Long Covid, MD – Détails, épisodes et analyse

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Dr Rachel Hall-Clifford is a medical anthropologist and a global health expert who has done extensive field work to improve systemic health inequities around the world. When she developed Long Covid after an infection in 2022, those systemic failures became a personal issue.
Dr Hall-Clifford wrote a powerful article on her experience with Long Covid and the role wealthy countries play in the global treatment of this disease. In our conversation, she speaks about her personal struggles and the universal need for Long Covid treatment.

"Long Covid Feels Like a Gun to My Head"
https://www.statnews.com/2024/06/18/long-covid-infectious-disease-expert-personal-story-life-with-no-cure/

"Underbelly: Childhood Diarrhea and the Hidden Local Realities of Global Health"
https://mitpress.mit.edu/9780262547765/underbelly/

safe+natal
www.safenatal.org

Dr Hall-Clifford's TedX Talk on Co-Design in global public health: https://www.youtube.com/watch?v=rvRAdsQ1_hA

Rachel Hall-Clifford (PhD, MPH, MSc) is Associate Professor in the Center for the Study of Human Health and the Department of Sociology at Emory University. She is a medical anthropologist who applies social science approaches to global health research and implementation. Her research areas include accessible health care for marginalized populations, health systems strengthening in post-genocide contexts, and global health fieldwork ethics. She is author of the new book, Underbelly, focusing on the multivalent power asymmetries in global health.  Rachel is also Co-Founder of safe+natal, a perinatal monitoring and care toolkit developed with Guatemalan midwives. Global health was brought home in a new way for Rachel since the covid infection that led to long covid in 2022. 

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In this episode of The Medicine Cabinet series, I explain how Metformin, a drug we often associate with diabetes, helps acute covid and may help Long Covid.

Metformin is an old, relatively inexpensive medication that has many established off-label uses. I explain its mechanisms of action, who it might be right for, and I discuss the recently published COVID OUT research findings that supported metformin's use in acute infection. It reduces hospitalizations, death, and the development of Long Covid.

What does that mean for those of us who already have Long Covid? I share my opinions.

Research Links
COVID OUT metformin dose used: 500mg on Day 1, 500mg twice daily on Days 2-5 and 500mg in the AM and 1,000mg in the PM on Days 6-14

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4214027/

https://www.medrxiv.org/content/10.1101/2023.06.06.23290989v1

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(23)00299-2/fulltext#%20

https://academic.oup.com/cid/article/79/2/354/7660393?login=false

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10595158/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9111510/#:~:text=Recent%20evidence%20has%20shown%20that,has%20immunomodulatory%2C%20anti%E2%80%90inflammatory%2C

CURE-ID Database
https://cure.ncats.io/home

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In all the years I practiced medicine, I didn't know much about fatigue-related conditions. While I was in the dark, researchers like Todd Davenport, Department Chair of Physical Therapy at the University of the Pacific, shed light on how fatigue affects patients with disease and even those who are healthy. In our interview, Todd shares how he and other physical therapists approach fatigue, how he saw Long Covid coming, and how to find a physical therapist who is right for you.

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Todd E. Davenport, PT, DPT, PhD, MPH
TODD DAVENPORT is Professor and Chair in the Department of Physical Therapy at University of the Pacific in Stockton, California. He earned his bachelor’s degrees in psychology and exercise science (sports medicine) from Willamette University in Salem, Oregon, Doctor of Physical Therapy degree from the University of Southern California in Los Angeles, California, Master of Public Health degree from the University of California at Berkeley, California, and Doctor of Philosophy in Health, Exercise, and Sport Sciences from the University of Portsmouth in the United Kingdom. Dr. Davenport is a scientific advisor to the Workwell Foundation and Chair of Long Covid Physio.

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The incomparable science journalist David Tuller (https://crowdfund.berkeley.edu/project/42302) shares how he dissects and reports on medical research. He made a name for himself contesting the methods used in the PACE trial, a study that claimed to support the use of cognitive behavioral therapy (CBT) and exercise as a treatment for ME/CFS, but has now been debunked. He sees similarities between the approach to ME and now Long Covid. I ask David about the legacy of the PACE trial today, and how we can we trust what we read in scientific journals.

David is an independent science journalist and holds a fellowship at UC Berkeley Center for Global Public Health. His position is entirely funded by donations from the public. Consider supporting his work here:  https://crowdfund.berkeley.edu/project/42302

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Welcome to The Medicine Cabinet, a series of episodes where I pull out a pill bottle and explain why it might be used in Long Covid.

