1 00:00:01,000 --> 00:00:04,720 Speaker 1: It's the start of the pandemic in and David Petrino 2 00:00:04,880 --> 00:00:09,080 Speaker 1: is scrambling. He's the director of Rehabilitation Innovation at the 3 00:00:09,119 --> 00:00:11,960 Speaker 1: Mount sign A Health System in New York, the city 4 00:00:12,039 --> 00:00:16,159 Speaker 1: that's about to become the global COVID nineteen hotspot. It 5 00:00:16,280 --> 00:00:21,000 Speaker 1: was grim. We had a countdown for the number of 6 00:00:21,079 --> 00:00:24,360 Speaker 1: days before we ran out of beds, you know, And 7 00:00:24,480 --> 00:00:28,360 Speaker 1: that was something that we were just managing with my 8 00:00:28,480 --> 00:00:33,720 Speaker 1: team while we were testing out clever ways of turning 9 00:00:33,760 --> 00:00:38,680 Speaker 1: bipad machines into ventilators, building our own ventilators, building a 10 00:00:38,680 --> 00:00:44,080 Speaker 1: remote patient monitoring out to track acutely all patients, chasing 11 00:00:44,120 --> 00:00:48,680 Speaker 1: down PPE. David does what he can, but it's mostly 12 00:00:48,720 --> 00:00:53,560 Speaker 1: distributing face masks and medications. The reality is doctors don't 13 00:00:53,560 --> 00:00:56,320 Speaker 1: know much about COVID or how to fight it. The 14 00:00:56,400 --> 00:00:59,320 Speaker 1: most they can do is try to prepare. I was 15 00:01:00,120 --> 00:01:04,560 Speaker 1: meeting people on the street who had boxes of ten, 16 00:01:04,720 --> 00:01:08,880 Speaker 1: you know, in n and I was immediately rushing that 17 00:01:09,000 --> 00:01:14,759 Speaker 1: off to whichever friend at whichever hospital needed most. There 18 00:01:14,840 --> 00:01:18,080 Speaker 1: was just all sorts of crazy stuff going on in 19 00:01:18,200 --> 00:01:23,280 Speaker 1: the early phase of the pandemic. The pandemic just gets 20 00:01:23,319 --> 00:01:27,199 Speaker 1: worse and worse numbers continue to rise, and every part 21 00:01:27,200 --> 00:01:30,480 Speaker 1: of the healthcare system becomes strained. People were getting COVID 22 00:01:30,480 --> 00:01:33,720 Speaker 1: symptoms going to the hospital, they're being told, look, we 23 00:01:33,800 --> 00:01:36,959 Speaker 1: don't have beds and you're not sick enough, go home 24 00:01:37,640 --> 00:01:40,800 Speaker 1: and come back if you're worse, which is a really 25 00:01:41,720 --> 00:01:45,560 Speaker 1: terrifying thing to say to someone who is sick with 26 00:01:45,560 --> 00:01:48,600 Speaker 1: an unknown illness, with an unknown disease. Course, you know 27 00:01:48,640 --> 00:01:51,440 Speaker 1: how much sick of do? At what point do I 28 00:01:51,480 --> 00:01:55,040 Speaker 1: come back? So David and his colleagues start thinking about 29 00:01:55,040 --> 00:01:58,000 Speaker 1: a way they can monitor COVID patients safely from their homes, 30 00:01:58,440 --> 00:02:00,880 Speaker 1: and they settle on the idea of creating an app. 31 00:02:01,160 --> 00:02:03,880 Speaker 1: My team has a lot of expertise and remote patient monitoring, 32 00:02:04,000 --> 00:02:08,040 Speaker 1: so we developed an app in something like or thirty 33 00:02:08,120 --> 00:02:12,400 Speaker 1: six hours, launched it. We said, here's a hotline. If 34 00:02:12,440 --> 00:02:16,080 Speaker 1: you're having symptoms, call this number. The app proms uses 35 00:02:16,160 --> 00:02:19,080 Speaker 1: to answer simple questions like whether they have a fever 36 00:02:19,280 --> 00:02:23,200 Speaker 1: or a cough. David says, pretty soon hundreds and then 37 00:02:23,320 --> 00:02:27,040 Speaker 1: thousands of patients are being monitored this way. Then around 38 00:02:27,120 --> 00:02:30,639 Speaker 1: mid April, as strange pattern emerges for all, we started 39 00:02:30,680 --> 00:02:36,280 Speaker 1: seeing this cluster of people who were expressing different symptoms 40 00:02:37,080 --> 00:02:41,079 Speaker 1: patients report diligently on the app. At first, they were 41 00:02:41,080 --> 00:02:44,440 Speaker 1: predominantly complaining of headaches, fevers, and shortness of breath, But 42 00:02:44,720 --> 00:02:48,320 Speaker 1: suddenly they are symptoms more. Now they were talking about 43 00:02:48,360 --> 00:02:52,240 Speaker 1: dizziness and fatigue, and I can't seem to exercise the 44 00:02:52,240 --> 00:02:55,480 Speaker 1: way I used to, and you know, there's something about 45 00:02:55,520 --> 00:02:57,560 Speaker 1: this that can't shake. And my heart feels like it's 46 00:02:57,600 --> 00:03:00,960 Speaker 1: beating out of its chest, and you know, arms are tingling, 47 00:03:01,240 --> 00:03:03,200 Speaker 1: my feet are going blue, you know, all of these 48 00:03:03,760 --> 00:03:09,000 Speaker 1: very odd symptoms. What was immediately striking to me was 49 00:03:09,080 --> 00:03:12,160 Speaker 1: just how similar all of these how random these accounts were, 50 00:03:12,280 --> 00:03:16,160 Speaker 1: but really similar, David says. What's also bizarre is that 51 00:03:16,360 --> 00:03:21,240 Speaker 1: almost all of these patients were never hospitalized. A common narrative, 52 00:03:21,400 --> 00:03:25,240 Speaker 1: in fact, is yeah, I got it. I was fine, 53 00:03:25,639 --> 00:03:30,800 Speaker 1: you know, I was more or less asymptomatic, um, you know, 54 00:03:31,560 --> 00:03:33,640 Speaker 1: and I didn't think there was anything to worry about. 55 00:03:34,200 --> 00:03:37,360 Speaker 1: And then two weeks after my symptoms went away, I 56 00:03:37,440 --> 00:03:40,760 Speaker 1: got hit with this. What David is describing Harold's the 57 00:03:40,760 --> 00:03:43,280 Speaker 1: start of his journey into trying to understand long COVID. 