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Long COVID · The SHEA Podcast

• 0:08
  SPEAKER_00: Welcome to the Rapid Response Podcast brought to you by the Society for Healthcare Epidemiology of America, SHA, promoting the prevention of healthcare associated infections and antibiotic resistance and seeking to advance the field of healthcare epidemiology and antibiotic stewardship.
• 0:23
  SPEAKER_00: I'm Dr.
• 0:24
  SPEAKER_00: Christopher Cernich, Chief of Medicine and Hospital Epidemiologist at the Madison VA Hospital and Associate Professor of Medicine at the University of Wisconsin School of Medicine and Public Health.
• 0:34
  SPEAKER_00: I will be serving as today's podcast moderator.
• 0:36
  SPEAKER_00: Discussion on the podcast does not reflect Shay's perspective, but facilitates communication of multiple perspectives and experiences as we go through this challenging time together.
• 0:46
  SPEAKER_00: Shay is excited to launch this episode of the podcast, COVID-19 updates, what we know now.
• 0:52
  SPEAKER_00: Today's discussion will be on long COVID.
• 0:55
  SPEAKER_00: We are delighted to have with us today our speaker, Dr.
• 0:58
  SPEAKER_00: Igo Ofotokun, who's a professor of medicine at the Emory University School of Medicine and the primary investigator for the Atlanta hub of the Recover Study, which is an NIH-funded study to better characterize and study long COVID.
• 1:11
  SPEAKER_00: Thank you for joining us today, Dr.
• 1:13
  SPEAKER_00: Ophotakun.
• 1:14
  SPEAKER_00: You're welcome.
• 1:14
  SPEAKER_00: Thanks for having me.
• 1:16
  SPEAKER_00: So I'd like to jump right in since this is a big topic that I know is of extreme interest to our membership.
• 1:23
  SPEAKER_00: Before we kind of get into specific questions, can you provide our listeners with your background and research around long COVID today?
• 1:30
  SPEAKER_01: Yeah.
• 1:30
  SPEAKER_01: Thank you so much, Chris.
• 1:32
  SPEAKER_01: As you mentioned, I am at Emory University.
• 1:34
  SPEAKER_01: I started my career as an HIV researcher.
• 1:37
  SPEAKER_01: So I'm a clinician scientist that is focused on HIV comorbidity research with special emphasis on how comorbidity affects men and women differently.
• 1:48
  SPEAKER_01: Towards the end of 2020, after the COVID-19 pandemic started, it became obvious that people were recovering with the aftermath, with symptoms beyond the acute phase.
• 2:01
  SPEAKER_01: So NIH invited us, a group of us, for a focus group session to think through how to really study this phenomenon that is evolving, that is now being referred to as a long COVID.
• 2:15
  SPEAKER_01: So that was how I became involved with this.
• 2:18
  SPEAKER_01: NIH wanted us to use our experience in HIV research, especially the chronic aftermath of HIV infection, to really help understand what is going on with people who are recovering from COVID.
• 2:30
  SPEAKER_01: So that is my background.
• 2:32
  SPEAKER_01: And when the RFA for the recover study was released by NIH, I led the Atlanta group, which includes Emory University, Moorhouse School of Medicine, Kaiser Permanente of Georgia, and the VA Medical Center to apply for the recover.
• 2:47
  SPEAKER_01: And we were successful and we are now part of this big national study that is recruiting people into a large cohort to understand how people recover from a COVID-19.
• 2:59
  SPEAKER_00: Great.
• 3:00
  SPEAKER_00: Thank you for that.
• 3:01
  SPEAKER_00: So one of the things that I really struggle with has been really nomenclature through this process.
• 3:08
  SPEAKER_00: And, you know, certainly I think there have been a number of terms that have been thrown out.
• 3:12
  SPEAKER_00: But the two terms that I hear most frequently is long COVID and post-acute sequilae of COVID-19 or PASC.
• 3:21
  SPEAKER_00: And my question is are those the same things?
