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Ziyad Al-Aly, MD Profile picture
@zalaly
Aug 9, 2024 • 19 tweets • 8 min read • Read on X
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📢Our review "Long COVID science, research and policy" is out in @NatureMedicine

By @zalaly @ahandvanish @LisaAMcCorkell @leticiasaurus @swulfie @VirusesImmunity @EricTopol

A thread
nature.com/articles/s4159…
In this review, we provide (1) a synthesis of the state of science on Long COVID; (2) assess the impacts of Long COVID on individuals, health systems, the economy & global health metrics; and (3) provide a forward-looking research & policy roadmaps nature.com/articles/s4159…
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We begin with a timeline of the history of #LongCovid. We recognize the prescience of the #MECFS community that warned us about what’s to come, the op-ed by @fi_lowenstein in @NYTimes, the first mainstream media piece by @edyong209 in @TheAtlantic & more
nature.com/articles/s4159…
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What is Long COVID? It is a complex, multisystem disorder that affects nearly every organ system, including the cardiovascular system, the nervous system, the endocrine system, the immune system, the reproductive system and the gastrointestinal system. nature.com/articles/s4159…
It affects people across the age spectrum (from children to older adults), people of different race and ethnicities, sex and gender, and baseline health status. nature.com/articles/s4159…
How common is Long COVID?
We estimate that the cumulative incidence of Long COVID till the end of 2023 is about 400 million cases – this is a staggeringly high burden.
nature.com/articles/s4159…
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Mechanisms of Long COVID include viral persistence, immune dysregulation, mitochondrial dysfunction, complement dysregulation, prothrombotic inflammation and microbiome dysbiosis. Details in our review. nature.com/articles/s4159…
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We review the impacts of Long COVID on individuals and communities, health systems, economies, and sustainable development goals (SDGs) nature.com/articles/s4159…
Impact on Individuals: Long COVID severely affects patients' well-being and sense of self. It affects the ability to work, socialize, and perform daily activities, often leading to social exclusion, isolation and stigma, often from medical providers.
nature.com/articles/s4159…
Impact on Economies: Long COVID affects labor participation and productivity, causing significant financial strain on individuals & economies.

We estimate that the annual global economic toll of Long COVID is around $1 trillion or 1% of the global GDP
nature.com/articles/s4159…
This is a significant drag on global economic output and demands the attention of every government on earth.

Addressing Long COVID is not just a health imperative but an economic one.

nature.com/articles/s4159…
Impact on Sustainable Development Goals (SDGs): Long COVID threatens progress towards SDGs, affecting poverty, hunger, health, education, and gender equality across the globe. It exacerbates existing inequalities and strains resources​. nature.com/articles/s4159…Image
Research Roadmap: A comprehensive research agenda is needed to understand biological mechanisms, develop diagnostics, and design therapeutic trials. Understanding Long COVID requires a multidisciplinary approach and collaboration across disciplines. nature.com/articles/s4159…Image
Policy Roadmap: Effective policies should focus on prevention, support for affected individuals, access to quality care, professional education, and public health communication. A coordinated global response is essential to address Long COVID challenges​. nature.com/articles/s4159…Image
In sum, Long COVID is a defining health crisis of our time, with wide-reaching impacts.

Addressing the crisis of Long COVID requires an ambitious and coordinated—but so far absent—global research and policy response strategy.

nature.com/articles/s4159…
Thanks to my co-authors @ahandvanish @LisaAMcCorkell @leticiasaurus @swulfie @VirusesImmunity @EricTopol

Thanks to our editors @naturemedicine and our reviewers.

nature.com/articles/s4159…
TLDR: The global cumulative incidence of Long COVID is around 400 million with an annual economic cost of around $1 trillion; it poses significant challenges to individuals, health systems and economies across the globe.
nature.com/articles/s4159…
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Coverage by @cbarbermd in @FortuneMagazine

fortune.com/well/article/l…
By @PamBelluck in @nytimes
nytimes.com/2024/08/09/hea…

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More from @zalaly

Ziyad Al-Aly, MD Profile picture
Jan 20, 2025
1. What are the benefits and risks of GLP1?