58 00:03:43,800 --> 00:03:45,760 Speaker 1: He would go on to search for ways to help 59 00:03:45,800 --> 00:03:48,560 Speaker 1: the millions of people across the world dealing with symptoms 60 00:03:48,880 --> 00:03:53,000 Speaker 1: months after their coronavirus infection. Many patients are caught in 61 00:03:53,000 --> 00:03:56,800 Speaker 1: a sort of medical purgatory where their problems aren't understood, 62 00:03:57,160 --> 00:04:01,000 Speaker 1: much less treated, and the advice they get is well, 63 00:04:01,160 --> 00:04:04,080 Speaker 1: not always reliable. If anyone tells you that they know 64 00:04:04,160 --> 00:04:07,600 Speaker 1: what's going on, they're lying to like, don't trust that person. 65 00:04:08,040 --> 00:04:10,160 Speaker 1: That's the one person you can't trust is the person 66 00:04:10,200 --> 00:04:13,160 Speaker 1: who tells you categorically they know what's going on. And 67 00:04:14,240 --> 00:04:17,920 Speaker 1: I've certainly seen a lot of clinicians doing that. As 68 00:04:17,960 --> 00:04:20,560 Speaker 1: scientists rushed to figure out the causes of long COVID, 69 00:04:20,960 --> 00:04:24,200 Speaker 1: some health providers aren't waiting for answers. There are already 70 00:04:24,240 --> 00:04:28,720 Speaker 1: finding ways to help patients now. I'm Jason Gale, chief By, 71 00:04:28,760 --> 00:04:31,919 Speaker 1: a security correspondent and a senior editor at Bloomberg News 72 00:04:32,480 --> 00:04:53,640 Speaker 1: from the Prognosis podcast. This is breakthrough and they told 73 00:04:53,680 --> 00:04:56,200 Speaker 1: my family she's not going to make it, and so 74 00:04:56,279 --> 00:04:59,080 Speaker 1: you need to come in and say yo, goodbyes. Billie 75 00:04:59,120 --> 00:05:01,840 Speaker 1: McCarthy could it bad case of COVID? Back in February 76 00:05:01,880 --> 00:05:04,600 Speaker 1: this year, Kelly is a fifty one year old grandmother 77 00:05:04,640 --> 00:05:07,360 Speaker 1: from a town in Massachusetts amount twenty miles southwest of 78 00:05:07,400 --> 00:05:12,080 Speaker 1: Boston called Foxboro. Soon after falling ill, Kelly couldn't move. 79 00:05:12,440 --> 00:05:14,279 Speaker 1: I couldn't even get out of bad. My husband's like, 80 00:05:14,360 --> 00:05:16,080 Speaker 1: I have to throw you over my shoulder. You're going 81 00:05:16,240 --> 00:05:19,040 Speaker 1: urgent care, which is good because when I got there, 82 00:05:19,080 --> 00:05:22,640 Speaker 1: my oxygen was below seventy, which I guess is bad. 83 00:05:23,720 --> 00:05:27,039 Speaker 1: Kelly's condition deteriorated fast once she got sick. It got 84 00:05:27,120 --> 00:05:29,440 Speaker 1: so bad that she had to be introbrated and put 85 00:05:29,440 --> 00:05:33,040 Speaker 1: into an induced coma. She couldn't breathe on her own. Eventually, 86 00:05:33,240 --> 00:05:35,360 Speaker 1: she was given a tracking ostomy so a tube could 87 00:05:35,360 --> 00:05:38,960 Speaker 1: be inserted directly into her windpipe, but the prognosis was 88 00:05:39,000 --> 00:05:41,680 Speaker 1: still grim, and doctors thought Kelly would need a double 89 00:05:41,760 --> 00:05:45,679 Speaker 1: lung transplant. That wasn't needed in the end, and after 90 00:05:45,720 --> 00:05:50,039 Speaker 1: two months in three hospitals, she was eventually released. But 91 00:05:50,240 --> 00:05:54,880 Speaker 1: the second chapter of Kelly's COVID story was just beginning. Hospitals, 92 00:05:55,160 --> 00:05:58,920 Speaker 1: medical tests, and chronic disability have turned her world upside down. 93 00:06:00,040 --> 00:06:04,800 Speaker 1: Kelly's main deficits are neurological. She can't feel her fingertips, 94 00:06:05,160 --> 00:06:09,480 Speaker 1: and she's suffering memory problems. Kelly's doctors are familiar with 95 00:06:09,480 --> 00:06:12,800 Speaker 1: her symptoms but she says it's not always so easy 96 00:06:12,920 --> 00:06:16,240 Speaker 1: for long haulers to get good medical advice. I go 97 00:06:16,320 --> 00:06:20,479 Speaker 1: over to the COVID clinic um to meet with all 98 00:06:20,520 --> 00:06:25,800 Speaker 1: the people there, because if you go to a regular 99 00:06:25,839 --> 00:06:28,240 Speaker 1: doctor with you know this is the problem, they're gonna 100 00:06:28,320 --> 00:06:32,240 Speaker 1: look at it like a normal symptom of a normal thing. 101 00:06:33,279 --> 00:06:35,520 Speaker 1: Kelly is referring to an outpatient clinic at that bring 102 00:06:35,600 --> 00:06:38,880 Speaker 1: him in Women's Folking Hospital in Boston. It's been four 103 00:06:38,920 --> 00:06:41,359 Speaker 1: months since she was discharged, and Kelly goes there for 104 00:06:41,400 --> 00:06:44,520 Speaker 1: follow up treatment. Today she's sitting in the park across 105 00:06:44,560 --> 00:06:48,000 Speaker 1: the street after seeing her doctor. Her recovery, she says, 106 00:06:48,480 --> 00:06:51,279 Speaker 1: is still touch and go, like today, I'm having a 107 00:06:51,320 --> 00:06:55,560 Speaker 1: good day, yesterday and Saturday or terrible. I can't grasp 108 00:06:55,680 --> 00:06:59,440 Speaker 1: the words I need. Um, I get confused what I'm saying. 