WEBVTT - Breakthrough, Part Four: Covid’s Long, Scary Tail 0:00:01.080 --> 0:00:02.880 The part about my job that I love the most 0:00:03.000 --> 0:00:07.400 is talking to patients, spending time with them, explaining answering 0:00:07.400 --> 0:00:11.160 their questions on more of a human level than sometimes 0:00:11.760 --> 0:00:14.760 um that you would get in a busy hospital. Alex 0:00:14.840 --> 0:00:17.959 McCutcheon says she went into medicine because she wanted to 0:00:17.960 --> 0:00:20.599 help people. One of my friends had told me, I 0:00:20.640 --> 0:00:24.000 think you'd be a really good obstetrician. Alex lives in Darwin, 0:00:24.120 --> 0:00:27.480 in Australia's Northern Territory. When she was in high school 0:00:27.480 --> 0:00:31.000 in suburban Melbourne, Alex looked into becoming a midwife, and 0:00:31.080 --> 0:00:35.120 at a career spare, she watched instructors explain the childbirth process. 0:00:35.920 --> 0:00:38.080 It got to a point during a simulation of an 0:00:38.200 --> 0:00:41.080 obstetric patient that they said, all right, now this is 0:00:41.080 --> 0:00:43.000 where we stop. We'll have to go and get the doctor. 0:00:43.880 --> 0:00:45.840 You'd have to go and get the obstetrician. And I said, 0:00:46.000 --> 0:00:49.360 how what what about that? What can I do that? 0:00:49.400 --> 0:00:51.240 And they said, oh, you'd have to go to medical school. 0:00:51.760 --> 0:00:56.720 So I went to medical school. Last forward to early 0:00:57.720 --> 0:01:00.920 Alex's entering her second year working as a fully qualified 0:01:00.960 --> 0:01:03.960 doctor when she hears news of a novel coronavirus emerging 0:01:03.960 --> 0:01:07.080 in China. The first place I heard about it when 0:01:07.480 --> 0:01:12.040 it was when I was in Argentina in January and 0:01:12.560 --> 0:01:14.960 the person that I was backpacking with he said, oh, 0:01:15.000 --> 0:01:18.560 have you heard about this coronavirus? And from from a 0:01:18.600 --> 0:01:21.279 science background, I just thought, what are you talking about? 0:01:21.959 --> 0:01:25.320 What coronavirus? They're they're a family of viruses, which particular 0:01:25.360 --> 0:01:28.680 one are you talking about? And then it just snowballed 0:01:28.720 --> 0:01:33.679 from there. Patients are already coming to the Metropolitan Hospital 0:01:33.800 --> 0:01:36.600 with the disease by the time Alex gets back to Melbourne. 0:01:36.640 --> 0:01:39.279 Because you'd see young patients come in who were COVID 0:01:39.280 --> 0:01:43.360 positive and you can't help but think this could be me, 0:01:43.520 --> 0:01:45.039 or this could be a friend of mine, or this 0:01:45.080 --> 0:01:48.320 could be a family member. So it was it was 0:01:48.360 --> 0:01:53.240 a scary time to work. A few months later, cases 0:01:53.320 --> 0:01:56.640 are escalating and Alex is working on a general medical 0:01:56.640 --> 0:02:00.280 award when she starts feeling off. I was doing run 0:02:00.320 --> 0:02:02.080 of seven nights in a row and I was on 0:02:02.160 --> 0:02:05.560 my seventh night and it was about two am and 0:02:05.600 --> 0:02:07.680 I was walking around the wards thinking, oh, I'm a 0:02:07.680 --> 0:02:11.440 bit short of breath. I shouldn't be. I my heart 0:02:11.480 --> 0:02:14.040 rate didn't drop below a hundred so I thought, maybe 0:02:14.120 --> 0:02:16.640 something's up here, and I've been treating a lot of 0:02:16.639 --> 0:02:21.600 positive patients throughout the week um and towards the end 0:02:21.600 --> 0:02:23.880 of the shift, I got really sore all over my body. 0:02:23.919 --> 0:02:27.840 I couldn't really ignore those symptoms, so I went straight 0:02:27.840 --> 0:02:32.799 away to go and get tested. The test comes back positive, 0:02:33.240 --> 0:02:37.400 so Alex goes to a hotel. Australia uses hotels as 0:02:37.480 --> 0:02:40.280 quarantine centers to try to prevent the coronavirus spreading in 0:02:40.280 --> 0:02:44.120 the community. About a week into her infection, Alex gets 0:02:44.120 --> 0:02:46.520 a running nose and cough, and then a few days 0:02:46.639 --> 0:02:49.760 later she completely loses her sense of smell and taste. 