a sore throat," she added.

Clark is one of five people interviewed by NBC News who described what it has been like to get Covid at least five times. All five either tested positive at home, received a positive antibody test later or were diagnosed by a health care provider each time. They provided images of test results, medical records or correspondence with friends or family as verification. Overall, they said, the experiences have left them confused and curious about the reasons for their frequent illnesses.

Three people said their later infections were all less severe than the first - though there wasn't necessarily a clear pattern of milder symptoms with each new illness. Even so, having Covid was still mentally and emotionally exhausting each time, they said, since it disrupted their work and time with loved ones.

Brenda Keele, a 38-year-old resident of Casper, Wyoming, said her symptoms got worse with each round of Covid. Keele recently enduredher fifth and most severe coronavirus infection, which she said caused body aches and trouble breathing.

At the height of that illness, she said, Keele could barely walk and felt "like every single one of my lymph nodes in my body is swollen and painful."

In the two weeks since she stopped testing positive, her symptoms have improved, though she still has lingering congestion, Keele said.

Although each reinfection should theoretically be milder than the previous one for most people, doctors said, cases like Keele's do happen. McComsey estimated that about 20% to 25% of her patients report that their reinfections are more severe.

Keele has chronic heart failure and adrenal insufficiency, so she takes medications that compromise her immune system. Her heart condition has declined over the last year and a half, she said, but doctors aren't sure if Covid is responsible.

Severe reinfections could be more likely if lots of time has elapsed since a person's last Covid shot or if they were exposed to a high viral load, McComsey said.

Keele was vaccinated but did not get booster shots. The others interviewed each said they got at least one booster after their original vaccines.

Emily, a 36-year-old singer in Brooklyn who asked that her last name be withheld to maintain her privacy, said all five of her infections were relatively mild. But she noticed that her symptoms tended to be more severe if several months had passed since her most recent Covid vaccine.

Emily's third infection in May 2022 - six months after her booster shot - was the worst, she said.

"This was more of a body ache, feverish feeling," she said. "I felt laid out for about a week."

Why do some people get Covid so many times?

The Centers for Disease Control and Prevention identified more than 2.7 million Covid reinfections from September 2021 to December 2022 across a set of regions containing about 45% of the U.S. population. But because some states stopped tracking reinfections or never recorded them, it's not clear how common it is to be infected multiple times.

Doctors who study Covid say it's not surprising that some people have gotten Covid more than once a year, given how widely the virus has spread and how frequently cases surge.

"The virus continued to mutate, so it has a way of escaping immunity," said Dr. Miriam Merad, chair of the Department of Immunology and Immunotherapy at ​​Mount Sinai School of Medicine in New York.

There aren't always easy explanations for why a patient has gotten Covid many times, McComsey said, but a few factors could be at play. The most obvious is that if people are immunocompromised, their immunity from a prior infection is more likely to wane.

Getting long Covid could also make people more prone to reinfection, she added, since it's associated with inflammation and blood clots. At least 10% of Covid cases have led to long Covid (defined as symptoms lasting at least 12 weeks), though the rate is higher among people who were hospitalized for their infection.

Merad, meanwhile, noted that because Covid can trigger inflammation in people with underlying health issues, that may contribute to severe symptoms even if the viral infection isn't aggressive itself.

Like Clark, Kiah Williams - a 27-year-old personal trainer in Hemel Hempstead, England - thinks his work setting exposed him to more Covid than other people, given that his job requires in-person interactions in confined indoor spaces.

Williams said his fourth infection produced just one symptom - a runny nose - and his fifth brought only a sore throat.

'It really took a toll on my mental health'

Even with manageable, mild symptoms, several people said getting Covid five-plus times was mentally exhausting.

Each time Williams got sick, he had to take time away from the gym and isolate from his partner.

"Getting sick every other month, it really took a toll on my mental health," he said. "Not being able to even just sit with my partner, just be with her, just talk, because essentially I can't get her sick, well - it was just a lonely time."

Makenzie Boyle, a 28-year-old human resources administrator in San Francisco, went to the emergency room when she was infected with Covid for the first time in December 2020 and was diagnosed with pneumonia. A year later, Boyle was diagnosed with diabetes, which her doctor said was an effect of Covid - research has shown a link between the two conditions.

Boyle's third infection, though mild, exacerbated lingering symptoms from her first illness, such as fatigue and swelling in her extremities. Then after her fifth infection in June, she developed chronic kidney disease and chest pain that hasn't gone away, she said. ( Studies have indicated that Covid can directly infect kidney cells, and consequently contribute to kidney disease.)

Boyle's manifold symptoms, combined with how frequently she has gotten sick, have led her to continue masking in crowded places and ask family members to take Covid tests before they see her.

But those precautions can be isolating.

"Most of my peers are spending the weekends at the bar, at the club, out with friends, going to concerts, and I am by and large isolated and alone," Boyle said.

Her boyfriend, she said, is moving out of their shared home because he works in food service and they don't want to risk exposing her to another infection.

Reinfections do bring a new risk of long Covid, McComsey said: Each time someone gets Covid, it introduces another assault to the immune system that can result in long-lasting symptoms.

However, Merad said, young, healthy people shouldn't panic about getting Covid multiple times.

"We are going to be reinfected, the same way we are reinfected by flu. But the most severe infection was the one that we observed when we were not vaccinated," she said.

Emily said that after getting Covid five times, she feels less worried about the virus' threat.

"I don't want to stay inside to avoid it," she said. "It just seems like something we live with now."

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People who've had Covid at least 5 times describe how the illness changed with each reinfection

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Three people interviewed said their later infections were less severe than their first ones. Even so, getting Covid over and over takes a mental toll.

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"The studies done thus far on long COVID in children have been limited by small sample size, reliance on parental survey rather than interviews, lack of controls, short duration, poor design, and false assumptions about children's viral loads and antibody responses, experts say".

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"The studies done thus far on long COVID in children have been limited by small sample size, reliance on parental survey rather than interviews, lack of controls, short duration, poor design, and false assumptions about children's viral loads and antibody responses, experts say".

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https://www.cidrap.umn.edu/covid-19/not-little-adults-experts-say-long-covid-undercounted-misdiagnosed-kids

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Not ‘little adults’: Experts say long COVID undercounted, misdiagnosed in kids

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Research on long COVID in children is limited, and reported prevalences range widely, from less than 1% to 70%. And while it’s a relatively new condition in an evolving field, experts say it could be better defined and measured through well-designed longitudinal studies that take children’s unique presentations into account.

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"As a result, the National Institute of Health and Care Excellence cautions against using graded exercise therapy for treating post-COVID fatigue. For POTS patients whose condition wasn’t triggered by a COVID-19 infection, exercise can be helpful, but as many have discovered, it’s not a cure, nor is it an effective first-line treatment". 

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"As a result, the National Institute of Health and Care Excellence cautions against using graded exercise therapy for treating post-COVID fatigue. For POTS patients whose condition wasn’t triggered by a COVID-19 infection, exercise can be helpful, but as many have discovered, it’s not a cure, nor is it an effective first-line treatment". 

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https://archive.ph/2023.10.02-231608/https://www.nationalgeographic.com/premium/article/pots-exercise-harm-fatigue-long-covid

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"But doctors who treat people for active Covid infections say they aren’t widely prescribing Paxlovid, since the medication interacts with several common drugs and is only approved for people vulnerable to severe illness — older adults and people with underlying medical conditions".

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"But doctors who treat people for active Covid infections say they aren’t widely prescribing Paxlovid, since the medication interacts with several common drugs and is only approved for people vulnerable to severe illness — older adults and people with underlying medical conditions".

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https://docs.google.com/document/d/1WgexHAYZQ56R08GtYGL8FeOoPvjtaNtARLteMVZWFlA/edit

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A consensus has emerged among experts who study and treat long Covid: Paxlovid seems to reduce the risk of lingering symptoms among those eligible to take it.

The idea is intuitive, experts say. Paxlovid prevents the coronavirus from replicating, so researchers think it may also reduce the risk of an infection causing inflammation or organ damage, which in turn can lead to chronic illness.

Clinical observations and a large study published in March support that theory. Among the 282,000 people in the study who were eligible for Paxlovid, the drug was associated with a 26% lower risk of long Covid.

"Research definitely backs up that it helps prevent lingering symptoms - it helps prevent long Covid," said Ashley Drapeau, director of the Long Covid Clinic at the GW Center for Integrative Medicine.

Some patients who took Paxlovid during their illness also seem to have less severe long Covid symptoms overall than those who did not, according to Drapeau.

But doctors who treat people for active Covid infections say they aren't widely prescribing Paxlovid, since the medication interacts with several common drugs and is only approved for people vulnerable to severe illness - older adults and people with underlying medical conditions.

Data from the Veterans Affairs St. Louis Health Care System indicates that just 30% of patients who qualify for Paxlovid are being prescribed it, said Dr. Ziyad Al-Aly, the system's chief of research and development.

Research from Helix, a genomic data company, similarly showed that around one-third of nonhospitalized adults at risk of severe Covid were prescribed an antiviral from February to June.

"It's really unfortunate that people are not prescribing it enough, especially going into the winter season," said Al-Aly, who authored the March study.

"It's kind of like when a vaccine is available and people are not using it," he added. "It's really, profoundly sad."

Some long Covid patients regret not taking Paxlovid

Reta Greenier, a 61-year-old special education teacher in Saint David, Maine, said she asked her doctor for Paxlovid shortly after testing positive for Covid in August 2022. At the time, she said, she had a cough, a slight fever and fatigue.

"I said, 'I heard there's a medicine out there now that you can take that will make this less severe,'" she recalled. "I didn't know much about long Covid at that point. In fact, I don't think I knew about it at all."

But Greenier's doctor told her he didn't know enough about Paxlovid to feel comfortable writing her a prescription, she said, despite several factors that made her eligible: her age, weight and a history of asthma. Her doctor did not respond to a request for comment.

Since then, Greenier said, she has had long Covid symptoms including painful constipation and a combination of dizziness and an elevated heart rate that makes her feel like she might pass out. In June, she said, she called her attorney's office and asked to update her will.

"I thought I was dying," she said.

Greenier said she can only work part-time now, and wonders whether she would be back full-time if she had taken Paxlovid.

Drapeau said many of her long Covid patients report that they weren't offered Paxlovid or were told by their health care provider that they didn't need it.

"Many of my patients come to me and say, 'If only I had taken the Paxlovid ...'" she said.

Why aren't more people taking Paxlovid?

Drapeau said doctors probably don't consider long Covid as a primary risk factor when deciding whether to prescribe Paxlovid.

"They're thinking, 'How can I prevent this person from being in the hospital?'" she said. "Versus, 'How can I prevent them having lingering symptoms that are going to cause major debility in their life?'"

Doctors, for their part, cite a few other reasons: Paxlovid interacts negatively with some anti-seizure and heart medications, as well as certain drugs that lower blood pressure or cholesterol. The medication can also have side effects, such as diarrhea, nausea and a metallic taste in the mouth.

Doctors also weigh how severe a person's symptoms were the last time they got Covid, if this is not their first infection.

"In general, if you had mild symptoms the first time, you're probably going to have mild symptoms again, and Paxlovid often makes people feel worse," said Dr. Geoffrey Mount Varner, an emergency room physician in Virginia and Maryland.

To a lesser extent, doctors see Paxlovid's potential "rebound" effect as a deterrent as well. A small study found that less than 1% of Covid patients saw their symptoms come back one to two weeksafter taking Paxlovid. Other research that's yet to be peer-reviewed found that 6% of a group of 11,300 Covid patients saw symptoms rebound in the month after they took the medication.

But Al-Aly said concerns about rebounds and side effects are overblown.

"You may have malaise again or fever, but it's all in the acute phase," he said. "It usually gets better a few days later, and in the long term is inconsequential."

A potential treatment option for long Covid?

Paxlovid is taken twice daily, in sets of three pills, for five days. It's the National Institutes of Health 's preferred treatment for mild to moderate Covid and has been approved since December 2021.

At first, doctors touted Paxlovid as a breakthrough: The drug lowered the risk of severe illness and death from Covid by 89% in a clinical trial, and reduced the risk of hospitalization by 51% in a real-world study.

In the spring and summer of 2022, Paxlovid made up a much larger share of prescriptions filled at pharmacies than it did over the same period this year, according to GoodRx's prescription tracker. Now, the weekly share of Paxlovid prescriptions is about the same as last October.

Some experts think the drug might even improve symptoms for patients who already struggle with long Covid. As the theory goes, Paxlovid may help clear lingering virus or viral proteins in the body that continuously aggravate the immune system.

But researchers are still evaluating that application of the drug. The NIH's RECOVER Initiative is giving people Paxlovid for up to 25 days to see if it improves their long Covid symptoms. The first participant in that study was enrolled in July. Studies at the Yale School of Medicine and Karolinska Institutet in Sweden are also investigating Paxlovid as a potential long Covid treatment.

Dr. Benjamin Abramoff, director of the Post-COVID Assessment and Recovery Clinic at Penn Medicine, said he recommends Paxlovid for people with long Covid who get reinfected.

"I've had a couple patients report improvement through that process," he said. "Even if they're not necessarily high risk, I think there's a lot of benefit for many of our patients who have significant long Covid symptoms."

Another unanswered question is whether young, healthy people might benefit from Paxlovid. Though doctors don't have evidence of that yet, Drapeau said there's reason to believe the drug could reduce the risk of long Covid even for people without underlying risk factors.

"It makes sense to me that we give it to a wider population," she said.

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Paxlovid may reduce the chance of long Covid. Why don't doctors prescribe it more?

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Long Covid experts agree that the antiviral pill Paxlovid seems to reduce a person's risk of lasting symptoms. But the drug is no longer very widely prescribed.

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"However, at this year’s ID Week conference in Boston, Igho Ofotokun, MD, MSc, FIDSA, Grady Distinguished Professor of Medicine at the Emory University School of Medicine, shared the latest data that COVID-19 research team, RECOVER, has gathered on Long COVID and its symptoms".

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"However, at this year’s ID Week conference in Boston, Igho Ofotokun, MD, MSc, FIDSA, Grady Distinguished Professor of Medicine at the Emory University School of Medicine, shared the latest data that COVID-19 research team, RECOVER, has gathered on Long COVID and its symptoms".

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https://www.managedhealthcareexecutive.com/view/the-latest-on-long-covid-most-prevalent-symptoms-to-research-underway-idweek-2023

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The investigation to understand Long COVID, or post-acute sequelae SARS-CoV-2 infection (PASC), is still on-going.

However, at this year's ID Week conference in Boston, Igho Ofotokun, MD, MSc, FIDSA, Grady Distinguished Professor of Medicine at the Emory University School of Medicine, shared the latest data that COVID-19 research team, RECOVER, has gathered on Long COVID and its symptoms.

Ofotokun is chair of the RECOVER (Researching COVID to Enhance Recovery in adults) committee, which focuses on understanding the incidence, prevalence, clinical symptoms, organ dysfunction, natural history and biological mechanisms of sequelae of SARS-CoV-2 infection.

One of the recent studies Ofotokun presented and conducted by RECOVER was an ambi-directional longitudinal meta-cohort study, including individuals with and without COVID-19 of all ages and ethnicities. The study followed patients from one year into their COVID infection up to month 48.

Researchers made sure "the population groups affected the most were represented in the study," Ofotokun said.

The participants were categorized into three tiers based on acute and post-acute symptoms, with standardized testing varying across the tiers.

In another study within RECOVER's initiative earlier this year, approximately 9,764 participants were included to develop a definition of Long COVID.

Using a 3-step analysis, researchers identified 12 common symptoms associated with Long COVID, which included post-exertional malaise, fatigue, brain fog, dizziness, GI symptoms, palpitations, sexual desire or capacity, smell or taste issues, thirst, chronic cough, chest pain, and abnormal movements.

Key findings from this study revealed an estimated prevalence of Long COVID in the overall population of roughly 10%. Positivity for Long COVID was more common and associated with more severe manifestations in participants infected in the pre-Omicron era.

Additionally, fully vaccinated individuals showed a lower proportion of Long COVID positivity compared to unvaccinated participants.

Lastly, PASC positivity was more common among those who were reinfected compared to those with one reported infection, indicating a link between reinfections and Long COVID.

The electronic health record was also a component of RECOVER's research.

EHRs have collected data from over 14 million individual patients and helped define clusters of Long COVID, revealing that it is not a homogeneous disease, Ofotokun shared.

Six different clusters were identified, relating to the prevalence of symptoms in different organ systems, including neurologic, metabolic and obesity-related, cardio, and more.

Ofotokun expressed there are ongoing analyses by RECOVER with around 40 independent studies planned.

Researchers are exploring sex differences in Long COVID, refining the definition by adding clinical risk and laboratory findings, and aligning findings from electronic health records with prospective observational studies, he added.

Additionally, investigations into Long COVID in different population groups across the lifespan, including pediatric, pregnant, and aging populations, are underway.

The understanding of Long COVID is expanding, with a high estimated prevalence of 10% or higher and the involvement of almost every organ system, RECOVER research found.

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The Latest on Long COVID - Most Prevalent Symptoms to Research Underway | IDWeek 2023

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At this year's ID Week conference in Boston, Igho Ofotokun, MD, MSc, FIDSA, Grady Distinguished Professor of Medicine at the Emory University School of Medicine, shared the latest data that COVID-19 research team, RECOVER, has gathered on Long COVID and its symptoms.

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"New research published on Monday in Cell implicates both interferons and serotonin in long Covid in a way that brings together those hypotheses and could also explain “brain fog,” or the neurocognitive difficulties people endure".

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"New research published on Monday in Cell implicates both interferons and serotonin in long Covid in a way that brings together those hypotheses and could also explain “brain fog,” or the neurocognitive difficulties people endure".

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https://www.statnews.com/2023/10/16/long-covid-brain-fog-serotonin-interferons/

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Serotonin levels are depleted in long Covid patients, study says, pointing to a potential cause for ‘brain fog’

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Serotonin levels are depleted in long Covid patients, a new study says, pointing to a potential cause for “brain fog.”

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"By challenging the long-held assumption that treating infectious disease is all about tackling acute infection, a moonshot initiative for long COVID could ultimately change the way all of us think about the effects of pathogens on our health".

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"By challenging the long-held assumption that treating infectious disease is all about tackling acute infection, a moonshot initiative for long COVID could ultimately change the way all of us think about the effects of pathogens on our health".

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https://www.nature.com/articles/d41586-023-03225-w

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Long COVID research risks losing momentum – we need a moonshot

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Investing US$1 billion every year for the next ten years into long COVID research could improve the lives of millions and save trillions in economic costs.

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"Hopefully, corporate memory of COVID-19 will endure and trigger a sustained interest and support of both the scientific and public health buckets. If not, many of us will be spending a lot of time awake in bed or having nightmares when asleep"! Dr. Fauci

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"Hopefully, corporate memory of COVID-19 will endure and trigger a sustained interest and support of both the scientific and public health buckets. If not, many of us will be spending a lot of time awake in bed or having nightmares when asleep"! Dr. Fauci

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https://www.science.org/doi/10.1126/scitranslmed.adj9469

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"Rao says he's not sure any drug currently being studied will become a magic bullet, but he’s encouraged by the field’s progress. “My hope is, in the near future, we’ll be able to identify the cause [of Long COVID] and therefore provide more thorough treatment options, rather than treating just the symptoms". 

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"Rao says he's not sure any drug currently being studied will become a magic bullet, but he’s encouraged by the field’s progress. “My hope is, in the near future, we’ll be able to identify the cause [of Long COVID] and therefore provide more thorough treatment options, rather than treating just the symptoms". 

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https://time.com/6327296/long-covid-treatments-tests-research/

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A phenomenal amount of research on Long COVID-the name for chronic symptoms following a case of COVID-19-has been published over the past three years. But scientific advances have yet to bring relief to people who are already sick, a group estimated to include about 5% of U.S. adults but hard to precisely quantify due to the difficulty of diagnosing people correctly.

Researchers are optimistic that breakthroughs are coming. The U.S. National Institutes of Health (NIH) has launched multiple clinical trials focused on potential therapies, and several recent studies have pointed to biomarkers that may help doctors accurately diagnose-and, hopefully, treat-people with Long COVID.

"In the short history of studying this disease, this is probably the most hopeful moment we've ever had," says Christoph Thaiss, an assistant professor of microbiology at the University of Pennsylvania's Perelman School of Medicine who co-authored a recent study on Long COVID in Cell.

More From TIME

The search for biomarkers

Long COVID is currently a disease mostly defined by its symptoms, which range from brain fog and fatigue to headaches and nervous-system dysfunction. There is no single test that can diagnose it-although recent research points to a variety of potential testing methods, from full-body scans to eye exams.

A September study published in Nature was widely heralded as a step toward finally having a blood test to confirm Long COVID. Researchers analyzed blood samples from almost 300 people, some of whom had Long COVID, some of whom had never had COVID-19, and some of whom had it and fully recovered. Long COVID patients tended to have low levels of the stress hormone cortisol, and their blood also often suggested that virus lingered in their bodies-either remnants of the virus that causes COVID-19, or other viruses that had been dormant in the body after prior infections and become reactivated.

Co-author Akiko Iwasaki, an immunobiologist who directs Yale University School of Medicine's Center for Infection and Immunity, says it's unlikely there will ever be a single biomarker for Long COVID, since the disease can look very different from person to person. But when a machine-learning model was trained to pick up on all of those potential signals together, it was able to distinguish the blood of Long COVID patients from the blood of people without the condition with 96% accuracy.

"That doesn't mean we're going to have biomarkers next week," Iwasaki says, "but I think we are moving forward in the right direction."

Thaiss' recent study in Cell found another potential biomarker in the blood of Long COVID patients: low levels of the neurotransmitter serotonin, which is largely produced in the gut and involved in numerous bodily functions. Using stool samples, Thaiss and his colleagues found genetic material from the SARS-CoV-2 virus in the gastrointestinal tracts of a subset of Long COVID patients, mirroring results from other studies. They then hypothesized, and used mice to demonstrate, that this stubborn viral material can trigger an immune response that leads to excess inflammation in the body, in turn hampering the gut's production of serotonin. Inadequate serotonin seems to contribute to a number of neurological symptoms of Long COVID.

The study is important because it "gets us closer to understanding what's happening" in the bodies of people with Long COVID, says Hannah Davis, one of the leaders of the Patient-Led Research Collaborative for Long COVID.

Low levels of cortisol or serotonin could be useful "signals" for assessing people with Long COVID, but-at least for now-they cannot serve as stand-alone diagnostics, says Dr. Adupa Rao, medical director of the COVID Recovery Clinic at the University of Southern California's Keck School of Medicine. For one thing, the studies on potential Long COVID biomarkers have been fairly small and must be replicated in larger groups of patients, Rao says. Beyond that, there are plenty of reasons why someone would have low cortisol or serotonin, including non-COVID viral infections, he says.

Will biomarkers lead to treatments?

Still, Maayan Levy, who co-authored the Cell study and is also an assistant professor of microbiology at UPenn, believes serotonin may be a target for Long COVID treatment. Building on their findings in mice, her group is designing a clinical trial to test whether selective serotonin reuptake inhibitors (SSRIs)- a widely prescribed class of antidepressant, including fluoxetine (Prozac) and escitalopram (Lexapro), used to boost serotonin levels in the brain-are effective against Long COVID. She also plans to test whether supplementing tryptophan, an amino acid that the body uses to make serotonin, may be beneficial.

But Davis is skeptical. SSRIs are already so widely used, she says, that "if SSRIs worked, we would know." And researchers working on ME/CFS, a condition similar enough to Long COVID that many long-haulers meet its diagnostic criteria, have previously warned that tryptophan supplementation may be dangerous for patients. "It would be good to not reinvent the wheel" by re-testing these ideas, Davis says, noting that there is plenty of research on ME/CFS treatment that could inform researchers working on Long COVID.

In her view, there are other, more promising possible treatments in the research pipeline, including antivirals (which could, in theory, destroy remnants of either reactivated viruses or the SARS-CoV-2 virus lingering in the body); drugs that interact with the immune system; and medications that prevent blood clotting.

Rao says he's not sure any drug currently being studied will become a magic bullet, but he's encouraged by the field's progress. "My hope is, in the near future, we'll be able to identify the cause [of Long COVID] and therefore provide more thorough treatment options, rather than treating just the symptoms," Rao says.

In Davis' view, testing treatments may achieve both goals: "Understanding what drugs help patients," she says, "will also help us understand what's actually happening in patient bodies."

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Researchers are getting closer to understanding how to diagnose and treat people with Long COVID.

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"These findings indicate that both COVID-19 and AD have synergistic effects; however, further research is required to elucidate their long-term implications".

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"These findings indicate that both COVID-19 and AD have synergistic effects; however, further research is required to elucidate their long-term implications".

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https://www.nature.com/articles/s41467-023-41879-2

AD= Alzheimer's Disease

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In a recent review published in the Journal of Neurochemistry, researchers evaluate the impact of the coronavirus disease 2019 (COVID-19) on Alzheimer's disease (AD) pathology.

Study: COVID-19 and the impact on Alzheimer's disease pathology . Image Credit: alexialex / Shutterstock.com

Background

COVID-19 primarily affects older individuals with medical disorders that compromise their immunity. The varied neurological manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection indicate that the virus could impact the brain in several ways.

Previous studies have reported that viral infections may result in neurodegeneration. Since COVID-19 and AD share risk factors and pathological characteristics, there have been significant public health concerns regarding the neurological impact of SARS-CoV-2 infection and its probable contribution to AD onset and progression through inflammation.

Pathogenesis and risk factors of AD and COVID-19

AD is characterized by increases in amyloid plaques, neurofibrillary tangles (NFTs), neuroinflammation, and neuronal loss. Extracellular amyloid plaques, which are predominant in the hippocampus and neocortex, develop due to amyloid beta (Aβ) peptide accumulation, which results from amyloidogenic processing and amyloid precursor protein (APP) cleavage by proteolytic enzymes such as beta- and gamma-secretase.

NFTs are abnormal filaments comprising misfolded and abnormally hyperphosphorylated tau proteins that accumulate in axons and dendrites and lead to neuronal loss. NFT accumulation occurs in the entorhinal cortex, CA1, and subiculum hippocampal regions. Aβ accumulation results in glial cell activation and inflammation.

Astrocytes are the most abundant glial cell type in the central nervous system (CNS). Upon activation, astrocytes and microglia secrete pro-inflammatory cytokines such as tissue necrosis factor-alpha (TNF-α), interferon-gamma (IFN-γ), interleukin-1 (IL-1), and IL-6. The release of these cytokines can induce neuronal damage and Aβ production, which is associated with elevated Aβ42/Aβ40 ratios, tau pathology, and neurotoxicity.

Risk factors for COVID-19 include age and certain comorbidities like diabetes, obesity, cardiovascular disease, and hypertension. Previous studies have indicated pre-existing dementia is a prominent risk factor for COVID-19 severity and mortality. Apolipoprotein E4 (APOE4), the strongest genetic risk factor for AD, can also enhance COVID-19 risk.

SARS-CoV-2 infections, neurodegeneration, and Alzheimer's disease

Viral infections such as COVID-19 are associated with an increased risk of cognitive decline and neurodegenerative diseases. SARS-CoV-2 has amyloidogenic properties and can initiate amyloid aggregation. SARS-CoV-2 infection can increase Aβ42 protein neurotoxicity in brain cells, impair Aβ42 clearance from the blood, and enhance amyloid protein aggregation in the cerebrospinal fluid (CSF).

The presence of Aβ42 can enhance SARS-CoV-2 spike (S) protein-angiotensin-converting enzyme 2 (ACE2) interactions, thus facilitating entry into the host and stimulating the release of inflammatory cytokines like IL-1β and IL-6, which are linked to Aβ deposition and impaired neurogenesis in the hippocampus.

ACE2 elevation in AD murine models reduces Aβ42 accumulation in the hippocampus, reduces hyperphosphorylated tau protein and inflammatory cytokine levels in brain cells, and improves cognition. Therefore, ACE2 inhibition, which has been observed during SARS-CoV-2 infection, may worsen AD-related neuroinflammation and pathology.

ACE2 regulates brain-derived neurotrophic factor (BDNF) levels, essential for neurogenesis, cognition, and development. Reduced BDNF can increase tau protein phosphorylation, neuroinflammation, and neurodegeneration among SARS-CoV-2-infected individuals. Researchers have identified ACE2-expressing CNS cells such as microglia, neurons, astrocytes, and oligodendrocytes as probable interventional targets.

Experimental coronavirus infections in the CNS of mice have stimulated astrocytes and microglia related to pro-inflammatory cytokine and chemokine release that activate both the innate and adaptive immunological systems. SARS-CoV-2-induced microglial activation, partly regulated by the NLR family pyrin domain containing 3 (NLRP3) inflammasome, impairs Aβ protein clearance and increases neuroinflammation-related gene expression.

Post-mortem analysis of brains from SARS-CoV-2-infected individuals exhibits gliosis and immune cell accumulation associated with axonal injury and blood-brain barrier (BBB) disruption and, as a result, increased capillary permeability and endothelial damage. Elevated serological neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) levels among moderate-to-severe COVID-19 patients indicate neuronal and astrocytic injury.

One year after severe COVID-19, reduced axonal density has been reported in the superior longitudinal fasciculus corpus callosum and corona radiata of the brain. Alterations in the olfactory cortical and limbic systems, including tissue injury and reduced gray matter thickness, have also been reported.

Conclusions

Overall, the study findings highlight the link between COVID-19 and AD, with SARS-CoV-2 infections linked to neuroinflammation, neurodegeneration, and long-term cognitive impairment. These findings indicate that both COVID-19 and AD have synergistic effects; however, further research is required to elucidate their long-term implications.

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Is COVID-19 a risk factor for Alzheimer's disease?

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The study explores the interconnected risks between COVID-19 and Alzheimer's Disease (AD), highlighting how SARS-CoV-2 can aggravate AD pathology through neuroinflammation and neurodegeneration. It raises significant concerns about the long-term cognitive implications of COVID-19, especially among those already at risk for AD.

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Can We Still Contain, and Possibly Eliminate, COVID-19? Yes, and Here Is How

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"My recommendation in the US is a “warp-speed”-like project between government, industry, and academia and a minimum of five billion per year,  a similar world commitment to public health and drug development, and with global clinical trial capabilities in place".

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"My recommendation in the US is a “warp-speed”-like project between government, industry, and academia and a minimum of five billion per year,  a similar world commitment to public health and drug development, and with global clinical trial capabilities in place".

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https://www.insideprecisionmedicine.com/news-and-features/can-we-still-contain-and-possibly-eliminate-covid-19-yes-and-here-is-how/

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Can We Still Contain, and Possibly Eliminate, COVID-19? Yes, and Here Is How

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It is becoming increasingly clear that we have misunderstood SARS-CoV-2, the virus that causes COVID-19. Many people, including some experts in the scientific community, deemed the pandemic over with the release of the mRNA vaccines. The belief—or perhaps it was hope in disguise—was that with the development of the vaccines, we could go back to […]

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“If we go there, we do have the tools and the capability of quickly mitigating it compared to previously.  Those tools, of course, entail the same advice since the beginning of the pandemic: wearing masks in public, testing when exposed or experiencing symptoms, improving indoor air quality and staying up to date on vaccinations".

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“If we go there, we do have the tools and the capability of quickly mitigating it compared to previously.  Those tools, of course, entail the same advice since the beginning of the pandemic: wearing masks in public, testing when exposed or experiencing symptoms, improving indoor air quality and staying up to date on vaccinations".

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https://www.salon.com/2023/10/29/has-the-winter-variant-arrived-heres-why-experts-are-closely-monitoring-the-jn1-strain/

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SARS-CoV-2 continues to mutate, as is natural for a virus, always trying to evolve news ways of infecting us. Though the pandemic has seemingly slipped from most people's minds, there are still dedicated teams of virus trackers who are closely monitoring these microscopic changes, to see if they can predict which ones may prove problematic, like the Omicron variant.

In August, virus trackers discovered a new strain - BA.2.86, nicknamed "Pirola" - that was as genetically different from Omicron as Omicron was from the original "wild type" strain from Wuhan, China. With nearly double the number of mutations on the spike protein than other strains, Pirola has a stronger ability to bind to our cells and is thus more infectious. However, without a specific mutation in which neighboring genes swap places called the "FLip mutation," Pirola didn't spread throughout the population as quickly as many other variants that do have this mutation did - like EG.5 and HV.1, which together account for over 47% of estimated cases in the U.S.

"This has all the features of becoming a dominant lineage."

Now, the virus has once again mutated, and this time, BA.2.86 underwent a mutation very similar to the FLip mutation in a new strain called JN.1, making its ability to bind to our cells even stronger than most other Omicron variants still currently dominating as well as increasing its transmissibility.

First detected in Luxembourg in late August, JN.1 has since been identified in 130 infections, including cases in England, France, the U.S. and 15 other countries. However, because very few COVID-19 cases are sequenced and testing, in general, has fallen by the wayside after the public health emergency ended in May, virus trackers believe this is only a fraction of the true number of JN.1 cases in circulation. With the winter and holiday season approaching, this strain is expected to become "the winter variant," said Dr. Rajendram Rajnarayanan, of the New York Institute of Technology campus in Jonesboro, Arkansas.

"With travel and the holidays coming up, we know that it's gonna spread everywhere," Rajnarayanan told Salon in a video call. "This has all the features of becoming a dominant lineage like EG.5 or XBB.1.16.6."

Although JN.1 has characteristics that suggest it could become a dominant strain, the landscape of COVID-19 variants has transformed since last summer when one variant could cause a new wave of cases, said Dr. T. Ryan Gregory, an evolutionary and genome biologist at the University of Guelph in Canada. Instead, cases have been sustained at a high baseline over the past year with highs and lows caused by dozens of different variants coming and going within an "alphabet soup" of circulating variants.

The Centers for Disease Control and Prevention (CDC) are currently monitoring 35 variants, but there are hundreds more that haven't reached the level of community spread to appear on their radar. In August, the CDC and the World Health Organization (WHO) added the original Pirola "parent," BA.2.8.6 to the agencies' respective lists of variants to monitor.
Want more health and science stories in your inbox? Subscribe to Salon's weekly newsletter Lab Notes.
"I am not so concerned about any one variant causing a huge wave anymore," Gregory told Salon in an email. "I don't think wondering if any particular new variant will take over and cause a huge wave is the right way to think about variants anymore."

Instead, it's more about the cumulative effects of multiple strains circulating and putting a constant stress on health systems, Gregory said. JN.1 isn't the only mutation stemming from the BA.2.86 lineage. JN.1, JN.2, JN.3 and JQ.1 have all diverged from the original strain in what trackers are calling the "Pirola clan." Other variants, including HK.3, have diverged from the EG.5 variant, nicknamed "Eris," that has been dominating in the U.S. since August.

Vaccine manufacturers said the latest shots hold up against the Pirola lineage, and the CDC said antibody therapies like Paxlovid, Veklury and Lagevrio should work against it as well. Because sequencing has been minimal and virus trackers are relying on hospital or wastewater data for their analyses, it's still unclear whether the BA.2.86 lineages will cause differences in COVID-19 symptoms or whether they increase the chance of things like long COVID.

"We're really just getting a glimpse of what is out there, so it is a certainty that any of the variants appearing in multiple countries are more common and widespread than the number of sequences alone would indicate," Gregory said. "This is a good reminder that the virus continues to evolve in many different ways and that our best approach is not to rely only on one measure but to take a layered approach that includes vaccination but also mitigation."

JN.1 isn't yet a cause for alarm, but it is a signal to vaccine manufacturers that can help them ensure future vaccines and therapies continue to protect against new variations in SARS-CoV-2, Rajnarayanan said. At the moment, there are plenty of mitigation measures in the country's toolkit to prevent JN.1 and other strains from spreading further, including vaccination, public health measures like masking and improving air filtration in closed buildings, he added.

Although data released last week showed just 3% of the population had gotten the latest COVID-19 vaccine, many Americans at this point have also had a COVID-19 infection, meaning they have some natural immunity as well. However, a study published in August in the International Journal of Molecular Science found the risk of long COVID increases with multiple COVID-19 infections, and many people like those who are immunocompromised still are not able to get vaccines and protect themselves from what could be a life-threatening infection.

"Right now we have so many things that are protecting us from having the big catastrophe that we had with Delta or Alpha or variants before that, and we are not in that situation yet," Rajnarayanan said. "If we go there, we do have the tools and the capability of quickly mitigating it compared to previously."

Those tools, of course, entail the same advice since the beginning of the pandemic: wearing masks in public, testing when exposed or experiencing symptoms, improving indoor air quality and staying up to date on vaccinations.

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Has the winter COVID variant arrived? Here's why experts are closely monitoring the JN.1 strain

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JN.1 isn't yet a cause for alarm, but that could change, serving as a reminder that COVID always has new tricks

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"This whole thing taught us that infections can cause chronic disease. That's really the number-one lesson that I take from this pandemic — that infections can cause chronic disease".

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"This whole thing taught us that infections can cause chronic disease. That's really the number-one lesson that I take from this pandemic — that infections can cause chronic disease".

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https://www.medscape.com/viewarticle/998107

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People infected multiple times with COVID-19 are more likely to develop long COVID, and most never fully recover from the condition. Those are two of the most striking findings of a comprehensive new 3-year research study of 138,000 veterans.

Lead researcher Ziyad Al-Aly, MD, chief of research at Veterans Affairs St. Louis Health Care and clinical epidemiologist at Washington University in St. Louis, spoke with Medscape about his team's findings, what we know - and don't - about long COVID, and what it means for physicians treating patients with the condition.

Excerpts of the interview follow.

Your research concluded that for those infected early in the pandemic, some long COVID symptoms declined over 2 years, but some did not. You have also concluded that long COVID is a chronic disease. Why?

We've been in this journey a little bit more than three and a half years. Some patients do experience some recovery. But that's not the norm. Most people do not really fully recover. The health trajectory for people with long COVID is really very heterogeneous. There is no one-size-fits-all. There's really no one line that I could give you that could cover all your patients. But it is very, very, very clear that a bunch of them experienced long COVID for sure; that's really happening.

It happened in the pre-Delta era and in the Delta era, and with Omicron subvariants, even now. There are people who think, "This is a nothing-burger anymore," or "It's not an issue anymore." It's still happening with the current variants. Vaccines do reduce risk for long COVID, but do not completely eliminate the risk for long COVID.

You work with patients with long COVID in the clinic and also analyze data from thousands more. If long COVID does not go away, what should doctors look for in everyday practice that will help them recognize and help patients with long COVID?

Long COVID is not uncommon. We see it in the clinic in large numbers. Whatever clinic you're running - if you're running a cardiology clinic, or a nephrology clinic, or diabetes, or primary care - probably of some of your people have it. You may not know about it. They may not tell you about it. You may not recognize it.

Not all long COVID is the same, and that's really what makes it complex and makes it really hard to deal with in the clinic. But that's the reality that we're all dealing with. And it's multisystemic; it's not like it affects the heart only, the brain only or, the autonomic nervous system only. It does not behave in the same way in different individuals - they may have different manifestations, various health trajectories, and different outcomes. It's important for doctors to get up to speed on long COVID as a multisystem illness.

Management at this point is really managing the symptoms. We don't have a treatment for it; we don't have a cure for it.

Some patients experience what you've described as partial recovery. What does that look like?

Some individuals do experience some recovery over time, but for most individuals, the recovery is long and arduous. Long COVID can last with them for many years. Some people may come back to the clinic and say, "I'm doing better," but if you really flesh it out and dig deeper, they didn't do better; they adjusted to a new baseline. They used to walk the dog three to four blocks, and now they walk the dog only half a block. They used to do an activity with their partner every Saturday or Sunday, and now they do half of that.

If you're a physician, a primary care provider, or any other provider who is dealing with a patient with long COVID, know that this is really happening. It can happen even in vaccinated individuals. The presentation is heterogeneous. Some people may present to you with and say. "Well, before I had COVID I was mentally sharp and now having I'm having difficulty with memory, etc." It can sometimes present as fatigue or postexertional malaise.

In some instances, it can present as sleep problems. It can present as what we call postural orthostatic tachycardia syndrome (POTS). Those people get a significant increase in heart rate with postural changes.

What the most important thing we can we learn from the emergence of long COVID?

This whole thing taught us that infections can cause chronic disease. That's really the number-one lesson that I take from this pandemic - that infections can cause chronic disease.

Looking at only acute illness from COVID is really only looking at the tip of the iceberg. Beneath that tip of the iceberg lies this hidden toll of disease that we don't really talk about that much.

This pandemic shone a very, very good light on the idea that there is really an intimate connection between infections and chronic disease. It was really hardwired into our medical training as doctors that most infections, when people get over the hump of the acute phase of the disease, it's all behind them. I think long COVID has humbled us in many, many ways, but chief among those is the realization - the stark realization - that infections can cause chronic disease.

That's really going back to your [first] question: What does it mean that some people are not recovering? They actually have chronic illness. I'm hoping that we will find a treatment, that we'll start finding things that would help them get back to baseline. But at this point in time, what we're dealing with is people with chronic illness or chronic disease that may continue to affect them for many years to come in the absence of a treatment or a cure.

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post-acute sequelae of sars-cov-2 infection; post-acute sequelae of sars-cov-2 infection (pasc); pasc - post-acute sequelae of sars-cov-2 infection; long covid

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Second Infection Hikes Long COVID Risk: Expert Q&A

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Lead researcher Ziyad Al-Aly, MD, spoke with Medscape about his team's findings, what we know - and don't - about long COVID, and what it means for physicians treating patients with the condition.

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"And if standards of care have slipped to such a low point with respect to COVID-19, why would anyone bother providing the best care possible for other conditions? This is a one-way feed-forward healthcare system degradation that will only continue".

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"And if standards of care have slipped to such a low point with respect to COVID-19, why would anyone bother providing the best care possible for other conditions? This is a one-way feed-forward healthcare system degradation that will only continue".

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https://johnsnowproject.org/insights/endemic-sars-cov-2-and-the-death-of-public-health/https://johnsnowproject.org/insights/endemic-sars-cov-2-and-the-death-of-public-health/

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While some are better than others, no national or regional government is making serious efforts towards infection prevention and control, and it seems likely this laissez-faire policy will continue for the foreseeable future. The social, political, and economic movements that worked to achieve this mass infection environment can rejoice at their success.

Those schooled in public health, immunology or working on the front line of healthcare provision know we face an uncertain future, and are aware the implications of recent events stretch far beyond SARS-CoV-2. The shifts that have taken place in attitudes and public health policy will likely damage a key pillar that forms the basis of modern civilized society, one that was built over the last two centuries; the expectation of a largely uninterrupted upwards trajectory of ever-improving health and quality of life, largely driven by the reduction and elimination of infectious diseases that plagued humankind for thousands of years. In the last three years, that trajectory has reversed.

The upward trajectory of public health in the last two centuries

Control of infectious disease has historically been a priority for all societies. Quarantine has been in common use since at least the Bronze Age and has been the key method for preventing the spread of infectious diseases ever since. The word "quarantine" itself derives from the 40-day isolation period for ships and crews that was implemented in Europe during the late Middle Ages to prevent the introduction of bubonic plague epidemics into cities ¹.

Modern public health traces its roots to the middle of the 19th century thanks to converging scientific developments in early industrial societies:

1. The germ theory of diseases was firmly established in the mid-19th century, in particular after Louis Pasteur disproved the spontaneous generation hypothesis. If diseases spread through transmission chains between individual humans or from the environment/animals to humans, then it follows that those transmission chains can be interrupted, and the spread stopped.

2. The science of epidemiology appeared, its birth usually associated with the 1854 Broad Street cholera outbreak in London during which the British physician John Snow identified contaminated water as the source of cholera, pointing to improved sanitation as the way to stop cholera epidemics.

3. Vaccination technology began to develop, initially against smallpox, and the first mandatory smallpox vaccination campaigns began, starting in England in the 1850s.

4. The early industrial era generated horrendous workplace and living conditions for working class populations living in large industrial cities, dramatically reducing life expectancy and quality of life (life expectancy at birth in key industrial cities in the middle of the 19th century was often in the low 30s or even lower²). This in turn resulted in a recognition that such environmental factors affect human health and life spans. The long and bitter struggle for workers' rights in subsequent decades resulted in much improved working conditions, workplace safety regulations, and general sanitation, and brought sharp increases in life expectancy and quality of life, which in turn had positive impacts on productivity and wealth.

5. Florence Nightingale reemphasized the role of ventilation in healing and preventing illness, 'The very first canon of nursing... : keep the air he breathes as pure as the external air, without chilling him,' a maxim that influenced building design at the time.

These trends continued in the 20th century, greatly helped by further technological and scientific advances. Many diseases - diphtheria, pertussis, hepatitis B, polio, measles, mumps, rubella, etc. - became things of the past thanks to near-universal highly effective vaccinations, while others that used to be common are no longer of such concern for highly developed countries in temperate climates - malaria, typhus, typhoid, leprosy, cholera, tuberculosis, and many others - primarily thanks to improvements in hygiene and the implementation of non-pharmaceutical measures for their containment.

Furthermore, the idea that infectious diseases should not just be reduced, but permanently eliminated altogether began to be put into practice in the second half of the 20th century 3-5 on a global level, and much earlier locally. These programs were based on the obvious consideration that if an infectious agent is driven to extinction, the incalculable damage to people's health and the overall economy by a persisting and indefinite disease burden will also be eliminated.

The ambition of local elimination grew into one of global eradication for smallpox, which was successfully eliminated from the human population in the 1970s 6 (this had already been achieved locally in the late 19th century by some countries), after a heroic effort to find and contain the last remaining infectious individuals 7,8. The other complete success was rinderpest in cattle 9,10, globally eradicated in the early 21st century.

When the COVID-19 pandemic started, global eradication programs were very close to succeeding for two other diseases - polio 11,12 and dracunculiasis ¹³. Eradication is also globally pursued for other diseases, such as yaws 14,15, and regionally for many others, e.g. lymphatic filariasis 16,17, onchocerciasis 18,19, measles and rubella ²⁰⁻³⁰. The most challenging diseases are those that have an external reservoir outside the human population, especially if they are insect borne, and in particular those carried by mosquitos. Malaria is the primary example, but despite these difficulties, eradication of malaria has been a long-standing global public health goal ³¹⁻³³ and elimination has been achieved in temperate regions of the globe 34,35, even though it involved the ecologically destructive widespread application of polluting chemical pesticides 36,37 to reduce the populations of the vectors. Elimination is also a public goal for other insect borne diseases such as trypanosomiasis 38,39.

In parallel with pursuing maximal reduction and eventual eradication of the burden of existing endemic infectious diseases, humanity has also had to battle novel infectious diseases ⁴⁰, which have been appearing at an increased rate over recent decades ⁴¹⁻⁴³. Most of these diseases are of zoonotic origin, and the rate at which they are making the jump from wildlife to humans is accelerating, because of the increased encroachment on wildlife due to expanding human populations and physical infrastructure associated with human activity, the continued destruction of wild ecosystems that forces wild animals towards closer human contact, the booming wildlife trade, and other such trends.

Because it is much easier to stop an outbreak when it is still in its early stages of spreading through the population than to eradicate an endemic pathogen, the governing principle has been that no emerging infectious disease should be allowed to become endemic. This goal has been pursued reasonably successfully and without controversy for many decades.

The most famous newly emerging pathogens were the filoviruses (Ebola ⁴⁴⁻⁴⁶, Marburg 47,48), the SARS and MERS coronaviruses, and paramyxoviruses like Nipah 49,50. These gained fame because of their high lethality and potential for human-to-human spread, but they were merely the most notable of many examples.

Such epidemics were almost always aggressively suppressed. Usually, these were small outbreaks, and because highly pathogenic viruses such as Ebola cause very serious sickness in practically all infected people, finding and isolating the contagious individuals is a manageable task. The largest such epidemic was the 2013-16 Ebola outbreak in West Africa, when a filovirus spread widely in major urban centers for the first time. Containment required a wartime-level mobilization, but that was nevertheless achieved, even though there were nearly 30,000 infections and more than 11,000 deaths ⁵¹.

SARS was also contained and eradicated from the human population back in 2003-04, and the same happened every time MERS made the jump from camels to humans, as well as when there were Nipah outbreaks in Asia.

The major counterexample of a successful establishment in the human population of a novel highly pathogenic virus is HIV. HIV is a retrovirus, and as such it integrates into the host genome and is thus nearly impossible to eliminate from the body and to eradicate from the population 52 (unless all infected individuals are identified and prevented from infecting others for the rest of their lives). However, HIV is not an example of the containment principle being voluntarily abandoned as the virus had made its zoonotic jump and established itself many decades before its eventual discovery 53 and recognition ⁵⁴⁻⁵⁶, and long before the molecular tools that could have detected and potentially fully contained it existed.

Still, despite all these containment success stories, the emergence of a new pathogen with pandemic potential was a well understood and frequently discussed threat ⁵⁷⁻⁶⁰, although influenza viruses rather than coronaviruses were often seen as the most likely culprit ⁶¹⁻⁶⁵. The eventual appearance of SARS-CoV-2 should therefore not have been a huge surprise, and should have been met with a full mobilization of the technical tools and fundamental public health principles developed over the previous decades.

The ecological context

One striking property of many emerging pathogens is how many of them come from bats. While the question of whether bats truly harbor more viruses than other mammals in proportion to their own species diversity (which is the second highest within mammals after rodents) is not fully settled yet ⁶⁶⁻⁶⁹, many novel viruses do indeed originate from bats, and the ecological and physiological characteristics of bats are highly relevant for understanding the situation that Homo sapiens finds itself in right now.

Another startling property of bats and their viruses is how highly pathogenic to humans (and other mammals) many bat viruses are, while bats themselves are not much affected (only rabies is well established to cause serious harm to bats ⁶⁸). Why bats seem to carry so many such pathogens, and how they have adapted so well to coexisting with them, has been a long-standing puzzle and although we do not have a definitive answer, some general trends have become clear.

1. Bats are the only truly flying mammals and have been so for many millions of years.

2. Flying has resulted in a number of specific adaptations, one of them being the tolerance towards a very high body temperature (often on the order of 42-43ºC).

3. Bats often live in huge colonies, literally touching each other, and, again, have lived in conditions of very high density for millions of years. Such densities are rare among mammals and are certainly not the native condition of humans (human civilization and our large dense cities are a very recent phenomenon on evolutionary time scales).

4. Bats are also quite long-lived for such small mammals⁷⁰⁻⁷¹ - some fruit bats can live more than 35 years and even small cave dwelling species can live about a decade.

These are characteristics that might have on one hand facilitated the evolution of a considerable set of viruses associated with bat populations. In order for a non-latent respiratory virus to maintain itself, a minimal population size is necessary. For example, it is hypothesized that measles requires a minimum population size of 250-300,000 individuals ⁷². And bats have existed in a state of high population densities for a very long time, which might explain the high diversity of viruses that they carry. In addition, the long lifespan of many bat species means that their viruses may have to evolve strategies to overcome adaptive immunity and frequently reinfect previously infected individuals as opposed to the situation in short-lived species in which populations turn over quickly (with immunologically naive individuals replacing the ones that die out).

On the other hand, the selective pressure that these viruses have exerted on bats may have resulted in the evolution of various resistance and/or tolerance mechanisms in bats themselves, which in turn have driven the evolution of counter strategies in their viruses, leading them to be highly virulent for other species. Bats certainly appear to be physiologically more tolerant towards viruses that are otherwise highly virulent to other mammals. Several explanations for this adaptation have been proposed, chief among them a much more powerful innate immunity and a tolerance towards infections that does not lead to the development of the kind of hyperinflammatory reactions observed in humans ⁷³⁻⁷⁵, the high body temperature of bats in flight, and others.

The notable strength of bat innate immunity is often explained by the constitutively active interferon response that has been reported for some bat species ⁷⁶⁻⁷⁸. It is possible that this is not a universal characteristic of all bats 79 - only a few species have been studied - but it provides a very attractive mechanism for explaining both how bats prevent the development of severe systemic viral infections in their bodies and how their viruses in turn would have evolved powerful mechanisms to silence the interferon response, making them highly pathogenic for other mammals.

The tolerance towards infection is possibly rooted in the absence of some components of the signaling cascades leading to hyperinflammatory reactions and the dampened activity of others ⁸⁰.

An obvious ecological parallel can be drawn between bats and humans - just as bats live in dense colonies, so now do modern humans. And we may now be at a critical point in the history of our species, in which our ever-increasing ecological footprint has brought us in close contact with bats in a way that was much rarer in the past. Our population is connected in ways that were previously unimaginable. A novel virus can make the zoonotic jump somewhere in Southeast Asia and a carrier of it can then be on the other side of the globe a mere 24-hours later, having encountered thousands of people in airports and other mass transit systems. As a result, bat pathogens are now being transferred from bat populations to the human population in what might prove to be the second major zoonotic spillover event after the one associated with domestication of livestock and pets a few thousand years ago.

Unfortunately for us, our physiology is not suited to tolerate these new viruses. Bats have adapted to live with them over many millions of years. Humans have not undergone the same kind of adaptation and cannot do so on any timescale that will be of use to those living now, nor to our immediate descendants.

Simply put, humans are not bats, and the continuous existence and improvement of what we now call "civilization" depends on the same basic public health and infectious disease control that saw life expectancy in high-income countries more than double to 85 years. This is a challenge that will only increase in the coming years, because the trends that are accelerating the rate of zoonotic transfer of pathogens are certain to persist.

Given this context, it is as important now to maintain the public health principle that no new dangerous pathogens should be allowed to become endemic and that all novel infectious disease outbreaks must be suppressed as it ever was.

The death of public health and the end of epidemiological comfort

It is also in this context that the real gravity of what has happened in the last three years emerges.

After HIV, SARS-CoV-2 is now the second most dangerous infectious disease agent that is 'endemic' to the human population on a global scale. And yet not only was it allowed to become endemic, but mass infection was outright encouraged, including by official public health bodies in numerous countries ⁸¹⁻⁸³.

The implications of what has just happened have been missed by most, so let's spell them out explicitly.

We need to be clear why containment of SARS-CoV-2 was actively sabotaged and eventually abandoned. It has absolutely nothing to do with the "impossibility" of achieving it. In fact, the technical problem of containing even a stealthily spreading virus such as SARS-CoV-2 is fully solved, and that solution was successfully applied in practice for years during the pandemic.

The list of countries that completely snuffed out outbreaks, often multiple times, includes Australia, New Zealand, Singapore, Taiwan, Vietnam, Thailand, Bhutan, Cuba, China, and a few others, with China having successfully contained hundreds of separate outbreaks, before finally giving up in late 2022.

The algorithm for containment is well established - passively break transmission chains through the implementation of nonpharmaceutical interventions (NPIs) such as limiting human contacts, high quality respirator masks, indoor air filtration and ventilation, and others, while aggressively hunting down active remaining transmission chains through traditional contact tracing and isolation methods combined with the powerful new tool of population-scale testing.

Understanding of airborne transmission and institution of mitigation measures, which have heretofore not been utilized in any country, will facilitate elimination, even with the newer, more transmissible variants. Any country that has the necessary resources (or is provided with them) can achieve full containment within a few months. In fact, currently this would be easier than ever before because of the accumulated widespread multiple recent exposures to the virus in the population suppressing the effective reproduction number (Re). For the last 18 months or so we have been seeing a constant high plateau of cases with undulating waves, but not the major explosions of infections with Re reaching 3-4 that were associated with the original introduction of the virus in 2020 and with the appearance of the first Omicron variants in late 2021.

It would be much easier to use NPIs to drive Re to much below 1 and keep it there until elimination when starting from Re around 1.2-1.3 than when it was over 3, and this moment should be used, before another radically new serotype appears and takes us back to those even more unpleasant situations. This is not a technical problem, but one of political and social will. As long as leadership misunderstands or pretends to misunderstand the link between increased mortality, morbidity and poorer economic performance and the free transmission of SARS-CoV-2, the impetus will be lacking to take the necessary steps to contain this damaging virus.

Political will is in short supply because powerful economic and corporate interests have been pushing policymakers to let the virus spread largely unchecked through the population since the very beginning of the pandemic. The reasons are simple. First, NPIs hurt general economic activity, even if only in the short term, resulting in losses on balance sheets. Second, large-scale containment efforts of the kind we only saw briefly in the first few months of the pandemic require substantial governmental support for all the people who need to pause their economic activity for the duration of effort. Such an effort also requires large-scale financial investment in, for example, contact tracing and mass testing infrastructure and providing high-quality masks. In an era dominated by laissez-faire economic dogma, this level of state investment and organization would have set too many unacceptable precedents, so in many jurisdictions it was fiercely resisted, regardless of the consequences for humanity and the economy.

None of these social and economic predicaments have been resolved. The unofficial alliance between big business and dangerous pathogens that was forged in early 2020 has emerged victorious and greatly strengthened from its battle against public health, and is poised to steamroll whatever meager opposition remains for the remainder of this, and future pandemics.

The long-established principles governing how we respond to new infectious diseases have now completely changed - the precedent has been established that dangerous emerging pathogens will no longer be contained, but instead permitted to 'ease' into widespread circulation. The intent to "let it rip" in the future is now being openly communicated ⁸⁴. With this change in policy comes uncertainty about acceptable lethality. Just how bad will an infectious disease have to be to convince any government to mobilize a meaningful global public health response?

We have some clues regarding that issue from what happened during the initial appearance of the Omicron "variant" (which was really a new serotype 85,86) of SARS-CoV-2. Despite some experts warning that a vaccine-only approach would be doomed to fail, governments gambled everything on it. They were then faced with the brute fact of viral evolution destroying their strategy when a new serotype emerged against which existing vaccines had little effect in terms of blocking transmission. The reaction was not to bring back NPIs but to give up, seemingly regardless of the consequences.

Critically, those consequences were unknown when the policy of no intervention was adopted within days of the appearance of Omicron. All previous new SARS-CoV-2 variants had been deadlier than the original Wuhan strain, with the eventually globally dominant Delta variant perhaps as much as 4× as deadly ⁸⁷. Omicron turned out to be the exception, but again, that was not known with any certainty when it was allowed to run wild through populations. What would have happened if it had followed the same pattern as Delta?

In the USA, for example, the worst COVID-19 wave was the one in the winter of 2020-21, at the peak of which at least 3,500 people were dying daily (the real number was certainly higher because of undercounting due to lack of testing and improper reporting). The first Omicron BA.1 wave saw the second-highest death tolls, with at least 2,800 dying per day at its peak. Had Omicron been as intrinsically lethal as Delta, we could have easily seen a 4-5× higher peak than January 2021, i.e. as many as 12-15,000 people dying a day. Given that we only had real data on Omicron's intrinsic lethality after the gigantic wave of infections was unleashed onto the population, we have to conclude that 12-15,000 dead a day is now a threshold that will not force the implementation of serious NPIs for the next problematic COVID-19 serotype.

Logically, it follows that it is also a threshold that will not result in the implementation of NPIs for any other emerging pathogens either. Because why should SARS-CoV-2 be special?

We can only hope that we will never see the day when such an epidemic hits us but experience tells us such optimism is unfounded. The current level of suffering caused by COVID-19 has been completely normalized even though such a thing was unthinkable back in 2019. Populations are largely unaware of the long-term harms the virus is causing to those infected, of the burden on healthcare, increased disability, mortality and reduced life expectancy. Once a few even deadlier outbreaks have been shrugged off by governments worldwide, the baseline of what is considered "acceptable" will just gradually move up and even more unimaginable losses will eventually enter the "acceptable" category. There can be no doubt, from a public health perspective, we are regressing.

