Reproducing my thread from the Other Place on our Lancet paper 'Long COVID - a clinical update'. Coauthors Manoj Sivan, Alice Perlowski, Janko Nikolich. 1/
www.thelancet.com/journals/lan...?
Long COVID: a clinical update
=> More informations about this toot | More toots from trishgreenhalgh.bsky.social@bsky.brid.gy
In writing this article, we wanted to get the basic science of Long COVID into dialogue with the clinical management of this condition and the patient lived experience. Alice, a doctor, brought lived experience to our author team. 2/
=> More informations about this toot | More toots from trishgreenhalgh.bsky.social@bsky.brid.gy
Most but not all definitions of Long COVID put the cut-off at around 12 weeks (that is, if you’re still symptomatic 12 weeks after your initial COVID-19 infection, you’ve got Long COVID). 3/
=> More informations about this toot | More toots from trishgreenhalgh.bsky.social@bsky.brid.gy
A LOT of people meet this definition. In the UK, almost 2% of the population do (grey bar to the left on this histogram. The most socio-economically deprived fifth of the population has TWICE the prevalence as the most affluent fifth. TY @chrischirp.bsky.social who drew this chart from @ONS data. 4/
=> More informations about this toot | More toots from trishgreenhalgh.bsky.social@bsky.brid.gy
So who’s at risk? Well, all of us. But this graphic summarises the things that make you more likely to get Long COVID. In sum: don’t catch COVID-19. Top up your vaccines. If you do catch COVID-19, get it mildly. [contd] 5/
=> More informations about this toot | More toots from trishgreenhalgh.bsky.social@bsky.brid.gy
[contd] During acute COVID-19, rest up and if possible, take antivirals. And make sure you don’t catch it again since many cases of Long COVID arise from REinfections. (And also, make sure you’re male, previously healthy, and affluent). 6/
=> More informations about this toot | More toots from trishgreenhalgh.bsky.social@bsky.brid.gy
Long COVID is a multi-system disease. Can cause almost every symptom in the book. But (and I learnt this from sitting in on Long COVID clinic hearing patient stories) there is often a distinctive narrative of how these symptoms fit together and fluctuate/persist/progress/resolve over time. 7/
=> More informations about this toot | More toots from trishgreenhalgh.bsky.social@bsky.brid.gy
The fatigue of Long COVID, for example, is a particular kind of fatigue. It’s persistent, draining, sometimes linked to triggers, and associated with sleep problems and cognitive blunting. 8/
=> More informations about this toot | More toots from trishgreenhalgh.bsky.social@bsky.brid.gy
Long COVID can make you unable to do your job. 6% of people who are “inactive, not looking for work” have Long COVID (see purple bars in chart above). This inability to work represents a huge human & societal burden. We need to prevent it affecting more people and help those already suffering. 9/
=> More informations about this toot | More toots from trishgreenhalgh.bsky.social@bsky.brid.gy
The longer you’ve had Long COVID, the lower your chances of full recovery. This is why everyone with significant symptoms of this disease should be seen promptly for assessment and treatment. 10/
=> More informations about this toot | More toots from trishgreenhalgh.bsky.social@bsky.brid.gy
The risk of organ damage is real, and while many people do recover, serious complications can occur even months after the acute infection. (Some heart attacks and strokes occurring in people who had COVID-19 are misclassified as ‘unrelated’ to that infection bc docs don't make the connection). 10/
=> More informations about this toot | More toots from trishgreenhalgh.bsky.social@bsky.brid.gy
Long COVID results from bad stuff occurring at the micro level. The literature on this is vast and confusing. Coauthor Janko Nikolitch cut through it nicely in this panel. Three PRIMARY pathological mechanisms (viral persistence, immune dysregulation, endothelial inflammation/thrombosis). 11/
=> More informations about this toot | More toots from trishgreenhalgh.bsky.social@bsky.brid.gy
These primary mechanisms then lead to all sorts of supplementary mechanisms including (to quote from my Substack): release of the neurotransmitter serotonin in the brain, neurones sending signals when they shouldn’t, antibodies attacking one’s own cells .... 12a/
=> More informations about this toot | More toots from trishgreenhalgh.bsky.social@bsky.brid.gy
...mitochondria (the energy powerhouses of cells) losing their oomph, proteins that come out wonky because they’re not folded right, deposition of some of those proteins in the muscles and other tissues, and awakening of other dormant viruses (e.g. Epstein-Barr, which causes glandular fever). /12b
=> More informations about this toot | More toots from trishgreenhalgh.bsky.social@bsky.brid.gy
In addition, the balance between ‘friendly’ and ‘unfriendly’ bacteria in the gut can change, with the latter getting the upper hand. 13/
=> More informations about this toot | More toots from trishgreenhalgh.bsky.social@bsky.brid.gy
Unpacking what the primary mechanisms are in Long COVID is crucial for developing mechanism-focused therapies. We talk about these in the paper. We’re not there yet with a proven therapeutic intervention but loads of ongoing studies suggest we may be on the cusp of more effective therapies. 14/
=> More informations about this toot | More toots from trishgreenhalgh.bsky.social@bsky.brid.gy
Generalist primary care clinicians (e.g. GPs) have a vital role to play in the management of this miserable condition. The opposite of gaslighting is engagement, active listening, acknowledging the story, witnessing suffering and getting your head round what’s at stake for the patient. 15/
=> More informations about this toot | More toots from trishgreenhalgh.bsky.social@bsky.brid.gy
In the paper, we have a huge table listing various symptoms along with current recommended management. Here’s the first two rows of that table. 16/
=> More informations about this toot | More toots from trishgreenhalgh.bsky.social@bsky.brid.gy
I had a go at summarising the whole paper in a single graphic. I’m not the world’s best artist so if someone wants to play with this and improve it, feel free! 17/
=> More informations about this toot | More toots from trishgreenhalgh.bsky.social@bsky.brid.gy
Do vaccines cause Long COVID? Tweeps, the overwhelmingly most important cause of Long COVID is catching COVID-19. Vaccines protect you against this! [contd]. 17a/
=> More informations about this toot | More toots from trishgreenhalgh.bsky.social@bsky.brid.gy
But in VERY RARE instances there appears to be some link between vaccination and the development of Long COVID (we’re talking many orders of magnitude less common than after COVID-19 infection). The HOPE is that protein-based vaccines will be less likely to produce these rare complications. /17b
=> More informations about this toot | More toots from trishgreenhalgh.bsky.social@bsky.brid.gy This content has been proxied by September (ba2dc).Proxy Information
text/gemini