0:02:50.400 --> 0:02:54.760 I remember having a green curry delivered to my hotel quarantine, 0:02:55.240 --> 0:02:58.880 and I filmed myself putting my face right up against it, 0:02:59.000 --> 0:03:02.239 and I couldn't not smell a single thing. I could 0:03:02.280 --> 0:03:04.680 taste that it was hot, and I could taste that 0:03:04.720 --> 0:03:07.600 it had some texture, but beyond that, I could not 0:03:07.680 --> 0:03:10.480 taste a single thing. And I also put my head 0:03:10.480 --> 0:03:15.600 in a coffee bag and that smelt nothing. It's a 0:03:15.639 --> 0:03:18.520 lot of weird videos that came out of COVID quarantine. 0:03:19.880 --> 0:03:24.120 Alex is eventually clear to leave quarantine, but her distorted 0:03:24.120 --> 0:03:27.480 sense of smell and taste persist. More than a year later, 0:03:27.800 --> 0:03:32.320 She's still suffering the consequences of catching COVID nineteen. It's 0:03:32.400 --> 0:03:36.520 unclear how long her symptoms will last, but Alex isn't 0:03:36.520 --> 0:03:39.080 alone and being plagued by the effects of the coronavirus 0:03:39.400 --> 0:03:42.320 long past her recovery from the initial stages of the illness. 0:03:43.160 --> 0:03:46.400 There haven't been any studies published yet estimating the global 0:03:46.440 --> 0:03:49.800 prevalence of patients like Alex, but at least one inten 0:03:49.920 --> 0:03:53.720 COVID patients have symptoms six months later, so the number 0:03:53.760 --> 0:03:56.680 of these so called long haulers could run well into 0:03:56.760 --> 0:04:00.560 the millions, if not tens of millions, well t wide. 0:04:01.720 --> 0:04:05.640 Once Alex loses her sense of smell, she knows exactly 0:04:05.680 --> 0:04:08.800 who to contact. It's been a very, very fruitful friendship. 0:04:08.880 --> 0:04:11.680 And then, obviously, when I got the very sad news 0:04:11.720 --> 0:04:15.200 that Alex was diagnosed with COVID, she Facebook message me. 0:04:15.280 --> 0:04:17.159 I think the message said a bit of fun news, 0:04:17.279 --> 0:04:20.720 I have COVID, you said it'll be right. That's Dr 0:04:20.800 --> 0:04:25.280 lea Bencham. She's a neuroscientist who studies smell. Alex and 0:04:25.400 --> 0:04:27.880 Lee are best friends. They've known each other for more 0:04:27.920 --> 0:04:32.039 than a decade inside, I was panicking um and then 0:04:32.120 --> 0:04:35.160 I asked her if she could smell, and she said, well, 0:04:35.160 --> 0:04:37.920 I can't taste. And then I actually sent her an 0:04:37.920 --> 0:04:40.400 olfactory kit in the in the hotel because I worked 0:04:40.400 --> 0:04:42.200 with those a lot, and I quantified her sense of 0:04:42.240 --> 0:04:46.479 smell and she did or abysmally. I spoke with Leah 0:04:46.520 --> 0:04:48.359 and Alex at the same time in a studio at 0:04:48.360 --> 0:04:51.440 the University of Melbourne where they both studied. Alex and 0:04:51.640 --> 0:04:54.479 returned for a short visit. This is the story of 0:04:54.520 --> 0:04:57.360 two friends, two doctors in fact, who were trying to 0:04:57.440 --> 0:05:00.360 understand one of the most common signs of COVID night team. 0:05:01.000 --> 0:05:03.160 The loss of the sense of smell or old faction, 0:05:03.400 --> 0:05:05.839 affects almost one and every two people who get the 0:05:05.880 --> 0:05:09.520 pandemic disease. Usually it resolves within a week or two. 0:05:10.120 --> 0:05:14.600 For some, like Alex, smell and taste distortions persist, leaving 0:05:14.800 --> 0:05:18.279 an invisible illness that leads to a profound disruption to 0:05:18.320 --> 0:05:21.560 their daily life that affects their mood and relationships. But 0:05:21.680 --> 0:05:25.760 scientists are learning that its significance doesn't end there. This 0:05:25.920 --> 0:05:28.400 is also a story about living with a mysterious condition 0:05:28.800 --> 0:05:32.640 that may have a lasting impact on health. Evidence is 0:05:32.680 --> 0:05:36.560 emerging that COVID survivors like Alex could face even worse 0:05:36.640 --> 0:05:41.359 neurological issues later in life. I'm Jason Galas, Senior Editor 0:05:41.640 --> 0:05:44.920 and Chief by a security correspondent at Bloomberg News. From 0:05:44.920 --> 0:06:11.800 the Prognosis podcast. This is breakthrough Lea and Alex meant 0:06:12.000 --> 0:06:15.719 just