We had a second, even more worrying real-life example of what the future holds with the global spread of the MPX virus (formerly known as "monkeypox" and now called "Mpox") in 2022. MPX is a close relative to the smallpox VARV virus and is endemic to Central and Western Africa, where its natural hosts are mostly various rodent species, but on occasions it infects humans too, with the rate of zoonotic transfer increasing over recent decades ⁸⁸. It has usually been characterized by fairly high mortality - the CFR (Case Fatality Rate) has been ∼3.6% for the strain that circulates in Nigeria and ∼10% for the one in the Congo region, i.e. much worse than SARS-CoV-2. In 2022, an unexpected global MPX outbreak developed, with tens of thousands of confirmed cases in dozens of countries 89,90. Normally, this would be a huge cause for alarm, for several reasons.

First, MPX itself is a very dangerous disease. Second, universal smallpox vaccination ended many decades ago with the success of the eradication program, leaving the population born after that completely unprotected. Third, lethality in orthopoxviruses is, in fact, highly variable - VARV itself had a variola major strain, with as much as ∼30% CFR, and a less deadly variola minor variety with CFR ∼1%, and there was considerable variation within variola major too. It also appears that high pathogenicity often evolves from less pathogenic strains through reductive evolution - the loss of certain genes something that can happen fairly easily, may well have happened repeatedly in the past, and may happen again in the future, a scenario that has been repeatedly warned about for decades 91,92. For these reasons, it was unthinkable that anyone would just shrug off a massive MPX outbreak - it is already bad enough as it is, but allowing it to become endemic means it can one day evolve towards something functionally equivalent to smallpox in its impact.

And yet that is exactly what happened in 2022 - barely any measures were taken to contain the outbreak, and countries simply reclassified MPX out of the "high consequence infectious disease" category 93 in order to push the problem away, out of sight and out of mind. By chance, it turned out that this particular outbreak did not spark a global pandemic, and it was also characterized, for poorly understood reasons, by an unusually low CFR, with very few people dying 94,95. But again, that is not the information that was available at the start of the outbreak, when in a previous, interventionist age of public health, resources would have been mobilized to stamp it out in its infancy, but, in the age of laissez-faire, were not. MPX is now circulating around the world and represents a future threat of uncontrolled transmission resulting in viral adaptation to highly efficient human-to-human spread combined with much greater disease severity.

This is the previously unthinkable future we will live in from now on in terms of our approach to infectious disease.

What may be controlled instead is information. Another lesson of the pandemic is that if there is no testing and reporting of cases and deaths, a huge amount of real human suffering can be very successfully swept under the rug. Early in 2020, such practices - blatant denial that there was any virus in certain territories, outright faking of COVID-19 statistics, and even resorting to NPIs out of sheer desperation but under false pretense that it is not because of COVID-19 - were the domain of failed states and less developed dictatorships ⁹⁶⁻⁹⁹. But in 2023 most of the world has adopted such practices - testing is limited, reporting is infrequent, or even abandoned altogether - and there is no reason to expect this to change. Information control has replaced infection control.

After a while it will not even be possible to assess the impact of what is happening by evaluating excess mortality, which has been the one true measure not susceptible to various data manipulation tricks. As we get increasingly removed from the pre-COVID-19 baselines and the initial pandemic years are subsumed into the baseline for calculating excess mortality, excess deaths will simply disappear by the power of statistical magic. Interestingly, countries such as the UK, which has already incorporated two pandemic years in its five-year average, are still seeing excess deaths, which suggests the virus is an ongoing and growing problem.

It should also be stressed that this radical shift in our approach to emerging infectious diseases is probably only the beginning of wiping out the hard-fought public health gains of the last 150+ years. This should be gravely concerning to any individuals and institutions concerned with workers and citizens rights.

This shift is likely to impact existing eradication and elimination efforts. Will the final pushes be made to complete the various global eradication campaigns listed above? That may necessitate some serious effort involving NPIs and active public health measures, but how much appetite is there for such things after they have been now taken out of the toolkit for SARS-CoV-2?

We can also expect previously forgotten diseases to return where they have successfully been locally eradicated. We have to always remember that the diseases that we now control with universal childhood vaccinations have not been globally eradicated - they have disappeared from our lives because vaccination rates are high enough to maintain society as a whole above the disease elimination threshold, but were vaccination rates to slip, those diseases, such as measles, will return with a vengeance.

The anti-vaccine movement was already a serious problem prior to COVID-19, but it was given a gigantic boost with the ill-advised vaccine-only COVID-19 strategy. Governments and their nominal expert advisers oversold the effectiveness of imperfect first generation COVID-vaccines, and simultaneously minimized the harms of SARS-CoV-2, creating a reality gap which gave anti-vaccine rhetoric space to thrive. This is a huge topic to be explored separately. Here it will suffice to say that while anti-vaxxers were a fringe movement prior to the pandemic, "vaccination" in general is now a toxic idea in the minds of truly significant portions of the population. A logical consequence of that shift has been a significant decrease in vaccination coverage for other diseases as well as for COVID-19.

This is even more likely given the shift in attitudes towards children. Child labour, lack of education and large families were the hallmarks of earlier eras of poor public health, which were characterized by high birth-rates and high infant mortality. Attitudes changed dramatically over the course of the 20th century and wherever health and wealth increased, child mortality fell, and the transition was made to small families. Rarity increased perceived value and children's wellbeing became a central concern for parents and carers. The arrival of COVID-19 changed that, with some governments, advisers, advocacy groups and parents insisting that children should be exposed freely to a Severe Acute Respiratory Syndrome virus to 'train' their immune systems.

Infection, rather than vaccination, was the preferred route for many in public health in 2020, and still is in 2023, despite all that is known about this virus's propensity to cause damage to all internal organs, the immune system, and the brain, and the unknowns of postinfectious sequelae. This is especially egregious in infants, whose naive immune status may be one of the reasons they have a relatively high hospitalization rate. Some commentators seek to justify the lack of protection for the elderly and vulnerable on a cost basis. We wonder what rationale can justify a lack of protection for newborns and infants, particularly in a healthcare setting, when experience of other viruses tells us children have better outcomes the later they are exposed to disease ¹⁰⁰? If we are not prepared to protect children against a highly virulent SARS virus, why should we protect against others? We should expect a shift in public health attitudes, since 'endemicity' means there is no reason to see SARS-CoV-2 as something unique and exceptional.

We can also expect a general degradation of workplace safety protocols and standards, again reversing many decades of hard-fought gains. During COVID-19, aside from a few privileged groups who worked from home, people were herded back into their workplaces without minimal safety precautions such as providing respirators, and improving ventilation and indoor air quality, when a dangerous airborne pathogen was spreading.

Can we realistically expect existing safety precautions and regulations to survive after that precedent has been set? Can we expect public health bodies and regulatory agencies, whose job it is to enforce these standards, to fight for workplace safety given what they did during the pandemic? It is highly doubtful. After all, they stubbornly refused to admit that SARS-CoV-2 is airborne (even to this very day in fact - the World Health Organization's infamous "FACT: #COVID19 is NOT airborne" Tweet from March 28 2020 is still up in its original form ¹⁰¹), and it is not hard to see why - implementing airborne precautions in workplaces, schools, and other public spaces would have resulted in a cost to employers and governments; a cost they could avoid if they simply denied they needed to take such precautions. But short-term thinking has resulted in long-term costs to those same organizations, through the staffing crisis, and the still-rising disability tsunami. The same principle applies to all other existing safety measures.

Worse, we have now entered the phase of abandoning respiratory precautions even in hospitals. The natural consequence of unmasked staff and patients, even those known to be SARS-CoV-2 positive, freely mixing in overcrowded hospitals is the rampant spread of hospital-acquired infections, often among some of the most vulnerable demographics. This was previously thought to be a bad thing. And what of the future? If nobody is taking any measures to stop one particular highly dangerous nosocomial infection, why would anyone care about all the others, which are often no easier to prevent? And if standards of care have slipped to such a low point with respect to COVID-19, why would anyone bother providing the best care possible for other conditions? This is a one-way feed-forward healthcare system degradation that will only continue.

Finally, the very intellectual foundations of the achievements of the last century and a half are eroding. Chief among these is the germ theory of infectious disease, by which transmission chains can be isolated and broken. The alternative theory, of spontaneous generation of pathogens, means there are no chains to be broken. Today, we are told that it is impossible to contain SARS-CoV-2 and we have to "just live with it," as if germ theory no longer holds. The argument that the spread of SARS-CoV-2 to wildlife 102 means that containment is impossible illustrates these contradictions further - SARS-CoV-2 came from wildlife, as did all other zoonotic infections, so how does the virus spilling back to wildlife change anything in terms of public health protocol? But if one has decided that from here on there will be no effort to break transmission chains because it is too costly for the privileged few in society, then excuses for that laissez-faire attitude will always be found.

And that does not bode well for the near- and medium-term future of the human species on planet Earth.

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'Endemic' SARS-CoV-2 and the death of public health

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Information control has replaced infection control, and that does not bode well for the near- and medium-term future of the human species on planet Earth.

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"This can explain long-term cardiovascular effects seen in some, if not all, COVID-19 patients. SARS-CoV-2 virus has already been found to infect many organs outside the respiratory system. But until now it hadn't been shown to attack the arteries". 

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"This can explain long-term cardiovascular effects seen in some, if not all, COVID-19 patients. SARS-CoV-2 virus has already been found to infect many organs outside the respiratory system. But until now it hadn't been shown to attack the arteries". 

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Now we know how COVID attacks your heart (archive.ph)

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People with post-polio syndrome continued to have symptoms of the disease long after the actual infection had passed. Some patients with post-polio were dismissed by their doctors because the doctors had never heard of the disease. People with post-polio syndrome, like those with long COVID, had to advocate for themselves in medical settings and seek ways to alleviate their symptoms outside of traditional medicine. 

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People with post-polio syndrome continued to have symptoms of the disease long after the actual infection had passed. Some patients with post-polio were dismissed by their doctors because the doctors had never heard of the disease. People with post-polio syndrome, like those with long COVID, had to advocate for themselves in medical settings and seek ways to alleviate their symptoms outside of traditional medicine. 

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https://yaledailynews.com/blog/2023/11/08/a-different-spirit-of-research-yale-clinic-seeks-to-unravel-the-mystery-of-long-covid/

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Eric Wang, Senior Photographer

Long COVID patients run a gauntlet of uncertainty. Many wonder whether their lives will ever be normal again.

Loved ones, medical staff, and the patients themselves doubt the reality of their symptoms. Doctors struggle to offer them explanations.

At the Yale Multidisciplinary Long Covid Clinic, however, medical workers try to unravel the mystery of long COVID. The center is directed by Lisa Sanders, associate professor of general medicine, who is no stranger to medical mysteries like long COVID. She currently writes the "Diagnosis" and "Think Like a Doctor" columns for the New York Times, and she previously published two medical books,"Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis" and "Diagnosis: Solving the Most Baffling Medical Mysteries."

In her role as director, Sanders is essentially a detective in a white coat. When a patient is referred to the clinic, Sanders first investigates whether the culprit is long COVID. This process involves ruling out other factors that may cause similar symptoms. For example, if a patient reports feeling fatigued, she checks that the patient does not have sleep apnea. According to Sanders, by repeating this process, the researchers remove some uncertainty from a long COVID diagnosis.

From there, Sanders told the News, she tackles the downstream effects of the disease. Because the symptoms of long COVID are known and treatable, Sanders said she can treat the effects, despite not understanding the root cause.

"If you can't treat the actual disease, just treat the symptoms that are tormenting people and reassure them that at least some people get better," Sanders said. "Depending on who you read, 80-plus percent of people don't have symptoms after a year."

The Yale Multidisciplinary Long Covid Clinic is on the third floor of Yale New Haven Hospital's St. Raphael Campus. Patients enter a waiting room adorned with long COVID support group flyers and prints of beach paintings. A narrow hallway connects Sanders' office, an examination room and a physical therapy room.

Sanders said that next month the Center will move to a larger space.

"Our patients say 'oh my god, this is such a small room, this is such a small space.' Like really?" Sanders said. "It's gonna be so luxurious."

Despite its small size, the Center provides each patient with help from social workers, physical therapists and Sanders.

Early in the pandemic, this level of treatment was not available to long-haulers, a colloquial term for people with long COVID. Instead, patients in New Haven with long COVID symptoms had to seek out specialists in separate departments that best aligned with their symptoms, Sanders said. Sanders said that eventually, specialists realized that the best way to help people with long COVID was not with specialty care, rather, it was with a specialized long COVID Center. Sanders was immediately interested in leading the center.

"The thought that I could learn about this, and maybe help people with it seemed appealing," Sanders told the News.

Part of this learning is trying to define long COVID.

Characterized by persistent symptoms long after initial infection, long COVID remains a puzzling challenge for patients, healthcare professionals and researchers. However, common symptoms include fatigue, brain fog, cough and shortness of breath after their initial COVID-19 infection, Sanders told the News. For many patients, these symptoms can become physically and emotionally debilitating, Sanders said.

"You had COVID, and then something bad happened," Sanders said. "But that's all we can say now because we have no idea what the pathophysiology is."
Parallels to polio
COVID-19 is not the first epidemic to leave a wake of people experiencing lingering symptoms, said Naomi Rogers, a history professor at Yale who studies 20th and 21st-century medicine and disability.

In the middle of the 20th century, the United States weathered a series of polio outbreaks, a virus that primarily affects children and can, in rare cases, cause long-term paralysis. One 1955 polio epidemic infected 3,950 people in Massachusetts. Of those infected, 2,771 were paralyzed, some for a few weeks or months and some permanently.

"Polio was seen as a really scary disease because of its disabling effects," Rogers said. "Everybody feared that if their child got it, they would never be able to work independently or live independently."

According to Rogers, some patients with polio also developed "post-polio" syndrome. These people had polio as children and fully recovered, but then, decades after their illness, became paralyzed.

Rogers pointed to similarities between post-polio syndrome and long COVID. Like patients with long COVID, people with post-polio syndrome continued to have symptoms of the disease long after the actual infection had passed, Rogers said. Some patients with post-polio were dismissed by their doctors because the doctors had never heard of the disease, according to Rogers. People with post-polio syndrome, like those with long COVID, Rogers said, had to advocate for themselves in medical settings and seek ways to alleviate their symptoms outside of traditional medicine.

Rogers also highlighted similarities between long COVID and diseases such as chronic Lyme and Chronic Fatigue Syndrome. For people with these conditions, she said, it is difficult to make friends, family or doctors aware that there is an actual disease behind what she said are relatively vague symptoms.

"You can't see pain. You can't see weakness. There are a lot of chronic responses that are not visible," Rogers said.

In addition to vague symptoms, Rogers said that long COVID is complicated because nobody knows exactly what it is or how to think about it.

Unlike other chronic diseases such as cancer or AIDS, she explained, long COVID is too recent for the public to have a clear picture of what it is like.

"When we say long COVID, we don't have in our minds what long COVID looks like," Rogers said.
Studying Long Covid
A group of interdisciplinary researchers at Yale are working to uncover what long COVID is and how it can be treated.

During the pandemic, researchers at Yale, including Akiko Iwasaki, Sterling Professor of immunobiology at the School of Medicine, noticed that some patients who had COVID-19 developed chronic symptoms that lasted for a long time after their infection. Iwasaki and her lab also noted that some people who got the COVID-19 vaccine had an immune response.

As the pandemic progressed, Iwasaki established a network of researchers studying COVID-19 who also wanted to understand the unusual immune responses caused by COVID-19. This collaboration became the Center for Infection and Immunity, or CII, which opened in August 2023.

The center, which Iwasaki directs, seeks to understand how chronic diseases develop and uncover links between infection and chronic disease. It also tries to connect immune responses to factors such as sex, genetics, age and environment, and develop therapies for treating chronic disease.

Iwasaki said that, because post-acute syndromes, such as long COVID, are difficult to understand and quantify, studying them requires an interdisciplinary approach.
Patient-centered approach
In studying chronic disease, the CII seeks to include patients as full participants in their research. CII partners with the Center for Outcomes Research and Evaluation, or CORE, to enhance their patient-centered research approach.

"We're trying to create a different spirit around the research," Harlan Krumholz, a professor at the School of Medicine and the director of CORE told the News. Krumholz is also on the CII leadership team.

Krumholz said patients with post-acute syndromes are "desperate for answers."

But because chronic syndromes like long COVID are poorly understood, he said many patients feel "abandoned" by doctors, caregivers and the medical system.

"There's not one evidence-based therapy," Krumholz said. "We even have trouble defining the condition, because there aren't any diagnostics."

To combat this feeling of neglect, CORE and CII developed a new model for doing patient research which Krumholz called "highly participant-centric."

One way the researchers study long COVID is through the Yale LISTEN study, which stands for Listen to Immune, Symptom and Treatment Experiences Now. The LISTEN study follows a pool of participants with long COVID who share health data and specimens like blood or saliva with researchers.

People participating in the LISTEN study can opt to participate in different research projects. For example, the CII is also conducting a trial on the effect of Paxlovid - an antiviral drug used to treat COVID-19 - on long COVID.

The trial is being conducted virtually, to make it easy for people to participate in research. Patients involved in the study receive drugs or placebo pills by mail, then fill out surveys online and electronically transmit their data to researchers.

The trial organizers also hold regular town hall meetings, where study participants can ask questions and suggest changes. When researchers learn new information through their research, they share it with the participants.
New long COVID study gives hope to researchers, patients
In September, researchers from the CII and Mount Sinai Hospital published a paper in Nature that identified biological markers associated with long COVID. By analyzing blood samples, the researchers found that hormonal dysfunction, exhaustion of certain immune cells and the reactivation of latent viruses are key factors in long COVID.

"To us, that means that there is an immunological underpinning to this disease," Iwasaki said.

According to Iwasaki, the evidence that long COVID is a biological disease is an important discovery not only to understand the disease but also to validate patients' struggles. People suffering from long COVID and other chronic diseases are often perceived as inventing or exaggerating their illness, Iwasaki said.

The idea that patients are making up their symptoms, Iwasaki said, is one of the major misconceptions that the CII seeks to debunk. Iwasaki added that the identification of biological markers helps dispel the belief that long COVID is only a psychiatric illness.

Sanders said she believes there should have never been a need to prove long COVID patients had an actual disease.

"I never thought they needed any validation. I thought that people who saw it as psychiatric alone were nuts," Sanders told the News. "Eleven million people have long COVID in the United States alone, and there's so many more than that in the world. Over a million people don't just come up with the same problem."

Long COVID is not the CII's only focus. Researchers at the Center also study diseases such as chronic Lyme disease, which is a disease spread by ticks, and myalgic encephalomyelitis chronic fatigue syndrome, or ME/CFS.

While post-acute syndromes are complex and tricky to study, long COVID provides a unique research opportunity, Iwasaki said. People with the disease became ill around the same time and from the same virus, which allows researchers to simultaneously study a large number of people who have a similar chronic illness.

Iwasaki said that it is difficult to find this kind of continuity with other post-acute viral syndromes because most chronic diseases occur in small numbers and at different times.

Research developments often come up in conversation during visits to the Long COVID Clinic. Patients frequently tell Sanders about new research they have encountered, and Sanders will follow up on it. Sanders even has a Google alert that sends her every online publication that has to do with long COVID.

Like Iwasaki, Sanders views long COVID as a unique opportunity to develop our understanding of chronic illness.

"It would be terrible to waste this and not learn anything from it, like we have done with so many other infections," Sanders said. "We have the technology and the curiosity. God only knows what other factors allowed this to be an active area of research, but I'm so glad it is."

Adults aged between 35 and 49 exhibited the highest prevalence of experiencing long COVID.

HANNAH MARK

CARLOS SALCERIO

# data[].attributes.attachment_link.title
'A different spirit' of research: Yale clinic seeks to unravel the mystery of long Covid - Yale Daily News

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At the Yale Multidisciplinary Long Covid Clinic, researchers and clinicians are racing to help patients and uncover the biology behind post-acute syndromes.

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"The stakes are high. Clear communication about what we do and do not know, when we know it and how we know it can help rebuild trust in our health care and public health systems and in society more broadly. And trust is a crucial ingredient to find, stop and prevent health threats".

# data[].attributes.subject
"The stakes are high. Clear communication about what we do and do not know, when we know it and how we know it can help rebuild trust in our health care and public health systems and in society more broadly. And trust is a crucial ingredient to find, stop and prevent health threats".

# data[].attributes.body
Dr. Tom Frieden: Covid-19 is still around, and so are these misconceptions

https://www.cnn.com/2023/11/09/health/tom-frieden-covid-19-misconceptions

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Dr. Tom Frieden: Covid-19 is still around, and so are these misconceptions | CNN

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Covid-19 hasn’t gone away, and it won’t any time soon. It’s now part of the landscape of health threats. Although the coronavirus continues to kill and cause lasting damage, our immunity, vaccines and treatments have tamed the pandemic.

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"JOIN US NOV 14! We are demanding $1B+ in annual research funding for Long COVID".

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"JOIN US NOV 14! We are demanding $1B+ in annual research funding for Long COVID".

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https://longcovidmoonshot.com/

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" Long COVID risk and severity can be significantly reduced by immune-modulating drugs and immunizations that attempt to improve immune function. Additionally, given the complexity of symptom trajectories and the unique disease burden, a patient-centered multidisciplinary strategy with an emphasis on tailored treatment programs and continuing symptom monitoring should be necessary to conduct these studies going forward".

# data[].attributes.subject
" Long COVID risk and severity can be significantly reduced by immune-modulating drugs and immunizations that attempt to improve immune function. Additionally, given the complexity of symptom trajectories and the unique disease burden, a patient-centered multidisciplinary strategy with an emphasis on tailored treatment programs and continuing symptom monitoring should be necessary to conduct these studies going forward".

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https://akjournals.com/view/journals/2060/aop/article-10.1556-2060.2023.00256/article-10.1556-2060.2023.00256.xml

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"Researchers compared doctor's online responses to patients questions with those generated by ChatGPT.  AI sent responses that were longer and higher in both quality and empathy".

# data[].attributes.subject
"Researchers compared doctor's online responses to patients questions with those generated by ChatGPT.  AI sent responses that were longer and higher in both quality and empathy".

# data[].attributes.body
atimes.com/opinion/story/2023-11-12/ai-healthcare-doctors-empathy-chatgpt

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Op-Comic: Is AI more empathetic than your doctor?

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Many physicians are burned out and rushed, so it's no wonder if they fail to connect meaningfully with each patient. If a robot can help, why not?

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"There's growing evidence that even a mild case of COVID can cause long-term changes to the immune system that affect the brain and nervous system".

# data[].attributes.subject
"There's growing evidence that even a mild case of COVID can cause long-term changes to the immune system that affect the brain and nervous system".

# data[].attributes.body
https://www.npr.org/sections/health-shots/2023/11/13/1211989263/pain-fatigue-brain-fog-long-covid-neurological-effects

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Michelle Wilson got COVID three years ago. She's still waiting for her brain and nervous system to recover.

Wilson's memory is spotty, she's frequently in pain, and even a short walk leaves her exhausted.

"I actually bought a cane that turns into a seat so I can go to the botanical garden," she says.

It's a big change for Wilson, 66, who had worked as a nurse at Barnes-Jewish Hospital in St. Louis. But after years of waiting to get better, she says she's realized something:

"This might be as good as it gets."

It's a story shared by a growing number of COVID "long-haulers" - those patients who suffer from persistent symptoms long after the initial infection has passed. Many of those symptoms, experts say, appear to be tied to COVID's effects on the brain and nervous system.

Government surveys suggest that millions of people in the U.S. are living with neurological symptoms linked to long COVID. Many, like Wilson, were infected before vaccines became available.

"It's a public health crisis," says Dr. Robyn Klein, who directs the Center for Neuroimmunology and Infectious Diseases at Washington University School of Medicine in St. Louis.

"There are a lot of people suffering and those people need treatment yesterday," says Dr. Ziyad Al-Aly, who holds positions at both Washington University and the Veterans Affairs St. Louis Health Care System.

But treatment remains a distant promise.

"There's still a ton we don't know," says Dr. Troy Torgerson of the Allen Institute for Immunology in Seattle. Scientists are "nibbling away" at the problem, he says.

The virus appears to do most of its damage to the brain indirectly, scientists say.

An infection in the body triggers an immune response that leads to inflammation in the brain. And the inflammation can persist long after the virus has apparently been cleared, scientists say.

The brain may be especially vulnerable to COVID because the disease appears to weaken the blood-brain barrier, which usually protects the organ from both germs and the immune cells that follow them.

Another possibility is that COVID-related inflammation affects the vagus nerve, which carries signals between the body and brain that are important to memory and attention.

From lungs to brain

Early in the pandemic, doctors tended to focus on what COVID did to a person's lungs.

In those days, Wilson was working in the post-anesthesia care unit at Barnes-Jewish Hospital.

"I got people ready for surgery, and woke them up after their surgeries," she says. "I loved that job."

But the job put her in close proximity to lots of potentially infected patients. And in November of 2020, Wilson got the disease.

When the symptoms grew worse, she went to the emergency department at her own hospital.

"I had bilateral pneumonia and I was in sepsis by that time," she says. "My blood pressure was really low and I had an irregular heartbeat."

The infection was primarily her lungs, but it was also disrupting her brain, including the circuits that control blood pressure and heart rhythm.

"Unfortunately, long COVID, as we know it now, can affect nearly every organ system, including the brain," Al-Aly says.

People with neurological symptoms do get better, he says, but full recovery is rare.

Three years after getting COVID, Wilson continues to struggle with a range of symptoms, including an unreliable memory.

"I have trouble with word retrieval, concept retrieval - and sometimes, like, remembering where I was going," she says.

Wilson also has problems sleeping at night, a condition Al-Aly says affects about 40 percent of people with long COVID.

"As a result, they wake up fatigued," he says, which contributes to their exhaustion from even moderate activity.

Poor sleep can also contribute to the pain that many long COVID patients report.

"It's not only 'my wrist is hurting' or 'my knee is hurting,'" Al-Aly says. "It's really almost like the whole body aches."

When Wilson first came home from the hospital, she was in agony.

"The pain across my chest and in my arms was so bad that I slept with pillows under both arms because I couldn't stand my arms to touch my chest," she says.

Now Wilson is able to do things like make breakfast or take a shower - so long as she takes her pain meds.

Immune system gone wrong?

There's growing evidence that even a mild case of COVID can cause long-term changes to the immune system that affect the brain and nervous system.

Torgerson of the Allen Institute was part of a team that studied blood samples from 55 people who had symptoms at least 60 days after a COVID infection.

"We saw persistent ongoing immune activation in about half," he says, even though only a handful had been sick enough to be hospitalized.

Once the immune system gets fired up, Torgerson says, it can affect the brain even if the virus itself doesn't infect brain cells.

For example, circulating immune cells and antibodies may cross from the bloodstream into the brain and damage neurons. Or the presence of an infection may activate a special set of immune cells found only in the brain.

Long COVID also has some striking similarities to autoimmune diseases, which occur when the immune system mistakenly attacks healthy cells, Torgerson says.

Lupus, for example, can cause inflammation that results in joint pain and fatigue. When Lupus reaches the brain, it can also cause the sort of brain fog often seen in long COVID.

A mouse model of COVID

To learn more about how long COVID affects a human brain, scientists have been studying mice that develop a mild version of the disease.

"Those animals have cognitive deficits a month after they were infected," Klein says. "They no longer have virus, they're no longer ill. But they can't remember and recognize things."

One reason may be that the infection weakens the blood-brain barrier in these animals, Klein says, allowing the body's immune response to affect brain cells.

The result is inflammation that causes subtle but significant changes in the brain.

"It's not like there's a multitude of dying neurons," Klein says. "What there is, is elimination of the connections between neurons."

Klein suspects that something similar is happening to the synaptic connections in the brains of people who get long COVID. And she says it appears this can happen even in people who don't get very sick.

"You and I may handle viruses differently," she says. "I may end up getting more inflammation in my brain than you because we have a different genetic makeup."

One way to protect the brain after an infection may be with drugs that reduce inflammation - and studies to test that idea are already underway. In the meantime, vaccination offers a way for people to reduce their risk of developing long COVID.

Michelle Wilson, though, got infected before vaccination was an option. And she'd like a treatment that can undo what COVID has done to her brain.

"We don't know everything about COVID yet," she says, "So I have hope."

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Pain, fatigue, fuzzy thinking: How long COVID disrupts the brain

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The neurological symptoms of COVID can persist for years after an infection. Scientists are just beginning to understand why.

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"A personalized approach aimed at preventing post-exertional malaise appears to be the right approach for this patient population for now. Further research is needed to understand the specific mechanisms underlying a limited exercise capacity and post-exertional malaise in patients with post-COVID condition".

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"A personalized approach aimed at preventing post-exertional malaise appears to be the right approach for this patient population for now. Further research is needed to understand the specific mechanisms underlying a limited exercise capacity and post-exertional malaise in patients with post-COVID condition".

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https://www.scienceopen.com/hosted-document?doi=10.14293/PR2199.000467.v1

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Physical exertion worsens symptoms in patients with post-COVID condition : Post-exertional malaise in patients with post-COVID condition

# data[].attributes.attachment_link.description
Patients with post-COVID condition suffer from fatigue, limited exercise capacity, and post-exertional malaise. Post-exertional malaise is the worsening of symptoms after physical or mental exertion, which reduces the efficacy of most forms of rehabilitation. This article presents the current understanding in the pathophysiology of post-COVID condition, particularly the underlying causes of post-exertional malaise.

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"The rise in cognitive issues aligns with a common symptom that plagues many Covid long-haulers: “brain fog".

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"The rise in cognitive issues aligns with a common symptom that plagues many Covid long-haulers: “brain fog".

# data[].attributes.attachment_link.title
Can’t Think, Can’t Remember: More Americans Say They’re in a Cognitive Fog

# data[].attributes.attachment_link.description
Adults in their 20s, 30s and 40s are driving the trend. Researchers point to long Covid as a major cause.

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" I think this is an excellent example highlighting the many layers of complexity surrounding neurotransmitter actions in the nervous system and beyond - and reiterates the point that caution is warranted when initiating therapies that impact serotonin signaling".

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" I think this is an excellent example highlighting the many layers of complexity surrounding neurotransmitter actions in the nervous system and beyond - and reiterates the point that caution is warranted when initiating therapies that impact serotonin signaling".

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https://lcbreakdown.substack.com/?r=a36iw&utm_campaign=pub&utm_medium=web

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A recent paper by Wong et al (2023) found decreased circulating serotonin levels were associated with long COVID, and used mouse models to show that viral inflammation can cause this effect by interfering with intestinal absorption and platelet destruction. In mouse models, viral infection had downstream effects on the vagus nerve and impacted novel object recognition.

Serotonin is synthesized from the amino acid tryptophan, which must be sourced from diet. However, tryptophan supplementation did not restore serotonin levels in virus-treated mice due to insufficient intestinal uptake.

Tryptophan is available over the counter as a nutritional supplement but has no evidence of therapeutic benefit for depression or sleep. People with myalgic encephalomyelitis (ME) should be particularly cautious with tryptophan supplementation, as side effects can exacerbate symptoms.

A theory by leading ME expert Dr. Ron Davis hypothesizes that common mutations in one of the genes involved in tryptophan metabolism, IDO2, could predispose individuals to develop ME. Loss of IDO2 function prevents the conversion of tryptophan to kynurenine when tryptophan concentrations are high, which could result in ME symptoms.

Selective Serotonin Reuptake Inhibitors (SSRIs) are commonly prescribed for depression and anxiety disorders. These drugs increase the concentration of serotonin within the synaptic cleft in the nervous system by blocking the serotonin transporter (SERT).

The majority of serotonin in the body is absorbed into circulation and taken up by platelets for storage via SERT. It doesn't actually cross the blood-brain barrier and instead participates in platelet activation and aggregation. By blocking SERT, SSRIs prevent platelets from storing serotonin, which instead is degraded by monoamine oxidase.

Interestingly, the ability of SSRIs to reduce circulating serotonin levels may be implicated in their therapeutic effect, as people who respond well to SSRIs can be distinguished from non-responders by the magnitude of circulating serotonin suppression. People with depression are more likely to have cardiovascular health problems, and SSRIs might protect against this.

Despite serotonin's known role in promoting platelet activation, Wong et al (2023) found that reduced serotonin levels also promoted platelet aggregation, an interesting distinction between major depression and viral infection.

Welcome back to Long COVID Research Breakdown! I'm finally returning from hiatus to talk about the big-picture implications of a new blockbuster study ¹ published in Cell last month showing a mechanistic link between post-acute viral sequelae and reduced levels of circulating serotonin, a neurotransmitter linked to many physiological processes but most famously implicated in so-called "affective" disorders like generalized anxiety and major depression. Most laypeople are familiar with this molecule as the target of selective serotonin reuptake inhibitors (SSRIs), one of the most commonly prescribed classes of medication used to treat mood disorders: the classic monoamine theory of depression purports that reduced serotonin signaling in the brain underlies depressive phenotypes, which could explain why SSRIs and other similar medications can be effective treatments for depression.

Based on this understanding, one could incorrectly argue the recent finding supports a "biopsychosocial" or "psychogenic" basis to illnesses like long COVID because the mechanism appears to overlap with major depression and other mood disorders. However, this logic makes several assumptions that quickly begin to fall apart upon investigation, namely that SSRI therapy increases circulating serotonin levels (it does not!) and that increasing plasma serotonin levels through medications or nutritional supplements would have a therapeutic benefit in long COVID patients (unclear and potentially harmful).

We're going to spend some time walking through these points and discussing what we actually know about the multifaceted role of serotonin in health and disease. My goal for this post is to convey an appreciation for the complexities surrounding receptor pharmacology and its connection to physiology and behavior. I argue that the Wong et al (2023) paper actually provides strong evidence against a psychological interpretation of long COVID and indeed concludes that viral infection produces measurable, distinct physiological changes in both mice and human volunteers with post-acute COVID syndrome (PACS). While the authors of the study were very careful to use language depicting PACS as an inherently physiological syndrome, such care does not always get translated to media coverage (or to your loved one that continuously recommends supplements and meditation as disease cures). Fear not - we'll dive into this exciting topic together, starting with a recap of the serotonin paper that captured all of our attention.

So what's all the hype about anyways? For starters, the Wong et al (2023) paper was an incredibly thorough investigation that utilized both human volunteer cohorts and mouse models, allowing the authors to translate clinical findings into an animal model for more controlled mechanistic investigation. In fact, the paper integrated patient data from several long COVID patient cohorts after identifying serotonin dysregulation in acute COVID-19 patients, finding that circulating plasma serotonin levels in the post-acute phase could predict PASC status.

The paper goes on to corroborate this finding in several animal models: mice expressing a humanized ACE2 receptor and infected with wild-type (Wuhan Strain) SCoV2 and wild-type (non-modified) mice infected with vesicular stomatitis virus (VSV) and lymphocytic choriomeningitis virus (LCMV). VSV and LCMV are RNA-based viruses like SARS-CoV-2, and are well-established laboratory models of persistent viral infections. As an additional experimental group, the researchers injected mice with a compound called poly(I:C), which mimics nonspecific viral RNA and can stimulate an immune response. All of these rodent models had similar results: viral infection significantly decreased plasma serotonin levels, and further experiments show that this occurs through the suppression of amino acid absorption in the gut by viral inflammation.

The paper further explores the impact of viral infection on the brain using something called the novel object recognition test. In this behavioral paradigm, mice are placed in a neutral environment and provided access to a novel object - often simple laboratory tools like test tubes filled with sand, or large paper clips. After this initial session, the mouse is then presented with two objects: the same object from the first session, and a different novel object they have never seen before. Mice will naturally spend more time investigating the novel object during this test, which can be expressed as the novel object preference as a percentage of time.

As you might expect, VSV, LCMV, and poly(I:C) treatment reduced the amount of time the mice spent investigating the novel object:

The authors are quick to call this a cognitive deficit, although as a (former) behavioral neuroscientist I disagree with that characterization. For starters, you can see in the graphs above (and in most of the expanded figures in the paper), the infected mice in the VSV, CL13, and poly(I:C) group spend less time investigating the novel object than the naive (untreated) mice. These statistical analyses relied on comparing each group of mice to each other to discern whether they are significantly different, as indicated by the asterisks. However, in this type of behavioral assay, there's another set of statistics that should be run - namely, each individual group should also be compared with the threshold value of 50%. Although I can't run these tests without the original data, it appears as though the statistically significant treatment groups above still spent the majority of the session interacting with the novel object - and spending less time investigating a novel object is not equivalent to failing to recognize the familiar object.

Why does this distinction matter? Behavioral studies in mice are useful for understanding the link between the brain and behavior, but the results are not simple to interpret. There could be many factors influencing a mouse's behavior toward a novel object: ability to remember the familiar object, ability to recognize and recall the familiar object, ability to distinguish between novel and familiar objects, ability to regulate attentional processes to seek out novel objects, stimulation or suppression of locomotor activity, etc. Broadly speaking, behavioral experiments - especially those involving mice - are very sensitive and easily influenced by environmental factors. Mice and rats are prey animals, and consequently are prone to stress and anxiety during these procedures without proper acclimation and handling. This is why behavioral studies typically include a variety of behavioral tasks designed to measure similar aspects of the behavior of interest to further refine the phenotype. Regardless, the results here still clearly show a connection between viral infection and novel object responses, as poly(I:C) treatment led to a decrease in neuronal activation in the hippocampus and brainstem following the novel object recognition test.

Selective activation of the vagus nerve during poly(I:C) treatment restored the behavioral and neuronal responses to normal levels. Because the vagus nerve is directly activated by serotonin released from the gut, the authors conclude that reduced circulating serotonin leads to vagus nerve dysfunction in long COVID, a hypothesis consistent with many other reports.

On the other hand, the authors do show that supplementing a glycine-tryptophan dipeptide or 5-HTP in poly(I:C) treated mice did restore circulating serotonin levels - because these molecules can be absorbed in alternative ways that do not depend on the downregulated transporters. This is an important distinction, and highlights the complexities of amino acid synthesis and metabolism.

However promising this might sound, I believe that caution is warranted around dietary supplementation of tryptophan and other serotonin precursors, particularly in patients with myalgic encephalomyelitis (ME), formerly known as chronic fatigue syndrome. The cardinal symptom of ME is post-exertional malaise, or a dramatic worsening of symptoms following mild physical or cognitive exertion. The onset of ME typically follows some kind of immune system insult, with viral infection being the most common trigger. Although ME research has been systematically neglected by funding agencies over the past 40 years, a sizable body of work showcases dramatic metabolic and mitochondrial abnormalities in ME patients, suggesting a fundamental disruption in energy production. Approximately half of long COVID patients meet the diagnostic criteria for ME.

Although the definitive mechanisms driving ME are still unclear, many hypotheses center around fundamental dysregulation of energy metabolism at the cellular level. Mitochondria perform their powerhouse function through generating a molecule called adenosine triphosphate (ATP), which powers the enzymes that keep our cells running. What does tryptophan have to do with this? Tryptophan can also be converted into another bioactive metabolite, kynurenine. Kynurenine itself is then converted into either kynurenic acid or quinolinic acid. While kynurenic acid is broadly neuroprotective through limiting excitotoxicity, quinolinic acid can have the opposite impact - as well as depleting the molecule nicotinamide adenine dinucleotide (NAD), a necessary component of the mitochondrial electron transport chain that produces ATP.

If kynurenine sounds familiar, that's because it was also highly dysregulated in COVID-19 patients in Wong et al (2023), but to the opposite degree: kynurenine and kynurenic acid levels were higher in acute COVID-19. However, figures from the supplemental materials show that kynurenine levels are not elevated in PASC patients and instead are lower compared with recovered controls. Tryptophan levels are also somewhat lower, which is consistent with decreased intestinal absorption.

But there's an additional layer of complexity surrounding kynurenine metabolism - the conversion from tryptophan to kynurenine involves two nearly identical enzymes, IDO1 and IDO2. When tryptophan levels are low, IDO1 takes the lead - but once they start to rise, its activity actually begins to decrease (an effect known as substrate inhibition, when the enzyme's target molecule can also inhibit activity). This is where IDO2 comes in, favoring conditions with higher concentrations. There are several mutations in the IDO2 gene that can potentially decrease the enzyme's activity, ranging from common (rs10109853, 0.418-0.487 allele frequency) to very rare (rs774492001, 0.000017-0.000020 allele frequency). ²

With this information, Stanford geneticist and Human Genome Project alumni Dr. Ron Davis formulated the IDO metabolic trap hypothesis for ME, speculating that deleterious IDO2 mutations might function as a risk factor for ME by promoting a "metabolic trap" where high concentrations of tryptophan prevent kynurenine synthesis. This is supported by mathematical models of enzyme kinetics showing that a reduction of IDO2 activity by 90% fully prevents IDO activity across higher concentrations. Note here that IDO1 activity (flux) drops off starting at around 30 uM of tryptophan, and that the average tryptophan level even in tryptophan-depleted PASC subjects is around 45 uM (see above figure from Wong et al (2023)).

Under this theory, the decreased ability to convert tryptophan to kynurenine via IDO2 means that higher concentrations of cytosolic tryptophan will actually prevent kynurenine synthesis and its downstream metabolism. According to this hypothesis cells that regularly utilize tryptophan and its derivatives, like serotonergic neurons, enterochromaffin cells, and melatonin-producing pinealocytes, are most likely to be impacted.

Importantly, this is just a theory based on mathematical models - much more research will be needed to establish a definitive link between IDO2 and ME/CFS. However, I would still argue that this hypothesis warrants caution around the use of dietary tryptophan supplementation in people with ME, whether it was triggered by a COVID-19 infection or something else. Even in healthy individuals, tryptophan supplements can have detrimental side effects like nausea, cognitive difficulties, and heart palpitations - symptoms often present in ME, which could be further exacerbated by supplementation. There is no data to support the use of tryptophan supplementation for sleep or mood disorders, meaning they carry risks that are not offset by any potential benefits. The more direct serotonin precursor, 5-HTP, should theoretically bypass the IDO "trap" but there is still limited evidence to support its clinical use. Always discuss any new supplements with a knowledgeable clinician or specialist before taking them.

Chances are, you or somebody you know has probably taken a selective serotonin reuptake inhibitor (SSRI) for conditions like anxiety and depression. They are commonly understood to "boost" serotonin signaling - which is true, but fails to convey that the mechanism through which SSRIs increase serotonin is specific to the synapse. Let's break this down.

Neurons in the brain are electrically active, but the majority of cell-to-cell communication in the nervous system occurs through what we call chemical transmission. Neurons have specialized, directional contact points called synapses where two neurons meet. The cells communicate by releasing neurotransmitters, which travel across the synapse to act on post-synaptic receptors. Chemical transmission between neurons gives rise to immense physiological complexity and forms the basis for principles like long-term potentiation of excitatory transmission following periods of high activity.

As you can imagine, neurotransmission is a tightly controlled process - various mechanisms are needed to ensure that the released neurotransmitters are quickly removed from the synaptic cleft to prevent diffusion to other sites. Neurotransmitter release is also energetically expensive, leading many neurons to engage in a recycling process where synaptic neurotransmitters are funneled back into the presynaptic neuron. This is where the term reuptake inhibitor comes from: SSRIs block the activity of the serotonin transporter (SERT), thereby increasing levels of serotonin only within the synapse.

The SSRI medications are much more selective than previous generations of antidepressants like monoamine oxidase inhibitors and tricyclic antidepressants, which are no longer widely used due to the high degree of side effects. SSRIs are certainly better tolerated and more effective compared with these previous therapies, but at the clinical level their effect is typically modest, with many patients failing to respond to several different SSRIs. Furthermore, it takes weeks for the therapeutic effect of SSRI medications to develop - indicating the underlying mechanism is likely more complex than simply increasing synaptic serotonin. This is further complicated by the multifaceted nature of behaviorally defined disorders like depression, which likely encompass dozens of different mechanisms that converge in a similar behavioral phenotype.

Due to the widespread understanding that SSRIs function by increasing serotonin concentration at the synapse, it's tempting to assume that these drugs would similarly increase the concentration of serotonin in the blood. However, that's not the case - circulating serotonin does not cross the blood-brain barrier, but instead can modulate nerve responses in the peripheral nervous system. Serum serotonin levels are actually maintained by platelets, which cannot synthesize serotonin but express the SERT transporter to vacuum up serotonin from the bloodstream before it's broken down by monoamine oxidase.

As you can see, blocking the SERT transporter with an SSRI will actually lead to lower platelet serotonin stores. This may seem counterintuitive at first, as decreased platelet serotonin would mean increased serum serotonin - but remember, free serotonin does not stick around for very long before encountering monoamine oxidase to break it down. Although initial treatment with SSRIs can increase plasma serotonin levels, chronic treatment causes sustained suppression of both intraplatelet and serum serotonin levels. ³⁻⁸

So how does this information tie into the Wong et al (2023) paper? Obviously, the effect of decreasing circulating serotonin levels is complex and multifaceted - in the case of SSRI therapy for depression or blood thinners for platelet depletion, reducing circulating serotonin levels might actually provide therapeutic benefits or correct deficits in serotonin signaling. On the other hand, infection by RNA viruses induces a host immune response that fundamentally disrupts our ability to synthesize serotonin from its dietary precursor, tryptophan. Following this logic, treating long COVID or other post-acute infection syndromes with SSRIs would likely exacerbate the circulating serotonin deficit and have reduced antidepressant efficacy.

Despite being best known as a neurotransmitter, serotonin has long been understood to act in the clotting cascade. Serotonin stores within platelets are released upon activation by pro-thrombotic factors, the downstream effects of which include vasoconstriction, inflammation, and conversion of fibrin to fibrinogen. Dysregulated and/or anomalous clotting has also been implicated in long COVID as well as serious cardiac sequelae following COVID-19, pointing toward another intriguing connection between the nervous and circulatory systems. ⁹

Long before the COVID-19 pandemic began, there was a well-known association between major depressive disorder and poor cardiovascular health. There is also a significant body of research showing pronounced neuroinflammation in major depression, although these physiological signatures are often attributed to depressive behaviors despite lacking causal evidence. In addition to their more subjective antidepressant properties, SSRI therapy seems to have multifaceted benefits which can include reduced markers of inflammation and endothelial damage in depressed patients with coronary artery disease, ¹⁰ reduced platelet aggregation, 4,11 and reduced endothelial and platelet dysfunction following acute coronary events. ¹² Some studies even suggest that SSRIs can reduce heart attacks and mortality in the clinically depressed population, 13,14 although there is some disagreement (i.e. Almuwaqqat 2019 ¹⁵). Although direct evidence is lacking, these data are consistent with the idea that elevated circulating serotonin can have adverse cardiovascular consequences, which can be reversed through pharmacological blockade of the serotonin transporter.

Notably, platelets themselves can be depleted during viral inflammation as demonstrated by Wong et al (2023, Fig. 6B-D). Curiously, though, Wong et al demonstrated increased platelet activation following viral infection - unlike depressed patients with low serotonin following SSRI therapy, the low levels of serotonin induced by viral inflammation promotes platelet coagulation. What might explain this discrepancy? It's hard for me to speculate as a non-domain expert in this area, and unfortunately the pro-coagulant properties of serotonin were not discussed in the Wong paper (no shade intended, these journals have strict page limits). Hopefully the authors of the Wong et al study are continuing their investigation of these phenomena. I think this is an excellent example highlighting the many layers of complexity surrounding neurotransmitter actions in the nervous system and beyond - and reiterates the point that caution is warranted when initiating therapies that impact serotonin signaling.
That's a wrap for today's post on serotonin in post-acute infection syndromes! What do you think? Have you had personal experience with these medications being prescribed for LC or ME? Let me know in the comments! Share Long COVID Research Breakdown
References:

2. Kashi, A. A., Davis, R. W. & Phair, R. D. The IDO Metabolic Trap Hypothesis for the Etiology of ME/CFS. Diagnostics 9, 82 (2019).

7. Honig, G., Jongsma, M. E., Hart, M. C. G. van der & Tecott, L. H. Chronic Citalopram Administration Causes a Sustained Suppression of Serotonin Synthesis in the Mouse Forebrain. PLOS ONE 4, e6797 (2009).

9. Kell, D. B., Laubscher, G. J. & Pretorius, E. A central role for amyloid fibrin microclots in long COVID/PASC: origins and therapeutic implications. Biochem. J. 479, 537-559 (2022).

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The convoluted role of serotonin in infection-associated chronic illness

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Could deficits in serotonin signaling explain cognitive dysfunction following viral infections?

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"Every single provider in the United States is going to have a long COVID patient. So it's not just about educating those at long COVID or post-COVID centers. It's about educating the entire medical community as a whole".

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"Every single provider in the United States is going to have a long COVID patient. So it's not just about educating those at long COVID or post-COVID centers. It's about educating the entire medical community as a whole".

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https://www.medscape.com/viewarticle/998615

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Janna Friedly was thrilled, hopeful - and relieved - by the email that had landed in her inbox: After years of fighting an uphill battle to treat patients with long COVID, her Seattle clinic, one of the first and longest-running facilities in the US, was finally getting a much-needed financial boost from the US Department of Health and Human Services.

The multimillion-dollar grant, which came through in September, was going to help Friedly and her colleagues at the University of Washington's Post-COVID Rehabilitation and Recovery Care at Harborview Medical Center meet some of the crushing demands of long COVID care.

"This entire year has been really filled with patients that have been trying to get access to the clinic for a year. And they're still struggling," said Friedly, MD, MPH, chair of the Department of Rehabilitation Medicine at the University of Washington School of Medicine and executive director at Harborview.

The tremendous demand and backlog had prompted the clinic in January 2023 to severely limit referrals to King County and the university. It was a hard decision that meant the rest of Washington, Wyoming, Alaska, Montana and Idaho - the five-state "WWAMI" region the clinic served - lost access to critical post-COVID healthcare.

At Harborview, there is now hope. The grant money will allow Friedly and her colleagues to make meaningful headway on their ambitious goals. But they are also realistic about the formidable task ahead.

Their circumstances are hardly unique. Clinics across the country are facing daunting challenges - amid dire patient needs, insufficient funding from state and federal health agencies has led to significant hurdles in patient care, especially for vulnerable and underserved communities, according to interviews and surveys with more than a dozen long COVID clinics, doctors, advocates, and patients. At the same time, a lack of training and education on long COVID within the broader medical community is hurting patients.

The grant announcement of a million dollars a year for up to 5 years per clinic - awarded to nine established multidisciplinary centers across the US through the Agency for Healthcare Research and Quality (AHRQ) of HHS - provides considerable relief.

But how far can $5 million stretch, given that long COVID is so complex, the needs of patients are so great, and the resources clinics have to manage them are so limited?

A Struggle to Help the Living

Nearly 4 years ago, Washington was at the epicenter of the first known US COVID case when an infected patient was identified in Snohomish County, less than 2 hours from Seattle. (Research later suggests the virus had been present long before it was first identified.)

In spring 2020, Julie Hodapp, MD, co-medical director of the Harborview clinic, was the first physician at UW to see patients recovering from severe COVID-19 following their discharge from intensive care. The clinic operated on minimal resources with no guide book on treatment strategies and a steep learning curve.

It did not take long, however, for Hodapp and her colleagues to identify an entire population of nonhospitalized patients who experienced mild to moderate COVID and who were suffering from persistent symptoms long after their initial infection. Referrals exploded once they opened the clinic to that group as well.

The deluge of patients in the early days of the pandemic meant they "could not humanly, physically see all the referrals," according to Hodapp, a rehab medicine physician. The clinic quickly brought in colleagues from multiple specialties in medicine, with as many as 17 physicians joining the team at its peak. Some doctors transitioned back to their regular clinical practice; currently, nine doctors and a nurse see hundreds of old and new long COVID patients a month. More physicians are coming on board soon.

"Clinicians have felt quite a bit of burnout and stress trying to manage the volume of patient care needs," said Friedly.

And resources have always been limited.

"That's incredibly frustrating to us because we know that patients will do better when they have good access to mental health treatments, to the physical therapy, cognitive rehab, and that just isn't happening," she said prior to receiving the AHRQ grant.

To set up a clinic requires resources that involve not only doctors and nurses but also administrative and IT staffing and expertise, said Jonathan Whiteson, MD, with the American Academy of Physical Medicine Rehabilitation (AAPMR). Expenses are not always covered by hospital or healthcare systems, and even when funding is rerouted to a clinic, sustaining the operation takes further financing, added Whiteson, who is also an associate professor at New York University Grossman School of Medicine.

Despite the substantially reduced referral zone at Harborview, patients continue to pour in. Collectively, the clinic has handled thousands of cases since its inception. This past summer, the team was seeing roughly 150 new patients a month and up to 150 to 200 returning patients. The newest ones had been waiting since October 2022 for their first appointment in late June. Just weeks earlier, the World Health Organization had declared the end of the COVID-19 global health emergency. But there is no end for long COVID doctors.

"People want to move on from the pandemic. They're not putting the money or the very limited personnel that they have into these clinics," said Karyn Bishof, with the Long COVID Alliance and founder of the COVID-19 Longhauler Advocacy Project.

Fast forward to autumn, and the backlog at Harborview remains. The clinic's first-time patients have waited since December 2022 and January 2023 to be seen. What began as an unrelenting battle to save the dying is now a much quieter but still steadfast struggle to help the living.

Long COVID Is Not Going Away

While wait times have shortened in many parts of the US, especially in major urban centers where multiple clinics operate, doctors from across the country who were surveyed say they are still seeing plenty of patients with post COVID problems for the first time. These post-COVID conditions are characterized by a broad range of symptoms that linger or develop weeks and months after an acute infection. For some, the persistent symptoms may be inconvenient or irritating, but for others, they are debilitating and devastating, lasting months or possibly years.

Wastewater samples at the end of September showed that COVID-19 levels remained high in nearly two dozen states, according to WastewaterScan, which analyzes wastewater from municipal treatment plants across the US that serve more than 10,000 residents.

The latest CDC Household Pulse Survey, taken between October 18 and October 30, 2023, found that 9.5% of American adults previously infected with SARS-CoV-2 say they are currently experiencing long COVID. While this figure has fallen from nearly 15% a year ago, it still means millions of adult Americans are grappling with the aftereffects of COVID-19 right now. Among those currently dealing with the complex condition, nearly 30% say it has caused "significant activity limitations" - the highest since at least September 2022.

Some patients have been wrestling with symptoms for 2 or 3 years and are unable to work, enjoy their hobbies, or be active and spend quality time with family, said Jessica Bender, MD, an internal medicine physician and a co-medical director at the Harborview clinic.

"It's really hard to see your patient not get better," she said. The group recognizes the mental toll long COVID takes and that providing mental health support is an important component of their multidisciplinary approach.

Compounding the problems are patients with other health problems. They are often the worst hit. The healthcare system is not well designed for people with chronic conditions or those with multiple chronic problems, Friedly said. "This just shines a bright light on all of the inadequacies and gaps in our healthcare system."

Hope, Despair and Frustrating Challenges

On the nearly 189,000-member Facebook group Survivor Corp, which educates and connects survivors of COVID-19 and long COVID, the impact of the system's deficiencies is unmistakable. Many have seen numerous specialists. Some travel hours and cross state lines to seek help. One patient in Georgia waited 9 months to be seen at a clinic 350 miles away in Florida. The patient took a week off to make the trip, but it was "time and money wasted." The ordeal was "awful, especially when you feel like you're dying," the patient told WebMD via Facebook Messenger.

For patients lucky enough to access a multidisciplinary clinic, it can be lifesaving. One Survivor Corp member said her symptoms kept worsening, but the healthcare system in her area was unable to help. A referral to the "University of Cincinnati saved my life," she told WebMD via the group's Facebook page. "I know if I hadn't gone to the COVID clinic, I would've died."

Not everyone is so lucky, however. Hundreds of facilities across the US are described as long COVID clinics, but there is no consensus as to what that entails. They are often geographically out of reach for many Americans, and many appear unequipped to provide multidisciplinary services.

Sophia Naide of Washington, DC, said her post-COVID symptoms worsened after "extremely harmful" treatment that left her using a wheelchair and out of the workforce.

"In my experience, these clinics are hit or miss. Some of them genuinely offer expertise on post viral illness, while others peddle outdated and disproven treatments. Unfortunately, my experience was the latter," she wrote via email, saying her "trust in doctors has been shattered."

Barriers to access are not just about the type of services available, quality of care, wait times, or geography. Some patients were denied care because they could not produce a positive COVID test result, Bishof said, despite health agencies such as the CDC saying one is "not required to establish a diagnosis of Post-COVID Conditions."

There are legal constraints too. During the public health emergency, the UW clinic was able to provide telemedicine across state lines, explained Nicole Gentile, MD, PhD, another veteran with the Seattle clinic. This crucial service was cut after it was declared that the emergency had ended, even as doctors described telemedicine as a critical national issue and an invaluable means of reaching more patients in dire need of help.

With so many obstacles, many look elsewhere for answers.

The Harborview team's concerns and needs are echoed all over the US, particularly in underserved communities.

Some 2100 miles southeast of Seattle, in San Antonio, Texas, a lack of resources and access to specialty care remains a key concern, said Monica Verduzco-Gutierrez, MD, a professor and chair of the Department of Rehabilitation Medicine at the University of Texas Health Science Center at San Antonio. Her clinic, also a recipient of the AHRQ grant, was "busting at the seams" earlier this year. While wait times have since shortened considerably thanks to an expanded care team, doctors have their hands full balancing post COVID care with their already-busy pre-COVID specialties.

In New Mexico, Alisha Parada, MD, head of general internal medicine and geriatrics at the University of New Mexico's School of Medicine, has had similar experiences.

"Everybody goes about it in a different way because it's really dependent on resources. And we have very limited resources," said Parada, who has been working with long COVID patients since April 2020. "Just like primary care physicians and clinicians, we have a shortage of specialty physicians in our state."

One Clinic, $5 Million, and Lofty Goals

For Friedly and her team at Harborview, the grant will not only help shore up resources and expand access and care, but it will also allow clinics to learn from one another to develop and implement better models.

The importance of collaboration between clinics is highlighted by AAPMR's own PASC (post-acute sequelae of SARS-CoV-2) collaborative, which brings together experts and stakeholders from more than three dozen clinics. They share research, data, and experiences through lectures and open access documents online, said Whiteson. "It's been absolutely essential in the process of disseminating the information."

But $45 million spread over 5 years and nine clinics is a small sum considering the magnitude of the problem, experts say.

"With the high prevalence of long COVID, there's no way that we're going to be able to fully address long COVID with this, and there's clearly more funding that's needed to help," said Friedly, who is nonetheless optimistic her team will do as much as it can with the much needed cash infusion. "This definitely will go a long way and take us a lot further than we've been able to do."

Physicians and patients alike say there is an enormous knowledge gap among general practitioners on the subject. The AHRQ funding also aims to help repair that chasm.

"I definitely tend to hear that from my patients who are coming from more rural settings - that they're told it's all in their head," said Caitlin McAuley, DO, a family medicine physician with the COVID Recovery Clinic at Keck Medicine of the University of Southern California.

One way to ensure that the message and the lessons reach doctors is to incorporate them into medical schools and also make education on the subject a requirement for doctors to recertify their licenses, said Long COVID Alliance's Bishof, an EMS firefighter who was infected in March 2020 while working and who developed severe, long-term health problems.