109 00:06:59,480 --> 00:07:02,600 Speaker 1: It's almost my brains working way over time, and my 110 00:07:02,640 --> 00:07:06,880 Speaker 1: mouth isn't working nearly fast enough. The problem extends to 111 00:07:06,960 --> 00:07:11,560 Speaker 1: her short term recall and cognition. I forget things all 112 00:07:11,600 --> 00:07:15,160 Speaker 1: the time, Like I'll look at one page and then 113 00:07:15,160 --> 00:07:17,480 Speaker 1: I'll look to another page to put what it was 114 00:07:17,520 --> 00:07:19,400 Speaker 1: I saw on this page, and I have to keep 115 00:07:19,440 --> 00:07:23,360 Speaker 1: flipping back and forth several times. I've even been known 116 00:07:23,400 --> 00:07:26,320 Speaker 1: to write it on my hands so I don't have 117 00:07:26,360 --> 00:07:30,000 Speaker 1: to keep flipping by. These are having a monumental impact 118 00:07:30,080 --> 00:07:33,760 Speaker 1: on Kelly, who before COVID was an insurance claims adjusta 119 00:07:34,040 --> 00:07:37,160 Speaker 1: working out who is what after an injury? And I've 120 00:07:37,320 --> 00:07:41,040 Speaker 1: never been the poster girl for for Strong Memory ever, 121 00:07:41,720 --> 00:07:44,400 Speaker 1: but this is like this, This is what makes it 122 00:07:44,440 --> 00:07:48,080 Speaker 1: difficult to go back to work because I have to know, 123 00:07:48,760 --> 00:07:52,040 Speaker 1: I have to be on the money, so to speak. Um, 124 00:07:52,080 --> 00:07:54,920 Speaker 1: Because if I'm talking to an attorney about their clients 125 00:07:54,920 --> 00:07:59,400 Speaker 1: and their clients injuries and how much you know, the 126 00:07:59,440 --> 00:08:03,760 Speaker 1: whole big picture is worth and to negotiate, if I 127 00:08:03,840 --> 00:08:09,120 Speaker 1: can't remember every little pod and peanut, then it's gonna 128 00:08:09,120 --> 00:08:12,160 Speaker 1: be hard to negotiate with them. Oh, your your client 129 00:08:12,240 --> 00:08:17,160 Speaker 1: broke is lead. No, actually they sprain their thumb, but okay, 130 00:08:17,640 --> 00:08:19,680 Speaker 1: you know, and I can't do that one. It's one. 131 00:08:19,720 --> 00:08:24,120 Speaker 1: It's embarrassing too. It's bad for the company to have 132 00:08:24,320 --> 00:08:31,080 Speaker 1: people like that trying to settle claims there. It's embarrassing. Um, 133 00:08:31,240 --> 00:08:34,360 Speaker 1: you know. So it's just like I can't do and 134 00:08:34,400 --> 00:08:36,880 Speaker 1: I hate to say this, I can't do anything important 135 00:08:37,800 --> 00:08:44,559 Speaker 1: because I can't I just can't yet. Kelly says that 136 00:08:44,640 --> 00:08:49,800 Speaker 1: her neurological issues also affect her driving. Get easily distracted, 137 00:08:50,240 --> 00:08:52,280 Speaker 1: and then I'll notice my car is going like this, 138 00:08:52,559 --> 00:08:55,080 Speaker 1: or I'll be walking and I'm shaking, and that sort 139 00:08:55,080 --> 00:08:59,080 Speaker 1: of goes into the car with me. I almost hit 140 00:08:59,120 --> 00:09:01,120 Speaker 1: a car on this eat the other eggause I didn't 141 00:09:01,120 --> 00:09:02,800 Speaker 1: even see it till I was right there. And that's 142 00:09:02,800 --> 00:09:07,480 Speaker 1: when I went home. And what road today. The symptoms, too, 143 00:09:07,600 --> 00:09:11,800 Speaker 1: came manifest at all hours. Another source of Kelly's distress 144 00:09:11,920 --> 00:09:15,240 Speaker 1: is the difficulty she has sleeping. A lot of that 145 00:09:15,240 --> 00:09:17,080 Speaker 1: has to do with the six weeks she spent in 146 00:09:17,120 --> 00:09:21,600 Speaker 1: a drug induced coma. Although heavily sedated, she was still 147 00:09:21,640 --> 00:09:24,400 Speaker 1: able to connect with some aspects of being intubrated in 148 00:09:24,440 --> 00:09:28,040 Speaker 1: the ICU, but not make sense of them. And this 149 00:09:28,160 --> 00:09:35,760 Speaker 1: delirium generates persistent nightmares, awful awful, awful nightmares. And but 150 00:09:36,240 --> 00:09:41,640 Speaker 1: I wasn't so sedated that reality wasn't coming in, so 151 00:09:41,760 --> 00:09:46,080 Speaker 1: like things were coming in from my reality, mixing into 152 00:09:46,120 --> 00:09:52,120 Speaker 1: the dream and making it worse. Hell. He says that 153 00:09:52,240 --> 00:09:56,240 Speaker 1: early on, fear of these nightmares kept her from falling asleep. 154 00:09:56,800 --> 00:09:58,360 Speaker 1: I was afraid I was going to have the dreams. 155 00:09:58,360 --> 00:10:00,240 Speaker 1: And I was having the dreams that I was having 156 00:10:00,240 --> 00:10:02,960 Speaker 1: in the column, and now my dreams are if I 157 00:10:03,040 --> 00:10:06,840 Speaker 1: start having a weird dream, a wake up and beating 158 00:10:06,840 --> 00:10:08,360 Speaker 1: on my husband, they're trying to put me in a 159 00:10:08,440 --> 00:10:12,680 Speaker 1: colma again. No they're not, they're not. No, go to sleep, Okay, 160 00:10:12,960 --> 00:10:17,079 Speaker 1: so I do, but it's a weird feeling. Think about 161 00:10:17,080 --> 00:10:19,600 Speaker 1: this from the doctor's point of view. Your patients are 162 00:10:19,640 --> 00:10:22,679 Speaker 1: coming to you with a slew of conditions that may 163 00:10:22,720 --> 00:10:25,959 Speaker 1: not even seem related. Their short term memory is failing, 164 00:10:26,200 --> 00:10:30,480 Speaker 1: they're having horrible nightmares, they shake. It's hard to imagine 165 00:10:30,600 --> 00:10:45,200 Speaker 1: where to start. But David Petrino, the starting point for 166 00:10:45,320 --> 00:10:48,439 Speaker 1: understanding how to treat long COVID is the patient data 167 00:10:48,679 --> 00:10:51,480 Speaker 1: coming in on his app. There's a pattern emerging that 168 00:10:51,640 --> 00:10:55,480 Speaker 1: offers some clues. For instance, these long haulers share some 169 00:10:55,520 --> 00:11:00,520 Speaker 1: common features. What we're seeing is a medium age of 170 00:11:01,240 --> 00:11:07,360 Speaker 1: forty two. Um. About of the patients who come to 171 00:11:07,480 --> 00:11:12,480 Speaker 1: us are women, So I'd say it's about fifty fifty 172 00:11:12,520 --> 00:11:16,120 Speaker 1: two people who had like some sort of significant medical 173 00:11:16,200 --> 00:11:20,400 Speaker 1: history versus just fit and healthy and used to run 174 00:11:20,400 --> 00:11:24,280 Speaker 1: marathons and keeps in good shape. And all of these 175 00:11:24,320 --> 00:11:28,720 Speaker 1: sorts of things. In the fall of David and his colleague, 176 00:11:28,760 --> 00:11:32,000 Speaker 1: doctor z gan Chan, set up a rehabilitation service for 177 00:11:32,040 --> 00:11:35,440 Speaker 1: COVID survivors at Mount Sinai. They call it the Center 178 00:11:35,520 --> 00:11:38,480 Speaker 1: for Post COVID Care. But at first they need to 179 00:11:38,480 --> 00:11:42,120 Speaker 1: figure out which patients will see which clinicians. So David 180 00:11:42,160 --> 00:11:45,319 Speaker 1: says to his colleague, Hey, here's what we're gonna do. 181 00:11:46,280 --> 00:11:48,840 Speaker 1: If you're examining someone and they've got a bunch of 182 00:11:48,840 --> 00:11:53,679 Speaker 1: symptoms and you can scan them, take their blood, look 183 00:11:53,720 --> 00:11:56,280 Speaker 1: at their organs and say, this is the proximate cause 184 00:11:56,280 --> 00:11:59,280 Speaker 1: of your symptoms. This is it. We we know what 185 00:11:59,400 --> 00:12:03,400 Speaker 1: this is um and it's because of COVID, but we 186 00:12:03,440 --> 00:12:08,400 Speaker 1: can see it. It's on a scan you take them. 187 00:12:08,440 --> 00:12:12,440 Speaker 1: If you have someone showing up with a laundry bag 188 00:12:12,440 --> 00:12:15,040 Speaker 1: of symptoms and you can't see a single thing on 189 00:12:15,080 --> 00:12:19,880 Speaker 1: their scan that would explain all of these symptoms, that 190 00:12:20,040 --> 00:12:22,680 Speaker 1: to me is what we're going to call post acute 191 00:12:22,960 --> 00:12:27,280 Speaker 1: COVID syndrome PACKS. And that was that was the term 192 00:12:27,320 --> 00:12:30,880 Speaker 1: we we coined in April, and we said we're calling 193 00:12:30,880 --> 00:12:34,600 Speaker 1: it packs, and they'll come to us and off we go. 194 00:12:35,679 --> 00:12:40,560 Speaker 1: Patients with medically explainable ailments are managed by pulmonologists, cardiologists, 195 00:12:40,559 --> 00:12:44,040 Speaker 1: and other relevant specialists. But then there are the long 196 00:12:44,120 --> 00:12:48,559 Speaker 1: haulers whose symptoms can't be easily explained. David knows their 197 00:12:48,600 --> 00:12:52,120 Speaker 1: conditions fall under a broad umbrella of needs, so he 198 00:12:52,280 --> 00:12:55,360 Speaker 1: brings together a team of doctors and allied health practitioners 199 00:12:55,400 --> 00:12:58,520 Speaker 1: with different expertise. They work with him to come up 200 00:12:58,559 --> 00:13:03,920 Speaker 1: with strategies to help manage their patients specific problems. There's 201 00:13:03,920 --> 00:13:07,280 Speaker 1: a cardiologist who specializes in how viruses affect the heart. 202 00:13:07,760 --> 00:13:11,560 Speaker 1: There's a nutritionist who helps patients with food sensitivities. A 203 00:13:11,600 --> 00:13:15,520 Speaker 1: couple of physiatrists. These are medical doctors who treat pain. 204 00:13:16,080 --> 00:13:19,280 Speaker 1: And there's a doctor of physical therapy and she is 205 00:13:19,360 --> 00:13:23,440 Speaker 1: focused entirely on, you know, treating people who have close 206 00:13:23,520 --> 00:13:27,319 Speaker 1: concussion syndrome, again, something that looks very very similar. You've 207 00:13:27,360 --> 00:13:32,480 Speaker 1: got heart palpitations, you've got difficulty with exercise and exertion. 208 00:13:33,640 --> 00:13:37,520 Speaker 1: Then there's Josh Dunt's formal naval special oms guy who 209 00:13:37,600 --> 00:13:40,839 Speaker 1: disarmed bombs for a living. He tells David that some 210 00:13:40,880 --> 00:13:44,160 Speaker 1: long COVID patients are displaying symptoms of something it's seen 211 00:13:44,200 --> 00:13:48,160 Speaker 1: in the military. It's called hypercapnia, which means a lack 212 00:13:48,200 --> 00:13:50,800 Speaker 1: of carbon dioxide in the blood. It can be the 213 00:13:50,840 --> 00:13:53,880 Speaker 1: result of deep or rapid breathing and can cause a 214 00:13:54,000 --> 00:13:57,600 Speaker 1: tingling sensation in the limbs, as well as a normal heartbeat, 215 00:13:57,800 --> 00:14:01,240 Speaker 1: muscle cramps, and anxiety. For this, he had seen this 216 00:14:01,320 --> 00:14:06,680 Speaker 1: sort of symptom cluster before UM and it had taken 217 00:14:06,679 --> 00:14:10,560 Speaker 1: the form of hypercapnea in in You know, fighter pilots 218 00:14:10,600 --> 00:14:14,400 Speaker 1: who had pulled too many g's and we're having a 219 00:14:14,400 --> 00:14:18,520 Speaker 1: physiological response to that, and their CEO two would drop, 220 00:14:19,040 --> 00:14:22,240 Speaker 1: get heart palpitations, they get dizziness, they get these attacks. 221 00:14:23,080 --> 00:14:27,320 Speaker 1: Josh tells David to test patients carbon dioxide levels. Sure enough, 222 00:14:27,320 --> 00:14:30,840 Speaker 1: a large proportion of our patients were hypercapnic. Josh works 223 00:14:30,840 --> 00:14:33,760 Speaker 1: in a breathing regiment to increase patients CEO two tolerance. 224 00:14:34,200 --> 00:14:38,680 Speaker 1: It involves changing the duration of inhalations and exhalations, with 225 00:14:38,800 --> 00:14:42,800 Speaker 1: the net effect of expelling less carbon dioxide. David says 226 00:14:42,880 --> 00:14:46,120 Speaker 1: he doesn't know the underlying cause of patient's hypercapnea, but 227 00:14:46,280 --> 00:14:51,080 Speaker 1: the technique helps. Again, this leads back to pat physiology, 228 00:14:51,080 --> 00:14:53,360 Speaker 1: and it's it's a bit of a blank slate, but 229 00:14:54,080 --> 00:14:58,520 Speaker 1: we know that when we increase people's SERO two levels, 230 00:14:58,560 --> 00:15:03,080 Speaker 1: an edge comes off of symptoms. In most cases, figuring 231 00:15:03,080 --> 00:15:06,320 Speaker 1: this out has given patients a way of controlling their symptoms. 