before beginning their first year at university. We were 0:06:15.839 --> 0:06:19.280 in a car on the way to an orientation camp 0:06:20.000 --> 0:06:25.040 and we met in the backseat and may have shared 0:06:25.160 --> 0:06:30.520 a bag of coon and we have been really good 0:06:30.560 --> 0:06:35.320 friends ever since. First friends. Goon listeners is an australianism 0:06:35.320 --> 0:06:37.680 that refers to wine that's sold in a plastic bag 0:06:37.760 --> 0:06:41.400 inside a cardboard box. After that, Lea and Alex stay 0:06:41.440 --> 0:06:45.839 close throughout undergrad and then Alex popped off to do 0:06:45.880 --> 0:06:50.159 postgraduate medicine and I popped off to do postgraduate biomedical science. 0:06:50.560 --> 0:06:53.680 We lived together during our postgraduate years. Odship is just 0:06:53.720 --> 0:06:58.440 a tipping balance between beer and science. Really. Leahel works 0:06:58.440 --> 0:07:01.640 at the University of Melbourne's floor Re Institute of Neuroscience 0:07:01.640 --> 0:07:05.000 and Mental Health. It's one of the world's largest brain 0:07:05.080 --> 0:07:09.039 research centers. After Leah gets the message about Alex's positive 0:07:09.080 --> 0:07:12.040 COVID tests. She says she wants to see how badly 0:07:12.080 --> 0:07:15.240 Alex has lost a sense of smell. Scientists have a 0:07:15.360 --> 0:07:18.920 standardized way of testing one's ability to detect sense and odors. 0:07:19.480 --> 0:07:22.520 It's a type of scratch and sniff test. It requires 0:07:22.600 --> 0:07:25.680 users to smell odorant molecules from separate panels in a 0:07:25.720 --> 0:07:29.000 series of booklets and then indicate which of four multiple 0:07:29.080 --> 0:07:33.320 choice answers best characterizes each smell. Users get a grad 0:07:33.360 --> 0:07:39.440 out of forty. Alex failed spectacularly. A nosmere and dyscousia 0:07:39.680 --> 0:07:42.360 are terms doctors used to describe a loss or impaired 0:07:42.400 --> 0:07:45.880 sense of smell and taste. People sometimes lose these senses 0:07:45.960 --> 0:07:49.800 in the early stages of Parkinson's and Alzheimer's diseases, but 0:07:49.920 --> 0:07:55.560 short term losses occur more frequently with upper respiratory tract infections. COVID, though, 0:07:55.640 --> 0:07:59.800 has added another dimension. Leah says, we don't really know 0:08:00.000 --> 0:08:03.200 why the coronavirus results in longer term effects on smell 0:08:03.240 --> 0:08:07.000 and taste. Initially it was thought to be because of inflammation, 0:08:07.280 --> 0:08:09.440 like the block nose you gave with a cold. I 0:08:09.480 --> 0:08:12.080 think it was a symptom that was ignored because It 0:08:12.120 --> 0:08:13.840 was very much thought of you've got a block nose. 0:08:13.880 --> 0:08:16.080 Of course you've lost your sense of smell. But then 0:08:16.120 --> 0:08:18.280 more and more data was coming out about people who 0:08:18.360 --> 0:08:22.280 had no other symptoms, that only symptom was a loss 0:08:22.320 --> 0:08:24.040 of spell. They had hyperson out, they didn't even have 0:08:24.080 --> 0:08:26.880 a running nose, and we started looking at that data 0:08:26.920 --> 0:08:29.920 and thinking there was there was more to it. There 0:08:30.000 --> 0:08:33.040 was also the belief that any lost sense of smell 0:08:33.160 --> 0:08:36.520 would be recovered within a month. It turns out that 0:08:36.679 --> 0:08:40.120 was based more on optimism than evidence. A study in 0:08:40.160 --> 0:08:42.880 the Journal of Internal Medicine and January found almost a 0:08:42.960 --> 0:08:46.240 quarter of sufferers hadn't recovered that sense of smell after 0:08:46.360 --> 0:08:50.520 two months, and by six months five were still living 0:08:50.559 --> 0:08:54.920 with the derangement. And we have no idea why. What 0:08:55.040 --> 0:08:57.760 we do know is that the coronavirus targets are protein 0:08:57.840 --> 0:09:01.240 on the surface of cells that lie the airways from 0:09:01.280 --> 0:09:04.640 the nose to the furthest reaches of the lungs inside 0:09:04.640 --> 0:09:08.280 the nasal cavity. The cells the coronavirus targets are right 0:09:08.320 --> 0:09:10.679 alongside the nerves that tell the brain what odors are 0:09:10.720 --> 0:09:14.679 being detected. Leah says it makes the nose a particularly 0:09:14.840 --> 0:09:18.000 interesting part of the body to study. This area of 0:09:18.000 --> 0:09:20.520 the nose is fascinating. It's one of the reasons I 0:09:20.559 --> 0:09:25.160 got into olfactory science in that there are brain cells 0:09:25.200 --> 0:09:27.720 that project down into that region. So it's actually an 0:09:27.760 --> 0:09:30.280 area of your body where your central nervous system is 0:09:30.320 --> 0:09:34.520 exposed to the environment, and that makes that region particularly vulnerable. 