1 00:00:01,080 --> 00:00:02,880 Speaker 1: The part about my job that I love the most 2 00:00:03,000 --> 00:00:07,400 Speaker 1: is talking to patients, spending time with them, explaining answering 3 00:00:07,400 --> 00:00:11,160 Speaker 1: their questions on more of a human level than sometimes 4 00:00:11,760 --> 00:00:14,760 Speaker 1: um that you would get in a busy hospital. Alex 5 00:00:14,840 --> 00:00:17,959 Speaker 1: McCutcheon says she went into medicine because she wanted to 6 00:00:17,960 --> 00:00:20,599 Speaker 1: help people. One of my friends had told me, I 7 00:00:20,640 --> 00:00:24,000 Speaker 1: think you'd be a really good obstetrician. Alex lives in Darwin, 8 00:00:24,120 --> 00:00:27,480 Speaker 1: in Australia's Northern Territory. When she was in high school 9 00:00:27,480 --> 00:00:31,000 Speaker 1: in suburban Melbourne, Alex looked into becoming a midwife, and 10 00:00:31,080 --> 00:00:35,120 Speaker 1: at a career spare, she watched instructors explain the childbirth process. 11 00:00:35,920 --> 00:00:38,080 Speaker 1: It got to a point during a simulation of an 12 00:00:38,200 --> 00:00:41,080 Speaker 1: obstetric patient that they said, all right, now this is 13 00:00:41,080 --> 00:00:43,000 Speaker 1: where we stop. We'll have to go and get the doctor. 14 00:00:43,880 --> 00:00:45,840 Speaker 1: You'd have to go and get the obstetrician. And I said, 15 00:00:46,000 --> 00:00:49,360 Speaker 1: how what what about that? What can I do that? 16 00:00:49,400 --> 00:00:51,240 Speaker 1: And they said, oh, you'd have to go to medical school. 17 00:00:51,760 --> 00:00:56,720 Speaker 1: So I went to medical school. Last forward to early 18 00:00:57,720 --> 00:01:00,920 Speaker 1: Alex's entering her second year working as a fully qualified 19 00:01:00,960 --> 00:01:03,960 Speaker 1: doctor when she hears news of a novel coronavirus emerging 20 00:01:03,960 --> 00:01:07,080 Speaker 1: in China. The first place I heard about it when 21 00:01:07,480 --> 00:01:12,040 Speaker 1: it was when I was in Argentina in January and 22 00:01:12,560 --> 00:01:14,960 Speaker 1: the person that I was backpacking with he said, oh, 23 00:01:15,000 --> 00:01:18,560 Speaker 1: have you heard about this coronavirus? And from from a 24 00:01:18,600 --> 00:01:21,279 Speaker 1: science background, I just thought, what are you talking about? 25 00:01:21,959 --> 00:01:25,320 Speaker 1: What coronavirus? They're they're a family of viruses, which particular 26 00:01:25,360 --> 00:01:28,680 Speaker 1: one are you talking about? And then it just snowballed 27 00:01:28,720 --> 00:01:33,679 Speaker 1: from there. Patients are already coming to the Metropolitan Hospital 28 00:01:33,800 --> 00:01:36,600 Speaker 1: with the disease by the time Alex gets back to Melbourne. 29 00:01:36,640 --> 00:01:39,279 Speaker 1: Because you'd see young patients come in who were COVID 30 00:01:39,280 --> 00:01:43,360 Speaker 1: positive and you can't help but think this could be me, 31 00:01:43,520 --> 00:01:45,039 Speaker 1: or this could be a friend of mine, or this 32 00:01:45,080 --> 00:01:48,320 Speaker 1: could be a family member. So it was it was 33 00:01:48,360 --> 00:01:53,240 Speaker 1: a scary time to work. A few months later, cases 34 00:01:53,320 --> 00:01:56,640 Speaker 1: are escalating and Alex is working on a general medical 35 00:01:56,640 --> 00:02:00,280 Speaker 1: award when she starts feeling off. I was doing run 36 00:02:00,320 --> 00:02:02,080 Speaker 1: of seven nights in a row and I was on 37 00:02:02,160 --> 00:02:05,560 Speaker 1: my seventh night and it was about two am and 38 00:02:05,600 --> 00:02:07,680 Speaker 1: I was walking around the wards thinking, oh, I'm a 39 00:02:07,680 --> 00:02:11,440 Speaker 1: bit short of breath. I shouldn't be. I my heart 40 00:02:11,480 --> 00:02:14,040 Speaker 1: rate didn't drop below a hundred so I thought, maybe 41 00:02:14,120 --> 00:02:16,640 Speaker 1: something's up here, and I've been treating a lot of 42 00:02:16,639 --> 00:02:21,600 Speaker 1: positive patients throughout the week um and towards the end 43 00:02:21,600 --> 00:02:23,880 Speaker 1: of the shift, I got really sore all over my body. 44 00:02:23,919 --> 00:02:27,840 Speaker 1: I couldn't really ignore those symptoms, so I went straight 45 00:02:27,840 --> 00:02:32,799 Speaker 1: away to go and get tested. The test comes back positive, 46 00:02:33,240 --> 00:02:37,400 Speaker 1: so Alex goes to a hotel. Australia uses hotels as 47 00:02:37,480 --> 00:02:40,280 Speaker 1: quarantine centers to try to prevent the coronavirus spreading in 48 00:02:40,280 --> 00:02:44,120 Speaker 1: the community. About a week into her infection, Alex gets 49 00:02:44,120 --> 00:02:46,520 Speaker 1: a running nose and cough, and then a few days 50 00:02:46,639 --> 00:02:49,760 Speaker 1: later she completely loses her sense of smell and taste. 