• 3:23
  SPEAKER_00: And if they're not, how do we kind of think about these different entities?
• 3:28
  SPEAKER_00: And maybe we don't quite understand that, but just want to really get your thoughts on that.
• 3:32
  SPEAKER_01: Yeah, I think that is a great question.
• 3:35
  SPEAKER_01: And this is part of the confusion about this condition.
• 3:38
  SPEAKER_01: Our knowledge is still emerging, the name is not even uniform.
• 3:43
  SPEAKER_01: So if you go to the NIH website, for example, it's referred to as post-acute sequelae of COVID or PASC.
• 3:50
  SPEAKER_01: If you look at the CDC website, it describes it as post-COVID-19 conditions.
• 3:56
  SPEAKER_01: See the WHO call it post-COVID-19.
• 4:00
  SPEAKER_01: And if you look at the lay literature, many of these newspapers, they call it different things.
• 4:06
  SPEAKER_01: It's long COVID, it's long colour, it's long-term COVID-19 or LTC-19.
• 4:12
  SPEAKER_01: Essentially, they refer to the same thing.
• 4:14
  SPEAKER_01: It just really emphasize the point that our knowledge about this condition is evolving.
• 4:21
  SPEAKER_01: We don't know everything about this condition yet, and we still don't have a consensus about the naming, the definition, how people present.
• 4:30
  SPEAKER_00: So is it possible then, rather than kind of having one big umbrella term, that we may be kind of looking at a variety of subcategories that may have different underlying pathology, natural history, and I guess ultimately treatments or therapeutics, and it may be too early to kind of answer that question confidently.
• 4:52
  SPEAKER_00: But what are your thoughts there?
• 4:54
  SPEAKER_01: Yeah.
• 4:54
  SPEAKER_01: So I think we kind of have a good sense that all of these names are referring to the same condition, but the manifestation of this condition is very, very diverse.
• 5:08
  SPEAKER_01: So if you look at the literature, for example, almost every publication on the clinical feature or clinical manifestation of let's refer to this as long COVID for the purpose of this discussion.
• 5:20
  SPEAKER_01: Almost every organ in the body is affected.
• 5:24
  SPEAKER_01: 50 different clinical signs and symptoms were described by one particular study.
• 5:30
  SPEAKER_01: And so that is kind of what we're dealing with: a condition that has very variety of clinical presentation.
• 5:37
  SPEAKER_01: But a few thoughts are beginning, consensus are beginning to emerge about the definition and also about the clinical presentation.
• 5:47
  SPEAKER_01: First, people think that this condition usually they define it as a condition that happens after the acute COVID infection that usually lasts beyond the first 12 weeks of the onset of the acute infection.
• 6:04
  SPEAKER_01: And some of the common symptoms that people have described very consistently include fatigue, shortness of breath, cognitive dysfunction, or brain fog.
• 6:14
  SPEAKER_01: And then, in addition to these common symptoms, there are also several overlap syndromes.
• 6:21
  SPEAKER_01: Like you may have heard of the myelgic encephalomyelitis, a chronic uh fatigue syndrome or NECFS, postural autostatic tachycardia syndrome or POTS.
• 6:32
  SPEAKER_01: There are other syndromes such as post-exceptional myelase or PEM, mast cell activation, macrophage activation syndrome.
• 6:41
  SPEAKER_01: These are all different spectrum of these phenomena that we're beginning to understand.
• 6:47
  SPEAKER_01: And it does appear that different people are present with different phenotype or unique phenotype of these conditions.
• 6:54
  SPEAKER_00: Great.
• 6:55
  SPEAKER_00: Just kind of really hammers home how complex this is.
• 6:58
  SPEAKER_00: So we're really glad that people like you are studying this.
• 7:02
  SPEAKER_00: So when we kind of look at that complexity, do we have any leading hypotheses or suspicions of what is kind of triggering this post-COVID syndrome in many of these patients, perhaps not all of them, but a significant proportion of them.
