Thread by @WesElyMD

1/🧵 The Haunting Brain Science of Long COVID 🧠

@washingtonpost Aug 25

📍Brain shrinking
📍Corona ghosts
📍Autoimmunity
📍Clinical clusters

“The good news is that in some pts #LongCovid #BrainFog may not be permanent.”

Link👇 but paywall so see 🧵

wapo.st/3wvPBlF

2/ Mild Covid is biologically dangerous long after initial viral infection.

81 mild COVID pts:

Study revealed:
✔️Astrocytes (🧠 support cells for neurons) get infected
✔️Neurotransmitters are altered
✔️Neurons die indirectly
✔️Then we lose brain power

bit.ly/3pcqbFV

3/ Epidemiology💥

Long COVID is tightening its grip on society.
 
We’re still losing >600 people a day to death from COVID in US alone

Over 100,000 new infections per day (Johns Hopkins data).
 
This is an epic global 🌍#PublicHealth catastrophe.

wb.md/3SKjGrh

4/ New @TheLancet study says 12.5% of those infected get LongCOVID:


Yet they didn’t ask about brainfog or mental health, which 1 in 3 pts have.

CDC study of 63M says 20% have LC:


So…

~15% x 600M = 90 MILLION

SO what is LCovid? bit.ly/3Aiyi9W
bit.ly/3AmPHhM

5/ Fascinating new study from @VirusesImmunity team on LongCOVID…

🔸Other dormant viruses like VZV and EBV are reactivated
🔸Also, low cortisol is a Biomarker of severity
🔸It’s an example of how our body is taken advantage of by our own immune system

bit.ly/3QUgebZ

6/ CoronaVirus Ghosts: 👻

Antibody patterns over time indicate prolonged antigenic stimulation long after COVID infection.

We find virus in the GI system of some patients mos later.

One theory about #LongCOVID is that COVID has figured out how to…

go.nature.com/3w1jnhZ

7/…#COVID virus rents space in our gut mucosa wreaking havoc on some people’s immune system.

📌N=113. Ongoing viral “ghosts” (& not friendly Casper)
📌Fecal shedding in 50% initially & still present in 12.5% pts at 4 mos
📌GI symptoms 1 yr later
📌Ugh
 
bit.ly/3BYVThj

8/ This study of 46 patients with Inflammatory Bowel Disease (IBD) >200 dys after COVID showed viral RNA in a whopping 70% of them 7 months later.

Most patients w ongoing COVID antigen persistence got #LongCOVID.

That’s not proof of cause & effect…yet.

bit.ly/3vT7dYz

9/ We learned in @Nature that patterns of B cell response (antibody production) continued to evolve 6 mos after initial infection.

This supports that ongoing Ag stimulation of our immune systems by COVID ghosts in GI tract is a source of Long COVID.

go.nature.com/3bQgHNo

10/ Ongoing inflammation is also supported by this study of N=2,320 pts in which systemic high levels of IL-6 & LC symptoms support ongoing tissue damage that translated into disability & low quality of life 1 year later.
 
bit.ly/3LUsHu9

11/ Three different profiles of #LongCOVID were found in N=1,500 patients:

🧨 brain predominant
🧨 heart/lung predominant
🧨 multi-system (including joints & GI).

Which profile do you or your loved ones suffer?
 
bit.ly/3QjM5mq

12/ It is estimated by large datasets using ICD-10 codes that ~75% of #longCOVID patients were never hospitalized.

📍third <50 y/o (4% kids <12)
📍third between 51-66 y/o
📍third >65 y/o
 
bit.ly/3djfkqN

13/ BRAIN FOG: Early autopsy studies of COVID pts showed lack of virus in neurons & made us think the brain wasn’t involved.

We know lots more now...

UK Biobank MRI study N=401 pts(most mild COVID) found ⬇️ brain SIZE vs 384 controls & slower brains 😩

go.nature.com/3ILTN4Z

14/ Other neuroimaging, PET & cognitive testing data support abnormalities in the hippocampus & frontal cortex.

PET studies showing metabolic slowing help explain profound anxiety, loss of memory & neurocognitive deficits in long COVID pts.
 
bit.ly/3axWlaN

15/ The virus infects not only endothelial cells but also astrocytes, both of which indirectly affect longevity and overall health of our neurons.

Glial cells are the glue that holds the brain together and provide the environment for neurons to thrive.
 
bit.ly/3SIWiKC

16/👇Frere showed glial cells are activated by COVID & sustain inflammation, which in turn, sadly sets into motion a pathway toward overall brain atrophy (shrinking), long-term cognitive disability & mental health disorders seen in your friends w LC.
 
bit.ly/3zB7gLk

17/ We have solid data across mammals (e.g. humans and mice) that COVID infection causes increases of neurotoxins and neuronal cell death similar to that seen in the brains of patients with cancer after receiving chemotherapy.
 
bit.ly/3JM0fdE

18/ Neuropsychological testing we do as part of our @CIBScenter’s NIH studies indicates many of our long COVID patients have deficits equivalent to acquired dementia.

Clinical trials are being designed, including therapies to prevent/heal dementia.
 
go.nature.com/3Qx6XXe

19/ Science makes it so clear that #Covid turns on inflammation & alters our nervous system even when the virus seems long gone.

Listen & validate your friends & patients.

It helps them simply to know they are heard.

TY @VirusesImmunity👇
 
go.nature.com/3zQqVFB

20/ LC pts describe over 200 symptoms‼️

Yet we have no cures…yet

At times, I must have seemed upset & perhaps sent the message to patients they’re a burden.

If I have, I am sorry.

It is in no small part because I'm grappling for answers, too.

bit.ly/3JLGNO5

21/ I remind myself that patients are not difficult. It’s the situation that is difficult.
 
New data in 1.28M COVID pts found mood & anxiety disorders improved BUT Acquired #BrainFog (dementia), psychosis & seizures persist at 2 YEARS.

 bit.ly/3PBsOvw

22/ Too many people are losing #hope.

A study of 150,000 COVID survivors, both hospitalized & not, showed they had 10-15 times ⬆️ risk of considering suicide at 1 year versus 11M control patients.

Our daily zoom support groups are part of recovery ❤️‍🩹
 
bit.ly/3HnHZpB

23/ In 20 years of studying long-term ICU outcomes, we’ve learned that acquired dementia is often partially correctable.
 
#PICS patients can benefit from brain exercises even years after ICU care.

There will be overlap w #LongCOVID & we must study this.

bit.ly/3vCMTtc

24/ Patients with cancer who suffer #ChemoBrain may benefit from cognitive rehabilitation.

Some use sudoku, wordle & online games to help. The brain wants exercise & can often rebuild and sharpen.

We are conducting more clinical trials.

H/T @tmprowell

bit.ly/3KimRCG

25/fin
#LongCOVID patients, please don’t lose hope. Your brain is packed w powers of neuroplasticity.
 
Caregivers serving patients during difficult times, harness empathy & compassion to aid patients’ recovery.
 
Neuroscience is real & patients must be heard to start healing ❤️‍🩹

26/ Here is the link w easy to tap image from @washingtonpost and since it’s behind the paywall the next tweet is a screenshot of the piece…hyperlinks are fleshed out in the 🧵…

wapo.st/3wvPBlF

27/fin
Haunting Brain Science of Long COVID -

It’s astonishing what we are learning.

Here you go for full text screen shots of the entire OpEd 💥

Long COVID Brain science data

Gifted link

(no paywall) 😘wapo.st/3Tf0WQR

Read Op-Ed without paywall: 🙌

https://twitter.com/WesElyMD/status/1562860505089593347