51 00:02:50,400 --> 00:02:54,760 Speaker 1: I remember having a green curry delivered to my hotel quarantine, 52 00:02:55,240 --> 00:02:58,880 Speaker 1: and I filmed myself putting my face right up against it, 53 00:02:59,000 --> 00:03:02,239 Speaker 1: and I couldn't not smell a single thing. I could 54 00:03:02,280 --> 00:03:04,680 Speaker 1: taste that it was hot, and I could taste that 55 00:03:04,720 --> 00:03:07,600 Speaker 1: it had some texture, but beyond that, I could not 56 00:03:07,680 --> 00:03:10,480 Speaker 1: taste a single thing. And I also put my head 57 00:03:10,480 --> 00:03:15,600 Speaker 1: in a coffee bag and that smelt nothing. It's a 58 00:03:15,639 --> 00:03:18,520 Speaker 1: lot of weird videos that came out of COVID quarantine. 59 00:03:19,880 --> 00:03:24,120 Speaker 1: Alex is eventually clear to leave quarantine, but her distorted 60 00:03:24,120 --> 00:03:27,480 Speaker 1: sense of smell and taste persist. More than a year later, 61 00:03:27,800 --> 00:03:32,320 Speaker 1: She's still suffering the consequences of catching COVID nineteen. It's 62 00:03:32,400 --> 00:03:36,520 Speaker 1: unclear how long her symptoms will last, but Alex isn't 63 00:03:36,520 --> 00:03:39,080 Speaker 1: alone and being plagued by the effects of the coronavirus 64 00:03:39,400 --> 00:03:42,320 Speaker 1: long past her recovery from the initial stages of the illness. 65 00:03:43,160 --> 00:03:46,400 Speaker 1: There haven't been any studies published yet estimating the global 66 00:03:46,440 --> 00:03:49,800 Speaker 1: prevalence of patients like Alex, but at least one inten 67 00:03:49,920 --> 00:03:53,720 Speaker 1: COVID patients have symptoms six months later, so the number 68 00:03:53,760 --> 00:03:56,680 Speaker 1: of these so called long haulers could run well into 69 00:03:56,760 --> 00:04:00,560 Speaker 1: the millions, if not tens of millions, well t wide. 70 00:04:01,720 --> 00:04:05,640 Speaker 1: Once Alex loses her sense of smell, she knows exactly 71 00:04:05,680 --> 00:04:08,800 Speaker 1: who to contact. It's been a very, very fruitful friendship. 72 00:04:08,880 --> 00:04:11,680 Speaker 1: And then, obviously, when I got the very sad news 73 00:04:11,720 --> 00:04:15,200 Speaker 1: that Alex was diagnosed with COVID, she Facebook message me. 74 00:04:15,280 --> 00:04:17,159 Speaker 1: I think the message said a bit of fun news, 75 00:04:17,279 --> 00:04:20,720 Speaker 1: I have COVID, you said it'll be right. That's Dr 76 00:04:20,800 --> 00:04:25,280 Speaker 1: lea Bencham. She's a neuroscientist who studies smell. Alex and 77 00:04:25,400 --> 00:04:27,880 Speaker 1: Lee are best friends. They've known each other for more 78 00:04:27,920 --> 00:04:32,039 Speaker 1: than a decade inside, I was panicking um and then 79 00:04:32,120 --> 00:04:35,160 Speaker 1: I asked her if she could smell, and she said, well, 80 00:04:35,160 --> 00:04:37,920 Speaker 1: I can't taste. And then I actually sent her an 81 00:04:37,920 --> 00:04:40,400 Speaker 1: olfactory kit in the in the hotel because I worked 82 00:04:40,400 --> 00:04:42,200 Speaker 1: with those a lot, and I quantified her sense of 83 00:04:42,240 --> 00:04:46,479 Speaker 1: smell and she did or abysmally. I spoke with Leah 84 00:04:46,520 --> 00:04:48,359 Speaker 1: and Alex at the same time in a studio at 85 00:04:48,360 --> 00:04:51,440 Speaker 1: the University of Melbourne where they both studied. Alex and 86 00:04:51,640 --> 00:04:54,479 Speaker 1: returned for a short visit. This is the story of 87 00:04:54,520 --> 00:04:57,360 Speaker 1: two friends, two doctors in fact, who were trying to 88 00:04:57,440 --> 00:05:00,360 Speaker 1: understand one of the most common signs of COVID night team. 89 00:05:01,000 --> 00:05:03,160 Speaker 1: The loss of the sense of smell or old faction, 90 00:05:03,400 --> 00:05:05,839 Speaker 1: affects almost one and every two people who get the 91 00:05:05,880 --> 00:05:09,520 Speaker 1: pandemic disease. Usually it resolves within a week or two. 92 00:05:10,120 --> 00:05:14,600 Speaker 1: For some, like Alex, smell and taste distortions persist, leaving 93 00:05:14,800 --> 00:05:18,279 Speaker 1: an invisible illness that leads to a profound disruption to 94 00:05:18,320 --> 00:05:21,560 Speaker 1: their daily life that affects their mood and relationships. But 95 00:05:21,680 --> 00:05:25,760 Speaker 1: scientists are learning that its significance doesn't end there. This 96 00:05:25,920 --> 00:05:28,400 Speaker 1: is also a story about living with a mysterious condition 97 00:05:28,800 --> 00:05:32,640 Speaker 1: that may have a lasting impact on health. Evidence is 98 00:05:32,680 --> 00:05:36,560 Speaker 1: emerging that COVID survivors like Alex could face even worse 99 00:05:36,640 --> 00:05:41,359 Speaker 1: neurological issues later in life. I'm Jason Galas, Senior Editor 100 00:05:41,640 --> 00:05:44,920 Speaker 1: and Chief by a security correspondent at Bloomberg News. From 101 00:05:44,920 --> 00:06:11,800 Speaker 1: the Prognosis podcast. This is breakthrough Lea and Alex meant 102 00:06:12,000 --> 00:06:15,719 Speaker 1: just before beginning their first year at university. We were 103 00:06:15,839 --> 00:06:19,280 Speaker 1: in a car on the way to an orientation camp 104 00:06:20,000 --> 00:06:25,040 Speaker 1: and we met in the backseat and may have shared 105 00:06:25,160 --> 00:06:30,520 Speaker 1: a bag of coon and we have been really good 106 00:06:30,560 --> 00:06:35,320 Speaker 1: friends ever since. First friends. Goon listeners is an australianism 107 00:06:35,320 --> 00:06:37,680 Speaker 1: that refers to wine that's sold in a plastic bag 108 00:06:37,760 --> 00:06:41,400 Speaker 1: inside a cardboard box. After that, Lea and Alex stay 109 00:06:41,440 --> 00:06:45,839 Speaker 1: close throughout undergrad and then Alex popped off to do 110 00:06:45,880 --> 00:06:50,159 Speaker 1: postgraduate medicine and I popped off to do postgraduate biomedical science. 