After last week's LIINC / UCSF study, I wanted to go back and re-listen to this work from Jason Gale with
Bloomberg: "
How the Dead Are Helping the Living" from 10/25/2021 (and since I hadn't caught the 30-minute episode back then) and to then just to gauge how things have fared since (and was curious to analyze some of Nath’s hypotheses)
Features Walter Koroshetz (NINDS), Avindra Nath (NINDS), Steven Deeks (UCSF) & Daniel Chertow (NIH Clinical Center)
'By looking for clues among the deceased, Daniel Chertow aims to understand how to treat and prevent the disease in the living, including the lingering symptoms afflicting millions of Covid “long haulers.”
Excerpts:
“The condition is called long Covid, and Dan's research could help us understand how to better combat it. But science is an iterative process."
“..and in a reasonable portion of the population of survivors, long-term symptoms that are really distressing. Dan and his group are also trying to figure out how the virus and the body interact...Dan's research will not only help us understand what the causes are, but how to counter them.”
“Walter says it's this group of patients, the ones with unexplained fatigue, brain fog, weird heart palpitations and body aches and pains, who also represent the largest pool of patients who are persistently unwell as a result of the pandemic.”
Koroshetz: “Fatigue is a major problem. The long Covid symptoms consist of fatigue, trouble with memory, trouble with thinking quickly, executive function, trouble with sleep, pain syndromes, sometimes exercise intolerance. Those are the features of this syndrome that we don't have good explanations for at this point.”
“In some ways, the disease pattern many long Covid sufferers experience resembles mono or infectious mononucleosis...with infectious mononucleosis, there is another syndrome which you've probably heard about, called myalgic encephalomyelitis, chronic fatigue syndrome. And symptoms are very overlapping between what long Covid folks are complaining of and what happens in ME/CFS. It's just that ME/CFS has a six-month period.”
“Walter says researchers have been trying for years to figure out the causative driver of that longer-term illness after infectious mono.”
“Now with the 34 million people with Covid, it's a tremendous challenge now that we have to take up to try to figure that out. There is a greater chance that we're going to figure it out now because we have this opportunity to study so many people and to try and understand what differentiates those who get better quickly versus those who have these persistent symptoms. So the hope is that we can get some answers that would allow us to try different treatments to see what helps and then potentially also learn something about what causes ME/CFS as well.”
“This is Dr. Avi Nath. He's the clinical director at the NINDS...Avi says there could be two main driving forces behind the clinical manifestations. One is that the coronavirus manages to persist in the body somewhere, somehow, and that its lingering presence is damaging the body directly, or it's triggering an immune response that's causing the damage.”
“Another hypothesis is that the coronavirus has sent the immune system haywire, and it's this dysregulated immune response that's driving long Covid...I think there are all reasonable hypotheses, but they're not exclusive. They could be interrelated. Avi's been researching chronic fatigue for years, and now he's also trying to understand it, as well as other ailments in long Covid patients.”
Nath: “...but if you had a mild illness, perhaps you never mounted a strong enough immune response. You thought, oh, you know, I escaped this. But in reality, you never got rid of the virus...Avi says another possibility is that what's persisting are viral particles that may not be completely replicating, but are instead expressing some features of the virus.”
Nath: “Now what the body is going to see it as a foreign object is going to try to mount an immune response against it. So you get this chronic immune activation that persists in these individuals. But it's never good enough to get rid of it because they never got rid of it in the first place. But it's enough to start causing collateral damage. Avi sees the same pattern of immune activation and exhaustion in chronic fatigue or ME/CFS patients. They look very much like these long-haul Covid patients. And they have the similar problems. They usually start off with some viral infection, then they recover from it, and then this thing persists forever.”
“Steve Deeks from UCSF thinks the coronavirus might be leaving traces behind. It could be viral protein, strands of its genetic material, or even bits of antigen that the immune system responds to...we don't think it's virus replication, but I guess it could be virus that's replicating in target cells and tissues. We always thought that that was a potential reason for why this symptom persists."
“Steve says circumstantial evidence supports the concept that there's something persistent that's causing long Covid.”
“Deep in his lab, Dan Chertow and his team have amassed more than 10,000 autopsy specimens for meticulous study. Their analysis is beginning to yield some answers to the many questions around Long Covid and what causes it.”
“Dan says he expects this last bit of information shortly and then can finish a manuscript. But evidence pointing to the causes of long Covid are of little help to patients, unless the findings can yield ways to help them.”