"Every single provider in the United States is going to have a long COVID patient. So it's not just about educating those at long COVID or post-COVID centers. It's about educating the entire medical community as a whole," said Bishof. He noted that a "domino effect" can occur when there are backlogs and delays and the care itself is siloed.

At UW, a formal curriculum was developed and incorporated into the training for the global health fellowship in the Department of Family Medicine. "The reality is, as this becomes more of a chronic illness, just like diabetes or chronic fatigue syndrome, it will fall on the shoulders of primary care doctors for the vast majority of patients," said Bender.

In the meantime, Harborview and clinics like it aim to continue efforts to educate and help those suffering in what some have called the "silent" pandemic.

"It's a message to our patients that yes, we're still thinking of you," said Whiteson. "We will never stop thinking of you. We value your function, your quality of life, your day to day activities."

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post-acute sequelae of sars-cov-2 infection; post-acute sequelae of sars-cov-2 infection (pasc); pasc - post-acute sequelae of sars-cov-2 infection; long covid

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washington dc;  washington (district of columbia)

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A Long COVID Clinic's Fight to Meet Crushing Patient Needs

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'This entire year has been really filled with patients that have been trying to get access to the clinic for a year. And they're still struggling.'

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“There’s no data” that suggests the different variants cause a different length of time in symptoms".

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“There’s no data” that suggests the different variants cause a different length of time in symptoms".

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https://www.msn.com/en-us/health/medical/symptoms-of-covid-19-usually-last-around-10-days/ar-AA13Cvwl?cvid=f75522cc059949f594a5c4f8865a9ada&ocid=socialshare&ei=9&sc=shoreline&fbclid=IwAR3-vE4d242E7LV71DzoYJHbWeCyGMKUbK5YmUASpLtU1EaVUiqkaHXL9n8

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"On the face of it, it doesn’t make sense. Once you get infected by a pathogen, your body should be better prepared to deal with it the next time it comes around, but instead of being better at fighting off the invader, people with long COVID are getting more hammered by it the second (or third or fourth) time around".

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"On the face of it, it doesn’t make sense. Once you get infected by a pathogen, your body should be better prepared to deal with it the next time it comes around, but instead of being better at fighting off the invader, people with long COVID are getting more hammered by it the second (or third or fourth) time around".

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https://www.healthrising.org/blog/2023/11/24/re-infection-long-covid-chronic-fatigue-syndrome/

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The Re-Infection Question in Long COVID, ME/CFS and Post-Infectious Diseases - Health Rising

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Getting infected with the coronavirus more than once increases the chance of coming down with long COVID and having more severe symptoms.

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"While there are currently no treatments for Long Covid that have been approved by the FDA, Dr. Verduzco-Gutierrez says activity modification, Enhanced External Counter Pulsation (EECP), and treatments meant for dysautonomia and POTS can help some patients recover or experience periods of remission". 

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"While there are currently no treatments for Long Covid that have been approved by the FDA, Dr. Verduzco-Gutierrez says activity modification, Enhanced External Counter Pulsation (EECP), and treatments meant for dysautonomia and POTS can help some patients recover or experience periods of remission". 

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https://clearhealthcosts.com/blog/2023/11/is-long-covid-a-remitting-relapsing-disease/

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Nearly four years after the emergence of SARS-CoV-2, an estimated 65 million people worldwide living with Long Covid still do not know whether recovery is within reach.

Because Long Covid is an umbrella term encompassing diverse experiences, and there is a lack of long-term research, it's difficult to draw conclusions about the rate of recovery for this illness.

Definitions for Long Covid sometimes vary, but the illness can be marked by 200 or more symptoms ranging from severe fatigue to cognitive dysfunction, and is generally believed to impact as many as 10 to 30 percent of people who are infected with Covid-19. However, patient anecdotes, research into related illnesses, and a recent study examining Long Covid outcomes after two years indicate that the road to recovery is often "long and arduous," as Long Covid researcher Dr. Ziyad Al-Aly puts it, and experiences of recovery or relief can be precarious and short-lived.

What does remission mean?

The word remission is most commonly associated with cancer, said Dr. Al-Aly, who is the chief of research and development at the Veterans Administration St. Louis Healthcare System. "The implication is that...we got it under control," he said.

Dr. Monica Verduzco-Gutierrez, who lives with Long Covid and is the Chair of Rehabilitation Medicine at the University of Texas Health Science Center at San Antonio, where she directs their Long Covid Clinic, said she is familiar with the term from the context of multiple sclerosis (MS).

"There could be periods where someone is stable, periods where they're doing much worse," she said. While remission can sometimes mean a complete recovery from all symptoms, Verduzco-Gutierrez prefers to think about it as a reduction. "Think of a flame or a fire," she said. "Is it down to a simmer? That's...a remission. Something, like a lighter fluid, can cause a relapse."

The term remission has also sometimes been used to describe fluctuating symptoms in people with myalgic encephalomyelitis (often abbreviated as ME/CFS) and dysautonomia, two diseases that pre-date Long Covid and are commonly diagnosed in Covid-19 long-haulers.

Dysautonomia is an umbrella term for a complex group of medical conditions defined by dysfunction of the autonomic nervous system - the component of one's nervous system that regulates involuntary processes, such as blood pressure, body temperature, heart rate, digestion, breathing, and more. ME/CFS is a complex, multi-systemic chronic disease that is often characterized by post-exertional malaise - the worsening of symptoms following physical, mental, or emotional exertion.

According to the advocacy organization #MEAction, research indicates that nearly half of all people with Long Covid have myalgic encephalomyelitis. A 2021 paper found that 66 percent of respondents with Long Covid "reported autonomic symptom scores significant with moderate to severe autonomic dysfunction, suggesting a high prevalence of dysautonomia."

While remission as defined as an absence of all symptoms may be rare for people with ME/CFS, waxing and waning symptoms are not entirely uncommon, and full remissions have occurred. Full remission for people with dysautonomia and postural orthostatic tachycardia syndrome (POTS) - a subset of dysautonomia - may be more common, though Dr. Tae Hwan Chung, Director of Johns Hopkins' POTS Program, cautions that he has not personally seen it.

Lauren Stiles, president of the advocacy organization Dysautonomia International, said she is aware of cases in which someone with adolescent onset POTS experiences remission in their early twenties, only to experience a resurgence of symptoms after a triggering event.

Is Long COVID remitting-relapsing?

Dr. Al-Aly cautions that because Long Covid is a multi-systemic illness that manifests in diverse ways, it may be dangerous to imply that all symptoms can remit and relapse. He likes to classify Long Covid symptoms within two large constellations: First, fatigue, brain fog, and symptoms related to dysautonomia and post-exertional malaise - which he believes can be cyclical - and second, metabolic and cardiac problems, such as new onset diabetes or hyperlipidemia, which typically do not remit.

He also pointed out that because the term remission is so often associated with cancer after chemotherapy, using the term for Long Covid may imply that there are good treatments for sometimes cyclical Long Covid symptoms, such as fatigue, which there currently are not.

"I definitely see relapsing-remitting," Dr. Verduzco-Gutierrez said. "There are some patients where we can get their symptoms under control ... and then something happens in their environment...that can kind of bring on this re-emergence of some symptoms."

Andrew, 36, who spoke on condition that we identify him by only his first name for privacy reasons, agreed. "In my own experience, it's been very nonlinear...sometimes it's two steps forward, three steps back."

Steph Fowler, 42, who has been living with Long Covid since the summer of 2020, has also experienced short-term relief and relapse. "Certain symptoms will relapse and remit," she said. "Feeling Long Covid consuming your entire life might relapse and remit."

Gina Assaf, a Covid-19 long-hauler and founding member of the Patient-Led Research Collaborative, said her team has seen remission and relapse in their research and in online groups. Their recent study examines long-haulers' experiences returning to work through an episodic disability lens commonly used in the context of HIV.

"We framed [Long Covid] that way because...the experience and characteristics of the disease and severity can vary over time," she wrote in an email. "We have seen...many examples of remission and what appears as full recovery to the[n] later relapsing and having varying severity of symptoms reappear."

Experiences of short-term recovery

Andrew believes he first contracted Covid-19 in March 2020. He was bedridden for a year after developing Long Covid, during which time he did not work. After about 15 months, he started to see improvements. By September 2021, he felt like he had returned to about 90 percent of his previous baseline health. "I felt sharp," he said. "I didn't feel the post-exertional malaise. I was able to pretty much hop back into regular life."

Fowler also experienced an eventual improvement in her symptoms, nearly two years after her initial infection. "It wasn't as if the insomnia totally went away, but it was more sporadic instead of every single day," she said. The new cascading symptoms she'd been experiencing since she got sick seemed to stop. "I still had fatigue, I still had brain fog, I was still working in a reduced capacity, but I was starting to feel like there was a possibility of being able to...resume a little bit of the life that I had had."

Jessica Lovett, 44, got Covid-19 in June 2020 and was sick until October 2021 when she says almost all of her symptoms disappeared, except for tinnitus, slight vision issues, and PTSD from the experience. "I was even able to exercise again...and was able to land a job," she wrote in an email. "I traveled for work [and] was able to be a vivacious mom again without crumbling the next day. ... My chest pain went away, and I could breathe easily."

Andrew, Fowler, and Lovett are not alone. I, too, contracted Covid-19 during the first year of the pandemic, and declared myself recovered several times after experiencing significant relief at various points in the months and years that followed. But, my journey, like Andrew's, has not been linear. Old and new symptoms have returned following periods of stress, changes in weather, and new infections. This, I have learned, is not entirely unusual.

Why do people get better? Why do they get worse?

Very few people I spoke with were confident pointing to a singular factor that they thought had improved their health, though most mentioned some combination of rest, treatments, and luck. While there are currently no treatments for Long Covid that have been approved by the Food and Drug Administration, Dr. Verduzco-Gutierrez says activity modification, Enhanced External Counter Pulsation (EECP), and treatments meant for dysautonomia and POTS can help some patients recover or experience periods of remission.

For myself, Andrew, and Grant Paulsen, 25, who was infected in 2021 and lived with Long Covid symptoms until the spring of 2022, when he began to experience significant improvement after a vaccination, Covid-19 vaccines may have provided temporary relief - though these vaccines have also been known to trigger worsened symptoms in some patients.

"If we knew what got everybody well, we'd all be doing it," Stiles said. "I think what's easier to spot is what can make [symptoms] flare again."

Infections and reinfections

Dr. Verduzco-Gutierrez and Dr. Al-Aly both mentioned that Covid-19 reinfections and other types of infections can lead to a re-emergence of symptoms. "In my own life experience it's a bit scary, because I'm doing well for now, but what happens if I get sick again?" Dr. Verduzco-Gutierrez asked.

Andrew believes his symptom relapse was triggered by taking antibiotics for a bacterial infection in December 2021. "Within two weeks of finishing my course...I started noticing [post-exertional malaise], a racing heart and...the return of other symptoms."

Lovett was reinfected with Covid-19 in October 2022, and initially felt the experience was better, because she took Paxlovid and knew more about what to expect. But, she says "the Long Covid monster returned" after she participated in a geriatric dance class at the YMCA a few months later. "I crashed and couldn't get back to baseline. I had to choose between working or being a mom, because I didn't have energy for both," she wrote.

When Fowler was reinfected with Covid-19 in March 2023, her short-lived period of improvement ended entirely. Her insomnia, brain fog, and neurological symptoms returned, along with new migraines, vision, and speech problems. She characterizes the experience as devastating. "I don't know how to describe how gut-wrenching it is to have felt a little relief, and a little bit of hope and have it ripped away after doing everything that I possibly could to protect myself from getting reinfected," she said.

Stress, exercise and weather

Stress and exercise also often seem to play a part in symptom relapse. Paulsen, who has experienced several periods of relief and relapse and one significant period of full remission, recalls exercising especially hard in the days that preceded his re-emergence of symptoms.

"I had been so stressed out with work and my personal life, on top of the changing weather, going out too hard, and then having two really hard workouts afterward and one drink," he said. "It was the perfect storm of maybe just putting my body under [too] much stress."

Exercise intolerance is well-documented in some people with Long Covid, as well as people with ME/CFS, but Paulsen's experience is slightly different because he was able to tolerate exercise for months prior to his relapse.

Paulsen's description of the weather impacting his symptoms resonated with me, as someone who has experienced the " seasonal slide " some people with chronic illnesses describe. Dr. Verduzco-Gutierrez said she sees Long Covid patients' health worsen during "cedar season" in San Antonio, Texas, when allergens change, as well as during barometric pressure changes - which she said she believes can worsen migraines and chronic pain.

Lovett described feeling an alleviation of symptoms after she left Austin, where she lives, to spend the summer in The Philippines. "Austin...my hometown has horrific seasonal allergens, environmental factors, and extreme temperatures that affect my body," she wrote. "I believe this place makes my 'histamine buckets' overflow."

Fowler similarly has noticed her symptoms fluctuate with environmental changes. After her reinfection last spring, she began to develop what she describes as POTS-like symptoms when the weather warmed in July and August. Other symptoms worsened when the air quality deteriorated in Chicago, where she lives.

"Even with an N95 and the shortest time outside...it set off a flare," she said. She was not able to work for a week, and experienced respiratory problems, cognitive functioning issues, and worsened body aches and migraines. "Now I am terrified of bad air quality days," she said.

In a world where there's no proven treatment that can trigger remission, but plenty of factors that seem to have the potential to worsen the health of a person with Long Covid, life can feel like a game of chance.

"I live on an immunological tightrope," said Stiles, who has been living with POTS and Sjögrens syndrome for 13 years and experienced "significant illness" for about a year following a Covid-19 infection in February 2020. "If I take the right medicine and do the self-care management stuff...I can kind of keep my feet on the tightrope," she said. "If I mess anything up...it's very hard."

Andrew echoed these sentiments: "It's really hard to get better.... It's really easy to get worse."

Getting medical care

Getting medical care for a remitting-relapsing illness can be difficult when there are long wait-times. Paulsen, who lives in New York City, where there is a relative abundance of Long Covid care centers and specialists compared to other areas, still had to wait an average of six months to see the specialists he wanted.

This was especially difficult, because the waxing and waning nature of his symptoms meant that he was sometimes in a period of remission when appointments finally opened up. The remitting-relapsing nature of symptoms may present additional challenges for Covid long-haulers applying for Social Security Disability Insurance, who have to prove an ongoing inability to work for a year or more.

Fowler has had a similar experience, though her symptoms have never fully remitted. "There would be a flare-up of some type of system in my body for weeks or a month, and then that system would calm down, and a new system would flare up," she said. "By the time I could see the specialist, that system was not necessarily still the same problem."

Flawed healthcare systems

Stiles is concerned that these sorts of delays in care may exacerbate health issues for patients who are not able to be treated quickly, but she's also worried that our healthcare systems are fundamentally not set up to treat these types of illnesses.

"There's very few centers that are actually good at this even though...we have seen a lot of new Long Covid clinics get started," she said. "There's a big learning curve."

Dr. Verduzco-Gutierrez echoed Stiles' concern that not all providers treating Long Covid know what to look for, or ask about. Providers lacking information or time may struggle to adequately track a patient's progress long-term.

She cautioned that if providers are pressed for time, focus only on test results or don't ask about how a patient is functioning at work, their quality of life at home, or ability to manage certain tasks, they may fail to fully understand that patient's health status. Covid long-haulers who have to change providers as a result of losing employment or having to relocate are also less likely to be tracked well by providers over time.

More long-term studies are needed

Dr. Al-Aly and Stiles both agreed it is difficult to draw conclusions about the future of Long Covid without longer-term studies. "I worry about if SARS-CoV-2 has some other tricks up its sleeve that we still haven't seen yet," Dr. Al-Aly said. "We're still working with...four-year data at most, and none of us has seen, what are the consequences?"

He pointed out that we already know that infections can cause chronic disease - the gut bacteria helicobacter pylori can cause gastrointestinal cancer and Epstein-Barr virus can cause MS - and some viruses, such as human papillomavirus and hepatitis C, can cause cancer.

But, Dr. Al-Aly says these sorts of outcomes are typically only determined five or ten years after the disease onset, which is why he believes it's so important to study people who have had a Covid infection over longer periods of time.

Stiles says these sorts of long-term longitudinal studies are crucial because people who seem to have recovered are often dropped from studies, but we know from patient anecdotes that these recoveries are not always permanent. "There should be studies that are going to track people forever," she said. "That's expensive and hard to do, and that usually requires substantial government investment."

Dr. Al-Aly has conducted one of the longest Long Covid D studies thus far, which tracked health trajectories over two years. Using the DALY metric - for disability-adjusted life years - to estimate the quantitative measure of the burden of disease, Dr. Al-Aly's team found that the total DALY for Long Covid was almost identical to that of heart disease or cancer. "Long Covid is a serious illness," he said. "Most people do not fully recover, even after one year or even after two years."

Dr. Verduzco-Gutierrez has seen patients make recoveries but she said, "it isn't frequent, and it isn't everyone." She noted that recovery seems to be more common in patients who start out with fewer and more mild Long Covid symptoms.

A mismatch in recovery narratives

People like myself, Andrew, Fowler and Lovett, who have been sick for over three years, have witnessed a variety of outcomes in the patient communities we're a part of.

"I've seen people get better. I've seen people deteriorate or stay the same," Andrew said.

"I initially put some faith in these ideas that even untreated, this would only last for a year or 18 months," said Fowler, who has seen media articles that emphasize a faster recovery from Long Covid than she's experienced. "I now know too many people and I've heard too many stories in these online Long Covid spaces of people who only got better by not working...or did get better, took time off, and then as soon as they started trying to resume a life, everything came back."

Her words resonate with me. When asked about my health, I often emphasize the lifestyle factors and privileges that I feel allow me to balance on the immunological tightrope Stiles described - being able to work from home with a flexible schedule, being childless, living near friends who can help out, and being able to afford regular testing, air filters and high-quality respirators.

"I know there's these ideas that people will just get better, but it seems a lot like magical thinking without actual research...and understanding of all of the intricacies of Long Covid," Fowler said.

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Is Long Covid a remitting-relapsing disease? - ClearHealthCosts

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Some Covid-19 long-haulers have declared themselves recovered, only to experience a re-emergence of symptoms later on.

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"As we enter the fifth year and another surge of the ongoing SARS-CoV-2 pandemic, our understanding of HIV’s overlap with Covid-19 and Long Covid is building, but stigmas surrounding both illnesses have impeded research funding and support".

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"As we enter the fifth year and another surge of the ongoing SARS-CoV-2 pandemic, our understanding of HIV’s overlap with Covid-19 and Long Covid is building, but stigmas surrounding both illnesses have impeded research funding and support".

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https://thesicktimes.org/2023/12/05/hiv-may-increase-the-risk-of-long-covid-why-arent-major-advocacy-groups-addressing-it/

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The Sick Times - Chronicling the Long Covid crisis

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At the beginning of the SARS-CoV-2 pandemic, Philip Shubin went to the emergency room when he was infected with Covid-19. At the hospital, he said he was treated like a pariah and went home expecting to die. The visit reminded him of being hospitalized in 1996 with an AIDS-related lung cancer called pulmonary Kaposi sarcoma, which led to the loss of his right lung. The arrival of anti-viral medications saved him from dying of AIDS-related complications, but he lost his entire social circle during the crisis.

"I'm a survivor of two pandemics," Shubin said during a Long Covid Justice webinar last year about the intersections between HIV, Long Covid, and Covid-19. His acute case of Covid-19 led him to be diagnosed with Long Covid, dysautonomia, and myalgic encephalomyelitis (ME), which made him bedbound, he explained. "All of my doctors keep referring to my original case of Covid as 'mild'," he said. His is acute case lasted a week and he has since been debilitated for years with Long Covid."This terminology needs to change, there is nothing "mild" about the condition."

As we enter the fifth year and another surge of the ongoing SARS-CoV-2 pandemic, our understanding of HIV's overlap with Covid-19 and Long Covid is building, but stigmas surrounding both illnesses have impeded research funding and support. People living with both have described the serious lack of adequate care for Long Covid and ME, and the low quality of life they experience.

Advocates say that the government is not doing enough to support people with Long Covid, nor are most well-funded LGBTQ+ or HIV advocacy groups, even though Long Covid may be burdensome for their communities. Recent studies suggest that HIV may be a risk factor for Long Covid and that people with HIV have an elevated Covid-reinfection rate. Yet The Sick Times reviewed websites from several major HIV and LGBTQ+ advocacy groups and found very little information or resources about Long Covid.

The overlap of HIV and Long Covid

"Several (but not all) studies suggest that HIV is a risk factor for Long COVID," Michael Peluso, an infectious disease physician at the University of California, San Francisco who has studied both HIV and Long Covid, wrote to The Sick Times. "There are several reasons why this might be, but they can be summed up as HIV (even undetectable HIV) causing a background level of immune disturbance that is compounded by COVID."

All of the things that are thought to contribute to Long Covid in people without HIV - including inflammation, reactivation of other viruses like Eppstein Barr virus, mitochondrial dysfunction, and immune perturbations - could be further exacerbated by pre-existing HIV, Peluso explained. But many studies on this connection have been too small to draw definitive conclusions, he wrote. "I would like to see more investment in larger studies that can tackle these questions, in the form of NIH grants or foundation grants."

Still, some research based on health systems data has suggested that people with HIV are more likely to have more health issues after COVID compared to people without HIV. One preprint found that people with HIV were more likely than HIV-negative people to have diabetes, heart disease, blood clots, and mental health problems after Covid. Another showed that people with HIV who had Covid were more likely to have these types of complications compared to people with HIV who did not get Covid.

The second study "really supports the idea that the combination of HIV and SARS-CoV-2 infection may be a perfect storm for some people," Peluso wrote.

Peluso and collaborator Annie Antar, an assistant professor of medicine at the Johns Hopkins University School of Medicine, are currently working on a larger study funded by amFAR, The Foundation for AIDS Research. The study will assess immune dysregulation in people with HIV and Long Covid."We know that living with HIV is a chronic inflammatory state," Antar said. "We're very curious to see how that intersects immunologically with Covid and Long Covid."

In the meantime, Peluso wrote that "outside of avoiding COVID altogether, the single best thing that a person can do to avoid getting Long COVID is to be up to date on their COVID vaccines." He advised people with HIV who get Covid to discuss with their doctor whether they should be treated with a Covid antiviral like Paxlovid, which may slightly reduce the chances of Long Covid.

Lack of recognition from LGBTQ+ and HIV advocacy groups

Despite some clues like the CDC and Census's Pulse Household Survey suggesting that Long Covid may have higher rates in transgender and bisexual communities - likely due to pre-existing health disparities - many of the largest LGBTQ+ and HIV advocacy groups in the United States still aren't urgently educating their community about Long Covid or taking precautions to curb the spread of Covid-19 at their in-person gatherings.

For example, the National LGBTQ Task Force - an advocacy group that founded its conference Creating Change during the AIDS crisis - failed to institute any mandatory Covid-19 precautions during its in-person conference this year, leading to heavy criticism by disability and chronic illness advocates, I reported for Them. "The organization has forgotten its history and the history of the people it supposedly represents," writer and activist Emmett Patterson wrote of the event in the Bay Area Reporter.

Numerous other LGBTQ groups and Pride organizers have also abandoned common sense Covid-19 precautions for their in-person events during the rush to "get back to normal." While acknowledging that Long Covid can affect anyone of any orientation, gender, or age, some advocates have felt abandoned by queer and leftist groups that they believed would help advocate for members of their community most affected by the pandemic. Or at the very least, that they would help sound the alarm.

To examine this gap in advocacy, The Sick Times searched the websites of several major LGBTQ advocacy groups for information and resources about Long Covid. We looked at the Human Rights Campaign, The Trevor Project, PFLAG, Los Angeles LGBT Center, The Center, and the LGBTQ Task Force; the search, as of December 4, 2023, found almost no mention of Long Covid. GLAAD had one mention of Long Covid in an announcement about vaccination while the Human Rights Campaign mentioned the diagnosis in an in-memoriam for a trans person of color, Morgan Moore, who died of "criminal neglect from his parents" in 2023.

Similarly, a thorough search of many HIV/AIDS advocacy groups including Elton John AIDS Foundation, AIDS United, Black AIDS Institute, and AIDS Healthcare Foundation didn't find any informative information or resources about Long Covid on their websites. UNAIDS, however, had numerous mentions of Long Covid. A search of Positive Women's Health Network mentioned Long Covid once in a recent newsletter and linked to a Long Covid Justice survey in 2022.

The burden of educating these communities about Long Covid and Covid-19 has since fallen on advocacy groups with fewer resources, especially as the Biden administration largely ignores Long Covid crisis and the ongoing pandemic altogether. Last month, Long Covid Justice - an intersectional Long Covid advocacy group -partnered with Trans Equity Consulting for a webinar, Long Covid is a Trans Issue. The event featured a presentation by Sari Reiser, a researcher at Harvard T.H. Chan School of Public Health, sharing results from a 2022 study that found numerous health disparities exacerbated by Covid and Long Covid according to a survey of over 2,000 transgender people.

The stigma around Long Covid and ableism within the HIV community are two major reasons why Covid-19 and Long Covid aren't adequately addressed by larger advocacy groups, said JD Davids, co-director of Long Covid Justice, who has Long Covid and ME.

People who have gone through the trauma of acquiring other illnesses and conditions deserve to have resources and support in tackling a new health crisis that is disproportionately affecting their communities, Davids said. But the organizations best positioned to create such resources and support fail to acknowledge the continued Covid-19 pandemic, he said. "To truly understand that reinfection increases the risk of chronic illness, and even death, would be to acknowledge the institutional roles in preventing Covid in the first place."

I think we are in a moment where approaching disability justice and disability identity in a very coalitional way is incredibly important.
Sami Schalk

Towards broader disability politics

The intersections between Long Covid, HIV, and many other associated conditions and health crises have led some advocates and scholars to push for bigger-picture research and support for the people most impacted.

It's common in disability movements for people to "organize around their specific disability," as shown by patient advocates now organizing around Long Covid, said Sami Schalk, an associate professor of Gender and Women's Studies at the University of Wisconsin Madison and the author of "Black Disability Politics." But moving forward, "connection to a broader disability community would be beneficial," Schalk added.

Schalk sees parallels between the Long Covid and AIDS crises: in both, with limited support from the medical community and government, patients have been forced to organize and advocate for themselves. "I think we are in a moment where approaching disability justice and disability identity in a very coalitional way is incredibly important," she said. Building a larger movement is vital "especially as more of us become disabled."

The overlaps of Long Covid and HIV are complex and are still not fully understood, but it is clear that broadly educating the public about Covid-19 and Long Covid would be beneficial for all people.

To start, education around Long Covid and its many crossovers with other diagnoses would do a great service in helping the public understand the risks of Covid infection. Annie Antar said that everyone should do follow-ups with their primary care doctors around 3 months after their acute Covid infection to screen for symptoms of Long Covid or other associated conditions that arise following Covid-19 infection. She says information about Long Covid should be applied widely and featured in more public service announcements. "If we don't mention Long Covid whenever we talk about COVID, it just disappears from people's minds."

While major advocacy groups aren't yet discussing Long Covid, smaller grassroots organizers are and their work is having an impact. Besides the many important webinars and resources provided by Long Covid Justice, The Reunion Project, an HIV advocacy group that organizes annual summits, hosted a webinar this summer on Long Covid in people with HIV.

During the AIDS crisis, Philip Shubin said he took to the streets with ACT UP to demand funding for HIV/AIDS research and found that using his voice was a powerful tool to help change the way people think and act. "Today, I find myself in a similar position with Long Covid and ME/CFS," he said, "I am compelled to fight for respect, research, and funding."

All articles by The Sick Times are available for other outlets to republish free of charge. We request that you credit us and link back to our website.

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HIV may increase the risk of Long Covid. Why aren't major advocacy groups addressing it? - The Sick Times

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Advocates say that the government is not doing enough to support people with Long Covid, nor are most well-funded LGBTQ+ or HIV advocacy groups, even though Long Covid may be burdensome for their communities. Recent studies suggest that HIV may be an increasedrisk factor for Long Covid and that people with HIV have an elevated Covid-reinfection rate.

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What’s happening this week, December 5: most important LC research and Events.

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What’s happening this week, December 5: most important LC research and Events.

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https://thesicktimes.org/2023/12/05/whats-happening-this-week-december-5/

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The Sick Times - Chronicling the Long Covid crisis

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What’s happening this week, December 5 - The Sick Times

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Research updates and events for this week include two papers advancing the study of potential Long Covid biomarkers, The Sick Times’ town hall, and an update on ME/CFS research from the NIH.

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"Getting care is still a struggle, she said.“When I go to the ER or to another doctor’s visit, instead of saying I have chronic fatigue syndrome, I usually say I have long COVID,” Powell said. “And I am believed almost immediately.”

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"Getting care is still a struggle, she said.“When I go to the ER or to another doctor’s visit, instead of saying I have chronic fatigue syndrome, I usually say I have long COVID,” Powell said. “And I am believed almost immediately.”

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https://www.boston.com/news/health/2023/12/09/chronic-fatigue-syndrome-is-not-rare-says-new-cdc-survey-it-affects-3-3-million-u-s-adults/

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Health
There is no cure, and no blood test or scan to enable a quick diagnosis.

NEW YORK (AP) - Health officials on Friday released the first nationally representative estimate of how many U.S. adults have chronic fatigue syndrome: 3.3 million.

The Centers for Disease Control and Prevention's number is larger than previous studies have suggested, and is likely boosted by some of the patients with long COVID. The condition clearly "is not a rare illness," said the CDC's Dr. Elizabeth Unger, one of the report's co-authors.

Chronic fatigue is characterized by at least six months of severe exhaustion not helped by bed rest. Patients also report pain, brain fog, and other symptoms that can get worse after exercise, work, or other activities. There is no cure, and no blood test or scan to enable a quick diagnosis.

Doctors have not been able to pin down a cause, although research suggests it is a body's prolonged overreaction to an infection or other jolt to the immune system.

The condition rose to prominence nearly 40 years ago, when clusters of cases were reported in Incline Village, Nevada, and Lyndonville, New York. Some doctors dismissed it as psychosomatic and called it "yuppie flu."

Some physicians still hold that opinion, experts and patients say.

Doctors "called me a hypochondriac and said it was just anxiety and depression," said Hannah Powell, a 26-year-old Utah woman who went undiagnosed for five years.

The new CDC report is based on a survey of 57,000 U.S. adults in 2021 and 2022. Participants were asked if a doctor or other health-care professional had ever told them they had myalgic encephalomyelitis or chronic fatigue syndrome, and whether they still have it. About 1.3% said yes to both questions.

That translated to about 3.3 million U.S. adults, CDC officials said.

Among the other findings: The syndrome was more common in women than men, and in white people compared with some other racial and ethnic groups. Those findings are consistent with earlier, smaller studies.

However, the findings also contradicted long-held perceptions that chronic fatigue syndrome is a rich white woman's disease.

There was less of a gap between women and men than some previous studies suggested, and there was hardly any difference between white and Black people. The study also found that a higher percentage of poor people said they had it than affluent people.

Those misperceptions may stem from the fact that patients who are diagnosed and treated "traditionally tend to have a little more access to health care, and maybe are a little more believed when they say they're fatigued and continue to be fatigued and can't go to work," said Dr. Brayden Yellman, a specialist at the Bateman Horne Center in Salt Lake City, Utah.

The report relied on patients' memories, without verifying their diagnoses through medical records.

That could lead to some overcounting, but experts believe only a fraction of the people with chronic fatigue syndrome are diagnosed, said Dr. Daniel Clauw, director of the University of Michigan's Chronic Pain and Fatigue Research Center.

"It's never, in the U.S., become a clinically popular diagnosis to give because there's no drugs approved for it. There's no treatment guidelines for it," Clauw said

The tally likely includes some patients with long COVID who were suffering from prolonged exhaustion, CDC officials said.

Long COVID is broadly defined as chronic health problems weeks, months or years after an acute COVID-19 infection. Symptoms vary, but a subset of patients have the same problems seen in people with chronic fatigue syndrome.

"We think it's the same illness," Yellman said. But long COVID is more widely accepted by doctors, and is being diagnosed much more quickly, he said.

Powell, one of Yellman's patients, was a high school athlete who came down with an illness during a trip to Belize before senior year. Doctors thought it was malaria, and she seemed to recover. But she developed a persistent exhaustion, had trouble sleeping, and had recurrent vomiting. She gradually had to stop playing sports, and had trouble doing schoolwork, she said.

After five years, she was diagnosed with chronic fatigue and began to achieve some stability through regular infusions of fluids and medications. She graduated from the University of Utah and now works for an organization that helps domestic violence victims.
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute's Science and Educational Media Group. The AP is solely responsible for all content.
Getting care is still a struggle, she said.

"When I go to the ER or to another doctor's visit, instead of saying I have chronic fatigue syndrome, I usually say I have long COVID," Powell said. "And I am believed almost immediately."

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Chronic fatigue syndrome is not rare, says new CDC survey. It affects 3.3 million U.S. adults

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There is no cure, and no blood test or scan to enable a quick diagnosis.

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"The questions are: Are there similar events in Long Covid?  If yes, this may happen also in children. Are they somehow treatable?"

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"The questions are: Are there similar events in Long Covid?  If yes, this may happen also in children. Are they somehow treatable?"

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https://open.substack.com/pub/danilobuonsenso/p/endothelial-cess-mecfs-long-covid?r=a36iw&utm_campaign=post&utm_medium=web

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Historically, the endothelium has been simply considered as a thin layer of cells (endothelial cells) lining every blood vessel allowing blood circulation and playing a pivotal role in blood clotting. However, endothelial cells have a much more important role in our organism. They play a primary role in regulating the dilation and constriction of blood vessels, and therefore in controlling blood flow in organs and preassure. In this, they are mostly regulated by the autonomous system, and therefore the central nervous system. In addition, they are now well established as being considered immune cells, playing a necessary role in inflammatory responses, regulating the trafficking of immune cells from the blood to the tissues. Last, but not least, the oxygen moves from blood to tissues, passing through the endothelial cells.

As such, it is quite easy to understand how important immune cells are for our organism. I wrote more in details and with a scientific background about the endothelium elsewhere. Ah, and not forget that endothelial cells are present EVERYWHERE!

The endothelium has become more famous since the pandemic. Briefly, during SARS-CoV-2 infection there is a clear short and long term impact on endothelial health, with a clearly increased cardiovascular risk in covid-19 adults, at least during the first few years. There is also clear evidence that SARS-CoV-2 can infect endothelial cells. The "hot period" of the ehdothelial cells even more increased since the descriptions of Prof Pretorius from South Africa about the precence of activated platelets (microclots) in the blood of patients with Long Covid, suggesting that some persisting mechanisms are stimulating endothelial cells that, in turns, activate platelets. What these activated platelets can do is not yet fully clear, but they may play a role in some of the pivotal problems of Long Covid, such as cardiovascular events, abnormal cell perfusion and oxygenation.

Since then, there is growing interest toward understanding the concept of "endothelial disfunction" in chronic diseases like Long Covid and ME/CFS.

Let's summarize current literature on the topic.
ENDOTHELIAL DYSFUNCTION IN ME/CFS PATIENTS
The clinical presentation of ME/CFS, with major symptoms arising from several organ systems, indicates disturbance of a biological system with widespread functions. Some of the most common and distressing symptoms of ME/CFS, i.e. orthostatic intolerance and post-exertional malaise, and findings of reduced anaerobic threshold and lactate accumulation in tissues after exercise could be indicative of disturbances in the vascular homeostasis, and therefore the endothelial cells.

Newton et al, investigating flow-mediated dilation (FMD) for large vessel endothelial function and post-occlusive reactive hyperemia (PORH) for microvascular function in ME/CFS patients, concluded that ME/CFS patients have both large and small vessel endothelial dysfunction as compared to age- and sex-matched controls. Scherbakov et al also described peripheral endothelial dysfunction was frequent in ME/CFS patients and was associated with disease severity.

More recently, Sandvik et al compared endothelial disfunction at baseline and after 18 months of treatment in 39 patients and compared with healthy controls. ME/CFS patients had markedly reduced FMD compared to healthy controls at baseline (5.1% vs. 8.2%, p< 0.0001, adjusted for arterial diameter and sex), and significantly lower microvascular regulation measured by PORH than healthy controls (1354 PU vs. 2208 PU, p = 0.002). They concluded that ME/CFS patients had reduced macro- and microvascular endothelial function, indicating that vascular homeostasis may play a role in the clinical presentation of this disease.

A recent study of invasive cardiopulmonary testing in ME/CFS patients demonstrated impaired peripheral oxygen extraction and reduced cardiac output due to reduced venous return, manifestations of peripheral neurovascular dysregulation that are plausible contributors to ME/CFS exertional intolerance.

All together, these studies suggest that abnormal, chronic immune responses may disturb vascular function and cause inadequate autoregulation of blood flow according to the metabolic demands of tissues, resulting in tissue hypoxia with early lactate accumulation on exertion. Tissue hypoxia on exertion could underlie several characteristic symptoms of ME/CFS and may further cause secondary and compensatory mechanisms, such as autonomic and metabolic adaptations.

The questions are:

1- Are there similar events in Long Covid?

2- If yes, this may happen also in children?

3- Are them somehow treatable?
ENDOTHELIUM AND LONG COVID
It is well established that SARS-CoV-2 can infect endothelial cells. It is hypothesized (more than hypothesis, as been showed by several studies), that endothelial cell infection can drive inflammatory response, microclot formation within the blood due to hyperactivation of platelets, subsequently blocking capillaries from delivering oxygen and nutrients to local tissues. So far, this is one of the most lausible mechanistic pathway that could explain several symptoms of long COVID including fatigue, cognitive impairment, and pain, exactly as happens with ME/CFS.

Of note, it seems that Long Covid and ME/CFS patients have a similar endothelial disfunction. A case-case-control study evaluated flow-mediated dilation measurements in 51 participants (17 long COVID patients, 17 ME/CFS patients, and 17 healthy age-matched controls), finding significantly impaired endothelial function in both long COVID and ME/CFS groups compared with healthy age-matched controls as determined by maximum % brachial artery diameter post-occlusion compared with pre-occlusion resting diameter (6.99 ± 4.33% and 6.60 ± 3.48% vs 11.30 ± 4.44%, respectively, both P < .05). Notably, there was no difference in flow-mediated dilation between long COVID and ME/CFS groups ( P = .949), despite significantly longer illness duration in the ME/CFS group (ME/CFS: 16 ± 11.15 years vs long COVID: 1.36 ± 0.51 years, P < .0001).

These data further reinforce a potential link between endothelial dysfunction, microclot formation, and persistent symptoms.
Give a gift subscription DOES ENDOTHELIAL DYSFUNCTION HAPPEN IN CHILDREN AS WELL?
In general, endothelial dysfunction has been described in pediatric cohorts before the pandemic, such as those with hypertension or type 1 diabetes. During the pandemic, it has been documented in children with Multisystem Inflammatory Syndrome. About Long Covid in children, we have less evidence, although we have indirect studies showing abnormal lung perfusion which may be related with endothelial dysfunction and POTS. Personally, we have investigated platelet hyperactivation in a small cohort of children, and our preliminary data suggest that this parameter is significantly higher in chidren and adolescents with long covid, compared with controls.

IS ENDOTHELIAL DYSFUNCTION TREATABLE?

Actually, we don't know. However, adult studies have suggested to use anticoagulation/anti-aggregation, due to findings of microclots and increased cardiovascular events in post-covid patients. However, anticoagulants like heparin have much more than the known effects, that are not limited to anticoagulation. In particular, heparin has protective ( pleiotropic) effects on endothelial cells and several anti inflammatory effects, not only on the endothelial cells. The potential anti inflammatory effects have been described in several inflammatory conditions, including asthma, inflammatory bowel disease, cardiopulmonary bypass, and cataract surgery, and others.

All these findings, suggest that heparin can have a significant role in patients with Long Covid, and this is actually why many clinicians are trying this off label treatment in their patients. Trials are not yet available, but many of us attempting this treatment in the most severe cases have great results on small case-series, suggesting that this is a promising drug to trial in patients with Long Covid.

If of interest, I will share some case report in future. Let me know your thoughts!

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ENDOTHELIAL CELLS, ME/CFS, LONG COVID, and CHILDREN

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THE ENDOTHELIUM Historically, the endothelium has been simply considered as a thin layer of cells (endothelial cells) lining every blood vessel allowing blood circulation and playing a pivotal role in blood clotting. However, endothelial cells have a much more important role in our organism.

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"Researchers analyzed data from 388,980 patients who had a positive test for SARS-CoV-2 between October 1, 2021, when the ICD-10 code for PCC was introduced, and January 31, 2023. Patients had an average age of 61 years; 87.3% were men". 

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"Researchers analyzed data from 388,980 patients who had a positive test for SARS-CoV-2 between October 1, 2021, when the ICD-10 code for PCC was introduced, and January 31, 2023. Patients had an average age of 61 years; 87.3% were men". 

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https://www.medscape.com/viewarticle/wide-regional-variation-diagnosis-long-covid-2023a1000un0

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post-acute sequelae of sars-cov-2 infection; post-acute sequelae of sars-cov-2 infection (pasc); pasc - post-acute sequelae of sars-cov-2 infection; long covid

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Wide Regional Variation in Diagnosis of Long COVID

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The percentage of patients with a U09.9 diagnostic code in the year after a SARS-CoV-2 infection ranged from less than 4% in one region to more than 24% in another

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Recent info about JN.1 Variant, Acute COVID, Long COVID...

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Recent info about JN.1 Variant, Acute COVID, Long COVID...

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https://drruth.substack.com/p/covid-news-and-more-12923

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As CDC Director Dr. Mandy Cohen said in her recent video message, it is not too late to be vaccinated against the three circulating respiratory viruses (COVID, Flu, RSV). Dr. Cohen also urged people to take additional measures now like avoiding sick people, washing hands, improving ventilation, and wearing a mask. Only 16% of adults have gotten the updated COVID XBB.1.5 vaccine in the United States. The updated vaccine protects against all of the latest COVID variants including the exponentially growing JN.1. With Christmas two weeks away, there is still time to get the vaccine and have enough time to make neutralizing antibodies. Flu shots and COVID vaccines can be scheduled via vaccines.gov.

Nationally wastewater levels show High COVID, High RSV, Low Influenza A and Influenza B, High Norovirus (stomach flu). Locally, Redwood City (Silicon Valley Clean Water) wastewater shows High COVID, High RSV, Low Influenza A, High Norovirus (stomach flu). If someone thinks that they had "food poisoning", be careful and make sure to wash your hands often as it may actually be the very contagious Norovirus stomach flu. RSV levels are still high, but they appear to have just peaked and are starting to decrease.

Acute COVID infections

Regarding Rapid Antigen Testing for COVID, a new study finds that swabbing both the throat and nose increases the sensitivity of rapid antigen COVID testing for both healthcare worker-sampling and self-sampling. Researchers compared four methods of monitoring COVID and Influenza A virus activity in schools. Air sampling was found to be equivalent to PCR testing, cause-specific absenteeism reporting and school-based rapid antigen tests. The air sampling method tested cartridges left passively in the school cafeterias. The authors also noted that SARS-CoV-2 detection was more stable (endemic pattern) and Influenza A was more epidemic in November and December.

Long COVID

SIM01 is not available in the United States, but there are other prebiotics available. A study earlier this year showed that gut microbiome changes may be a signature for ME/CFS. Low amounts of butyrate-producing bacteria such as F. Prausnitzii (F. Prau) in the gut are associated with increased fatigue severity in ME/CFS, suggesting a possible link between gut bacteria and ME/CFS symptoms. All ME/CFS participants in this study had lower F. Prau in their gut, but they also were found to have lower bacteria associated with tryptophan metabolism. Of note, tryptophan is used to make serotonin. A paper in Cell magazine in October from the M. Levy's lab showed that SARS-CoV-2 viral fragments and viral RNA from a reservoir possibly in the gut can lead to abnormally low peripheral serotonin which triggers cognitive impairment in Long COVID from reduced vagus nerve signaling to the hippocampus in the brain.

In non-COVID news, the FDA approved two new gene therapies to treat sickle cell disease. Although low dose naltrexone (6 mg) was found not to reduce fibromyalgia pain, it did improve memory problems associated with fibromyalgia. Bodybuilding protein supplements can affect male fertility because they can contain high levels of estrogen.

Stanford University is offering free online courses including Computer Science 101, Machine Learning Specialization, Advanced Cybersecurity, Intro to the Internet of Things, Game Theory, and others. Physicians and health care providers who need to fulfill the new DEA requirement on opioids can take this online class for free through NEJM.

Have a good rest of your weekend,

Ruth Ann Crystal MD

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

JN.1 is taking over.

12/8/23 Eric Topol

Variants in locations around the globe:

https://outbreak.info/

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

Weekly ED visits for respiratory illnesses, by age and disease: https://www.cdc.gov/ncird/surveillance/respiratory-illnesses/index.html
US Wastewater Monitoring:
CDC Wastewater Monitor https://covid.cdc.gov/covid-data-tracker/#wastewater-surveillance

NEW CDC wastewater reporting: https://www.cdc.gov/nwss/rv/COVID19-nationaltrend.html

and

CDC wastewater map: https://www.cdc.gov/nwss/rv/COVID19-currentlevels.html

(last updated 11/25/23)

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

Wastewater SCAN dashboard: https://data.wastewaterscan.org/

National wastewater levels show High COVID, High RSV, Low Influenza A and Influenza B, High Norovirus (stomach flu)

Redwood City (Silicon Valley Clean Water) wastewater shows High COVID, High RSV, Low Influenza A, High Norovirus (stomach flu)

California statewide view Sewer Coronavirus Alert Network () project by Stanford University:

CDC Respiratory vaccination trends: https://www.cdc.gov/respiratory-viruses/data-research/dashboard/vaccination-trends-adults.html

12/6/23 CDC Director Dr. Cohen's video message
https://twitter.com/CDCDirector/status/1732547659292967203

CDC Director Mandy Cohen, MD, MPH, said it's not too late to be vaccinated against the three respiratory viruses for those who haven't already, and she urged people to take additional measures like avoiding sick people, washing hands, improving ventilation, and wearing a mask.

JP Weiland: https://twitter.com/JPWeiland

"As of December 4th: As predicted, a huge jump in numbers this week. 40% increase over last week. Pirola is increasing a lot.

850,000 new infections/day

1 in every 390 new people were infected today

1 in every 39 people currently infected

There is a big differential between regions at the moment. Looking at biobot and other metrics:

No changes to JP Weiland's forecast:

12/9/23
Variants
12/5/23 Eric Topol: From a Detour to Global Dominance, The rise of the JN.1 variant https://buff.ly/3Rg1DJu

Globally, Pirola descendent JN.1 is causing large increases in cases as seen by skyrocketing virus levels in wastewater. https://twitter.com/dfocosi/status/1732802560178766186

D. Focosi showed charts showing that SARS-CoV-2 wastewater levels are skyrocketing in Austria and The Netherlands, Germany, Denmark, Sweden, Switzerland and France, Australia.

Austria:

U.S.

Acute COVID infection

11/8/23 Cell: RAGE engagement by SARS-CoV-2 enables monocyte infection and underlies COVID-19 severity https://buff.ly/3NdQHuF

Receptor for Advanced Glycation Endproducts ( RAGE) pathway in monocytes

RAGE activation in monocytes strongly correlates with COVID-19 severity at admission

Patients' healing is associated with deactivation of the RAGE pathway

RAGE and the S1-RBD of SARS-CoV-2 interact directly in silico and in vitro

RAGE is involved in monocyte permissiveness to SARS-CoV-2 entry

4/6/2022 Nature: FcγR-mediated SARS-CoV-2 infection of monocytes activates inflammation https://buff.ly/37rMOAw

Testing

12/6/23 JAMA: COVID-19 Rapid Antigen Tests With Self- vs Health Care Worker-Collected Specimens https://buff.ly/3Rx6pnn

Pediatrics

12/5/23 International Journal of Infectious Diseases: Developmental impairment in children exposed during pregnancy to maternal SARS-COV2: A Brazilian cohort study. https://buff.ly/46PYA0j

All mothers studied were unvaccinated, April 2020 to July 2021.

Babies exposed in utero to maternal SARS-CoV-2 infection had increased risk of neurodevelopmental delay.

Fine motor and personal-social were the subdomains most impaired.

10% of exposed infants had an abnormal result on head ultrasound, mainly mild ventriculomegaly which is a swelling in the brain caused by cerebrospinal fluid buildup.

12/5/23 JAMA: Four Methods for Monitoring SARS-CoV-2 and Influenza A Virus Activity in Schools https://buff.ly/46UlKmd

Four methods of monitoring COVID and Influenza A virus activity in schools were found to be equivalent- air sampling, PCR testing, cause-specific absenteeism reporting and school-based rapid antigen tests. The air sampling method tested cartridges left in the school cafeterias. The found that SARS-CoV-2 detection was more stable (endemic) and Influenza A was more epidemic in November and December.

Vaccines
12/6/23 Nature Immunology: Repeated mRNA vaccination sequentially boosts SARS-CoV-2-specific CD8+ T cells in persons with previous COVID-19 https://buff.ly/3ReWrWa

12/6/23 Nature: N1-methylpseudouridylation of mRNA causes +1 ribosomal frameshifting https://buff.ly/3T9LIPH

The use of N1-methylpseudouridine into mRNA vaccines causes +1 ribosomal frameshifting with off-target cellular immune responses.

Although not linked to adverse outcomes, mistranslation of mRNA-based SARS-CoV-2 vaccines in humans causing off-target immune effects should be avoided with future mRNA-based vaccines.

Long COVID
12/4/23 MedRxiV (Oxford and Germany): Long COVID is associated with severe cognitive slowing https://buff.ly/3T9MJat

Two online cognitive tests, Simple Reaction Time (SRT) and Number Vigilance Test (NVT), were given to 270 patients diagnosed with Long COVID (PCC) at two different clinics in UK and Germany were compared to two control groups: had COVID and recovered without Long COVID (No-PCC group) and uninfected individuals (No-COVID group).

People with Long COVID (PCC) had pronounced cognitive slowing that was 3 standard deviations slower than age-matched controls who recovered from COVID without Long COVID (no PCC). This was seen in Long COVID patients in both the UK and Germany.

Comorbidities such as fatigue, depression, anxiety, sleep disturbance, and post-traumatic stress disorder did not account for the extent of cognitive slowing in Long COVID (PCC) patients.

"These results robustly demonstrate pronounced cognitive slowing in people with PCC [Long COVID] which distinguishes them from age-matched healthy individuals who previously had symptomatic COVID-19 but did not manifest Long Covid."

Simple Reaction Time (SRT) Test: Number Vigilance Test (NVT)
12/7/23 Lancet: A synbiotic preparation (SIM01) for post-acute COVID-19 syndrome in Hong Kong (RECOVERY): a randomised, double-blind, placebo-controlled trial https://buff.ly/3Gwn4kC

A randomized, placebo-controlled trial of a synbiotic (prebiotic + probiotic) called SIM01 modulated the gut microbiome to successfully alleviate fatigue, memory loss, difficulty in concentration, gastrointestinal upset, and general malaise in people with Long COVID.

2 sachets daily of either SIM01 (n=232) or placebo (n=231) were given to people with at least one Long COVID symptom for 6 months.

At 6 months, significantly higher proportions of the SIM01 group had alleviation of fatigue, memory loss, difficulty in concentration, gastrointestinal upset, and general unwellness compared to the placebo group.

The synbiotic (prebiotic + probiotic) preparation (SIM01) is a micro-encapsulated lyophilised powder containing 20 billion colony-forming units of three bacterial strains, B adolescentis, Bifidobacterium bifidum, and Bifidobacterium longum with three prebiotic compounds including galacto-oligosaccharides, xylo-oligosaccharides, and resistant dextrin, which has been shown to promote the growth of these bacterial strains but also other probiotic strains.

Bifidobacterium adolescentis showed positive correlations with alleviation in fatigue, gastrointestinal upset, and memory loss.

Bifidobacterium bifidum increases correlated with alleviation in fatigue and general unwellness.

Bifidobacterium longum correlated with an alleviation in difficulty in concentration.

Long COVID symptom alleviation at 6 months

12/1/23 Denver Post: Colorado looks to expand Long COVID care beyond specialty clinics https://buff.ly/4a9Q3IH

AI:

11/29/23 Arxiv: Towards Accurate Differential Diagnosis with Large Language Models https://arxiv.org/abs/2312.00164

12/8/23 Geoffrey Hinton interview by Eric Topol:

12/1/23 HealthDay: Most Men Taking Bodybuilding Protein Supplements Don't Know They Can Harm Fertility https://buff.ly/3Nei8Vp

Free course for new DEA opioid requirement for doctors and APPs: NEJM Knowledge+ Free Pain Management and Opioids course https://buff.ly/46FJkDi

12/6/23 AP: 52 sea turtles experiencing 'cold stun' in New England flown to rehab in Florida https://buff.ly/41d28ZF

10/26/23 Fast Company: Why gas leaf blowers are being banned across the country https://buff.ly/468iIdT

12/5/23 Lancet: Naltrexone 6 mg once daily versus placebo in women with fibromyalgia: a randomised, double-blind, placebo-controlled trial https://buff.ly/3GAWk2o

12/8/23 AP: FDA approves 2 gene therapies for sickle cell. One is the first to use the editing tool CRISPR https://buff.ly/3TfUQlE

12/7/23 Reuters: US sets policy to seize patents of government-funded drugs if price deemed too high https://buff.ly/3t7TvTo

12/8/23 Santa Claus liked my post on BlueSky

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The JN.1 COVID variant, a descendant of the very mutated Pirola BA.2.86, is taking off around the world. A mutation made JN.1 able to evade our antibodies better. Daniele Focosi tweeted wastewater charts from around Europe and Australia showing that JN.1 is causing SARS-CoV-2 wastewater levels to skyrocket.

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"The response must involve prioritization of research, such as that which led to the fast development of COVID vaccines and antivirals".

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"The response must involve prioritization of research, such as that which led to the fast development of COVID vaccines and antivirals".

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https://theconversation.com/could-antivirals-reduce-your-risk-of-long-covid-where-the-research-is-up-to-on-prevention-and-treatment-216529

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Evidence is continuing to accumulate on the burden and frequency of chronic effects after a COVID infection, which fall under the umbrella term "long COVID".

At least 5%-10% of people who contract COVID experience long COVID. This can include symptoms (for example, fatigue, brain fog and breathlessness) or conditions (for example, heart conditions, neurological conditions and diabetes) after the initial infection that may be persisting, new or relapsing.

Studies show the symptoms and increased risk of chronic conditions can persist for up to two years after infection. The individual impact of long COVID can range from temporary to severely disabling, and the societal cost - for example due to reduced workforce and increased health-care costs - is enormous

The lower risk of developing long COVID with up-to-date COVID vaccinations is substantially offset by the high levels of infections and re-infections globally. As a result, the cumulative burden of long COVID has increased, including in lower and middle income countries. A conservative estimate suggests 65 million people may be currently affected globally.

So where are we at with reducing the risk of, and treating, long COVID?

Could antivirals reduce the risk of long COVID?

COVID antiviral drugs, taken orally, continue to play an important role in reducing acute severe disease after infection. In Australia, they're available to those at highest risk from COVID.

Observational research has suggested taking antivirals during a COVID infection can reduce the risk of long COVID in people with at least one risk factor for acute severe COVID.

In one study, nirmatrelvir and ritonavir, known as Paxlovid, was associated with a 26% reduced risk of developing long COVID. It was also linked to a 47% reduced risk of death and a 24% reduced risk of hospitalisation after the acute infection phase.

A similar 14% reduction in long COVID risk has been reported for molnupiravir (Lagevrio).

Ensitrelvir - a COVID antiviral available in Japan - could also reduce the risk of long COVID, preliminary analyses suggest.

More research is needed, but this data indicates antiviral medications may be a key approach to lessening the risk of long COVID.

The population most at risk of long COVID (often working-age adults) differs from those most at risk of severe disease from a COVID infection (older adults or those with chronic medical conditions). Eligibility criteria to access antivirals do not currently include consideration of long COVID.

Read more: Long COVID symptoms can improve, but their resolution is slow and imperfect

Meanwhile, one randomised trial found metformin, a commonly prescribed diabetes medication, could also reduce long COVID risk. The study offered people with symptomatic COVID who were overweight or obese metformin for two weeks (beginning within a week of symptoms starting). This group was 41% less likely to develop long COVID compared with a placebo group that didn't take metformin.

The way this works might involve an effect on the powerhouses of our cells, mitochondria, or directly on the virus. Whatever the precise mechanism, further research should be priortised to fast-track this potential.

We're understanding more about long COVID

There are no effective or approved treatments for long COVID at present. Currently about 12 clinical trials are testing potential drugs. A number of candidate treatments exist for certain components of long COVID that may be useful in subgroups of patients.

However, recently we've seen major advances in understanding what's actually driving long COVID in the body. This knowledge opens up approaches for both diagnosis and treatments or interventions.

Read more: Common diabetes drug metformin could protect against long COVID

Research on treatments is lacking

An Australian parliamentary inquiry into long COVID stressed the best way to avoid the condition is to lower the risk of getting infected with COVID in the first place (through protective behaviours such as vaccination, mask wearing and cleaner indoor air).

While these are all important measures, we would benefit from having more tools at our disposal to prevent and treat long COVID. After all, COVID is still evolving rapidly and vast numbers of people are likely to be reinfected in the months and years ahead.

Overall, the quantity and speed of clinical trials into long COVID treatments has been insufficient. And most public health policy approaches are focused on preventing severe disease from a COVID infection, rather than the long-term effects.

That said, Australia recently announced an initial A$22 million of funding and a plan for research into long COVID through the Medical Research Future Fund.

In July 2023, the White House established the Office of Long COVID Research and Practice which will coordinate the US government's response to long COVID, as well as two randomised trials of Paxlovid.

What now?

Given what we now know about long COVID, and the additional concern of what we don't know (for example, could organ damage reveal itself many years down the track?), we desperately need diagnostic tools, clinical care pathways coupled with health worker training, and treatments to prevent and cure long COVID.

Unaddressed, long COVID may well lead to a new and substantial health and societal burden for many years to come. The response must involve prioritisation of research, such as that which led to the fast development of COVID vaccines and antivirals.

While there are some positive signs in the policy and research space, we need to see stronger recognition of long COVID and a greater sense of urgency around finding solutions.

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Could antivirals reduce your risk of long COVID? Where the research is up to on prevention and treatment

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A promising collection of studies suggests taking antivirals such as Paxlovid during an infection could reduce the risk of developing long COVID.

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"In fact, it’s simply good journalistic practice to give weight to the most knowledgeable sources. Long-haulers saw and predicted the rise of long Covid before credentialed academics did.". 

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"In fact, it’s simply good journalistic practice to give weight to the most knowledgeable sources. Long-haulers saw and predicted the rise of long Covid before credentialed academics did.". 

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https://www.nytimes.com/2023/12/11/opinion/long-covid-reporting-lessons.html

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Opinion | Reporting on Long Covid Taught Me to Be a Better Journalist

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Covering long Covid solidified my view that science is not the objective, neutral force that it is often said to be.

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"Understanding the cognitive implications of long COVID is crucial for medical professionals and individuals navigating the complexities of this extended illness".