111 00:06:50,560 --> 00:06:53,680 Speaker 1: We lived together during our postgraduate years. Odship is just 112 00:06:53,720 --> 00:06:58,440 Speaker 1: a tipping balance between beer and science. Really. Leahel works 113 00:06:58,440 --> 00:07:01,640 Speaker 1: at the University of Melbourne's floor Re Institute of Neuroscience 114 00:07:01,640 --> 00:07:05,000 Speaker 1: and Mental Health. It's one of the world's largest brain 115 00:07:05,080 --> 00:07:09,039 Speaker 1: research centers. After Leah gets the message about Alex's positive 116 00:07:09,080 --> 00:07:12,040 Speaker 1: COVID tests. She says she wants to see how badly 117 00:07:12,080 --> 00:07:15,240 Speaker 1: Alex has lost a sense of smell. Scientists have a 118 00:07:15,360 --> 00:07:18,920 Speaker 1: standardized way of testing one's ability to detect sense and odors. 119 00:07:19,480 --> 00:07:22,520 Speaker 1: It's a type of scratch and sniff test. It requires 120 00:07:22,600 --> 00:07:25,680 Speaker 1: users to smell odorant molecules from separate panels in a 121 00:07:25,720 --> 00:07:29,000 Speaker 1: series of booklets and then indicate which of four multiple 122 00:07:29,080 --> 00:07:33,320 Speaker 1: choice answers best characterizes each smell. Users get a grad 123 00:07:33,360 --> 00:07:39,440 Speaker 1: out of forty. Alex failed spectacularly. A nosmere and dyscousia 124 00:07:39,680 --> 00:07:42,360 Speaker 1: are terms doctors used to describe a loss or impaired 125 00:07:42,400 --> 00:07:45,880 Speaker 1: sense of smell and taste. People sometimes lose these senses 126 00:07:45,960 --> 00:07:49,800 Speaker 1: in the early stages of Parkinson's and Alzheimer's diseases, but 127 00:07:49,920 --> 00:07:55,560 Speaker 1: short term losses occur more frequently with upper respiratory tract infections. COVID, though, 128 00:07:55,640 --> 00:07:59,800 Speaker 1: has added another dimension. Leah says, we don't really know 129 00:08:00,000 --> 00:08:03,200 Speaker 1: why the coronavirus results in longer term effects on smell 130 00:08:03,240 --> 00:08:07,000 Speaker 1: and taste. Initially it was thought to be because of inflammation, 131 00:08:07,280 --> 00:08:09,440 Speaker 1: like the block nose you gave with a cold. I 132 00:08:09,480 --> 00:08:12,080 Speaker 1: think it was a symptom that was ignored because It 133 00:08:12,120 --> 00:08:13,840 Speaker 1: was very much thought of you've got a block nose. 134 00:08:13,880 --> 00:08:16,080 Speaker 1: Of course you've lost your sense of smell. But then 135 00:08:16,120 --> 00:08:18,280 Speaker 1: more and more data was coming out about people who 136 00:08:18,360 --> 00:08:22,280 Speaker 1: had no other symptoms, that only symptom was a loss 137 00:08:22,320 --> 00:08:24,040 Speaker 1: of spell. They had hyperson out, they didn't even have 138 00:08:24,080 --> 00:08:26,880 Speaker 1: a running nose, and we started looking at that data 139 00:08:26,920 --> 00:08:29,920 Speaker 1: and thinking there was there was more to it. There 140 00:08:30,000 --> 00:08:33,040 Speaker 1: was also the belief that any lost sense of smell 141 00:08:33,160 --> 00:08:36,520 Speaker 1: would be recovered within a month. It turns out that 142 00:08:36,679 --> 00:08:40,120 Speaker 1: was based more on optimism than evidence. A study in 143 00:08:40,160 --> 00:08:42,880 Speaker 1: the Journal of Internal Medicine and January found almost a 144 00:08:42,960 --> 00:08:46,240 Speaker 1: quarter of sufferers hadn't recovered that sense of smell after 145 00:08:46,360 --> 00:08:50,520 Speaker 1: two months, and by six months five were still living 146 00:08:50,559 --> 00:08:54,920 Speaker 1: with the derangement. And we have no idea why. What 147 00:08:55,040 --> 00:08:57,760 Speaker 1: we do know is that the coronavirus targets are protein 148 00:08:57,840 --> 00:09:01,240 Speaker 1: on the surface of cells that lie the airways from 149 00:09:01,280 --> 00:09:04,640 Speaker 1: the nose to the furthest reaches of the lungs inside 150 00:09:04,640 --> 00:09:08,280 Speaker 1: the nasal cavity. The cells the coronavirus targets are right 151 00:09:08,320 --> 00:09:10,679 Speaker 1: alongside the nerves that tell the brain what odors are 152 00:09:10,720 --> 00:09:14,679 Speaker 1: being detected. Leah says it makes the nose a particularly 153 00:09:14,840 --> 00:09:18,000 Speaker 1: interesting part of the body to study. This area of 154 00:09:18,000 --> 00:09:20,520 Speaker 1: the nose is fascinating. It's one of the reasons I 155 00:09:20,559 --> 00:09:25,160 Speaker 1: got into olfactory science in that there are brain cells 156 00:09:25,200 --> 00:09:27,720 Speaker 1: that project down into that region. So it's actually an 157 00:09:27,760 --> 00:09:30,280 Speaker 1: area of your body where your central nervous system is 158 00:09:30,320 --> 00:09:34,520 Speaker 1: exposed to the environment, and that makes that region particularly vulnerable. 