Proud to have been a Subject Matter Expert to the POTUS Health Equity Task Force!
They're presenting today on what they learned about #LongCOVID (hhs.gov/live) & their presentation is so full of good recommendations that I can't even keep up.
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I'm thrilled at their takeaways, including 1) lab confirmation of COVID can't be required for care, 2) creating a federal advisory committee including LC patients, ME experts, & disability advocates, 3) help patients navigate the disability system & expediting claims, & others 2/
Excellent public comments from Michael Sieverts on how biases in PCR and antibody testing will trickle their way into research. Super important as research plans for #LongCOVID are currently being decided....
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Some examples of bias:
1) PCR: positive results are related to how early you get tested (false negative rates increase every day from day 3 of symptoms) so PCR-negative patients are less likely to have good access to healthcare
On those who participated in the survey on the clinical case definition - Patient AND Researcher is a new category (requested by @Dr2NisreenAlwan and yours truly) :)
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The parts of the clinical case definition that have reached consensus:
@itsbodypolitic and @patientled worked together to give feedback on these and it's really emotional to see our research, including the first report we did back in April 2020, cited here. 1/
It's going to take a while to go through & see what ended up in here, but a few things stand out to me that we pushed hard for:
A) The inclusion of a comprehensive symptom list, including PEM (and a definition for PEM!) and lesser-discussed but common symptoms. 2/
B) Instructions not to use lab confirmation: "Objective laboratory/imaging findings shouldn't be used as the only assessment of a patient’s well-being; lack of laboratory/imaging abnormalities does not invalidate the existence, severity, or importance of a patient’s symptoms." 3/
These areas of research are less known, including metabolic profiling, antiviral response phenotypes, neuroimmunology, cerebral blood flow, mitochondrial fragmentation, viral persistence, hypermobility, craniocervical issues, altered T&B cells, metabolomics & proteomics, etc. 2/
These researchers have made astounding post-viral findings in the above areas. Everyone interested in #LongCOVID should stop treating this as an illness unlike any other and instead dive into the massive amount of research that has already been done. 3/
In a study of (mostly male) #LongCOVID patients in the military, those with lab-confirmed COVID diagnoses were 69% less likely to have anxiety/mood symptoms!
This supports the idea that LC patients w' false negatives have more anxiety bc they can't access the care they need. 1/
The study also found that a lack of lab-confirmed diagnosis led to a huge delay in #LongCOVID care: 8.5 weeks for those w' confirmation, 16 weeks (4 months!!) without.
Those without lab confirmation were also 63% more likely to have pain, likely because of lack of care. 2/
A thread on models for patient involvement in research! #LongCOVID
First up:
This paper on design strategies in citizen science highlights a scale of 5 levels of participation. From lowest to highest involvement (through a patient lens):
A) Contractual: members from the public (patients) ask scientists to conduct study; no direct involvement in the research process, apart from defining the problems & setting research priorities. 2/
B) Contributory: the lowest level of direct involvement consists of contributory projects, where patients assist academic scientists in data collection or processing according to neatly defined protocols (i.e. crowdsourcing).
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There are a lot of #LongCOVID gems in this webinar from HCA Healthcare UK. I'm going to try to tweet them succinctly:
1. Non-hospitalized COVID patients had a slower recovery than hospitalized patients.
2. At 12 months out, the majority of non-hospitalized #LongCOVID patients are still not back to work full time.
Next speaker is a cardiologist.
3. Cardiac MRIs are helpful. Even when they look normal from a functioning standpoint, supepicardial late gadolinium enhancement can be identified, showing post-viral myocarditis. (Screenshotted case was in a patient 200+ days out from onset).