Thread by @elisaperego78

There are some big issues with this interview by Dr Fauci, although I appreciate him raising the alarm on #LongCovid. It is incorrect to say we didn't know basically much about LC until very recently. Most key issues in acute/LC were known about by 2020 and 2021. I was there.

https://twitter.com/mehdirhasan/status/1704970139341402532

Not that *everything* was clear by 2020/2021 on LC, but already known were issues like multiorgan sequelae, lung pathology, cardiovascular disease, kidney disease, metabolic disease, evidence of autoimmunity, thrombotic disorders, potential/early evidence for viral persistence ~

Diagnoses of post Covid arthritis, vasculitis were made. Risk for delayed thromboembolic/cardiac complications, immune dysfunction (including reactivation of latent pathogens and secondary/oppotunistic bacterial infections), skin and eye issues, etc. were all documented by 2020/1

Neurological sequelae, including in the brain, and persistent low oxygen saturations, were also documented. All these issues, and more, were known both in the patient community and in early research and quite a few in the medical community by 2021, especially in early hotspots

The early post Covid clinics were already being created by late spring / summer 2020 in many early hotspots, like hard hit Lombardy. While these clinics often focused only on hospitalized patients, many issues (like cardiac damage, thrombotic issues) apply to the wider community

Italy, just to make an example, was reporting on long-term, possibly irreversible damage to the lung in a significant percentage of patients already in spring 2020. How many first wavers are yet to receive an in depth respiratory or lung evaluation?

tg24.sky.it/salute-e-benes…

If you think that only hospitalized patients were only the medical gaze until 2022 or 2023, think again. Patients, often abandoned at home with no care, took to social media/own research to literally identify, name and define what we call #LongCovid

sciencedirect.com/science/articl…

#LongCovid was openly recognized by the WHO on August 21, 2020, after intense advocacy by Covid survivors, to which I took part personally (I definitely know it happened and I know the evidence and competences the WHO could have drawn upon)

sciencedirect.com/science/articl…

By July 2020 persistent symptoms (Carfi et al.) and sequelae such as cardiac complications even in mild/asymptomatic patients (Puntmann et al.) after Covid were being reported in major medical journal, like JAMA



jamanetwork.com/journals/jamac…
jamanetwork.com/journals/jama/…

By September 2020, the first papers about the potential underpinnings of #LongCovid were being published (e.g. Perego et al 2020 WORes). For example, organ damage, viral persistence, immune dysfunction, cardiovascular, neurological, thrombotic sequelae, potential for reinfection

By mid-October 2020, it was known Covid could case multi-organ damage even in so called low-risk, youngish/young patients in #LongCovid. How many patients, including from the first waves, have been given exams to identify such damage as a routine?

medrxiv.org/content/10.110…

That #LongCovid could cause, for example, cardiac issues even in "low risk" patients was openly discussed in the press already in 2020. I fail to understand why all key policymakers could have missed this, together with the emerging scientific data 🙃

theguardian.com/world/2020/oct…

That SARS-CoV-2 infection left survivors with a wide array of sequelae was openly discussed in 2020 in the press and studied by teams across the world, for example from hard-hit Bergamo, Italy (long-term health effects and newly triggered conditions)

washingtonpost.com/world/2020/09/…

By late 2020 and early/mid 2021, the scientific literature on #LongCovid was multiplying. Persistent and evolving symptoms for months (e.g. Davis et al 2021, pre-print late 2020), and then 1 year + were being reported in a significant percentage of survivors

Patients themselves were still reporting in support groups and social media like Twitter issues, 1 year in, like coagulation abnormalities, microvascular damage to the lung via the VQ SPECT scan, autoimmunity, arthritis, vasculitis, cardiac injury. We're late 2020 to spring 2021

Studies on prolonged damage and persistent symptoms across multiple organs and body systems were growing fast by 2021. #LongCovid was being reported even in the first survivors from 2020 China





thelancet.com/journals/lance…
qz.com/2052244/a-chin…
evidence.nihr.ac.uk/alert/organ-da…

"Evidence of laboratory abnormalities in several organ systems" and issues spanning multiple body parts, including the cardiovascular, neurological, gastrointestinal etc systems, was published in the top journal @Nature by April 2021. One more paper

nature.com/articles/s4158…

@Nature The importance of clinical guidelines and case definitions respectful of people's lived experience were being throughly addressed, discussed, including by patient-researchers themselves already in 2020 and 2021. A lot of work and reflection went into it

thelancet.com/journals/lance…

@Nature Increasingly sophisticated studies were being published already by 2021, addressing issues, such as viral persistence in certain tissues (e.g. Kresch et al.), endothelial dysfunction (many), immune dysfunction, cancer post Covid >



onlinelibrary.wiley.com/doi/10.1002/bi…
medrxiv.org/content/10.110…

@Nature In view of all this knowledge which was already accruing by 2020 and 2021, I believe it is misleading to say something along the lines "yeah trials are late but it was impossible to do better before because we didn't have enough knowledge or a case definition for LC"

@Nature I remain appreciative that Fauci is calling for faster trials and he's acknowledging the gravity of #LongCovid. But it's too little too late in my opinion. I hope trials will be improve soon and people will find relief to their symptoms and hopefully a cure

@Elle07335804 especially in view of potential reinfections, patients potentially not seroconverting or loosing antibodies with time, etc. I suggest to talk to a physician especially given the very early timeline and condition you mentioned

@Elle07335804 The most sophisticated tests are often also only available in research settings, but obviously I can't speak for your situation (if you have access) and the US (I am not there)

@WillowLymeInfo So my post is about LC specifically and what Fauci said