Unlocking the Mysteries of Long COVID

For most people, the threat of hospitalization and death from COVID-19 has plummeted since the early days of the pandemic. But the threat of long COVID – in the form of prolonged, sometimes disabling, symptoms – remains. Lekshmi Santhosh and Michael Peluso will discuss what is known about long COVID through the lens of our own experience at UCSF and ZSFG. Ziyad Al-Aly of Washington University in St. Louis has conducted pioneering studies that have demonstrated that each episode of COVID may elevate the long-term risk of heart attack, stroke, diabetes, and cognitive decline; he will join us to discuss this research and its troubling implications.

Speakers:
Lekshmi Santhosh, MD, is a pulmonary and critical care physician at UCSF Health and is the founder and Medical Director of the multidisciplinary long-COVID/post-ICU OPTIMAL Clinic at UCSF Health, which was established in May 2020. The OPTIMAL clinic served as an early role model to other institutions in establishing their own clinics and has also been featured in the popular press. Her medical education focus lies in clinical reasoning and transitions of care.

Michael Peluso, MD, is an infectious disease physician at ZSFG. Prior to COVID, his research focus was on the chronic sequelae of HIV infection. When the SARS-CoV-2 pandemic emerged, he led the efforts to implement the Long-term Impact of Infection with Novel Coronavirus (LIINC) study examining COVID’s long-term impacts on health and well-being. LIINC was one of the first post-COVID cohorts in the U.S. and now includes hundreds of individuals with and without long COVID, many of whom have been followed for more than two years. He focuses on the underlying biological mechanisms that drive long COVID and is the UCSF lead for the NIH’s RECOVER initiative.

Ziyad Al-Aly, MD, is chief of the Research and Development Service and director of the Clinical Epidemiology Center at the VA Saint Louis Health Care System, as well as a clinical epidemiologist at Washington University. He serves on the White House Intra-agency Policy Committee on Long COVID, co-chaired the Biden-Harris Administration committee that developed the U.S. Government National Research Action Plan on Long COVID and serves on the Federal Government Long COVID Coordination Council. He has had numerous publications in Nature regarding the long-term impacts of COVID.

Note: Closed captions will be available within 48-72 hours after posting.

Program:
Bob Wachter: Introduction
00:04:53-00:15:37 – Lekshmi Santhosh, MD, (pulmonary and critical care physician at UCSF, founder and Medical Director of the multidisciplinary long-COVID/post-ICU OPTIMAL Clinic at UCSF Health)
00:15:38-00:27:45 – Michael Peluso, MD, (infectious disease physician at ZSFG)
00:27:47-00:44:49 – Ziyad Al-Aly, MD, (chief of the Research and Development Service and director of the Clinical Epidemiology Center at the VA Saint Louis Health Care System, clinical epidemiologist at Washington University)
00:44:50-01:05:50 Q&A

See previous Medical Grand Rounds:

• September 29: Stem Cell Transplants and Emerging Cellular Therapies for Cancer: Challenges and Opportunities
• September 22: AI for Computational Imaging in Medicine: Promise, Pitfalls, and What's Next
• September 15: A Fireside Chat with Renowned Pandemic Expert Michael Osterholm
• June 30: America’s Epidemic of Gun Violence: The State of the Science

See all UCSF Covid-19 grand rounds, which have been viewed over 3M times, here.

[dantemawji]

Thank you all for fighting for us. After 20 months suffering LC, being dismissed by physicians, friends, family, employers, and society at large; I see a light at the end of the tunnel thanks to the work you all are doing. Not just for treatment, but simply for understanding.