# data[].attributes.subject
"Understanding the cognitive implications of long COVID is crucial for medical professionals and individuals navigating the complexities of this extended illness".

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https://longevity.technology/lifestyle/does-long-covid-cause-cognitive-slowing-new-study-sheds-light/

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Longevity.Technology Lifestyle | Health, Fitness & Technology

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A recent study delves into the potential cognitive effects of long COVID, shedding light on a previously underexplored aspect of this condition [ 1].

Published on , the research investigates the correlation between long COVID and cognitive slowing, adding valuable insights to the evolving understanding of this lingering health issue.

The study adopts a comprehensive approach to assess cognitive function in individuals grappling with long COVID.

Researchers employ a range of cognitive tests to unveil any discernible patterns or abnormalities in cognitive performance among those affected.

Understanding the cognitive implications of long COVID is crucial for medical professionals and individuals navigating the complexities of this extended illness [ 2].

As the medical community grapples with the multifaceted nature of long COVID, the study, albeit not yet peer reviewed, would seem to indicate a step forward in elucidating the potential cognitive repercussions.

By scrutinizing cognitive slowing specifically, researchers seek to contribute nuanced information to aid healthcare providers in tailoring interventions and support for those contending with long-term COVID symptoms.

There were significant cognitive delays in patients with persistent symptoms after having COVID.

These delays were noticeable even in a quick 30-second task measuring basic reaction time, where these patients were much slower than healthy individuals who had COVID but didn't develop persistent symptoms.

This discovery held true across two different groups of patients in Germany and the UK.

Interestingly, issues like fatigue, depression, anxiety, sleep problems and post-traumatic stress didn't explain the extent of cognitive delays in these patients.

Also, the slow reaction times in the quick task were closely linked to poor performance in a more comprehensive test measuring sustained attention.

This suggests that the cognitive challenges experienced by these patients go beyond common mental health issues and might be a distinct aspect of their condition.

The findings of this study could refine our understanding of the intricate interplay between COVID-19 and cognitive health.

If a definitive link between long COVID and cognitive slowing is established, it would prompt further research into the underlying mechanisms and potential therapeutic interventions.

In addition, the study prompts reflection on the broader societal implications of long COVID [ 3]. Cognitive function is integral to daily life, affecting work, relationships and overall wellbeing.

Recognizing and addressing cognitive challenges associated with long COVID becomes imperative for crafting comprehensive strategies to support individuals on their recovery journey.

While the study provides valuable insights, it also underscores the need for continued research in this domain.

Understanding the full spectrum of effects of long COVID requires ongoing scientific investigation.

The study published contributes to the evolving narrative surrounding long COVID by focusing on its potential impact on cognitive function.

By delving into cognitive slowing, the research sheds light on a facet of long COVID that warrants further investigation.

As our understanding of long COVID expands, so does the need for targeted approaches to address the diverse challenges posed by this lingering condition [ 2].

[1] https://www.medrxiv.org/content/10.1101/2023.12.03.23299331v1
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10545886/
[3] https://www.thebritishacademy.ac.uk/documents/3238/COVID-decade-understanding-long-term-societal-impacts-COVID-19.pdf

The information included in this article is for informational purposes only. The purpose of this webpage is to promote broad consumer understanding and knowledge of various health topics. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

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Does long COVID cause cognitive slowing? New study sheds light

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Explore the latest study on long COVID and its impact on cognitive function. Understand how it may contribute to cognitive slowing.

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"We don’t have time. The longer a person’s body is in a state of chronic illness, the harder it can be to recover fully. For many, the pandemic seems over. But the threat is not over. Although vaccination and prior COVID exposure lessen the risk, people can still get long Covid, even a severe, debilitating version like mine".

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"We don’t have time. The longer a person’s body is in a state of chronic illness, the harder it can be to recover fully. For many, the pandemic seems over. But the threat is not over. Although vaccination and prior COVID exposure lessen the risk, people can still get long Covid, even a severe, debilitating version like mine".

# data[].attributes.body
1,374 Days: My Life With Long Covid https://www.nytimes.com/interactive/2023/12/14/opinion/my-life-with-long-covid.html?smid=nytcore

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Opinion | 1,374 Days: My Life With Long Covid

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Chronic illness has a way of picking apart your mind and breaking your heart.

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"Hospitals and emergency rooms could be forced to ration care by the end of this month, the Centers for Disease Control and Prevention warned Thursday, saying recent trends in COVID-19 and influenza are now on track to again strain America's health care system".

# data[].attributes.subject
"Hospitals and emergency rooms could be forced to ration care by the end of this month, the Centers for Disease Control and Prevention warned Thursday, saying recent trends in COVID-19 and influenza are now on track to again strain America's health care system".

# data[].attributes.body
https://www.cbsnews.com/news/covid-variant-jn1-flu-surge-hospitals-cdc-warns/

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/ CBS News

Hospitals and emergency rooms could be forced to ration care by the end of this month, the Centers for Disease Control and Prevention warned Thursday, saying recent trends in COVID-19 and influenza are now on track to again strain America's health care system. The new COVID variant JN.1 is making up an increasing share of cases, the CDC's tracking shows.

"COVID-19 hospitalizations are rising quickly," the agency said in its weekly update. "Since the summer, public health officials have been tracking a rise in multisystem inflammatory syndrome in children (MIS-C), which is caused by COVID-19. Influenza activity is growing in most parts of the country. RSV activity remains high in many areas."

The CDC has been urging people to get vaccinated as the peak of this year's mix of three seasonal respiratory viruses - influenza, COVID-19 and RSV - is nearing.

In pediatric hospitals, the CDC says beds "are already nearly as full as they were this time last year" in some parts of the country. Data from emergency rooms published Wednesday tracked emergency room visits nearly doubling in school-age children last week.

The increase, driven largely by an acceleration in flu cases, follows weeks of largely plateauing emergency room figures nationwide ahead of Thanksgiving.

Similar to this time last year, influenza emergency room visits are now outpacing COVID-19 for the first time in months across most age groups. Only in seniors do rates of COVID-19 remain many times higher than influenza.

Nursing homes have seen a steep rise in reported COVID-19 across recent weeks. In the Midwestern region spanning Illinois, Indiana, Michigan, Minnesota, Ohio and Wisconsin, infections in nursing home residents have already topped rates seen at last year's peak.

Is there a new COVID-19 variant? What to know about JN.1

A new COVID-19 variant called JN.1 has been driving a growing share of the latest wave of infections, officials estimate.

The JN.1 lineage - a closely related descendant of the highly mutated BA.2.86 variant that scientists first warned about over the summer - was estimated last week in the CDC's projections to make up as much as 29% of infections nationwide. That's up from 8.8% at the end of November.

Health officials have been closely tracking the acceleration of BA.2.86 and its descendants, like JN.1, around the world in recent months. More than 4 in 10 test results from the CDC's airport testing program for international travelers have turned up these strains.

A panel of experts convened by the World Health Organization concluded this month that JN.1's changes were not steep enough to warrant a new revision to this season's vaccines, but acknowledged early data suggesting these shots were less effective at neutralizing the strain.

"CDC projects that JN.1 will continue to increase as a proportion of SARS-CoV-2 genomic sequences. It is currently the fastest-growing variant in the United States," the CDC said last week.

"Right now, we do not know to what extent JN.1 may be contributing to these increases or possible increases through the rest of December like those seen in previous years," they wrote.

However, so far the CDC had said that so far JN.1's fast spread does not appear to be leading to any upticks in the severity posed by COVID-19.

How big is the vaccination gap?

As COVID-19 and other respiratory viruses have accelerated in recent weeks, health officials say they have also been closely tracking an unprecedented drop in vaccinations this season.

Data from insurance claims suggest flu vaccinations in adults are around 8 million doses behind vaccination levels seen last year. The CDC's survey data suggests flu shots in children are also down around 5 percentage points from the same time last year.

"Covering the missed volume is going to be very difficult or not possible," vaccine manufacturers concluded at a recent stakeholder meeting with the CDC, according to a readout from the National Adult and Influenza Immunization Summit.

Health officials have also been urging providers to redouble their efforts to buoy COVID-19 vaccinations this year, especially for those most at-risk of severe disease like seniors.

In nursing homes, just a third of residents and less than 1 in 10 staff are vaccinated with this season's COVID-19 shot.

"We aren't seeing the uptake in vaccines that we would like to see," CDC Director Dr. Mandy Cohen told doctors at an American Medical Association event Tuesday.

Cohen also cited survey data on uptake of the RSV vaccinations, which were greenlighted for the first time this year in older adults. Around 16% of adults ages 60 and older say they have gotten the shot.

"We acknowledge that is too low and it is one of the reasons we wanted to have this conversation," she said.

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COVID and flu surge could strain hospitals as JN.1 variant grows, CDC warns

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"COVID-19 hospitalizations are rising quickly," the CDC said, and the new variant JN.1 is making up an increasing share of cases.

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"There were many interesting abstracts about the latest research on Long COVID including these two that showed ongoing SARS-CoV-2 viral replication in people with Long COVID". 

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"There were many interesting abstracts about the latest research on Long COVID including these two that showed ongoing SARS-CoV-2 viral replication in people with Long COVID". 

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https://drruth.substack.com/p/covid-news-and-more-121623?publication_id=713112&utm_medium=email&utm_campaign=email-share&triggerShare=true&r=a36iw

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It's beginning to look a lot like... JN.1 season around the world. The JN.1 COVID variant, a descendant of the very mutated Pirola BA.2.86, continues to skyrocket around the world as it becomes globally dominant. After JN.1 became dominant, hospitalizations spiked significantly in the Ile-de-France (Paris and its suburbs in France) which may be related to the sheer number of people infected. When the JN.1 variant became dominant in Singapore, there was a 500% increase in SARS-CoV-2 viral wastewater levels within three weeks. The updated XBB.1.5 vaccine offers good protection against JN.1 and other circulating variants and can help reduce severe infections and hospitalizations for COVID.

As I was writing this newsletter today, JP Weiland tweeted a new warning, "Witnessing some of these record setting wastewater signals is now MANY European countries after Pirola (JN.1) dominance is eye opening. We have to prepare ourselves for at least the *possibility* that we see a very large spike in the US in coming weeks." According to Dr. Wolfgang Hagen on his blog, Austria is seeing extremely high wastewater SARS-CoV-2 levels and this is associated with a large increase in hospitalizations.

On December 14th, the CDC posted a Health Alert Network advisory warning that COVID hospitalizations are quickly rising in the U.S. and there has also been an increase in pediatric multisystem inflammatory syndrome in children (MIS-C) related to COVID infections. Influenza infections are increasing as expected in most of the United States and RSV has peaked, but cases remain high in many parts of the country. Americans are undervaccinated for COVID, Flu and RSV. As of December 2nd, only 17% of adults have received the updated COVID vaccine, 41% had gotten the flu shot and about 16% of adults over age 60 have received a RSV vaccine. The CDC highly recommends getting vaccinated now in order to help reduce severe infections that could land people, including children, in the hospital. Other mitigation methods include wearing N95 or KN95 masks indoors when SARS-CoV-2 virus levels are high, improving air circulation and filtration indoors, testing for COVID before going to a group event, and staying home when sick. These can all help to stop the spread of JN.1 over the holidays.
Rapid antigen tests
Since most people have some immunity to COVID from prior COVID infection and/or COVID vaccination, people tend to get symptoms earlier in the course of the illness now. But often, rapid antigen tests can be negative early in a COVID infection because the viral load has not reached a high enough level yet to be detected by the tests. So, it is very important to repeat rapid antigen tests after a few days to exclude COVID. During that time, it is best to stay at home to avoid infecting others if you have symptoms or if you were exposed to COVID. If a rapid antigen test is positive for COVID, that means that the person's viral load is high enough for them to be contagious to others, whether or not they have symptoms.
Vaccines Antiviral treatments
https://covid-19-therapeutics-locator-dhhs.hub.arcgis.com/

can let you know where you can get antivirals. Fill in your state and which medication is needed in the dark blue boxes (Therapeutic Selector). I have heard that some insurance companies may require a prior authorization for Paxlovid. It may be worth checking your plan to make sure that this is not the case, as Paxlovid needs to be started within 5 days of COVID infection.
Long COVID
UCSF presented their end-of-the-year update on Long COVID, featuring Dr. Michael Peluso, Dr. Ziyad Al-Aly, Dr. Akiko Iwasaki and moderated by Dr. Bob Wachter. The UCSF Department of Medicine tweeted about the speakers and their research on Long COVID.

Have a good rest of your weekend,

Ruth Ann Crystal MD

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

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

Weekly ED visits for respiratory illnesses, by age and disease: https://www.cdc.gov/ncird/surveillance/respiratory-illnesses/index.html
US Wastewater Monitoring:
NEW CDC wastewater reporting: https://www.cdc.gov/nwss/rv/COVID19-nationaltrend.html

and

CDC wastewater map: https://www.cdc.gov/nwss/rv/COVID19-currentlevels.html

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

Wastewater SCAN: https://data.wastewaterscan.org/

California statewide view https://buff.ly/3YObiul

Sewer Coronavirus Alert Network () project by Stanford University:

Santa Clara county wastewater: https://covid19.sccgov.org/dashboard-wastewater

Marin county: https://coronavirus.marinhhs.org/surveillance

Mask bloc San Jose, CA: https://masksanjose.org/

CDC US Respiratory vaccination trends: https://www.cdc.gov/respiratory-viruses/data-research/dashboard/vaccination-trends-adults.html

JP Weiland updates: https://twitter.com/JPWeiland
https://twitter.com/JPWeiland/status/1734373314099892644

"December 11th Update:

Biobot downgraded last week's signal to 815k. WW is still rising, though stuttering a bit this week, as we've seen in early Dec in past years.

870,000 new infections/day

1 in every 380 became infected today

1 in every 38 people currently infected

photo credit: Via Violet Blue, "A very COVIDY Christmas" from the John Snow Project on YouTube

Austrian hospitals are packed with COVID cases from JN.1 per Wolfgang Hagen MD of Austria:

Update: The current infection situation, a press conference on air hygiene and the Swedish Way in a panel discussion https://buff.ly/3GGLatb

German translated by Google to English

Update: Die derzeitige Infektionslage, eine Pressekonferenz zur Lufthygiene und der Schwedische Weg in einer Podiumsdiskussion

Variants
Americans are undervaccinated for COVID, Flu and RSV. The CDC highly recommends getting needed vaccines now in order to help reduce severe infections that could land people, including children, in the hospital.
Social Acute COVID infection
12/12/23 Annals of Internal Medicine: Replication-Competent Virus Detected in Blood of a Fatal COVID-19 Case https://buff.ly/4axs5aD
Pediatrics
12/12/23 CIDRAP: COVID study: 40% of children still infectious after symptom resolution https://buff.ly/3RElu6B

12/12/23 Clinical Infectious Diseases: Viral dynamics of the SARS-CoV-2 Omicron Variant in Paediatric Patients; A prospective cohort study https://buff.ly/3Trfob5

Vaccines
12/6/23 Updated BioRxiV (Ho lab): XBB.1.5 monovalent mRNA vaccine booster elicits robust neutralizing antibodies against emerging SARS-CoV-2 variants https://buff.ly/3GLcgzi

The updated monovalent mRNA vaccine (XBB.1.5 MV) boosted serum virus-neutralization antibodies significantly against not only XBB.1.5 (27.0-fold) and the currently dominant EG.5.1 (27.6-fold) but also key emergent viruses like HV.1, HK.3, JD.1.1, and JN.1 (13.3-to-27.4-fold).

In individuals previously infected by an Omicron subvariant, serum neutralizing titers were boosted to highest levels (1,504-to-22,978) against all viral variants tested.

12/13/23 Nature: A next-generation inhalable dry powder COVID vaccine https://buff.ly/41rxTye

Current injectable COVID-19 vaccines require refrigeration for manufacture, transport and final storage and administration. They are unable to induce robust immunity in the mucosal tissues lining the airways.

Ye et al. report a vaccine formulation that is not only able to induce respiratory mucosal immunity after local lung delivery, but is also inhaled as a dry powder - avoiding the need for cold chains and the use of needles.

12/12/23 Lancet Rheumatology: Effect of a 2-week interruption in methotrexate treatment on COVID-19 vaccine response in people with immune-mediated inflammatory diseases (VROOM study): a randomised, open label, superiority trial https://buff.ly/3RHeOEX

12/8/23 Science Immunology: SARS-CoV-2 vaccination enhances the effector qualities of spike-specific T cells induced by COVID-19 https://buff.ly/48ieJwI
Antiviral treatments
FYI- Some insurance companies are requiring people to get prior authorization before getting Paxlovid! I don't know if people will be able to get it in time.

You can look up medication interactions with COVID medications like Paxlovid on the University of Liverpool COVID drug interaction site: https://www.covid19-druginteractions.org/checker

You can print out the list of meds and if they interact with Paxlovid or not.

Here is the Paxlovid Rx finder

https://covid-19-therapeutics-locator-dhhs.hub.arcgis.com/

You have to fill in your state and which medication is needed in the dark blue boxes (Therapeutic Selector) which was not obvious to me.

6/12/23 Medscape: COVID-19 Treatment: Investigational Drugs and Other Therapies: Introduction, Antiviral Agents, Immunomodulators and Other Investigational Therapies https://buff.ly/3uR7mhs
Long COVID
12/11/23 Prevalence of covid-19 and long covid in collegiate student athletes from spring 2020 to fall 2021: a retrospective survey - BMC Infectious Diseases https://buff.ly/48eOp6A

Photo: Roger Smith on Flicker

12/14/23 UCSF end of the year update on Long COVID, featuring Dr. Michael Peluso, Dr. Ziyad Al-Aly, Dr. Akiko Iwasaki and moderated by Dr. Bob Wachter

12/14/23 https://twitter.com/Dakota_150/status/1735325502871626031

Shared from NIH ACD Meeting this morning, courtesy of a LC patient advocate - Neil Shapiro, NIH Budget Director announced that RECOVER has secured an additional $200 million from the pandemic funds [the supplemental appropriations] for a second round of clinical trials.

18 months after hospitalization.

Compared to seasonal influenza, hospital admission for COVID-19 was associated with higher long-term risks of death and adverse health outcomes in nearly every organ system (except for the lungs) and significant cumulative excess disability-adjusted life-years (DALYs) than hospital admission for seasonal influenza.

Figure 4:

B) Disability-adjusted life-years (DALYs) per 100 persons presented for the COVID-19 (red) and seasonal influenza (blue) groups in each organ system.

(C) Event rates per 100 persons presented for COVID-19 (red) and seasonal influenza (blue).

(D) DALYs per 100 persons presented for COVID-19 (red) and seasonal influenza (blue).
https://twitter.com/zalaly/status/1735444944070885868
Thread from Dr. Ziyad Al-Aly on this study:

Long-term outcomes of people hospitalized for COVID-19 vs seasonal influenza.

81,280 individuals hospitalized for SARS-CoV-2

10,985 individuals hospitalized for seasonal influenza

The study included:

Covid had higher risk of death, healthcare utilization and sequelae in most organ systems than flu. Risks were higher in Covid for all organ systems except for the pulmonary system which was higher in flu.

Covid is more multisystemic than flu. Flu is more respiratory than Covid.

Both COVID-19 and seasonal influenza had a higher burden of health loss in the post-acute phase of infection compared to their respective acute phases, but loss was higher for COVID.

Review of Dr. Al-Aly and colleagues study showing that as compared to people who were hospitalized for Influenza, veterans admitted to the hospital for COVID infections had significantly higher rates of death, healthcare utilization, hospital readmission, ICU care and adverse health outcomes in 9 out of 10 organ systems than did patients with the flu.

"COVID is really a multi-systemic disease, and flu is more a respiratory virus." said Dr. Al-Aly.

"Conceptualizing the illness as an acute event obscures the much larger burden of health loss that occurs later."

COVID-19 poses a much higher risk, both in the short run and long term, than flu. But the flu remains "a formidable foe," Al-Aly says.

"We trivialize COVID infections at our peril," says Al-Aly. "The objective evidence is clear, whether it is a first infection or reinfection, COVID is still a serious threat to human health."

12/14/23 Fortune: COVID-19 v. Flu: A 'much more serious threat,' new study into long-term risks concludes https://buff.ly/471jUQT

"Long Covid is a physical affliction, but chronic illness, stretching over months and years, has a way of picking apart your mind and breaking your heart."

"Even if my body, from the outside, resembles the old me, long Covid has rewritten my core personhood on a cellular level."

"Long Covid runs the show now. I know from experience that if I overdo it in any way, which can mean taking actions as small as sitting up for too long or trying to make the bed, I could make myself feel far worse, shrinking the tiny life I have left into something even smaller."

12/11/23 NY Times by Ed Yong: Reporting on Long Covid Taught Me to Be a Better Journalist https://buff.ly/3uOrNvl

"This piece is sort of a manifesto for a journalism grounded in compassion, rigor, and care."

"Around the world, tens of millions of people are suffering from long Covid. Some might recover but most long-haulers don't fully return to their previous base line. At the same time, the pool of newly sick people will continue to grow..."

"I witnessed almost every publication that I once held in esteem become complicit in normalizing a level of death once billed as incalculable. It was galling, crushing work that wrecked my faith in journalism and its institutions. But the solace that many long-haulers drew from my pieces gave me solace in turn."

Cohort study of 6932 families

Long COVID (persistent COVID-19 symptoms), and to a lesser extent previous severe COVID-19, were associated with increased odds of pandemic-related economic hardship in a cohort of US families.

Skeletal muscle biopsies obtained from 11 patients suffering from enduring fatigue and post-exertional malaise after an infection with SARS-CoV-2 vs. historical controls.

The skeletal muscles of patients with post-COVID exertion intolerance had:

fewer capillaries

thicker capillary basement membranes

increased numbers of CD169+ macrophages.

No SARS-CoV-2 RNA was detected in muscle biopsies.

Complement system related proteins were more abundant in the serum of patients with PCS, matching observations on the transcriptomic level in the muscle tissue.

12/12/23 JAMA: COVID-19 Symptoms (Long COVID) and Economic Hardship Among US Families https://buff.ly/48gZ7tr

For speech and language therapists and others to help Long COVID patients with speech, swallowing, dysphonia, and communication issues:

https://www.rcslt.org/news/new-long-covid-guidance-and-patient-handbook/
https://academicmedicaleducation.com/sites/default/files/2023-11/Abstract_Book_Long%20COVID%202023.pdf
Demystifying Long COVID conference Dec 7-9, 2023 in Spain.

Abstracts can be found here:

Q&A for Dr. Upi Singh:

Q: why only 15 days (of Paxlovid) given

A: the drug was under emergency authorization etc, lots of safety concerns

Q: evidence that paxlovid works against viral persistence

A: they found gut reservoirs 7 months after infection. Don't know yet if it helps against gut colonization yet.

Q: did they notice paxlovid rebound effects?

A: the study hasn't been unblinded yet. People feel a lot better overall. They get more tlc than in regular care. Some people had symptoms come back. That's why they had the long time point.

Billboards for Long COVID awareness in several countries

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It's beginning to look a lot like... JN.1 season around the world. The JN.1 COVID variant, a descendant of the very mutated Pirola BA.2.86, continues to skyrocket around the world as it becomes globally dominant. After JN.1 became dominant, hospitalizations spiked significantly in the Ile-de-France

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"‘We trivialize COVID infections at our peril. Clearly, long COVID remains a looming threat. Moreover, research shows that with each successive COVID-19 infection, we roll the dice. One can be young, healthy, and vaccinated, having experienced only mild symptoms during initial infections–then, almost inexplicably, develop long COVID on the next infection".

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"‘We trivialize COVID infections at our peril. Clearly, long COVID remains a looming threat. Moreover, research shows that with each successive COVID-19 infection, we roll the dice. One can be young, healthy, and vaccinated, having experienced only mild symptoms during initial infections–then, almost inexplicably, develop long COVID on the next infection".

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https://fortune.com/2023/12/14/covid-19-v-flu-more-serious-threat-new-study-health-carolyn-barber/

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Almost from the start of SARS-CoV-2's rampage around the globe, researchers and epidemiologists warned that it appeared to behave differently than known viruses, particularly seasonal flu. That included not only COVID-19's general contagiousnesscompared to flu viruses, but also its ability to cause clotting problems in the veins and arteries, result in loss of smell and/or taste, and even lead to a rare multisystem inflammatory syndrome in children.

That message was taken more or less seriously, depending on geography and, often, politics. But as a new study makes clear, the warnings have proved darkly prophetic.

The study, a comparative analysis with 18 months of follow-up of hospital admissions for those with COVID-19 and those with seasonal flu, found that COVID-19 patients experienced significantly higher rates of death, healthcare utilization, and adverse health outcomes in most organ systems than did patients with the flu. Its results were published on Dec. 14 in the infectious diseases section of the medical journal .

'A multi-systemic disease'

"This was evident in pre-Delta, Delta, and Omicron (strains), and evident in both vaccinated and unvaccinated individuals," says Ziyad Al-Aly, the director of the Clinical Epidemiology Center, chief of research and development service at the Veterans Affairs Saint Louis Health Care System, and senior author of the study. "COVID remains a much more serious threat to human health than the flu."

The study arrives as the U.S. is seeing a significant uptick in COVID-related hospitalizations and with 15 states reporting high or very high levels of respiratory illness, which takes in COVID-19, the flu, RSV, and other respiratory diseases. The hospitalization numbers are well below those posted during Omicron's peak, but with colder weather moving more people indoors and into crowded settings, they may reasonably be expected to continue rising.

Al-Aly's study undertook a comparative analysis of 94 pre-specified health outcomes and found that over 18 months of follow-up, COVID was associated with a "significantly increased risk" for 64 of them, or nearly 70%. The disease's enhanced risk list includes everything from cardiac arrest, stroke, chronic kidney disease, and cognitive impairment to mental health and fatigue, two characteristics often associated with long COVID.

By comparison, the seasonal flu was associated with increased risk in only six of the 94 conditions specified. Further, while COVID increased the risks for almost all the organ systems studied, the flu heightened risk primarily for the pulmonary(lung) system. Those findings, Al-Aly says, suggest that "COVID is really a multi-systemic disease, and flu is more a respiratory virus."

'A formidable foe'

Though COVID poses a greater risk, the seasonal flu should continue to be taken seriously, the researcher says. In fact, one clear finding of the study is that, much in the same way that long COVID is much more of a health problem than acute COVID, long flu poses more danger than does its acute phase.

"Five years ago, it wouldn't have occurred to me to examine the possibility of a 'long flu,'" Al-Aly says. " But a major lesson we learned from SARS-CoV-2 is that an infection which was initially thought to only cause brief illness can also lead to chronic disease. Conceptualizing the illness as an acute event obscures the much larger burden of health loss that occurs later. This revelation motivated us to look at long-term outcomes of COVID-19 versus flu."

The result: COVID-19 poses a much higher risk, both in the short run and long term, than flu. But the flu remains "a formidable foe," Al-Aly says. "Going into this winter season where cases of COVID and flu are rising, people should make sure they are vaccinated for both, and for RSV if they qualify, and take precautions to lower their risk."

According to the federal Centers for Disease Control and Prevention(CDC), nearly 80% of adult Americans have completed their primary series of COVID-19 vaccines, but only 17% have received a booster. Meanwhile, nearly four in 10 adults had received a seasonal flu shot as of Nov. 25, the CDC estimated.

Roughly 15% of all U.S. adults have experienced long COVID symptoms, though figures range as high as the reported 34% in Oklahoma. According to a paper published earlier this year by Al-Aly's team in Nature Medicine, the physical fallout from long COVID may last two years or longer - and it can take a toll on the quality of life even for those whose initial cases didn't require hospital care.

'We trivialize COVID infections at our peril'

Clearly, long COVID remains a looming threat. Moreover, research shows that with each successive COVID-19 infection, we roll the dice. One can be young, healthy, and vaccinated, having experienced only mild symptoms during initial infections-then, almost inexplicably, develop long COVID on the next infection. Considering that long COVID can include conditions like memory loss, new diabetes, stroke, etc, and we have no proven treatments, the best strategy is to avoid it altogether.

Al-Aly's study mined the databases of the U.S. Department of Veterans Affairs to analyze data for more than 80,000 COVID-19 patients admitted to hospitals between March 2020 and June 2022, and for nearly 11,000 flu patients between October 2015 and February 2019. Up to 18 months of follow-up for participants was chosen "to comparatively evaluate risks and burdens of death" in addition to the pre-specified health outcomes, organ systems, hospital readmission, and admission to intensive care, the study says.

As part of their analysis, the researchers composited the health outcomes into 10 organ systems: cardiovascular, coagulation and hematological, fatigue, gastrointestinal, kidney, mental health, metabolic, musculoskeletal, neurological, and pulmonary. COVID-19 showed increased risk in nine of the 10, with the flu showing increased risk only in the pulmonary system.

The COVID group also had a higher risk of admission to intensive care in all of the time periods studied (30, 180, 360, and 540 days) versus the flu group, as well as a higher risk of readmission to the hospital. And absolute rates of death, adverse health outcomes, and healthcare utilization, while high for both viruses, were "significantly higher for COVID-19 compared to seasonal influenza," despite changes in SARS-CoV-2 over time from pre-Delta to Delta to Omicron, the researchers said.

The study's authors noted two key limitations. First, the V.A. study population is predominantly older white males, which may limit the generalizability of the study's findings. And as the researchers assessed only people who were hospitalized with COVID or flu, the results should not be extrapolated to include non-hospitalized individuals.

Another strain of the virus, JN.1, has been detected. The growth advantage it appears to have over other variants suggests that it is either more transmissible or more capable of evading our immune systems. And the specter of long COVID hangs over each infection, to some degree or other. "We trivialize COVID infections at our peril," says Al-Aly. "The objective evidence is clear, whether it is a first infection or reinfection, COVID is still a serious threat to human health."

Carolyn Barber, M.D., is an internationally published science and medical writer and a 25-year emergency physician. She is the author of the book Runaway Medicine: What You Don't Know May Kill You, and the co-founder of the California-based homeless work program Wheels of Change.

More must-read commentary published by Fortune:

Economic pessimists' bet on a 2023 recession failed. Why are they doubling down in 2024?

Inside long COVID's war on the body: Researchers are trying to find out whether the virus has the potential to cause cancer

Access to modern stoves could be a game-changer for Africa's economic development-and help cut the equivalent of the carbon dioxide emitted by the world's planes and ships

Melinda French Gates: 'It's time to change the face of power in venture capital'

The opinions expressed in Fortune.com commentary pieces are solely the views of their authors and do not necessarily reflect the opinions and beliefs of Fortune.

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COVID-19 v. Flu: A 'much more serious threat,' new study into long-term risks concludes

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'We trivialize COVID infections at our peril,' says the author of the study.

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"In the open letter published on Monday, health policy experts, leading Long Covid researchers, clinicians, journalists, chronic illness and health advocacy groups, and many others demand that Biden demonstrate support for the millions of Americans with Long COVID and infection-associated chronic conditions (IACCs)" 

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"In the open letter published on Monday, health policy experts, leading Long Covid researchers, clinicians, journalists, chronic illness and health advocacy groups, and many others demand that Biden demonstrate support for the millions of Americans with Long COVID and infection-associated chronic conditions (IACCs)" 

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https://thesicktimes.org/2023/12/18/policy-experts-scientists-disability-groups-urge-biden-to-address-the-long-covid-crisis/

Open letter: https://patientresearchcovid19.com/wp-content/uploads/2023/12/Letter-to-President-Biden-on-Long-COVID-Funding.pdf

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The Sick Times - Chronicling the Long Covid crisis

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A wide breadth of policy experts, scientists, and disability groups are calling on President Biden to urgently address the Long Covid crisis with annual funding in the billions.

In the open letter published on Monday, health policy experts, leading Long Covid researchers, clinicians, journalists, chronic illness and health advocacy groups, and many others demand that Biden demonstrate support for the millions of Americans with Long COVID and infection-associated chronic conditions (IACCs). The authors demand Biden acknowledge this crisis and outline the actions his administration is taking to address it in his State of the Union address.

"Failure to address this problem," the letter's authors write, "will result in significant economic, health, quality of life, and societal costs, in the trillions of dollars. Moreover, every dollar invested in Long COVID and IACC research will prepare our country for future pandemics and emerging infection-associated conditions."

The Biden administration developed the HHS Office of Long Covid in 2022, but advocates and scientists have criticized it for failing to move more urgently on the Long Covid crisis and make meaningful changes in the everyday lives of people with this disease and related infection-associated illnesses.

Many citizens have also pointed out Biden's unfulfilled campaign promises of containing the spread of Covid-19. Since he took office in 2021, over 750,000 Americans have died from Covid and millions have developed Long Covid, but Biden continues to deny the reality of the ongoing pandemic. Current data - which are not comprehensive estimates, thanks to the dismantling of Covid-19 surveillance systems - suggest hundreds of thousands of Americans are getting infected and more than one thousand are dying each week of Covid-19. We know that around 10% of daily cases will go on develop Long Covid, meaning many thousands of Americans will become debilitated by Long Covid in the coming months.

The letter serves as a call to not only support people with Long Covid and IACCs financially with safety nets, but to also take steps to prevent millions more Americans from getting Covid-19 and developing Long Covid. The authors call for the Biden administration to implement common sense prevention efforts such as "improved ventilation and air filtration in commercial, educational, and work environments to reduce the spread of COVID, thereby ensuring more people do not develop Long COVID."

To support people with Long Covid and IACCs, the letter demands that federal agencies fund social safety net programs, biomedical research, clinical trials, healthcare provider education, healthcare delivery research and equitable access to high-quality care, public health education, and home- and community-based care.

The letter echoes a recent Nature op-edthat called for investing at least one billion dollars a year in Long Covid research for the next ten years in a "moonshot" that could help improve the lives of people with Long Covid (pwLC) and save the U.S. trillions in economic costs. The Nature article later inspired a telethon advocacy effort in November by pwLC and their allies that made hundreds of calls to representatives across the country. The Long Covid moonshot effort continues this month with an "Unhappy Holidays" letter-writing campaign.

"We recognize that Long COVID is a public health crisis and an economic and social challenge of immense proportions, but this has not been reflected in the President's budget to date," said Lisa McCorkell, one of the authors of the letter and a co-founder of the Patient Led Research Collaborative. "When the President is considering his priorities for FY25, he must show that he values the over 20 million Americans with Long COVID and the millions more at risk."

So far, over 60 prominent researchers, clinicians, and others have signed on. They include Ezekiel Emanuel, a health policy expert, former Obama advisor, and Biden Transition COVID Task Force member, and Bob Wachter, chair of the department of medicine at the University of California, San Francisco. Other signatories include Akiko Iwasaki, Ziyad Al-Aly, Ed Yong, Eric Topol, Anthony Komaroff, David Putrino, Resia Pretorius, Michael Peluso, and many principal investigators of the National Institute of Health's RECOVER initiative.

Also signed onto the letter are over twenty health advocacy and disability organizations, including Center for Economic and Policy Research, Long COVID Justice, LONG Covid Families, BIPOC Equity Agency, Black COVID-19 Survivors Alliance, Inc., The Black Long Covid Experience, Disability Rights California, COVID-19 Longhauler Advocacy Project, Dysautonomia International, #MEAction, and Patient-Led Research Collaborative.

"My experience is a stark reminder of the systemic inadequacies in healthcare that many face, particularly in marginalized communities," Cynthia Adnig, co-founder of BIPOC Equity Agency, wrote to The Sick Times when we reached out to ask about why her organization signed the letter. "As a caregiver, I also see the ripple effects of Long COVID on families and the looming threat it poses to our nation's future generations and economic health." Adinig testified in Congress in July 2022, detailing her and her son's experience with Long Covid before the Select Subcommittee on the Coronavirus Crisis.

"We implore the Biden Administration to take the recommendations in this letter to heart," Adnig wrote. "The health of our nation, the well-being of our communities, and the economic stability of our country hinge on the actions we take now to address the challenges of Long COVID and related conditions."

All articles by The Sick Times are available for other outlets to republish free of charge. We request that you credit us and link back to our website.

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Policy experts, scientists, disability groups urge Biden to address the Long Covid crisis - The Sick Times

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A wide breadth of policy experts, scientists, and disability groups are calling on President Biden to urgently address the Long Covid crisis with annual funding in the billions. In the open letter published on Monday, health policy experts, leading Long Covid researchers, clinicians, journalists, chronic illness and health advocacy groups, and many others demand that Biden demonstrate support for the millions of Americans with Long COVID and infection-associated chronic conditions (IACCs).

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"The linkage between blood vessel dysfunction (but not immune activation) and neuroinflammation suggests blood vessel problems could be playing a really major role in these diseases".

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"The linkage between blood vessel dysfunction (but not immune activation) and neuroinflammation suggests blood vessel problems could be playing a really major role in these diseases".

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https://www.healthrising.org/blog/2023/12/20/blood-vessel-neuroinflammation-long-covid/

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The brain and the blood vessels. So intimately intertwined but so rarely studied together. In retrospect, that's kind of strange as blood vessels may have more to do with brain functioning than anything else.

By weight, the brain is almost a non-entity - it takes up about 2% of our body weight - but blood flows are another story. The brain receives 15-20% of our blood supply; i.e. it may be the most blood vessel-rich and blood vessel-dependent organ in the body.

Given that we know the spike protein of the coronavirus triggers coagulation, and that several other things (platelet activation, endothelial dysfunction) have gone wrong with the blood vessels, it only seems to make sense to check out the impact blood vessel functioning might have on the brain in long COVID.

Of course, there's the ME/CFS angle as well. We know that blood flows to the brain are impaired in ME/CFS, and there's evidence of neuroinflammation, basal ganglia dysfunction, prefrontal cortex problems, etc., but until the coronavirus popped up - except for Ron Davis's exploration of red blood cell deformability - there was almost no focus on blood factors.

In both illnesses, the brain imaging studies tend to be locked into the brain and only the brain. While blood flows within the brain are often assessed, anything outside of the brain is a no-no. Not so with this PolyBio Research Foundation-funded study.

The Study

That changed with the " Neuroinflammation in post-acute sequelae of COVID-19 (PASC) as assessed by [ 2 11C]PBR28 PET correlates with vascular disease measure " study (it's currently a preprint) featuring Michael VanElzakker and Marco Loggia.

This study asked whether neuroinflammation in the brain and markers of blood vessel dysfunction in the plasma were correlated; i.e. it asked if people with higher levels of blood vessel dysfunction in the blood plasma also experienced more neuroinflammation in their brains.

A positive finding would putatively connect what's going on in the blood vessels in the body to damage to the brain. We've heard of the gut-brain axis. Now we have the blood vessel-brain axis.

The researchers specifically looked at the activity of the glial cells in the brain. The innate immune cells found in the brain, the glial cells are composed of microglial cells and astrocytes.

These are the cells that produce the "sickness behavior" symptoms (flu-like symptoms such as fatigue, pain, etc.) we experience when we encounter a pathogen. In the short term, they play a vital role in clearing pathogens and the damage they've caused to our systems. If they remain in a chronically activated state, they may - besides producing a lot of symptoms - produce a lot of dysregulation that shows up in all sorts of neurological symptoms.

The study included 12 long-COVID patients and 43 pre-pandemic healthy controls. The authors used a second-generation ligand [32 11C]PBR28 that can pick up glial cell activation to assess neuroinflammation, and assessed the following factors in the plasma:

Vascular health (α2- 238 macroglobulin, orosomucoid, CRP [C-reactive protein], fetuin A, fibrinogen, haptoglobin, 239 sL-selectin, PF4 [platelet factor 4], pentraxin-2)

Cytokines (GM-CSF, IFNγ, IL-1β, IL-1RA, IL-2, IL-4, IL-5, IL-6, 241 IL-8, IL-10, IL-12(p40), IL-12(p70), IL-13, MCP-1, TNFα)

Angiogenesis (angiopoietin-2, BMP-9, EGF, endoglin, endothelin 243 1, FGF-1, FGF-2, follistatin, G-CSF, HB-EGF, HGF, IL-8, leptin, PLGF, VEGF-A, VEGF 244 C, VEGF-D).

(The plasma is a light-colored fluid that contains what's left over in the blood after the red blood cells are removed).

They also assessed symptoms using the Brief 252 Pain Inventory (BPI), and the Beck Depression Inventory (BDI). The patients were screened to fulfill a modified myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) International Consensus Criteria (ICC) criteria. Most of the long-COVID cases (10) had not been hospitalized for COVID-19.

Results

"To our knowledge, ours is the first study to provide direct evidence that processes related to neuroinflammation and vascular dysfunction are directly related in PASC (long COVID)." the authors

They found evidence of neuroinflammation (activated glial cells) across a wide swath of the brain in the long-COVID patients. The inflamed areas included the midcingulate cortex, corpus callosum, thalamus, basal ganglia/striatum, subfornical organ, anterior cingulate cortex, medial frontal gyrus, and precentral gyrus.

They really hit the nail on the head with their blood vessel factors. With elevations in 7 of the 9 vascular factors (fibrinogen, α2-macroglobulin, orosomucoid (alpha-1-acid glycoprotein 427 or AGP), fetuin A, sL-selectin (soluble leukocyte 428 selectin, or sCD62L), pentraxin-2 (serum amyloid P component, or 429 SAP), haptoglobin), they found strong evidence of vascular dysfunction.

THE GIST

Although the brain gets from 15-20% of the blood in the body and may be the most blood vessel-rich organ in the body, brain studies tend to focus on the brain alone. With ample evidence of blood vessel problems showing up in the long COVID, though, that's changing. A recent PolyBio Research Foundation study assessed both neuroinflammation in the brain and factors associated with blood vessel damage.

The study found evidence of widespread neuroinflammation in long COVID in several areas of particular interest for ME/CFS. The anterior cingulate cortex, basal ganglia, and thalamus have all shown up prominently in ME/CFS as well. Reduced activation of two of these regions - the ACC and the basal ganglia - has been associated with fatigue and other symptoms in ME/CFS.

With 7 of the 9 blood vessel damage factors significantly increased in the long COVID patients, blood vessel damage showed up big time. More importantly, the blood vessel factors were positively correlated with the neuroinflammation found; i.e. the worse off the blood vessels appeared, the more neuroinflammation was found. That suggested that blood vessel damage may be contributing to the neuroinflammation in the brain and a wide raft of brain-derived symptoms such as fatigue, chronic pain, flu-like symptoms, and brain fog.

The authors speculated that remaining reservoirs of the coronavirus were triggering clotting, which was then damaging the blood vessels, and opening up the brain to inflammatory factors via a leaky blood-brain barrier.

They found that neuroinflammation was positively correlated with blood vessel dysfunction (but not with cytokines or angiogenesis factors); i.e. the more evidence of blood vessel problems that showed up in the patient's plasma, the more neuroinflammation was found.

These upregulated vascular factors do things like trigger coagulation, glial cell activation, draw immune factors to the blood vessels, and increase the permeability of the blood vessels. Interestingly, the study found increased signs of neuroinflammation in some areas featuring small thin blood vessels such as the basal ganglia, which seem to be more susceptible to damage.

Similarly, parts of the brain called the circumventricular organs (CVOs) lack a complete blood-brain barrier and seem to be "particularly vulnerable to being activated by blood-borne factors."

These blood-borne factors could be triggering inflammation, putting holes in the blood-brain barrier, activating glial cells (which promote more neuroinflammation and a leakier blood-brain barrier), and wreaking havoc on the blood vessels.

The Brain Regions

Back in 2004, Chaudhuri and Behan proposed that problems in the basal ganglia, thalamus, limbic system, and higher cortical centers were causing 'central' or brain-induced fatigue.These areas showed up in spades in this latest study.
Anterior cingulate cortex (ACC)
Of all the brain regions, the anterior cingulate cortex (ACC) and the basal ganglia/striatum stand out with regard to ME/CFS. The ACC appears to be kind of a favorite in ME/CFS. It's been associated with fatigue in ME/CFS numerous times.

Like all brain regions, the ACC is involved in a number of functions including attention allocation, reward anticipation, decision-making, impulse control - each of which I, at least, have trouble with. The "reward anticipation" is interesting as low reward has been associated with fatigue in the basal ganglia. The ACC also processes a lot of stimuli and is involved with motor control. It appears to kick in when effort is needed to complete a task.

Reduced cerebral blood flow, reduced glutathione levels and perhaps energy production, altered metabolites, altered connectivity associated with increased fatigue, dysfunctional motor planning and reduced acetylcarnitine uptake in the anterior cingulate cortex have all been found in ME/CFS.
Basal ganglia
Found deep in the brain, the basal ganglia have connections to the brainstem, thalamus, and other regions. The dopamine-producing center of the brain and an important facilitator of movement, basal ganglia dysfunction has been associated with fatigue in both ME/CFS and multiple sclerosis.

Andrew Miller - whose CDC-funded study found evidence of significantly reduced activation throughout the basal ganglia - believes basal ganglia dysfunction may be impacting the movement problems in ME/CFS, as well as causing both physical and mental fatigue, increasing the effort needed to do anything, etc.

Some evidence suggests that the basal ganglia may be uniquely vulnerable to inflammation.
Thalamus
Located just above the brainstem, the thalamus's role in relaying sensory and motor signals from the body to the brain would seem to make it a potentially key factor in multisymptomatic and fatiguing diseases like long COVID and ME/CFS. Another brain region that has cropped up several times in ME/CFS, both the thalamus and basal ganglia have strong connections to the brainstem.

Conclusion

This kind of study which attempts to connect multiple systems together is vitally needed in these complex illnesses. The study was small - but its findings - if validated - loom large. The large differences in neuroinflammation found (no inflammation in any the healthy controls) and the rather dramatic evidence of blood vessel dysfunction (7/9 factors elevated in long COVID) suggested that while the study was small, it was on the right track.

In other words, this was not one of those - if only we'd added another 100 people to the study, this borderline result might become 'significant' - type of study. The differences were glaring even with these few patients.

The linkage between blood vessel dysfunction (but not immune activation) and neuroinflammation suggests blood vessel problems could be playing a really major role in these diseases. That's not exactly new - Klaus Wirth and his colleagues have been postulating that's true in ME/CFS for quite a while now - but, as the authors noted, it's the first direct evidence that this is so.

While no one thinks just one treatment is going to do the trick, the study suggests that improving blood vessel functioning might have a significant impact on brain functioning (fatigue, brain fog, pain, movement) and overall health. The cause of the blood vessel problems is unclear but could result when the remaining spike proteins from the coronavirus produce clots that damage the blood vessels.

The results need to be validated in a larger study, but it's hard to imagine, given this study's findings, that we won't see those bigger studies.

Health Rising's BIG (little) Donation Drive Update

I am still behind in my tallies, but thanks to the many, many people who have supported Health Rising during our end-of-the-year drive.

This is the kind of study - one that links different systems together to provide more complete explanations of these complex illnesses - that I love to emphasize. If that floats your boat as well, please support us in a manner that works for you.

Like the blog you're reading? Don't miss another one.

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A Bad Blood Vessel - Neuroinflammation Connection Shows Up in Long COVID - Health Rising

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The brain and the blood vessels. So intimately intertwined but so rarely studied together. In retrospect, that's kind of strange as blood vessels may have more to do with brain functioning than anything else. By weight, the brain is almost a non-entity - it takes up about 2% of our [...]

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"The idea of this meeting is to try and identify pathways that will be treatable and druggable and really make an impact for patients based on the things that we've learned over the last number of years".

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"The idea of this meeting is to try and identify pathways that will be treatable and druggable and really make an impact for patients based on the things that we've learned over the last number of years".

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https://www.medscape.com/viewarticle/new-research-aims-unravel-both-me-cfs-and-long-covid-2023a1000w

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post-acute sequelae of sars-cov-2 infection; post-acute sequelae of sars-cov-2 infection (pasc); pasc - post-acute sequelae of sars-cov-2 infection; long covid

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New Research Aims to Unravel Both ME/CFS and Long COVID

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A 2-day research conference sponsored by the US National Institutes of Health highlighted research that points to mechanisms that suggest potentially "druggable" pathways.

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"I know it's hard, but if you're feeling sick, please stay home. Avoid spreading germs to others, especially your loved ones who are at higher risk of getting very sick." CDC Director 12/22/23

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"I know it's hard, but if you're feeling sick, please stay home. Avoid spreading germs to others, especially your loved ones who are at higher risk of getting very sick." CDC Director 12/22/23

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https://www.washingtonexaminer.com/policy/healthcare/cdc-director-warns-people-stay-home-christmas-covid-variant?utm_source=msn&utm_medium=referral&utm_campaign=msn_feed

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Washington Examiner - Political News and Conservative Analysis About Congress, the President, and the Federal Government

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Centers for Disease Control and Prevention Director Mandy Cohen urged people to stay home if they are feeling sick as new variants of COVID-19 and other respiratory viruses circulate.

"Right now, flu, COVID, and RSV are spreading in most of the country," Cohen said in a recorded video message posted on X, formerly Twitter, on Friday. "I know it's hard, but if you're feeling sick, please stay home. Avoid spreading germs to others, especially your loved ones who are at higher risk of getting very sick."

HERE'S WHERE YOU CAN EXPECT TO HAVE A CHANCE OF SNOW IN THE US THIS CHRISTMAS

Three respiratory viruses, which some public health officials have labeled a "tripledemic," have surged since the end of November and have continued to increase through this month.

The most recent COVID-19 variant, JN.1, is estimated to account for 44% of the infections of the disease across the United States but is accounting for a higher concentration, 57%, of cases in the Northeast, including New York and New Jersey.

The World Health Organization designated JN.1 as a "variant of interest" on Tuesday. So far, public health authorities have not determined the new strain is more severe than prior variants, but it may be more transmissible.

Data from early WHO studies on JN.1 indicate that it poses "higher immune evasion" compared to its parent strain BA 2.86, the viral strain that worried public health officials this summer. At this point, public health officials are still considering the current vaccines to be effective against JN.1.

The CDC, Food and Drug Administration, and Department of Health and Human Services have increasingly urged the public to get vaccinated against COVID-19, the flu, and RSV heading into the holiday season. Vaccination rates, however, have remained low for all three diseases.

Cohen strongly recommended that people who are feeling sick get tested early so that treatment can be administered quickly, especially for those who are at a higher risk of developing severe complications.

"Getting tested and treated early can prevent you from getting severely sick and could save your life," Cohen said.

CLICK HERE TO READ MORE FROM THE WASHINGTON EXAMINER

Cohen also stressed that government-provided at-home COVID-19 tests are available at COVIDtest.gov.

"We have treatments for flu, for COVID, for pneumonia, but you have to know what you have so you can get the right treatment," she said.

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CDC director warns people to 'stay home' if sick this Christmas with new COVID variant - Washington Examiner

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Centers for Disease Control and Prevention Director Mandy Cohen urged people to stay home if they are feeling sick as new variants of COVID-19 and other respiratory viruses circulate.

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"This is not a universal resource, and unfortunately reflects a Western, U.S.-centric bias in its current form; part of this is structural and due to the fact that the pandemic itself has largely been driven by the United States and its destructive policy choices from the start". 

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"This is not a universal resource, and unfortunately reflects a Western, U.S.-centric bias in its current form; part of this is structural and due to the fact that the pandemic itself has largely been driven by the United States and its destructive policy choices from the start". 

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https://covid.tips/#about-the-authors

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About this document

The work we are doing to stay safe matters. The work we are doing to keep ourselves alive-fully alive, not just existing-matters.

-Leah Lakshmi Piepzna-Samarasinha and Tina "constant tt" Zavitsanos

Every chain of transmission that is broken is valuable, every person that doesn't get sick, that doesn't lose that week of work, or doesn't become disabled or die, from the minorest of inconveniences, to the greatest of losses: every single one of those things is valuable.

- Becca, speaking on Death Panel

About the authors

Who are we? We are a multiracial, multiethnic and international group of queer, disabled, chronically ill, and neurodivergent writers, workers, artists, and organizers from various socioeconomic backgrounds and different sets of lived experiences. This document represents the labor of those whose resources we drew from and gathered, our own original words, and feedback from others who have already begun the hard and necessary work of talking to their loved ones about the realities of Covid. We are grateful to everyone whose work and care has made this living document possible, and we plan to continue expanding it together.

What's new in this edition? (2023.12)

In this updated version, we've added sections on talking to your children about Covid, the importance of allowing ourselves to grieve, some tips on traveling safely, and more. We've expanded the section on the mitigations being taken by the rich, updated some links throughout to include more recent studies and stats, and added information about mitigations.

This is not a universal resource, and unfortunately reflects a Western, U.S.-centric bias in its current form; part of this is structural and due to the fact that the pandemic itself has largely been driven by the United States and its destructive policy choices from the start. We are still working toward a more global and more modular version of this document and will continue to improve on this front as we grow and expand the doc. Until then, we hope that your conversations will always move toward a discussion of Covid as a global issue, not just an American or Western one. We hope that you will use this resource as a starting point in your own conversations and find local statistics for your area whenever possible, keeping in mind that this pandemic is global and affects all of us, no matter where we are.

We hope this guide will continue to serve as a useful tool for your advocacy work, and we're so grateful to each and every person who is doing the work of sharing these truths. Thank you for all the hard work you're doing.

Questions, comments, or suggestions for revision can be sent to maskupwithus at gmail dot com.

So, you love someone who has stopped taking Covid precautions (or never took them to begin with)

What are you going to do now? If you're here, you're concerned about keeping your community safe. But how? What do those conversations actually look like? This guide is a template for navigating these emotionally-charged and difficult conversations. It attempts to put you on a good path for teaching others what you know while encouraging mask wearing, doing what you can to protect your community, including yourself.

We are speaking across a huge divide.

Everyone who has stopped masking is living in a different version of reality than we are. In their minds, Covid is over. Or milder, or a problem for the sick. All around, restaurants are open. The bars are open. The mall is open. False 'normalcy' is everywhere.

The truth of the matter is unfathomable. What we know to be true defies belief. We are asking people to believe that everything they see around them right now is a lie. That every single person in charge has lied to them. That we are in freefall. It is entirely unsurprising that so many people cannot and will not believe us. Not at first.

The horror of what we are saying is nearly incomprehensible. Please try to fathom what it would be like to hear this, if you believed things were normal. Try to put yourself in this other person's shoes. Explaining transmission is not enough. Awareness is not enough. We must model and inspire action, and so we have to explain why restaurants are still open. Why the media says it's over. Why all around us, there is silence.

We are asking people, essentially, to distrust the choices and assessments of everyone around them, as well as what their eyes and ears are telling them. We are asking them to realize their old life is gone forever. This is a huge ask. It is the hugest possible ask. On top of that, people cannot fathom how it could be true.

We have to find a way to build an on-ramp, to essentially "onboard" people into this reality we've all gotten so used to. We have to remember that we are asking a lot. All of this is normal to us now, and we've gotten acclimated (somehow). Our mitigations reflect the truth, and they are the right things to do. But we are asking people to change their entire lives in a very serious way. It's not just masks, at this point. It's everything.

But ALL IS NOT LOST. We have been deeply lied to and actively betrayed-by our governments, media outlets, and even medical professionals-for years. But there is hope and there is a way out. We can make a future without Covid.

To quote perhaps the most comprehensive analysis of the pandemic so far, " Let Them Eat Plague":

You could be forgiven for not realizing we're still in the middle of a pandemic, considering the total absence of media coverage. If it was important, you'd surely be hearing about it, right? The last variant you heard about was likely omicron. The last you heard about vaccines was likely "we strongly encourage everyone to get boosted." The last you heard about masks was that they work, but they're not required. And why would you bother wearing masks anyway if, as the United States president himself proclaimed, "The pandemic is over"?

Here's the truth: the pandemic is not over. It's much worse than you have been led to believe. And unless you've spent the past several years reading scientific studies on the subject, it can be hard to convey just how wrong the public perception of Covid really is. Everything from how it's spread, to how it's prevented, to what it does once it's in your body, is being tragically misunderstood.

None of this is an accident. It's not your "fault" if you aren't a virologist, immunologist, epidemiologist, or evolutionary biologist. It's the job of experts and trusted voices to convey the truth and give you guidance. Not only have they failed at this, they have engaged in an active disinformation campaign dedicated to making the pandemic "disappear". This has not been the result of a classic caricature of conspiracy - some tiny council of elites, gathered in the shadows to craft policy out of whole cloth. What we're actually witnessing is the quiet collusion of class interest. This form of conspiracy is a feature of cultural hegemony, and it has aligned itself in direct opposition to public health and scientific reality. A "conspiracy" of this sort takes place in full view of the public. Every actor within it has openly telegraphed motivations that we are all taught to see as acceptable: keeping the current economic system intact at all costs.

-" Let Them Eat Plague"

The end of the emergency, the continuation of our struggle

On May 5, 2023 the World Health Organization officially ended the public global health emergency, signaling (wrongly) to the public that the threat of Covid-19 is behind us. Never mind that this very same day, they put out another official statement that conveyed the opposite message:

"The worst thing any country could do now is to use this news as a reason to let down its guard, to dismantle the systems it has built, or to send the message to its people that #COVID19 is nothing to worry about."

Never mind that millions are dead, long term outcomes for repeated infections are unknown (though the statistics aren't looking good), and millions more are suffering from Long Covid.

This WHO announcement was a devastating blow, utterly unsurprising, and paradoxically, a moment filled with potential.

It was devastating, because it made it even easier for workplaces and healthcare providers to justify their lack of mitigations, and because this announcement misled many ordinary people into thinking the threat has passed. It will likely lead to an increase in the harassment that disabled people face in medical settings, or while wearing a mask in public spaces. It is unsurprising, because the capitalist strategy for handling the pandemic has been a strategy of minimization and erasure from the start (as we will discuss at length in this resource). And yet, this is also a moment filled with potential.

Why potential? The truth is that many, many people are waking up to the non-normalcy of this forced "back to normal" approach. People are expressing their disbelief and frustration over being sick all year long. People are running out of sick days. Friends and relatives are getting Long Covid. Basically, the so-called normal world is showing cracks in the façade-and people are asking: "Why is this happening?" Trust in governments and politicians is at an all-time low. People are fed up. And the official narrative (with all of its confusion and contradictions) makes no sense.

Meanwhile, the things that we are saying make a lot of sense. We have the truth on our side. The government's strategy is one of denial, negation, and lies. But presence, truth, and a vision for a better future will always be more compelling than a lie. Unlike what WHO is saying, our narrative is honest, consistent, and backed by science. Unlike the WHO, we value human life and are offering actual care. Denial as a strategy cannot work for long. People are seeking answers; we have to educate one another and offer a path forward. We have to keep one another safe.

Our mission and the challenge ahead

Most people trust that it is the government's job to protect them. And most people don't have the time, resources, scientific literacy, or energy to keep up with the latest research, conflicting guidance, and up-to-date information about the pandemic.

Reducing the number of Covid infections happening in our communities is essential. Giving people the knowledge and tools to protect themselves in the face of government neglect and violence is essential. Trying to reduce harm in our communities is essential. And a livable future depends on us addressing Covid.

As we prepare for what's to come, we cannot abandon one another or decide that these conversations are pointless. In other words: we can't leave our neighbors behind. We have to try to share the knowledge that we have learned. So let's get to work.

Political frameworks

We believe in abolition, mutuality, bodily autonomy, self-determination, equality, and interdependence. We believe in centering the most vulnerable and approaching others with curiosity. We value intentionality, humility, compassion, directness, honesty, trust, accountability, and consent.

