A tumultuous 24-ish hours since our preprint was released yesterday. I mentioned that this was a fraught issue and I genuinely do understand that people have mixed feelings about the work. I wanted to take some time to respond to some of the concerns and comments that have 1/ arisen. First, and most importantly: #LongCOVID (LC) and post-vaccine syndrome (PVS) both exist. Anyone claiming that all LC or even *most* LC is actually PVS is unserious and is making up nonsense that is not supported by the consensus science. I cannot stress this strongly 2/

Grateful to continue to be able to do great work with the amazing team at @YaleMed, led by @VirusesImmunity and @hmkyale. Today one of our preprints dropped on what is a fraught and divisive topic: vaccine injury or post-vaccine syndrome (PVS). Before
1/medrxiv.org/content/10.110… we dig into the results, I want to state a few things very clearly about the team that conducted this work:
- We firmly believe in the value of vaccinations. However, we also believe that drugs will always have side-effects in a percentage of the population. Holding these two 2/

This is an amazing example of how certain things simply cannot be broken down to a magic pill or formula and I think this is a wonderful #scicomm learning opportunity.

Note the communication from @hubermanlab. 1) Makes a statement about how a key opinion leader says you can 1/

https://twitter.com/hubermanlab/status/1889323186489033145

*dramatically* increase endurance and strength. 2) Makes the caveat (“start slow”). Simple, direct, informative. Right?

Ok, so what’s the secret?
- Once a week, jog a mile with a kettle bell that is equal to 30% of your own weight in a briefcase carry. Switch arms from time 2/

Honored to be a part of the work led by @polybioRF and @microbeminded2 published in @TheLancetInfDis discussing actionable strategies to adequately address SARS-CoV-2 persistence in #LongCovid. This paper covers discourse on how to look for and measure severity of persistence 1/

https://twitter.com/polybiorf/status/1889299846105911777

so that it can be used as an outcome measure in clinical trials, discussion about promising antiviral and monoclonal agents: what has the best chance of working and when combination therapies should be considered, the critical need for more sophisticated clinical trial designs 2/

Feels like a good time for a little reminder: Countries aren't supposed to be run like businesses. Countries are supposed to spend money to support and serve their people. This means spending to support those living below the poverty line, the disabled and historically 1/ excluded groups. This means investing in research that doesn't immediately have a profitable output so that future innovations can be incubated and accelerated through companies that form within the country that supported the work. This means engaging in international aid so 2/

Wanted to check-in with these new @NIH changes that are going to affect so many. First let me remind everyone: I run 6 hybrid clinical/research centers, each with a specific clinical focus. Unlike the vast majority of my colleagues, federal funding sources account for less 1/ than 20% of my operational budget across all of these centers, so understand that my thoughts on this topic have nothing to do with self-preservation or any sort of self-serving agenda. First, sweeping change of this magnitude is going to cause great pain for thousands and 2/

With everything that has happened over the past few days with regard to layers of censorship being imposed upon workers for US federal agencies around reporting gender, race, ethnicity and disability status, I just need to make an appeal to my colleagues who work in spaces 1/ adjacent to government: federal governments of any country can make uninformed policy decisions about what their workers are and aren't allowed to do. This is what democracy means and although this may lead to unconscionable consequences for historically and currently excluded 2/

Reflecting on the past week a few basic themes and lessons that strike me as worth repeating over and over:
1) First contact providers for #LongCOVID, #MECFS, chronic tick-/vector-borne illness and other infection-associated chronic conditions should be PCPs/family medicine. 1/ These are the folks that most people will come to with the non-specific symptoms that often emerge at the start of IACCs, so it is imperative that these professionals know how to identify and diagnose them. IACCs should be a categorical part of a coherent differential Dx for 2/

Those who have been following me for a while will know that I have been a voice for @NIH reform for quite some time. Regardless of the changes the current administration will bring to NIH, the events of the past 24hrs have been extreme and have caused, IMO, unnecessary stress 1/ and instability to hundreds of thousands of researchers and research support staff. I would strongly argue that whatever steps toward reform that the NIH want to take can be done without media blackouts, mass confusion and complete shutdown with no indication of next steps. 2/

Since my episode with the wonderful @longcovidanswer has been released highlighting viral persistence as a major driver of some #LongCOVID pathology, I’ve been asked repeatedly, “what should we do about it?” - totally fair question. Here is my proposed roadmap: 1/ First, let me point out that there are antiviral programs and drugs out there that people have been trying to mixed effects: e.g. Truvada, Maraviroc, Maraviroc + Statins, Valtrex, Valtrex + Celebrex, Paxlovid and various combos of these. This is NOT medical advice or urging 2/

@Gmwetz Hi Marco, what a great question. I'll start by saying that unfortunately it is hard to get drugs approved for improving mitochondrial function because it is so hard often to measure modulations in mitochondrial function in a person. There are supplemental approaches, of course 1/ @Gmwetz but many of these supplements haven't necessarily been proven to boost mitochondrial function, but they are able to boost materials that mitochondria need to make energy or reduce oxidative stress. These are supplements like NMN, NAD+, nicotinamide riboside, glutathione, 2/

Banger of a #LongCovid paper in pre-print today showing that replicating viral DNA can persist in hamsters up to 80 days after intranasal infection.

