Thread by @drclairetaylor

1/ To all the #longcovid doubters- I diagnose neuroinflammation all the time. It is clear to see in patients’ presentation.
It is not brain fog-it’s cognitive dysfunction🧠

@polybioRF have linked it with vascular problems.
Covid is a vascular disease🩸

biorxiv.org/content/10.110…

https://twitter.com/polybiorf/status/1715768235511988660

2/we don’t usually have access to PET scans&vascular inflammation markers for patients .
But then we don’t for other diseases either. It doesn’t mean we cannot diagnose&treat them.

This chart shows long Covid in red&normal in blue.
Clearly those with long Covid are different

3/ what is different? More of a PET signal=neuroinflammation
🔥

https://twitter.com/polybiorf/status/1715772782330417512

4/ The inflamed areas correlated with gaps in the blood-brain-barrier. This is there to protect the brain from damage.
Seven vascular factors were raised. 🩸 🔥

https://twitter.com/polybiorf/status/1715773575951446332

5/ the more Orange the area the more inflamed it is.
Brains on fire 🔥

6/ I know these people have neuroinflammation because they cannot remember the word for ‘Fridge’. They forget to turn the cooker off. They cannot find common words that were once immediately available. They search the folders of their mind for words they once knew.
Before Covid

7/ yet they are STILL told
- they are anxious
-they are traumatised by the pandemic
- they are stressed
- they are depressed
- they need to imagine they are not any of these things and then their brain will work

8/ there is a condition known as anti-NMDAR encephalitis.
It is an autoimmune condition with antibodies against receptors in the brain-leading to inflammation.
What we are seeing with Covid is a different mechanism

9/ there is more than one way to a similar outcome with disease.
Inflammation can be achieved by antibodies (autoimmune diseases) or increase in inflammatory chemicals from the immune system (auto-inflammatory diseases).

10/ in this study they used [11C]PBR28 PET neuroimaging, a marker of neuroinflammation, to compare 12 PASC individuals versus 43 normative healthy controls. They found significantly increased neuroinflammation in PASC versus controls across a wide swath of brain regions

11/ Regions of the brain with inflammation included immidcingulate and anterior cingulate cortex, corpus callosum, thalamus, basal ganglia, and at the boundaries of ventricles.

12/ what does each of these areas do?
Midcingulate and anterior cingulate cortex:

Emotion, action and memory
link.springer.com/article/10.100…

13/ corpus callosum:
It connects the right and left side of the brain.
Sounds pretty important. Ce

14/ thalamus:

The thalamus relays sensory impulses from receptors in the body to the cerebral cortex. A sensory impulse travels from the body surface towards the thalamus. This is passed to the cerebral cortex which interprets it as touch, pain, temperature etc

15/basal ganglia.
This is what I spent a year researching years ago. The movement centre using dopamine. When it dysfunctions you get Parkinson’s disease&other movement disorders.

However, It has other roles such as:
motor learning
executive functions and behaviors
emotions

16/ the ventricles:
Great word, ventricle.

The ventricles produce cerebrospinal fluid, and transport it around the cranial cavity.

There are four ventricles; right and left lateral ventricles, third ventricle and fourth ventricle.
Adults have around 250mls of CSF

17/ CSF plays an important role in supporting the brain growth, protecting against external trauma, removal of metabolites produced by neuronal and glial cell activity, and transport of biologically active substances (like hormones and neuropeptides) throughout the brain

18/ blockage of ventricles leads to hydrocephalus (build up of fluid).

Other diseases of the ventricular system include inflammation of the membranes (meningitis) or of the ventricles (ventriculitis) caused by infection or the build up of blood following trauma or haemorrhage

19/ all of these inflamed areas have a blood supply of their own.
Covid is a vascular disease.
Anywhere with a blood supply can be affected.
It may feel like a cold, but how do you know if your anterior cingulate cortex is inflamed?

