Thread by @AppgCoronavirus

🗣Prof. Danny Altmann:
“Every word that Colin, Ravi & Rebecca said resonates so strongly, that all I can do really is put some meat on the bones and add to it. An overarching starting point, like everybody I get called by journalists and people.. 1/
#APPGCoronavirus #LongCovid

“All the time, ‘are we there yet? Is it over? Has Omicron saved us?’ And of relevance for today, a pandemic is a fluid progression, there isn’t a day when it’s over and we’ve been through many phases and many variants and all of the countries are interlinked.” 2/

“It could still be a very long and bumpy road. In the UK, the situation at the moment appears better under Omicron and more hopeful than it did under Delta. But just to remind you in terms of the discussion we’re having today.. 3/

“we still look to be facing 50k+ excess deaths a year. We’ve got a very heavy outbreak, very heavily skewed to schoolchildren who still don’t have specifications in place like sufficient vaccination and unclear whether mask mandates will continue in the coming period”4/

“And we have an NHS at breaking point and unequipped to cope. What that means in todays discussion, especially on Long Covid, we already as we’ve heard have a backlog of misery and disease dating back to the beginning of the first wave in 2020.” 5/

“We don’t really have the data in yet to know how badly we’re adding on to that total from the Delta and then the Omicron wave. If you look at the NHS and WHO websites, we have the beginnings of convergent definitions of Long Covid and the beginnings of a declaration of… 6/

“..intent in the UK for services but I think we’re a way off the ability to ensure that everybody with Long Covid who has those symptoms can access the care pathway that they need. I think in some cases we need to have a lot of discussions about the support they need for..” 7/

“..their disability irrespective of whether they have formal proof of SARS-COV2 infection or not. Two years into the pandemic it becomes a harder and harder discussion to have with certainty. As we now have many many people who receive no formal diagnosis in the days before.. 8/

“..we had PCR and antibody testing. We now have a very complex landscape of people who were infected in different ways, by different variants, variably overlayed by vaccines. It’s harder and harder to retrospectively workout what peoples infection history was.” 9/

“The UK, we’re ahead of the curve in the declaration of intent to roll out Long Covid clinics and putting money into along Covid clinics. And yet, all the questions we’ve heard about in the last hour is how reliably can you get referred?“ 10/

“Which clinical specialities sit in them? Do we have enough people to sit in them? And where were they trained and what were they trained in? How do we link up that care pathway, so there’s actually meaningful specialist support?” 11/

“What kind of therapeutics will they offer to actually make people better? And how many years are we planning this for? Those were big questions a year ago and they’ve just become bigger now I’m afraid. My impression of Long Covid care is that we do have the intent.. 12/

“..to treat people but often clinicians, running the clinics are working out guidelines and really using their training in general internal medicine, to improvise a service and principles. There are no guidelines, there is no textbooks.” 13/

“So patients across the country get a very uneven experience, & they don’t want rehab or to learn to adjust to their disability. They want their old lives back, they really, really do. This depends on having in place specialist teams: provision, diagnostics and therapeutics” 14/

“We are so, so far from having that in place. The screen grab on the left is for me, an exemplar of a dream team doing their very best at University College Hospital & this is them publishing this paper which I’d encourage you to look at, which is them giving the narrative..” 15/

“Of their first years experience, of how to set up and run a Long Covid clinic. To try & speak about some of those gaps, from everything we’ve heard of in the last hour, things would be better if we eased the acceptance and the pathway into Long Covid care and partly that.. 16/

“..depends on better diagnosis and things like bio markers and blood tests. Around the world that field has moved on considerably, we’ve heard a lot about gaslighting and failure to recognise - please let everybody in the UK understand that this is a global pandemic,” 17/

“And everywhere that’s had this virus, has Long Covid & the findings are similar all across the world. There are many meta-analysis papers reporting that you have the same thing whether you’re in Wuhan, Bangladesh or anywhere else.” 18/

“Some papers like this one from Aus, the beginnings of the kind of things the lab does as well, looking at serum biosignatures that would help to diagnose Long Covid & they came up with this test that if you had strongly elevated interferon-beta, gamma, pentraxin.. 19/

“..and interleukin-6, that was a strong marker of Long Covid. That’s the kind of thing we’re all trying to do to get better clues about Long Covid. I know that people are very, very anxious to understand the mechanism and implications for therapeutics.” 20/

“A lot of people are interested in, for example microclots and my response to everything we’ve heard in the last hour is I so understand the anxiety to get the ball rolling and treatments rolled out. In that perhaps I’m a little conservative that in the same way we had.. 21/

“The recovery trial for Covid, let’s stick with a randomised, controlled trials and proper guidelines and research to work out what we like best and what works best and try and do it like that. We’ll do a bit of immunology, this is actually not from our lab, it’s from our.. 22/

“..rival lab at Yale, this is the kind of direction of travel. The thing on the right that looks like a starry, starry night is a kind of heat map of all the different autoimmune bodies that come up in people who have been infected with Covid.” 23/

“What it says is we’ve got plenty of potential explanation for the pathogenesis of Long Covid. What this virus does it to turn on a massive array of autoimmunity in those who have had it. It’s not surprising to me that, that’s linked to the symptoms that we’ve heard about.” 24/

“What we’re doing in the study that we’re embarking on in my lab, is to really look properly at underlying mechanism. So that’s looking at disrupted immune subsets, autoantibody screening, programming of T cells and at immune response of the virus to itself.” 25/