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

[SNT Gatchaman]

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

"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.

On viral reservoirs —

Dr. Michael Peluso, an infectious disease specialist at [UCSF], 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."

On activated T-cells —

"We saw some very unexpected findings," says Dr. Timothy Henrich, an associate professor of medicine at [UCSF].

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.

On microclots —

"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."

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

On hormones —

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."

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.

 

[rvallee]

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."

On this, there really needs to be more attention paid to Barry Marshall's work. He won a Nobel prize for showing that most peptic ulcers are caused by H. Pylori, but has continued his research since and found that most people carry it, and in fact that some people who don't carry it at all have other health problems.

The germ theory of disease is not the simple version of "get pathogen X, get disease-Y-caused-by-X, eliminate the pathogen or die" that is clearly the one in operation. It's far more complex than this and medicine needs to freaking accept that they can't know everything, there will always be unknowables about everything that they do, meaning that they absolutely need to stop with extreme prejudice their current obsession with psychosomatics out of "we don't know, therefore psychosomatic".

Meanwhile we are still in the "what, you think a virus did this to you?" phase of things. An adolescent phase, at best.

 

[ahimsa]

Thanks for posting that link, @SNT Gatchaman!

On a slight tangent, I've been pleased to see so many media outlets using photos from this year's May 12 Millions Missing demonstration. That array of 300 cots, spread out on the lawn at the base of the Washington Monument, makes a good visual statement.

 

[Solstice]

Was searching for this on google to see if it was available in audio but can't find it. Looks interesting at least, thanks for posting.

 

[Jaybee00]

Maybe they should have invited experts on MECFS since that is what they are studying—don’t reinvent the wheel.

 

[Dakota15]

@Jaybee00 Nath & Walitt were there, who led the NIH ME Intramural Study. Systrom was there too (ME Researcher). You probably already knew that though (is my guess), but sharing if others weren’t privy to.

 

[Jaybee00]

@Jaybee00 Nath & Walitt were there, who led the NIH ME Intramural Study. Systrom was there too (ME Researcher). You probably already knew that though (is my guess), but sharing if others weren’t privy to.

Nope—didn’t know this—thanks. Not indicated in the NPR article.