Our political frameworks include: the abolitionist movement, Black liberation, intersectional historical materialism, antifascism, anticapitalism, anticolonialism, anti-imperialism, disability justice, transformative justice, Indigenous sovereignty, trans rights, and liberatory harm reduction.

From the river to the sea, Palestine will be free! 🇵🇸 ( All of our struggles are linked.)

We are always willing to learn and grow, but we are not willing to compromise on any of these values.

Summary of praxis

We believe in humanity. It is not true that most people are selfish, bad, stupid, ignorant, or unwilling to learn. Most people do not know what is going on, or feel powerless to stop it, or both.

A great majority of people who have stopped taking Covid precautions have done so because they have been misled, because they are exhausted, and because we are in an information vacuum. In ways large and small, the U.S. government is downplaying Covid's continued existence and evolution. The U.S. is not alone in this, and almost no matter where you are in the world-as we write this in 2023-your government is probably using the same violent tactics to downplay and minimize the pandemic.

The abandonment by our governments under the guise of "individual responsibility" has meant that harming others as the pandemic continues has been unavoidable for many, many people. Through public policy decisions, propaganda campaigns, and economic pressures, most of us have been forced to be complicit at one point or another; for example, many of us have been forced to travel for work, or have unmasked in a social situation under pressure (to our own deep regret). But many people who are presently engaging in reckless behaviors (like not wearing masks) are not fully aware of the consequences of their actions. Or if they are aware, they don't feel empowered to act, or to face the truth.

Individual risk assessment is nonsensical in an airborne pandemic with a disease that can be transmitted asymptomatically; we share the air and we all share this earth.

So we ask that you do not tell people to assess their individual risk, because encouraging more individuality will not get us out of this mess. Instead, you can say: "Save your own life. Protect your loved ones. Protect your neighbors. Break the chain of transmission." We don't want to lose all of our friends and family (most of whom are no longer taking the same precautions we are), and we don't think you should have to, either.

When we have conversations with people in our communities, we need to remember that this is all so much bigger than us and our feelings about individuals. By doing this work, we have taken on the role of agitating for change. So we have to try to hold ourselves to a higher standard: in our personal lives, in our politics, and in our art. We should always be cultivating and nurturing our love and respect for the people (including ourselves). We must continually strive to understand the needs and ideas of the people in our communities, and avoid distancing ourselves from our neighbors by seeing ourselves as better or more enlightened. We should do our best to be patient and undertake this task with care, and not misdirect our righteous anger at these injustices towards our friends. Indulging in that type of thinking maintains the divides created to keep us from collaborating together.

We believe that the great majority of people can, and must, be reached and cared for. In our art and in our organizing, we must remember that our own communities are not our enemy.

We recognize that it is not actually possible to know who is open to change and who is not without first speaking with someone and showing genuine curiosity and compassion.

So when we say we use liberatory harm reduction approaches as a political framework re: Covid, we're not talking about personal risk assessments or justifying harm. We are taking this approach when talking with other people about mitigations.

We are seeking to transform the root causes of harmful ableist behaviors using harm reduction strategies to:

Advocate for, center, and protect the people who are most vulnerable to harm from Covid, while recognizing that everyone is at risk for severe outcomes and death

Provide accurate and non-judgemental education to people who have stopped masking

Help people obtain high-quality masks that fit them

Teach others how to wear their masks properly

Teach others how to gather more safely in person

Encourage more and better masking practices, recognizing that imperfect mask wearing is better than none at all

Push for better air filtration, air cleaning, and better ventilation in indoor spaces

Create community with others who are shielding themselves from Covid

Protect the right to wear masks in public spaces (which is already under threat)

Protect ourselves and others from forced infection with Covid

For us, this looks like educating people, encouraging mask wearing as much as possible, and recognizing that most people are not going to stay home indefinitely.

We are not telling people to stay home altogether. We are asking them to wear the highest-quality masks they can obtain while sharing indoor air with others. We understand the anger at others who are engaging in unnecessary travel, etc., and we often feel it. But more people masking imperfectly and more often is what needs to happen.

We cannot control how others behave or act on the information we give them. We won't tell them it's OK to go to stadium shows, and we can share with them how those choices impact others. We can speak honestly with loved ones about our feelings and share our knowledge. What they do with that knowledge is up to them.

We fully understand why some people might disagree with these choices and we do not want to speak over or minimize those people's perspectives. Our choices and our experiences with disabilities do not negate the different perspectives of other disabled people.

Guidelines and our boundaries

If you are planning to use this guide as a resource for your conversations, we ask that you respect the following boundaries (and agree to all of the following guidelines) before reading further:

1. We do not believe in dehumanizing other people OR any kind of abuse. Spreading a virus that can disable and kill people is unacceptable behavior, but it is mainly happening because of failures of government, not individual choice. It is in that context that we are trying to end this behavior by sharing the realities of Covid transmission and the harms this virus can cause. We fundamentally believe that this is not inevitable, and that there is always hope for a future without Covid. DO NOT use this guide to rationalize harming others or to spread despair and hopelessness.

2. We do not believe in excusing the behavior of those who have the ability, knowledge, and resources to wear high-quality masks when sharing air with others. Encouraging masking more often does not imply that we are giving people a pass to unmask sometimes. DO NOT use this guide to tell others that it's OK for them to unmask sometimes in public spaces. Our entire society has already given us permission to unmask and think only of ourselves. We don't need to add to this chorus.

3. You do not have the ability to absolve other people for their harmful behavior. It is possible to invite other people to reflect honestly on their behavior and make better choices without shaming them AND also without making excuses for their harm. DO NOT use this guide to berate other people OR to absolve them.

4. DO NOT use this guide to minimize the harms of spreading Covid.

5. We believe in bodily autonomy, in mutuality, and in consent. DO NOT use this guide to coerce or manipulate others into changing their behavior.

"Harm reduction happens in the pockets of exquisite care we show our loved ones, without questioning or judging their life choices, or imagining that we know better than they do. It's extending a belief system of true autonomy and self-determination: I trust you, I'm not afraid of you, here are tools that might be useful to you, do with them what you will."
-Tourmaline, fromSaving Our Own Lives: A Liberatory Practice of Harm Reduction

Who this guide is for

This guide is meant to help those who are still taking strict Covid precautions and who believe in the principles of disability justice, abolition, anticapitalism, and harm reduction to talk with people who:

Are engaging in good faith

Are basing their decisions and behavior on misconceptions about Covid

Are willing to grow and change
Only you can say if someone meets those criteria. This guide won't help you argue with abusive people or people arguing in bad faith. Sometimes it's worth using these arguments with bad faith actors if your responses are posted publicly (because people watching the interaction may recognize the truth of your statements even though the bad faith actors won't), but generally, it's better to save your energy to speak with the people who are willing to change.

Core resources

Harm reduction

What is harm reduction and how can it apply to Covid advocacy work?
To quote Dominique Morgan: " Liberatory Harm Reduction is grace in practice", and to quote Shira Hassan:

Harm reduction was started by BIPOC organizers, by people in the sex trade, by sex workers, by trans people, by drug users, by young people, by people who were street based, by disabled and chronically ill people, by anti-racist activists.

If you are using the term harm reduction, we highly recommend listening to (or reading) this episode of Movement Memos where Hassan explains Liberatory Harm Reduction and the history of this movement. We cannot separate this term from its history and its radical roots.

Because harm reduction demands that interventions designed to protect people reflect specific individual / community needs, there is no universal definition of or formula for implementing harm reduction. We are working from Hassan's definition of harm reduction:

Liberatory Harm Reduction is a philosophy and set of empowerment-based practices that teaches us how to accompany each other as we transform the root causes of harm in our lives. We put our values into action using real life strategies to reduce the negative health, legal, and social consequences that result from criminalized and stigmatized life experiences such as drug use, sex, the sex trade, sex work, surviving intimate partner violence, self injury, eating disorders, and any other survival strategies deemed morally or socially unacceptable. Liberatory harm reductionists support each other and our communities without judgment, stigma, or coercion.
And we do not force others to change. We envision a world without racism, capitalism, patriarchy, misogyny, ableism, transphobia, policing, surveillance, and other systems of violence. Liberatory harm reduction is true self determination and total body autonomy.

-Shira Hassan

Making sure you have the facts and necessary context

Before you can teach somebody else what's going on, it's important to make sure you understand the thing you're trying to explain. There's so much misinformation and propaganda about Covid, our understanding of the virus keeps evolving (and is still very incomplete). This is a very, very complicated situation for so many reasons.

If your understanding of the current moment is that 'people are just behaving really selfishly / irrationally, and that's why we're in this situation!' then you're framing a systemic problem in terms of individual bad behavior, and this is inaccurate too. We really, really recommend reading or watching some of the following resources before trying to tackle misinformation around Covid or unpack propaganda with someone else:

1. "Let Them Eat Plague" There is a reason we link this document dozens of times throughout this guide. It's an extremely comprehensive analysis of the pandemic and how we got here. It's a bit academic, but it is very thorough and worth reading.

2. This (Alberta) website is a great resource. It has videos, toolkits, mask resources, air quality resources, opinion pieces from medical experts, and other educational materials.

3. Covid Isn't Over Pt. I and Covid Isn't Over Pt. II by Central Jersey DSA (Slides available here)

4. Safer In-Person Gatherings by The People's CDC

Health and safety

Taking care of you

( Borrowed heavily from this document.)

This is going to be hard. You are doing this work in the middle of a raging pandemic, so you absolutely need to take care of yourself and honor your limits.

Are you ready? You might be too mad or too sad to have this conversation right now. That's OK. Don't try to have an open and vulnerable conversation at a time when you aren't emotionally OK enough to handle it. You risk creating deeper division instead of moving towards your goals. Connect with your loved one over other topics and mutual values until you're ready to talk about Covid.

Find a buddy. Is there someone in your life who can be ready to receive a rage-text-storm from you after? Someone who can talk on the phone afterward? Get that person in place before you go into this hard conversation.

Eat first. Don't go in hangry (or cold, or overheating)! Take care of your basic needs first.

Remember yourself. If you have any marginalized identity at all (especially true for disabled people), this conversation will hurt personally. You're allowed to take care of you. You're allowed to tap out of the conversation, take breaks, or set boundaries.

Here are some general principles for having these conversations with your loved ones. Remember to start by acknowledging the things they are doing right (no matter how small), reminding them that you care about them and love them, and establishing trust and safety however you can. This really, really helps.

The spectrum of allies

This will not be a one-off conversation.

People are not going to change overnight. Be ready for a series of hard conversations. Make space for people to move into. Remember the spectrum of allies:

You need to move people along from where they are now, not where you think they should be. Can you get someone who would glare at a mask-wearing person in the store to consider why they should stop doing that? Can you get someone who swears they aren't sick with Covid, just a bad cold, to take a rapid test and wear a mask or stay home entirely? Can you get someone who won't stop going to nightclubs to at least wear a mask when they're at the pharmacy, where sick people have to go? Remember: you climb a staircase one step at a time, not by jumping all the way to the top.

If possible, talk one-on-one.

Face-to-face is hard right now. But seeing one another helps. Can you find a way to safely see them in-person outdoors? Can you video chat on a service you know works for both of you?

Try to avoid jargon / speak the same language

Ask yourself: who am I talking to? Consider your language, and consider how it might come across to someone else. Don't talk down to them but try your best to use terms and ideas this person will be likely to understand. Try to approach them as you would approach a friend. Generosity goes a long way. It's really, really important to avoid giving speeches or talking at them-remember, this person also has knowledge to offer you, too! It's so important to take pauses and check in with them; questions go a long way in helping. A general rule of thumb is that it doesn't hurt to avoid jargon, and try to explain things in your own words. Political and scientific terminology (especially complex terms that have multiple concepts baked into them) can be alienating or confusing.

For example, in order for someone to understand what "post-acute sequelae of Long Covid" means they have to first know 1) what sequelae are, 2) what "post-acute" / "acute" means, 3) what Long Covid is. It's better to try to explain concepts in straightforward terms; you're making the same argument, either way-but you're less likely to alienate your friend if you sound like a friend and not a scientist teaching a class.

Try to avoid lecturing and try your best not to get heated

People don't want to be yelled at. Your anger is valid, and worth expressing, and absolutely justified. All of us writing this are frequently very angry about all of this and having to advocate nonstop for our right to exist! But yelling will most often cause someone else to shut down, and can even be verbally abusive. If you are serious about using conversations for good, it is best to avoid yelling, name calling, generalizations, etc.. Though it is always OK to express your hurt, anger, and frustration in other ways.

📝: We are all about righteous anger, and please do not think we are trying to police your tone. You are a human being and you are allowed to show up as your messy, angry self. But people are more receptive to gentleness, and it is often possible to be very angry while staying gentle.

Be ruthless with systems, be kind to people.

-Michael Brooks

Each of us is precious. We, together, must break every cycle that makes us forget this.

-adrienne maree brown

General tips

Start from inquiry. Ask questions. Find out why (and when) they stopped taking precautions or why they are skeptical about vaccines / masks. Don't assume you know! Try to understand what exactly they believe and why. Remember: there has been SO MUCH propaganda and outright lying.

Let them know where you agree. Find the most basic thing that you agree on, let them know you agree, and add a caveat. If they say, "I wore a mask and stayed home for a full year! Why should I keep having to do it now?" You can say, "It's really good you did that. I agree that you sacrificed a lot and that wearing a mask is getting harder due to social pressure. What were the reasons you wore a mask when you did?"

Find common points of shared experience. Scaffolding to support the conversation's more sensitive ground is really important. Going right for the hardest part is risky. So try to build up to it by establishing common ground. The truth is, there are many common areas of frustration, between misleading and confusing guidance from our leaders, being forced back into unsafe working conditions, and the pain and grief of everything we're living through together. We can find these common points and use them to build bridges. Some other examples are: the lack of access to paid sick days, travel delays due to constantly sick staff, the ridiculous cost of living, the impossibility of finding up-to-date / accurate Covid information, etc. Find your own and find a way to convey that you share some concerns.

Engage their values, not their positions. Values are things like: "Caring for the elderly and sick is important." Positions are things like: "Biden's Covid response is good / bad." If you can engage on the level of values, you can build a frame to talk about positions in the future.

Start with feelings and stories, not facts. You're probably operating from a very different set of facts than your loved one. Fighting them about the details of what they're wrong about is unlikely to actually change their minds (at least not until they've had time to consider these things on their own). Talk about how you feel ("I'm scared of losing my ability to work if I get Long Covid because I already have a chronic condition") and stories from your friends ("My friends keep their playdates safer by testing beforehand and meeting up outdoors").

This means affirming their feelings, too. Let them know you hear their fears and take them seriously. They're scared of being the only person in a mask at their school? Talk to them about why. Maybe they're afraid of losing their job if they are the only person masking; that's a valid fear.

Share your own stories of changing your mind about mitigations. Be ready with some stories of times you changed your mind. Example: "I stopped masking after my booster shot because I thought it protected me from getting Covid or transmitting the virus. But then I talked to some people who got Long Covid even after getting vaccinated, and I realized now isn't the time to let my guard down."

Use humor if you can and acknowledge the absurdities. This is a tricky one, because humor can go horribly wrong too. But humor over common experiences of unfairness, absurdity, and sheer ridiculous situations can help break up the tension if it is reaching too much of a tipping point. NOTE: please don't punch down! Sarcasm can be really corrosive, also.

Notice where they identify confusion. This is NOT about finding where you think their position is ideologically inconsistent. This is about noticing where they sound unsure or conflicted. For example, they might say something like: "I really think we need to go back to normal, but my son says half of his classmates are out sick every week and I can't miss more workdays." Encourage them to consider that contradiction that already exists within them.

Take breaks. Run to the bathroom and text a friend, if you find yourself getting upset. Get a glass of water. Make space if they're getting emotional, too. Try to show them that you are willing to care for them, even if you disagree with the choices they are making.

Invite them to try something new. Be ready with a few actions they can take that you think might be just on the edge of their comfort zones. Can you get them to commit to masking when they're in the grocery store or on public transit? Can you get them to sit on the restaurant patio when they go out to eat? Can you get them to commit to reading an article? Even if the conversation doesn't go well, you can try saying things like "Well, dad, just for me, can you just wear a mask when you're in places where sick people have to go?" or "Can you at least read this article and tell me what you think?"

Be there with them. Make sure you let them know that the conversation isn't over and they can reach out to you if they want to talk more about what you've said.

Give them space. Let them marinate on what you're telling them. This isn't going to happen overnight.

Affinity groups

If there are vulnerable and oppressed groups that the person you're talking with has an affinity with, invite them to see how wearing a mask is a crucial step toward supporting that community, and share how Covid is affecting that group in particular (see our Affinity group resources section). If the people you're talking to are part of an oppressed group themselves, it's likely that they already understand many of the ways in which the government has let their communities down before. Remember: our struggles are all linked, and the point of considering affinity groups is not for sympathy or charity but for solidarity and connectedness.

If you have come here to help me, you are wasting your time. But if you have come because your liberation is bound up with mine, then let us work together.

-Aboriginal activist group, QLD Australia (1970s)

There is no such thing as a single-issue struggle because we do not live single-issue lives.

-Audre Lorde

We need to move away from framing our decision to mask as doing so mainly out of charity for "the most vulnerable." Framing Covid as something that only affects the sick has led to where we are right now. The policy decisions that work to normalize Covid and downplay its risk to the working class benefit from the pre-existing political and economic conditions that have long been used to control working people. These are intentionally designed policies that serve to utilize the disabled population as a threat to control and disempower the working class.

"Public policy that equates disablement with poverty means that becoming disabled (a nonworker) translates into a life of financial hardship, whether one has public assistance or not, and generates a very realistic fear in workers for becoming disabled"

"If workers were provided with a federal social safety net that adequately protected them through unemployment, sickness, disability, and old age, then business would have less control over the workforce because labor would gain a stronger position...Business retains its power over the working class through a fear of destitution that would be weakened if the safety net were to actually become safe."

-Marta Russell, "Marxism and Disability," as referenced in this article

So of course, in a society that equates medical aids with disability and illness, it is easy to consider mask wearing and other Covid precautions as something that is only for the "vulnerable" or disabled, a category that is understandably feared by the working class due to the political and economic realities of being disabled under a system that uses your suffering for leverage and profit.
We are all at risk from Covid. And we all deserve freedom from that risk.
The framing of risk as exclusive to vulnerable people leverages pre-existing political and economic pressures around disability to allow people to continue to see themselves as separate from those considered "at-risk", "vulnerable" or disabled and gain a false feeling of safety. It has never been true that only the "sick and elderly" are at risk-and it wouldn't be okay to abandon them if they were-but many people still believe this lie in order to feel safe.
Feeling safe and being safe are not the same thing.
Safety comes from taking actions that protect the whole community. Covid continues to wreak havoc on the global population-and the death toll is much higher than original estimates suggested. According to The Economist in November of 2022:

Although the official number of deaths caused by covid-19 is now 7m, our single best estimate is that the actual toll is 27.4m people. We find that there is a 95% chance that the true value lies between 18.2m and 33.5m additional deaths.

The death toll continues to climb. Many millions more have Long Covid as a result of these governmental failures. The policy choices that have been put in place have never been about protecting our safety, and they have never been about protecting our collective interests. Once again, it has been about profit over people.

Transmission data

If you can, familiarize yourself with your local transmission data, how that data is currently being recorded, and the pattern over time. Governments have been cutting back on Covid reporting and research for a long time now. This means that we have less and less comprehensive data sources, especially real-time sources. But that doesn't mean we're completely in the dark; there's still many people analyzing the clues and information we do have available. Where there is poor transmission data collection, you can look for analysis from actuaries, wastewater testing, death certificate info, and excess death data for information on how Covid has affected where you live.

Data is even more sparse now than it was when we wrote the first version of this document, but there may still be updated resources for your area. Look to local advocacy groups as a starting point. For example, in Canada there is the COVID-19 Resources Canada, which provides bi-weekly hazard indexes for each province and territory. Many Canadian Covid advocacy groups share and use this data to help better understand what is happening in their area.

Other resources to find available data for various countries and regions:

Affinity group resources

What kind of things does the person you're talking to care about? What communities do they have connections to? Find out, research the impact that Covid has, and talk to them about it.
Here's some examples:

BIPOC are disproportionately affected by Covid.

So are members of the 2SLGBTQIA+ community.

If they're a feminist (or a woman, or someone who knows and loves women), they should know that women are at a greater risk for developing Long Covid.

Disabled and chronically ill people are being confined to their homes indefinitely and left to die.

Poor people and homeless people are extremely vulnerable to dying from Covid.

People in prisons are extremely vulnerable to dying from Covid.

People in nursing homes or institutional facilities are extremely vulnerable to dying from Covid.

Infants and pregnant people are very at-risk (worth reminding people that babies can't wear masks and are greatly at risk from Covid and other respiratory diseases).

People trying to get pregnant should know that Covid has been linked to infertility.

Working class people are getting sick repeatedly and missing work (without access to healthcare or paid sick leave) and are forcibly exposed to Covid if they have to work in-person. Many workplaces have had outbreaks of Covid.

Musicians are getting Long Covid because of having to perform in front of so many unmasked crowds. Here's a massive Twitter thread showing all of the tours that have been canceled or postponed due to artists being sick.

Pet owners should know that their pets can get sick with Covid.

Animals and wildlife can get Covid (and Long Covid). Covid is very much an environmental issue.

Side note from a former waitress:

I've heard a lot of people justify not masking around waitstaff because the workers themselves are unmasked. What they don't realize sometimes is that these workers may be penalized at work for wearing a mask or outright forbidden from doing so. It's worth pointing this out to people. When I worked in restaurants, I was told I'd be fired if I didn't wear makeup every shift, and restaurant owners know that many of their customers hate seeing masks.

Mask up

Wearing a mask is simple, but the topic is complicated. Masks have been politicized. Hospital shortages in the past once meant that people were directly discouraged from buying and wearing them. Misinformation about masks is everywhere. And on top of all of that, there are so many different types of masks with varying degrees of effectiveness (which is also determined by whether or not they fit). But masks remain one of the most effective and accessible tools we have to reduce the transmission of Covid. And they might work even better than you think!

Masking, like much of public health, is a collective action and a shared responsibility. In societies where collective masking isn't established, people often don't want to stand out and wear a mask. But many, many people would wear masks if they knew most people would also be wearing them; in this case, people can get superior protection and they don't risk standing out.

Our governments have given confusing messaging around masking, even outright discouraging it. We believe there should be widespread endorsement by our governments, pro-masking campaigns and education, and free and accessible availability of quality masks. We still hope these are actions taken in the future, but the failure of governments have left it up to us. The good news is that every person that masks has an impact on reducing transmission that is larger than themselves. The more interactions that contain masks, the better! So let's do what we can to encourage masking and make it accessible. Every mask worn makes an impact! Masks work!

Responding to common objections without (outward) judgement

But what about specific arguments? How can you respond to the specific things that people say to you without losing your temper? Here are some ideas and sample scripts, along with suggestions for following up in further conversations (plus additional resources where you can learn more).

📝 A note on conversational approach:
In this document (and when we're talking to others), we are often starting from a point of taking people at their word. Of course, many people are making flimsy excuses. But there are many reasons we take this conversational approach, and none of them are intended to accept what others are saying uncritically.

Why go this route? Well, if someone says they aren't masking because masks give them acne, and you respond by offering to troubleshoot their acne problem or find them a better mask, they will then have to come up with another (likely truer) reason for why they stopped wearing a mask. Or, they might feel uncomfortable in the face of their own lie, which is a productive sort of discomfort that can sometimes lead to positive change.

You also might find that some people haven't been given a chance to really think about and discuss these topics, and by talking about it openly, hearing them out and finding shared values, they may come to their own conclusions and end up asking you what they should do.

Asking genuine questions and offering pragmatic solutions is one way we have actually gotten people in our lives to start wearing masks again. And angry accusations-while often completely deserved and sometimes unavoidable-frequently lead others to shut down.

Remember: We need more people to wear masks.

In our view, taking others at their word in the beginning is an effective way of disarming defensiveness and getting to the real root of why someone stopped wearing masks, but we are not suggesting that this is the only way to approach these conversations. As with all things, your mileage may vary. No, facial acne is not a good reason to stop wearing masks, and we want to make it abundantly clear that's not what we're saying or arguing! We are being strategic and empathetic as much as possible, because telling someone "Hey, you're full of shit" might sometimes be the move, but it can also lead someone to exit the conversation or the relationship altogether, or just emotionally tune out (while the harm continues). And again: most people do not know what we know about Covid.

It's extremely understandable to feel betrayed and upset at individuals, but the primary focus and blame should always be on the systems and people in power, who bear the brunt of the responsibility for this disaster.

Masks

📝: this document uses N95 as a stand-in for a respirator that has minimal inward leakage. (More on this shortly.) Substitute your own local variant (where applicable) as needed.

"Masks don't work" / "masks aren't safe" / "masks are dangerous."

There has been a lot of confusing and bad guidance going around about masks, and I don't blame you for thinking that. A lot of people have been claiming masks don't work. But those people either A. don't know what they're talking about, or B. they're just trying to minimize the risk to make people return to business as usual, most likely so we'll all go back to work and not disrupt the economy too much. If someone is telling you this, it's because they're selling something (and selling the illusion of normal counts as selling something!) Why do you think masks don't work?

Listen to what they say. They will probably reference some article they read or point to a high-profile 'expert'.

It's scary that even some trusted experts have been loud and wrong about this! The truth is, the op-ed that went viral about masks not working was based on flawed research, according to the vast majority of scientists who have responded to it. Here's an article that explains why (in a really straightforward way). Can I share it with you?

The truth is, N95 and similar masks are really, really good at protecting you from Covid, especially if they're fitted. Surgical masks are better than nothing but way, way less effective. And masks only work as well as you wear them-if there's big gaps in your mask, they can't work the way they were designed to. If you want, I can help you find a good mask that fits you!

Next steps

Plus, lots of businesses rely on people doing things in person. That means that people choosing to limit their in-person activities would impact the economy, and that's the one thing all of our political leaders and our bosses are always going to do everything in their power to avoid. Masks remind people that the pandemic is not over, and that's why a lot of companies and leaders are urging people to throw caution to the wind and stop wearing masks; they want us to live like it's 2019, because they need to keep making money.

Also, we know masks work, because people used them all the time even before the pandemic! Firefighters wear masks to protect themselves from smoke inhalation. Painters wear masks to avoid inhaling dangerous particles and chemicals. People in Japan have been wearing masks during flu season for years to prevent people from getting sick. And they are a key piece of PPE (personal protective equipment) for many industries. We wouldn't need masks in all those scenarios if masks didn't work to filter the air. Would you be interested in me sharing some articles that helped me trust that wearing a mask was safe?

Further reading

"Masks do work, but cloth masks are fine." / "I wear a cloth mask!"

It's great that you're trying to protect yourself and the people around you! But because we now know that Covid travels like smoke through the air, because there's been more research since the pandemic started, and because Covid is way more contagious than it used to be, we now know that sadly, cloth masks don't offer very much protection at all.

N95s provide the best protection against Covid, and they work against all variants.

There's vast differences in inward mask leakage between N95s and other masks (and remember: leakage is what we're trying to avoid):

Fabric 70%

Surgical 44.2%

KN95 16.1%

N95: only 0.6% (this is why they're the safest!)

It takes only a very tiny amount of viral aerosol to cause a Covid infection, so N95s are the best masks for preventing infections, because they filter air the best and offer the best seal.

However, there are a lot of other considerations. If someone is opposed to wearing a head strap N95 but is willing to wear a bifold KN95 mask, they are far safer (and the people around them are safer) with this person wearing an imperfect mask than this person not wearing a mask at all. Remember: the goal is harm reduction.

Adding a head strap (like this one) to KN95 earloop masks can make them fit more like an N95. It helps create a tighter seal, and also takes pressure off the ears.

If they're still wearing cloth masks:

"Masks are uncomfortable" / "I can't breathe in a mask" / "Masks make my skin break out" / "Masks fog up my glasses so I can't see" / etc
Start by asking questions about which masks they've tried! A lot of people have only ever worn blue surgical masks, or the kind of cloth mask that sits directly across your lips (AWFUL). Try to figure out which masks they've tried and what the issue is. Approach their concern as genuine and offer them actual solutions to see if this is just a deflection from their real reason. Some people really might not realize that there are ways to stop their skin from breaking out/glasses from fogging up/masks from suffocating them!
If they don't wear masks because masks aren't comfortable:

Some masks are really uncomfortable! I can't stand wearing cloth masks against my mouth. But I've found masks that I can wear for hours, and I'd rather be slightly uncomfortable than risk my long-term health or get someone sick. Living with chronic illness means having to deal with pain every single day, and that's why I'm wearing a mask right now. What if I found you a more comfortable mask so you can stay safe? Are you willing to at least try one of mine?

Troubleshooting:

If they don't wear masks because their glasses are always fogging up:

Here's a guide that troubleshoots foggy glasses from masks

Help them make sure their mask fits and has a nosewire

Offer to give them some anti-fog lens wipes (or lens cleaner)

If they don't wear masks because their skin is breaking out:

If they don't wear masks because they don't want to shave their beard:

"I can't find a mask that fits my face!"

N95 sizing tips

3M Auras are a comfortable, widely-available respirator option, and they fit most people's faces well. Start by trying these. If the 3M Aura is too big, try the CAN99, then the VFlex small. If the 3M Aura is too small, we recommend the VFlex regular.

"I don't want to wear a mask because I'm wearing a formal outfit / I don't want to mask because it's not stylish."

Fashionable mask options exist! If you're looking for a fancier mask option, check these out:

masklab makes gorgeous masks (in adult and children's sizes)

Private Stock Labs sells fancy KN95s in a wide range of colors (and in multiple sizes)

wellbefore sells KN95s (with nose foam!) in a wide range of colors

Benehal and BNX both sell black head strap N95s

Canada Strong Masks sells a wide variety of masks in different colors
Masks are an extra accessory, and you can absolutely find one that works with your outfit!

"I can't afford high-quality masks."

First of all, I'm really, really sorry that you are financially struggling. It should not be our responsibility to pay for this PPE. The government can and should be providing us with masks. Fortunately, there are groups providing free masks, and I can try to help you find some. If you want, I can try to help you locate masks in your city.

Try calling your local free / low-cost health clinic (if that's an option); some of these places offer masks

Mask blocs are activist groups popping up across the country, offering free masks.

Check harm reduction orgs in your city as well

Many retail stores (including grocery stores and hardware stores) stock respirators

Donate a Mask is a good place to find masks in Canada

Most N95s can be reworn a few times, and a lot of people don't realize this! We don't throw out our masks after a single wear. We use the paper bag method:

Additional mask considerations

Reality clashes / Not seeing eye to eye

"All you talk about is Covid." or: anger/hostility toward you, for bringing up the subject

The following reflection comes from Dr. Lisa Iannattone (@lisa_iannattone) and was originally posted as a series of Tweets (16 Jul 23):

I have experienced the same thing from a few people. Have to gently remind them that if they would call me once in a while instead of only following me on Twitter, they would know that I'm still a full person. A toddler mom. Working full time. New university position. I garden. I cook. I go out and enjoy the world safely every day.

'Covid has taken over your life.' LOL no. My life is full actually. I don't need to live in covid denial to experience joy. I actually feel more peace and joy when I allow myself to care about things that matter to me. Some people don't seem to intuitively understand that part.

There's also a phenomenon of displaced anger from some people that haven't worked through the trauma of the last 3 years. They weirdly direct their anger about the pandemic at me, as if I'm covid, instead of working through their feelings about the pandemic in a healthy way. I've literally had to stop people to say 'Hey, it sounds like you're upset about how covid changed a lot of things, but you seem to be directing your anger at me? I'm not the virus. None of this is even remotely my fault and I can't fix it for you.

-Dr. Lisa Iannattone, MD

"I couldn't live the way you do and take all those precautions! It's too hard" / "It's not fair that I should have to change my lifestyle. Other people are still eating indoors, so why shouldn't I?"

The following comes from Misha (@MishaCopyninja), who first shared these reflections on Twitter on July 19, 2023:

I've used HIV as an analogy, not to instill fear in people, but within queer circles it tends to be very effective because most of us know about condoms and PrEP, and PEP, and retrovirals, and viral load etc. etc. And many of us didn't know what it was like before.

So, from that point of view saying 'I think COVID changed forever the risks of sharing air, similar to how HIV changed forever the risks of sex.' It's still brutal but our minds can go to: OK how do we mitigate, prevent, do harm reduction and what tools do we have, etc.

And I'm my first case study because honestly I was freaking out 24/7 until my mind landed on that idea. That I don't know how having a sex life was like before, but I managed to have a reasonably safe one, thanks to groups like ACT UP, and it's just a matter of trying and caring.

-Misha (MishaCopyninja)

Individual vs government responsibility

"Nobody's masking anymore"

Lots of people (including me) are still wearing masks! Just because you don't see them doesn't mean they don't exist. One 2023 poll showed that nearly a quarter (21%) of Americans still mask most or all of the time, and about half of Americans (48%) are continuing to mask up in public on at least some occasions. Half of Americans polled said they are taking Covid precautions this winter.

People in large cities, people in other countries, people who shop at the grocery store right when it opens to avoid peak hours, people undergoing cancer treatments: all of these people are wearing masks, but you're not seeing them because you're not going to the same places at the same times. I still wear a mask! Also, the rich and powerful are absolutely still wearing masks and requiring the people around them to mask and test frequently.

Look at how the billionaires at Davos protected themselves from Covid just earlier this year. They had tests, masks, high-end air filters, UV filtration, upgraded ventilation, and more, because they know the pandemic isn't over and that Covid is extremely dangerous. They're telling us it's over, because they don't want to pay to make their buildings safer, because they don't want us to stop spending money, and because they don't care about whether we live or die.

"I shouldn't have to wear a mask. It's the government's responsibility to enforce masking / improve ventilation. / This is a systemic problem and the burden shouldn't be put on individuals to do the right thing."

You're right that the government should be doing something! It should not be on each of us as individuals to do the right thing, and we've been left to fend for ourselves as things get worse. But our individual actions do matter, and we can't use the government's lack of a response to justify harming one another. Prioritizing our short-term comfort over our futures is a recipe for disaster. Besides, every chain of transmission that we break is valuable. Preventing another person from getting sick and having to miss work means that the other person won't lose a week of income. That matters. Not everyone has paid sick leave. Not everyone has health insurance. Small actions can make a huge impact on someone else.

As we continue to pretend everything is normal, the virus continues to evolve. The longer we allow ourselves to be led by individualism or to only think of our own needs, the sicker we will all become.

"Just because the state is not doing its part, doesn't mean we as community members and individuals are absolved of our responsibilities for cultivating collective safety in our everyday interactions."

Case studies in mitigations for the rich and powerful

The richest and most powerful people in the world are taking zero chances with Covid, and they know the pandemic is not over and that Covid is airborne. Their precautions are extensive and hidden from view. From politicians to the military to musicians, here's some examples of ongoing protections for the rich and powerful:

Billionaires are staying safe! We should too! (#DavosSafe)

" World Economic Forum: Here Are All The Covid-19 Precautions At Davos 2023" by Bruce Y. Lee ( Forbes):

...so why is the WEF [World Economic Forum] going through all of these efforts when many stores, restaurants, airplanes, trains, Ubers, workplaces, or even health clinics around you don't seem to be doing the same? Is it more about them than you? Or, more specifically, is it about who is attending the WEF than you? Let's see, how might the types of people attending the WEF at Davos be different from you?

...It's by invitation only. Attendees include several thousand investors, business leaders, political leaders, economists, celebrities, and the like. Founded on January 24, 1971, by German engineer and economist Klaus Schwab, the WEF is a not-for-profit foundation that "engages the foremost political, business, cultural and other leaders of society to shape global, regional and industry agendas," as described by the WEF website...

So the WEF Davos 2023 is clearly a collection of people who have access to resources, connections, and influence that most people don't have.

Therefore, it is interesting to see the contrast between what's being implemented at the WEF versus what you see in places around you and hear from the political and business leaders.

While elites take every COVID precaution possible when they meet with each other at the World Economic Forum, they go home and tell us that COVID is no longer a threat, and the pandemic is over. Actions speak louder than words.

So if you are wondering what to do about Covid-19, maybe you should take a closer look at what political and business leaders are actually doing rather than saying. For example, are those political leaders who are pushing against Covid-19 precautions on public transit actually taking public transit themselves? Are they actually putting themselves at the same risk for getting Covid-19 as every day people? Or are they really doing more to protect themselves? If you don't do what leaders actually do for themselves, you could find yourself in some deep doo-doo.

-" World Economic Forum: Here Are All The Covid-19 Precautions At Davos 2023" by Bruce Y. Lee ( Forbes)

Politicians

Joe Biden isn't taking his chances with Covid, because he knows it's deadly. When Biden gave a maskless speech last year at a high school, his team literally removed gym windows to rig a (temporary) high-end ventilation setup (see below)! This is not a standard event setup; this is an unprecedented level of precaution that was undertaken to keep the president safe. Photos from this event show Joe Biden smiling and maskless; what most people didn't get to see was the extra air conditioners (possibly equipped with HEPA filtration and/or UV).

Here is the link to the original tweet, which shows the view from inside the building as well. Here is a blog post about this story, because some parents wrote about this exact situation and drew these exact same conclusions:

Friday, August 26, 2022
Biden Brings His Own Ventilation to @mcps High School #CovidisAirborne #CO2

On Thursday, August 26, 2022, President Joe Biden held a rally in the gym of Richard Montgomery High School in Rockville. Montgomery County is currently in a period of HIGH Covid-19 Transmission with a Positivity Rate of 11.65%. What's a President to do with a potential super spreader event?Why, bring his own ventilation, of course!

Take a look at the air handling units that were added to the outside of the Richard Montgomery High School gym for President Biden's rally:

How do MCPS students that use this gym year round get the same type of ventilation upgrade for their use of this space?

This picture should raise questions and set off alarm bells. Why should Joe Biden tell parents their kids are safe to be maskless in crowded, poorly-ventilated classrooms and gymnasiums during periods of high Covid transmission, when he is well aware that ventilation in these spaces is a dangerous problem? Why should he get clean air, but not your kids?

Further, air conditioners like the ones in these photos can be equipped with HEPA filters (which trap viral particles and make indoor spaces safer as a result). And bringing in lots of fresh outdoor air significantly reduces the concentrations of CO2 indoors, lessening the amount of virus in the air and making the space much safer.

The company whose equipment is pictured has HEPA filtration options available in their online brochure. It's very possible and very likely that Biden's team went with the premium option and added HEPA filtration (the company offers UV light sanitation options as well).

But whether HEPA filters were added on or not (we can't tell from the photo), bringing in so much fresh indoor air made the gym much safer for him while he was at the school...but the White House is not funding upgrades to school ventilation systems, or being transparent about the mitigations undertaken to keep Biden safe at all costs. The parents at Richmond Montgomery were rightly angered by this, and so are we.

In response to the image of the AC units on Twitter, NALTIC Industrials, LLC (the company that is the first distributor of Aranet4 in the US) described the elaborate setup as "unprecedented" (see below).

And they would know! NALTIC services "Aerospace, Military, Gas/Oil Wellhead, and Manufacturing companies" and NALTIC Industrials (NALTIC) "provides only top-of-the-line industrial hardware, and raw and specialty chemicals, all across the United States and worldwide." If they're describing this setup as "unprecedented" (and if you have ever been to a televised indoor event where the building's windows remained intact), it is pretty safe to say that this was not an ordinary AC setup.

(Shoutout to the Parents' Coalition of Montgomery County, Maryland for sharing this information with the rest of us. We share your belief that kids deserve clean indoor air.)

Other presidential precautions

(Know of other heads of state who continue to take Covid precautions despite outwardly suggesting otherwise? maskupwithus at gmail dot com.)

CO2 monitoring

Carbon dioxide (CO2) is a gas that naturally occurs in the air. Measuring CO2 levels is a way to assess indoor air quality. We exhale CO2, and if indoor spaces aren't adequately ventilated, the concentrations of indoor CO2 will go up-and higher amounts of the air we breathe in will consist of other people's exhalations. Well-ventilated buildings that bring in plenty of fresh outdoor air (reducing the concentrations of other people's exhaled breath indoors) lessen the amount of exhaled virus in the air, making the space much safer-which is why monitoring CO2 matters.

CO2 sensors (like the Aranet4) are being installed in certain schools, workplaces, and public buildings. Belgian law requires public spaces to display CO2 levels. Some parents (who have hundreds of dollars to drop on these sensors) are even sending their children to school with them to ensure their classrooms are safe.

Nasal photodisinfection

There's no way to know how many other celebrities and wealthy individuals are using this tool to stay safe, but it's doubtful that KISS is the only touring act taking advantage of this tech.

EventScan and Covid prevention companies

Corporations and the US government are blatantly, openly admitting to using a fancy Covid prevention services company for their parties and meetings. EventScan promises "the best available in COVID-19 prevention services for event hosts, guests, vendors and venues" and they provide testing services for "corporate conferences, privately confidential meetings, federal courthouses, government offices, sporting events, commercial/TV/film shoots."

Their website lists several major corporations and governmental agencies as current clients, including the US Department of Homeland Security, The White House, the US DOJ, SpaceX, Chevron, MasterCard, UPS, and more.

The Covid tests sold at drugstores are rapid antigen tests (RATs). They're diagnostically unreliable, and the chances of getting false negatives are very high. Molecular testing (like PCR testing) is the only way to get accurate results. The end of the public health emergency has meant the end of most Americans' access to PCR testing (since a single PCR test can cost upwards of $150 without insurance). Knowing whether or not you and your guests have Covid has become a luxury that only the rich can afford to pay for.

And they are paying for it. The rich CEOs of these major companies and rich government officials are getting everyone PCR (or LAMP) tested before their big corporate parties, screening all their guests beforehand, and taking Covid very seriously-while telling their low-level employees to return to the office.

EventScan Services

Far UV-C

The schools, workplaces, and homes of the rich are being outfitted with special UV lights that kill viruses in the air-including SARS-CoV-2. Far UV can continuously and autonomously eliminate over 90% of pathogens in the air (and on the exposed surfaces) of an enclosed room. These high-tech lights cost thousands of dollars. Portable versions can be yours for hundreds of dollars. Fortunately for government employees, many government buildings and military facilities have already been outfitted with these lights. Unsurprisingly, it's the " preferred disinfection solution for many Department of Defense organizations."

Source: Far UV Technologies

LAMP Testing

Covid-sniffing dogs

In some places, trained dogs are being used to detect Covid infections, with a stunningly high degree of accuracy (~90%). These dogs have been used to detect Covid infections in select schools, airports, and more. The Miami Heat has used Covid-sniffing dogs to stay safe. Multiple people have reached out to us and shared stories of these dogs being used on film sets and in their own workplace settings.

Avoiding the public

Billionaires are homeschooling their kids. They have private airport terminals ( where their drivers wear masks) and private aviation companies with masked luggage handlers. They're not working in the office-they're 'working' remotely from their superyachts.

All of the above: #DavosSafe

Billionaires gathered at Davos took maximum precautions at the World Economic Forum in January 2023. High-filtration masks were made available, and many attendees were photographed wearing these respirators. Participants were required to have a negative PCR test result in order for their badges to be activated. HEPA air cleaners were set up in every room and UV lights were installed. Venues were cleaned multiple times daily, and "additional state-of-the-art ventilation systems were installed in areas with restricted air circulation."

U.S. Military

The military knows that Covid is not over. The U.S. Department of Defense is investing in state-of-the-art wearable tech for soldiers that could rapidly predict disease, because they know Covid is extremely serious. They literally have wristwatch devices that can predict if the wearer is getting sick. Do regular people (us) have access to this kind of safety? What other kinds of tech do they have available just for them?

The algorithm leverages biometric data from commercial grade off-the-shelf wearables. The RATE algorithm enabled early detection of infectious diseases up to 48 hours before symptoms appeared. The algorithm, which, in some cases, predicted infections up to six days prior to onset, and included asymptomatic cases, was featured in a 2022 study published by the journal "Nature's Scientific Reports," highlighting the efficacy of the algorithm-powered wearables to aid military readiness, Schneider said.

- DOD Investing in Wearable Technology That Could Rapidly Predict Disease

How many other rich people are doing this stuff and not saying so openly? What other kinds of treatments do celebrities have access to that regular people do not? Why are you risking your life to go to these shows, when these artists are protecting themselves but not protecting their fans?

(Source: Normalcy Fugitive)

Not me

"Covid isn't dangerous anymore." / "I've already had Covid, so I can't get it again." / "I have immunity to Covid now and I'm not worried about getting reinfected." / "Reinfections after vaccination are rare." / "Reinfections do happen, but they're mild." / "I'm healthy and so I'm not worried!"

📝 This is what many other objections are built around, so no matter what other talking points you end up using, you should try to find a way to share this information, too.

You can get Covid over and over. The idea that you become immune to Covid after getting infected or vaccinated is based on the concept of immune memory-a concept that took me a while to understand! Basically, every time a virus enters your body, your immune system works to stop it. Your immune system is trained to recognize that specific virus in the future by taking a snapshot of it. This is why vaccines help: they show your immune system a harmless part of the disease so your body can remember it when it sees the real thing. You can think of your immune system like a photo album ( not like a muscle that weakens if you don't use it).

But the problem is that Covid keeps evolving and changing. So the variants right now don't look like the version your body has a snapshot of. The more people who are getting infected right now, the more times the virus is changing-meaning it's more likely your immune system won't recognize the new strain. The version of Covid that we saw in 2020 isn't around anymore. The virus looks entirely different now, and our bodies don't recognize it: meaning we're all still very vulnerable.

There's also lots of evidence that Covid weakens our immune systems and changes how they work. What does this mean? Your body's ability to fight off disease has been weakened, not strengthened, the more times you've had Covid. Many studies have shown that if you've had Covid, you're at an increased risk of contracting fungal, bacterial, and viral infections. Here's an article that talks about this and explains it really well, if you want to read it!

It wasn't until 2022 that we learned that Covid can persist in tonsils, the brain, the lymph nodes, the heart; generally anywhere in the body. We also recently found out that even so-called "mild" infections can cause 2% loss of grey matter in the brain. Here's another good article that helped me understand this, if you want to learn more and decide for yourself. Each year, we learn more about this disease. There's so much we still don't know.

We know that vaccines don't prevent you from catching Covid or transmitting it to other people, so you could still get other people really sick by not wearing a mask. We also know that vaccines don't stop people from ending up with Long Covid, which is what we're calling it when people get Covid and then never recover. Anyone can get Long Covid, even people who were really healthy before-even kids.

Have you heard about all of the professional athletes and celebrities who have ended up with Long Covid? Even the "healthiest" people in the world are being disabled by Covid. And it's ending people's careers. I can't afford to lose my job. I'm wearing a mask because I don't want to end up with another chronic illness, or lose my ability to care for my family and do the things I love. By wearing a mask, I'm protecting my future.

More complex version for science-minded folks

( Once again, taken from this incredible article):

You can get Covid over and over. The idea that you become immune to Covid after getting infected or vaccinated is based on the concept of immune memory. Every time a virus enters your body (either through infection or vaccination), your immune system mounts a defense to stop it: first a broad "kill anything that moves" phase we call innate immunity, then a phase of adaptive immunity, which is targeted to kill the specific thing that triggered the immune response. Pieces of the invader are used to create, recruit, and activate a variety of immune components-including antibodies, T cells, and B cells-that are trained to recognize that specific pathogen. Some cells of the immune system, called memory cells, are kept around from that second stage as a sort of permanent record. If the exact same pathogen shows up again, the immune system already knows what to look for. This is the key behind vaccination: expose your immune system to a harmless piece of the virus, and it'll remember it when it encounters the real thing.

Except this isn't even close to the whole story. For one thing, the snapshot stored in your immune memory is just a physical piece of the pathogen, and viruses evolve very quickly. As the virus changes, the real thing starts to resemble the record being kept by your immune system less and less, and it becomes easier and easier for new variants to evade adaptive immunity. The more people that get infected, the more times the virus randomly mutates-and the more likely it is that a particular combination of those mutations makes a virus that is unrecognizable to your immune system. For a while, the WHO used to categorize these mutants as "variants of concern," giving them each a new name. When the virus mutated enough to evade the immunity to the wild-type virus, they named it alpha. The lineage that was able to evade alpha was called beta. Delta was particularly immune evasive and its mutations brought high levels of lethality. Omicron was so different from all existing strains that it was practically able to infect everyone, no matter when they got infected and/or vaccinated. And then... they stopped giving the variants names. "Omicron" is still used to describe every descendant of that original variant, despite the dozens of highly-infectious, highly dangerous variants circulating today, none of which look enough like omicron itself for your immune system to efficiently recognize them.

Covid is dangerous and damaging because it's syncytial. Syncytial means that it can enter a cell, hijack its internals, and use that cell to create nanotubes that reach out and grab other cells melting into them. Then Covid can repeat this process over and over again until it makes a giant super structure out of your cells.

-" Let Them Eat Plague "

"I don't need to mask because I'm vaccinated and boosted!" / "I don't need to mask because I have hybrid immunity."

It's good that you got vaccinated! For a while, the vaccines were really effective at preventing severe acute (short-term) Covid outcomes and preventing some hospitalizations-not because they prevented people from getting Covid in the first place or created lasting immunity, but because they prompted your body to create antibodies to the virus, which can stay in your blood for months. So if you got infected while these antibodies were present, it helped your immune system compensate. Your immune response was less likely to go haywire, cause massive tissue damage, or lead to severe clinical outcomes. But here's the thing: Covid has kept evolving and changing. The new strains don't look like the old ones, and our bodies won't recognize them very well. By the time boosters became available, the original vaccines weren't very effective anymore: they were made to target the original version of the virus, which isn't the same variant that's being spread now.

We also know more now about the vaccines than we did before. We know that vaccines don't prevent you from getting sick with Covid or transmitting it to other people, so you could still get other people really sick by not wearing a mask. We also know that vaccines don't stop people from ending up with Long Covid. A huge study showed that the risk of Long Covid falls only slightly after vaccination. ( This article explains it well).

Plus, Covid is still really, really dangerous. It can damage your entire body, and it's still killing people-we go into more detail about this here.

This graph shows the devastating impact of reinfections. We know that three infections compared to one can result in an increase in health problems. Your third infection carries a 8x greater risk of being hospitalized, a 5x risk of cardiovascular disease, and a 4x risk of blood clots.

"We're using HEPA filters, so we don't need to wear masks at the party."

Nationwide Covid wastewater in the U.S. is on a steep incline over the last week, meaning we are in a big surge right now. There's no safety at this event unless people mask indoors (KN95 or N95); people will do what they see fit, but HEPA filters don't prevent transmission and aren't a substitute for layered mitigations. Meals should take place on the patio, not indoors. Rapid test effectiveness has sharply declined against new variants, but if everyone tested beforehand, it would be better than not testing at all. This is not just an issue for already-sick people; in fact, rich healthy people take zero chances with it. For comparison, the White House uses this company called EventScan for all their maskless events (and everyone who meets with the president is PCR tested beforehand).

If you look at the precautions governments and companies take, you'll see that everyone is PCR tested (not rapid antigen tested) before gathering and several layers of mitigations are in place. Because that is the level of precaution that is necessary to ensure safety, sans masks. Other major companies use these services as well, because they're not taking their chances. Unless you have access to the same tools they're using, unmasked events aren't safe. I wish this weren't the case and I wish public health hadn't completely failed all of us. I highly encourage you to check out the EventScan services list in particular. Y'all deserve this information so you can make an informed choice.

"I don't need to wear a mask when I'm outdoors."

It's good that you're moving plans outdoors and masking indoors! I appreciate the steps you're taking to keep your community safe. You're right that spending time outdoors is safer spending time indoors right now. But when in crowds, it's best to mask up. Covid is a lot more contagious than it used to be!

Older strains of the virus were a lot harder to catch outdoors. But remember, Covid travels in the air like smoke and can linger in the air. So I still wear a mask when I'm outdoors around groups of other people. Here's a podcast that talks about outdoor transmission where I learned about this. What other questions do you have? Masks do work, though. What you're describing is called one-way masking, and you're right that it is better than no masks. But the more people that wear masks, the safer we all are. It's being tracked less closely but transmission is still high right now, and the more people who wear masks, the less germs and viruses are present in shared indoor air.

Here's an article that explains this really well! Can I share it with you?

Share this: " Why One-Way Masking Isn't a Very Good Public Health Solution" ( Slate)

"Why should I care? I'm not old/disabled/unvaccinated."

Response copied from another fantastic resource ( the Covid info database) and used here with permission from the author.

If you genuinely only care about yourself, you should know that you are in danger, too-both from the disease itself and the consequences of it disabling and killing millions of people.

You should care about other people. But if only care about yourself and people like you, then advocate for preventing Covid for selfish reasons: Workers getting sick causes major supply chain disruption, which costs everyone more money; more people getting sick and hospitalized means fewer hospital beds open if you have a bad sports injury or get into a car accident; sick pilots, flight attendants, and air traffic controllers mean canceled flights; it goes on. Long Covid is disabling so many people that rampant infections have the chance to permanently upend travel, manufacturing, food service, and health care.

"My doctor said I don't have to wear a mask."

It's good that you're trying to care for your health and take care of yourself. But the truth is, doctors can be wrong-they're people just like us. Remember how many doctors used to claim cigarette smoking was perfectly safe? (see below) They were wrong about that, and your doctor is really, really wrong about the pandemic being over. There are many doctors who are continuing to wear masks around their patients, and I can share some resources from doctors who have taken the time to explain why it's still so important to wear a mask in 2023.

Option: show them the ad below, which was a real 1946 magazine advertisement for Camel cigarettes by the R.J. Reynolds Tobacco Company.

In 1946, in response to concerns about smoking and lung cancer raised by prominent chest surgeons Richard Overholt, Alton Ochsner, Dwight Harken, Michael DeBakey, and other physicians, the R.J. Reynolds Tobacco Company introduced a print and radio advertising campaign for its Camel cigarette brand, with the slogan 'More Doctors Smoke Camels.' Although the company claimed the campaign was based on a survey of 113,597 physicians, the methodology was not described, and it is not known if free samples of Camels had been sent to doctors just prior to the survey.

"The only people harmed by Covid are old and immunocompromised people." / "Healthy children don't get Long Covid."

A lot of people have been promoting this lie, and it's really the CDC's fault that so many people still believe this. The truth is, anyone can develop Long Covid, regardless of vaccination status or age. Covid can damage every organ in the body, including the brain, heart, and GI system- even in young, previously healthy people and kids.

Also. Even if the only people being harmed by Covid were the elderly and the immunocompromised (not true), these people are part of our communities and their lives matter! I'm disabled and high-risk. I'm not disposable. Think about what you're saying right now.
Depending on the values/politics of the person you are in conversation with, you could bring up ableism/eugenics ideology here:

able·ism /ˈābəˌlizəm/ noun: A system of assigning value to people's bodies and minds based on societally constructed ideas of normalcy, productivity, desirability, intelligence, excellence, and fitness. These constructed ideas are deeply rooted in eugenics, anti-Blackness, misogyny, colonialism, imperialism, and capitalism. This systemic oppression that leads to people and society determining people's value based on their culture, age, language, appearance, religion, birth or living place, "health/wellness", and/or their ability to satisfactorily re/produce, "excel" and "behave." You do not have to be disabled to experience ableism.

- working definition by @TalilaLewis
If they have anti fascist political leanings, consider sharing this essay:
" Hate fascism? Then don't be a health supremacist " by Maarten Steenhagen

Children and parenting

Parents face a lot of judgment from society for how they raise their kids, and could be understandably defensive or be feeling guilty. Make sure you're asking questions and showing genuine interest in their concerns. Show compassion and understanding for what they've been dealing with during the pandemic. They are carrying a huge burden and have been left with huge responsibilities that shouldn't be solely on their shoulders. And they have to do it while juggling school policies, childcare arrangements, and their own jobs. Remember that they are doing their best.

"What about immunity debt?" / "Kids need to be exposed to Covid."

I'm sorry you've been lied to about immunity debt. The idea that your immune system trains itself up like a muscle, by being exposed to lots of different infections is not true. That's not how it works. Here's a great video of a doctor who explains this in under a minute! And here's an article that helped me understand why "immunity debt" doesn't actually make sense.

Also: if exposing children to infections at young ages was better, children in countries where this happens would be doing great, but this isn't the case.

Mortality in children is higher and at younger ages in countries where childhood exposure to infections is high (i.e., more children die, and more children die younger in populations with high rates of infectious diseases). Children are healthier and have lower mortality rates in populations with higher vaccination rates and less exposure to infectious diseases. Can I share some resources that helped me learn more about this?

"But kids need to be exposed to germs when they're young" / "Our doctor said it builds immunity"
(see above answer as well)
Kids don't need to get sick to be healthy! And we're all exposed to germs every day, but we still wash our hands and treat or filter our water because we know those things are good for us. Think about it: we know that viruses like the cold and the flu evolve over time. All of the colds you caught when you were a kid didn't stop you from catching colds as an adult, right?

We don't actually know what early infection to Covid does long-term, because Covid has only been around for a few years. What happens ten years down the road? We can't say. But there are already signs that exposure in utero can negatively affect traits like lung development, birth weight, neurodevelopmental impairment, brain injury, and a Covid infection in early to mid pregnancy is associated with an increased risk of stillbirth, with even more possible negative consequences later.

And even if we only look at the last couple of years, Covid is a leading cause of pediatric deaths. This study based on data from mid-2021 to mid-2022 found that Covid was the leading cause of pediatric (0-19) infectious disease deaths in the US and concluded that it was a "significant disease burden for children and young people, so pharmaceutical and nonpharmaceutical interventions continue to be important to limit transmission of the virus and to mitigate severe disease".
For suggestions on talking with children and youth about Covid, see this section.
How Covid works

"Stop the spread by washing hands, standing 6 feet apart, and sanitizing surfaces." / "Covid is not airborne" / Social distancing means I can take off my mask." / "I keep my distance from people who are sick!"

There's been a lot of confusing guidance about how Covid spreads, so I understand why you think that! But the truth is, Covid is airborne and moves through the air like cigarette smoke. Airborne transmission is different from droplets, which are large particles containing the virus, expelled when you speak, cough, sneeze, etc.

Droplets are heavy enough that they will eventually drop to the ground or nearby surfaces, meaning droplets are easy to contain: any physical barrier-like a cloth mask or plexiglass- will block these droplets before they can reach another person. At the start of the pandemic, this is how we thought Covid worked; we thought it spread through droplets. That's why "social distancing" was recommended. But staying six feet apart only works for droplet transmission, because it assumes that virus-containing droplets will fall to the ground before reaching someone 6 feet away. We know better now, and so we have to change our understanding of how to protect ourselves. It's in the air.

Covid is not confined to droplets. Aerosols are composed of much smaller particles that bounce around between air particles, and can stay suspended and infectious in the air. Picture someone smoking and think about how the smoke travels. Can you still smell the smoke behind a plexiglass shield? How about if you're six feet apart? In a crowded indoor room, how many people would breathe in the smoke of one smoker?

Measures designed to protect against droplets aren't exactly pointless against Covid, since it also spreads via droplets. But just because you're keeping your distance does not mean you're keeping your germs to yourself (and the same is true for the people in a room with you)! And just like smoke can linger in a room after a smoker leaves, so can Covid. That's why I always wear a high-quality mask when I'm in public spaces; I'm protecting myself and my family from getting this really dangerous illness.