232 00:15:06,920 --> 00:15:09,200 Speaker 1: David says that if they feel an attack coming on, 233 00:15:09,680 --> 00:15:13,000 Speaker 1: they can rein in these manifestations faster by focusing on 234 00:15:13,040 --> 00:15:16,080 Speaker 1: their breathing for a couple of minutes. Psychologically, that's a 235 00:15:16,120 --> 00:15:18,680 Speaker 1: big big deal, you know, just being able to say 236 00:15:18,680 --> 00:15:22,080 Speaker 1: I have control over this, as opposed to I have 237 00:15:22,120 --> 00:15:24,680 Speaker 1: almost fainted and I have no idea why, you know 238 00:15:24,800 --> 00:15:28,160 Speaker 1: like that, that is a horrifying feeling to be somewhere 239 00:15:28,200 --> 00:15:31,000 Speaker 1: public and feel like you're going to pass out and 240 00:15:31,080 --> 00:15:33,960 Speaker 1: have no understanding of what's happening to your body. You 241 00:15:34,000 --> 00:15:35,920 Speaker 1: don't want to go to the emergency department for the 242 00:15:35,960 --> 00:15:39,240 Speaker 1: fifth time because you know they're just gonna test everything 243 00:15:39,240 --> 00:15:42,280 Speaker 1: they've already test, give you an I V for hydration, 244 00:15:42,920 --> 00:15:44,800 Speaker 1: and then send you on your way with probably a 245 00:15:44,840 --> 00:15:47,880 Speaker 1: five grand bill. Pulling together a team of specialists with 246 00:15:47,960 --> 00:15:51,240 Speaker 1: wide ranging skills and knowledge is one thing, but getting 247 00:15:51,240 --> 00:15:54,880 Speaker 1: these experts to work collectively to actually help long haulers 248 00:15:55,080 --> 00:15:57,760 Speaker 1: is another. One of the first things David needs to 249 00:15:57,760 --> 00:16:00,480 Speaker 1: figure out is how exactly he's going to offer the 250 00:16:00,560 --> 00:16:04,280 Speaker 1: kind of coordinated holistic care patients need, and then he 251 00:16:04,320 --> 00:16:06,520 Speaker 1: needs to work out how that's going to be delivered. 252 00:16:07,120 --> 00:16:10,280 Speaker 1: Many of his patients are so debilitated that frequent face 253 00:16:10,360 --> 00:16:14,240 Speaker 1: to face therapy sessions just aren't an option. What was 254 00:16:14,440 --> 00:16:19,360 Speaker 1: alarming to me was how, because the medical system is 255 00:16:19,400 --> 00:16:23,920 Speaker 1: really hyper specialized here, um, how many people would just 256 00:16:25,080 --> 00:16:29,640 Speaker 1: be bounced from specialist to specialists without anyone offering a 257 00:16:29,680 --> 00:16:35,000 Speaker 1: treatment or anyone offering a plan. And it was almost 258 00:16:35,040 --> 00:16:38,920 Speaker 1: like a game. You know, Oh, you got sent to me. No, no, no, 259 00:16:38,960 --> 00:16:42,640 Speaker 1: you've got g I symptoms. You know, here's the gastro intrologists. 260 00:16:42,680 --> 00:16:46,280 Speaker 1: You get to the gastro intrologists. Oh, you've got a headache. 261 00:16:46,680 --> 00:16:49,240 Speaker 1: That's a neurology problem. If you go to the neurologist, 262 00:16:50,480 --> 00:16:53,920 Speaker 1: patients typically have to wait three weeks for a specialty appointment. 263 00:16:54,520 --> 00:16:58,520 Speaker 1: Many aren't working, and their insurance is running out, and 264 00:16:58,640 --> 00:17:01,960 Speaker 1: all of this is compared outting their stress. Often by 265 00:17:01,960 --> 00:17:05,439 Speaker 1: the time they made it to our clinic, they're so overwrought, 266 00:17:06,119 --> 00:17:10,720 Speaker 1: um that it's it's a miracle that they're still standing, 267 00:17:11,200 --> 00:17:16,000 Speaker 1: let alone managing this highly debilitating condition. There are no 268 00:17:16,160 --> 00:17:20,000 Speaker 1: established practices and protocols to follow with long COVID patients 269 00:17:20,000 --> 00:17:23,439 Speaker 1: aren't fitting into neat boxes. David finds that you have 270 00:17:23,560 --> 00:17:26,840 Speaker 1: to start with the basics. It's trial by error and 271 00:17:26,880 --> 00:17:30,360 Speaker 1: there are no guarantees of success. He says, being upfront 272 00:17:30,400 --> 00:17:33,399 Speaker 1: and telling patients that from the outset is actually a 273 00:17:33,440 --> 00:17:36,480 Speaker 1: source of comfort, just being able to say, you know what, 274 00:17:37,520 --> 00:17:39,679 Speaker 1: this is what we think is going on. And we 275 00:17:39,720 --> 00:17:42,600 Speaker 1: would always lead with so much uncertainty, like there was 276 00:17:42,640 --> 00:17:46,760 Speaker 1: no this is what's happening to you. It is, here's 277 00:17:46,800 --> 00:17:49,280 Speaker 1: what we think is going on. It's an entirely novel virus. 278 00:17:49,440 --> 00:17:52,679 Speaker 1: I can tell you that I've spoken to a thousand 279 00:17:52,760 --> 00:17:56,800 Speaker 1: other people who have symptoms just like yours. Here's what 280 00:17:56,920 --> 00:18:00,399 Speaker 1: we think is happening, and here's how we're gonna manage 281 00:18:00,400 --> 00:18:03,600 Speaker 1: a few things in the moment. And if these things 282 00:18:03,600 --> 00:18:05,800 Speaker 1: don't work, come back to me, because then we're going 283 00:18:05,880 --> 00:18:12,800 Speaker 1: to try these things. It's really leading with vulnerability. But um, 284 00:18:12,840 --> 00:18:15,560 Speaker 1: all of the patients that we saw which just would 285 00:18:15,560 --> 00:18:18,520 Speaker 1: appreciate it so much to just be like, thank you, 286 00:18:18,640 --> 00:18:22,399 Speaker 1: thank you for not being overconfident, thank you for not 287 00:18:22,520 --> 00:18:26,720 Speaker 1: dismissing my symptoms, thank you for taking a multi system approach. 