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A cell phone app used in the UK has helped researchers track many of the symptoms of the syndrome known as ‘long Covid.’ Brian Garibaldi, a critical care medicine expert at Johns Hopkins, says this data provides just one part of an emerging picture.

Garibaldi: NIH has clearly identified this appropriately as an important issue to tackle, and I think we really do need these longitudinal studies to better unpack what these symptoms are because a lot of what we’re seeing are self-described symptoms like in the study that came out of the UK looking at a cell phone based app tracking symptoms and showing that up to a third of people are having symptoms 28 days later particularly if they’ve been hospitalized. Those are important data but there are limitations to how far you can take that because those are people who have self-selected to continue putting their symptoms in the app before they got Covid and after they got sick.  :30

Garibaldi says more inclusive studies including those who don’t opt in to cell phone tracking are needed, and will point the way to interventions to help. He notes that a close look at many viral illnesses reveals persistent symptoms. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Is long Covid more than one condition? Elizabeth Tracey reports

Long Covid refers to symptoms of Covid-19 infection that persist for long periods of time, and some people who report it say their symptoms resolved after they got vaccinated against the virus. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, reviews what’s known so far.

Garibaldi: By most reports right now and these are anecdotal it’s forty or fifty percent of people who are maybe getting better, and since we know that by and large people are developing immune responses to the vaccine, in those people it’s probably not a persistent low level viral infection that’s causing the problem. So I think what we’re going to find out is that long Covid, or if you want to call it post acute sequelae of Covid or PASC which is what the NIH has called it, it’s a heterogeneous disease. For some people it’s going to be predominantly neurological, for other people it’s going to be cardiovascular, others it’s going to be pulmonary, we may end up finding that these different types of long Covid are actually caused by different things.  :33

For now Garibaldi says get the vaccine, since it is recommended. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Does getting a vaccine help people who have long term symptoms after Covid-19 infection? Elizabeth Tracey reports

Some people who’ve reported long term symptoms of Covid-19 infection and have gotten a vaccine against the virus report that their symptoms resolved. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, considers why that might be so.

Garibaldi: It is possible that re-exposing someone to the antigens of the virus could somehow either reset the immune system or alter that immune response such that you no longer have prolonged inflammation. There’s also some component of people’s response to all the stressors of the pandemic, and this is not to say  that long Covid is attributable to people’s response to psychological stressors, but I think there could be some component of the symptoms that are related to that and getting a vaccine could have powerful implications for how people are coping with what’s happening around them and knowing that they’re now protected. I think the truth is we don’t know.   :30

Garibaldi notes that vaccination is recommended for those who’ve had Covid-19 so much more data is being gathered on the phenomenon. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Can monoclonal antibodies help transplant patients avoid severe Covid-19? Elizabeth Tracey reports

People who’ve received an organ transplant don’t respond effectively to Covid-19 vaccines, a study by Dorry Segev, a transplant surgeon at Johns Hopkins, and colleagues has found. Segev says there is a strategy to help, however.

Segev: In the meantime, if you’re a transplant patient and you’ve gotten vaccinated and you don’t have antibodies, if you are exposed to Covid then certainly post-exposure monoclonal antibody treatment is a very very good option, and one of my hopes is that when pre-exposure prophylaxis becomes more readily available, we’ll be able to use monoclonals for pre-exposure prophylaxis in transplant patients to buy them more time, until we reach herd immunity or otherwise figure out what’s happening immunologically.  :30

Segev says monoclonal antibodies must be administered intravenously, so if you have had a transplant and been exposed to Covid-19, get in touch with your healthcare provider as soon as possible. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: How risky is Covid-19 for transplant recipients? Elizabeth Tracey reports

People who’ve gotten organ transplants experienced more severe Covid-19 disease than many others at the beginning of the pandemic, but Dorry Segev, a transplant surgeon at Johns Hopkins, says the picture is much more optimistic today.

Segev: So far what we know is that if we treat properly we can lower the mortality risk in transplant patients down to what would be equivalent in an immunocompetent patient. At the beginning of the pandemic mortality rates in transplant patients were near forty to fifty percent. This was very very scary for transplant patients. But we’ve learned a lot. One of the things we know is that the medications that transplant patients are on to prevent rejection, also seem to prevent the immuno-inflammatory response of Covid.  :32

Segev’s recent study shows that vaccine response among transplant recipients is blunted, so he’s advocating for a third dose. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: People whose immune systems aren’t completely functional may have more Covid-19 worries, Elizabeth Tracey reports

People who’ve gotten organ transplants take medicines to keep their immune systems from rejecting the organ, and this unfortunately also dampens their response to Covid vaccinations, a study by Dorry Segev, a transplant surgeon at Johns Hopkins and colleagues has shown. Segev says there may be additional risks.

Segev: It is certainly possible that people who are immunocompromised who get the virus will shed it longer after their symptoms have resolved, than immunocompetent people. This is obviously dangerous in terms of the people they encounter, dangerous in terms of development of variants, and reemphasizes the fact that we need to protect immunosuppressed people as much as we possibly can, from getting exposed to this virus and getting infected with it.  :28

Segev notes that anyone taking steroids or other medicines that affect the immune response may also be at risk. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: People who’ve had organ transplants and been vaccinated against Covid-19 must exercise caution, Elizabeth Tracey reports

Most people who receive vaccines against Covid-19 produce robust antibody responses, clinical trials show. Not so for those who have gotten organ transplants, research by Dorry Segev, a transplant surgeon at Johns Hopkins and colleagues has shown.

Segev: This is really important because there are guidelines coming out that says if you have your vaccine you’re fine, you’re immune, you can go out you can hug your family members and your friends, you don’t need to worry about getting the virus. That is not true for transplant patients or probably not true for anybody who’s immunosuppressed. There are about half a million people living in the United States who’ve had an organ transplant and are immunosuppressed. And there are about 11 million other people who take immunosuppression for other  diseases like autoimmune diseases.  :32

Segev says that while more research is needed, anyone who is immunosuppressed needs to remain vigilant. At Johns Hopkins, I’m Elizabeth Tracey.