[MarcSen]

Suffering severely from the Post-Covid-Condition and being a Dr. myself it is great to see that so many engaged individuals are eager to ease our pain and suffering - especially since here in Germany red tape bureaucracy slows down all kind of research. Please reach out to me if you need insights or have experimental treatments.
Heaps of thanks from Europe

[alwaysovercomingbear]

It would've been helpful if the data differentiated between UNvaccinated and vaccinated. Because of that one simple "error, " it's impossible for us to tell whether the symptoms are from covid or from the vaccine, or a combination of both. 😔

[kirbywebb]

It’s presenting exactly the same as Chronic Fatigue and Immune dysfunction syndrome that no one paid attention to.

[theresacroghan]

What the heck is going on in Boston university with development of a new strain of covid using gain of function????

[Turtledove]

Once again, this channel does not disappoint. Thank you for your attention to this critical matter and in addition, I wish Dr. Wachter's wife and all other Long Covid sufferers a full and complete recovery. We owe much to this dedicated team here and others around the world and I hope they get continued support.

[thehealthcubby]

Excellent presentation. In watching Al-Aly's segment, I'm starting to become highly concerned about the impact of multiple infections over time. I hope that subsequent studies will take this into account and I look forward to hearing more about the long-term studies underway. Thanks so much for hosting this channel and keeping us informed.

[SEASCAT]

I had been led to understand that the term long-covid also applied to people with vaccine injury who may or may not have actually ever had covid. I have a LOT of chemical sensitivities! But I did not have diagnosible measles, mumps, chicken pox when my sister and all my cousins had them. So, I chose to remain unvaccinated. I recently read that the nih was studying fibromyalgia and chronic fatique in relation to covid and that very much interests me. I suffer greatly from both fibromyalgia and chronic fatique. It would help me understand and accept vaccines if they were not created and tested by big pharma whom I do not trust at all!

[coreprime]

Short covid, long covid, two shots, three shots. Up and down and wrong way round.

[catmandont]

Sounds like "Long Covid" has the same symptoms as many other things. Are we simply relabeling old afflictions, to maximize profit and hysteria?

[ishesabi]

While watching this video, I realized how lucky the Europeans are once again. Unfortunately my English is not very good so I don't understand the video very well. But in my country (Turkey) there is not even one person talking about long covid yet. We form groups among ourselves and look for our own solution. But we are not scientists and how can we find a solution to this disease without anything? I hope you reach a conclusion as soon as possible and we can benefit from it. Thanks for all your efforts

[susanyoder]

What we see at the grassroots level is that it takes months to get into family physicians, let alone a referral to specialists, such as pulmonologists. The infrastructure seems to simply be nonexistent for thorough follow up

[catherineobrien]

I NEED HELP! Happy to show up and be tested for whatever... had surgery n was exposed at hospital. several weeks later, arrived in ER w heart issues, 3x in one month. Never ever had any such thing in my life. now cycleing through chronic fatigue, brain fog, extreme body pain, gastro intestinal issues, the list is long....
let me know what I can do

[suegriffiths]

How can you tell the difference between long covid and vaccine injury?

[martaperalta]

Thank you for describing so well the current situation, with all its uncertainties.

[ahtan]

Dear Dr. Wachter- thank you for choosing to continue to share so generously important medical knowledge with the world. Again, this was an excellent and timely grand rounds that will benefit doctors and their patients around the world. Would UCSF be open to accepting physicians as Long Covid treatment trainees?

[ccahua]

Confounding aspect: which Long COVID? - how do you get a handle on disease mechanisms from all these SARS-CoV-2 variants and sub-variants manifesting variable multi-system presentations? Pango lineage gonna cop a plea.

[marieparker]

Great video. The problem is, Covid is so very infectious, and also mutates, that it is well-nigh impossible to escape unless you are a hermit. The Chinese 'polocy' of 'We are going to have Zero Covid' looks absolutely insane.

[kadirmullings]

Did i miss it or they did not offer any options for treatment?

[jeffreyastor]

What a fascinating multiplicity of industries & “studies” this “flash-in the pan-demic” has created : its time The Simpsons script-writers got to work on this for a new episode-……just imagine the field -day they could have with all of this new material …..it could run& run …..for years.