288 00:18:36,480 --> 00:18:39,440 Speaker 1: David takes that same level of honesty into the two 289 00:18:39,440 --> 00:18:42,000 Speaker 1: clinics he runs of along Haulers in New York City. 290 00:18:42,560 --> 00:18:46,479 Speaker 1: The centers are essentially big, open rooms with various pieces 291 00:18:46,480 --> 00:18:52,600 Speaker 1: of equipment ranging from you know, robotic tilt tables that 292 00:18:52,640 --> 00:18:58,639 Speaker 1: allow us to you know, specifically calibrate exercise for the 293 00:18:58,960 --> 00:19:02,520 Speaker 1: very very severe cases all the way out to treadmills 294 00:19:02,520 --> 00:19:04,520 Speaker 1: for the people who are getting to the point where 295 00:19:04,560 --> 00:19:08,359 Speaker 1: we can start pushing them. There are also devices for 296 00:19:08,400 --> 00:19:13,000 Speaker 1: taking patient measurements, blood pressure cuffs, wholes eximters, and instruments 297 00:19:13,040 --> 00:19:18,040 Speaker 1: to check for hypercapnia. We've got a set of things 298 00:19:18,080 --> 00:19:21,560 Speaker 1: called friends All goggles which allow us to measure the 299 00:19:21,640 --> 00:19:26,040 Speaker 1: vestibular system, your balance system that can identify autonomic nervous 300 00:19:26,080 --> 00:19:29,400 Speaker 1: system problems occurring in patients when they go from sitting 301 00:19:29,560 --> 00:19:33,240 Speaker 1: to standing. For example, the autonomic nervous system being part 302 00:19:33,320 --> 00:19:35,680 Speaker 1: of your nervous system that does all of the things 303 00:19:35,760 --> 00:19:37,760 Speaker 1: that you usually don't need to think about. You know, 304 00:19:37,800 --> 00:19:39,840 Speaker 1: when you should feel hot, when you should feel cold, 305 00:19:39,880 --> 00:19:42,119 Speaker 1: when you should sweat, when your heart should beat, when 306 00:19:42,160 --> 00:19:46,320 Speaker 1: you should breathe, and when that gets disordered, that's when 307 00:19:46,400 --> 00:19:50,119 Speaker 1: all of these odd symptoms start to emerge. Changing body 308 00:19:50,160 --> 00:19:52,919 Speaker 1: positions is often one of the biggest ways to stress 309 00:19:52,960 --> 00:19:56,680 Speaker 1: the autonomic nervous system. David says it's quite a challenging 310 00:19:56,760 --> 00:20:02,000 Speaker 1: thing logistically to get all of the blood vessels to 311 00:20:02,080 --> 00:20:05,800 Speaker 1: open and close and blood pressure to regulate as you're 312 00:20:06,280 --> 00:20:09,879 Speaker 1: moving from sitting to standing. That's actually a really challenging 313 00:20:09,920 --> 00:20:14,080 Speaker 1: thing to do. That Your body does automatically until a 314 00:20:14,160 --> 00:20:16,840 Speaker 1: virus or something or some form of trauma knocks it 315 00:20:16,880 --> 00:20:19,240 Speaker 1: out of balance, and then all of a sudden it 316 00:20:19,320 --> 00:20:23,640 Speaker 1: forgets how to do that. Rehab isn't slow and often 317 00:20:23,680 --> 00:20:28,880 Speaker 1: frustrating process that takes easily days. We start with prehab, 318 00:20:28,920 --> 00:20:32,960 Speaker 1: which is breathwork, so you know, first things first, we 319 00:20:33,040 --> 00:20:36,560 Speaker 1: just make sure that everyone is working on just getting 320 00:20:36,560 --> 00:20:39,480 Speaker 1: their blood gases in a place where they feel like 321 00:20:39,480 --> 00:20:42,720 Speaker 1: they have their symptoms under control. David says that it 322 00:20:42,800 --> 00:20:45,320 Speaker 1: sounds really basic, but it changes to the way you 323 00:20:45,400 --> 00:20:48,919 Speaker 1: breathe and the natural rhythm of your breath have different 324 00:20:48,920 --> 00:20:52,320 Speaker 1: effects on the body. We heard about the technique for hypercapnia, 325 00:20:52,640 --> 00:20:55,600 Speaker 1: but there are others. You know, there's one one protocol, 326 00:20:55,640 --> 00:21:00,439 Speaker 1: for instance, it's called box breathing, which is one of 327 00:21:00,440 --> 00:21:05,639 Speaker 1: the fastest ways to regulate your parasympathetic nervous system. So 328 00:21:05,680 --> 00:21:07,399 Speaker 1: we'll bring your heart right down, it'll bring your blood 329 00:21:07,400 --> 00:21:10,960 Speaker 1: pressure down, and he'll do it quickly. Um. And so 330 00:21:11,600 --> 00:21:14,520 Speaker 1: you know, finding the right breath work protocol for the 331 00:21:14,600 --> 00:21:17,320 Speaker 1: right set of symptoms can sometimes be a bit of 332 00:21:17,320 --> 00:21:22,480 Speaker 1: trial and error, but these things have measurable physiological effects 333 00:21:22,640 --> 00:21:26,880 Speaker 1: and so they can be really powerful. After breathwork, patients 334 00:21:26,960 --> 00:21:29,800 Speaker 1: moved to the first step of the rehab program. In 335 00:21:29,840 --> 00:21:33,320 Speaker 1: most cases, it involves line flight on your back, so 336 00:21:33,400 --> 00:21:39,200 Speaker 1: you're fully recumbent and we just getting gentle leg movements 337 00:21:39,480 --> 00:21:46,120 Speaker 1: going at this point. In most cases, our patients aren't 338 00:21:46,119 --> 00:21:48,560 Speaker 1: their heart rate isn't stable enough for us to use 339 00:21:48,600 --> 00:21:52,720 Speaker 1: heart rate as a guide, so we actually use a 340 00:21:52,840 --> 00:21:55,520 Speaker 1: scale called the Boord scale, which allows you to rate 341 00:21:55,600 --> 00:21:59,600 Speaker 1: received exertion how hard you think you're working. And you know, 342 00:21:59,640 --> 00:22:02,680 Speaker 1: if you think of the scale of you know, once 343 