159 00:09:35,440 --> 00:09:38,160 Speaker 1: These nerve cells protrude the bone in the skull that 160 00:09:38,240 --> 00:09:41,480 Speaker 1: separates the nasal cavity from the brain. The bone is 161 00:09:41,600 --> 00:09:45,679 Speaker 1: perforated like Swiss cheese. Some scientists contend that the loss 162 00:09:45,720 --> 00:09:49,000 Speaker 1: of smell and COVID patients results from the virus infecting 163 00:09:49,040 --> 00:09:53,199 Speaker 1: the nose and causing inflammation there that subsequently damages these 164 00:09:53,240 --> 00:09:56,760 Speaker 1: olfactory neurons or nerve cells, but that doesn't really hold 165 00:09:56,840 --> 00:09:59,160 Speaker 1: up when you're talking about a year down the track, 166 00:09:59,240 --> 00:10:02,600 Speaker 1: there shouldn't be any more of this acute inflammation. Leah 167 00:10:02,600 --> 00:10:06,200 Speaker 1: has some other theories. So one is that because of 168 00:10:06,240 --> 00:10:09,520 Speaker 1: these neurons that project into the nose directly from the brain, 169 00:10:09,760 --> 00:10:11,920 Speaker 1: the virus is actually able to get into those neurons 170 00:10:11,920 --> 00:10:14,760 Speaker 1: and it's able to get into your brain, therefore causing 171 00:10:14,840 --> 00:10:17,400 Speaker 1: damage because you have viral particles in your brain. That's 172 00:10:17,400 --> 00:10:20,679 Speaker 1: one hypothesis. The other is that it's not able to 173 00:10:20,720 --> 00:10:22,960 Speaker 1: get into your brain, but it can get close enough 174 00:10:23,000 --> 00:10:26,080 Speaker 1: to those neurons that it can trigger an inflammatory response. 175 00:10:27,280 --> 00:10:30,280 Speaker 1: Lea says that from there, the inflammatory response can cause 176 00:10:30,320 --> 00:10:37,680 Speaker 1: a reaction that still harms the brain. Some scientists have 177 00:10:37,760 --> 00:10:40,439 Speaker 1: published research showing that the virus can get into the brain. 178 00:10:41,040 --> 00:10:45,720 Speaker 1: Others have published research showing that it can't. Intriguingly, scientists 179 00:10:45,720 --> 00:10:48,840 Speaker 1: at the past Institute in Paris describe finding the sanskvt 180 00:10:49,000 --> 00:10:51,240 Speaker 1: virus in the cells that line the roof of the 181 00:10:51,320 --> 00:10:54,160 Speaker 1: nasal cavity in a half a dozen patients who lost 182 00:10:54,200 --> 00:10:57,319 Speaker 1: their sense of smell for months. I spoke with Dr 183 00:10:57,480 --> 00:11:01,240 Speaker 1: p M Marie Leto, neuroscientists who led the study, which 184 00:11:01,280 --> 00:11:04,920 Speaker 1: was published in Science Translational Medicine back in June, and 185 00:11:05,080 --> 00:11:08,760 Speaker 1: one of our surprise came when we find in fact 186 00:11:09,080 --> 00:11:13,120 Speaker 1: that for all of them, we could find the presence 187 00:11:13,160 --> 00:11:18,000 Speaker 1: of the viruses in the sensory organs, explaining why those 188 00:11:18,120 --> 00:11:23,640 Speaker 1: people were impaired in recovering this sense, which was very 189 00:11:23,760 --> 00:11:28,680 Speaker 1: surprising for us because several publications at least report that 190 00:11:28,840 --> 00:11:33,640 Speaker 1: old factory censory neurons located in the old factory organ 191 00:11:33,880 --> 00:11:37,840 Speaker 1: where those centory neurons were not expressing the receptor for 192 00:11:37,920 --> 00:11:41,119 Speaker 1: the for the various is therefore they should not be infected. 193 00:11:41,880 --> 00:11:45,080 Speaker 1: The French scientists found protein made by the coronavirus as 194 00:11:45,080 --> 00:11:48,280 Speaker 1: well as antibodies against it, but they weren't able to 195 00:11:48,320 --> 00:11:51,880 Speaker 1: demonstrate that TASKOV two can replicate in the sensory organ 196 00:11:52,480 --> 00:11:55,520 Speaker 1: It's something P. M. Marie is still exploring because if 197 00:11:55,520 --> 00:11:59,319 Speaker 1: they're still viable or infectious virus particles there, that could 198 00:11:59,320 --> 00:12:04,080 Speaker 1: have consequent answers for transmission. If with dealing with replicative 199 00:12:04,160 --> 00:12:09,320 Speaker 1: viruses in the Austrila, those people might be contagious by 200 00:12:09,320 --> 00:12:13,880 Speaker 1: by just breathing, they will be spreading the viruses around them. 201 00:12:13,960 --> 00:12:16,400 Speaker 1: So it's it's a it's a question that we are 202 00:12:16,440 --> 00:12:21,640 Speaker 1: now following by recruiting more and more people brooding chronicling 203 00:12:21,679 --> 00:12:24,960 Speaker 1: their old factions in order to address this question. So 204 00:12:25,000 --> 00:12:32,000 Speaker 1: this is under investigation. Lea says there's no agreement among 205 00:12:32,040 --> 00:12:34,719 Speaker 1: scientists about whether the virus is able to persist in 206 00:12:34,760 --> 00:12:38,080 Speaker 1: the body, much less the nostrils. I think it's a 207 00:12:38,120 --> 00:12:41,640 Speaker 1: good theory, though. Lea says it fits with another theory 208 