• 7:20
  SPEAKER_00: Any ideas that from your perspective seem like leading candidates for us to be pursuing?
• 7:25
  SPEAKER_01: So a lot of what we know today about the pathogenesis, for the most part, is still evolving.
• 7:33
  SPEAKER_01: A lot of it is speculatory.
• 7:35
  SPEAKER_01: Some of them are based on experience from other disease conditions.
• 7:40
  SPEAKER_01: So this idea of post-acute illness, you know, after an acute, severe infection is not unique to COVID.
• 7:48
  SPEAKER_01: It's been seen with West Nile virus, for example, EBV virus, the Ebola, and where people have really severe acute infection.
• 7:57
  SPEAKER_01: And then afterwards, many of them recover, most majority of people recover, but then a small number of people then assist with chronic sequence of the acute infection.
• 8:09
  SPEAKER_01: And I think from those conditions, the speculation is that when you have an acute injury, so of course the immune system is activated.
• 8:18
  SPEAKER_01: So activation of the immune system affects a number of systems within the body.
• 8:23
  SPEAKER_01: So you have this inflammation of many of the immune cells are activated, they are inflamed.
• 8:28
  SPEAKER_01: You also have dysregulation of the coagulation cascade.
• 8:32
  SPEAKER_01: All of this leads to release of various cytokines.
• 8:36
  SPEAKER_01: And there's also microvascular damage as a result of this effect.
• 8:41
  SPEAKER_01: And what some people think, at least from the literature in chronic fatigue syndrome with EBV virus and other viral infection, is that all of these events trigger more inflammation, both systemic neuroinflammation activation of what is described as the fatigue nucleus or the energy conserving neuron in the brain.
• 9:01
  SPEAKER_01: And that this process, what it does, it helps to really reduce energy consumption during the acute phase.
• 9:09
  SPEAKER_01: And so the energy, the body then uses the available energy to attack and fight the acute infection.
• 9:16
  SPEAKER_01: And then when the infection resolves, a vast majority of people return to normal health.
• 9:22
  SPEAKER_01: And for some people, the ability to return to normal health is impaired.
• 9:27
  SPEAKER_01: Why that is the case is not known.
• 9:30
  SPEAKER_01: Some of the speculation is that one, during that process of inflammation, you know, the inflammatory process involves both activation of certain immune cells as well as suppression of other cells.
• 9:41
  SPEAKER_01: And that these activities lead to reactivation of some latent virus, leads to persistence of even the acute infection in the reservoir sites, and there's regulation of the microbiome in different parts of the body.
• 9:55
  SPEAKER_01: There's also speculation that there's autoantibodies may be released, and that all of these effects may contribute to why some people are not able to recover as quickly as others.
• 10:09
  SPEAKER_00: Okay.
• 10:10
  SPEAKER_00: You mentioned that the vast majority of people recover.
• 10:14
  SPEAKER_00: And I guess I want to ask you a few questions about whether we know if there are certain patients that are at different risk of experiencing this post-acute sequelae of COVID.
• 10:26
  SPEAKER_00: So, what do we know about things like gender, age, ethnicity, vaccination status, and their kind of role and risk of experiencing this?
• 10:37
  SPEAKER_00: Yeah, that is a loaded question.
• 10:41
  SPEAKER_01: Yeah.
• 10:42
  SPEAKER_01: So first of all, what do we know about?
• 10:45
  SPEAKER_01: Yeah, we're two ways to answer these questions.
• 10:47
  SPEAKER_01: What do we know about the risk who gets uh lung COVID?
• 10:52
  SPEAKER_01: And then two, what is the risk of severity of lung COVID in those who get it?
• 10:58
  SPEAKER_01: So what we know from several of the studies is that the more severe the acute injury is, the higher the likelihood of developing lung COVID.
• 11:08
  SPEAKER_01: And this was a huge study that came from the St.
• 11:10
  SPEAKER_01: Louis group looking at the Veterans Administration and medical electronic health record across the country involved millions of people.
