Thread by @PutrinoLab

We are in our fourth year of work to understand #LongCovid and we now know things about it thanks to science. After being told again by a quasi-well meaning, if uninformed, clinician that LC is just functional neurological disorder (FND). Here’s a 🧵 on why LC IS NOT FND (1/)

So, what *is* FND anyway? Anyone who works in FND has to admit that over the years it has always been a problematic diagnosis with far too many unskilled and uninformed clinicians considering it to be synonymous with conversion disorder (read: “psychosomatic illness”) (2/)

More recently, those who know the field will acknowledge that a more nuanced point of view has emerged in regards to FND. Namely, skilled clinicians who are trying to treat FND in good faith hold the view that in the patient with FND, *some* change has occurred in the brain, (3/)

which is leading to downstream issues in the body. The issues occurring in the body are all very real, the skilled FND clinician will tell you, but the brain changes are the root cause. Now, the point of this 🧵is not to attack the validity of FND - whether or not FND exists (4/)

is immaterial to this conversation. Instead, let’s discuss how WE KNOW that #LongCovid *is not* FND. Let’s start with this image from the incredible recent @Nature review written by @ahandvanish, @EricTopol, @LisaAMcCorkell and @julialmv. It shows 5 ways that LC symptoms may (5/)

be caused by different systemic mechanisms. Now, to be clear: these 5 mechanisms were not proposed by the study authors just pulling theories out of the air. They were proposed because dozens of high-quality studies have been published in the best scientific journals in the (6/)

world showing evidence that people with #LongCovid now have different physiology to people who do not have Long COVID. So let’s start with the first one: immune dysregulation. Now, there are so many amazing pieces of literature that we can select to show immune dysregulation (7/)

in #LongCovid, but I want to select clean articles that don’t leave the door open for an argument that the brain is controlling the immune system, so let’s start with this gem from Zollner and colleagues that was published in Gastroenterology showing persistent virus in the (8/)

GI tract of those with #LongCovid, compared with healthy controls. As @VirusesImmunity, myself and many others have shown, we certainly do then go on to see immune sequelae and exhaustion that is highly consistent with a body under prolonged immune assault, but important to (9/)

note that this immune dysregulation is accompanied by clear evidence of viral persistence. In Zollner, we see it in the gut, which naturally leads to the sort of gut dysbiosis that has been reported by many, including Giannis and colleagues who showed changes in bacterial (10/)

colonies in the gut that were related to acute #COVID infection in those who then develop #LongCovid. So if you have LC, persistent virus is often found in your GI tract and then gut dysbiosis emerges. Logical, local cause and effect. But let’s keep looking, because next we (11/)

have the paper from David Walt’s group showing that spike proteins are still circulating in the bloodstream of a majority of folks with #LongCovid compared to none of those without LC. Wow! I wonder what that does to you? Welp, thanks to @giorgialupi we have an infographic! (12/)

It summarizes some of the brilliant work from @resiapretorius, @dbkell, @doctorasadkhan and many others showing us that when you add spike proteins to *healthy* blood, microclots form. That’s right, folks: nothing functional here, just another nice dose of CAUSE AND EFFECT (13/)

What about the brain? Of course when you start talking about brain changes and FND things get dicey, so let’s deftly avoid this TERRIFYING study in @Nature by Douaud et al showing that every acute #COVID infection, #LongCOVID or not, appears to damage your brain (😱🫣), and (14/)

look at some animal work from the brilliant @michelle_monje and @VirusesImmunity et al in Cell showing us that even COVID infections that were limited to the lungs in animals resulted in chemokine release that caused brain damage and cognitive impairments in those animals (15/).

If that were not worrying enough, we then also need to come to terms with the findings of Choutka et al in @Nature showing that different patterns of autoantibody production align with different symptom clusters based on different locations of viral persistence! What does (16/)

this tell us? It tells us that your particular set of #LongCovid symptoms may be related to the extent to which the virus is present in different organ systems. Taken together, we can start to feel confident now that the consensus scientific evidence is telling us that (17/)

#LongCovid is an infection-associated complex chronic illness, (just like what members of the #MECFS, #Lyme and other complex chronic illness communities have told us from the start). In those with LC, this virus gets under your skin. It DIRECTLY affects every single organ (18/)

system and disrupts many of their functions in ways that are sometimes too subtle to be easily detected by our blunt mainstream tests, but causing organ system dysfunction and damage nonetheless. The fact that we now have dozens of studies showing these direct causal links (19/)

means that a good-faith argument linking FND to #LongCovid is no longer possible. You can attempt to argue with the evidence presented on this thread, but you have to acknowledge that your feelings on the topic are exactly that: feelings that disagree with the current state (20/)

of the science. Please understand that the point of this thread is not to denigrate anybody’s professional background or clinical skillset (if you happen to be an FND specialist who is reading this), but it IS the point of this thread to inform people on the settled science (21/)

of #LongCovid. It is the point of this thread to encourage clinicians to rethink their biases and update their clinical approaches in the presence of new literature. To a hammer, everything looks like a nail. Please just be smarter, better informed and kinder than a hammer. (end)