Thread by @drclairetaylor

1/ 🧵What if ‘living with Covid’ literally means living with it inside you for a long time? 🦠🤔

This year has produced several studies around viral persistence that really have not had enough airtime.
These could have far reaching consequences
I will summarise..

2/ 🔴Virus in tonsils of children who have had tonsillectomy.

48 children who had adenotonsillectomy between Oct 2020-Sep 2021. None of them had experienced signs or symptoms of Covid prior to surgery

-SARS-CoV-2 genome detection rate was 20% in the tonsils

3/ It affected several types of immune cells

FCD123+ dendritic cells were CD14+ monocytes
CD4+ T lymphocytes
CD20+ B lymphocytes
CD8+ T lymphocytes cells

4/ conclusion:
Results suggest lymphoid tissue can be a reservoir of SARS-CoV-2.
It remains unclear for how long the lymphoid tissue can sustain the SARS-CoV-2 in a persistent infection, and whether this persistence has any impact on virus transmission.

ncbi.nlm.nih.gov/pmc/articles/P…

5/ Ok-so these kids were getting their tonsils out for a reason. Maybe they were unusual. So you look for more studies.
Next one is in the cells of the heart for a long time after Covid infection…

6/ 🔴MYOCARDITIS- inflammation in the heart 🫀
- 14 patients with myocarditis

Had biopsy (EMB) of right ventricle
-PCR diagnosis of viral infection
-immunohistochemical (IHC) examination with antibodies to CD3, CD45, CD68, CD20, SARS-Cov-2 spike, and nucleocapsid antigens.

7/ clinically-
Symptoms appeared 1-5 Months after infection
Cardiac MRI showed inflammation
ANTI-HEART antibodies increased in 92% of patients

The mean left ventricular (LV) ejection fraction (EF) was 28%- POOR heart function

8/ Two-thirds of the patients had PVCs ( premature beats) and nonsustained ventricular tachycardia (VT). Eg palpitations,irregular heart rate
-In 11 patients, fluid in legs , enlarged liver and fluid in the cavities eg lungs

9/ evidence of Covid
- SARS-Cov-2 RNA was detected in 12 cases (85.7%)

The maximal time after COVID-19, when the virus was detected in the myocardium was 18 MONTHS

This was the first study of CHRONIC myocarditis

10/photo of antibodies to the spike protein of SARS-Cov-2:

onlinelibrary.wiley.com/doi/10.1002/cl…

Endothelitis (Inflammation of blood vessels) and microvascular thrombosis- eg clots in small blood vessels.
See my pinned post 🩸

11/ ok-so it was only 14 patients with chronic inflammation in the heart and persistent Covid.
More evidence of Covid hanging out in the body…

12/ 🔴AUTOPSY study

-autopsies on 44 patients who died with COVID-19, with extensive sampling of the central nervous system in 11 of these patients
-from acute infection to more than seven MONTHS following symptom onset.

nature.com/articles/s4158…

13/ results
-detected persistent SARS-CoV-2 RNA in multiple anatomic sites, including throughout the brain
-as late as 230 days following symptom onset in one case.

‘In some patients SARS-CoV-2 can cause systemic infection and persist in the body for months.’

14/ methods-

-quantitative real-time PCR with reverse transcription (RT–qPCR) to detect subgenomic RNA, a marker suggestive of RECENT virus replication

- plus replication-competent SARS-CoV-2 in respiratory&non-respiratory tissues, by virus ISOLATION in Vero E6 cell culture.

15/ evidence of viral replication was found in many tissues including
- brain
-lymph nodes
- vitreous humour- eg the fluid in the eyes 👀🫠

‘CoV-2 RNA persistence was detected across multiple tissue groups among all late cases despite being undetectable in plasma’

16/ you will have to zoom in for this table of where Covid was found at what point in time after the symptom onset

Extended Data Table 2 ‘Summary of SARS-CoV-2 RNA and subgenomic RNA by tissue group over time’

17/ conclusion

demonstrates virus replication in multiple non-respiratory sites during the first two weeks following symptom onset&detected subgenomic RNA in at least one tissue in 14/27 cases beyond D14,indicating that viral replication may occur in non-resp tissues for months

18/ but..
This study largely represents older unvaccinated individuals with pre-existing medical conditions who died from severe COVID-19, limiting the ability to extrapolate findings to younger, healthier or vaccinated individuals.
So..more evidence…

19/ 🔴’Lingering SARS-CoV-2 in Gastric and Gallbladder Tissues of Patients with Previous COVID-19 Infection Undergoing Bariatric Surgery’

Eg they had biopsies taken just because they were having surgery. None apparently had Covid at the time of surgery

link.springer.com/article/10.100…

20/ Gastric&gallbladder specimens from 80 patients who underwent bariatric surgery between Nov2021 &May 2022 &had a history of COVID-19 infection with gastrointestinal symptoms were examined for the presence of lingering SARS-CoV-2 nucleocapsid proteins using immunohistochemistry

21/ results
- Gastric specimens from 1/3 patients and 4 (100%) cholecystectomy specimens showed positive cytoplasmic staining for the anti-SARS-CoV-2 nucleocapsid protein in surface mucosal epithelial cells.

22/ The median time between initial COVID-19 infection and surgery was 274 and 380 days in the positive and negative staining groups
⭐️that is a long time with regards to virus possibly hanging about

23/ conclusions

‘Gastric and gallbladder tissues can retain SARS-CoV-2 particles for a long time after COVID-19 infection, handling stomach specimens from patients during an operation must be done with care’

1/3 had Covid particles and up to and over 1 year after infection

24/ they said for their method of detection of Covid

-‘Immunostaining may be more accurate because it detects viral particles in the cytoplasm of cells.’

This was a younger cohort (mean age 37) but higher BMI (44)

25/ ⭐️summary ⭐️
These studies demonstrate mounting evidence Covid has been found in nearly all tissues of the body for months or even a year after Covid infection.

🔴If Covid can hide in the body&continue to wreak havoc in organs and drive inflammation- what do we do?🤷🏻‍♀️
End

I think *we have totally underestimated Covid

* not all of us.