11/3/22, Open Mics with Dr. Stites:
Show Me the Science: National Study on Long COVID
“Joining us virtually from Washington, DC is Rear Admiral and Assistant Surgeon General and Deputy Assistant Secretary in the US HHS for Science and Medicine, Dr. Michael Iademarco.”
Host: "“What are some of the similarities between long COVID and other infection associated conditions?”
Iademarco: “When we think about long COVID, it depends on how you categorize it. There could be up to 40 different conditions, and some of them share symptoms with previously recognized infection associated conditions. One of them, for example, is ME/Chronic Fatigue Syndrome."
Another is the Dysautonomia, which I mentioned previously, and Cognitive Impairment, which is often termed Brain Fog in the media or lay press. And so there are examples of conditions that share symptom overlap, to a significant degree, to what we're seeing definitively in patients with long COVID. And then there's other conditions, you know, viruses, there's all different types of viruses and a few bacteria that cause these more chronic conditions.
For example, Lyme disease or West Nile virus, etc. A number of these conditions we know cause a whole host of symptoms. And so when you compare the vast array of perhaps over 200 symptoms that have been categorized so far with long COVID, you can find conditions or sub conditions that share overlap with these other conditions.”
“So if we can understand and study the basic causes of long COVID, it's hoped that we'll actually be able to benefit, not just patients prevent and help patients with long COVID, but the understanding and the therapies could extend to people with these other conditions.”
Host: “The cognitive issues, all these symptoms overlap with other health disorders like chronic fatigue syndrome as you talked about, and myalgic encephalomyelitis. So what can we learn from these other conditions as well?
Iademarco: "Yeah, I think that's another point that we're trying to do from a federal coordination view. So you know how in different areas of medicine, we have sort of separations between different disciplines, cardiology or psychiatry, etc. And so when you think about all those other conditions that we've just been talking about, they have their own experts."
And because long COVID and how long COVID is new, there's a new emerging set of experts. So one thing we try to do is to get these experts together as quickly as possible, whether it's a research study or trying to design best practices. We're working closely with professional societies to also help with some of these bridges.”
“In terms of the causes with long COVID, I think there's two emerging tracks that people are thinking about. One is the virus causes direct effects on tissues and cells throughout the body, causing the damage leading to the symptoms and then the condition. And then the second theory or second bucket of theories is that the virus causes inflammation in a complicated way where that the virus may settle down or be eradicated or eliminated, but the continued persistent inflammation goes on to have bad effects on the body. So two examples might be that in the first category, the virus is affecting, say, blood vessels.
There could be small clots, and this could be contributing to the cognitive impairment. That's just one of several ideas in that area, where in the second category, the virus is causing an immunologic reaction, and then that immunologic reaction hits the pancreas and then causes diabetes. So these are the two major pathways. But I think in the end, we're going to find multiple pathways in terms of cause and effect for long COVID.”
Host: "“Joellen wants to know, could this type of research for COVID and long COVID help with research for other conditions like fibromyalgia? Are there similar characteristics with fatigue?”
Iademarco: "Yeah, in the RECOVER studies, actually, one of the challenges with the RECOVER studies is defining what we call the endpoints. That is, you do the study and you have to measure something at the end to see if there was an effect. Did the patient get better or not? Did the cancer go away or not? With long COVID, because it's new, defining these measurements to determine whether a certain treatment has been successful or not, or effective or not, has really been challenging. And fatigue is one of them.
It's hard to measure fatigue from a objective machine-measured endpoint or testing endpoint. But the NIH and their partners in academic centers, relying on previous literature from other fatigue conditions, including fibromyalgia, have come up with ways that they're going to measure fatigue. So yes, fibromyalgia includes overlap with these long COVID conditions. Fatigue is one of those important symptoms. And measuring it is really important. And people, everybody wants everything to go really, really fast, which is very understandable. But at the same time, we have to get it right so that we end up with meaningful results at the end, so that can lead to approved tests and treatments.”
“Where it's more challenging are the conditions in this third bucket that we talked about in terms of chronic fatigue syndrome, dysautonomia or POTS and the cognitive impairment, along with other autoimmune types of conditions. There things are less well defined.”