• 11:19
  SPEAKER_01: What they saw was that people who had acute COVID that required ICU admission and mechanical veterinary support have the highest risk of developing a post-acute sickle.
• 11:33
  SPEAKER_01: And then that is followed by those who had severe enough disease to be hospitalized, and then followed by those who had milder disease.
• 11:41
  SPEAKER_01: So the risk goes from more severe disease, severe disease to mild to moderate disease.
• 11:47
  SPEAKER_01: So the more severe your acute episode, the higher the likelihood.
• 11:52
  SPEAKER_01: And one study that was published, I think about a month ago in Cell also looked at some of the biological risk of developing an acute COVID.
• 12:02
  SPEAKER_01: And what they came up with was that the more during the acute episode, the peak viremia for SARS-CoV-2 virus during the acute episode, the higher the peak, the higher the risk of developing a post-acute sequel.
• 12:18
  SPEAKER_01: They also noted that activation of latent viruses, particularly EBV, also increases the risk of developing a post-acute sequel.
• 12:27
  SPEAKER_01: Then those who develop autoimmune antibodies during the acute illness, and then presence of comorbidities, particularly type 2 diabetes.
• 12:37
  SPEAKER_01: So those four risks actually increase the risk of those who will develop a sequel after the acute episode.
• 12:45
  SPEAKER_01: And what we're seeing from large epidemiological studies is that the women seem to be more affected.
• 12:51
  SPEAKER_01: So about 60% of the cases of post-lung COVID seems to be reported among women.
• 12:58
  SPEAKER_01: And the rest of it is just really age, comorbidity, all of those are things that really predisposes to more severe acute cases.
• 13:06
  SPEAKER_01: And so when you have acute illnesses that is more severe, you're more likely to develop acute COVID.
• 13:12
  SPEAKER_01: And then the question of whether vaccine affects COVID.
• 13:17
  SPEAKER_01: That is, there was actually a study that was just released, was it yesterday, in Nature Medicine Medicine that looked at development of lung COVID among those who were vaccinated who had breakthrough infection compared to those who had infection without their vaccination.
• 13:34
  SPEAKER_01: And what they were able to show in that study, which I'm still trying to understand, was that vaccination, although reduces the risk of severity of breakthrough infection, only reduces the likelihood of developing a lung COVID by about 15%.
• 13:51
  SPEAKER_01: So people who got vaccinated also can proceed to develop lung COVID.
• 13:57
  SPEAKER_01: And so the key here is really don't get infected, if possible.
• 14:02
  SPEAKER_01: That is a tall order given how widely spread this infection is going around.
• 14:09
  SPEAKER_00: A lesson that I unfortunately not enough people are uh taking to heart.
• 14:14
  SPEAKER_00: So I think we've established that we should avoid getting COVID, which is good.
• 14:20
  SPEAKER_00: So when an individual develops a syndrome that's compatible with long COVID, can you walk us through kind of what we know about the natural history as far as duration of symptoms and to what extent people recover?
• 14:36
  SPEAKER_00: And maybe we're too early in kind of this pandemic to kind of make any conclusive statements about that, but just wondering kind of what your experience has been and what the literature might be telling us about that natural history of this syndrome.
• 14:50
  SPEAKER_01: Yeah, so that is really one of the questions that recover is designed to answer the trajectory of recovery of people who have long COVID.
• 15:02
  SPEAKER_01: So we're two years or two and a half years into the pandemic.
• 15:06
  SPEAKER_01: And so what the trend we're seeing with long COVID is that, like I said, the symptoms, the presentation is really, really varied.
• 15:15
  SPEAKER_01: It you know, vary from one individual to another.
• 15:18
  SPEAKER_01: Some people have symptoms that last for about four weeks.
• 15:21
  SPEAKER_01: Some people have symptoms that last for several months.
• 15:24
  SPEAKER_01: And the what is really perplexing about this, about the cause of illness of long COVID is that some people have their acute infection, they develop symptoms, and then that symptoms refuse to go away.