Further reading

We have known for years that Covid can spread through aerosol as papers published in the New England Journal of Medicine, Emerging Infectious Diseases, and Risk Analysis demonstrate going back to 2020.

"Covid is just like the flu."

You know how flu season happens at the same time every year? People are catching Covid multiple times a year, all year long. And Covid is way more dangerous than the fludid you know that Covid is the third-leading cause of death in America right now (and globally)? It's true. Even with vaccines, Covid is more transmissible, more deadly, and more damaging than the flu. Also, I don't know about you, but I've only had the flu a couple of times-it's not something I catch every single year.

Covid is 5-10 times deadlier than the flu. It's not the flu.

Next steps

I don't know about you, but I don't like getting sick with the flu, either! Protecting ourselves through actions like masking, cleaning indoor air, and staying home when sick are great ways to reduce our chances of catching the flu, which can also cause immune system damage or serious health outcomes. Reducing the spread of Covid also reduces the spread of other damaging diseases, and it's good for all of us!

"Covid is endemic now."

There's a lot of confusion about what Covid becoming endemic means. Plus we still take precautions for endemic diseases all the time (e.g. condoms). Can I share a short essay with you from a scientist explaining why a disease being endemic doesn't make it less serious? This article helped me understand what endemic means.

When you say Covid is endemic, what exactly do you mean? Endemic means that a disease is found within a specific geographical location and has a constant presence within that area at steady predictable levels. An epidemic means widespread outbreak of a disease in a particular area or community. A pandemic is an outbreak of disease that occurs over a large geographical area, usually globally.

All of these terms seem very similar but have distinct differences. When people use the term endemic to describe Covid, it is an inaccurate description of what is actually happening. I think many people really just mean that Covid is here to stay. But Covid is not restricted to any geographical location, so it's not endemic. Covid is found globally around the world at high levels. Covid is a rapidly mutating virus and governments globally have restricted testing and data to the public. Telling the public Covid is endemic is a political decision, not a scientific truth. It is purposely shaping the narrative that Covid is inevitable and giving governments a pass on fixing healthcare, updating existing infrastructure, and improving labor laws and regulations. When people say it's endemic, they are often saying this to argue that there's nothing we can or should be doing to prevent transmission but we are not helpless bystanders in our current situation. We have the power to stop and slow the spread of transmission, which starts with individual actions like wearing a well-fitting mask (respirator).

"I recovered from Covid and now I'm out of the woods." / "I had a mild case of Covid, so I'm not worried anymore."

I'm glad you are feeling OK and that you didn't end up in the hospital. And I'm not trying to scare you, but the truth is, none of us can know yet if we're really out of the woods here just because we feel OK.

What's the long-term consequence of Covid infections? The truth is, we still have no idea. Covid is a coronavirus, and we know this kind of virus can stay in your body long after your infection.

Chickenpox is the same exact virus as shingles; the virus lives in your body and can get reactivated years down the road, making you sick again.

We have proof that Covid stays in the body and lingers there, even in people who had seemingly mild infections. And we know that while it's still hanging out, it raises your risk of heart attacks, strokes, neurological symptoms, and death -and it only gets worse with every reinfection.

So even if you've already had Covid, and even if we're all going to catch it at some point, it's really worth trying to catch it as few times as possible, at least until we know more about the disease and until treatments or better vaccines are available. Do you still have masks you can wear? Can I help you find some?

A more complex explanation (again, from "Let Them Eat Plague"):

We've known for years that other coronaviruses, like SARS, can persist in your body long after initial infection. This is likely a byproduct of their evolutionary history; they evolved to spread through bat populations and survive bats' unique immune systems. Bats are very long-lived for their size, potentially living for decades, even with multiple different infections quietly simmering inside them. However, in humans, these viruses' tactics for suppressing a well-regulated bat immune system present a form of overwhelming force, which wreaks havoc on our bodies.

After the chaotic and potentially-lethal initial stage of acute infection, the virus is able to settle in for the long haul -evidence has been found in the gut, in human waste, and among "cured" patients. This can happen whether the acute phase was disastrous and hospital-worthy, or quiet enough for you to experience no symptoms at all. By this point, the virus will have suppressed your body's immune memory, infiltrated throughout various organ systems-including your cardiovascular, nervous, and renal systems-and begun pumping out a steady supply of new virus.

Of course, this persistent infection causes damage to the various organs where the virus has made its home, especially since it can trigger further inflammation. Your immune system is constantly trying to smoke it out, damaging more organ tissue as it does so. Your risk of heart attacks, strokes, neurological symptoms, and death in general are much higher during this persistent phase-and it only gets worse with every reinfection. It still remains unclear how long this persistent phase can last-certainly as many months as have been studied so far.

Evidence has been mounting for years that Covid is actually a type of autoimmune disorder, with several components of your immune system turning against your own cells. Not only are pro-inflammatory molecules heightened in both the acute infection and in so-called long Covid, high levels of antibodies against normal cellular pieces have been found in over half of patients hospitalized with Covid. The implications of Covid triggering autoimmunity are broad and can get fairly technical, but needless to say, the population being infected over and over with such a debilitating virus is catastrophic.

-" Let Them Eat Plague "

"Once enough people have been exposed, herd immunity will end the pandemic."

Herd immunity is no longer possible and it was probably never possible.

From what I've read, I know that herd immunity only happens when a large enough portion of a population has acquired immunity to a disease in order to limit its spread and therefore protect a small portion of the population who do not have immunity.

This term is also used to refer to the vaccination strategy of eliminating/restricting transmission of a disease by vaccinating the population to a specific threshold and maintaining that threshold in order to protect the whole population including those who can't be vaccinated (people with immature or malfunctioning immune systems like babies and some people with immune conditions or allergies).

Next steps

Different diseases have different effects in our immune system, with some conferring lifelong immunity and others barely any, with frequent reinfections possible. Similarly, different vaccines have different effects and dosing schemes based on what gives the best immunity. Some last a short period of time for viruses that are constantly mutating-sometimes not providing immunity at all, but at best, providing a more robust immune response to the virus (the annual combination flu shot, Covid shots). Some last longer (tetanus shot for example is recommended after potential exposure if you haven't had one in 10 years), and some can even provide lifelong immunity in one dose (17D Yellow fever vaccine).

Whether immunity via vaccination or infection, the threshold needed differs based on the transmissibility of the disease. Diseases with high infectiousness like measles means a higher portion of the population needs to be immune to confer protection to the non-immune population. Covid-19 is both highly transmissible/highly infectious and frequently mutating.

Here's an article that explains five reasons why Covid herd immunity is probably impossible, back from 2021 (there's even more reasons it's impossible now).

"Viruses naturally evolve to become less deadly / Covid is milder now."

I've heard a lot of people saying this, so I understand why you'd think it's true. But the idea that viruses naturally evolve to be less deadly is an idea from the 1800s ("the law of declining virulence ") and we've known for a long time it isn't true!

The latest research shows that Omicron is just as severe as previous variants. Getting Covid could actually weaken your immune system. I just read an article that helped me understand this that I can share with you.

Taking other precautions

"We have the tools!"

We do! Implementing indoor air quality standards and encouraging masking are things that can be done right now that would make all of our lives safer. But they're either being ignored by the government or even discouraged in favor of pharmaceutical tools. Pharmaceutical tools (like the vaccines and Paxlovid) that simply aren't as effective anymore. We are starting to lose what tools we have by allowing the virus to spread unchecked and become resistant.

So rapid tests are not as effective, the vaccines are not as effective, the antivirals are not as effective, and one-way masking is not as effective...What are we going to do? Well, these are all problems created or made worse by our governments failing us. Unmitigated Covid spread means many more chances for Covid to continue to mutate (and get more dangerous). Our governments are not investing in updating our tools, because they're too busy selling the lie that "Covid is over"/"Covid is endemic"/"Covid is like the flu." We deserve better! It's not fair that all of this is so confusing and so many of our tools are becoming less useful.

But there's still hope! Did you know that the Covid vaccines in Cuba are really effective?

It is possible to do more about this virus! And even though there is more that can be done in the future, there are still things we can do now. We can ask questions about the indoor air quality in the places we spend time, and learn ways to make it better. Opening windows improves ventilation and therefore lessens transmission. And masking is still the best and most accessible tool we have to reduce the spread. Do you still have masks you can wear? Can I help you find more comfortable ones?

"We're all taking rapid tests before the event, so we don't need to wear masks!"

"I'm feeling sick, but my rapid test was negative! So I don't need to wear a mask."

Current rapid tests aren't picking up lots of Covid cases. The false negative rate is high for asymptomatic cases. This means it's important to keep testing if you're negative and having symptoms. More importantly: stay home if you are sick! Getting another person sick with Covid could disable or kill them.

Also, did you know you need to swab your throat when taking your rapid tests now, in order to get the most accurate result with the new variants? The tests were designed for older variants. Here's a guide on how to do that.

"I don't need to mask because I stay home when I'm feeling sick."

It's really good that you're staying home when you're sick! But also, many Covid cases are asymptomatic, which means you can have Covid and not have any symptoms at all-but you're still contagious. At least 50% of Covid transmission happens without symptoms. Also, people with Covid-19 are generally considered infectious from 48 hours before any symptoms start (and sometimes, even longer than that). And our Covid tests aren't nearly as accurate anymore because the virus has changed so much. There's no way to know for sure that you or the people around you don't have Covid, so the only way to protect yourself and the people around you is to wear a mask when you're sharing indoor air.

"I'm following CDC guidance!"

The CDC is not an apolitical or infallible institution, and they have been wrong about this virus from day one. Remember when they told us not to buy masks because they didn't want healthcare workers to run out of them? Remember when they said vaccines stopped transmission?

Here's a post that explains how the CDC is actively hiding the data from the public, written by an expert:
Source: CDC Statement on their Data Tracker
By saying that transmission levels are "no longer calculable," the CDC is saying: the spread of Covid is out of control. Covid has not gone anywhere; the CDC has abandoned us and left us on our own. The pandemic hasn't ended; the CDC has simply decided to hide the data, hoping the public won't realize what they've done.

This is not OK. We deserve to know how many people in our communities are still sick. They've taken away our tools, and they're leaving us to die. We cannot and should not accept this. Without access to testing, case data, or treatments that work, things are about to get so much worse. The president, the rich, and our leaders still have access to PCR testing and information about the pandemic. Why shouldn't we have these things, too? And why should we ever trust what they're telling us about Covid, when we know for a fact that they are rushing to cover everything up (while still carefully protecting themselves)?
Consider showing them The People's CDC website and its weather reports.
Long Covid

"Long Covid is psychological, not physical."

Well, first off, this has been a common reaction to many systemic, chronic health conditions that Western medicine has difficulty diagnosing and treating. When doctors don't know what's wrong with someone, a common response is: are you sure you're not just anxious? And as a result, people suffer. Yes, it's true that sometimes psychological symptoms (or our states of mind) can contribute to physical symptoms (and vice versa)! Our brains and the rest of our bodies are interconnected and impact each other in complex ways. But there are millions of people suffering from Long Covid, and many of them have shared stories about their debilitating physical symptoms. Long Covid has severe physical impacts. We have so much evidence.

Unfortunately, the idea that complex illnesses are "psychological" is often used to dismiss people whose symptoms aren't easily explainable or treatable. It's also deployed whenever someone's disease has many contributing factors that show up differently in different people. It's especially weaponized against people with marginalized identities; disabled people, racialized people, queer people, and women are often not believed by their doctors and their pain is minimized or erased. For example, sufferers of diseases like Chronic Lyme Disease and Chronic Fatigue Syndrome have had their symptoms dismissed for decades.

Next steps

In the case of Long Covid, scientists are developing hypotheses that could provide physical explanations for Long Covid. Right now, there are three leading theories about the physical cause:

Persistent virus theory

Some researchers have detected "viral persistence" in people experiencing symptoms of Long Covid. Viral persistence means that the body has been unable to fully clear the virus after infection. Meaning: some people get Covid, and it doesn't go away. Researchers have found it hiding out in certain organs and tissues in the body, long after the person was first infected. GI doctors and scientists have discovered Covid lingering in the digestive tract in several people (and other researchers have found it hiding elsewhere). This is really bad.

Viruses that live in the body for long periods of time can sometimes be reactivated years down the line. The shingles virus is reactivated chickenpox. This is what is called a "post-viral illness." Long Covid is not the only post-viral illness, it's just the newest one. In fact, post-viral illnesses are way more common than you might think. Lots of viruses can cause lasting damage, like autoimmune diseases, chronic fatigue syndrome, vision loss, and more.

Tiny blood clots theory

In some Long Covid cases, the cells and tissues that control blood flow are damaged in a way that amplifies the blood's tendency to clot. This theory suggests that very small blood clots (which have either been left over from the initial Covid infection itself or formed in the aftermath) might be gumming up the body's circulation. Researchers found evidence of these microclots when using specialized scans that looked at blood flow in the lungs. Many researchers now believe that Covid is actually a vascular disease, and this theory supports that idea. And the thing about microclots in your blood is that they can cause damage everywhere: from your brain, to your joints, to your organs.

Haywire immune system theory

The third theory is that Covid is making immune systems go haywire. In some Covid-19 patients, their immune systems get revved up and destabilized by the initial attack by the virus-and these immune systems seemingly can't reset themselves to their former baseline, idle state.

Why does this happen? Well, researchers found that white blood cells (which normally recruit other cells to sites of infection) were highly activated in Long Covid patients. And this activity might explain why patient levels of interferons (proteins made by the body to fight invaders) were sky-high even 8 months after infection. Even worse, these patients had many inactivated T-cells and B-cells (which usually hang around and wait for instructions to attack disease). All of this is bad, because it signals chronic inflammation, which can cause a ton of different health problems and conditions.

Regardless of the physical cause, the latest estimates are saying that Long Covid affects about 30 to 40 percent of people who have had Covid. And the actual number could be much higher, because many people are not able to access healthcare or seek treatment.

Every Covid infection increases your risk of developing Long Covid; each time we get sick, we're rolling the dice and risking disability. That's why I'm still wearing a mask. I can't afford to get sick and stay sick.

Sources

Further reading

"Long Covid is physical, but not a big concern."

Long Covid is an umbrella term that encompasses a wide range of symptoms and newly onset conditions that can be completely debilitating for some. As of right now, there's no cure. There aremany estimates of the prevalence of Long Covid ranging from 5% to 50% of infections (with varying degrees of severity and debilitation). Finally, in April 2023, the World Health Organization came out and warned that 1 in 10 infections can result in Long Covid, "suggesting that hundreds of millions of people will need longer term care". I know people with this condition, including close friends. They're suffering a lot. They've had to reorganize their lives. Many of them are out of work or unable to do the things they used to do for fun. It's really, really worth avoiding this disease. And from everything we know so far, Long Covid isn't actually rare.

It's important to clarify the distinction here: they're now saying 1 in 10 infections lead to Long Covid, not 1 in 10 people who get Covid. This means that every time you catch Covid, you're rolling the dice again, on a serious disability! And don't forget: reinfections are way more dangerous than initial infections. Remember: there is no permanent immunity to this virus, and it's possible to be reinfected within a very short timeline. Most infections are asymptomatic, meaning it's very likely for someone to catch Covid and not know, because they won't have any symptoms. This is why I tell people: I don't know if I've had Covid or not. If we don't take steps to stop the spread, we are going to keep giving this dangerous virus opportunities to mutate, get stronger, and change, meaning we'll all be more at risk of getting it over and over again. The best way to stay safe is to mask up.

A report released in March 2023 by Canada's Chief Science Advisor, Dr. Mona Nemer, indicated that Long Covid could be a mass disabling event. ( Link to full report)

Excerpt:

Acute infection in around 10-20% of individuals leads to a complex and, at times, debilitating chronic condition in some individuals, known as post-COVID-19 condition or long COVID. Additionally, it is increasingly evident that acute COVID-19 increases the risk for several chronic cardio-metabolic diseases, including diabetes, hypertension and arrhythmia.The long-term effect of COVID-19 on the nervous system is equally concerning with accumulating evidence that several common symptoms reported by individuals suffering from PCC (Post COVID-19 Condition), such as memory loss, blurred vision, mood disorders and neuropathies, may reflect irreversible cellular changes observed in aging or in some neurodegenerative disorders. Thus, PCC has the potential to become a mass-disabling event given the highly transmissible SARS-CoV-2 Omicron variant in circulation and the unpredictability of evolving future variants

-Dr. Mona Nemer

Also, if you want to see a group of folks taking the risks of Covid and the economic implications of Long Covid as a mass disabling event very seriously, just check out Covid coverage in business/finance publications. Here, you'll find accurate portrayals of the risks of Covid provided to wealthier classes worried about shrinking workforces.

(📝: read the feature articles, not the opinion section. The opinion section isn't fact-checked)

Here's an article that gets into this more, and see also the " Case studies" section of this document.

Further reading on Long Covid

Mental health

"What about the detrimental effects of isolation from missing out on events?"/ "Socializing is important for my mental health"/ "Being the only person wearing a mask triggers my social anxiety."

Yes, missing out on events or standing out from the crowd have negative effects on our mental health. Humans are, in general, very social so there is definitely a real challenge and struggle there! I have had some painful moments turning down certain events. I have cried and grieved over some of these changes in my life.

However, there are many ways to contribute to Covid mitigation without isolating yourself, like socializing outdoors, masking in crowds and indoors, and looking for indoor spaces with good ventilation.

In terms of being the only person masked, it has really helped me connect with others who I know are also masking in public. So, even if I enter a public space by myself and am the only one masking, it doesn't feel as difficult when I know I'm actually not alone in taking action like this. Does that sound like it could help you with difficulties standing out?

Like I said, we're such a social species! But right now, high-risk people are being forced to stay home and away from almost all events due to lack of protections in place. Every action counts, so while there have been low points, it has also been a boost to my mental health to know I am contributing to making public spaces safer. When more of us do that, there will be more opportunities for socializing for more people!

Some of these choices are a sacrifice, but I'm trying to protect my baseline health, as well as my community members, so we can live long and healthy lives. I know that my mental and physical health are connected, and that if I end up with a lifelong disability that limits my ability to exercise or work, my mental health will be much worse.

Next steps

You could go back and forth, sharing feelings like, "As someone who wears a mask every time I'm in public, I feel judged and alone. I wish I didn't feel that way. Sometimes, though, people see me wearing my mask and pull one out of their pocket to wear around me, because they just didn't want to be the only person wearing one.

Do you think maybe a lot of the people who aren't wearing masks want to start doing so again, but are afraid of what other people might think? Do you think that if more of us wore masks, it would make it easier for the people who are high-risk to keep doing so without being targeted?" or "Sometimes people tell me that starting precautions again feels like admitting they made a mistake or hurt other people. They feel like they can't admit to having been wrong about Covid.

Another option, if you personally stopped masking at any point

I also stopped wearing a mask for a while indoors, but it's a sign of strength, not failure, to change your mind when presented with new information. I wonder if you're being hard on yourself for not knowing these things, and that could be making it harder to make a change-but it's not your fault you didn't know, and you were doing the best you could. Here's some testimonies from (amazing!) people who have also resumed masking: The_Gloria_Sun and Chescaleigh.

"I have to live my life." / "I'm not just going to sit around and do nothing."

I am living my life! I go to art museums, travel, spend time with friends, and even eat at restaurants sometimes (on the patio!). But whenever I'm indoors sharing air with other people, I'm wearing a high-quality mask, because I can't tell by looking at someone else if they're immunocompromised and I don't want to get them sick.

Remember: many Covid infections are asymptomatic, which means it's very possible to be sick with Covid and not feel or show any symptoms at all. And if you've had Covid, your immune system IS compromised now. I'm doing this to protect my health and the people around me, too. When I eat at a restaurant, I sit outdoors on the patio or get takeout. And even if you can't wear masks all of the time, wearing them some of the time-like at the grocery store or on public transit-is better than not masking at all. Do you need help finding a good mask to wear?
See also: this section below.
"Wearing a mask is living in fear."

What makes you believe that wearing a mask is living in fear? Taking precautions to preserve our physical and mental health in other ways isn't viewed as living in fear.

Does the person you are speaking to do any activities to preserve their health in some way? Ask them if the activities they enjoy doing or do because they care about their health in other ways would also be considered living in fear. Would you say working out is living in fear? Is trying to eat healthy living in fear? Is brushing our teeth living in fear? Is playing sports living in fear? Is meditation living in fear? Is good sleep hygiene living in fear? Is playing or listening to music living in fear? All of these activities could be viewed as something many people do to enrich our lives and not as hindrances. Many of these activities are to help preserve our health in various ways. Is being an active participant in our own health and well being living in fear? Wearing a mask to protect ourselves isn't living in fear; it's an act of self care (and community care).

Freedom / government control

"Wearing a mask infringes on my freedom."

What about your freedom to live to old age? What about your freedom from getting sick over and over again? I wear a mask because I'm protecting my own right to live and be healthy. I don't trust the government to keep me safe, because the government doesn't care whether we live or die. They want us to go back into the workplace and back to spending money so the economy doesn't collapse, not because things are any safer than they were in 2020.

"Masks are attempts at government control."

Wearing a mask is actually going against what the government wants us to be doing right now! It's also a great way to protect yourself from facial recognition software and protect your privacy. Attempts to ban masks in businesses aren't about shoplifting, they're about surveillance and limiting your bodily autonomy.

Vaccines

Talking to your friends and family about vaccines can be an especially emotional topic, and is one that takes time. It's important to ask a lot of questions and get to the root of their concerns. Focus on shared values and be patient. You'll probably hear a lot of popular anti-vax points repeated initially. Continue to discuss with them and try to find out what is underlying their concerns in their own words.

It is particularly important to come well-informed to these conversations about vaccines. Familiarize yourself with the technology and history of vaccines in general and the different types available for Covid in your area. That way, you can identify incorrect information and be ready to recommend a specific vaccine if they ask.

"Vaccines kill more people than Covid."

You can't catch Covid from the vaccine. While you may feel sick after getting the Covid-19 vaccine, that is a sign your body is building protection against the virus that causes Covid-19. A controlled dose of part of a virus is not worse than an uncontrolled infection with a fully operational virus. Can you tell me more about your hesitation here, and what your main concern is?

"This was just a scam for big pharma to make money off of us!" "The vaccines aren't safe!" "We don't know the long term side effects of the vaccines!" "mRNA is a new technology!"

Unfortunately, it is true that we live in a predatory society. But the truth is that the predatory aspect is the cost and patenting of drugs; it's not true that all drugs produced by the pharmaceutical industry are useless or harmful. People who have chronic health conditions who rely on medication to live (such as insulin) are placed in an impossible situation in our society. They have no choice but to rely on these drugs at whatever cost the pharmaceutical industry decides otherwise their life is at risk. Can you tell me more about your hesitation here, and what you're most worried about?

If Novavax is an option and they are skeptical about mRNA

Did you know that Novavax is not an mRNA vaccine? If you were skeptical about mRNA vaccine technology, you should look into getting Novavax instead, which relies on more traditional vaccine tech.

"Why should I get vaccinated?"

Thank you for trusting me enough to ask this question! It's good that you're thinking about your health, and it means a lot to me that you feel safe enough with me to ask. So basically, when looking at any medication, we have to look at the risk/benefit analysis, right? In this case, that means: What are the risks of not being vaccinated? And for people who aren't vaccinated against Covid, there's a higher risk of Long Covid and higher risk of being hospitalized if you get infected. Even though Covid has mutated greatly, the vaccines still do provide some protection and help our bodies if we become infected. Sadly, governments around the world have restricted access to testing, making it harder for people to know how much Covid is around them. But by looking at wastewater data, hospitalizations, and deaths, we know that Covid is still running rampant in our communities.

While the Covid vaccines do give our bodies a head start if we are infected, they are not as effective as they once were. It is important that we see vaccines as an added layer of precaution and not as a safety net.
Insert your personal connection to Covid. Do you know people who are currently sick? Did you recently have Covid? Share this story.
The damage Covid is capable of doing to our bodies is much, much greater than the risk of an adverse reaction to the vaccines. If you're nervous about having a bad reaction to the vaccine, the best thing you can do is talk to your doctor.
If they are thinking about maybe getting vaccinated, offer to go with them as a support person.
"How do we know they are safe?"

The peer review process for vaccines is extremely in-depth. To get rid of bias, the scientists' names have actually been removed, and their research passes through many hands and stages before it can be considered peer-reviewed. The peer review process creates a standard in the scientific community which proves the integrity of the study. Drugs like insulin save millions of lives every day.

And as for the Covid vaccines, they have been given primarily to the wealthiest countries (even hoarded for them). That wouldn't have happened if they weren't extremely safe. And many countries are still fighting to access the vaccines. Lack of access to the vaccines has led to additional Covid deaths.

It's not just Covid vaccines, either. Other vaccines (like ones for the flu), HIV treatments, and even antibiotics or other medical treatments we might take for granted have seen massive delays in availability and limited accessibility in the Global South. Would you be interested in learning about what some of these countries are doing to try and improve their own production of medicine so they don't have to rely on the charity of rich countries?

About mRNA

mRNA technology was first discovered in the 1960s, and testing with mRNA technology began in the 1990s. Several vaccines were being studied with this technology, including a flu vaccine and a rabies vaccine. Currently, even more vaccines are being studied with mRNA technology, including vaccines for cancer and HIV. The Covid vaccines are based off of the mRNA vaccine that was being produced during the SARS epidemic in 2003. What does this mean? It means we have several decades worth of testing and information regarding mRNA vaccines and the Covid vaccines. They're not brand-new; they were built from existing research and pre-existing technology.

The Covid vaccines have been extremely well-studied. Pfizer's trials had over 43,000 participants and Moderna's vaccine trials had over 30,000 participants. We have a lot of data showing that these vaccines are safe for the great majority of people who receive them.

Most side effects from vaccines happen within the first few days. The most common side effects are mild, and you may feel under the weather the following day. These symptoms happen as the result of a normal immune response, which helps your body recognize the pathogen without becoming infected. This gives your body a head start in being able to be able to fight against Covid, if you were to become infected.

Long-term effects from pharmaceuticals happen when people take medications continuously (often daily) for extended periods of time and build up in our bodies. This is very different from vaccines, which degrade quickly in our bodies. Vaccine injuries are a real phenomenon, but they are very rare and would be something that would present quickly, not something that would show up over months or years. What we do know, however, is that Covid can cause long-term damage to our bodies and we don't know what the future holds for the impact of a novel virus infecting the vast majority of the population repeatedly. Many viruses can stay in your system after infection and can become reactivated later. This is why those who have been infected with chickenpox are at risk of developing shingles later in life. We are already seeing health impacts from Covid infection only a few years into this pandemic. We don't know what the future holds yet, and we need to prevent everyone from being infected over and over.

Further reading

"Aren't the pharmaceutical companies still profiting off of us?"

Vaccines only account for a very small percentage of profits from pharmaceutical companies; preventative medicine is not much of a money maker. Pharmaceutical companies make most of their money from exploiting people with chronic illnesses, since these people rely on ongoing treatments that they need to live. If you are concerned about big pharma profiting off of you, the best thing you can do is wear a well-fitted respirator to prevent catching Covid or other illnesses, which could leave you disabled and possibly reliant on pharmaceuticals for life.

Next steps

For some time, governments around the world have been pulling back on resources for Covid, such as testing and sick leave. More recently, governments have been restricting the availability of Covid vaccines. The U.S. government is no longer providing free Covid vaccines. In the UK, children are no longer eligible for vaccination. Both in the UK and Canada, only those who can prove they are immunocompromised and those above 65 are eligible for boosters. This is not because Covid is no longer a threat; it is because governments are turning this into an individual problem and putting the burden (wrongly) onto us. Basically, they're trying to absolve themselves of responsibility for keeping us safe. What they should (and could) be doing is investing in infrastructure. They should be providing funding for schools and businesses to upgrade ventilation and clean the air. They should be passing legislation around sick days. They should be offering us free masks, free vaccines, and free tests. The government has the power to do so much more to protect us. They don't want to pay to do that, so they're telling us the pandemic is over. It's not over.

"Why are there some doctors and some health/nutrition/fitness influencers telling me I don't need to get vaccinated or wear a mask?"

The truth is, there are some doctors and influencers with no moral integrity. There is an overwhelming consensus in the scientific community that the Covid vaccines are safe and do help prevent hospitalizations (during the acute phase of an infection). There is a small minority of people (sadly, including some doctors) who have been purposely lying to you about vaccines because they are looking to sell you a product (like supplements). These people will tell you that you don't need to get vaccinated under the guise that their supplements will keep you healthy and/or that these supplements will "treat" you after you get Covid. Some of these influencers and doctors have investments in alternative treatments. Remember: treatments are what get you coming back frequently. They want you to be sick and reliant on their products.

The Environment

"Wearing masks is unnatural."

Handwashing used to be considered unnatural! Viruses are natural, but they're still a danger to human beings. Just because something is natural does not mean it's safe, or that we shouldn't protect ourselves. Tobacco plants are natural but we know tobacco causes cancer. Capsaicin found in hot peppers can cause your eyes to swell shut, burn, and cause nerve damage. Forest fires are natural, but we evacuate if one is heading toward our house!

Also, did you know that human activity around the world has been bringing Covid to animals? It's sad, and it's true. Our pets-such as dogs, cats, hamsters, and ferrets-are all capable of catching Covid. They can't protect themselves, but we can protect ourselves for them.

Humans have been encroaching more and more on wildlife and Indigenous land through predatory development like deforestation and mining. Animals we once thought could not get Covid seem to be catching Covid, giving the virus more chances to mutate. There's been documentation of Covid spreading to minks, otters, deer, lions, tigers, hyenas, hippopotamuses, and the endangered snow leopard. So if you care about the environment, it's important to stop Covid transmission from happening; it's affecting our entire ecosystem.

And like I said: virus mutations are constantly happening. But when viruses jump to different species, there is even more reason for serious concern. When new species catch Covid, we're put at a higher risk of mutations that could make Covid even more deadly or transmittable. And that could further comprise our already-waning vaccines and treatments.

Protecting our pets and wildlife from Covid is so important. Disrupting the balance of our ecosystems could have dire consequences. Our existence relies on many ecological factors, and we are part of nature, too. The more we allow Covid to spread, the more likely it is that animals and wildlife will be exposed to Covid, threatening both their survival and ours.

"Aren't disposable masks bad for the environment?"

First of all, it's important to remember that human life is our main consideration. Single-use disposable products used in infection control (like latex gloves) save the lives of both people and animals every day. Other disposable and single-use products can be necessary survival tools for disabled people. So while yes, disposable masks aren't the most environmentally friendly objects, there are things we can do to reduce the impact. It's possible to safely re-wear disposable masks (see: paper bag method), and there are reusable masks you can get which have less waste.

Unfortunately because of the world we live in, we all produce waste. It is important to keep in mind that the biggest contributors to climate change can be boiled down to about 100 corporations and the US military. Our governments directly profit from passing loose and flimsy regulations on fossil fuels (and their manufacturers) and pollutants in our environments. We have the technology and power to live in a much more eco-friendly, sustainable society, but there hasn't been much movement because of the power these corporate interests have over the government.

You don't blame yourself for purchasing essential needs that come in packaging, do you? I didn't think so. So blaming individuals for wearing a mask doesn't really make sense. We need to keep in mind who we should really be holding accountable for keeping our environment free of pollutants, and blaming each other isn't the solution.
Further reading:
How to talk to organizations or event organizers

Are you trying to bring back masking and other precautions to an event or space? Have you been struggling to have a conversation with event members or group organizers? Let's walk through how to get started.

First off, we need to ask ourselves some questions. Does this event or organization have radical politics? Does this organization have a website with mission goals and objectives? Who is this event or organization serving? Are they serving marginalized communities who are at a greater risk of adverse effects from Covid? Do they state that they are fighting against ableism and/or that their space is accessible? Do they have monetary resources to provide masks, air filtration etc? Are they a volunteer-run organization?

When talking or writing to organizers, don't make assumptions about what you think they know about Covid or masking, even if they supposedly have radical politics. It's important to name who they are leaving out and putting at risk by not having masking requirements. People often have more empathy for a situation when we put a face to those being left out or hurt by their actions. Tell them how it makes you feel and explain how people in your community are left out by the organization's decision to not to require masking.

Consider the following: If this group is volunteer-run, are they able to factor in the costs of masks into the event price? Can they request donations to make safer events? Do you know any local organization who may donate masks or money towards creating a safer event or space? Are you able to gather names in the community who would support having masks in this space or event? For organizations that have plenty of resources, it should be solely their responsibility to provide an accessible space and/or event. Volunteer-run events or organizations are more complex. They may be much more open to the suggestion of masks with assistance since their resources may be scarce or non-existent.

Below is a real life example of a letter written to a volunteer-run, anti-capitalist art collective that also hosts shows, workshops, and other events. Feel free to use this as a template to mold your own letter or conversation to organizers.

Dear (Organization/Group)

We are reaching out in regards to Covid precautions in the space. (Organization) has been a place of inclusion for anti-capitalists and a space that people have been able to access for different community needs [Talk about your personal connection to organization, why you care about masks being required in their space at their events or how you've participated in their events previously].

On your About Us section on your website, you state:

-quote from website regarding how they challenge ableism-

Unfortunately, when (organization) dropped mask requirements, the space stopped living up to this goal. This space has shut out disabled people and those who are trying to keep themselves and their loved ones safe. Marginalized people such as those with chronic illness, disabilities, racialized people, and 2SLGBTQIA+ folks are at a higher risk of adverse outcomes from Covid.

While no one can live in a completely risk-free world, we are asking (organization) to commit to a harm reduction approach (masking & air filtration) because we believe that everyone deserves human connection, resources, and community space and we hope you do too.

We are reaching out because we want to know if the collective is open to reinstating mask requirements for all shows, workshops, and open hours. We would be willing to pitch in on masks and help set up some budget & effective air filtration options for the collective, if you're open to our request.

If you are looking for any info on Covid, masks, or how to create a safer space with air filtration, please don't hesitate to reach out, and let us know what your decision is. We hope you are open to suggestions and look forward to hearing back from you.

We also recommend this excellent piece which provides suggested answers to many of the movement specific objections you might encounter.

Hope

"I don't want to wear a mask forever"

It helps to remind people that no one is asking them to mask FOREVER. We are asking them to mask until the pandemic is actually under control and until it's safe to stop masking. And so reminding them that treatments and better vaccines are in development can make this psychologically easier/assuage people's fears to some extent. Taking things one day at a time can be very helpful, too.

Some good news

Proof that you can still live your life and wear masks

really lovely video from ji-youn kim 김지연 showing how they still participate in in-person activities (art galleries, social events, going shopping, etc.) while wearing a high-quality mask indoors

@mask4maskjoy dedicated to proving that "Events & collective spaces can be both Covid-safe AND fun, joyful, sexy, debaucherous, connective! Share your stories/images to show what's possible."

People are still going to host celebrations, game nights, birthday parties, etc. Show them this account to let them know it is possible to gather safely.

Check out Covid conscious groups in your city or town on Facebook (often called "Still Coviding" groups) They often share local events or do things as groups

More useful resources

Individual sources

Compiled resources

Visualizing transmission

Here's an interactive flow chart where you can adjust variables and visualize how transmission happens (and how quickly) in indoor or outdoor spaces. Keep in mind that this resource is from 2021. With the new variants, transmission happens more quickly. But this is still a useful visual tool for explaining how transmission happens.

Extra mitigations

Everyone should know about additional mitigation strategies that can be layered into their routine for further protection from Covid. Respirators are by far the best tool we have now, but there are other mitigations that can be added into our routines for additional safety.

Here is the unfortunate truth: some people in our lives are not going to wear masks at this point, no matter what we say. They may eventually resume masking, but they are not going to go from not masking at all to wearing a mask all the time. And even for those that are, masks aren't 100% effective on their own but are a crucial part of layered mitigation strategy (see: the "Swiss Cheese" model). Everyone should know about other mitigations that reduce Covid's infectivity. CPC mouthwash is easy to get people to agree to using, because it's cheap and easy. Most people have not heard about this layer of protection, and this one is not hard to get people to start doing.

HOWEVER! We don't want these non-mask mitigations to be used as a way to avoid asking someone to wear a mask just because it's uncomfortable or very difficult to bring up the topic of masking. The fear is real, right? It's scary to bring up masks sometimes. It's scary to be direct, and scary to risk losing someone, or to feel like by doing so, you're giving them a 'reason' to distance themselves from you.

But we want to make sure that people are at least saying, "Hey, this is what would really, actually, truly protect you, and your community, and me, and this is what I would hope for you to be doing and what my real ask is here." That sentence is really, really hard to say, but this is a situation where every second does count. Someone could be disabled at any time by this virus. So we want to make sure we're talking about respirators, somehow, even in the first conversation. And then saying, I get that this is a lot to take in. I also want you to know that there are other mitigations you can take also.

Asking people to wear masks is really crucial. You can't know why people are avoiding masking until you try suggesting masks. It can be brief, but don't suggest CPC mouthwash and not bring up masks at all. Please do not do that.

In the past, many of us avoided asking people directly to wear a mask around us, even people who know and love us already. We were each scared of losing even more friendships than we have up until now. But our close friends know us and trust us. We have a foundation.

So, we're each trying to overcome that shyness / social programming / fear of losing people / fear of upsetting others by just saying:

"I'm not going to like, harp on it and you obviously can make your own decisions. But I really do wish you would wear a mask in public spaces, because I'm personally affected by this choice that everyone is making right now, and I'm stuck at home indefinitely, and you are more vulnerable than you think, and I want both of us to be safe. Wearing a mask could save your life. I am asking you to wear a mask."

We've got to remember that what we are asking is NOT rude. We are asking for the opposite of rudeness. We are asking for our humanity to be considered, for people to consider their own humanity.

It's not rudeness to ask others to wear masks.

Additional mitigations to encourage

Encourage them to stay home when they are feeling sick, even if they don't think they're contagious.

Encourage them to open windows and improve ventilation at home when other people are visiting and explain why this is important.

Show them how to switch their AC fan from "auto" to "on" when people are visiting (along with opening windows and turning on other fans) and explain that ventilation reduces risk because Covid travels in the air like smoke.

📝: Having an air conditioner does not count as improving ventilation. Increase air movement by turning up available fans including AC and opening windows. In larger buildings (usually businesses, schools etc) the AC and ventilation might be the same and buildings may even have HEPA filters and ventilation but not have it on due to cost saving or other reasons. In this context, turn the system from 'Auto' to 'On' while the room/building is occupied for cleaner indoor air.

Basic ventilation at home: Put a fan in a window (facing out the window) and open that window. Open another window on the opposite side of the room/house for cross airflow.

Climate control: Whether it's hot or cold outside, having the windows open a crack on opposite sides of the house will increase ventilation without sacrificing climate control.

If possible, give them rapid tests or PCR tests to keep at home (make sure they know how to use them)

Encourage them to move plans outdoors as often as the weather allows. For example, help them pick a restaurant that has outdoor seating, patio heaters, or misters if they're planning a restaurant celebration.

Encourage them to keep up with Covid transmission data, if wastewater tracking is available in their area. And teach them how to find this info!

Tell them about / buy them some CPC mouthwash, which studies have shown to be effective
at reducing the infectivity of Covid.CPC in mouthwashes has been shown in humans to break the membrane of SARS-CoV-2 and reduce the amount of active virus in saliva and is very inexpensive:

Tell them to use nasal sprays before and after potential exposures. Here's a guide to the ones with studies to back them up:

Tell them about HOCL spray. Studies have shown that it can be an effective antiseptic against many viruses including SARS-CoV-2 It can be used directly on skin. (here is an example)

Buy them / encourage them to buy a HEPA filter to use at home, at work, or in their child's school, or build them a Corsi-Rosenthal box.

HEPA filters can be expensive, but they often go on sale. Check sites like Walmart, Target, Best Buy, and Amazon regularly for sales, or set a price alert on Google to be notified about deals.

Keep shopping carts open in several tabs and wait for price drops

If you can afford it, buy an Aranet4! And carry it with you everywhere. Having the data can really help people grasp the indoor air quality problem and measuring air quality can help you learn more intuitively what high risk situations look like. I waited until they went on sale and I'm using it to talk to people about Covid safety (and logging my readings on the Raven app whenever I have to go someplace.)

Search Twitter / Google for "Aranet coupon" and you can probably snag a $30-$50 discount

Here's a video specifically about testing a bunch of under-$100 CO2 testers. A few are good enough to know if you're in a high risk situation, but their accuracy is hard to guarantee

Here is another list of affordable CO2 monitors

The Swiss Cheese model

(Image sourced from: this tweet)

Testimonies

Here's some powerful ones:

Pandemic analysis sources

People whose analysis of the pandemic we largely trust:

Further reading

Traveling safely during the pandemic

Ideally no one would be traveling during an ongoing pandemic. But we understand that many of us don't have that option, for many different reasons. So this is an attempt to collect some tips for how to travel as safely as possible.

Fortunately, the same techniques that apply in other areas of our lives apply here, too. The "Swiss cheese model" works on planes and trains and cars and boats and public transport and hotels (and so on).

Wear a mask (FFP2/3/N95/etc)

Do what you can to improve airflow. Open a window or even bring a portable HEPA.

Bring some masks for others! Being able to hand out factory-wrapped masks when someone asks is a great way to help other people be safer and have some of the other conversations throughout this doc!

Travel during off-peak times. Depending on where you live and what kind of transport you're taking, you can probably guesstimate when things will be busiest.

Take advantage of various tools that exist to track traffic:

flightradar24 for planes

your local train/ferry/bus app

various mapping tools (Google/Apple Maps, Citymapper, etc.) can be useful for this, as they often have traffic flow built-in, or you can even check traffic webcams

you can also check Google's popularity estimator

Some tips for searches: "(airport) busy times", "quieter travel (travel network)", "traffic at (location)", "traffic webcam (city name)".

There are plenty of additional mitigations you can add to your routine. Nasal sprays and mouthwash can be found in travel sizes, and are sometimes sold at stations or in airports.

For long journeys where you won't be in a safe environment for removing your mask, or as necessary, see if you can get a SIP valve. It is not a 100% perfect solution, but for situations where it is necessary, it is better than taking off your mask entirely. (More details on these valves can be found in this helpful thread.)

Modes of Transportation

Cars

The safest way to travel (if we're only talking about Covid) is by taking your own car or the car of someone you trust. You can control the air (more or less), and if traveling with others, you can do things like testing, masking, and keeping windows open.

If you are traveling in a rideshare vehicle or taxi, you can't really control what prior occupants have done. But you can wear a mask, and if you feel up to it, you can encourage the driver to do so also. You can also ask to open the window(s). Some people have had success bringing their CO2 monitor along for the ride, and using that as a conversation starter. We've had really good conversations with drivers about mask types and why masks are still necessary. Many drivers and other gig workers know all too well the risks and likelihood of getting sick on the job, so you can be their passenger today that doesn't put them at risk!

Another thing you might do is drop a note in the pickup notes section some rideshare apps have and just mention that you are wearing a mask to avoid getting sick, not because you are sick, this can help put your driver at ease and be a good way to start a conversation, if you wish. (Don't feel you have to do this every time, of course!)

For transport workers

In addition to following the tips above, you might want to look into a SIP valve, and consider an in-car portable HEPA. You are doing a hard and unforgiving job, so anything you can do to take care of yourself and your passengers will benefit you in the long term. (One of the authors of this doc was recently in a rideshare where the CO2 hit ~2200!)

Public transportation, short and long distance (buses, trains, ferries, etc)

Some systems will allow you to open windows, but not all. If you're taking the ferry, there may be an outdoor section. Generally speaking though, these are systems with uneven air changes and lots of people using them. Still, plenty of people have managed to take public transportation throughout the pandemic without getting sick; they wear good masks and try to travel during quieter times. If you have a CO2 meter, try gathering data along your usual route(s) and see if you might need to reconfigure. Public transit systems do not always have filtration systems, or if they do, sometimes you will need to rely on them being switched on. Some people have had success bringing portable HEPA units onto trains with private cabins, but this is often expensive and limited in terms of availability. A portable HEPA certainly won't hurt, though.

Airplanes

The same advice for other forms of transit applies here, with a few caveats. One thing to note is that airplanes generally have some degree of filtration for their onboard air systems. However, the filtration systems are not switched on until the plane has left the gate. Before the plane starts moving, treat the cabin as you would any other potentially infectious environment. In fact, even when the plane is in the air and has switched to internal air, you should still treat it that way; as this Twitter thread points out, a densely packed cabin means you're still at a high level of risk. Avoid flights as much as possible, or wear a fitted high quality mask throughout the flight. The SIP valve is your friend.

Cruises/long distance journeys by ship

Honestly, there are not very many ways to travel safely by ship. You are trapped in a small space on a large vehicle surrounded by hundreds (if not thousands) of people. And on cruises, your fellow passengers will hop on and off the boat, visiting multiple towns and cities along the voyage. Unless you have absolutely no other way to get from point A to Z, just say no to these methods of transportation. But if you must travel long distances on a ship, try to bring a portable HEPA and wear your mask as much as possible.

Staying in hotels

All of the above advice can and should be applied when you're staying in hotels. This thread is an interesting look at the specific design and technical features of most hotel rooms, though this may vary by region, hotel chain, etc. When in a room, since you don't know how long it has been since someone else was in there, most people suggest running a HEPA filter for at least an hour before taking your mask off. It's also smart to sanitize surfaces in the room with disinfecting wipes. You may also want to bring your own sheets/covers or request new ones. Hotels have been short-staffed, and taking these extra steps can help in case the room wasn't thoroughly cleaned (or someone sick stayed there before you).

An Airbnb or other short term rental may be safer, but you still have no control over who was in the space before. And if the Airbnb is a shared space, you are totally reliant on the kindness and Covid-sensibility of the owner. There are some other options (here's another good Twitter thread). Doing some research in advance will set you up for a safer journey.

How to talk to children and youth about Covid

Living in a pandemic is challenging. Caring for children and youth is challenging. Caring for children and youth during an ongoing global pandemic... 'challenging' is putting it lightly. However, we are certainly not the only people experiencing these challenges, even when it sometimes feels this way.

Here, we'll discuss talking with general ideas and tips for talking with children in our care, some considerations for navigating a school environment, submitted suggestions from caregivers, and resources that may help.

Ideas and tips

If you are caring for a young person, you have likely realized that they are smart. They are able, adept, and capable of learning and experiencing the worlds around them. Living in a pandemic is a big experience, and most people had little preparation for this experience prior to 2020. Presented are some ideas and tips for talking with kids. Some of these might be relevant to the children in your care, and some of these may not apply. Just like adults, kids share some similarities while also being unique individuals with different needs.

These conversations will likely not all happen at once. They may arise during teachable moments in day to day life; when putting on your mask, for example, you might take this chance to discuss masking and safety.

Explain the science

For some kids, understanding the science and how things work helps them understand big concepts easier. You can explain the science of Covid in terms the children in your care will understand. Explanations should be tailored according to their age. It's a good idea to break the idea down into pieces and then add the amount of detail that's appropriate for their age. For Covid, some main points of discussion could be:

1. Airborne spread: Explain how the germs that cause Covid are in the air. Covid germs spread when a person who is sick breathes out germs from their lungs. When people gather indoors together, without open windows or ventilation, it's easier to become sick because there are more germs in the air being shared.

2. Why masks work: Masks protect our nose and mouth from breathing in germs that enter our lungs. Masks help stop many different germs. The best masks are ones that fit snug on our faces, so all the air that comes in and out of our bodies is passing through the mask.

3. Safe and risky places, with solutions: Providing solutions and strategies for being in different places can be a good Q&A problem solving activity. One person (kid or adult) can toss out suggestions for potential spaces, and the other can provide the solutions. For example: Space is outdoors. Solution: If there are people nearby, we'll wear a mask.

4. Protecting yourself and others: Emphasize how important staying as healthy as we can be is important. Being sick isn't fun, and we all want kids to be able to do the fun things they enjoy. We know everyone is vulnerable to this virus, and we all deserve to be safe.

5. Long Covid: Some families have come up with a variety of different terms for this, including 'forever Covid' and 'Covid that doesn't go away'. Explain how this would limit the fun activities the kids can do, and the adults around them. Some kids resonate with the math: 1 out of 5 people have Covid that doesn't go away (according to the CDC).

6. Cats and dogs can get Covid: Kids love their family pets. Talking about staying healthy for people and pets can give one more example of why keeping Covid out of the family home is important.

Science is not intended to be scary. But sometimes, science can be scary. One strategy to overcome the fear is providing concrete strategies of things we can do. For example, you might say: "Long Covid sounds scary, but we know what we need to do: avoid becoming infected with Covid. And if we do get Covid, we try really hard to not become infected again."

If the children around you are older, they may want to see more information that they can read and understand on their own. An excellent resource is the Public Health Agency of Canada, which discusses the effects of Covid, Long Covid, and ongoing effective mitigations. The language is written in a way the general public can understand, approximately at a Grade 6 reading level.

Your perspective

For some kids, personal stories resonate greater than science. Consider sharing why you are taking the safety measures you're taking, and why this is important. Is it to protect yourself? Or someone else? Is it to avoid the risks of Long Covid? There are so many reasons to avoid Covid. Sharing your own reasons can create greater understanding for those around you.

Prior knowledge and explaining differences

Kids come across information from a variety of different sources in many different ways, be it from their extended family, friends, the media, or elsewhere. If you are practicing strict ongoing disease mitigations, these practices may not be common in your area. Here are three effective notes to talk about this difference:

1. Being different is okay. It's okay to do things differently, because people can be very different from one another.

2. We don't have to be like everyone else. We do what's best for us and those around us. If some families don't wear masks or don't avoid large gatherings, that is their choice. And we make our own choices that work for us.

3. Is this information true? We hear and see all sorts of information, and not all of it is correct. Comparing the source and where the information came from to a known true source is an excellent skill to have, whether we're talking about the pandemic or not.

Respect

Just like us, children and youth are living through and navigating an ongoing pandemic. Take moments to acknowledge the incredible and commendable work they are doing. Speak to them with respect; they deserve it.

School environments

Traditional schooling has never been the only option. There are a variety of ways for students to get an education, including traditional schooling, homeschooling, or virtual schooling. For homeschooling, there are a variety of curricula available to suit many different families and cultures. Virtual school is available in many countries in a variety of forms. We can find the systems that work best for us, even when they aren't common. The method of instruction that works best for you and your family is the right one.

Navigating Covid in the current school system can be incredibly challenging. There are many different schools that can operate in many different ways, even in the same regional area. One recommendation would be to reach out to parents who share your same concerns. If there are none in your area, the search can be widened to a larger zone. Sometimes a post on social media or messages to like-minded folks can get the momentum started (on Facebook there are many 'Still Coviding' regional groups). A small group of parents can be incredibly powerful, especially when there is science and compassion on their side.

Parents respond: How do you talk with your children about Covid?

I lived with a chronic illness and my daughter understands the importance of protecting my health. While I've recovered, she continues to wear a mask to protect others who are sick or vulnerable. We always frame it to be about the collective and social justice. She's been such a champ.

-CC

My kid was 8 years old when Covid first started. She played the game Pandemic and watched an anime called Cells at Work, which helped explain what was going on. Plus, she's a big aficionado of Japanese entertainment, and masks aren't looked down upon there.

-JO

I give accurate information. They know it's airborne, the difference between a mask and a respirator. They know what fit testing is and why it's needed and that 'mild' SARS2 infection can cause immune/organ/etc damage. They know it's easy to stop transmission with science based policies.

-FMK

Kids are in college. Every phone call ends with 'Are you wearing a mask? Using Enovid?'

-SC

My son is autistic and masks were very difficult at first due to sensory issues. After we talked about safety and how we wear masks to protect others and ourselves, it was a non issue. He wears his mask every time we go out and even reminds others.

-LMM

She knows Covid is bad. She knows masks help reduce the risk of contracting. We're open with her about sharing feelings on masking. She's more concerned about her friends not masking and getting sick than she is about being the only masker.

-CO

We've discussed airborne transmission at length. Both kiddos understand how Covid spreads and they also know it's bad news. I've tried to be honest without terrifying them, so they know it can disable you. They also know the government is hiding a lot of info from us, but I generally try to let them ask questions rather than just telling them stuff.

-SB

For masks, I use the same line as flu shots. We wear masks to protect our friends and people who can't wear them. My kids don't love masks. But they've never complained, because they know that the world they live in is bigger than they are. They also enjoy not being sick. I'm not sure if they remember what it's like to have a cold. They have very few memories of the snotty nosed before times.

-HJ

We explain to them that because it's a new virus we don't know the full scope of how it's harming people. We recently explained how the immune system works and what can happen when it's damaged. That seemed to resonate with them as well. My kiddos are 6 and 8 years old. We have watched How do people catch a cold? Ask the Storybots a few times as kind of a springboard to chat about the difference between a cold and Covid and why masking is an excellent layer of protection.

-SSB

Resources for children and youth

Books

Videos

For younger kids:

For older kids:

For all ages:

How to deal with grief: From 'normal' to normal

📝 ⚠️ Important: None of us are mental health professionals. The following section represents the reflections of people living through and coping with pandemic grief, sharing our thoughts with others doing the same.

How to deal with grief in times of global crisis

We want things to go back to normal. But normal is what got us here. Now, we find ourselves in a state of climate catastrophe, unmitigated spread of disease, war, and fascism.

Normal will eventually wither away our world if we continue to cling on to it. We cannot hold onto something that is dying. Reminiscing on getting back to normal is holding us back from creating a better world. The truth is this: The earth is dying. People are dying. Genocide is happening. Animals are dying. People are starving. People are losing their homes to the climate crisis. People are enslaved even on this very soil we call our home. The people, the animals, the plants and the earth are dying. To be more accurate: the earth isn't dying, we are killing it, and the symptoms of death are the result. We aren't free if we're clinging on to death. We'll never be free until we face it and let go.

This is a huge thing for people to grapple with. It's overwhelming and carries more weight than anyone alone could bear. When confronting this reality, we have to remember what we are experiencing is grief. We all are dealing with grief. To grapple with this means each of us have to grieve the loss of what we thought we would have, grieve vision(s) of our future and our children's futures. We have to Grieve our former plans, hopes and dreams, because they cannot fruitfully exist in a dying world.

Grief is tough. Most of us have dealt with grief in the form of losing a loved one or a pet. Many of us haven't even yet dealt with grieving the things we envisioned for ourselves. To grieve something as big as our future; it's understandable to want to push this grief aside. But not dealing with it doesn't mean the loss goes away. We cannot change our future for the better without acknowledging our current reality. But we have to face it to change it. We have to grieve to move on. We must process this and heal. This is a huge thing to face.

It's a big ask to truly let the old world go.

Not everything faced can be changed but nothing can be changed until it is faced

-James Baldwin

But after grieving the old world and letting go opens up so many possibilities, we get to imagine a new normal, a new future. Grief opens us up to new possibilities for our world. One that is safe and healthy. Where people are fed and housed. Where we create things that are sustainable, useful and fun. Where we repair the harm humans have caused to the planet and to ourselves. We have to fundamentally change course and think differently. Our whole mindset has to change if we want a chance to create this world.

The old normal will come to an end eventually. We can only choose if it ends in disaster or in healing. It's time to choose.

There are stages to grief, but usually those apply to expected things, like the loss of a loved one. How do we grieve a loss as big as this?

Stages of grief

Shock and denial

Shock is the stage of grief where we continue to behave normally detached emotion, because the gravity of the situation has not sunk in yet. It seems strange to receive bad news and get up and say well, is anyone hungry? or hey, let's go see that new movie. Almost as if you never received the news. But this is a normal reaction for people in the initial state of shock.

Dealing with the shock of the climate crisis, pandemic and ongoing global crises is a huge shock, because so much of what's happening is not in our control. We kind of know what's happening, but we are so used to normal that we often go on autopilot. The news is so big and so heavy we effectively stand still in our "normal" lives, often not acknowledging these truths, or only acknowledging in part just how bad things are. This shock can lead us towards denial. It is moving from a numb disbelief to the denial of one's feelings towards the new reality.

This is when many people will intentionally ignore reality because to our brains, reality is a threat that they can't deal with. Denial is knowing the reality but actively choosing to ignore it because it's so overwhelming. The climate crisis, pandemic, and fascism are all overwhelming things to acknowledge. These are big problems and as individuals, we can feel powerless. So we often turn to denial. This can be as simple as pretending to not be aware of some information, finding conflicting information that seems more palatable, pretending that everything's fine, keeping distance from people who acknowledge reality, or finding other ways to avoid facing the problem. But ignoring it and proceeding as normal doesn't mean these things aren't happening.

Denial can last a long time. Many people never get out of denial. In fact, this is where many people are right now: stuck in the first stage of grief, denying themselves of the freedom of moving on.

In order to move from denial or help others do the same, it's important to acknowledge being overwhelmed by reality is human and valid. You must understand that no one is a bad person for being in denial. It is a part of our western society to normalize and minimize these crises, because there are people with power and money that benefit from things not changing. You must give yourself compassion and grace. Grief, in all stages, is normal; it is a fundamental part of being human. Moving on from denial comes with a lot of emotions that make it overwhelming. Understand that as humans we are supposed to feel all of these emotions. Emotions are natural human responses, and engaging with them is engaging with parts of our humanity.

How do we process these emotions? We have to talk to each other. We have to move out of the expectation of silent disengagement of the horrors of reality. Start by talking to your friends, family, neighbors or a therapist (if you have access to one). To move on, we have to learn to acknowledge and process what is happening, how we got here, and how we feel-about it and ourselves.

Lastly, find a community and start reaching out. Find a community that will keep you accountable to your values and where you feel safe. Processing grief must be done in community; grief in isolation is not effective.

Resources to find community

Finding community can be a challenge. Everyone is grieving right now, and finding your people takes time. Try to be gentle with yourself and not give up.

Some Instagram accounts that talk about grief in an anti-colonial way (and sometimes host free online events)

Therapy resources

Pain and guilt

Coming out of denial brings a lot of pain, because this is the first step towards accepting a new reality. A lot of emotions come with this. You may feel like there is an emptiness that can't be filled anymore. The void that's left behind after a major life change might even feel similar to the void left behind after a death. Maybe you would talk to that person everyday and now you can't; there is a void in your life. Grieving a lost future is much like this. You've spent so much time envisioning it and planning for it, only to realize that the world you planned for doesn't exist. Many of us experience this when a huge part of what we had planned for our future chances. For example, you might grieve your lost future after the sudden loss of a loved one, after the end of an abusive relationship, after the loss of a job or loss of a home, or after a sudden loss of health.For some of us, our future may never have been clear or had a positive outlook to begin with. Whatever you have experienced or envisioned in your life leading up until the pandemic, you were most likely unprepared for this type of grief.

None of us expected the world to change so dramatically. We don't typically expect the framework of our life or the earth we inhabit to start crumbling. It's a scary reality to accept, and it's normal to feel pain and guilt. You may be asking yourself: What can we envision as a future if everything must change for our survival? How do we plan for our future if it's uncertain? What are our goals for ourselves? What can we do about the current way of life that isn't working in a collapsing world?

There may be a feeling of wishing you had realized the truth sooner. You might have a guilty sinking feeling or wish that you could have done something else with your time. Maybe your inner monologue is: "If only I had realized sooner. If only...if only..." And it's OK to feel this way; all of the emotions we feel are human and valid. It is also human to not have understood how bad things were before now. Every effort was made by those in power to keep all of us in the dark about the pandemic in order to uphold the status quo.