20/ from @MBVanElzakker ,one of the researchers, explaining the distribution amongst controls and those with long Covid.

https://twitter.com/mbvanelzakker/status/1715761758315422085

21/ this is a graph of the vascular factors versus inflammation seen on PET scan. The higher the vascular factor level, the more neuroinflammation
Seen by diagonal lines

Link to study pre-print biorxiv.org/content/10.110…

22/ why do some people get this and some don’t?
If you don’t get it on your 1st Covid infection can you get it on your 3rd?
Can we fix it?
Will it lead to increases in things like Parkinson’s disease and dementia?
What happens by infection 10?

23/ Since we don’t know the answers -we shouldn’t be letting covid pass through schools over and over and those growing brains 🧠

24/ how do we treat similar neuroinflammatory conditions?
Immunoglobulins
Immunosuppressants
Plasmapheresis
But we also have the vascular issues here- what do we treat that with? Blood thinners? Statins? Steroids?
Do we need anti-virals?

25/ we are learning the mechanisms thanks to groups like @polybioRF
I can’t see our leaders shouting this from the rooftops.

Protect your brain.
Protect your blood vessels.
I suspect the fixing is much harder-&most long Covid patients do not have a specialised PET scan.

@polybioRF 26/ It can be seen in the doctors who got long Covid, 1 in 5 who can no longer work.
Rachel Ali, A GP said:

‘My brain stops working, my mouth stops working, I’ll be mid-sentence and not know where I’m going with it.’bmj.com/content/382/bm…

27/ Dr Kerry Smith, a GP and former marathon runner said

“I’m not that person anymore. Day-to-day I can do very little. After my acute infection, I improved physically but I started to notice that my brain was not right…contd

@polybioRF 28/ ‘I would leave the front door open in the middle of the night and the gas cooker on. I couldn’t remember who I worked for, the names of any people I worked for, or what my practice was called.’

@polybioRF 29/ Dr Smith also said:

‘When occupational health told me I wasn’t fit for work, I felt I had no choice but to leave. That was in September 2021. Now I’m on Employment Support Allowance& Universal Credit. The difference is huge—I’m living on about a third of my previous income’

@polybioRF 30/ and yet still- the doctors are working with no PPE. Many don’t even appear to want it.
Listen to those who have already suffered the consequences.
Covid is going nowhere.

It is weakening us as a species.
The most amazing thing about humans is our giant brains.

@polybioRF These doctors with long Covid who can no longer work are a warning- they functioned at high cognitive levels. They now leave the front door open&don’t know the names of their colleagues. They have, indeed, been left to rot.
‘MRI normal’. Of course it is. It’s the wrong test.

@polybioRF Which also raises questions for other professions requiring high executive function.
The term executive functions refers to the higher-level cognitive skills you use to control and coordinate your other cognitive abilities and behaviors.
Pilots
Drivers
Lawyers
Paramedics

Contd executive function:
Computer programmers
Civil servants
Teachers
Being a parent!
The list would go on and on.
What happens if Covid drops your executive function and YOU haven’t noticed?
Mistakes. That’s what happens.

@polybioRF Some good info on execute dysfunction



And the BEST piece of work I’ve seen yet on long Covid and return to work by @SOMNews

bestcolleges.com/careers/dealin…
som.org.uk/sites/som.org.…

Sadly not all will make it back to work. Not just because of neurological effects. But fatigue, post-exertional malaise, POTS etc
Some will make it back part time with adjustments (yes long Covid is likely
To be considered a disability if it affects day to day functioning)

We have 2 million people out of work.This is a graph compared to Feb 20. Do we have an epidemic of laziness? I think not.None of these 1/5 doctors out of work were lazy. Doctors don’t take time off unless it’s impossible for them to work. Look at the change in ‘long term sick’!

Red= long term sickness
Blue=students
Grey=other
Carers=Green
Yellow=retired
If a graph told a million words….