0:09:35.440 --> 0:09:38.160 These nerve cells protrude the bone in the skull that 0:09:38.240 --> 0:09:41.480 separates the nasal cavity from the brain. The bone is 0:09:41.600 --> 0:09:45.679 perforated like Swiss cheese. Some scientists contend that the loss 0:09:45.720 --> 0:09:49.000 of smell and COVID patients results from the virus infecting 0:09:49.040 --> 0:09:53.199 the nose and causing inflammation there that subsequently damages these 0:09:53.240 --> 0:09:56.760 olfactory neurons or nerve cells, but that doesn't really hold 0:09:56.840 --> 0:09:59.160 up when you're talking about a year down the track, 0:09:59.240 --> 0:10:02.600 there shouldn't be any more of this acute inflammation. Leah 0:10:02.600 --> 0:10:06.200 has some other theories. So one is that because of 0:10:06.240 --> 0:10:09.520 these neurons that project into the nose directly from the brain, 0:10:09.760 --> 0:10:11.920 the virus is actually able to get into those neurons 0:10:11.920 --> 0:10:14.760 and it's able to get into your brain, therefore causing 0:10:14.840 --> 0:10:17.400 damage because you have viral particles in your brain. That's 0:10:17.400 --> 0:10:20.679 one hypothesis. The other is that it's not able to 0:10:20.720 --> 0:10:22.960 get into your brain, but it can get close enough 0:10:23.000 --> 0:10:26.080 to those neurons that it can trigger an inflammatory response. 0:10:27.280 --> 0:10:30.280 Lea says that from there, the inflammatory response can cause 0:10:30.320 --> 0:10:37.680 a reaction that still harms the brain. Some scientists have 0:10:37.760 --> 0:10:40.439 published research showing that the virus can get into the brain. 0:10:41.040 --> 0:10:45.720 Others have published research showing that it can't. Intriguingly, scientists 0:10:45.720 --> 0:10:48.840 at the past Institute in Paris describe finding the sanskvt 0:10:49.000 --> 0:10:51.240 virus in the cells that line the roof of the 0:10:51.320 --> 0:10:54.160 nasal cavity in a half a dozen patients who lost 0:10:54.200 --> 0:10:57.319 their sense of smell for months. I spoke with Dr 0:10:57.480 --> 0:11:01.240 p M Marie Leto, neuroscientists who led the study, which 0:11:01.280 --> 0:11:04.920 was published in Science Translational Medicine back in June, and 0:11:05.080 --> 0:11:08.760 one of our surprise came when we find in fact 0:11:09.080 --> 0:11:13.120 that for all of them, we could find the presence 0:11:13.160 --> 0:11:18.000 of the viruses in the sensory organs, explaining why those 0:11:18.120 --> 0:11:23.640 people were impaired in recovering this sense, which was very 0:11:23.760 --> 0:11:28.680 surprising for us because several publications at least report that 0:11:28.840 --> 0:11:33.640 old factory censory neurons located in the old factory organ 0:11:33.880 --> 0:11:37.840 where those centory neurons were not expressing the receptor for 0:11:37.920 --> 0:11:41.119 the for the various is therefore they should not be infected. 0:11:41.880 --> 0:11:45.080 The French scientists found protein made by the coronavirus as 0:11:45.080 --> 0:11:48.280 well as antibodies against it, but they weren't able to 0:11:48.320 --> 0:11:51.880 demonstrate that TASKOV two can replicate in the sensory organ 0:11:52.480 --> 0:11:55.520 It's something P. M. Marie is still exploring because if 0:11:55.520 --> 0:11:59.319 they're still viable or infectious virus particles there, that could 0:11:59.320 --> 0:12:04.080 have consequent answers for transmission. If with dealing with replicative 0:12:04.160 --> 0:12:09.320 viruses in the Austrila, those people might be contagious by 0:12:09.320 --> 0:12:13.880 by just breathing, they will be spreading