Thread by @drclairetaylor

Long covid clinics are full of previously healthy people. 🧐
Where are all the
-rheumatology patients on DMARD or biological medication?
-diabetics?
-cardiac patients?

Are their medications protective for long Covid?

A study in Scotland looked at some medications at time of Covid infection and found injectable anti-coagulants to be the only one that was protective.
But many meds they could not analyse for various reasons
We urgently need to look at them all.

Some rheumatologists have already postulated that their medications may be protective-
Dr Laster said in 2022 said he was not seeing much long Covid in his patients on immunosuppressive therapy
This mirrors what I have observed

This could be due to reduction in IL-6 levels.
But what about viral persistence- one would think immunosuppressants would lead to more persistence?
Article here healio.com/news/rheumatol…

Of course there has been a lot of fuss about metformin preventing long Covid. That may well cover the diabetics.
This study found a 41% lower incidence of long Covid in patients in the metformin group.

.thelancet.com/journals/lanin…

And those with pre-existing cardiovascular disease- are NOACs( Novel oral anticoagulants ) for atrial fibrillation protective?
We know that Covid-19 causes a hypercoaguable state ( eg more likely to clot)

A 2022 study on NOACs found a lower risk of testing positive for SARS-CoV-2&severe COVID-19 outcomes than non-users;
? Effect of medication or more cautious behaviours.
This is a group that should be at higher risk..

bjgp.org/content/72/720…

In this study treating long Covid with ‘triple therapy’
(dual antiplatelet therapy and a NOAC- Apixaban) This was the result from 91 patients. All had ‘Fibrinaloid Microclots’ on fluorescent microscopy

They postulated that Fibrin amyloid microclots, platelet hyperactivation/ aggregation, and widespread endothelialitis inhibit the transport of oxygen at a capillary/cellular level and cause the symptoms of long Covid.

europepmc.org/article/ppr/pp…

Could it be those who are higher risk for Covid-19 have better access to anti-virals at time of infection? This meta-analysis concluded that PASC (long Covid) was 27.5% lower in the antiviral treatment group than in the nonantiviral group

.ncbi.nlm.nih.gov/pmc/articles/P…

Whatever the reason- we need to look into why long Covid clinics are full of previously healthy working age adults. It is of utmost importance given how devastating long Covid is and the rising number of people unable to work due to Ill health since 2020

2.8 million people aged 16-64 are not in the workforce due to ill health in the UK.

‘With 688,000 more people out of the workforce since before the pandemic, 6.6% of 16-64-year-olds are now economically inactive for health reasons, a record high since 1993.’

Further details here .'health.org.uk/news-and-comme…

It’s possible to hide Covid-19 and long Covid figures by not testing or counting/ but we always knew they would turn up in the Ill health statistics.
Good graph here @jukka235
Pink is long term sickness- rises steeply from 2020

If there is a way of preventing LC we should urgently be looking into it

If there are meds that are preventative it is high time we started testing again &protecting people from LC during infection.
Those who already have long Covid-we owe them the effort of finding treatments

The clues may be in those who are not in long Covid clinics….

These are just my observations and musings. Please do comment any thoughts/ideas.