• 15:37
  SPEAKER_01: They just go from the acute, evolve into a prolonged period of fatigue, a prolonged period of fogginess, a prolonged period of shortness of breath, depending on what type of symptoms they present with.
• 15:49
  SPEAKER_01: There are people who said, Oh, yeah, I got COVID in 2020, I still don't have my sense of smell or taste back.
• 15:56
  SPEAKER_01: I still have nightmare, I still can't think clearly, I forget things, I lose things.
• 16:00
  SPEAKER_01: And this was like a year and a half ago.
• 16:04
  SPEAKER_01: The other thing that is really complex is that there are people who actually the symptoms resolve and then it comes back again.
• 16:11
  SPEAKER_01: So the question is that at what time do you really say people have completely recovered from this condition?
• 16:17
  SPEAKER_01: It's still difficult, it's still too early to tell.
• 16:20
  SPEAKER_01: So part of what recover would do, most of we are recruiting people into this cohort and they're going to be followed for a period of four years at least for now.
• 16:28
  SPEAKER_01: And so we would have the information to be able to see these various patterns in a large cohort study of about 17 to 18,000 individuals to see when do people present, how long does the symptom last, do they recall, and in whom does the symptom recur and what type of symptoms recur.
• 16:47
  SPEAKER_01: So those are part of the question that recover is designed to address.
• 16:52
  SPEAKER_01: So we really don't know yet the full spectrum of the clinical manifestation or presentation of recall of long COVID, other than people have symptoms.
• 17:03
  SPEAKER_01: And some people, the symptom is severe, other is mild to moderate.
• 17:07
  SPEAKER_01: It goes away, it comes back, it just persists.
• 17:10
  SPEAKER_01: So all kinds of uh pattern of presentation.
• 17:13
  SPEAKER_00: Okay.
• 17:13
  SPEAKER_00: Along those lines, is there anything that we know now that has been shown or perhaps an inkling of promise as far as therapeutic intervention for these patients?
• 17:26
  SPEAKER_00: And I imagine it kind of depends on how a patient is presenting.
• 17:31
  SPEAKER_00: But do we have anything like rehabilitation, you know, hydration, etc., cognitive training?
• 17:38
  SPEAKER_00: I'm just spitballing here, but do you have have any sense of promising leads, at least things that can palliate or reduce the burden of the symptoms that these patients are experiencing?
• 17:49
  SPEAKER_00: Yeah, that is the$10 million question.
• 17:53
  SPEAKER_01: Yeah, we know this phenomenon is real.
• 17:56
  SPEAKER_01: We know it can be debilitating in some individuals.
• 18:00
  SPEAKER_01: I think all of us know at least one or two individuals with long COVID that have been very debilitating.
• 18:07
  SPEAKER_01: Majority of them are mild to moderate.
• 18:09
  SPEAKER_01: So the big question is what do we do about treatment?
• 18:14
  SPEAKER_01: So, to answer that question, so we kind of are beginning to think about what is the pathophysiology, what is the pathobiology of loved.
• 18:23
  SPEAKER_01: So several things have been speculated, and there are some small studies that now are beginning to help us understand some of the biology behind some of these symptoms.
• 18:35
  SPEAKER_01: So, like I said earlier, some people think that there's persistent reservoir of the SARS-CoV-19 in certain tissues.
• 18:42
  SPEAKER_01: And so there's been studies now that have looked at, you know, beyond the acute period where people have fought to within the first two weeks, most people clear the virus from their respiratory tract.
• 18:54
  SPEAKER_01: But there's evidence now that in other sites, maybe the GI tract, you know, neural sites, the virus may persist.
• 19:02
  SPEAKER_01: And then there's also this question of reactivation of certain pathogens, so latent viruses like EBV, CMV, HSV, that may result as a result of the immune dysregulation that occurs as a result of the acute infection.
• 19:17
  SPEAKER_01: And so some people think about SARS-CoV-19 affects the microbiome and the viron communities, you know, in the various surfaces across the body.