The study team were able to isolate and amplify infectious virus in 84% of experimental animals. 1/

biorxiv.org/content/10.110… This is really interesting data that, once again, provides rationale and paves the way for the need for more antiviral and monoclonal trials (and combination antiviral + monoclonal trials!). For those following the actual persistence data this is just one more study confirming 2/

After a fairly fraught week I just want to take a moment to take a moment to say that IMO violence and the taking of a human life is almost always morally wrong. However, I think there is also a message that everyone should hear: 1/ Denying healthcare to people who have paid into it for their entire lives based on arbitrary or algorithmic factors is violence. Threatening to stop covering the cost of anesthesia for a surgery if that surgery surpasses an arbitrary amount of time is violence. Making the 2/

Great week for remote monitoring studies! Proud to get this one out in pre-print as well! In the previous study we pre-printed this week, we used data from the @visible_health app to see if we could predict symptom flares (we could), this study is a 1/ researchsquare.com/article/rs-538… little more simple: we asked the users of the Visible Health (>1300 respondents) if monitoring their symptoms is helpful for disease self-management. The overwhelming response is yes - particularly for understanding and managing their energy budget. Respondents to this survey 2/

So excited to finally see this study out in pre-print! This study is the largest of its kind to date: Using data from 4,244 people with #LongCOVID, #MECFS and other complex chronic illnesses, we took hundreds of thousands of data points across hundreds of days to see if we 1/ could predict crashes using physiological and self-reported data. Turns out - yes we can. Data related to variations in HRV could predict crashes in individuals with quite good accuracy. The caveat: your data was good at predicting your patterns of crashing, but not good at 2/

I’ve been seeing some classic Monday morning quarterbacking as the necessity of #COVID19 lockdowns are being discussed once again. As usual, we’re seeing a lot of hyperbolic statements and attempts to create conversations around comparative suffering which is always just a 1/ garbage response to anything. The reality is that we had a once in a century pandemic. The virus was spreading like wildfire and we had limited options to keep the public safe. Not just from COVID but from #LongCOVID. In March and April of 2020, New York City was the epicenter 2/

Feels like a good time for a thread about all things exercise for people living with infection (and exposure)-associated complex chronic illnesses (IACCs) such as #MECFS, #LongCOVID and chronic #Lyme /tick- and vector-borne illness. Let’s start with a trip down memory lane. 🧵 1/ In the before times, many of us who treated postural orthostatic tachycardia syndrome (POTS) and dysautonomia worked with folks who did not have associated IACCs. Many of us were unaware of IACCs because it wasn’t part of our training in a substantive way and what training we 2/

I know today is a frightening day for many with #LongCOVID, #MECFS, chronic #lyme and other infection-associated chronic conditions. Today, all I can offer is a small piece of advice and a small piece of reassurance. Advice: please take care of yourselves and practice some 1/ emotional pacing today. If the election news is affecting you, avoid doom-scrolling, poking the fresh wound and take some time to quietly process the news. What’s done is done, so try to manage as best you can right now. Action can come later.
Reassurance: I’m proud of the 2/

Was swamped this week, but wanted a moment to talk about this #LongCovid work that was finally published. I’m grateful to @resiapretorius and @ArneauxK for leading this incredible work and to all the co-authors who contributed. Honored to be included.



1/thieme-connect.com/products/ejour… To start, it is important to acknowledge that endothelialitis is present in other infection-associated chronic conditions (IACCs), such as those diagnosed with pre-2020 #MECFS and chronic #lyme and other chronic tick- and vector-borne illnesses as well, so much of what is laid 2/

A deeply moving story from @thesicktimes covering the reality that @thephysicsgirl and Kyle having been living for years now since Dianna got #LongCovid. The reality of bed bound individuals with infection-associated chronic conditions is grim. While 1/

thesicktimes.org/2024/09/17/for… I will not be attending @NIH’s #RECOVER-TLC meeting next week (because I have at least 1000 ways to be actionably more productive to pw #LongCovid than to scream into that unmasked echo chamber), I sure do hope that someone brings up how badly they have failed to fund research 2/

Dangerous garbage being presented “science writing”. Two *actual* facts surrounding #COVID infection:
1. Your risk of #LongCOVID, a currently incurable chronic illness, after surviving an acute COVID infection currently sits conservatively at ~6-7%
2. Your risk of LC increases 1/

https://twitter.com/theipaper/status/1831051824452792589

with each infection.

Now, in the face of this information, there are really five (or so) types of reactions:
1. Disbelief and denial
2. Being unaware or uninformed of the risk
3. Believing appropriate caution is necessary to avoid Long COVID
4. Believing it is worth the risk 2/