TLC Sessions - Living with Long Covid

Dr Benjamin Krishna and the Virology & Immunology team at Cambridge University have identified a protein, elevated in the blood of Long Covid patients, that could act as a potential biomarker for the condition.  This week, we spoke to Dr Krishna about their study, published in Science, which sampled the blood of Long Covid patients across several years. They found Interferon Gamma (IFNɣ) at, an average of, six times the normal level.  IFNɣ is a key protein in the body’s immune response, a moderator of inflammation and a mediator for fighting infection.  These raised levels of IFNɣ are indicative of the immune system remaining active throughout Long Covid.  The team found that levels returned to normal in patients once they recovered from the disease. 

These findings could help develop treatment strategies and offer a clear diagnosis for some Long Covid patients.

Living with Long Covid? How was your week?

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Dr Theoharis Theoharides, aka “The Mast Cell Master”, has been exploring the world of Mast Cells, their influence on our bodily functions, neurology and genetic make up, for over half a century.  The Director of the Center of Excellence for Neuroinflammation Research and Professor at the Institute for Neuro-Immune Medicine at Nova Southeastern University joins us this week to discuss the role that Mast Cells play in neurological conditions such as Long Covid, and the way in which we influence and change our mast cells' behaviour with our infections, stress levels, trauma and activity.

Living with Long Covid? How was your week?

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Conor Browne, an independent Biorisk Consultant, analyses biosecurity risks for governmental bodies, commercial enterprises and NGOs, aiding with business continuity, forecasting and policy.  He understood that Covid-19 was airborne in February 2020 but, he says, “it’s the first message that sticks”. 

In this week’s episode he discusses how our governments’ initial messaging of handwashing and surface-to-surface transmission had a huge impact on the course of the pandemic.  We talk about the need for clean air in mitigating the perpetual spread of Covid-19, and he highlights the ultimate risks, of Long Covid, Covid-related illness and the viral mutations that could leave us with an even heavier burden than anticipated.

Living with Long Covid? How was your week?

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David Cutler, Professor of Applied Economics at Harvard University, has spent his career assessing the economics of healthcare.  Over the past four years he has applied his skills to assessing the cost of Covid, and subsequently Long Covid, on the U.S. economy.  His original analysis, published in JAMA in 2022, suggested that Long Covid would cost the U.S. economy $2.6 trillion, but with the chronic condition proving more prevalent and prolonged than originally estimated, those figures were revised to a massive $3.7 trillion.

In this week’s episode Cutler explains these costs and their implications.  We discuss what has been included in projecting these staggering costs, and what needs to be done, on governmental and clinical levels, to manage these costs and the condition.  Whilst the findings may seem bleak, it is Cutler’s hope that in highlighting the enormity of the problem, policymakers may see the urgent need to address it. 

Living with Long Covid? How was your week?

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Dr Nancy Klimas, Director of the Institute for Neuro-Immune Medicine, Nova Southeastern University, is an immunologist internationally renowned for her work in multi-symptom illnesses.  In this week’s episode she explains her work, from HIV through ME/CFS and Gulf War Syndrome, that has led to her having insight and an amazing team to channel efforts into Long Covid research and treatment. 

In an insightful overview she describes her work in understanding the mechanisms (viral persistence, viral reactivation), impacts of (MCAS, cell dysfunction, T-cell dysregulation) and potential alleviation of the disease.  She has been involved in studies looking at clinical therapeutics such as LDN and has seen remarkable results with the use of MABs which she is hoping to replicate in a larger clinical trial in the coming weeks.

Living with Long Covid? How was your week?

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Dr Rob Wüst, Assistant Professor in the Faculty of Movement and Behaviour Sciences, is an expert cardiac and skeletal muscle metabolism and mitochondrial function.  He and the team at Vrije Universiteit, Amsterdam, published the “PEM study” in Nature Communications, which investigated the muscular changes in Long Covid patients who experience post-exertional malaise (PEM), or “the worsening of fatigue- and pain-related symptoms after acute mental or physical exercise”.

 In this week’s episode Wüst talks us through the key findings of their study, including the muscular changes, mitochondrial dysfunction and microclots that were present in the Long Covid patients compared to their control group.  He discusses the effects of bedrest on the human body and how exercise is usually beneficial for overall health, but highlights what was revealed through blood tests and muscle biopsies in their study – that Long Covid patients have limited exercise capacity with lower mitochondrial function and our rehabilitation needs to be handled with this unique understanding.

Living with Long Covid? How was your week?

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Dr Thomas Chelimsky, Professor of Neurology and Director of VCU’s autonomic laboratory, is a specialist in autonomic dysfunction and a vocal advocate for considering the mind and body as one cohesive system.  He, along with his team at the VCU clinic, take a unique brain-body approach to treating Long Covid patients, with success.

In this week’s episode he discusses the autonomic issues faced by Long Covid patients including migraine, which he believes is prevalent in c. 50% of patients, and POTS which he discusses ‘almost never shows up alone’, linking  it with the migraine, fibromyalgia and IBS (irritable bowel syndrome).  He explains the roles of the periaqueductal gray region of the brain and the vagus nerve, alongside the implications of trauma (both physical and mental) on the autonomic system, and the role that it plays in Long Covid. 

Living with Long Covid? How was your week?

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Dr Andrew Klein, an anaesthetist at the Royal Papworth Hospital Cambridge, runs the Cambridge Iron Clinic where he treats people with Iron and B12 deficiencies.  Since the start of Covid he has seen an increase in people with these deficiencies, many of whom have been diagnosed with Long Covid.

In this episode Dr Klein talks us through the overlapping symptom sets that render people debilitated with all three conditions.  He describes the various ways in which are body is not able to uptake and store sufficient B12 and iron, the consequences of this, and the way in which they can be simply treated.  And we discuss the data ranges used by the NHS to determine conditions and allocate treatment and once again draw the conclusion that correct care should only be determined by listening to the patient.

Living with Long Covid? How was your week?

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Physiatrist Benjamin Abramoff, M.D. is the Director and Co-founder of the Post Covid Assessment and Recovery Clinic at the University of Pennsylvania, Philadelphia. An Assistant Professor in Physical Medicine and Rehabilition, Abramoff used his expertise to co-author the study, published in Cell, that found that serotonin depletion is prevalent in Long Covid patients.  

In this week’s episode, Abramoff talks us through the findings of their study, the hypothesis of what drives the depletion, the impacts that this has on the body, and preliminary ideas of what might help, both symptomatically and to address the root cause of the disease that seems to be viral persistance.

Living with Long Covid? How was your week?

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Tim Henrich is a Professor of Medicine and expert in infectious diseases, focused on chronic viral infections at the University of California, San Francisco. He is another member of the titan Long Covid research team who have tracked patients since the beginning of the pandemic (LIINC study) and are making roads into understanding the mechanism of the disease and potentials for treating it.

In this week’s episode he talks us through some of the exciting work that he is doing, alongside our previous guests Steven Deeks & Michael Peluso.  Using a combination of longitudinal studies, biopsies and high resolution PET / CT imaging, the team have established changes to t cells throughout the bodies of Long Covid patients, and found evidence of viral persistence.  They are currently conducting multiple clinical trials including monoclonal antibodies to act on viral reservoirs, and the anti-viral Ensitrelvir which has undergone several trials in active SARS-COV2 previously, and believe that they are getting to grips with the pathophysiology of the disease.

Living with Long Covid? How was your week?

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