• 19:28
  SPEAKER_01: And some people think it's an issue of clotting and coagulation, dysregulation, impact on the endothelia surfaces.
• 19:37
  SPEAKER_01: We talked about dysregulation or dysfunctional brainstem or the vagus nerve signaling that leads to autonomic uh disorders.
• 19:45
  SPEAKER_01: And then there's ongoing activity of fine immune cells, and then the issue of autoimmunity due to molecular mimicry.
• 19:53
  SPEAKER_01: So, based on this pathogenesis, people are trying different agents that attack one or more of these uh pathways that we think may be responsible for COVID-19.
• 20:04
  SPEAKER_01: For example, there are anecdoteal report of people using Paxlovid, which is the antiviral agent that has an EUA for the treatment of acute illness.
• 20:13
  SPEAKER_01: There have been anecdoteal report that if you treat people with PAX Lovics, you could actually, it may have an impact on long COVID.
• 20:21
  SPEAKER_01: If the mechanism of lung COVID in that individual is a result of persistent SARS-CoV-2 virus in the sanctuary sites.
• 20:28
  SPEAKER_01: So there have been reports, and people have tried antiviral agents to treat latent EBV, HSV, or CMV.
• 20:36
  SPEAKER_01: And there has been reports in the literature or preprint that says that some people have some improvement with that.
• 20:44
  SPEAKER_01: Most of the things that have been tried, though, have been things that are directed towards inflammation immune system.
• 20:51
  SPEAKER_01: People have used the histamine receptor antagonist because they think there's involvement of mass cell dysregulation during acute uh COVID-19 with the report of uh sources.
• 21:03
  SPEAKER_01: I have seen people try different doses of steroids for treatment of long COVID with some sources.
• 21:10
  SPEAKER_01: And then for people with really severe symptoms, such as the POTS, there have been trials of sterile ganglion blockade where people actually inject an aesthetic agent into some of the sterly ganglion.
• 21:23
  SPEAKER_01: And the thought is that actually there is dysregulation of the autonomic system when you block the ganglion, it's like resetting the autonomic nervous system and that it's actually helped with those uh symptoms.
• 21:34
  SPEAKER_01: And then the use of anti-coagulation or anti-platelet drugs.
• 21:39
  SPEAKER_01: So there are all kinds of things that have been tried in small number of people, sometimes n of two or three or four small studies.
• 21:48
  SPEAKER_01: So one of the things that Recover is doing now is to actually they've solicited for clinical trials of all of these different agents targeting these different pathways to test.
• 22:00
  SPEAKER_01: Whether some of these uh interventions would pan out to be effective against these conditions.
• 22:06
  SPEAKER_01: And of course, the things you mentioned, like rehabilitation for people who have really chronic fatigue, has been tried with some success.
• 22:14
  SPEAKER_00: Okay.
• 22:14
  SPEAKER_00: Well, you've already kind of touched on what was going to be my next question, focused on, you know, where does research kind of need to go?
• 22:22
  SPEAKER_00: And I think you've kind of laid out that we need more observational study to better characterize the illness.
• 22:29
  SPEAKER_00: We need basic pathogenic research, and you need to pair this with good, well-designed clinical trials to move us beyond kind of the anecdote N of two, I think is how you kind of referred to them, so we could truly identify the effective therapies.
• 22:46
  SPEAKER_00: So I'm not going to belabor that that point further, but what advice or recommendations do you have for patients and or providers who want to get involved and kind of contribute in this research?
• 22:57
  SPEAKER_01: So this is a call for all of us.
• 23:00
  SPEAKER_01: I think we so wanting to if long COVID, even if it's a small proportion of people are affected by this phenomenon, given the scale of the pandemic, that proportion is going to be significant.
• 23:15
  SPEAKER_01: So right now we have over 80 million people in the US that have been, you know, uh proven infection.