the viruses around them. 0:12:13.960 --> 0:12:16.400 So it's it's a it's a question that we are 0:12:16.440 --> 0:12:21.640 now following by recruiting more and more people brooding chronicling 0:12:21.679 --> 0:12:24.960 their old factions in order to address this question. So 0:12:25.000 --> 0:12:32.000 this is under investigation. Lea says there's no agreement among 0:12:32.040 --> 0:12:34.719 scientists about whether the virus is able to persist in 0:12:34.760 --> 0:12:38.080 the body, much less the nostrils. I think it's a 0:12:38.120 --> 0:12:41.640 good theory, though. Lea says it fits with another theory 0:12:41.679 --> 0:12:45.359 that scientists have mentioned several times in our earlier episodes 0:12:45.679 --> 0:12:50.520 that involves the consequences of immunization against the coronavirus. There's 0:12:50.520 --> 0:12:53.240 anecdotal evidence. None of this is published because it's very 0:12:53.240 --> 0:12:55.200 hard to quantify, but people have come out and said 0:12:55.200 --> 0:12:59.400 that after they've been vaccinated, they feel the symptoms of 0:12:59.440 --> 0:13:02.840 long covid getting better. They are not necessarily fully recovering, 0:13:03.120 --> 0:13:05.480 and some people notice nothing. Some people feel like they're 0:13:05.480 --> 0:13:06.880 a bit worse. But there are a large number of 0:13:06.880 --> 0:13:09.760 peabloo say I can actually smell a little bit better 0:13:09.800 --> 0:13:12.920 two weeks after the vaccinated, and that really lends itself 0:13:12.960 --> 0:13:17.120 to this reservoir hypothesis, because maybe your immune system wasn't 0:13:17.160 --> 0:13:20.160 able to clear that last little bit virus that's sitting 0:13:20.280 --> 0:13:24.360 in your ethelial cells, but a vaccine, which is a 0:13:24.440 --> 0:13:27.560 much sort of more direct approach at boosting the immune system, 0:13:27.720 --> 0:13:30.120 was able to clear it. So I think it's definitely 0:13:30.160 --> 0:13:32.880 got legs, but I think it's very early on um 0:13:32.960 --> 0:13:35.320 and we need many more studies to replicate it for 0:13:35.400 --> 0:13:39.840 us to say this is actually what's happening. There's still 0:13:39.880 --> 0:13:42.400 a lot of questions around how long COVID causes us 0:13:42.440 --> 0:13:46.120 to lose some of our senses. While scientists are accumulating 0:13:46.160 --> 0:13:49.800 evidence about the virus and its long term impacts on 0:13:49.920 --> 0:14:03.800 biological processes such as aging. There's been a lot of 0:14:03.840 --> 0:14:06.840 research published documenting the ways in which the brain is 0:14:06.920 --> 0:14:12.240 damaged following a saskvy to infection. There's inflammation, blood clots, 0:14:12.280 --> 0:14:15.880 and hemorrhages, not to mention respiratory failure that can cut 0:14:15.920 --> 0:14:20.040 off oxygen supply. But another aspect of COVID has surprise 0:14:20.080 --> 0:14:24.880 researchers in recent months, the loss of brain tissue. That's right, 0:14:25.280 --> 0:14:30.080 COVID is associated with brain shrinkage. A study in June 0:14:30.080 --> 0:14:32.320 from the University of Oxford, released a head of peer 0:14:32.320 --> 0:14:35.960 review and publication, found gray amount of deficits were more 0:14:36.080 --> 0:14:38.840 likely in patients who had had COVID than those who 0:14:38.840 --> 0:14:42.320 were never infected with the coronavirus. It was a unique 0:14:42.320 --> 0:14:45.240 study that used medical records and brain scans from patients 0:14:45.280 --> 0:14:49.120 taken before the pandemic. The researchers then invited hundreds of 0:14:49.120 --> 0:14:51.240 these patients back for another round of m r I 0:14:51.360 --> 0:14:55.040 brain imaging. There were marked differences between those who have 0:14:55.120 --> 0:14:58.040 been infected with COVID nineteen and those who had not 0:14:58.240 --> 0:15:00.680 in terms of gray manner, which is made up of 0:15:00.680 --> 0:15:03.520 the seal bodies of neurons that process information in the brain. 0:15:04.320 --> 0:15:07.280 More interesting still, there was a loss of brain volume 0:15:07.440 --> 0:15:10.840 even in COVID patients not sick enough to require hospitalization. 