Lastly, you may also have a feeling of losing time. What about all the time and effort we put into our former lives? Looking back, you may wonder, 'Was it a waste?' You may feel like you wasted your life to come to this point. Many of us are becoming more and more aware of the deep inequities in our society. Many of us are realizing that our institutions don't value our lives, or see our humanity at all; this is painful to come to terms with. You may ask yourself, "How did I miss this? What was I thinking?" Again, guilt and pain are human feelings, and allowing ourselves to feel the weight of these emotions is important. When we allow ourselves to face reality and feel the weight of losing the futures we once envisioned, we can move away from the guilt we may have around letting go of our old normal. We can start the process of letting go because we know now that we must.

Remember: we grieve in solitude but we also grieve in community. We are individuals, but we are also a part of a greater community. Grieving in community (and even alone) is always difficult. Not just because some emotions are difficult, but because Western culture conditions us to turn away from these emotions. Many of us were raised in cultures promoting a toxic positivity, "good vibes only" mindset. We may even feel guilty for bringing down the mood with our own pain. There is almost an expectation to look at everything on fire (figuratively and literally) and just think happy thoughts, or turn away. But turning away from negative emotions is turning away from our humanity. We have these emotions for a reason, to guide us towards a different path. The sadness we feel at seeing injustice is a call to action, and a call toward building a more just world.

We can learn to view ourselves and others with compassion. We can encourage the people around us to do the same. Compassion is a building block of a strong community. And community is what we need most of all if we're going to build a new future, a new normal.
to be continued! #MASKUP

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How To Talk To Your Loved Ones About Covid

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"Sadly, the tale of generational progress that we have taken for granted in recent generations is no longer a guarantee for Millennial and Gen Z women. The erosion of rights and protections, a complicated economic reality, and the mental health tolls of the political, ecological, and social climate have contributed to a less uncertain future for today’s young women" 

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"Sadly, the tale of generational progress that we have taken for granted in recent generations is no longer a guarantee for Millennial and Gen Z women. The erosion of rights and protections, a complicated economic reality, and the mental health tolls of the political, ecological, and social climate have contributed to a less uncertain future for today’s young women" 

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https://www.prb.org/wp-content/uploads/2023/11/Losing-More-Ground_Population-Bulletin-Vol-77-No-1.pdf

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"However, to realize this potential, BARDA and Project NextGen must prioritize the development of new oral antivirals to address gaps for vulnerable individuals and give us the best chance to finally turn the page on this pandemic".

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"However, to realize this potential, BARDA and Project NextGen must prioritize the development of new oral antivirals to address gaps for vulnerable individuals and give us the best chance to finally turn the page on this pandemic".

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https://thehill.com/opinion/4366619-project-nextgen-is-ignoring-new-covid-19-antivirals-when-we-need-them-most/https://thehill.com/opinion/4366619-project-nextgen-is-ignoring-new-covid-19-antivirals-when-we-need-them-most/

Biomedical Advanced Research and Development Authority (BARDA)-led Project NextGen

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Project NextGen is ignoring new COVID-19 antivirals when we need them most

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The time for complacency is over. Relying solely on vaccines and mAbs isn’t a sustainable long-term solution against a virus that rapidly outpaces our current preventive and therapeutic arsenal.

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"The good news is that we know a lot more now about how COVID affects the immune system.  The bad news is that it really, really does a number on our immune system".

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"The good news is that we know a lot more now about how COVID affects the immune system.  The bad news is that it really, really does a number on our immune system".

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https://www.dailykos.com/stories/2023/12/25/2213619/-Covid-is-not-done-with-us-It-s-just-getting-started-We-really-should-be-paying-attention

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attribution: uploaded by weareunited

Are we really done with Covid? The general perception now seems to be that Covid is like getting a cold or the flu-you get it, you get over it, and life goes on. No big deal. We are certainly not in the 5-alarm-fire mode that we were in four years ago, but that doesn't mean the fire is out. The pandemic may not have been an extinction-level event for humanity, in that we survived it, but Covid appears to have permanently altered our ability to resist infections at a "herd immunity" level.

I don't know how many of you saw (or read) the excellent article by Examined: Covid. It's On. Again. There are three resources linked in that story, which I would encourage you to read. There is an amazing amount of research that has been done and is still being done. The good news is that we know a lot more now about how Covid affects the immune system. The bad news is that it really, really does a number on our immune system.

From the linked Memorial Sloan Kettering website, we have this [emphases added]:

CD4⁺ helper T cells and CD8⁺ cytotoxic T cells have been identified as crucial in the immunologic response to SARS-CoV-2 infection. CD4⁺ T cells are responsive to the virus's spike protein, and the presence of CD8⁺ T cell expansion in bronchoalveolar lavage is correlated with illness moderation. However, one of the most remarkable characteristics of immune dysregulation in COVID-19 is an immense depletion of CD4⁺ and CD8⁺ T cells associated with disease severity.

While lymphopenia is observed in other respiratory viral illnesses such as influenza A H3N2 viral infection, COVID-19 induced lymphocytic depletion is distinctive for its magnitude and longevity. Additionally, CD8⁺ T cells, crucial for their cytotoxic activity against virally infected cells, may experience the more stark reduction. <snip>

Now, three years into the pandemic, with millions of infections and immunizations behind us, severe acute COVID-1 infections are becoming significantly less common -- though COVID-19 is still causing significant hospitalizations and mortality across the globe. But generally speaking most individuals are no longer concerned with the acute infection stage of COVID-19. To the point that getting the virus may seem unremarkable and not a cause for concern.

However, a new idea about how COVID can affect immunity has emerged: that even mild infections routinely cause consequential damage to our bodies' defenses. This degradation was referred to as "immunity theft" by T. Ryan Gregory, an evolutionary biologist, as a counterargument to "immunity debt" being the reason why respiratory infections were more severe than usual this past fall. <snip>

A March 2023 study published in the journal Immunity looked at how the immune system responded to both COVID-19 infection and COVID-19 vaccination. What the researchers found was that the magnitude and quality of CD8⁺ T cell activation and expansion after two COVID-19 vaccine doses were considerably lower in people with prior SARS-CoV-2 infection compared to people without prior infection, suggesting that previous infection can influence the T cell response to vaccination.

Taken together, the researchers write, "these findings suggest that SARS-CoV-2 infection damages the CD8+ T cell response, an effect akin to that observed in earlier studies showing long-term damage to the immune system after infection with viruses such as hepatitis C or HIV. The new findings highlight the need to develop vaccination strategies to specifically boost antiviral CD8+ T cell responses in people previously infected with SARS-CoV-2, the researchers conclude."

And from the linked World Health Network article, we have this [emphases added]:

We know that reinfections occur, and they seem to be increasing. With our present high levels of transmission, many individuals will likely be experiencing two or more infections per year going forward. The immune system is damaged for more than half a year after infection, with dendritic cell deficiencies at least 7 months and both innate (NK cells, LD neutrophils, CXCR3+ monocytes) and adaptive immune cells (T helper, T follicular helper, and regulatory T cells) shown to be involved in immune dysfunction which had not ended at 8 months after infection. Reinfection has been shown to increase the cumulative risk of death, hospitalization, and sequelae in multiple organ systems in both the acute and postacute phase. This shows the immune system is not protective enough to limit damage by further COVID-19 infections or other infections, even after vaccination. This is a serious issue if we are continually reinfected before the immune system recovers each time. It is also important to remember that although children can still produce naive T cells, adults have a limited number. A very serious concern is that multiple COVID-19 infections early in life might age the immune system leading to immune systems similar to those of elderly in considerably younger individuals.

Our immunological protection against infection is also showing signs of decline with the omicron variant, and especially its new subvariants. Immune responses are not effectively induced against the omicron variant by previous infections with earlier variants, even in triply vaccinated individuals, and omicron infection itself is not an effective natural immune booster against itself. Furthermore, this study indicates a decline in the positive aspects of the immune response by some means. Hence, we can expect the negative aspects of infection to increase in severity because the antibody responses are not as effective. Combined with the increased SARS-COV-2 binding affinity, and reduced ability to clear the virus, it appears we should anticipate more chronic infections.

COVID-19 infection has several very concerning effects on the immune system that might easily lead to advantages for other pathogens as well as worse outcomes in COVID-19 reinfections. This immune dysfunction or aging is at least one of the most likely scenarios explaining the recent surges in diseases like RSV, influenza, Strep A, and other infections. By contrast, immunity debt is not considered a viable explanation as the surges of these diseases continue in countries that had surges last season and immunity wanes for many of these diseases. Another serious concern at this point is that repeated infections by COVID-19 might lead to depletion or exhaustion of cytotoxic CD8+ T cells which could have downstream effects on other diseases like cancers, as these T cells are instrumental in limiting tumor proliferation and have been shown to differentiate to become dysfunctional.

The World Health Network article has a list of research articles at the end. The author has kindly quoted the researchers' conclusions or summarized their articles, and in several cases, has included a figure from an article that helps explain how the immune system works and how Covid damages it. Reading through these summaries makes it clear how devastating Covid is. It is not "just like a cold."

The bottom line is that, even if you had a mild case and fully recovered from the initial Covid infection without getting long Covid, your immune system has been compromised. This makes it more difficult for your body to resist other pathogens, like RSV and influenza viruses, which would account for the increased rates and severity of those infections that are now being seen. There is also evidence that Covid causes permanent, long-term changes in the immune system that are similar to AIDS.

The full effects of Covid will not be seen for years, but it is not hard to predict that we will have far more people who are disabled in the future. Our (inadequate) social safety nets for people with disabilities were already maxed out and now we have millions more who have been disabled from Covid-associated events (e.g., stroke, heart attack, kidney failure) and from long Covid. We already have a shortage of doctors and nurses as well as a shortage of long-term care facilities, but we haven't even begun to see the impacts from the increased incidence of autoimmune diseases and the increased susceptibility to other infectious diseases and cancers.

It is astonishing to me that there is not more concern about Covid and more effort to avoid infection. I understand that folks are just over it and want to move on with their lives. But Covid is not done with us. It's just getting started. We really should be paying attention.

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Covid is not done with us. It's just getting started. We really should be paying attention.

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Are we really done with Covid? The general perception now seems to be that Covid is like getting a cold or the flu-you get it, you get over it, and life goes on. No big deal. We are certainly not in the 5-alarm-fire mode that we were in four years ago,...

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"In light of long COVID possibly being cumulative, many of those involved with the disease, from clinicians and scientists to disability advocates and journalists, are so concerned they've signed an open letter to US President Biden urging for more support for the people facing this condition".

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"In light of long COVID possibly being cumulative, many of those involved with the disease, from clinicians and scientists to disability advocates and journalists, are so concerned they've signed an open letter to US President Biden urging for more support for the people facing this condition".

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https://www.sciencealert.com/every-covid-infection-increases-your-risk-of-long-covid-study-warns

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Vaccines ensure bouts of COVID are far less deadly than they were at the pandemic's start, yet multiple studies now suggest even seemingly mild cases of the coronavirus have a cost. With every single infection, our risk of long COVID increases.

While this risk starts (relatively) low for most of us, particularly those vaccinated and in younger people or children, there are concerning signs it may not stay low. If each new invasion of our bodies allows this insidious virus a greater chance to cause damage, such small risks will eventually add up to a big one.

Even if you only experience the symptom of the initial infection mildly.

"Each subsequent COVID infection will increase your risk of developing chronic health issues like diabetes, kidney disease, organ failure and even mental health problems," physician Rambod Rouhbakhsh warned journalist Sara Berg in an American Medical Association podcast earlier this year.

"This dispels the myth that repeated brushes with the virus are mild and you don't have to worry about it. It is akin to playing Russian roulette."

Long COVID is defined as a multisystem disease that have a devastating effect on any organ system, with potentially lifelong consequences. Rates of long COVID among people who have contracted SARS-CoV-2 vary controversially between studies and regions, from about 10 percent to a staggering 50 percent of people who've had the virus reported as having long term symptoms.

Global estimates suggest 65 million people now suffer from long COVID. Luckily, children currently appear to be impacted at much lower rates, but they're not entirely spared either.

So epidemiologist Benjamin Bowe and colleagues followed 138,818 US veterans with SAR-CoV-2 infections across 2 years, to learn more. Their data demonstrates that on reinfection patients had increased risk of long COVID in multiple organ systems.

The adverse health effects from two infections are worse than one, and three infections worse than two, the researchers explain. This means long COVID is cumulative, at least within this group of people and with this number of re-infections.

As their research is only based on US veterans affairs patients, it may not translate to everyone, but this is not the only study to find this concerning trend.

A study with much broader sampling involving people aged 18 and over across 10 Canadian provinces points to the same conclusion:

"The study adds to a growing body of evidence around the association between COVID-19 reinfection and the reporting of long-term symptoms," McGill University statistician Sianne Kuang and team write.

Another study, which has yet to be peer reviewed, used data recorded from 1.5 million people in the US to compare severities of initial and subsequent infections. They also note an increase in long COVID after reinfections in the variants following Delta and Omicron.

Whether this is down to reinfection in general or due to changes in newer SARS-Cov-2 strains is still unclear. What's more, Kuang and team caution the studies demonstrating this increase in risk are still "limited in number and generalizability."

However we also know the virus changes our immune systems. It preys on our memory T cells which are critical in forming long term immunity. SARS-Cov-2 forces its way into these cells and causes them to activate the cell's self-destruction programming and essentially implode.

Whether we experience a mild or severe COVID infection, COVID depletes our T cells. This is only one of the long term consequences of COVID, and may contribute to more severe and frequent outbreaks of other diseases like pneumonia and RSV.

Now, approaching the holiday season, wastewater testing indicates many countries, including in the US, are experiencing large new surges of COVID infections. Higher than ever in some places like Germany.

It seems allowing this rapidly mutating pathogen to run rampant has provided it with the perfect laboratory to keep testing out random gene mutations until SARS-CoV-2 stumbles on one that can get past our next line of defenses and out-competes the other strains.

The new JN.1 strain, also called Pirola, has managed just that. A single mutation appears to have made it harder for our immune systems to capture and thwart, meaning past vaccines and infections are no longer as protective.

Early signs indicate the most updated XBB.1.5 vaccines may have better luck against Pirola.

In light of long COVID possibly being cumulative, many of those involved with the disease, from clinicians and scientists to disability advocates and journalists, are so concerned they've signed an open letter to US President Biden urging for more support for the people facing this condition.

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Every COVID Infection Increases Your Risk of Long COVID, Study Warns

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Vaccines ensure bouts of COVID are far less deadly than they were at the pandemic's start, yet multiple studies now suggest even seemingly mild cases of the coronavirus have a cost.

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"For me, podcasts were patient companions who didn’t mind repeating themselves, and a descriptive medium when I couldn’t comprehend multimedia".

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"For me, podcasts were patient companions who didn’t mind repeating themselves, and a descriptive medium when I couldn’t comprehend multimedia".

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https://this.org/2023/12/19/how-tv-podcasts-helped-me-regain-my-memory-after-long-covid/

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When my girlfriend of six years broke up with me by text, followed by a short call, I couldn't comprehend it. It wasn't grief, shock, or denial. My brain, damaged from 16 months of Long COVID, couldn't read or write, splice voices from background noise, or parse words said fast enough to react. When our friends asked what happened, I couldn't explain the literally, not just emotionally, incomprehensible.

Early media coverage of the virus's neurocognitive impacts focused on smell and taste, driven by viral videos of patients unable to tell pickle juice from lemonade. But SARS-CoV-2 can affect every sense and most aspects of cognition. My experience was severe but not rare: impaired word recall and object recognition; executive functioning, such as following steps to do laundry; and spatial memory, even in my own apartment. Conversations were dream-like, disorienting, and difficult; technology use triggered sudden naps. The pandemic's collective TV-watching, live-streaming era passed me by. My life became as quiet as I could make it, and all the more isolating.

Louise Cummings, a professor in the Department of English and Communication at Hong Kong Polytechnic University, says that "language is breaking down" in adults with Long COVID. "Even a short, slow-paced conversation can induce a severe flare-up of symptoms," she says, "necessitating many days of rest in some cases." In her 2023 study, participants reported difficulty finding words (93 percent), losing concentration when talking (89.6 percent), recalling what was said (65.4 percent), or understanding speech (38 percent). Conservative estimates of Long COVID incidence are at least 10 percent of infections, and neurocognitive symptoms are among the most common and longest lasting. But while other types of brain injury (e.g., from a stroke) may show on a static scan, Cummings says "the disruption to brain physiology in Long COVID is likely...more subtle."

Studies that do show this disruption use specialized testing not available to most patients. A University of Waterloo study found reduced oxygen saturation in the prefrontal cortex during cognitive tasks. Oxygen is fundamental to brain functioning, implicated in fuel metabolism and neuron communication. Numerous studies, including two from the University of California, San Francisco and CAMH in Toronto, found inflammatory markers in the brain and cerebrospinal fluid, known to impact memory and mood.

When my hospital network opened a Long COVID clinic and I was seen virtually, 20 months post-infection, the cognitive rehab specialist recommended a maximum of 20 minutes per day of cognitive or screen activity. She said I'd likely never work again: my brain was irreparably damaged. Like most clinics, there were no neurologists, cardiologists, or infectious disease specialists, no diagnostics or prescriptions; only virtual patient education on adjusting to illness, social workers and dieticians, and a PDF handout on attention and memory I couldn't read. To get treatment, I had to find my own specialists, including in private practice.

Desperate for distraction while bedridden, I could only handle instrumental music: nigunim (Jewish songs in lilting rounds of nonsense syllables) or small classical ensembles. Slowly, I added podcasts, listening for short stints without multitasking. My favourite hosts were always two intimates whose conversations felt like lounging after a dinner party. I'd let the social ambiance wash over me, an experience that violated public health policy. Even when I couldn't handle watching closed-captioned TV, I listened to backlogs of "Witch, Please" ("a fortnightly podcast about the Harry Potter world"); official cast and crew pods for The Good Place and Hacks; recap shows like "Out on the Lanai;" and "Race Chaser" ("dedicated to the discussion, dissection and dissemination of every single episode of RuPaul's Drag Race "). It helped to hear familiar voices describing familiar things without pressure to contribute, to practice comprehension and memory in a low-stakes environment.

Some formats felt more accessible, even rehabilitating. Hannah McGregor, program director of Simon Fraser University's publishing program and co-host of "Witch, Please" with Marcelle Kosman, suggests this could be due to pedagogical principles built into good podcasting. "Core to teaching is repetition," McGregor says. "You need to articulate things multiple times for them to resonate with people, and ideally, you will articulate them in multiple different ways." Podcasts, like all serialized media, are "a balance of repetition and change," she says, a structurally predictable format with cues like segment intros or musical transitions. "Witch, Please" revisits every book and movie through different theoretical frameworks, glancing deftly sideways from critical theory back into fiction like the best undergrad class you never took. It uses the explainer format, in which one host presents research to the other, which McGregor says models "the actual process of listening" through active listening noises and follow-up questions, making it easier to stay engaged, especially for my overloaded brain.

Big Dipper, executive producer at the Moguls of Media (MOM) Network, says that "Race Chaser's" comforting balance of structure and improv is intentional, supported by guiding outlines and a timed four-segment format. "All the character, uniqueness, and what stands out...comes organically from [hosts, drag queens Willam and Alaska Thunderfuck] in conversation, but I give them a strong structure to hold onto so that they can really have freedom...to improv and talk shit." The hosts riff on a vast pastiche repertoire of Drag Race, queer canon, and cult classics, both reverential and sardonic, vividly describing the action on screen and outfits from hair to heel.

Big Dipper says the format made queens "far more accessible to their fanbase....long-form, true personalities, no facade." The podcast is a love letter to other media and mediums, not just in content but in style. The leisurely intros and outros come from Big Dipper's theatrical background. "I structure the majority of our shows [like this]: the cold open, theme song, intro, and an outro to let the audience down gently." Cummings says frameworks like these can be helpful. "If an interview has a set structure, you are able to use a mental template of how it will proceed, to facilitate comprehension," she says, compensating for the lack of visual cues. The format is comforting, says Big Dipper, because "nothing is expected of the listener" and you can "let it wash over you." Listening helped me rebuild memory retrieval pathways for sound and images.

For me, podcasts were patient companions who didn't mind repeating themselves, and a descriptive medium when I couldn't comprehend multimedia. They kept me company when I was too sick to leave the house, when in-person events were banned, and my community fell apart post-breakup.

Even now, three years into this, large Zoom meetings and dinner parties are still challenging and nightclubs are inconceivably inaccessible. But I can listen in on other people's friendships while they "improv and talk shit," and doing so has helped immensely as I relearn how to comprehend, remember, and connect with the world.

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How TV podcasts helped me regain my memory after Long COVID

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When my girlfriend of six years broke up with me by text, followed by a short call, I couldn't comprehend it. It wasn't grief, shock, or denial. My brain, damaged from 16 months of Long COVID, couldn't read or write, splice voices from background noise, or parse words said fast enough to react.

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"People with a history of allergies, anxiety or depression, arthritis, and autoimmune diseases and women are among those who appear more vulnerable to developing long COVID".

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"People with a history of allergies, anxiety or depression, arthritis, and autoimmune diseases and women are among those who appear more vulnerable to developing long COVID".

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https://www.medscape.com/viewarticle/long-covid-new-info-who-most-likely-get-it-2023a1000wq4?ecd=WNL_trdalrt_pos1_231227_etid6200233&uac=123390EZ&impID=6200233

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post-acute sequelae of sars-cov-2 infection; post-acute sequelae of sars-cov-2 infection (pasc); pasc - post-acute sequelae of sars-cov-2 infection; long covid

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Long COVID: New Info on Who Is Most Likely to Get It

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Fresh research and clinical anecdotes have given experts a much clearer picture of which patients are most likely to develop long COVID.

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"New-onset alcohol reactions and sensitivity can occur after COVID-19 infection in patients with PASC". 

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"New-onset alcohol reactions and sensitivity can occur after COVID-19 infection in patients with PASC". 

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https://www.cureus.com/articles/152512-new-alcohol-sensitivity-in-patients-with-post-acute-sequelae-of-sars-cov-2-pasc-a-case-series#!/ PASC = Post Acute Sequelae of SARS-COV-2

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New Alcohol Sensitivity in Patients With Post-acute Sequelae of SARS-CoV-2 (PASC): A Case Series

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Post-acute sequelae of SARS-CoV-2 (PASC), or long COVID, is characterized by persistent symptoms after acute SARS-CoV-2 infection that can vary from patient to patient. Here, we present a case series of four patients with a history of SARS-CoV-2 infection referred to the Post-Acute COVID-19 Syndrome (PACS) Clinic at Stanford University for evaluation of persistent symptoms, who also experienced new-onset alcohol sensitivity. Alcohol reactions and sensitivity are not well characterized in the literature as it relates to post-viral illness. While there have been some anecdotal reports of new alcohol sensitivity in PASC patients in the media, there is a paucity of published data in the medical literature about this topic. During their medical consultation, the patients self-reported new changes in their symptoms or behaviors following the use of alcohol. A new onset of alcohol sensitivities should be assessed along with other post-COVID-19 symptoms and may provide novel avenues to explore the pathobiology of illness and potential interventions.

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"While researchers are hard at work figuring out causes of and treatments for long COVID, we wanted to give you a window into what it’s like to live with it. Three women share their stories here".

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"While researchers are hard at work figuring out causes of and treatments for long COVID, we wanted to give you a window into what it’s like to live with it. Three women share their stories here".

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https://www.prevention.com/health/health-conditions/a45786978/living-with-long-covid/

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What It’s Really Like to Live With Long COVID, According to People Experiencing It

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“I’m doing everything in my power to manage my symptoms.”

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"Guidance issued in 2023 on how to formally report long COVID as a cause of death on death certificates should help get a more accurate count of these fatalities going forward".

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"Guidance issued in 2023 on how to formally report long COVID as a cause of death on death certificates should help get a more accurate count of these fatalities going forward".

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https://www.medscape.com/viewarticle/long-covid-has-caused-thousands-us-deaths-new-cdc-data-2024a100006l

Guidance: https://www.cdc.gov/nchs/data/nvss/vsrg/vsrg03-508.pdf

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"Many people with long Covid feel tired, unwell and in pain for lengthy periods after exercise, and researchers say they now know why".

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"Many people with long Covid feel tired, unwell and in pain for lengthy periods after exercise, and researchers say they now know why".

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https://www.theguardian.com/world/2024/jan/04/people-with-long-covid-should-avoid-intense-exercise-say-researchers

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Many people with long Covid feel tired, unwell and in pain for lengthy periods after exercise, and researchers say they now know why.

Experts say they have evidence that biological changes are to blame, such as severe muscle damage, mitochondrial problems and the presence of microclots in the body.

"It's really confirming that there is something inside the body going wrong with the disease," said Dr Rob Wüst, an author of the study at Vrije Universiteit (Free University) Amsterdam.

Long Covid is thought to affect about 2 million people in the UK alone, and many experience a worsening of symptoms for weeks after a single bout of exercise.

Published in the journal Nature Communications, the study involved 25 patients with long Covid who reported experiencing malaise after exercising, and 21 people who had had Covid but made a full recovery. None of the participants had been hospitalised with Covid, while all had been fit and healthy before catching the virus and were of working age.

Each participant spent about 10-15 minutes on an exercise bicycle, and blood samples and skeletal muscle biopsies were taken a week before and the day after the task.

While there was considerable variation between patients, on average, people with long Covid had a lower exercise capacity than healthy participants.

When the researchers analysed the biopsies taken before exercise, they found that those with long Covid had a greater proportion of white fibres in their muscles than healthy participants. These fibres have fewer power-producing structures, known as mitochondria, within their cells, and fewer capillaries.

The team also found signs that the mitochondria in people with long Covid did not work as well as those in healthy participants.

Wüst said the findings partly explained why people with long Covid had a lower capacity for exercise.

The team also found that people with long Covid had more clumps of a protein called amyloid in their skeletal muscles, although there was no evidence that these "microclots" were blocking blood vessels as some researchers have previously proposed.

Comparison of the biopsies taken before and after cycling revealed the function of the mitochondria worsened after exercise in those with long Covid, and these participants had far more tissue damage after exercising and signs of the body attempting repairs.

"That can explain, for instance, the muscle pain that these patients are experiencing after exercise," said Wüst.

He said the findings highlighted that people with long Covid should not undertake intense exercise.

"It damages your muscles, it worsens your metabolism, and it can explain why you feel muscle pain and fatigue up to weeks after the exercise," he said.

Prof Betty Raman, of the University of Oxford, who was not involved in the study, said her own research suggested that mitochondrial dysfunction might play a role in the fatigue that some people with long Covid experience. The latest study adds weight to the idea that treatments that improve mitochondrial health could be beneficial, she said.

But, Raman noted, this might not be the full story: "While it is plausible that fatigue is associated with these metabolic abnormalities, other contributing factors, such as persistent inflammation, may also play a role."

This article was amended on 4 January 2024. A previous version said the number of people in the UK thought to be affected by Long Covid was in the "tens of thousands"; this figure relates to those who have had symptoms for a year or more.

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Long Covid causes changes in body that make exercise debilitating - study

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Experts say severe muscle damage, mitochondrial problems and microclots may explain impact of working out

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"When you think of up to 2 million Americans getting infected in a day, even if only 1% go on to suffer from chronic Covid, which can be profoundly debilitating, that’s 20,000 eventual new long haulers added to the millions here already affected. In one day".

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"When you think of up to 2 million Americans getting infected in a day, even if only 1% go on to suffer from chronic Covid, which can be profoundly debilitating, that’s 20,000 eventual new long haulers added to the millions here already affected. In one day".

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https://open.substack.com/pub/erictopol/p/sotp-state-of-the-pandemic?r=a36iw&utm_campaign=post&utm_medium=web

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"Cuomo announced that he's starting a new series where he'll be bringing experts onto his show to discuss long COVID, so that he and his audience can learn more about it, together".

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"Cuomo announced that he's starting a new series where he'll be bringing experts onto his show to discuss long COVID, so that he and his audience can learn more about it, together".

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https://boingboing.net/2024/01/07/journalist-chris-cuomo-opens-up-about-his-struggle-with-long-covid.html

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"In the meantime, long Covid patient support groups recommend a “stop, rest, pace” approach to avoid severe crashes triggered by certain levels of physical, mental or emotional activity.

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"In the meantime, long Covid patient support groups recommend a “stop, rest, pace” approach to avoid severe crashes triggered by certain levels of physical, mental or emotional activity.

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https://www.bloomberg.com/news/articles/2024-01-09/exercise-could-be-harmful-for-some-people-with-long-covid-study-shows

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Strenuous Exercise Can Trigger Severe Damage to Muscle Tissue, Long Covid Study Shows

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Exercise is good for health, but it can be harmful for some long Covid sufferers, new research shows.

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"We had an opportunity to radically reimagine and restructure ways of connecting with and caring for each other when COVID-19 emerged. We can still recommit to this work". 

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"We had an opportunity to radically reimagine and restructure ways of connecting with and caring for each other when COVID-19 emerged. We can still recommit to this work". 

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https://communitycentricfundraising.org/2024/01/08/community-care-where/

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...isn't that why so many of us are here-to do the very hard work of tackling systemic issues in service to a more just and equitable world? Why are we ignoring something that has such widespread implications for our communities and movements?

Nonprofit leaders, does your organization speak of the pandemic in the past tense? No testing, masking, or vaccination policies to speak of? Back to all in-person everything, including those beloved happy hours, retreats, conferences, and gala events?

One more question: have you considered how COVID-19 minimization and denial will impact your organization's ability to survive long-term, and how failure to adapt to the reality of the present moment is disabling and in some cases, even killing staff and supporters?

It's not fun to think about. It contradicts the dominant "back to normal at all costs" and "keep producing and consuming no matter what" messaging we are receiving at all levels of society. It forces us to think about where we may have caused harm. It means that we need to create and advocate for systemic change around yet another issue.
But isn't that why so many of us are here-to do the very hard work of tackling systemic issues in service to a more just and equitable world? Why are we ignoring something that has such widespread implications for our communities and movements?
Facing the Reality of a Changed World

It has been surreal to watch otherwise "progressive" nonprofit leaders who speak of equity and justice participate in collective denial of the ongoing threat COVID-19 poses to our work. It has been heartbreaking to see fundraisers I once respected participating in this denial. I am by no means the first to observe this schism between stated values and action- Leah Lakshmi Piepzna-Samarasinha , , and others have written excellent pieces on this. In our sector, we talk at length about making data driven decisions- is , it's , and it's being actively ignored. COVID-19 is significantly impacting and health for people across age groups .

As a fundraiser, I see obvious connections between COVID-19 prevention, donor capacity, and staff capacity. I've seen development teams struggle to stay afloat with a revolving door of sick staff experiencing impacts from repeat infections, from brain fog to cardiovascular issues. I have had direct experience seeing increases in COVID-related medical costs impact the ability of donors to both give and engage actively with organizations they love. I have watched as colleagues struggle silently to maintain their baseline health after repeat infections from the workplace, with no support from their employers who continue to push them mercilessly into "back to normal."

The hard truth of this moment is that there is no "normal" to return to.

We had an opportunity to radically reimagine and restructure ways of connecting with and caring for each other when COVID-19 emerged. We can still recommit to this work. I want to push myself and my colleagues to develop creative ways to safely engage with donors and each other, because community care is not an abstract concept or a trite expression-it's love and justice in action. For this reason, I will not stop advocating for better education around COVID mitigations among the organizations I work with, and within my own, whenever possible.

Making Care, Love & Justice Actionable

How do we begin to do better? This list is not exhaustive, but here are some places to start:

1. Acknowledge that COVID-19 transmission is airborne and plan events and office layouts accordingly. People's CDC and Clean Air Club have some great resources on how to help keep the air clean to reduce transmission. Can't afford air purifiers? Try building Corsi-Rosenthal boxes -it can be a great team building exercise!

2. If your organization must host in-person events, consider purchasing a set of air purifiers and a CO2 monitor for use at your organization's events, creating clear policies and guidelines for use. Include researching HVAC and airflow into event venue research. Monitor wastewater levels in your region where possible to avoid hosting events during a surge.

3. Provide or subsidize quality N95s at the office as part of employee wellness in favor of baggy blue surgical masks or cloth masks. COVID-19 is airborne, so while hand hygiene is great for some things, providing an endless stream of hand sanitizer and no masks is a senseless approach to mitigating COVID-19. Consider providing mask fit testing guides for employees, as we know that masks work best when they fit.

4. No more magical thinking-be honest about the risks you're asking employees to take, and do not ostracize those who do not want to risk a COVID-19 infection or force them to request accommodation. Group meals are not inclusive activities for people who can't be unmasked around people outside of their household. COVID-19 does not disappear when we eat a meal or are outside . Outdoor gatherings are not inherently risk free . Provide alternate options for people who cannot risk infection to connect with one another, and at minimum, do not penalize employees who are unable to participate in unmasked social gatherings.

5. Accept that in-person activities are not inherently "better" than virtual activities. Not only is this line of thinking ableist, it routinely results in organizations deprioritizing the experience of virtual event attendees in favor of people attending in-person. I have been to in-person events that were extremely transactional and not engaging at all, and have also attended deeply meaningful and engaging virtual events. Events are as inclusive and engaging as we choose to make them, regardless of setting!

6. Normalize and treat them like any other piece of assistive technology. You wouldn't ask someone in a wheelchair to stand up or a person to hide their cane or remove their glasses for a photo, therefore it is inappropriate and ableist to ask someone to remove their mask for a photo or because you'd prefer they not wear one. Call it out if you see masked people deliberately being cropped out of your organization's photos.

7. Commit to building an organizational culture that treats COVID infection as preventable and not inevitable by talking about, normalizing and utilizing the many layers and types of protection that are available to us . Sustain this internal culture through reminders that COVID-19 is not just a "mild cold" but a complex pathogen that has major long-term effects, and that we have the power to protect each other.

8. Start or continue learning about disability justice. The work of Sins Invalid , Imani Barbarin , and are great, accessible places to start. Like other forms of bias, ableism can be internalized and challenging to unlearn, but must be addressed if we are truly working toward collective liberation.

It is never too late to learn, adapt, and change behavior. As I write this article, the eight wave and second biggest surge of COVID-19 since the start of the pandemic is approaching its peak. It is my sincere and heartfelt hope that more people within the nonprofit sector will begin to embrace real, effective COVID-19 mitigations for the health and wellbeing of themselves and their communities.

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Community care where? Nonprofit COVID-19 denial-The mass disabling elephant in the room

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isn't that why so many of us are here-to do the very hard work of tackling systemic issues in service to a more just and equitable world? Why are we ignoring something that has such widespread implications for our communities and movements?

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Hearings | The U.S. Senate Committee on Health, Education, Labor & Pensions

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FULL COMMITTEE HEARING: "Addressing Long COVID: Advancing Research and Improving Patient Care".  Date: Thursday, January 18th, 2024 Time: 10:00am 

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FULL COMMITTEE HEARING: "Addressing Long COVID: Advancing Research and Improving Patient Care".  Date: Thursday, January 18th, 2024 Time: 10:00am 

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https://www.help.senate.gov/hearings

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Hearings | The U.S. Senate Committee on Health, Education, Labor & Pensions

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The U.S. Senate Committee on Health, Education, Labor & Pensions

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"But, Davis says, all responsibility shouldn’t fall on individuals. She says it’s a “huge injustice” that the government hasn’t done more to warn the public that people can still get Long COVID, and that reinfections can lead to serious health issues".

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"But, Davis says, all responsibility shouldn’t fall on individuals. She says it’s a “huge injustice” that the government hasn’t done more to warn the public that people can still get Long COVID, and that reinfections can lead to serious health issues".

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https://time.com/6554340/covid-19-surge-2024/

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You probably know a lot of sick people right now. Most parts of the U.S. are getting pummeled by respiratory illness, with 7% of all outpatient health care visits recorded during the week ending Dec. 30 related to these sicknesses, according to the U.S. Centers for Disease Control and Prevention (CDC).

Many people are sick with flu, while others have RSV or other routine winter viruses. But COVID-19 is also tearing through the population, thanks largely to the highly contagious JN.1 variant. Just like every year since 2021, this one is starting with a COVID-19 surge-and Americans are getting a good glimpse of what their "new normal" may look like, says Katelyn Jetelina, the epidemiologist who writes the Your Local Epidemiologist newsletter.

"Unfortunately," she says, "signs are pointing to this [being] the level of disruption and disease we're going to be faced with in years to come."

The CDC no longer tracks COVID-19 case counts, which makes it harder than it once was to say exactly how widely the virus is spreading. Monitoring the amount of virus detected in wastewater, while not a perfect proxy for case counts, is probably the best real-time signal currently available-and right now, that signal is a screaming red siren. According to some analyses, wastewater data suggest the current surge is second in size only to the monstrous first wave of Omicron, which peaked in early 2022. By some estimates, more than a million people in the U.S. may be newly infected every single day at the peak of this wave.

More From TIME

Wastewater isn't the only sign that things are bad. Almost 35,000 people in the U.S. were hospitalized with COVID-19 during the week ending Dec. 30-far fewer than were admitted at the height of the first Omicron wave, but a 20% increase over the prior week in 2023. Deaths tend to lag a few weeks behind hospitalizations, but already, about 1,000 people in the U.S. are dying each week from COVID-19.

Yet even as the trends veer in the wrong direction, people are still working in offices, going to school, eating in restaurants, and sitting shoulder-to-shoulder in movie theaters, largely unmasked. It can be hard to know how to feel about that reality. Viewed through a 2020 lens, many people would consider it catastrophically concerning that people are living normally even as COVID-19 sickens the equivalent of an entire city's population every single day. But is it as worrisome in 2024, when the pandemic is over on paper, if not in practice?

Not according to Dr. Ashish Jha, dean of the Brown University School of Public Health and the Biden Administration's former COVID-19 response coordinator. Almost all of the U.S. population has some immunity from previous infections or vaccinations; treatments like the antiviral Paxlovid are available for people at risk of severe disease; and most people know the basics of masking, testing, and other mitigation measures. All of these factors, Jha says, mean COVID-19 is becoming less of a threat over time. Some groups of people, including the elderly and immunocompromised, are still at greater risk than others, and Long COVID -the name for potentially debilitating chronic symptoms that sometimes follow a case of COVID-19-remains a possibility for everyone. But Jha maintains that vaccines and treatments should make everyone feel safer.

"The straight facts are: COVID is not gone, it's not irrelevant, but it's not the risk it was four years ago, or even two years ago," Jha says. "It's totally reasonable for people to go back to living their lives."

The big challenge now, says Dr. Robert Wachter, chair of medicine at the University of California, San Francisco, is wrapping our heads around that change. "We've got to somehow reprogram our minds to think about this as a threat that is just not as profound as it was for a couple years," Wachter says. "When your minds have been pickled in terror for a couple of years, it's very hard to do."

How to assess COVID-19 risk in 2024

In the earlier days of the pandemic, Wachter closely watched the COVID-19 data and used exact numbers and percentages to decide what he felt comfortable doing. Now, with fewer of those precise numbers and more disease-fighting tools available, he goes by trends.

During COVID-19 lulls, "I'm living my life about as normally as I did in 2019," Wachter says. Once indicators like COVID-19 hospitalizations and wastewater surveillance data start to suggest the virus is on the upswing, he wears a KN95 mask in crowded places like airports and theaters, where there's little downside to masking. And in a full-blown surge, like now, Wachter masks almost everywhere and avoids some places he can't, such as restaurants.

Those decisions feel right to Wachter, based on his personal risk tolerance and vulnerability to severe disease. He's up-to-date on vaccines, which slashes his chances of being hospitalized or dying if he gets infected-but, at 66, those outcomes are still likelier for him than for his 30-year-old children. "Other people might make different choices," Wachter says. "And there are going to be people who say, 'This is a lot of mental energy...screw it.'"

With hard numbers scarcer than they once were and lots of people no longer willing or able to make detailed risk assessments, Jetelina instead recommends letting your objectives shape your behavior. Want to avoid infecting your grandmother before a visit? Maybe skip having dinner in a crowded restaurant a few days before and test before you go to her house. Want to minimize your risk of getting very sick if you do get infected? Stay up-to-date on boosters-as far too few people do, says Dr. Peter Hotez, co-director of the Texas Children's Hospital Center for Vaccine Development.

"The biggest failing right now in our response to COVID," Hotez says, is that only about 20% of U.S. adults got the latest vaccine, which was updated to target newer viral variants. "That should be the number-one priority," he says, since vaccination is the best way to prevent complications like hospitalization, death, and, to some degree, Long COVID.

The risks that don't go away

Even with boosters, Jetelina says Long COVID is a hard risk to plan around. The only tried-and-true way to avoid it is to avoid infection entirely; staying up-to-date on vaccines reduces the risk by up to 70%, according to recent research, but people can and do develop it even if they're healthy, fully vaccinated, and have had previous infections without incident. With variants as contagious as JN.1 running rampant, doing almost anything in public opens up the possibility of getting sick.

But there are plenty of choices between ignoring the virus entirely and completely locking down at home, says Hannah Davis, one of the leaders of the Patient-Led Research Collaborative for Long COVID. She recommends wearing good-quality masks in public, socializing outside or using open windows and air filters to improve ventilation inside, asking people to test before gatherings, and avoiding especially crowded places during surges. "I wish more of those were normalized, because they do at least decrease the chance of getting infected and causing long-term harm and disability to yourself or other people," she says.

But, Davis says, all responsibility shouldn't fall on individuals. She says it's a "huge injustice" that the government hasn't done more to warn the public that people can still get Long COVID, and that reinfections can lead to serious health issues. She also feels the data support policy measures like ventilation requirements for public places and mask mandates on public transportation.

The unclear future of COVID-19

Some mask mandates in health care facilities and nursing homes have been reinstated during this surge. But Jha says widespread mandates are unlikely to come back-and in his view, they shouldn't. "There was a role for mandates in the early days of the pandemic...when we had no other tools, no way of protecting people," he says. "Mandates four years in, when we have plenty of tests, plenty of vaccines, plenty of treatments, plenty of masks," are not as crucial, he says.

Jetelina says she wouldn't be surprised if 2024 brings a further relaxation of COVID-19 guidance rather than increased mitigation measures. She speculates that the CDC may change its isolation guidelines, for example.

"The threat [of COVID-19] will get baked into the other threats people have in their background that aren't front of mind," Wachter predicts, similar to the ever-present risk of getting sick with other illnesses or getting into a car accident. And, "as long as the virus doesn't shape-shift its way into laughing at our immune status," he says that's not such a bad thing. People will continue to reach different conclusions about the level of risk-taking they can stomach and behave accordingly, just as they do in other areas of life.

It's natural for guidance and behavior to change once a public-health menace begins to transition from emergency to endemic, Jha says. But that doesn't mean we should turn a blind eye toward COVID-19 or the numerous other pathogens swirling around.

"For a lot of people it's been about, 'How do we go back to 2019, to life before the pandemic?'" he says. But, in his view, that's not the right goal: "We actually want to look forward."

Jha says he's hopeful that lessons learned during the COVID-19 pandemic will spark a reimagining of how we deal with respiratory diseases in general. Such an approach wouldn't necessarily single out COVID-19, as much of the public-health messaging has done since 2020. Instead, Jha says, it could standardize and broaden guidance around all infectious diseases, hammering home the importance of things like vaccines, masks, ventilation, and sick-leave policies that allow people to stay home when they have any disease-not just the one that has dominated our collective consciousness for the past four years.

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This year has kicked off with a COVID-19 surge, offering people a glimpse into a new normal that includes COVID-19, flu, and other diseases.

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Paywall: “The study provides evidence that ‘LC is a tissue-based disease’ meaning.. dysfunction is happening in different organ systems, said @MichaelPelusoMD.”

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Paywall: “The study provides evidence that ‘LC is a tissue-based disease’ meaning.. dysfunction is happening in different organ systems, said @MichaelPelusoMD.”

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https://www.sfchronicle.com/health/article/ucsf-study-reveals-immune-system-anomalies-people-18601228.php

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"Notably, they found CD4 T cells were in a more inflammatory state in people with long COVID. Meanwhile, CD8 T cells, which normally kill cells infected by viruses or bacteria, showed signs of exhaustion preferentially in people with long COVID".

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"Notably, they found CD4 T cells were in a more inflammatory state in people with long COVID. Meanwhile, CD8 T cells, which normally kill cells infected by viruses or bacteria, showed signs of exhaustion preferentially in people with long COVID".

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https://www.insideprecisionmedicine.com/topics/coronavirus/omics-study-suggests-long-covid-involves-viral-persistence/

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Omics Study Suggests Long COVID Involves Viral Persistence

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People with long COVID are likely to have immune cells showing signs of chronic inflammation and other unusual characteristics, supporting the hypothesis that long COVID may involve a low-level viral persistence.

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"This lack of advocacy- the silencing of demands that governments take responsibility for public health- is, of course, the only real goal of minimizing COVID".

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"This lack of advocacy- the silencing of demands that governments take responsibility for public health- is, of course, the only real goal of minimizing COVID".

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https://www.thegauntlet.news/p/learning-to-live-with-covid-means?r=a36iw&utm_campaign=post&utm_medium=web

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As we hit the second largest peak of COVID cases ever, with an estimated 1.5 million cases occurring daily in the US, those who want to "learn to live with the virus" should take stock. It's clear that "learning to live with" COVID, as it stands currently, involves absolutely no learning and significantly less living, with current US deaths above 2,000 weekly and projected to continue rising for another 3 weeks at least (as death counts do not peak until 3 weeks after case counts).

What have we "learned" about the virus since 2020 that we are implementing? We learned that COVID is airborne, so what new indoor air quality measures have we introduced? We learned that the vaccines wane quickly and the virus mutates even faster, so how are the rates of annual vaccination going? We learned vaccines don't prevent spread, so how are we mitigating spread? We learned post-COVID health effects are serious and common, so how are we adapting our approach to COVID infection with this knowledge?

If your answers were none, badly, not at all, and zero, congratulations. Your prize is annual reinfection with a vascular disease that causes heart, brain, organ and immune system damage, free of charge. (Some restrictions apply. Free infection does not include diagnosis, lost wages, cost of associated healthcare, cost of long-term disability, or other associated costs. Each item sold separately. Visit a COVID distribution center- literally any public space- to redeem.)

COVID denialism has reached- forgive the pun- a fever pitch. Parents report their children's continual illnesses and attribute them to a three-year-old lockdown instead of documented post-COVID immune harm. The public notes the spike in cardiac events and sudden death but attributes them to vaccination instead of the novel virus proven to harm hearts. The media cycles through COVID's pseudonym of the week, the Festival Flu, the Summer Flu, the 100 Day Cough, the ever-popular Mysterious Virus. Tiktok videos emerge of bewildered people reporting never-ending sickness- commented on by thousands more experiencing the same. The word COVID isn't mentioned.

And don't look for airborne infection control in healthcare settings. Hospitals, too, are handing out complimentary COVID infections like lollipops to anyone who dares to seek care. Vulnerable patients are weighing their need for medical attention against the possibility of being infected. Let's recall that CDC guidance has always stated that COVID is dangerous for vulnerable groups. The danger hasn't changed; only the degree to which people care.

Of course, the public can't be blamed for their inability or unwillingness to remember what COVID is or what it can do. Many of them were either never told about COVID's risks, or were assured that COVID "became mild," right around the time COVID's purported mildness became important to Biden's political future. (Ron Howard narrator voice: It didn't.)

The purposeful and inaccurate minimization of the SARS-COV-2 virus has, ironically, occurred against the backdrop of thousands of increasingly concerning studies. Were the results of these studies communicated to the public, we wouldn't see the purported "COVID fatigue," "pandemic fatigue", and "mask fatigue," all of which were invented and encouraged by a Biden-apologist press that pushed the failed "Back to Normal" strategy years beyond its expiration date. When people are given proper information about their risks, from real authority figures (not just Substacks and researchers on twitter), they want to protect themselves and their loved ones. It's only when they are told that COVID presents no threat, and mitigations are socially stigmatized, that they relax their protocols.

In other words, minimization has cascading consequences in the community. People who are told "COVID is a cold" or "COVID is the flu", (both Trump-era talking points repurposed for the liberal crowd), will not get vaccinated every fall. They will not wear masks. They will not test before gathering. And they will not advocate for institutional mitigations- like new clean air standards. This lack of advocacy- the silencing of demands that governments take responsibility for public health- is, of course, the only real goal of minimizing COVID.

My last article tracked the progression of the "back to normal" vaccine-only pandemic strategy from "you won't get COVID" to "you will get it every year and every infection comes with a risk of disability, but just assume it'll happen to someone else". After it published, people asked about what my pandemic strategy might look like- did I want to go back into lockdown? Did I want to force everyone to wear a mask forever? Did I want unvaccinated people to be put into camps?? (No, only in a few places, and that is an epidemiologically terrible idea.)

So what should living with COVID - a highly contagious, fully airborne disease with a compounding, serious risk of long-term disability- look like?

The most under-discussed tool in our toolkit is indoor air quality improvement.

The topic may not be sexy, but we must foreground it in the conversation about COVID. Many people are politically polarized away from masking and the anti-science folks at the top are making it incredibly difficult to convey the benefits and importance of masks. Prioritizing long-term infrastructure upgrades- meaning increased ventilation, filtration, and indoor CO2 monitoring- will make it more difficult for anti-maskers to harm their neighbors with forcible infection. One-way masking is always inferior to two-way masking. However, one-way masking in a high air quality environment, with frequent air changes per hour (ACH), high-level filtration (MERV 13 or higher, HEPA filters) and CO2 monitoring will be significantly superior to one-way masking in a low air quality environment.

This strategy- of mandating cleaner air in all public spaces- would not just improve the individual risk of a single person entering a single space. It would have compounding benefits by significantly reducing how many people each COVID infected person is able to infect. This number- the expected number of additional cases generated by a single infection- is known as the "basic reproduction number", or R naught (written as R ₀). The R 0 is often thought of as a static measure that conveys the contagiousness of a disease- but it's actually a measure of the way the disease is interacting with the public. Improving air quality universally will lower COVID's R 0 and begin to bring down disease burden generally. This, in turn, makes it less likely that there are infected people in any indoor space to begin with.

A nice side effect is that, in the process of mitigating COVID, we will significantly reduce the spread of all other airborne viruses- which, it turns out, is most if not all of them. Even our imperfect masking and pseudo-quarantines eliminated a strain of flu in 2020; most viruses are significantly less contagious than COVID and many might be eliminated as a side effect of mitigation efforts.

Aerosol scientists are much better equipped than I am to design the details of indoor air quality (IAQ) policy, and they should be commissioned to do so. The Center for Health Security and the Center for Public Health Law and Policy at Arizona State University put together a Model Indoor Air Quality Act for State Legislatures, which would create IAQ Advisory Councils to advise the state and Governor. Additionally, indoor air quality experts must work with the CDC on infection control guidelines.

While I'm not an aerosol scientist, I have learned enough to give a broad overview. More air changes per hour means better ventilation. Even opening windows can significantly improve indoor air quality, making it an important, low-cost mitigation to communicate to the public (noting, of course, that no PSA will be effective at mitigating COVID without honesty about the risks to post-COVID health.)

CO2 is a proxy measure to estimate how good ventilation is- it estimates how long exhaled breaths are hanging in the air, contaminating it. Ideally, the lower the CO2 the better. 300-500 ppm, or ~400 parts per million, is outdoor air quality; the higher it goes, the worse it is. Above 1000 ppm, cognitive performance begins to decline. Parents are investigating their kids' schools' indoor air- and recording CO2 levels as high as 2,000, 3,000, 4,000 ppm in classrooms. In fact, citizen volunteers, using a CO2 monitoring device called an Aranet, are documenting poor air quality in many public spaces. Sadly, schools are consistently recorded as having some of the worst air quality in the community.

Do we really think parents would be happy with this critically poor air quality if they were aware? Can you imagine the community level reduction of illness if schools alone reduced their levels of viral spread?

Filtration is another component of clean air- it is not the same as ventilation and CO2 levels are not a proxy measure to determine filtration. Ventilation exchanges indoor air with outdoor air; filtration cleans it. You can have high CO2 and good filtration, as is sometimes the case on planes, which do have HEPAs. High quality filtration can be provided by MERV-13 or higher filters and HEPA devices, removing not only COVID from the air, but other viruses, bacteria, molds, allergens, and pollution.

As of now, guidelines put out by ASHRAE for residential buildings recommends MERV-6 filters or higher, although many homes still use MERV-4. These filters are not sufficient to filter viruses; MERV-13 or higher are. We need to start thinking about making our infrastructure pandemic-proof and understand that the cost of filter upgrades will far outpace the long-term savings to society. After all, even if continual waves of COVID weren't a completely unsustainable social burden (it is), we must assume we will continue to encounter new viruses. Wouldn't it be great to be prepared for the next one? If, when the next pandemic hits, we already have a national standard of MERV-13 and HEPA filters, indoor CO2 below 800 ppm, and a population well versed on airborne transmission and the types of masks that work?

Upgrading air quality is quite simply a slam dunk for public health- and will save exponentially more money than it costs. Frankly, it's wild that it's taken us this long to talk about filtration and ventilation as critical components of a successful pandemic response. Clean water has been critical to reducing waterborne disease like cholera; why should we think about airborne differently?

Clean air will not be the only component of a successful public health strategy. Masks must be mandatory in healthcare and hospitals- this is not up for debate. Vulnerable people must access medical care, medical care often involves the removal of masks, and infection control is a primary responsibility of health facilities. The argument that hospitals can stop mitigating because only weak people die from hospital-acquired infections is antithetical to the Hippocratic oath and every tenet of modern medicine. It is indefensible and this period in medicine will be remembered with shame.

I also would like to see masks return in pharmacies, on planes and public transit, and in supermarkets while we get clean air implemented, although I understand how politically difficult four years of misinformation and anti-mask propaganda has made such policy. While I do advocate for masks in these spaces, public education- coming from the US Government, the CDC, our President, the media, and prominent figures- is just as critical if not more critical in normalizing and promoting wearing proper masks.

In the era of mandates, we saw many people wearing ineffective masks, wearing masks below their noses, wearing masks on their chins, pulling them off to eat, and more behaviors that lessened universal masking's impact. People who are properly informed that they have a high risk of becoming long-term disabled by a virus currently circulating at a high level are much more likely to wear a good mask (KN95 or N95), wear it properly (over the nose and mouth, testing for fit), and keep it on throughout their day. Many people, when properly informed that they can seriously harm or even kill others with asymptomatic transmission, will be similarly motivated to mask properly.

It's true that over the past several years, some people proved that they simply don't care about others and would prefer vulnerable people to die than to be mildly inconvenienced. But many people are simply badly informed. In my experience, when people know better, they do better. All of the close friends that I see on a day-to-day basis are now consistent maskers because they are informed. My parents and brother have never had COVID because I never stopped keeping them up to date about emerging COVID studies. I know people who have recently returned to masking after finally understanding that the virus is mutating around vaccine protection, or after being asked to mask in leftist spaces. Most often, the explanation I hear from those who won't mask is, "COVID isn't dangerous anymore." To me this implies that an understanding of the dangers of COVID and post-COVID could lead to changed behavior.

Keeping COVID mitigation tools accessible and free is also critical. One of the most craven and disgusting efforts of the see-no-COVID Biden response has been the clawing back of free tests, masks, treatments, and vaccines. All of these tools more than pay for themselves by reducing virus in the community, reducing illness, reducing healthcare burden, reducing short staffing, reducing student absences, reducing long-term disability, and more. Tests must not only be free, but they must be accurate. Sending out a handful of rapid tests once a year is so insufficient as to be insulting- especially since rapid tests are notoriously inaccurate, and official guidance recommends performing three RATs on three consecutive days to confirm a negative test. For this reason, we should have accurate, PCR quality tests available on demand, for free- you know, like people who visit the President automatically receive.

Encouraging people to use our "tools"- masks, treatments, vaccines, and tests- means not charging them for the privilege. People who mask, test, get vaccinated and access treatments are following public health advice, protecting the community, and saving the government money in the short and long term; for this they deserve thanks, not to be taxed. Particularly not in a country where minimum wage isn't sufficient to afford a one-bedroom apartment in any major city. Punishing socially beneficial behaviors makes no sense.

Paid sick leave also benefits workers, employers, customers, families, everyone, everywhere. Having a contagious, ill person in a workplace- or depriving them of their paycheck for needed time off- does not produce more economic benefit for the business or the country. Rather, it exposes more people unnecessarily and exacerbates staff shortages, as we've surely seen over the last several years. Of course, for leftists, this isn't just an economic argument; workers deserve to rest and heal because it is a basic right. Watching upper-middle class progressives with paid sick leave abandon working class people to lost income and worsening health outcomes has been depressing. I'm hopeful that- with yet another massive wave cresting- people are beginning to notice how unsustainable this all is, that there is no immunity to COVID nor an end in sight to reinfections.

Of course, professional class people would also benefit from federal measures to address COVID; remote work options should be both promoted and maintained, not dismantled. Aside from the obvious epidemiological upsides, the ecological benefits of reducing commuter traffic were drastic in the early days of the pandemic. The left should hold firmly to the progress made and note that flexible workplace policies also empowered marginalized groups, in particular disabled people and single mothers.

I've written in the past about the existence of COVID-safe spaces for the super-rich, the White House being one, Davos being another. It's clear that where there's a will, there's a way, and when lives are valued, they can be protected. COVID, more than a biological problem, is an engineering and sociological problem. The good news is while there's no biological solution to such a new and dangerous virus, there absolutely are engineering and social solutions.

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"Learning to live with COVID" means upgrading air quality, now

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This level of illness is unsustainable. Fortunately, basic measures can drastically reduce viral spread.

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"Some BIG LC news this week, the US Senate is holding a hearing on Long Covid on Thursday. This is likely the best opportunity LC has to increase exposure and (try to) get more funding".

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"Some BIG LC news this week, the US Senate is holding a hearing on Long Covid on Thursday. This is likely the best opportunity LC has to increase exposure and (try to) get more funding".

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https://longcovidweekly.substack.com/p/long-covid-weekly-76-long-covid-senate?publication_id=999185&utm_medium=email&utm_campaign=email-share&triggerShare=true&r=a36iw

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Long Covid Weekly #76: Long Covid Senate Hearing,

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Hi everyone, Some BIG LC news this week, the US Senate is holding a hearing on Long Covid on Thursday. This is likely the best opportunity LC has to increase exposure and (try to) get more funding. As we all know, ReCOVer is going to run out of funding at some point, so we need back up options ready to go. If you are going in-person to the meeting,

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"This week, we’re excited to share an extensive story examining how Long Covid deeply impacts the Latino community.  Miles also reported this week on CDC Director Mandy Cohen avoiding the spotlight during one of the biggest surges of the pandemic".

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"This week, we’re excited to share an extensive story examining how Long Covid deeply impacts the Latino community.  Miles also reported this week on CDC Director Mandy Cohen avoiding the spotlight during one of the biggest surges of the pandemic".

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https://mailchi.mp/thesicktimes/long-covid-hits-hard-for-latinos-where-is-mandy?e=783aa51ef5

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Long Covid hits hard for Latinos; Where is Mandy?

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"Now, Long COVID patients are a significant demographic who are tired of being told to stay home and/or die. While thousands of studies show long-term damage to people’s bodies after COVID-19, treatments are still alarmingly far off for a rapidly growing population of disabled and severely ill Americans".