• 23:23
  SPEAKER_01: And I think some of the epidemiological studies indicate that about maybe 50 to 60 percent of all of us have been exposed or have been infected at one point or the other.
• 23:34
  SPEAKER_01: So even if the prevalence of lung COVID is just 5%, you know, you can imagine, you can do the math.
• 23:41
  SPEAKER_01: A lot of people are going to be affected.
• 23:44
  SPEAKER_01: And some of those symptoms are going to be mild, some are going to be severe.
• 23:48
  SPEAKER_01: So you can imagine that this is going to be a huge impact.
• 23:52
  SPEAKER_01: So there's really need for us to get to to understand the pathobiology of this phenomenon.
• 23:57
  SPEAKER_01: There's need for us to understand the risk factor who is going to be affected.
• 24:02
  SPEAKER_01: There's a there is a need for us to understand what we can do during the acute infection to prevent people from going into this prolonged symptom.
• 24:11
  SPEAKER_01: So there's so much there is to be done.
• 24:14
  SPEAKER_01: And that cannot be done by just the funding agency, the federal government, or NIH.
• 24:19
  SPEAKER_01: It cannot be done by scientists like you and I.
• 24:22
  SPEAKER_01: It will require all of us, you know, the federal government, the scientists, and the community, everybody have to come together.
• 24:29
  SPEAKER_01: That means that we need to volunteer for some of these studies.
• 24:33
  SPEAKER_01: The studies here, not just recover, all the long COVID studies that are going on, require not only those that are affected by COVID, but also we need negative control.
• 24:45
  SPEAKER_01: People who don't have COVID, that we can compare with.
• 24:48
  SPEAKER_01: So we really encourage the I think there's really need to mobilize the community around this effort to get to the bottom of this.
• 24:57
  SPEAKER_01: I think the goal is really to see is there anything we can understand during acute infection that can help us prevent people from going into the long COVID.
• 25:07
  SPEAKER_01: I think that is going to be the key.
• 25:08
  SPEAKER_01: Prevention is really if there's anything we can do to prevent people from lapsing into this period of prolonged latent illness, will be the key.
• 25:17
  SPEAKER_01: So my encouragement is to really get the world out there to our community.
• 25:24
  SPEAKER_01: Physicians should encourage both the patient with acute infection and those who don't have infection control to really volunteer for this study.
• 25:34
  SPEAKER_01: So we can begin to rapidly find out what this condition is about and how to prevent it.
• 25:40
  SPEAKER_01: And if we cannot prevent it, what are the effective treatments?
• 25:44
  SPEAKER_01: So it's a call to everybody.
• 25:46
  SPEAKER_01: No one is immune to long COVID or to COVID in general.
• 25:52
  SPEAKER_00: Such a great point.
• 25:53
  SPEAKER_00: So along those lines, when we kind of look at our existing health systems and obviously, you know, we have multiple health systems in the United States.
• 26:03
  SPEAKER_00: How should we who kind of work at big academic referral centers or VA facilities or even kind of the communities where they they have very limited access to health care, how should they be kind of looking at designing their health systems and referral patterns to kind of better support this population?
• 26:22
  SPEAKER_00: Because as you point out, even if this occurs less frequently than we think, given the huge volume of patients, there really isn't going to be a community out there that that isn't affected to some level by long COVID.
• 26:36
  SPEAKER_00: And so any thoughts or advice?
• 26:38
  SPEAKER_01: Thank you for that question.
• 26:40
  SPEAKER_01: I think that is really gets to the bottom of it where it really affects the community level, the individual level, the healthcare system level.
• 26:49
  SPEAKER_01: And I think the point, first of all, is not to discard this as you know, we do to most post-acute illness to say, get over it.
• 26:59
  SPEAKER_01: It's real.
• 27:00
  SPEAKER_01: You know, healthcare systems need to recognize that this is a real phenomenon.
• 27:05
  SPEAKER_01: And that it's really going to be in their interest, in the interest of their bottom line, to begin to think of strategies to really capture this phenomenon.