Today we're covering the Paxlovid and Molnupiravir, the two antivirals currently FDA approved to treat acute covid infections, and sometimes Long Covid. They are very different drugs, with very different side effect profiles...and they're not for everyone. Learn the basics on the very first episode of the The Medicine Cabinet.

What's in your medicine cabinet? What drug or supplement do you want to learn more about? Email me at LongCovidMD@gmail.com

*The contents of this podcast are for educational purposes only and do not constitute medical advice. Talk to your medical professional before starting any new treatment.*

Links:
Molnupiravir https://www.covid19treatmentguidelines.nih.gov/therapies/antivirals-including-antibody-products/molnupiravir/
Paxlovid https://www.fda.gov/media/158165/download

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Season 2 is here! It's also episode #13 so for something spooky, let's talk about getting reinfected with the virus that changed your life forever. Today I discuss how my recent reinfection felt, how reinfection affected my Long Covid symptoms, and how I responded. I'll share how antivirals work, who they work best for, and who shouldn't take them. We'll also peruse the existing literature on reinfection and Long Covid. 

How did reinfection affect you? Email me at LongCovidMD@gmail.com

Links:
https://www.fda.gov/media/158165/download
https://www.pfizer.com/science/coronavirus/severe-covid
https://www.covid19treatmentguidelines.nih.gov/therapies/antivirals-including-antibody-products/molnupiravir/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10454552/
https://www.longcovid.org/images/Documents/Reinfections_in_Long_Covid_Survey_Report_by_Long_Covid_Support_and_Long_Covid_Kids_080922.pdf

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In the final episode of Season 1 I discuss my favorite subject, anesthesiology. I explain how anesthesia works, whether it's an injection at the dentist or general anesthesia for major surgery, and discuss how your experience with anesthesia might change now that you have Long Covid. 

Expect a break in episodes while I prepare Season 2.  It's going to be bigger, bolder and even more informative. Follow me on X to stay updated.

Links
My article about Long Covid for the California Society of Anesthesiologists
https://csahq.org/2022/06/13/experiencing-long-covid-as-a-physician-and-a-patient/

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We doctors are an odd bunch, I will admit, but the medical system is even more odd. It's complicated, it's constricting, and the business of medicine infiltrates the patient-physician relationship.  Most doctors are as unhappy about this as you are. Today I explain the constraints doctors work within that directly affect your experience as a patient, and how to work within these constraints to make the most out of your doctor visits. 

Links:
Why Doctor Visits Are So Short
https://www.kevinmd.com/2014/05/10-minutes-doctor.html

Changes in Patient Outcomes Associated With Private Equity Acquisition
https://jamanetwork.com/journals/jama/article-abstract/2813379

Physician Burnout 
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2810256

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Some significant news hit the press this week, with significant backlash. Today I explain the news, the backlash, and how I stay up to date on Long Covid without getting swept up in the response. Emotions are important and require energy, so I share my step-by-step approach to processing heavy events without damaging my recovery. 

What do you think? Email comments to LongCovidMD@gmail.com

Links

Deep Phenotyping of Post-Infectious Myalgic Encephalomyelitis
https://www.nature.com/articles/s41467-024-45107-3

David Tuller, Virology Blog, Interview with Neuroscientist Michael VanElzakker
https://virology.ws/2024/02/28/trial-by-error-an-interview-with-neuroscientist-michael-vanelzakker-about-the-just-published-and-long-awaited-nih-study/

CDC Updated Covid Isolation Guidelines
https://www.cdc.gov/respiratory-viruses/background/index.html

Ashish Jha's X post
https://x.com/ashishkjha/status/1763661662739943810?s=20

Happiness Lab Podcast
https://www.pushkin.fm/podcasts/the-happiness-lab-with-dr-laurie-santos

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America hasn't found a cure or even a treatment for Long Covid. Today I explain why. It's about money, but it's more complicated than just money.

Links:
RECOVER https://recovercovid.org/
https://www.statnews.com/2023/08/09/long-covid-nih-trials/#:~:text=Among%20the%20trials%20announced%20so,along%20with%20several%20behavioral%20options.
AHRQ  https://www.ahrq.gov/coronavirus/long-covid.html
PAHPA https://aspr.hhs.gov/legal/pahpa/Pages/default.aspx

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