0:15:11.680 --> 0:15:14.640 The findings haven't been published in a scientific journal, but 0:15:14.760 --> 0:15:18.080 Leah says the study offers important insights into what might 0:15:18.120 --> 0:15:21.520 be going on inside the brains of long haulers. This 0:15:21.600 --> 0:15:24.000 is probably one of the most impressive papers that I've 0:15:24.040 --> 0:15:27.680 ever read. It is, and what they've shown is that 0:15:29.400 --> 0:15:32.400 quite scarily, actually there's there's a loss of gray matter 0:15:32.680 --> 0:15:35.360 in a number of regions of the brain. Most of 0:15:35.400 --> 0:15:41.479 them are related to olfactory and gustatory pathways, which explains 0:15:41.640 --> 0:15:45.080 why potentially many people are not recovering their sen's a 0:15:45.120 --> 0:15:47.040 smell or even if they have recovered it, it's not 0:15:47.080 --> 0:15:50.520 fully recovered um because you've actually you've you've actually lost 0:15:50.800 --> 0:15:55.280 brain tissue in those regions. And there's also some indications 0:15:55.280 --> 0:15:59.280 that the limbic region might be involved. Lea says that 0:15:59.360 --> 0:16:01.760 the part of the sing that COVID appears to shrink 0:16:01.920 --> 0:16:07.000 affects mood regulation. This might explain why anxiety, depression, and 0:16:07.120 --> 0:16:10.920 brain fog are common symptoms of long COVID. We're seeing 0:16:11.360 --> 0:16:13.880 huge numbers of anxiety above and beyond what we would 0:16:13.880 --> 0:16:17.320 have expected in long COVID. But it's not just that 0:16:17.400 --> 0:16:21.280 COVID can affect mood. Scientists predict that it will also 0:16:21.320 --> 0:16:26.040 be associated with longer term neurological problems like dementia. Lea 0:16:26.080 --> 0:16:29.840 says inflammation caused by COVID essentially primes the brain for 0:16:29.920 --> 0:16:33.880 further injury down the road. And once your brain is primed, 0:16:33.880 --> 0:16:36.760 if you get another hit later in life, like another 0:16:36.880 --> 0:16:40.160 severe virus, viral infection that gets into your brain, or 0:16:40.720 --> 0:16:43.760 you're exposed to a toxin, you're closer to the edge 0:16:43.760 --> 0:16:46.240 because your brain is primed and it's ready to overfire. 0:16:46.360 --> 0:16:48.640 And when it does that and the new inflammation takes hold, 0:16:48.760 --> 0:16:52.000 it's going to kill cells faster. So we're talking here 0:16:52.040 --> 0:16:55.160 about not COVID causing any of these diseases, but it's 0:16:55.200 --> 0:16:56.800 just an increased risk factor that we need to be 0:16:56.840 --> 0:16:59.320 aware of that a very large population of the world 0:16:59.400 --> 0:17:04.080 has now had. Leah says that because COVID affects so 0:17:04.119 --> 0:17:07.160 many different parts of the brain and its functions like memory, 0:17:07.560 --> 0:17:12.920 it could predispose degenerative diseases such as Alzheimer's. She's particularly 0:17:12.960 --> 0:17:16.399 concerned about what this could mean for Parkinson's disease too. 0:17:17.040 --> 0:17:20.000 It's a disorder of the central nervous system that affects movement. 0:17:20.560 --> 0:17:23.840 About ten million people worldwide have the condition, and the 0:17:23.920 --> 0:17:26.680 number is growing, in part because age is a major 0:17:26.800 --> 0:17:30.439 risk factor and humans are living longer. So at the 0:17:30.440 --> 0:17:33.480 moment we're actually living through a Parkinson's pandemic. It's doubled 0:17:33.520 --> 0:17:35.440 in the last twenty years our incidents, and it's set 0:17:35.480 --> 0:17:37.480 to double again, and that's after we correct for the 0:17:37.520 --> 0:17:41.320 aging population. Now that we've just added covid in, there's 0:17:41.320 --> 0:17:43.760 a chance that we have just even the slightest shift 0:17:43.880 --> 0:17:47.920 of people more likely to get Parkinson's that could push 0:17:48.000 --> 0:17:51.199 us into numbers that we can't cope with. Parkinson's is 0:17:51.200 --> 0:17:53.679 a very long disease. It's a very expensive disease. We 0:17:53.760 --> 0:17:56.000 don't have disease modifying drugs or we can do is 0:17:56.000 --> 0:17:58.760 help you symptomatically for a few years until that stops working. 0:17:59.600 --> 0:18:02.400 It's really scary and we need to be really vigilant. 