Thread by @PutrinoLab

As we continue to learn more each day about #LongCOVID and other infection-associated complex chronic illnesses like chronic #Lyme and #MECFS, I want to once again transparently share our team's approach, thought process and philosophy for interpreting science and translating 1/

it into common clinical practice. We are approaching our new center through the lens of establishing novel ways of treating chronic, persisting pathogens and the damage that they cause. This is why our scientific strategy is being led by the incredible @microbeminded2, because 2/

IMO there is no one better in the world who has been consistently and relentlessly leading and facilitating great research in this space. Part of understanding how to detect AND treat persistent pathogens in the body is to understand how they affect physiology. Why is this 3/

important? Because often we cannot reliably test for evidence of the persisting pathogen itself. Not everyone with #LongCOVID has easily measurable evidence of persistent virus in their gut, only around 30% have circulating spike proteins in their blood, many tissues that may 4/

harbor persistent SARS-CoV-2 can only reasonably be accessed post-mortem, so what I'm saying is that at this time testing for persistent virus, though we still try, is shaky. There is technology on the horizon being developed for radioligands that bind to spike and can be used 5/

in conjunction with PET scanning to search the whole body for viral persistence. I think that this is a very promising direction, but I'm also mindful of the fact that PET scans carry with them a non-zero chance of causing malignancy (~0.16%) - which sounds small until 60M ppl 6/

get tested...either way, we are all in when it comes to new techniques for identifying persistent pathogens, but also IN PARALLEL (not in isolation) we see the value in understanding the effect on physiology of these pathogens. Hence our excitement about our own recent study 7/

in people with #LongCOVID that we completed with the wonderful @VirusesImmunity and other work like that completed by @MaayanLevy_Lab and co-authors this week. These studies highlight biological differences between people with LC and health controls. We strongly acknowledge 8/

that due to the complexity of infection-associated chronic illness not all people with #LongCOVID will show these differences. When media reports on work like this they often want to overstate the importance of the work so that it fits into a nice press-release, but the source 9/

materials will ALWAYS present a more nuanced interpretation. You will not see serious authors of this sort of work saying "we've done it: this is THE biomarker", because that it NOT what our research shows. We also won't say that cortisol is a TREATMENT for #LongCOVID or 10/

even an appropriate treatment for the low cortisol that we saw in the MY-LC cohort we published in @Nature earlier this month. Similarly, my team IS NOT is saying that based on the results of this weeks @CellCellPress paper that all folks with #LongCOVID should take prozac. 11/

I DID mention that the serotonin findings were interesting because it explains why *some* folks with #LongCOVID experience benefit from low dose SSRIs. I know that not ALL people experience benefit, and in fact some people experience worsening symptoms, but we must not ignore 12/

those who experience benefit just because it doesn't fit everyone's narrative. Similarly it is important to highlight physiological reasons WHY these people may be experiencing benefit because for too long this benefit has been framed as treating depression and contributes to 13/

ongoing gaslighting. The same can be said of folks with #LongCOVID, #MECFS and #Lyme who respond to low-dose ativan because it is a mast cell stabilizer NOT because it is treating anxiety. Mechanisms matter, and fitting these pieces of the puzzle are crucial for making sure 14/

less people are being minimized and gaslit as they attempt different treatments. Our team is highly focused on understanding the underlying pathophysiology of #LongCOVID and other infection-associated complex chronic illness. We have multiple clinical trials in the works 15/

that focus on symptom management (such as use of enzymes, antihistamines and nerve stimulation) and addressing persistent pathogens (various antiviral therapies). We believe both to be important because while cures are the goal, people need treatments that can move the needle 16/

NOW, and we also must acknowledge that persistent pathogens cause damage that may need to be fixed even if the persistent pathogen is eventually eliminated. That is why understanding how people with #LongCOVID, #Lyme and #MECFS biologically differ from healthy controls is a 17/

research priority for us. Once again - this is *our* approach and thought process as we tackle these challenging issues. We are aware that there are other approaches exist and have validity, so we are respectful of differing opinions (and ask for the same grace!). One thing 18/

you can count on is that we won't stop looking for new, better and actionable solutions for people living with infection-associated complex chronic illnesses🙏 /end