• 27:13
  SPEAKER_01: Because what we are beginning to see from a lot of these large studies is that it increases healthcare utilization.
• 27:20
  SPEAKER_01: So the number of clinic visits, even after a year or two years out, after acute illness, is higher in people that have had a COVID versus those who did not have COVID.
• 27:31
  SPEAKER_01: So there's this issue of volume, the impact of this on your healthcare system.
• 27:36
  SPEAKER_01: And so what I really would encourage the healthcare system to do, and I think many of them have begun to do, is to create a special clinic, a special group entity that really try to look at this within their system.
• 27:51
  SPEAKER_01: No matter how small that system is, I think many hospitals now have what they call the Long COVID clinic.
• 27:57
  SPEAKER_01: I think that is a good place to start.
• 28:00
  SPEAKER_01: One thing that does for you or for the system is that at least it gives people a place to go to.
• 28:06
  SPEAKER_01: And then you can begin to understand the characteristics of the presentation of this condition within your local environment.
• 28:14
  SPEAKER_01: I believe that the presentation is going to vary from places to places.
• 28:18
  SPEAKER_01: I think part of it is biological, but remember, biological factors are also influenced by social determinants of health, the environment you come from, the kind of support you have influences the way people respond, manifest to some of these diseases.
• 28:34
  SPEAKER_01: So I would encourage healthcare system hospitals to create at least a unit within their system to begin to look at people who are recovering from COVID and so to capture the pattern.
• 28:45
  SPEAKER_01: And I think it will help us to come to begin to understand this phenomenon.
• 28:50
  SPEAKER_01: Both at the large academic center and then the small community hospitals, we need because everybody is affected.
• 28:58
  SPEAKER_01: So that would be my recommendation.
• 29:00
  SPEAKER_01: And I think, and then as we understand the biology, as we understand this clinical syndrome and treatment becomes available, then that becomes a forum, you know, an avenue for deploying any available treatment for this condition.
• 29:17
  SPEAKER_00: Well, I just want to thank you for really an amazing session, Dr.
• 29:20
  SPEAKER_00: Fodakun.
• 29:21
  SPEAKER_00: But before we kind of leave you, do you have any final thoughts for our listeners or any issues that we didn't touch on?
• 29:27
  SPEAKER_01: Oh, thank you so much, Chris.
• 29:28
  SPEAKER_01: I think this has been very comprehensive questions and the order in which you have asked them has been really comprehensive.
• 29:36
  SPEAKER_01: And I think what I would say to the SHA community is just this increased level of awareness and to continue to support this effort, refer both controls, people who don't have COVID-19.
• 29:50
  SPEAKER_01: That is really perhaps the biggest challenge now for the recover study.
• 29:54
  SPEAKER_01: We're having difficulty recruiting controls because almost everybody is affected.
• 30:01
  SPEAKER_01: Yeah, so bring people who are healthy, who don't have disease.
• 30:05
  SPEAKER_01: We need those people to be part of this effort.
• 30:08
  SPEAKER_01: Just raise awareness.
• 30:09
  SPEAKER_01: And we need to do this and we need to do it quickly so that we can get to the bottom of this, find a solution to this problem.
• 30:16
  SPEAKER_00: Well, thank you for such a great conversation and for joining us today.
• 30:19
  SPEAKER_00: Thank you so much for the opportunity.
• 30:21
  SPEAKER_00: Thank you again to our speaker for sharing his perspective and experience.
• 30:25
  SPEAKER_00: This podcast can be accessed on SHA's online education center, Learning CE, under the Rapid Response Program, where you will also find resources such as the SHA COVID-19 town halls.
• 30:37
  SPEAKER_00: Are you interested in becoming a SHA member?
• 30:39
  SPEAKER_00: Take$20 off any membership type using the coupon code LearningCE22 at checkout.
• 30:45
  SPEAKER_00: This concludes today's episode of the Rapid Response Podcast.
• 30:49
  SPEAKER_00: Thank you for tuning in.