0:18:03.080 --> 0:18:05.919 There was a surge in cases of Parkinson's disease in 0:18:05.920 --> 0:18:11.160 the decades following the nineteen eighteen Spanish influenza pandemic. Epidemiologists 0:18:11.160 --> 0:18:14.119 determined that Spanish flu survivors had a two to three 0:18:14.119 --> 0:18:18.560 times higher risk of developing Parkinson's now term viral parkinson 0:18:18.680 --> 0:18:21.480 Is UM compared with those who didn't get the deadly 0:18:21.520 --> 0:18:25.000 flu strain. If a similar effect were to occur in 0:18:25.000 --> 0:18:28.920 the wake of COVID, Leah says EQUOD cripple health systems. 0:18:30.240 --> 0:18:33.879 There's warning bells, and where we're trying to listen to 0:18:33.920 --> 0:18:35.639 those warning bells, I think because we don't want to 0:18:35.680 --> 0:18:39.040 be caught off guard and our community itself. Would you know, 0:18:39.119 --> 0:18:41.080 most people who are diagnosed with Parkinson's are still of 0:18:41.160 --> 0:18:44.880 working age. We can't lose that workforce loss, so there's 0:18:44.880 --> 0:18:46.720 an economic side to it as well. We need to 0:18:46.760 --> 0:18:48.960 be really prepared and the only way we're going to 0:18:49.040 --> 0:18:51.600 do that is to keep studying it and preparing as best. Weekend, 0:18:57.400 --> 0:18:59.720 as we sit in the studio in Melbourne, Lea in 0:18:59.760 --> 0:19:03.440 our sitting side by side, Alex knows that when Lea 0:19:03.520 --> 0:19:07.040 talks about the future risks around long COVID, she's talking 0:19:07.080 --> 0:19:10.480 about pretty frightening things that she could face one day. 0:19:11.000 --> 0:19:14.240 It's a bit hard to listen to. I have known 0:19:14.320 --> 0:19:16.080 Lea for a very long time and She's been very 0:19:16.080 --> 0:19:19.240 frank and honest with me about the research and the 0:19:19.240 --> 0:19:23.240 places that this could go. That's why I think research 0:19:23.440 --> 0:19:27.480 likely is is so amazing that we can be putting 0:19:27.520 --> 0:19:32.280 money into finding the exact mechanisms behind how this happens. 0:19:32.480 --> 0:19:38.159 Why why does one person get more affected than another person? 0:19:38.400 --> 0:19:40.160 Are the things that they could have changed in their 0:19:40.200 --> 0:19:42.760 life or their lifestyle factors that could have been different 0:19:43.280 --> 0:19:45.960 that makes them less or more susceptible to a disease 0:19:46.000 --> 0:19:49.639 and to long term COVID as well. Some of alex 0:19:49.720 --> 0:19:52.479 the smell has come back, but she says it's not 0:19:52.560 --> 0:19:56.760 the same. It's quite sad not being able to smell 0:19:56.800 --> 0:20:00.560 and taste the things that you have loved before. I 0:20:00.800 --> 0:20:04.520 was previously quite into my beer and craft beer. I 0:20:04.600 --> 0:20:08.240 used to brew beer at home, and I now don't 0:20:08.280 --> 0:20:11.520 really like dark beer, which is it's maybe trivial to 0:20:11.560 --> 0:20:14.600 some people, but it's really sad to me. I don't 0:20:14.680 --> 0:20:16.920 like particular foods that I used to make. I make 0:20:17.200 --> 0:20:19.240 dumplings quite a lot with friends, and I can't eat 0:20:19.240 --> 0:20:22.119 them now because it tastes like COVID. I don't know 0:20:22.160 --> 0:20:24.800 how to describe what that taste is. It doesn't taste 0:20:24.840 --> 0:20:27.280 like anything that I've tasted pre COVID, but it reminds 0:20:27.320 --> 0:20:30.240 me of particular time in my life, and it doesn't 0:20:30.240 --> 0:20:34.480 taste good. Alex says she's fortunate her loss of smell 0:20:34.640 --> 0:20:38.119 hasn't depressed her. I think I've had a lot of 0:20:38.280 --> 0:20:41.199 support from my friends and family about being able to 0:20:41.200 --> 0:20:44.720 talk about the ways that it's affected me. It has 0:20:44.760 --> 0:20:48.600 certainly removed a lot of the pleasure in tasting food, 0:20:48.920 --> 0:20:52.359 and I don't get a lot out of fine dining 0:20:52.440 --> 0:20:57.200 experiences now that other people might find. But I'm also 0:20:57.320 --> 0:21:00.560 part of a Facebook community of people who have lost 0:21:00.800 --> 0:21:04.640 their smell