Our new study in @naturemedicine comprehensively maps all the benefits and risks of GLP-1 receptor agonists (GLP-1) (Ozempic, Wegovy, Mounjaro, Zepbound).

By @Biostayan, Taeyoung Choi and me
🧵

nature.com/articles/s4159…
2. Why we did this study?

We saw that GLP1 use has substantially increased, and reports emerged about some off-target effects. But we realized that no one had comprehensively investigated effectiveness & risks of GLP-1 across all possible health outcomes
nature.com/articles/s4159…
3. So, we decided to do the comprehensive study!

We did a discovery analysis which comprehensively examined 175 possible health outcomes (leaving no stone unturned) in 215,970 people on GLP1 and more than 2 million individuals not on GLP1

nature.com/articles/s4159…Image
Read 16 tweets
Ziyad Al-Aly, MD Profile picture
Dec 30, 2024
How the Pandemic Increased US Deaths!
Visualized in 8 charts by @jwgale in @business

1. The Covid Pandemic Fueled a 4-Year Mortality Surge in the US Image
2. Heart disease has long been the leading cause of death in the US and globally. The Covid pandemic worsened its effects. Image
3. Deaths From Heart Disease Accelerated as Covid Spread Image
Read 10 tweets
Ziyad Al-Aly, MD Profile picture
Oct 15, 2024
🚨 Long COVID is a significant health crisis in China too!

My commentary on the largest Chinese study to date, involving 74,075 participants, which found that 10-30% of them reported long COVID symptoms such as fatigue and brain fog #LongCovid

thelancet.com/journals/lanwp…
The features of Long Covid reported in this Chinese study are remarkably similar to those reported in studies conducted in other parts of the world.

This underscores the consistency of Long Covid features across national borders and cultures!!!

thelancet.com/journals/lanwp…
The study also shows that:

🔸Reinfections increase risk of Long Covid
🔸Vaccines reduce risk of Long Covid

This is also consistent with evidence from studies performed in other parts of the world.

thelancet.com/journals/lanwp…
Read 6 tweets
Ziyad Al-Aly, MD Profile picture
Sep 23, 2024
Here are key slides of my talk at the NIH-RECOVER-TLC
#RECOVERTLC
nature.com/articles/s4159…
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The number of people with Long Covid is huge. This demands global attention. nature.com/articles/s4159…
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The economic toll of Long Covid is significant.

nature.com/articles/s4159…
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Read 11 tweets
Ziyad Al-Aly, MD Profile picture
Sep 10, 2024
Here is the first randomized trial to show that an antiviral can prevent Long Covid.

In the PANORAMIC trial, people randomized to molnupiravir had less risk of Long Covid than people who received no antivirals

My comment in the link below. A short🧵
thelancet.com/journals/lanin…
The study included people with at least one risk factor for progression to severe COVID-19 illness.

People randomized to molnupiravir or usual care (no antivirals) were followed for 6 months

thelancet.com/journals/lanin…
People who were randomly assigned to molnupiravir during the acute phase of COVID-19 had better outcomes at 3 months and 6 months than those randomly assigned to usual care

thelancet.com/journals/lanin…
Read 9 tweets
Ziyad Al-Aly, MD Profile picture
Sep 1, 2024
400 million reasons to care about #LongCovid

ICYMI: our review on #LongCovid in @NatureMedicine

Long Covid has affected at least 400 million people worldwide at a cost of $1 trillion per year.

#LongCovid is a defining health crisis of our time!

nature.com/articles/s4159…Image
We review the mechanisms of Long Covid including viral persistence, immune dysfunction, thrombo-inflammation, neuronal inflammation, and microbiome dysbiosis.
nature.com/articles/s4159…
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We review the devastating impacts of Long Covid on individuals and communities, health systems, economies, and global health metrics.

nature.com/articles/s4159…
Read 6 tweets

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