Wednesday, May 1, 2024

Yup. Still Here. Still Need to Clean the Air.

Covid has been implicated in creating more cases of PANDAS - pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. A 9-year-old girl dramatically changed personality after a viral infection she didn't even know she had! It was only after years of treating her symptoms as a mental health condition that they turned to a 44 day course of antibiotics which had fantastic results. 

"PANDAS presents in patients with sudden extreme anxiety and some can develop ticks or even can't walk. Others have regression in their speech, and it is all caused by the inflammation of their brain due to an infection. . . . Covid can also cause it. Both times the infection Ava had was missed as she was asymptomatic."

Current work on Long Covid from Akiko Iwasaki, PhD who works as a Sterling Professor of Immunobiology at Yale and was named one of top 100 influential people by Time Magazine. She explains that there are four hypotheses on different causes of Long Covid and all have growing evidence. Covid does all the things!

The number one cause of Long Covid appears to be persistence viral infection from replication or remnants of viral antigen or mRNA hidden in tissues and causing inflammation. They're well hidden in deeper tissues, but circulating spike proteins can be detected which might mean a simple blood test could be used in future to test for Long Covid. Second, autoimmunity from T cells and B cells attacking host proteins and antigens, which can happen after different types of stresses including acute infection with SARS-CoV-2. This is very hard to stop once it starts. Third, is reactivation of dormant viruses, like herpes and chicken pox, which also activates immune responses to those viruses, leading to Epstein-Barr and shingles. Fourth is the change in tissue from the acute phase that can, for instance, inflame microglia in the brain, which can't be restored, resulting in neurocognitive dysfunction. 

She suggests the next step, regardless the cause, is to look into targeting viruses with antivirals and antibiotics. She's studying the role of Paxlovid, looking for biomarkers that indicate who is and isn't going to be helped by the course of meds since some studies show it's effective and others show no effect. And then she gets into prevention with vaccinations, suggesting that booster doses are important in preventing risk. With the Omicron variants, one in ten adults are getting Long Covid, and a lot more people are getting infected now. About six million kids are affected by Long Covid in the U.S. right now, with teens and females at higher risk. 

Unfortunately, she doesn't mention cleaning the air or filtering it directly before viruses get in your system, you know, with an N95, so the entire interview feels like an ad for Pfizer! 

By contrast, Dr. S. Blitshteyn, who works at a Dysautonomia Clinic (disorders that affect the autonomic nervous system) wrote this warning a few months ago. She works from the patient end of care instead of the research end:

"As a neurologist specializing in Dysautonomia, I see patients with LongCovid every day. Most of these patients were vaccinated and had either no or minimal health problems prior to Covid. I am going to be honest: even those Long Covid patients that have improved are at risk of getting worse with recurrent Covid infections. Additionally, every healthy person is at risk of getting Long Covid and numerous other post-Covid neurologic, cardiovascular, metabolic and immune complications. Of course we don't want to scare the public, of course things are definitely better now than in 2020, of course treatment of acute Covid is a lot better now, of course hospitalization rates are down now compared to 2020, but... what is NOT better is us dropping all of the mitigation strategies that we had for Covid starting in 2020, what is NOT better is our lack of FDA-approved therapies for Long Covid, what is NOT better is the general health of Americans because of the ongoing Covid pandemic and the ongoing shadow pandemic of LongCovid.

LongCovid and all post-Covid complications are a major threat to public health in the United States and worldwide. We can pretend that things are fine and that we are "back to normal" pre-pandemic state of affairs, but it's not our reality, it's wishful thinking. Our "new normal" should not include at least 7-10% of population falling chronically ill with Long Covid and post-Covid complications. Our "new normal" should not include billions of dollars in economic loss and disability payments to previously employed people who are too sick to work. Our "new normal" should not include children having Covid every year and long-term neurologic and cognitive dysfunction as a result of the repeated Covid. Our "new normal" should not include adults with brains 20 years older than their age because of Covid. Our "new normal" should not include a higher risk of heart disease, diabetes, blood clots and stroke for every person, young and old, who has had Covid once and a higher risk with every repeated Covid infection.

So... it's not a good time to deny and dismiss the gravity of Covid pandemic. What we need:
✔️ Bring indoor masking back during the months with high Covid rates
✔️ Improve ventilation at schools and all crowded buildings
✔️ Require at least 7-days of quarantine for students and employees with Covid before returning to school/work.
✔️ Provide free Covid testing everywhere and to everyone
✔️ Require all healthcare facilities and clinics to have indoor masking for healthcare providers and patients
✔️ Invest in developing better Covid vaccines
✔️ Make Paxlovid free and available to most Americans
✔️ INVEST IN REAL LONG COVID THERAPEUTICS (not exercise or psychotherapy trials)
✔️ INVEST IN REAL LONG COVID CLINICS (not the ones that gather data and have nothing to offer to patients)"

If you're still wearing a seatbelt in a car, consider wearing a mask when you're inside public transport or buildings!

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