and taste, and there are some really tragic 0:21:04.680 --> 0:21:06.880 stories of people not being able to smell their kids 0:21:06.920 --> 0:21:10.600 anymore and how much that upsets them, and how they're 0:21:10.640 --> 0:21:13.520 now six eighteen months down the truck from their COVID 0:21:13.520 --> 0:21:17.280 diagnosis and they still don't get any enjoyment from tasting food. 0:21:18.359 --> 0:21:20.959 She's clearly concerned about the fact that long COVID might 0:21:20.960 --> 0:21:23.600 continue to affect her, and that the full extent of 0:21:23.640 --> 0:21:28.240 her infection might not be revealed for decades. I think 0:21:28.560 --> 0:21:33.720 the respiratory symptoms may play out in the next ten 0:21:33.760 --> 0:21:37.399 to twenty years. I don't have a scientific base for 0:21:37.520 --> 0:21:44.159 that prediction. I think that as a fit, healthy person 0:21:44.280 --> 0:21:47.679 that can still run five case if I need to, 0:21:48.520 --> 0:21:52.200 I don't think my lungs have been that horribly scarred, 0:21:52.920 --> 0:21:55.720 but I would not rule out getting some kind of 0:21:55.760 --> 0:21:59.400 interstitial lung disease in my thirties or forties or fifties, 0:22:00.119 --> 0:22:04.280 which is really scary. Interstitial lung disease is a pretty 0:22:04.320 --> 0:22:07.880 horrible condition that causes the development of fibratic scar tissue. 0:22:08.640 --> 0:22:13.320 Eventually the lungs become brittle and resemble honeycomb. In the US, 0:22:13.400 --> 0:22:16.399 there's already been a big jump in double lung transplants 0:22:16.400 --> 0:22:19.960 and COVID survivors because of this. I don't want to 0:22:20.000 --> 0:22:23.920 die prematurely. I don't want to have a chronic disease 0:22:23.960 --> 0:22:27.840 that leaves me on oxygen at home. That's not the 0:22:27.880 --> 0:22:34.919 future that I envisaged for myself. But I also know 0:22:35.040 --> 0:22:38.159 that I'm very lucky in that I don't have a 0:22:38.160 --> 0:22:41.120 lot of other symptoms of long COVID. So I don't 0:22:41.160 --> 0:22:45.400 have the memory fog, I don't have the anxiety or depression. 0:22:45.960 --> 0:22:49.399 I don't have the crippling fatigue, I don't have the 0:22:49.480 --> 0:22:54.360 motor symptoms yet, So I also feel quite guilty when 0:22:54.400 --> 0:22:59.159 I talk about losing my sense of smell and taste, 0:22:59.240 --> 0:23:01.800 because I know that so many other people, including my 0:23:01.880 --> 0:23:04.399 patients that I treated at the time, have it so 0:23:04.480 --> 0:23:09.640 much worse. Alex says, hairy experience of COVID and it's 0:23:09.760 --> 0:23:13.439 alarming consequences will at least help it be a been 0:23:13.480 --> 0:23:18.800 a family doctor. I think it's it's scary to know 0:23:19.000 --> 0:23:22.520 that I might have a shortened lifespan. Potentially, I might 0:23:22.600 --> 0:23:26.439 have Alzheimer's earlier, I might develop Parkinson's, I might end 0:23:26.520 --> 0:23:30.760 up one oxygen. But I can't change any of these things. 0:23:31.040 --> 0:23:34.280 All I can do is as a GP in the future, 0:23:34.320 --> 0:23:37.560 I can look after patients who have had COVID. I 0:23:37.600 --> 0:23:41.640 can support them through that and just impress upon other 0:23:41.720 --> 0:23:46.919 people the seriousness of COVID and the importance of getting vaccinated. 0:23:47.640 --> 0:23:50.520 The legacy of COVID is still emerging, and we won't 0:23:50.520 --> 0:23:53.120 know the full extent of its economic and social impacts 0:23:53.680 --> 0:23:57.960 or the repercussions on health for decades. But the more 0:23:58.000 --> 0:24:01.679 we learn about the coronavirus and after it thanks, the 0:24:01.760 --> 0:24:05.000 more it's showing to be an infection. We should do 0:24:05.080 --> 0:24:26.439 whatever we can to avoid h that's it for this 0:24:26.520 --> 0:24:30.640 episode of Prognosis Breakthrough. On the next episode, my colleague 0:24:30.640 --> 0:24:33.479 John Lawman goes into a Boston hospital to learn how 0:24:33.520 --> 0:24:38.040 the pandemic has reshaped health services. COVID is leaving indelible 0:24:38.119 --> 0:24:42.160 marks not just on patience, but also on those delivering 0:24:42.160 --> 0:24:47.640