00:12:41,679 --> 00:12:45,359 Speaker 1: that scientists have mentioned several times in our earlier episodes 209 00:12:45,679 --> 00:12:50,520 Speaker 1: that involves the consequences of immunization against the coronavirus. There's 210 00:12:50,520 --> 00:12:53,240 Speaker 1: anecdotal evidence. None of this is published because it's very 211 00:12:53,240 --> 00:12:55,200 Speaker 1: hard to quantify, but people have come out and said 212 00:12:55,200 --> 00:12:59,400 Speaker 1: that after they've been vaccinated, they feel the symptoms of 213 00:12:59,440 --> 00:13:02,840 Speaker 1: long covid getting better. They are not necessarily fully recovering, 214 00:13:03,120 --> 00:13:05,480 Speaker 1: and some people notice nothing. Some people feel like they're 215 00:13:05,480 --> 00:13:06,880 Speaker 1: a bit worse. But there are a large number of 216 00:13:06,880 --> 00:13:09,760 Speaker 1: peabloo say I can actually smell a little bit better 217 00:13:09,800 --> 00:13:12,920 Speaker 1: two weeks after the vaccinated, and that really lends itself 218 00:13:12,960 --> 00:13:17,120 Speaker 1: to this reservoir hypothesis, because maybe your immune system wasn't 219 00:13:17,160 --> 00:13:20,160 Speaker 1: able to clear that last little bit virus that's sitting 220 00:13:20,280 --> 00:13:24,360 Speaker 1: in your ethelial cells, but a vaccine, which is a 221 00:13:24,440 --> 00:13:27,560 Speaker 1: much sort of more direct approach at boosting the immune system, 222 00:13:27,720 --> 00:13:30,120 Speaker 1: was able to clear it. So I think it's definitely 223 00:13:30,160 --> 00:13:32,880 Speaker 1: got legs, but I think it's very early on um 224 00:13:32,960 --> 00:13:35,320 Speaker 1: and we need many more studies to replicate it for 225 00:13:35,400 --> 00:13:39,840 Speaker 1: us to say this is actually what's happening. There's still 226 00:13:39,880 --> 00:13:42,400 Speaker 1: a lot of questions around how long COVID causes us 227 00:13:42,440 --> 00:13:46,120 Speaker 1: to lose some of our senses. While scientists are accumulating 228 00:13:46,160 --> 00:13:49,800 Speaker 1: evidence about the virus and its long term impacts on 229 00:13:49,920 --> 00:14:03,800 Speaker 1: biological processes such as aging. There's been a lot of 230 00:14:03,840 --> 00:14:06,840 Speaker 1: research published documenting the ways in which the brain is 231 00:14:06,920 --> 00:14:12,240 Speaker 1: damaged following a saskvy to infection. There's inflammation, blood clots, 232 00:14:12,280 --> 00:14:15,880 Speaker 1: and hemorrhages, not to mention respiratory failure that can cut 233 00:14:15,920 --> 00:14:20,040 Speaker 1: off oxygen supply. But another aspect of COVID has surprise 234 00:14:20,080 --> 00:14:24,880 Speaker 1: researchers in recent months, the loss of brain tissue. That's right, 235 00:14:25,280 --> 00:14:30,080 Speaker 1: COVID is associated with brain shrinkage. A study in June 236 00:14:30,080 --> 00:14:32,320 Speaker 1: from the University of Oxford, released a head of peer 237 00:14:32,320 --> 00:14:35,960 Speaker 1: review and publication, found gray amount of deficits were more 238 00:14:36,080 --> 00:14:38,840 Speaker 1: likely in patients who had had COVID than those who 239 00:14:38,840 --> 00:14:42,320 Speaker 1: were never infected with the coronavirus. It was a unique 240 00:14:42,320 --> 00:14:45,240 Speaker 1: study that used medical records and brain scans from patients 241 00:14:45,280 --> 00:14:49,120 Speaker 1: taken before the pandemic. The researchers then invited hundreds of 242 00:14:49,120 --> 00:14:51,240 Speaker 1: these patients back for another round of m r I 243 00:14:51,360 --> 00:14:55,040 Speaker 1: brain imaging. There were marked differences between those who have 244 00:14:55,120 --> 00:14:58,040 Speaker 1: been infected with COVID nineteen and those who had not 245 00:14:58,240 --> 00:15:00,680 Speaker 1: in terms of gray manner, which is made up of 246 00:15:00,680 --> 00:15:03,520 Speaker 1: the seal bodies of neurons that process information in the brain. 247 00:15:04,320 --> 00:15:07,280 Speaker 1: More interesting still, there was a loss of brain volume 248 00:15:07,440 --> 00:15:10,840 Speaker 1: even in COVID patients not sick enough to require hospitalization. 249 00:15:11,680 --> 00:15:14,640 Speaker 1: The findings haven't been published in a scientific journal, but 250 00:15:14,760 --> 00:15:18,080 Speaker 1: Leah says the study offers important insights into what might 251 00:15:18,120 --> 00:15:21,520 Speaker 1: be going on inside the brains of long haulers. This 252 00:15:21,600 --> 00:15:24,000 Speaker 1: is probably one of the most impressive papers that I've 253 00:15:24,040 --> 00:15:27,680 Speaker 1: ever read. It is, and what they've shown is that 254 00:15:29,400 --> 00:15:32,400 Speaker 1: quite scarily, actually there's there's a loss of gray matter 255 00:15:32,680 --> 00:15:35,360 Speaker 1: in a number of regions of the brain. Most of 256 00:15:35,400 --> 00:15:41,479 Speaker 1: them are related to olfactory and gustatory pathways, which explains 257 00:15:41,640 --> 00:15:45,080 Speaker 1: why potentially many people are not recovering their sen's a 258 00:15:45,120 --> 00:15:47,040 Speaker 1: smell or even if they have recovered it, it's not 259 00:15:47,080 --> 00:15:50,520 Speaker 1: fully recovered um because you've actually you've you've actually lost 260 00:15:50,800 --> 00:15:55,280 Speaker 1: brain tissue in those regions. And there's also some indications 261 00:15:55,280 --> 00:15:59,280 Speaker 1: that the limbic region might be involved. Lea says that 262 00:15:59,360 --> 00:16:01,760 Speaker 1: the part of the sing that COVID appears to shrink 263 00:16:01,920 --> 00:16:07,000 Speaker 1: affects mood regulation. This might explain why anxiety, depression, and 264 00:16:07,120 --> 00:16:10,920 Speaker 1: brain fog are common symptoms of long COVID. We're seeing 265 00:16:11,360 --> 00:16:13,880 Speaker 1: huge numbers of anxiety above and beyond what we would 266 00:16:13,880 --> 00:16:17,320 Speaker 1: have expected in long COVID. But it's not just that 267 00:16:17,400 --> 00:16:21,280 Speaker 1: COVID can affect mood. Scientists predict that it will also 268 00:16:21,320 --> 00:16:26,040 Speaker 1: be associated with longer term neurological problems like dementia. Lea 269 00:16:26,080 --> 00:16:29,840 Speaker 1: says inflammation caused by COVID essentially primes the brain for 270 00:16:29,920 --> 00:16:33,880 Speaker 1: further injury down the road. And once your brain is primed, 271 00:16:33,880 --> 00:16:36,760 Speaker 1: if you get another hit later in life, like another 272 00:16:36,880 --> 00:16:40,160 Speaker 1: severe virus, viral infection that gets into your brain, or 273 00:16:40,720 --> 00:16:43,760 Speaker 1: you're exposed to a toxin, you're closer to the edge 274 00:16:43,760 --> 00:16:46,240 Speaker 1: because your brain is primed and it's ready to overfire. 275 00:16:46,360 --> 00:16:48,640 Speaker 1: And when it does that and the new inflammation takes hold, 276 00:16:48,760 --> 00:16:52,000 Speaker 1: it's going to kill cells faster. So we're talking here 277 00:16:52,040 --> 00:16:55,160 Speaker 1: about not COVID causing any of these diseases, but it's 278 00:16:55,200 --> 00:16:56,800 Speaker 1: just an increased risk factor that we need to be 279 00:16:56,840 --> 00:16:59,320 Speaker 1: aware of that a very large population of the world 280 00:16:59,400 --> 00:17:04,080 Speaker 1: has now had. Leah says that because COVID affects so 281 00:17:04,119 --> 00:17:07,160 Speaker 1: many different parts of the brain and its functions like memory, 282 00:17:07,560 --> 00:17:12,920 Speaker 1: it could predispose degenerative diseases such as Alzheimer's. She's particularly 283 00:17:12,960 --> 00:17:16,399 Speaker 1: concerned about what this could mean for Parkinson's disease too. 284 00:17:17,040 --> 00:17:20,000 Speaker 1: It's a disorder of the central nervous system that affects movement. 285 00:17:20,560 --> 00:17:23,840 Speaker 1: About ten million people worldwide have the condition, and the 286 00:17:23,920 --> 00:17:26,680 Speaker 1: number is growing, in part because age is a major 287 00:17:26,800 --> 00:17:30,439 Speaker 1: risk factor and humans are living longer. So at the 288 00:17:30,440 --> 00:17:33,480 Speaker 1: moment we're actually living through a Parkinson's pandemic. It's doubled 289 00:17:33,520 --> 00:17:35,440 Speaker 1: in the last twenty years our incidents, and it's set 290 00:17:35,480 --> 00:17:37,480 Speaker 1: to double again, and that's after we correct for the 291 00:17:37,520 --> 00:17:41,320 Speaker 1: aging population. Now that we've just added covid in, there's 292 00:17:41,320 --> 00:17:43,760 Speaker 1: a chance that we have just even the slightest shift 293 00:17:43,880 --> 00:17:47,920 Speaker 1: of people more likely to get Parkinson's that could push 294 00:17:48,000 --> 00:17:51,199 Speaker 1: us into numbers that we can't cope with. Parkinson's is 295 00:17:51,200 --> 00:17:53,679 Speaker 1: a very long disease. It's a very expensive disease. We 296 00:17:53,760 --> 00:17:56,000 Speaker 1: don't have disease modifying drugs or we can do is 297 00:17:56,000 --> 00:17:58,760 Speaker 1: help you symptomatically for a few years until that stops working. 298 00:17:59,600 --> 00:18:02,400 Speaker 1: It's really scary and we need to be really vigilant. 299 00:18:03,080 --> 00:18:05,919 Speaker 1: There was a surge in cases of Parkinson's disease in 300 00:18:05,920 --> 00:18:11,160 Speaker 1: the decades following the nineteen eighteen Spanish influenza pandemic. Epidemiologists 301 00:18:11,160 --> 00:18:14,119 Speaker 1: determined that Spanish flu survivors had a two to three 302 00:18:14,119 --> 00:18:18,560 Speaker 1: times higher risk of developing Parkinson's now term viral parkinson 303 00:18:18,680 --> 00:18:21,480 Speaker 1: Is UM compared with those who didn't get the deadly 304 00:18:21,520 --> 00:18:25,000 Speaker 1: flu strain. If a similar effect were to occur in 305 00:18:25,000 --> 00:18:28,920 Speaker 1: the wake of COVID, Leah says EQUOD cripple health systems. 