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Ziyad Al-Aly, MD Profile picture
@zalaly
Sep 10 • 9 tweets • 4 min read • Read on X
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…
They had:

⚡️better self-reported wellbeing
⚡️fewer and less severe COVID associated symptoms
⚡️less health care utilization
⚡️less absenteeism from work/study
⚡️improved quality of life

These translated into 2 to 2.5 fewer cases per 100 treated people
thelancet.com/journals/lanin…
This is a very important finding.

The use of antivirals to reduce the risk of long COVID is grounded in the hypothesis that viral persistence and possible ongoing replication of SARS-CoV-2 are major mechanistic pathways responsible for long COVID.
thelancet.com/journals/lanin…
The evidence for viral persistence (for months or years in key organs including the gut, brain, kidneys, and blood vessels) as a key mechanistic pathway for Long Covid is growing - thanks to visionary work by @MichaelPelusoMD and others

thelancet.com/journals/lanin…
This raises the plausibility that targeting viral persistence (via antivirals) could be a key therapeutic avenue to both prevent and treat long COVID.

The results from this large, randomized trial (PANORAMIC) are encouraging!

thelancet.com/journals/lanin…
The paper is not without limitations; these are detailed by the authors. And concerns have been raised about the mutagenecity of molnupiravir.
thelancet.com/journals/lanin…
A lot of work lies ahead and we must keep making progress. Addressing the research and care needs of people with long COVID must remain a high priority for governments. The health and wellbeing of millions of people now and in the future depends on us making this progress.

Paper here:

My comment here: thelancet.com/journals/lanin…
thelancet.com/journals/lanin…

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More from @zalaly

Ziyad Al-Aly, MD Profile picture
Sep 1
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…
Image
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
Ziyad Al-Aly, MD Profile picture
Aug 26
🧵1/ A Significant surge in the number of people with a disability in the U.S.

The @stlouisfed just released an analysis using data from the Current Population Survey (CPS), revealing some concerning trends. Here’s what they found:

#Disability #DisabilityJustice #LongCovid Image
2/ Above Trend Increase in Disability
Since 2019, the number of disabled individuals has surged beyond the expected trend by nearly 2 million. This isn't just a statistical anomaly—it's a huge indicator of a deeper, underlying health crisis.Image
3/ Cognitive Disabilities Skyrocket
Most alarming is the rise in cognitive disabilities. The population reporting only a cognitive disability has grown by nearly 1 million—a 43% increase since 2019.
Read 8 tweets
Ziyad Al-Aly, MD Profile picture
Aug 22
ICYMI #LongCovid is a defining crisis of our time

Long Covid affects at least 400 million people globally with an economic cost of $1 trillion/yr

Addressing Long Covid requires a coordinated—but so far absent—response strategy

Our review @NatureMedicine
nature.com/articles/s4159…
ロングコビッドは、私たちの時代を決定づける危機です。

ロングコビッドは、世界中で少なくとも 4 億人に影響を与え、年間 1 兆ドルの経済的損失を招いています。

@NatureMedicine での私たちのレビュー

nature.com/articles/s4159…
La COVID prolongada es una crisis que define nuestro tiempo.

La COVID prolongada afecta al menos a 400 millones de personas en todo el mundo y tiene un coste económico de un billón de dólares al año.

Nuestra reseña en @NatureMedicine
nature.com/articles/s4159…
Read 6 tweets
Ziyad Al-Aly, MD Profile picture
Aug 9
📢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…
Image
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…
Image
Read 19 tweets
Ziyad Al-Aly, MD Profile picture
Aug 2
My Statement on the introduction of the Long COVID Research Moonshot Act #LongCovidMoonshot

I fully support this bill and urge the U.S. Congress and our community to support it.

Short thread: Image
Today U.S. Senator Bernie Sanders @SenSanders formally introduced the Long COVID Research Moonshot Act. This marks a historic moment, the culmination of relentless effort and dedication from countless individuals. #LongCovidMoonshot
The bill calls for the establishment of a Long Covid program at NIH with research funding of $1 billion per year for 10 years, and additional funding to other federal agencies for clinician education, public awareness, and more. #LongCovidMoonshot
Read 9 tweets
Ziyad Al-Aly, MD Profile picture
Jul 23
COVID increases risk of diabetes.

This has now been demonstrated in many studies including the largest (more than 16 million) in @TheLancetEndo

Paper

My comment here
doi.org/10.1016/S2213-…
doi.org/10.1016/S2213-…
Perhaps most alarmingly, the authors report that the
risk of type 2 diabetes remained high beyond the first
year after SARS-CoV-2 infection.

This is yet another study showing the long risk horizon of COVID-19

doi.org/10.1016/S2213-…
It is very clear that SARS-CoV-2 can cause new health problems years after the initial infection

doi.org/10.1016/S2213-…
Read 7 tweets

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