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"Now, Long COVID patients are a significant demographic who are tired of being told to stay home and/or die. While thousands of studies show long-term damage to people’s bodies after COVID-19, treatments are still alarmingly far off for a rapidly growing population of disabled and severely ill Americans".

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https://www.thegauntlet.news/p/senator-tammy-baldwins-chief-to-long

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Tomorrow is an important day for the Long COVID community: the Senate HELP Committee will finally be holding a hearing to discuss Long COVID. All eyes are on the Senate, and advocacy groups from around the country are organizing to pressure HELP Committee members to attend.

The worsening Long COVID crisis is simply an outgrowth of Biden's barely-there pandemic policy, the continual, unending reinfection strategy that has already left tens of millions of Americans with long-term symptoms and even disability. For years, victims of this strategy and their allies have been warning that the "let it rip" approach to COVID is unsustainable; for years we've warned about the widespread anger that waits on the other side of allowing this mass disabling event to continue. "Get COVID over and over again and you'll be fine!" is not a lie that looks good in the rearview mirror to the millions of people who followed this advice and lost their independence, health, careers, relationships, and freedom.

Now, Long COVID patients are a significant demographic who are tired of being told to stay home and/or die. While thousands of studies show long-term damage to people's bodies after COVID-19, treatments are still alarmingly far off for a rapidly growing population of disabled and severely ill Americans.

This week, thousands of calls and e-mails flooded into HELP Committee members' offices. Among them were messages from a group called Long COVID Action Project, which has been demanding that Long COVID be declared a national emergency, and that billions be allocated to Long COVID treatment research. Not everyone was happy to hear from them.

Senator Tammy Baldwin, one of the two remaining HELP Commitee members who have not yet committed to attending the hearing, expressed via her staff that the millions of patients desperate for treatment are quite the annoyance to her and her team.

"I'm trying to be helpful," Chief of Staff Ken Reidy says with badly concealed irritation, going on to condescendingly explain to journalist and activist Joshua Pribanic, "I have about 600 emails in my inbox from your organization, from people from Scotland, from California, from Maryland. Um. Senator Baldwin represents Wisconsin. If I had every organization that just blasted my email inbox where I do my professional work, I would not be able to do my job."

Let's unpack these comments. First, let's start with the implication that Long COVID activists are too stupid to understand that Senator Tammy Baldwin represents Wisconsin. Long COVID patients are targeting the members of the HELP Commitee because the members are federally elected officials who have significant impact on national health policy. People around the country- and indeed around the world- will be heavily impacted by how the HELP Committee hearing discusses COVID, and what actions are taken as a result of this hearing. This need certain Hill staffers have to be endlessly patronizing to activists is hardly confined to this topic, but it is perhaps more jarring to observe when the activists in question are disabled and, in some cases, dying individuals desperate for treatment.

Second, there's the tone-deafness of saying he "won't be able to do his job" if he continues to receive this volume of emails from people who were, again, grievously harmed and disabled by policies his boss supported and continues to support. As Joshua correctly points out, many Long COVID patients can no longer do their jobs. Not because they have "600 emails in their professional inbox" (the horror), but because they have heart, organ and brain damage, and cannot get out of bed.

"Part of the action is to drive that point home- with your office and with every office," offers Joshua calmly, "that we can't go on living. And therefore, we need you to pay attention to us right now."

"We have forms on our website and ways for folks to contact us," Ken explains, instructing these patients to submit their complaints about being slowly murdered by the state less disruptively. Preferably, he should not have to see or hear from Long COVID patients at all; better they confine themselves to inboxes checked by interns and content themselves with form-letter responses.

He also repeats, irrelevantly and again with great condescension, that Senator Baldwin "doesn't represent the entire United States," a bizarre perspective that seems to imply that the great people of Wisconsin, alone, are exempt from the impacts of Long COVID. "We live in a representative democracy," he kindly explains to the activist trying to get his democracy to represent him.

Worst of all is the nasty tone Ken uses as he "educates" activists about how best not to bother him. As he repeatedly states, "this is the worst way to go about things." What he is communicating here is that, if he personally is annoyed by activists, he personally will, spitefully and out of personal malice, try to block any aid or help to the tens of millions of people suffering from long-term health effects after COVID. Most of whom, of course, had nothing to do with this capital crime of "flooding his professional inbox" with work-related email correspondence.

"How are you dealing with these demands, I guess would be the question," counters Joshua, stating that if Ken can give him any concrete actions being taken by Senator Baldwin's office, he can certainly communicate that to LCAP's volunteers.

"If this is the way you guys want to do your advocacy," Ken snipes back, "you're totally entitled to do that. I was trying to do this in a way to be helpful to you all." Rather than answering Joshua's very straightforward question- what, exactly, does Senator Tammy Baldwin plan to do about the millions of Americans living with Long COVID? Ken pivots back to his previous threat: keep annoying me and we'll just see how much research funding you get. This is not the way legislative decisions or priorities should be made, yet Ken repeatedly implies that if he personally is too inconvenienced by patients living with a debilitating illness, he will try to prevent the allocation of resources to the crisis.

Let's really think about what a horrific statement that is: his party and his boss have advanced a status quo whereby the public was repeatedly informed that it was safe to catch COVID, and that all protections should be abandoned. His boss and party have removed free, accessible testing and vaccines, stigmatized mask wearing, and publicly bragged that "COVID is over" although we are currently in the second-highest wave of the entire pandemic. As a result of these anti-science policies, tens of millions of people may never recover their former health. And as these newly ill and disabled people flood the lines of the people who did this to them, they are told to shut up or expect to be punished.

Thanks to the advocacy of dozens of groups and thousands of activists, only two members of the HELP Committee have not yet committed to attending the hearing tomorrow, Senator Mitt Romney and Senator Tammy Baldwin. You can reach their offices at (202) 224-5251 and (202) 224-5653 respectively.

Long COVID- and COVID- are not going away, and as millions of Americans are infected and reinfected amidst an ongoing, uncontrolled pandemic this week, tens of thousands will join the ranks of those left behind by the "let it rip" non-response. Ignoring this problem will not make it go away; it will make it worse. Anger over emails will not make them stop, but action could. For the record, Ken Reidy, we do live in a representative democracy. How about some representation?

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Senator Tammy Baldwin's Chief to Long COVID Patients: Stop Annoying Me or Else

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Under Biden, the entire nation was encouraged to go ahead and get COVID. The people who were disabled by this strategy are a little inconvenient.

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"People need access to specialized care prepared to meet the needs of a person living with Long Covid, disability accommodations are crucial".

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"People need access to specialized care prepared to meet the needs of a person living with Long Covid, disability accommodations are crucial".

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https://open.substack.com/pub/emilymendenhall/p/national-academies-of-science-engineering?r=a36iw&utm_campaign=post&utm_medium=email

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It is a privilege to address the NASEM Committee on Examining the Definition for Long COVID today. I am a medical anthropologist and professor at Georgetown University. For the past two years I have engaged with hundreds of people living with Long Covid, family members and clinicians caring for patients with Long Covid, or scientists investigating Long Covid from various points of view. I have spoken with some of you, in fact, and find interviewing scholars or practitioners whose lives have been upended by COVID to be the most instructive. I have also learned a great deal by attending meetings here at the National Academies as well as the NIH on Long Covid and ME/CFS. I explain my perspective in part because my words today come from this bottom-up perspective rather than a clinical of biological perspective.

Before I discuss diagnostic implementation, let me address how Long Covid is a heterogeneous construct. This matters for several reasons that I will address, but first it's important to identify the four major clusters of Long Covid symptoms, which frequently overlap and co-occur.

First, there are the patients who suffer severe acute infection with prolonged hospitalization or intensive care unit stays. These are the patients that most closely align with the condition known as post-intensive care syndrome. Their condition, in many cases, is not only physical but also emotional in part due to medical trauma and social dislocation. For instance, I spoke with a nurse who was infected at work and hospitalized in a coma and on a respiratory for more than a month. She lost her job, home, and life to her hospitalization and disabling physical morbidity. She also experiences panic attacks linked to traumatic memory and depression associated with losing a life she worked so hard to build.

Second, there are those who present with severe allergy. For instance, I have a student at Georgetown who described how intense her allergic reactions have become since infection. Some people are diagnosed with mast cell activation syndrome, where their body responds in an immense way to their environment, foods, and other things that may have been slightly triggered before COVID but now are highly sensitive. However, many patients with MCAS also present with other severe and disabling conditions.

Third, vascular conditions are common and overlapping with many people living with Long Covid. Perhaps the largest category of people with vascular damage has had no cardiac events or pre-existing conditions; rather, they present with chest pain, tachycardia, vascular damage, and POTS with no other known causes. Others present with more visible conditions like heart attacks, strokes, a-fib, and other cardiac irregularities; in other ways they are hidden behind pre-existing diagnoses like diabetes, hypertension, and heart disease. The role of previous diagnoses is important to understand because, particularly when clinicians are caring for publicly insured patients, they are more likely to treat on the basis of preexisting diagnoses because care is easier to administer.

Finally, nearly half of Long Covid patients present with autonomic nervous system dysregulation and neurological conditions with disabling symptoms that align closely with ME/CFS or fibromyalgia; many people who develop moderate to severe Long Covid have pre-existing auto-immune conditions or develop them through the course of the illness. Many of the most severely disabled patients also have mast cell activation, neurological problems, post-exertional malaise, and a whole slew of symptoms that emerge and impoverish people's health. While nearly a quarter are bed-bound, many patients have lost jobs, homes, family, their children, and other things that bring them joy and security to this illness. Most become completely exhausted by routine tasks, such as taking a shower, climbing the stairs, and visiting the doctor. Some cannot sit in the sunlight because it causes extreme migraines. One woman lost her home and lived in a tent in a national park for two years because the government had no program in place to care for her. Certainly, this is something the committee is very well aware of.

In what follows, I will speak to implementation of care. I have spoken to more than fifty researchers and practitioners, with about one-third reporting a previous Long Covid diagnosis, thereby exhibiting a personal as well as clinical experience with the condition. For what follows, I draw on several of these interviews as well as particular conversations Dr. Ali Christy, Dr. Oni Blackstock, Dr. Jodi Roque, Dr. Alba Azola, and Dr. Rebecca Wilson Zingg, including a neurologist, internist, family medicine doctor, physiatrist, and osteopath, respectively.

The first issue is taking patients seriously. Very few people at this point who have described a supportive clinical experience through diagnosis, treatment, and recovery. This is particularly true for children, people of color, transpeople, and those already living with disabilities whose experiences have worsened with Long Covid. In particular, Black and Brown patients face extraordinary distrust and disbelief when they seek care, particularly when their clinician doesn't look like them. This is why in longitudinal studies we have found that Latinx and Black Americans have higher rates of biological dysregulation due to COVID-19, yet there is more representation in media and clinical care among white Americans.

Part of the dismissal of patients with complex and chronic conditions stem from the biomedical model itself. Long Covid is tricky because it's difficult to clearly delineate what stems from Long Covid from what is pre-existing. That's why some clinicians struggle to diagnose Long Covid, and why Long Covid often becomes a default diagnosis after ruling out potential causes. Many clinicians find it's hard to disentangle what's from the infection and what is further dysregulation of a more established diagnosis. This matters mostly because of the way our medical system is structured.

It is well known that our health system in America is deeply unequal. It's important to recognize how this affects those living with disabling health conditions since a COVID-19 infection. In overstretched federally qualified health centers in America, every day is an absolute scramble so covering diagnostic tests is difficult even for well understood conditions like diabetes or asthma. A Spanish Speaking clinician in a FQHC in Chicago described how fatigue and ongoing shortness of breath increased most among her patients. Some patients also had ongoing blood pressure issues or vascular effects which were not present before they had COVID. However, these medical problems are compounded by the specter of underinsurance and uninsurance. Without money, most of these patients go untreated.

One solution that has been devised is curated Long Covid Clinics. Yet, most people I have spoken to are irate about these clinics. This is not because they are a bad idea. It's because of the way they are structured. Long Covid Clinics have primarily been set up to be switch boards. Instead of meeting one clinician who can care for the whole person, Long Covid clinics are set up to help patients manage their specialty care. Most people I've spoken to have sought care from two dozen doctors. In fact, Long Haulers' most difficult activity that they have to save energy for is to see the doctors once or twice a week. In other words, the Long Covid Clinic is a misnomer; it is an effort to help provide access to needed specialist care but provides no meaningful care coordination across specialties. In short, this system is not set up for people dealing with the autonomic dysregulation that so many people with Long Covid are managing day in and day out.

What people need are holistic healers who can sit, listen, and spend time coming up with plans for navigating a new normal. This involves not only training clinicians about complex and chronic conditions, and autoimmune conditions in particular, but also matching patients living with chronic and complex conditions with clinicians who are knowledgeable and experienced caring for them. Moreover, we need to learn from the expertise of physicians treating patients living with similar syndromes before the pandemic, such as autoimmune conditions, ME/CFS, MS, and fibromyalgia-indeed, there is no need to start from scratch.

There are some good examples in biomedicine that should be emulated and amplified across all health systems. The most important element is creating clinical space for clinicians who have been trained and have experience in caring for people living with complex and chronic conditions. As a clinician specializing in complex and chronic conditions, Dr. Alba Azola, a physiatrist at Johns Hopkins University and an assistant professor of medicine, described five key elements of Long Covid care that are essential for this committee.

4. Fourth, cultural competency needs to be understood for explaining symptoms of Long Covid. In this way, not everyone will come to the clinic with the same knowledge and the conversations people can and want to have about their symptoms and underlying causality will differ enormously. I have found that highly educated women find they are dismissed by doctors because they come to the clinical encounter with too much information while people less familiar with what is causing their symptoms may be dismissed because they are perceived to understand too little.

This requires clinical spaces that are holistic and integrative. This means there are clinicians who can work across biological and health systems. It may also require clinicians to engage in house visits for patients who suffer from post exertional malaise, or PEM, so they can save their energy for healing. This may require practitioners that are trained to implement holistic approaches for evaluating a patient and coordinating multidisciplinary care for people with Long Covid, as opposed to conventional medical subspecialists who are so narrowly focused on a certain part of the body.
Share Long Covid: An Anthropological Perspective
Finally, to summarize what an ideal Long Covid care might look like, I will highlight five key elements.

5) Providing an integrative team in one place. Clinical environments can be disabling for Long Covid patients. The optimal clinical context for a Long Covid patient would involve knowledgeable providers, including specialists, who can move in and out of a clinical room during an elongated session for a Long Covid patient. This would mean that the Long Covid patient would need to travel to the clinic or hospital fewer times. It would also require a team or collaborative care approach focused on the unique social, psychological, and physical needs of the patient.

Thank you sincerely to the committee for inviting me to share these comments.
Share Long Covid: An Anthropological Perspective

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National Academies of Science, Engineering, and Medicine

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My thoughts for the committee Examining the Definition of Long Covid*

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"Dr. Al-Aly to room of unmasked Senators: Long COVID comes from COVID Advocates were thrilled when the HELP Committee announced a hearing on Long COVID.  But why is basic prevention being ignored"?

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"Dr. Al-Aly to room of unmasked Senators: Long COVID comes from COVID Advocates were thrilled when the HELP Committee announced a hearing on Long COVID.  But why is basic prevention being ignored"?

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https://www.thegauntlet.news/p/dr-al-aly-to-room-of-unmasked-senators?r=a36iw&utm_campaign=post&utm_medium=web

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Last week, the US Senate Committee on HELP (Health, Education, Labor & Pensions) announced a hearing on Long COVID. The reaction among patients and advocates was instant, loud, and joyous; finally, the government would acknowledge the worsening crisis. Finally, elected officials were saying the words "Long COVID." (Joe Biden, for the record, still has never said nor tweeted the words Long COVID; tens of millions are now suffering with it thanks to his mass infection-normalizing policies). Finally, an institution admits the disease is real.

The bar, as you can tell, is not high.

My emotions as I watched the hearing were mixed. Senator Sanders' opening statements were fantastic; he acknowledged that Congress had "not done enough," promised to do what he could to help, and also made critically important statements about the risks of Long COVID, correctly stating:

Each reinfection increases the risk of developing Long COVID. If you are under the impression that once you've gotten COVID you never need to worry about it again, you are mistaken.

This simple piece of information has the potential to be world-changing were it widely understood and incorporated into public health guidance. Taken together, the facts that Long COVID is a serious, debilitating illness, that many people do not recover, that it is common, that risks compound- not decrease- with continued reinfections- any logical person will understand that the only reasonable approach to COVID is a serious, institutional mitigation strategy.

Our collective approach to a virus that carries a high risk of long-term and even disabling illness cannot be to reinfect every person with it 1-2 times a year. No society, no economy, can bear the illness burden, disruption, and cascading consequences of population-level worsening health. This should be obvious, the ground floor of understanding the COVID/Long COVID crisis.

We've already begun to see the society-level outcomes of normalizing constant reinfection with COVID. We've got record student absences. Reintroduction of child labor as industries struggle to stay staffed. Immune dysregulation resulting in massive waves of RSV, deadly outbreaks of Strep A, a surge in fungal infections, and more. High excess deaths and, particularly, high cardiac deaths among young and middle-aged people. Unsustainable pressures on global healthcare systems that, while they existed before COVID, can clearly be seen to drastically accelerate post-COVID in this NHS data.

Senator Sanders, however, did not wear a mask during his opening statement. The other Senators, including doctors, including Senator Markey who stated "22-38% of people who get COVID will get Long COVID" and Senator Marshall who described a "close loved one" badly struggling with Long COVID, did not wear masks.

Senator Sanders did put on a mask when he was done speaking, which I was pleased to see. But the irrationality, the rejection of basic science and the promotion of poor public health inherent in removing a mask to speak is both incredibly damaging as well as discrediting if you'd like to be a champion of the cause. Millions are desperate to be able to point to progressive role models like Senator Sanders when they chose to wear a mask to protect their health. The refusal to mask by prominent progressives is a major contributor to the continued stigmatization of masks in leftist spaces.

Having a Long COVID crisis hearing in a room where COVID mitigations are absent is like having an AIDS crisis hearing and trying not to mention HIV prevention. It's unserious if you're not going to address the root cause.

Fortunately, tireless Long COVID researcher Dr. Ziyad Al-Aly appeared in the second half of the hearing in a blue suit and well-fitting brown mask, perfectly willing to talk about the elephant in the room. "There is no Long COVID if you never get COVID," he pointed out, going on to discuss the importance of air quality upgrades. While pushing for mitigation measures, he made the memorable and evocative comparison:

We proof buildings for earthquakes that happen once every 50 or 100 years. We invest millions. Why can't we do the same thing to make sure that our buildings are proofed against natural hazards like airborne pathogens?

Hearing these words before a Commitee of U.S. Senators was thrilling. I'm very hopeful that this discussion is the first of many, that the electeds in the room and their teams will begin to do the economic math on massive illness reduction via engineering.

The assembled Senators were empathetic and attentive as they listened to patients express their pain and researchers describe their findings. But the message sent by the lack of masks and COVID mitigation in the room is an inability to understand- or unwillingness to acknowledge- that the Long COVID crisis represents the utter failure of Presidents Trump and Biden's shared COVID approach. Long COVID isn't a mysterious curse from the Gods or an unknowable affliction of fate; it's the result of a COVID infection. Last week, we hit the peak of the second largest COVID wave of the entire pandemic, with nearly 1.5 million infections per day. That is, conservatively, 150,000 new Long COVID patients. Daily.

Patients who, as was so thoroughly demonstrated at the HELP hearing, will be left without treatment, will be disbelieved by doctors who've absorbed years of "COVID is the flu now" propaganda, and will in some cases become housebound, bedbound, and unable to work.

Patients who need not have joined the ranks of those who've already been harmed, if they'd been properly informed that a single COVID infection can ruin your life, but simple mitigations can drastically decrease your risk of catching it.

To think you can address a public health crisis of this scale while putting out zero messaging on prevention, while refusing to model basic mitigations, while holding fast to the failed "just ignore it" strategy, is entirely unserious. Letting COVID rip despite knowing it will inevitably ruin the lives of many who contract it (including children who cannot possibly consent to their forcible infections), is indefensible and sadly completely unnecessary. When our leaders talk about "having the tools," to handle COVID, they are technically correct. They have simply made these tools unavailable, expensive, and unmentionable through privatization and misinformation.

Entering year five of life with COVID, we could have a properly educated population that has not been politically radicalized against masks or pumped full of propaganda about how they don't work. We could have fully upgraded indoor air quality with MERV-13 filters, HEPAs and CO2 monitoring. We could have normalized and distributed accurate COVID tests and staying home when sick. Instead, every single policy change coming from the Biden White House and CDC has been to encourage folks to pretend COVID has gone away, to ignore it, to contract it, to spread it, and to get back to work.

Most Long COVID patients are well aware that another infection could further disable or even kill them. As they await treatment, what would the HELP Committee advise the tens of millions of people who cannot afford another COVID infection to do? When 1 in 30 or 1 in 20 people have active COVID infections, and have been told they no longer need to try not to spread it? When basic public health interventions have been portrayed as crazy, weird, stupid, annoying, impossible and rude?

Yesterday, as a roomful of Senators contemplated the packed house of masked advocates in front of them (an overflow room also filled up), California announced that it would reduce its COVID isolation period to a single day. This obvious concession to capitalism over human lives will do nothing to address the globally worsening staff shortages, but instead hasten long-term staffing crises in every public-facing industry as more and more are disabled.

Today, Long COVID trended on twitter with over 30,000 tweets discussing the hearing, the illness, the implications, and the future.

Tomorrow, the ranks of Long COVID patients will rise yet again. And the day after that, and the day after that.

Until our political leaders and public health bodies understand and acknowledge that our collective health is being slowly drained by continual COVID reinfections, the Long COVID crisis is here to stay.

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Dr. Al-Aly to room of unmasked Senators: Long COVID comes from COVID

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Advocates were thrilled when the HELP Committee announced a hearing on Long COVID. But why is basic prevention being ignored?

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"I was a young person of color. Not elderly and white. Now, even the CDC’s data shows that Latina and LGBTQ+ communities are currently experiencing the highest levels of long COVID in the US.”  

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"I was a young person of color. Not elderly and white. Now, even the CDC’s data shows that Latina and LGBTQ+ communities are currently experiencing the highest levels of long COVID in the US.”  

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https://thehill.com/homenews/senate/4417576-senators-more-investment-long-covid-research/

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Angela Meriquez Vázquez said she used to be an active and healthy runner. But when she contracted COVID-19 in March 2020, her condition continued declining long after the initial infection.

She had severe blood clots and mini-strokes. She struggled with confusion and numbness that eventually resulted in her inability to walk for days. She knew something was wrong within weeks, but Vázquez said doctors dismissed her symptoms.

Vázquez told the Senate Committee on Health, Education, Labor and Pensions that her story is similar to many Americans struggling with long COVID.

Senators largely agreed during the hearing Thursday that the government must become more involved in long COVID research and provide support for the growing number of Americans struggling with lasting symptoms.

Her age and ethnicity, Vázquez said, also contributed to her lack of care. She was turned away from the hospital multiple times with serious symptoms, since she did not fit the stereotypical demographic of COVID-19 patients, often white and older.

"I was a young person of color. Not elderly and white. Now, even the CDC's data shows that Latina and LGBTQ+ communities are currently experiencing the highest levels of long COVID in the US."

Vázquez said doctors originally didn't acknowledge that her COVID-19 infection could be linked to chronic illness, but her symptoms later matched with "long overdue" research on infection related pathology.

"High markers for an autoimmune disease, labs that showed my blood was severely clotted, markers of an overactivated and exhausted immune system," Vázquez said, "all were dismissed by doctors as anxiety."

Sen. Bernie Sanders (I-Vt.), committee chair, said long COVID is a crisis that "has not gotten the attention that it deserves from the community, from the media and certainly from members of the congress."

Sen. Tim Kaine (D-Va.) said he has been struggling with symptoms of long COVID for four years and said he was upset by the difficulty for people of color and women to be believed and get treatment.

"Doing a hearing about this has a way of sending a message. You are believed," Kaine said.

Long COVID is an assortment of medical issues that can develop after a person has the COVID-19 infection, according to the Centers for Disease Control and Prevention (CDC). Symptoms vary, with some patients experiencing severe fatigue, shortness of breath, sleep problems or fever.

Dr. Ziyad Al-Aly, a clinical epidemiologist at Washington University in St. Louis, said during Thursday's hearing that long COVID affects at least 20 million Americans across multiple demographics.

There are currently no medicines approved by the Food and Drug Administration to treat long COVID, which Al-Aly said makes it difficult for patients to find and get insurance to pay for treatment.

Vázquez said she had to pay $4,000 out of pocket for care her insurance would not cover.

Sen. Mike Braun (R-Ind.) said situations like Vázquez's highlight significant issues within the current health care system.

"No one should go broke in this country because they get sick or have a bad accident," Braun said.

Sanders said long COVID is an economic issue as well as a health issue. He cited a study from The Brookings Institution estimating that between 2 million and 4 million people are out of work because of the disease.

If 3 million people were out of work, it could result in a $168 billion loss in annual earnings, while if the number was closer to 4 million, it could be a $230 billion loss, according to the study.

Al-Aly said the best way to prevent long COVID is by preventing COVID-19 infections and investing in more large-scale research.

The disease has low recovery rates and more cases due to COVID-19 reinfection, Al-Aly said. The number of people suffering from long COVID is expected to rise unless there are better ways to prevent and treat it.

"People suffering from long COVID need treatment yesterday," Al-Aly said.

Copyright 2024 Nexstar Media Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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Senators push for more investment in long COVID research

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Angela Meriquez Vázquez said she used to be an active and healthy runner. But when she contracted COVID-19 in March 2020, her condition continued declining long after the initial infection. She had severe blood clots and mini-strokes. She struggled with confusion and numbness that eventually resulted in her inability to walk for days.

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"Indeed, prevention is the only real solution to the ongoing global crisis whose roots are intimately tied to the crisis of capitalism".

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"Indeed, prevention is the only real solution to the ongoing global crisis whose roots are intimately tied to the crisis of capitalism".

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https://www.wsws.org/en/articles/2024/01/19/xlsk-j19.html

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Four years late, and amid the second largest wave of COVID infections, where models based on wastewater data indicate that close to 100 million Americans have been infected since mid-October, the US Senate Committee on Health, Education, Labor, and Pensions held the first congressional hearing on Long COVID, the mass disabling condition that can affect one in 10 people with rates increasing with each reinfection. On the day the hearing took place, about 1.6 million people were infected with COVID and upwards of 160,000 people can be expected to develop post-acute COVID syndromes.

In one sense, the hearing was remarkable, because it provided at least some honest assessments of the real state of the pandemic and its devastating impact on the population of the US, and by extension, the rest of the world. But it entirely avoided the role successive administrations have played in facilitating the onslaught. The ruling classes in the US and around the world have adopted the policy of "forever COVID." Mass death, eugenics, disease and disability have all been "normalized."

At no point did Senator Bernie Sanders, chair of the committee, nor any other member acknowledge the scale of the current mass infection or demand a massive reinvestment in halting the progress of the pandemic and the reinstatement of the emergency measures to fund these efforts.

In other words, the entire hearing amounted to be window dressing for a horror show for which the federal government and the elected officials have no inclination to acknowledge and no qualms about allowing it to continue unchecked. What was left unsaid was the massive funding that could end the pandemic must be used instead in prosecuting the wars of empire that include continued support for the war against Russia in Ukraine, unquestioned support of Israel's genocidal slaughter of Palestinians, and risking a global military conflagration that would embroil every country across the globe in a bitter conflict that would dwarf the near 30 million death toll from the COVID pandemic.

As Dr. Ziyad Al-Aly, a physician-scientist at Washington University in St. Louis who is a leading expert on Long COVID, with numerous high-impact publications on the devastation wrought by COVID-19 infections, stated bluntly during his testimony, "The best way to prevent Long COVID is to prevent COVID in the first place. This requires a multilayers/multipronged approach. We must develop sustainable solutions to prevent repeated infections with SARS-CoV-2 and Long COVID that would be embraced by the public. This requires acceleration of development of oral and intranasal vaccines that induce strong mucosal immunity to block infections with the virus. Ventilation and air filtration systems can also play a major role in reducing the risk of infection with airborne pathogens. We did an amazing job proofing our buildings against earthquakes that happen once every few decades or few centuries. Why don't we proof our buildings against the hazards of airborne pathogens?"

However, given the mass rates of infections and the complete dismantling of all systems that track and trace, including guidance on how to manage and prevent infections, the surest and obvious first efforts to "prevent COVID" in the first place is to acknowledge the crisis of the pandemic and implement the basics of public health and pandemic controls on an international scale. Indeed, prevention is the only real solution to the ongoing global crisis whose roots are intimately tied to the crisis of capitalism.

Halting the pandemic also means the opportunity for health systems and health resources to be redirected to the needs of addressing what Dr. Al-Aly called Infection-Associated Chronic Conditions (IACC), which include a host of other viral infections that cause chronic syndromes and prepare the world for the next pandemic at the same time.

As he noted in his testimony, "At least 20 million Americans are affected by Long COVID. It affects people across the lifespan-from children to older adults. It affects people across race, ethnicity and sex. The burden of disease and disability in Long COVID is on par with heart disease and cancer. Long COVID has wide and deep ramifications on the labor market and the economy-some estimates suggest that the toll of Long COVID in the US economy is $3.7 trillion-on par with the 2008 recession."

Senator Bernie Sanders, chair of the committee, who opened the hearing, acknowledged Long COVID is a very serious illness, with conservative estimates of 16 million suffering from the disabling condition. It includes more than 200 symptoms, including serious cognitive impairment and severe cardiovascular and neurological problems that can last for weeks, months, and sometimes years after initial infection. It can trigger disabling conditions like extreme fatigue, shortness of breath, impairment of consciousness and psychiatric dysfunction that for many leads to contemplation of suicide.

But neither in his opening remarks, or at any other time, did he suggest a return to the policies of mitigation through lockdowns, mask wearing and contact tracing, long abandoned by the Biden administration, let alone a full-scale campaign to eliminate the virus altogether.

The three Long COVID witnesses on the first panel-Angela Meriques Vazquez, Rachel Beale, and Nicole Heim-provided compelling testimony about both their personal disabling conditions (or those of their family members), and the utter bankruptcy of the health systems to acknowledge and treat their condition.

Angela, previously a long distance runner, is barely capable of doing her daily work, relies on her medical insurance to access care, and still pays out more than $4,000 out of pocket to get the medicines and specialized treatments she desperately requires. She told the committee, "Unlike me, at least half to nearly two-thirds of surveyed Long COVID patients could not work full-time, according to research conducted by the Patient-Led Research Collaborative, a group of patients with Long COVID that started their peer-reviewed research through our Body Politic support group. Many patients like me experience deep fatigue along with neurological and cognitive symptoms that make it difficult to drive, make decisions, remember instructions, follow conversations, and plan ahead."

Each witness recounted the frustrations they felt with the multiple doctor visits, facing long waits for specialists, lack of Long COVID clinics for referral, failure to fund necessary research on Long COVID, and being marginalized by the health systems as hypochondriacs or neurotics.

Rachel Beales, who used to work as Human Resources Director at a community college in Sedley, Virginia, said, "I had a very full life before I got sick. Long COVID has affected every part of my life. I wake up every day feeling tired, nauseous, and dizzy. I immediately start planning when I can lay down again. There are many days when I sleep all day. On my good days I get about two to three hours of energy." She had been denied twice for Social Security Disability Insurance, and the case is on appeal.

COVID, Capitalism, and Class War: A Social and Political Chronology of the Pandemic

A compilation of the World Socialist Web Site's coverage of this global crisis, available in epub and print formats.

She concluded, "When I think about what comes next, I just don't know. Full recovery seems out of reach for me. I've been sick for almost three years. It feels like there hasn't been much progress in Long COVID research ... for now I am trying to make peace with my situation. It makes me sad to think about my future. This may be as healthy as I get." Indeed, as of now, there are no FDA-approved treatments for Long COVID.

Dr. Tiffany Walker, an assistant professor of medicine at Emory University School of Medicine, who co-founded the Long COVID clinic at Grady Memorial and is a principal investigator for many of the ongoing RECOVER trials, equated the current crisis with Long COVID as roughly equal to the rate of diabetes mellitus in the population, a disease for which there is substantial healthcare and research funding.

She said, "We know that long haulers are more likely to be unemployed or work reduced hours, with one estimate reporting nearly half were unable to work at all. This is corroborated by recent CDC data showing that over a quarter of long haulers suffer from significant activity limitations. This level of disability also mirrors that seen in diabetes, for which $30 billion of indirect costs is spent annually on reduced employment due to disability. The duration of this disease remains unknown; however, there is mounting evidence supporting significant overlap between Long COVID and pre-existing infection-associated chronic diseases such as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and dysautonomia, which are known to be debilitating and can persist in individuals indefinitely."

Dr. Al-Aly, in his testimony, also remarked:

The current research effort on Long Covid does not match the scale and the urgency of the problem. Research effort must be commensurate with the burden of disease caused by these infections. And it should be executed with a sense of urgency.

The US should consider the establishment within the National Institutes of Health of an Institute for Infection-Associated Chronic Illnesses with a budget of at least $1 billion per year to address the complexity and multisystemic nature of Long Covid, ME/CFS and other IACC. Because pandemics will continue to happen (and their frequency will likely be higher in the 21st century than in the 20th century), and because pandemics will likely produce in their wake droves of people with chronic disease and disability, understanding how infections cause chronic illnesses should also be a cornerstone of pandemic preparedness and resilience.

An NIH institute for the study of Infection-Associated Chronic Conditions will help us address the needs of Long Covid, other IACC and position us to be more optimally prepared for the next pandemic. I urge the US Congress and the Executive Branch to work together to materialize this. You have an historic opportunity to act. The lives of millions of Americans now and in the future depend on this.

Rather than address the issues of which they are quite well informed, raised by the witnesses and expert panels, the committee members utilized the moment to simply shed crocodile tears at the decrepit state of the health system, or promote once more the unfounded lab-leak conspiracy for the cause of the current crisis, offering little more than platitudes and empty promises. However, each one of them is complicit in the crisis of the ongoing pandemic and is responsible for the deaths and misery of their constituents.

The pandemic, as a trigger event, has accelerated the rot at the core of bourgeois democracy that is unable to address any of the maladies that have been created out of capitalist production. The Senate hearing on Long COVID is an exercise in futility for those who continue to harbor illusions in reform. The struggle against the global pandemic requires the mobilization of the working class on the basis of a revolutionary perspective, to provide both care for those already sick and the maximum preventive measures to halt the spread of the infectious disease.

Join the fight to end the COVID-19 pandemic

Someone from the Socialist Equality Party or the WSWS in your region will contact you promptly.

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Long COVID specialist tells US Senate that "the best way to prevent Long COVID is to prevent COVID in the first place!"

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The US Senate Committee on Health, Education, Labor and Pensions held its first hearing on Long COVID, four years after the outbreak of the pandemic. However, the working class can expect little but empty words from this belated display of concern.

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"Lighting up Long Covid: An important new mechanistic study and a blitz of other reports that help our understanding".

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"Lighting up Long Covid: An important new mechanistic study and a blitz of other reports that help our understanding".

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https://erictopol.substack.com/p/lighting-up-long-covid

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The findings included lower levels of anti-thrombin III, higher levels of thrombospondin-1 and von Willebrand factor-known factors associated with blood clots. Using machine learning to model the data for predicting Long Covid at 6 months, activation of the complement system was identified, and verified by an independent data set for predicting Long Covid at 12 months.

Oh no, not the complement cascade! It's complicated, with 3 different pathways for activation and all these C components, which few of us remember from biology classes. Hard to keep it all straight. But let's get it simplified.

Besides activation of the complement system, another activation was seen with cytomegalovirus (CMV) and Epstein-Barr virus (EBV) specific antibodies, with the former correlating with extent of symptoms.

It's not the first report about the central role of complement dysregulation. A preprint by Baillie and colleagues had many similar findings, and highlighted the alternative complement pathway activation (of the 3 pathways). This new work adds substantially to 2 other major reports in published in Nature of immune dysregulation in Long Covid, the work by Akiko Iwasaki and colleagues and the recent report by Nadia Roan, Timothy Henrich and colleagues each identifying different parts of innate and adaptive immunity that are out of whack, with systemic inflammation. Many of the findings overlap, such as re-activation of CMV and EBV. The Science paper may get to a/the molecular mechanism underpinning the dysregulation. Another report, but in people with myalgic encephalomyelitis (ME/CFS) this week, using single-cell sequencing, found similar immune dysregulation with monocytes and platelet activation, which gets worse with exercise.

The new report offers hope that complement markers in the blood can be used as a biomarker, which is something we really need in the clinic to confirm diagnosis, provide an objective way to follow patients under treatment, and help develop effective treatments. Furthermore, there are complement inhibitor drugs (such as pegcetacoplan, iptacopan, and vemircopan) used for rare immune diseases that might be worth consideration for testing in Long Covid.

Two new reports further our understanding of potential damage to neurons in the central nervous system. Both are worrisome.

The striking dose relationship for protection in the Sweden national study can be seen in this graph below made by Katelyn Jetelina and Kristen Panthagani.

These new reports strongly reinforce how important it is to keep boosted-the protective effect against Long Covid has not been emphasized enough.

There's a lot here from the past couple of weeks! Most importantly, we have multiple independent confirmations of the immune dysregulation in people with Long Covid via controlled studies. We may be closer to a biomarker with the central finding of persistent complement activation, which would help in both managing individuals with Long Covid and clinical trials testing candidate interventions.

The new publications that confirm the protective power of vaccination against Long Covid cannot be underscored enough. There is general lack of awareness of this benefit of vaccines, and except for not getting Covid or a reinfection, it is the best way to protect against Long Covid.

Into our 5th year of Covid, the chronic sequelae of Long Covid, which can be profoundly disabling, and continue to be inadequately acknowledged. The risk has not gone away, especially with the massive number of infections globally that have been seen during the JN.1 variant rise to dominance. Fortunately, the science and research presses on to illuminate the pathobiology and means of prevention. Hopefully, 2024 will the year we finally get some validated treatments to alleviate so much suffering that's out there.

Thanks for reading, subscribing and sharing this post.

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An important new mechanistic study and a blitz of other reports that help our understanding

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"Long COVID represents the constellation of long-term health effects of COVID-19. It is a multisystem disease that can affect almost every organ system. It affects the brain, it affects the heart, it affects the endocrine system, it affects the immune system, it affects the gastrointestinal system".

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"Long COVID represents the constellation of long-term health effects of COVID-19. It is a multisystem disease that can affect almost every organ system. It affects the brain, it affects the heart, it affects the endocrine system, it affects the immune system, it affects the gastrointestinal system".

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https://24ssports.com/long-covid-expert-at-us-senate-hearing-the-burden-of-illness-and-disability-from-long-covidequivalent-to-the-burden-of-cancer-and-heart-disease/ Dr. Ziyad Al-Aly

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On Thursday morning, January 18, 2024, the U.S. Senate Committee on Health, Education, Labor and Pensions (HELP) held a meeting chaired by Bernie Sanders Hear to discuss the current state of research and clinical practice regarding Long-COVID: Fighting Long-COVID: Promoting Research and Improving Patient Care. senate.gov provided an overview of the need and purpose of the hearing:

"The impacts of this pandemic are still being felt by millions of families," Sanders said. "We cannot turn our backs on the American people as they continue to struggle with long COVID. We must do more at all levels of government to address the health crises facing countless Americans due to the coronavirus. Lives are at stake. We look forward to hearing from patients, experts and researchers about what we need to do to address this crisis, including the advanced research and patient care that so many Americans desperately need."

Today, millions of Americans are living with long COVID and its many symptoms. These include fatigue, cognitive impairment (commonly called brain fog), muscle or joint pain, shortness of breath, heart palpitations, trouble sleeping, mood swings, and more. With millions of Americans suffering every day, more must be done to address this crisis.

For many people, the symptoms of long COVID interfere with childcare, exercise, work ability and social activities - disruptions that can impact mental health. The Census Bureau's Household Pulse Survey estimates that 16 million working-age Americans reported having long-COVID - and of those, 2 million to 4 million are unemployed due to long-COVID. For some, the change in employment status may impact health insurance, which may further complicate treatment options.

Panelists included: (1) Angela Meriquez Vázquez, MSW, Long COVID patient, Los Angeles, CA; (2) Rachel Beale, MBA, Long COVID patient, Southampton County, VA; (3) Nicole Heim, parent of a Long COVID patient, Winchester, VA; (4) Michelle Harkins, MD, Professor of Medicine, University of New Mexico, Albuquerque, NM; (5) Ziyad Al-Aly, MD, clinical epidemiologist, Washington University in St. Louis, St. Louis, MO; (6) Charisse Madlock-Brown, Ph.D., associate professor of health informatics, University of Iowa, Iowa City, IA; and (7) Tiffany Walker, MD, assistant professor, Emory University School of Medicine, Atlanta, GA.

I watched most of the hearing and am really excited to see topics like air filtration, longstanding COVID research and treatment, and more being discussed by experts in a public setting. I was impressed by many of the panelists, but the comments from Dr. Ziyad Al-Aly I particularly noticed. Dr. Al-Aly, who has been studying COVID for a long time during the ongoing pandemic, is director of the Clinical Epidemiology Center and assistant professor of medicine at Washington University School of Medicine in St. Louis. He is also director of research and education for the Department of Veterans Affairs Health Care System in Saint Louis.

In his statement, he discussed how widespread long COVID is, how destructive it is to so many body systems, the fact that there are no FDA-approved treatments for long COVID, and the need for oral intranasal vaccines that can stop infections. He also emphasized the importance of preventing long COVID infection in the first place by preventing transmission of COVID - which can be facilitated by air filtration and masking with high-quality respirators. He and the other panelists are calling for immediate government action to fund more research into the causes and treatments of long COVID.

I have transcribed his statement below to the best of my ability (some passages were unintelligible due to audio problems). If you would like to see the entire hearing, you can find it here shortcut.

Long COVID represents the constellation of long-term health effects of COVID-19. It is a multisystem disease that can affect almost every organ system. It affects the brain, it affects the heart, it affects the endocrine system, it affects the immune system, it affects the gastrointestinal system. Long COVID affects at least 20 million Americans. It affects people across the entire lifespan. We have children with long COVID, we have people 100 years old with long COVID. It affects people across the lifespan and all demographic groups. The burden of long-COVID, the burden of illness and disability of long-COVID, if measured, is equivalent to the burden of cancer and heart disease. And even if people come out unscathed after the first infection, they can still get long COVID after reinfection, and I don't think enough people really know or know about that fact. Long COVID recovery rates are also low. Given the low recovery rates from long COVID and cases attributable to reinfection, we are likely to see the burden of long COVID continue to rise until we find better ways to prevent and treat it.

Now you should ask me: How do we prevent long COVID? Well, the best way to prevent long COVID is to prevent COVID in the first place. There is actually no long COVID without COVID. If you go back to 2019, go back to 2018, none of us have heard of Long-COVID, right? You don't have that. It didn't exist. There is no long COVID without COVID.

We need a sustainable, multi-pronged approach to preventing repeat infections that will be embraced by the public. This requires accelerated development of oral intranasal vaccines that block infections. This is very, very, very important. Ventilation and air filtration systems are also very important. They can play an important role in reducing the risk of transmitting airborne pathogens.

We also need variant-proof vaccines. In reality, the virus continues to mutate towards us. Every few months you will see a new variant. We need a variant-proof vaccine that lasts a long time, that is long-lasting. This provides lasting immunity. People are tired of getting booster shots every few months. We need vaccines that last about five years so they can make it and get it over with for five years.

We also need to understand the side effects of vaccines. This needs to be acknowledged and understood very, very deeply. This is very, very important.

Now you should also ask me: How do we treat long COVID? You've heard it before - there are zero, ZERO approved drugs to treat long COVID. So these people [gesturing to the folks suffering from long COVID who have come to the hearing] I have nothing to really rely on for healing treatment. Nothing. ZERO. ZERO FDA-approved drugs to treat long COVID. That needs to change. We really need to change that. It is not beyond the power and skill of American medicine to solve this problem. That's absolutely not it. We've solved much, much harder problems in the past. We just need to focus on it and solve it. We are the best nation in the world and we can solve this problem. It is absolutely not beyond our ability to address this problem.

Now people suffering from long COVID have to be treated yesterday. The ongoing and planned trials for LC are too slow and too small. . . . We have developed vaccines at record speed, at warp speed. Do you know what we are doing for Long-COVID? We are conducting trials for long COVID at a snail's pace. That's what we do. We urgently, URGENTLY need studies, large-scale trials to test a wide range of repurposed drugs and the development of new drugs to defeat Long COVID. . . .

So what do we learn from all this? Well, what we learn from all of this is that acute infections do happen. The first lesson I learned from this whole pandemic is that acute infections can lead to chronic diseases. That pandemics hinder people. And this isn't new - it happened after the Spanish Flu, but we just ignored it and swept it under the rug. We refer to all of these in the broadest sense as "infection-related chronic diseases". This also includes Long-COVID and also ME/CFS [Myalgic encephalomyelitis/chronic fatigue syndrome]and other clinical pictures that arise from acute infections. If we had understood the connections between acute infections and chronic diseases before the pandemic, we would have been in a much, much better position to actually address the challenge of long COVID. We failed to connect these dots before the pandemic. Let's not make the same mistake again and be ready to truly tackle the challenge of the long COVID period and also the next pandemic.

So where do we go from here? The amount of research on Long-COVID must match the urgency and scale of the problem. That is my opinion and it will require a coordinated approach. In my opinion, the US should consider establishing a... within the NIH Institute for Advanced Infection-Associated Chronic Diseases. These include Long COVID and ME/CFS, which have long been ignored. And other infection-related chronic diseases. You have a historic opportunity to act. The lives of millions of people here and around the world depend on it now and in the future. Thank you very much.

"The burden of disease and disability from Long COVID is equal to the burden of cancer and heart disease."

The best way to prevent long COVID is to prevent COVID in the first place. Without COVID, there is no long COVID."

Brilliant testimony from @zalaly! #HELPLongCovid pic.twitter.com/Cw24Eg8TiJ

- Dr. Lucky Tran (@luckytran) January 18, 2024

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Long COVID expert at US Senate hearing: "The burden of illness and disability from long COVID...equivalent to the burden of cancer and heart disease." - 24ssports

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On Thursday morning, January 18, 2024, the U.S. Senate Committee on Health, Education, Labor and Pensions (HELP) held a meeting chaired by Bernie Sanders Hear

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"Several Senators pressed the patients and researchers about what more the federal government can do to ease obstacles to care and add resources for clinicians and scientists".

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"Several Senators pressed the patients and researchers about what more the federal government can do to ease obstacles to care and add resources for clinicians and scientists".

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https://www.cidrap.umn.edu/covid-19/patients-experts-take-center-stage-senate-long-covid-hearing

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Also, healthcare providers and researchers described the challenges in managing and studying a condition with a wide spectrum of health impacts and debilitating effect on patients. Today's hearing attracted a large crowd of patients and their advocates that spilled over into a second room.

People suffering from long COVID needed treatment yesterday.

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Patients, experts take center stage at Senate long-COVID hearing

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Also, healthcare providers and researchers described the challenges in managing and studying a condition with a wide spectrum of health impacts and debilitating effect on patients. Today's hearing attracted a large crowd of patients and their advocates that spilled over into a second room. People suffering from long COVID needed treatment yesterday.

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"Long Covid activists disrupted a Senate HELP Committee Hearing on Jan. 18 chanting for a declaration of a national emergency and more funding and treatments before quickly being escorted out".

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"Long Covid activists disrupted a Senate HELP Committee Hearing on Jan. 18 chanting for a declaration of a national emergency and more funding and treatments before quickly being escorted out".

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https://longcovidactionproject.com/long-covid-activists-disrupt-senate-hearing/

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Long Covid Activists Disrupt Senate Hearing

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Long Covid activists disrupted a Senate HELP Committee Hearing on Jan. 18 chanting for a declaration of a national emergency

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"In her written remarks she noted that the current research landscape is "alarmingly disjointed," and that experts across a range of medical specialties "remain siloed." Additionally, the lack of adequate funding is a disincentive for both scientists and drug companies who might otherwise be investigating potential treatments".

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"In her written remarks she noted that the current research landscape is "alarmingly disjointed," and that experts across a range of medical specialties "remain siloed." Additionally, the lack of adequate funding is a disincentive for both scientists and drug companies who might otherwise be investigating potential treatments".

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https://www.medpagetoday.com/publichealthpolicy/healthpolicy/108345

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While one expert called for a "moonshot" to address long COVID, some lawmakers questioned whether federal dollars on such research have been well spent, during a hearing of the Senate Health, Education, Labor, and Pensions Committee (HELP) on Thursday.

Informatics expert Charisse Madlock-Brown, PhD, of the University of Iowa in Iowa City, argued that a "long COVID moonshot," similar to President Biden's Cancer Moonshot, is urgently needed.

In her written remarks, she noted that the current research landscape is "alarmingly disjointed," and that experts across a range of medical specialties "remain siloed." Additionally, the lack of adequate funding is a disincentive for both scientists and drug companies who might otherwise be investigating potential treatments.

Sen. Roger Marshall, MD, (R-Kan.), whose "loved one" has had long COVID for more than 2 years, said he's frustrated with the lack of progress from the NIH, which received over $1 billion for long COVID research in December 2020. "They've been focused on, as I call it, 'forming committees and praying about it,'" he said.

Marshall acknowledged that researchers are studying risk factors and causes, but argued that the agency should be prioritizing diagnosis and treatment.

He also floated the idea of redirecting some funding to the Biomedical Advanced Research and Development Authority (BARDA), which he said is more streamlined and more willing to engage the private sector.

He noted that private-sector physicians are currently studying "cytokine panels and coagulation workups, plasminogen activation inhibitors, fibrin, monomer, [and] dimers," as well as "microclots ... too small for us to see on the typical scans."

Marshall asked Ziyad Al-Aly, MD, a clinical epidemiologist at Washington University in St. Louis, whether his work included similar research.

Al-Aly said it didn't, but he endorsed the idea of finding treatments "as soon as possible." Throughout the hearing, he argued that current and even planned trials are "too small" and "too slow."

Marshall also asked the witnesses -- physicians and scientists involved in long COVID research -- whether any had been successful with off-label treatments such as hydroxychloroquine and acyclovir.

Tiffany Walker, MD, of Emory University School of Medicine in Atlanta, pointed to observational data from Stanford University on the use of low-dose naltrexone, which "doesn't work for everybody, but is very beneficial for some."

While it's important to look for curative treatments, Walker noted, "we just need medications that will cause some relief of symptoms, as we're trying to learn more about this disease and find treatments for it."

During the patient panel, Nicole Heim described how her 16-year-old daughter who has long COVID suffered from daily constipation, nausea, and vomiting that was so constant, "she'd walk around with a puke bag in her hand, all the time." That was before her physicians and family realized there was still COVID in her stool.

"We did a 'clean out' through a colonoscopy ... kind of by chance ... and then we started on a pro- and prebiotic that Children's [National Hospital's Pediatric Post-COVID Program] recommended," she explained. "And those symptoms almost completely went away."

Heim said many physicians aren't well-informed about long COVID, and one gastroenterologist she spoke with recently didn't know that COVID can live in a person's gut for months, or even a year.

"I want the doctors to know what we're learning," she said.

Angela Meriquez Vázquez, MSW, a patient with long COVID and the former president of Body Politic, a patient-led organization for long COVID advocacy, said that basic diagnostic and screening tools need to be shared broadly with primary care physicians in particular. "They're the first person that folks go to after an infection with these ... somewhat nebulous symptoms."

Vázquez also noted that she hoped that greater understanding of long COVID might help to reduce the amount of "medical gaslighting" patients experience, adding that when she first developed symptoms, "I was told multiple times that unless I was elderly, and in need of a ventilator, that I needed to go home and save beds for people who are really sick," despite labs showing that she had severe blood clots.

"I was sent home as a 'psych' patient," she said. Being a woman and a person of color didn't help, she noted.

Michelle Harkins, MD, of the University of New Mexico in Albuquerque, recommended establishing a "national network for telementoring" clinicians and sharing the most up-to-date research findings and treatments.

In her written testimony, she said that during the pandemic, a similar virtual network through Project ECHO (Extension for Community Healthcare Outcomes) had helped nursing homes to train staff on infection control.

Circling back to the question of off-label drugs, Marshall asked Al-Aly specifically about whether he used any with patients. Al-Aly said there weren't any he would publicly endorse.

"Anecdotally, there are a lot of things that people say ... might work," he noted, "but I think we need to accelerate trials, so we actually find out what works and what doesn't."

Marshall said he is "all for longitudinal studies," but "desperate times call for desperate measures" and doctors shouldn't be "persecuted" for using medications off-label.

Shannon Firth has been reporting on health policy as MedPage Today's Washington correspondent since 2014. She is also a member of the site's Enterprise & Investigative Reporting team. Follow

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Informatics Expert Presses Congress for Long COVID 'Moonshot'

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But one senator questioned NIH's progress: agency is 'forming committees and praying about it'

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"I'll say the testimony really underscored just how hard it is to navigate the health care system with this illness. Many doctors aren't familiar with it. Some patients still aren't believed. Long COVID clinics can be hard to get into. And doctors, they can treat symptoms, but as we said earlier, there are no approved treatments".

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"I'll say the testimony really underscored just how hard it is to navigate the health care system with this illness. Many doctors aren't familiar with it. Some patients still aren't believed. Long COVID clinics can be hard to get into. And doctors, they can treat symptoms, but as we said earlier, there are no approved treatments".

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https://www.wwno.org/2024-01-20/advocates-push-for-greater-investment-in-long-covid-research-at-senate-hearing

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SCOTT DETROW, HOST:

On this day four years ago, scientists at the CDC discovered the first case of COVID-19 in the United States.

(SOUNDBITE OF ARCHIVED NPR BROADCAST)

NOEL KING: A resident of Washington state in the Seattle area is infected.

DETROW: At that point, the new virus and the illness that caused were a mystery, and as the years have gone on, we have learned more and more. But one of the biggest remaining unknowns is long COVID, that constellation of symptoms that plagues some people but not others long after an infection. So where do things stand with long COVID now? That was the topic of a Senate hearing held on Thursday. NPR health reporter Will Stone covers long COVID and joins us now. Hey, Will.

WILL STONE, BYLINE: Hey, Scott.

DETROW: And before we get into that hearing, you're based in Seattle, and you were on the ground covering those very early first known cases of COVID, right?

STONE: I was. You know, many of us have our first COVID memories, that moment when it suddenly became very real. For me, it was rushing to the Washington Public Health Laboratory and sitting there. No one was wearing masks yet, and the governor and health officials talked about this first case. And if you recall, it wouldn't be until later in February that we actually realized there were more cases in Washington and elsewhere in the country that had no connection to overseas travel.

DETROW: Yeah. Yeah. And since then, you've been covering long COVID for years now. You were watching this recent Senate hearing. What stood out to you?

STONE: More than anything, I would say the very fact that this took place, that it was well attended, senators were engaged - that visibility was a big deal. Many of those who have long COVID, they've been ill for months, even years. Their lives have been upended, and they feel forgotten. I'm thinking about people like Rachel Beale, who's had long COVID for almost three years. She lives in Virginia and spoke at the hearing.

(SOUNDBITE OF ARCHIVED RECORDING)

RACHEL BEALE: I had a very full life before I got sick. Long COVID has affected every part of my life. Now I wake up every day feeling tired, nauseous and dizzy. I immediately start planning when I can lay down again.

STONE: And frankly, Scott, this kind of story is pretty common in the world of long Covid, so it was significant that Senator Bernie Sanders kicked off this hearing by calling long COVID a crisis.

DETROW: How far along are scientists in understanding this illness at this point?

STONE: Well, to put it simply, they still don't know the underlying cause of this illness, and to be fair, this is complex, painstaking work. Lots of scientists are working on it, and in fact, no one really thinks this is just one illness. There are very likely different causes in different people, and in the past year, there have been some meaningful advances in the science of findings related to changes in hormones, evidence of a chronic viral infection, immune dysregulation, a buildup of tiny blood clots. There are lots of different fronts here. That said, there are still no validated treatments for the condition, and this is a point Dr. Ziyad Al-Aly made at the hearing. He's at Washington University in Saint Louis.

(SOUNDBITE OF ARCHIVED RECORDING)

ZIYAD AL-ALY: This must change. We really need to change this. It's not beyond the might and the prowess of American medicine to solve this problem.

STONE: He wants to see the might and prowess of American medicine, which, you know, after all, got us those vaccines very quickly, go toward long COVID. And basically, the message from scientists is that there need to be more rigorous clinical trials testing different treatments.

DETROW: Again, we're talking about a Senate hearing here. So remind us what the role of the federal government is in all of this.

STONE: Yeah. I'd say, number one, it's resources. The patient advocates and researchers want to see more money and coordination coming from the government. Take a listen to this exchange between Senator Bernie Sanders and the panel of doctors and scientists.

(SOUNDBITE OF ARCHIVED RECORDING)

BERNIE SANDERS: I'm assuming that all of you believe that the federal government has got to play a much more active role with substantial sums of money for research, development, clinical trials, etc. Is that...

UNIDENTIFIED PERSON #1: Absolutely, yes.

UNIDENTIFIED PERSON #1: No doubt.

SANDERS: All right.

STONE: Now, I will say Congress did allocate more than a billion dollars for long COVID research. That supported a huge initiative called RECOVER, but there has been growing criticism about how that money was spent, that it hasn't led to meaningful breakthroughs. Earlier this month, before the hearing, I spoke to Dr. Admiral Rachel Levine about these concerns. Levine is assistant secretary for health at the Department of Health and Human Services.

RACHEL LEVINE: I want to emphasize that there is a lot of money going for research. As the NIH has pointed out, that money has been allocated, but the research continues.

STONE: There was some new funding announced by the National Institutes of Health, the NIH, recently. But, you know, patient advocates say a problem of this magnitude doesn't get solved without billions of dollars more in funding.

DETROW: Is there a big-picture way to frame how patients are doing, this many years in?

STONE: Scott, I'll say the testimony really underscored just how hard it is to navigate the health care system with this illness. Many doctors aren't familiar with it. Some patients still aren't believed. Long COVID clinics can be hard to get into. And doctors, they can treat symptoms, but as we said earlier, there are no approved treatments. So overall, there's a sense that if things don't change, it could take a long time for scientists to get to the bottom of this and for patients to get the care they need.

DETROW: That's NPR's Will Stone. Thanks so much.

STONE: Thank you. Transcript provided by NPR, Copyright NPR.
NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR's programming is the audio record.

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Advocates push for greater investment in long COVID research at Senate hearing

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Four years after the first known case of COVID-19 in the United States, long COVID remains a mystery to scientists. Medical experts called for more research funding at a Senate hearing Thursday.

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"Media and Research this week: This is the first time I can remember highlighting any LC research in Science".

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"Media and Research this week: This is the first time I can remember highlighting any LC research in Science".

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https://longcovidweekly.substack.com/p/long-covid-weekly-77-senate-hearing?publication_id=999185&utm_campaign=email-post-title&r=a36iw

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Long Covid Weekly #77: Senate Hearing Results, LC gets published in Science

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Hi everyone, The biggest news this week was the Senate Hearing held on Long Covid on Thursday! For the full recording, please see here. I had the opportunity to tune in for the first hour or so of the hearing and it did not disappoint! With senators on both sides of the aisle finding more common ground on LC ( see