00:22:02,800 --> 00:22:05,560 Speaker 1: ten where well zero to ten where zero is nothing 344 00:22:05,600 --> 00:22:09,560 Speaker 1: and and tenders maximal as hard as you could possibly 345 00:22:09,600 --> 00:22:14,360 Speaker 1: think you're working. Um, we don't let anyone exceeded too 346 00:22:15,320 --> 00:22:18,560 Speaker 1: from their patients move slowly into a more upright position 347 00:22:18,920 --> 00:22:22,399 Speaker 1: and the intensity gradually increases. We get them to a 348 00:22:22,440 --> 00:22:25,000 Speaker 1: point where we actually can use their heart rate as 349 00:22:25,040 --> 00:22:27,480 Speaker 1: a guide. Their heart rate has started to regulate. It's 350 00:22:27,480 --> 00:22:30,600 Speaker 1: not racing all the time and ramping up and ramping down. 351 00:22:30,640 --> 00:22:32,800 Speaker 1: It's starting to regulate, so we can now use it 352 00:22:32,840 --> 00:22:36,840 Speaker 1: as a guide to you know, um, paced the exercise 353 00:22:36,880 --> 00:22:39,720 Speaker 1: the way that we want to. We're now calling it exercise. 354 00:22:40,359 --> 00:22:42,679 Speaker 1: David says that up until this point, the goal of 355 00:22:42,760 --> 00:22:47,000 Speaker 1: the rehabilitation is to slowly condition the autonomic nervous system 356 00:22:47,160 --> 00:22:49,960 Speaker 1: so it gets used to being challenged. What we're trying 357 00:22:50,000 --> 00:22:56,600 Speaker 1: to do is just stress the body enough that the 358 00:22:57,119 --> 00:22:59,400 Speaker 1: that the body has to react. So your heart rate 359 00:22:59,400 --> 00:23:02,640 Speaker 1: needs to read is up. Maybe you need to breathe slightly, 360 00:23:02,680 --> 00:23:06,560 Speaker 1: you know, slightly more. Your respiratory rate might increase by 361 00:23:06,720 --> 00:23:11,320 Speaker 1: one breath per minute. You know, we're talking very little. Um. 362 00:23:11,440 --> 00:23:15,000 Speaker 1: Your body temperature may change slightly, but you're not really 363 00:23:15,960 --> 00:23:19,840 Speaker 1: doing anything difficult. The center tries to help patients within 364 00:23:19,880 --> 00:23:23,040 Speaker 1: the limits of what their insurance will cover. David says 365 00:23:23,119 --> 00:23:26,040 Speaker 1: that usually means capping sessions at two a week, and 366 00:23:26,080 --> 00:23:28,000 Speaker 1: if someone is quite severe, it will be three times 367 00:23:28,000 --> 00:23:31,640 Speaker 1: a week. We tried to do from home where possible 368 00:23:31,840 --> 00:23:37,320 Speaker 1: because um, you know, you just heard what I described right, 369 00:23:37,400 --> 00:23:40,920 Speaker 1: Laying flat on your back and moving your legs. All 370 00:23:40,920 --> 00:23:42,400 Speaker 1: of that is blown out of the water. If I'm 371 00:23:42,400 --> 00:23:44,720 Speaker 1: asking you to leave your apartment and come see me 372 00:23:44,760 --> 00:23:50,119 Speaker 1: in Manhattan, you know, like, that's that's exertion. So you know, 373 00:23:51,080 --> 00:23:55,480 Speaker 1: we we do our absolute best to try to to 374 00:23:55,880 --> 00:24:01,160 Speaker 1: reduce burden on the patient, both financial and physical. Somewhere 375 00:24:01,200 --> 00:24:06,440 Speaker 1: around day one, patients are typically able to work at 376 00:24:06,440 --> 00:24:10,159 Speaker 1: their maximum heart rate. They're on a treadmill or a 377 00:24:10,200 --> 00:24:13,440 Speaker 1: bike or whatever is comfortable for them, and they're getting 378 00:24:13,440 --> 00:24:16,720 Speaker 1: a workout, and that's usually the point where we're like, okay, well, 379 00:24:17,240 --> 00:24:19,880 Speaker 1: these are all your triggers, these are the behaviors, these 380 00:24:19,920 --> 00:24:22,160 Speaker 1: are things to avoid, these are the things to encourage. 381 00:24:23,320 --> 00:24:26,879 Speaker 1: Keep going with the exercise. Every day. There are graduates 382 00:24:26,880 --> 00:24:31,120 Speaker 1: from the program, which is encouraging. I'd say we've at 383 00:24:31,119 --> 00:24:34,440 Speaker 1: this point successfully discharged a few dozen, so probably fifty 384 00:24:34,520 --> 00:24:39,240 Speaker 1: or sixty to the point where they're happy to move on. 385 00:24:39,600 --> 00:24:43,359 Speaker 1: We're happy to let them go. Um. But then yeah, 386 00:24:43,359 --> 00:24:46,360 Speaker 1: there's a large number of people just still in ongoing rehab. 387 00:24:47,000 --> 00:24:50,520 Speaker 1: But for some their symptoms come back after months of treatment, 388 00:24:51,080 --> 00:24:54,360 Speaker 1: and David says that raises questions about the long term 389 00:24:54,359 --> 00:24:58,159 Speaker 1: trajectory for long haulers. Some of our patients who have 390 00:24:58,200 --> 00:25:02,040 Speaker 1: been discharged for the longest their experience relapses. So, you know, 391 00:25:02,760 --> 00:25:05,160 Speaker 1: we need to understand the path of physiology to understand 392 00:25:05,160 --> 00:25:06,639 Speaker 1: how long is this going to be going on for? 393 00:25:07,400 --> 00:25:09,199 Speaker 1: How long are people are going to be symptomatic for. 394 00:25:09,480 --> 00:25:12,159 Speaker 1: Is this something you're gonna have to manage for your 395 00:25:12,280 --> 00:25:14,359 Speaker 1: entire life, or is this something that you're gonna have 396 00:25:14,400 --> 00:25:17,000 Speaker 1: to manage for the next five to ten years. Or 397 00:25:17,119 --> 00:25:19,919 Speaker 1: is this something that we can rehabilitate and we'll just 398 00:25:20,040 --> 00:25:21,560 Speaker 1: charge you and you will never have to think about 399 00:25:21,600 --> 00:25:24,640 Speaker 1: it again. So these are all open questions right now. 400 00:25:25,800 --> 00:25:29,480 Speaker 1: Unlike ASMIR on diabetes, long COVID isn't a chronic disease 401 00:25:29,520 --> 00:25:32,440 Speaker 1: doctors and researchers have known about and studied for decades. 