306 00:18:30,240 --> 00:18:33,879 Speaker 1: There's warning bells, and where we're trying to listen to 307 00:18:33,920 --> 00:18:35,639 Speaker 1: those warning bells, I think because we don't want to 308 00:18:35,680 --> 00:18:39,040 Speaker 1: be caught off guard and our community itself. Would you know, 309 00:18:39,119 --> 00:18:41,080 Speaker 1: most people who are diagnosed with Parkinson's are still of 310 00:18:41,160 --> 00:18:44,880 Speaker 1: working age. We can't lose that workforce loss, so there's 311 00:18:44,880 --> 00:18:46,720 Speaker 1: an economic side to it as well. We need to 312 00:18:46,760 --> 00:18:48,960 Speaker 1: be really prepared and the only way we're going to 313 00:18:49,040 --> 00:18:51,600 Speaker 1: do that is to keep studying it and preparing as best. Weekend, 314 00:18:57,400 --> 00:18:59,720 Speaker 1: as we sit in the studio in Melbourne, Lea in 315 00:18:59,760 --> 00:19:03,440 Speaker 1: our sitting side by side, Alex knows that when Lea 316 00:19:03,520 --> 00:19:07,040 Speaker 1: talks about the future risks around long COVID, she's talking 317 00:19:07,080 --> 00:19:10,480 Speaker 1: about pretty frightening things that she could face one day. 318 00:19:11,000 --> 00:19:14,240 Speaker 1: It's a bit hard to listen to. I have known 319 00:19:14,320 --> 00:19:16,080 Speaker 1: Lea for a very long time and She's been very 320 00:19:16,080 --> 00:19:19,240 Speaker 1: frank and honest with me about the research and the 321 00:19:19,240 --> 00:19:23,240 Speaker 1: places that this could go. That's why I think research 322 00:19:23,440 --> 00:19:27,480 Speaker 1: likely is is so amazing that we can be putting 323 00:19:27,520 --> 00:19:32,280 Speaker 1: money into finding the exact mechanisms behind how this happens. 324 00:19:32,480 --> 00:19:38,159 Speaker 1: Why why does one person get more affected than another person? 325 00:19:38,400 --> 00:19:40,160 Speaker 1: Are the things that they could have changed in their 326 00:19:40,200 --> 00:19:42,760 Speaker 1: life or their lifestyle factors that could have been different 327 00:19:43,280 --> 00:19:45,960 Speaker 1: that makes them less or more susceptible to a disease 328 00:19:46,000 --> 00:19:49,639 Speaker 1: and to long term COVID as well. Some of alex 329 00:19:49,720 --> 00:19:52,479 Speaker 1: the smell has come back, but she says it's not 330 00:19:52,560 --> 00:19:56,760 Speaker 1: the same. It's quite sad not being able to smell 331 00:19:56,800 --> 00:20:00,560 Speaker 1: and taste the things that you have loved before. I 332 00:20:00,800 --> 00:20:04,520 Speaker 1: was previously quite into my beer and craft beer. I 333 00:20:04,600 --> 00:20:08,240 Speaker 1: used to brew beer at home, and I now don't 334 00:20:08,280 --> 00:20:11,520 Speaker 1: really like dark beer, which is it's maybe trivial to 335 00:20:11,560 --> 00:20:14,600 Speaker 1: some people, but it's really sad to me. I don't 336 00:20:14,680 --> 00:20:16,920 Speaker 1: like particular foods that I used to make. I make 337 00:20:17,200 --> 00:20:19,240 Speaker 1: dumplings quite a lot with friends, and I can't eat 338 00:20:19,240 --> 00:20:22,119 Speaker 1: them now because it tastes like COVID. I don't know 339 00:20:22,160 --> 00:20:24,800 Speaker 1: how to describe what that taste is. It doesn't taste 340 00:20:24,840 --> 00:20:27,280 Speaker 1: like anything that I've tasted pre COVID, but it reminds 341 00:20:27,320 --> 00:20:30,240 Speaker 1: me of particular time in my life, and it doesn't 342 00:20:30,240 --> 00:20:34,480 Speaker 1: taste good. Alex says she's fortunate her loss of smell 343 00:20:34,640 --> 00:20:38,119 Speaker 1: hasn't depressed her. I think I've had a lot of 344 00:20:38,280 --> 00:20:41,199 Speaker 1: support from my friends and family about being able to 345 00:20:41,200 --> 00:20:44,720 Speaker 1: talk about the ways that it's affected me. It has 346 00:20:44,760 --> 00:20:48,600 Speaker 1: certainly removed a lot of the pleasure in tasting food, 347 00:20:48,920 --> 00:20:52,359 Speaker 1: and I don't get a lot out of fine dining 348 00:20:52,440 --> 00:20:57,200 Speaker 1: experiences now that other people might find. But I'm also 349 00:20:57,320 --> 00:21:00,560 Speaker 1: part of a Facebook community of people who have lost 350 00:21:00,800 --> 00:21:04,640 Speaker 1: their smell and taste, and there are some really tragic 351 00:21:04,680 --> 00:21:06,880 Speaker 1: stories of people not being able to smell their kids 352 00:21:06,920 --> 00:21:10,600 Speaker 1: anymore and how much that upsets them, and how they're 353 00:21:10,640 --> 00:21:13,520 Speaker 1: now six eighteen months down the truck from their COVID 354 00:21:13,520 --> 00:21:17,280 Speaker 1: diagnosis and they still don't get any enjoyment from tasting food. 355 00:21:18,359 --> 00:21:20,959 Speaker 1: She's clearly concerned about the fact that long COVID might 356 00:21:20,960 --> 00:21:23,600 Speaker 1: continue to affect her, and that the full extent of 357 00:21:23,640 --> 00:21:28,240 Speaker 1: her infection might not be revealed for decades. I think 358 00:21:28,560 --> 00:21:33,720 Speaker 1: the respiratory symptoms may play out in the next ten 359 00:21:33,760 --> 00:21:37,399 Speaker 1: to twenty years. I don't have a scientific base for 360 00:21:37,520 --> 00:21:44,159 Speaker 1: that prediction. I think that as a fit, healthy person 361 00:21:44,280 --> 00:21:47,679 Speaker 1: that can still run five case if I need to, 362 00:21:48,520 --> 00:21:52,200 Speaker 1: I don't think my lungs have been that horribly scarred, 363 00:21:52,920 --> 00:21:55,720 Speaker 1: but I would not rule out getting some kind of 364 00:21:55,760 --> 00:21:59,400 Speaker 1: interstitial lung disease in my thirties or forties or fifties, 365 00:22:00,119 --> 00:22:04,280 Speaker 1: which is really scary. Interstitial lung disease is a pretty 366 00:22:04,320 --> 00:22:07,880 Speaker 1: horrible condition that causes the development of fibratic scar tissue. 367 00:22:08,640 --> 00:22:13,320 Speaker 1: Eventually the lungs become brittle and resemble honeycomb. In the US, 368 00:22:13,400 --> 00:22:16,399 Speaker 1: there's already been a big jump in double lung transplants 369 00:22:16,400 --> 00:22:19,960 Speaker 1: and COVID survivors because of this. I don't want to 370 00:22:20,000 --> 00:22:23,920 Speaker 1: die prematurely. I don't want to have a chronic disease 371 00:22:23,960 --> 00:22:27,840 Speaker 1: that leaves me on oxygen at home. That's not the 372 00:22:27,880 --> 00:22:34,919 Speaker 1: future that I envisaged for myself. But I also know 373 00:22:35,040 --> 00:22:38,159 Speaker 1: that I'm very lucky in that I don't have a 374 00:22:38,160 --> 00:22:41,120 Speaker 1: lot of other symptoms of long COVID. So I don't 375 00:22:41,160 --> 00:22:45,400 Speaker 1: have the memory fog, I don't have the anxiety or depression. 376 00:22:45,960 --> 00:22:49,399 Speaker 1: I don't have the crippling fatigue, I don't have the 377 00:22:49,480 --> 00:22:54,360 Speaker 1: motor symptoms yet, So I also feel quite guilty when 378 00:22:54,400 --> 00:22:59,159 Speaker 1: I talk about losing my sense of smell and taste, 379 00:22:59,240 --> 00:23:01,800 Speaker 1: because I know that so many other people, including my 380 00:23:01,880 --> 00:23:04,399 Speaker 1: patients that I treated at the time, have it so 381 00:23:04,480 --> 00:23:09,640 Speaker 1: much worse. Alex says, hairy experience of COVID and it's 382 00:23:09,760 --> 00:23:13,439 Speaker 1: alarming consequences will at least help it be a been 383 00:23:13,480 --> 00:23:18,800 Speaker 1: a family doctor. I think it's it's scary to know 384 00:23:19,000 --> 00:23:22,520 Speaker 1: that I might have a shortened lifespan. Potentially, I might 385 00:23:22,600 --> 00:23:26,439 Speaker 1: have Alzheimer's earlier, I might develop Parkinson's, I might end 386 00:23:26,520 --> 00:23:30,760 Speaker 1: up one oxygen. But I can't change any of these things. 387 00:23:31,040 --> 00:23:34,280 Speaker 1: All I can do is as a GP in the future, 388 00:23:34,320 --> 00:23:37,560 Speaker 1: I can look after patients who have had COVID. I 389 00:23:37,600 --> 00:23:41,640 Speaker 1: can support them through that and just impress upon other 390 00:23:41,720 --> 00:23:46,919 Speaker 1: people the seriousness of COVID and the importance of getting vaccinated. 391 00:23:47,640 --> 00:23:50,520 Speaker 1: The legacy of COVID is still emerging, and we won't 392 00:23:50,520 --> 00:23:53,120 Speaker 1: know the full extent of its economic and social impacts 393 00:23:53,680 --> 00:23:57,960 Speaker 1: or the repercussions on health for decades. But the more 394 00:23:58,000 --> 00:24:01,679 Speaker 1: we learn about the coronavirus and after it thanks, the 395 00:24:01,760 --> 00:24:05,000 Speaker 1: more it's showing to be an infection. We should do 396 00:24:05,080 --> 00:24:26,439 Speaker 1: whatever we can to avoid h that's it for this 397 00:24:26,520 --> 00:24:30,640 Speaker 1: episode of Prognosis Breakthrough. On the next episode, my colleague 398 00:24:30,640 --> 00:24:33,479 Speaker 1: John Lawman goes into a Boston hospital to learn how 399 00:24:33,520 --> 00:24:38,040 Speaker 1: the pandemic has reshaped health services. COVID is leaving indelible 400 00:24:38,119 --> 00:24:42,160 Speaker 1: marks not just on patience, but also on those delivering 401 00:24:42,160 --> 00:24:47,640 Speaker 1: medical care. I'm hearing more more clinicians now who say 402 00:24:48,440 --> 00:24:50,440 Speaker 1: I cried all the way to work. I didn't want 403 00:24:50,440 --> 00:24:52,600 Speaker 1: to get up this morning. I love my job, I 404 00:24:52,680 --> 00:24:55,359 Speaker 1: usually love my job. I don't want to go to work. 405 00:24:56,160 --> 00:24:59,840 Speaker 1: It's too hard, it's too much. This episode of Prognosis 406 00:24:59,880 --> 00:25:03,000 Speaker 1: for Through was written and reported by me Jason gale 407 00:25:03,560 --> 00:25:07,520 Speaker 1: Jo for Forehes is our senior producer. Cole Kevin Robinson Jr. 408 00:25:07,640 --> 00:25:11,560 Speaker 1: Is our associate producer. Special thanks to Chris hatss A. 409 00:25:11,720 --> 00:25:14,760 Speaker 1: Theme music was composed and performed by Hannes Brown. Rick 410 00:25:14,800 --> 00:25:17,639 Speaker 1: Shin is our editor. Francesco Levi is the head of 411 00:25:17,680 --> 00:25:21,800 Speaker 1: Bloomberg Podcasts. Be sure to subscribe if you haven't already, 412 00:25:22,160 --> 00:25:25,040 Speaker 1: and if you liked this episode, please leave us a review. 413 00:25:25,400 --> 00:25:28,160 Speaker 1: It helps others to find out about the show. Thanks 414 00:25:28,160 --> 00:25:28,639 Speaker 1: for listening.