402 00:25:33,040 --> 00:25:35,359 Speaker 1: It's been around for just over a year and a half. 403 00:25:35,880 --> 00:25:38,800 Speaker 1: There's not the accumulated wisdom of published medical studies to 404 00:25:38,840 --> 00:25:41,720 Speaker 1: guide treatment. A lot of it, David says, is about 405 00:25:41,800 --> 00:25:53,200 Speaker 1: learning from patients. So I remember, you know very well, thinking, wow, 406 00:25:53,440 --> 00:25:57,199 Speaker 1: you know, this is someone who was told at some 407 00:25:57,240 --> 00:25:59,240 Speaker 1: point that her family were told that she's not going 408 00:25:59,280 --> 00:26:02,760 Speaker 1: to make it, or they were told that she might 409 00:26:02,840 --> 00:26:04,919 Speaker 1: not come off the breeding machines who might mean the 410 00:26:05,080 --> 00:26:08,359 Speaker 1: long transplant at some point. This is Dr carlord Ismail. 411 00:26:08,840 --> 00:26:11,679 Speaker 1: He's the medical director of the pulmonary division of the 412 00:26:11,680 --> 00:26:15,480 Speaker 1: outpatient tour Ambulatory section where Kelly McCarthy is going for treatment. 413 00:26:16,080 --> 00:26:19,119 Speaker 1: Colored began seeing Kelly in the summer. At the start, 414 00:26:19,560 --> 00:26:22,119 Speaker 1: he found it hard to match his new patient with 415 00:26:22,200 --> 00:26:26,480 Speaker 1: her recent medical history. Here she is walking in clinic 416 00:26:27,200 --> 00:26:30,679 Speaker 1: on her own feet h and having a conversation with 417 00:26:30,720 --> 00:26:33,720 Speaker 1: me that she was in an actually a very cheerful mood, 418 00:26:34,800 --> 00:26:37,720 Speaker 1: much like David's work. Colored describes his approach to helping 419 00:26:37,760 --> 00:26:40,760 Speaker 1: Kellys seems to management that's based on listening to the patient. 420 00:26:41,440 --> 00:26:44,800 Speaker 1: For example, for her memory problems, Kelly's is a neurologist 421 00:26:45,200 --> 00:26:47,480 Speaker 1: a taking images of her brain to look for anything 422 00:26:47,480 --> 00:26:50,440 Speaker 1: else that could be affecting her. But Carlin says, if 423 00:26:50,440 --> 00:26:53,480 Speaker 1: they can't find an underlying cause, they have to use 424 00:26:53,520 --> 00:26:58,280 Speaker 1: the tools available to them. We will probably rely on 425 00:26:58,440 --> 00:27:06,520 Speaker 1: things like neurologic rehab, things that help with memory, memory exercises. 426 00:27:07,320 --> 00:27:10,919 Speaker 1: But there's no telling whether memory exercises and other forms 427 00:27:10,920 --> 00:27:15,240 Speaker 1: of neurological rehab will help the fact is there's still 428 00:27:15,280 --> 00:27:18,040 Speaker 1: a lot of uncertainty around treating Kelly and patients like her. 429 00:27:19,119 --> 00:27:22,240 Speaker 1: It's hard to know. Again, we don't know what's causing it, 430 00:27:22,280 --> 00:27:25,200 Speaker 1: so it's hard to tell how long it's gonna last. 431 00:27:26,000 --> 00:27:28,080 Speaker 1: Kelly says she gets a lot of comfort from the 432 00:27:28,119 --> 00:27:30,200 Speaker 1: case she receives that that bring them in Women's COVID 433 00:27:30,240 --> 00:27:34,440 Speaker 1: Recovery Center, but the ambiguity of getting back to normal 434 00:27:34,600 --> 00:27:37,400 Speaker 1: ways on her. Is it ever going to be normal again? 435 00:27:37,920 --> 00:27:39,359 Speaker 1: Am I ever going to be able to be me? 436 00:27:39,480 --> 00:27:43,240 Speaker 1: And I don't feel like me so and I don't cry, 437 00:27:43,359 --> 00:27:48,320 Speaker 1: but I don't feel like me anymore. It's taking things 438 00:27:48,400 --> 00:27:51,600 Speaker 1: from me that are the most important to me, you know. 439 00:27:53,119 --> 00:27:57,320 Speaker 1: Even as one pandemic of infectious disease rages on another 440 00:27:57,440 --> 00:28:02,080 Speaker 1: scourges accumulating in its way, Long COVID is leaving behind 441 00:28:02,080 --> 00:28:07,960 Speaker 1: a mysterious, pernicious, and ultimately unvaluable wave of chronic, debilitating 442 00:28:07,960 --> 00:28:13,760 Speaker 1: disease that may take years to understand. Treatments don't have 443 00:28:13,840 --> 00:28:39,400 Speaker 1: to wait. That's it for this episode of prognosis Breakthrough. 444 00:28:39,960 --> 00:28:43,560 Speaker 1: On our next episode Long COVID's Legacy, we'll meet too 445 00:28:43,600 --> 00:28:46,800 Speaker 1: best friends who together are navigating the persistent loss of 446 00:28:46,880 --> 00:28:49,760 Speaker 1: smell and what it means for long haulers now and 447 00:28:49,800 --> 00:28:52,880 Speaker 1: in the future. It's been a very very fruitful friendship. 448 00:28:52,920 --> 00:28:55,720 Speaker 1: And then obviously when I got the very sad news 449 00:28:55,760 --> 00:28:59,280 Speaker 1: that Alex was diagnosed with COVID, she Facebook message me. 450 00:28:59,280 --> 00:29:01,200 Speaker 1: I think the message it a bit of fun news. 451 00:29:01,320 --> 00:29:04,480 Speaker 1: I have COVID, so it'll be right, I said, you'll 452 00:29:04,520 --> 00:29:08,960 Speaker 1: get it back. Inside I was panicking. This episode of 453 00:29:09,000 --> 00:29:12,360 Speaker 1: Prognosis Breakthrough was written and reported by me Jason Gale, 454 00:29:12,520 --> 00:29:15,520 Speaker 1: with help from John Leleman. So for Foes is our 455 00:29:15,600 --> 00:29:19,800 Speaker 1: senior producer. Carl Kevin Robinson Jr. Is our associate producer. 456 00:29:20,360 --> 00:29:23,080 Speaker 1: Our theme music was composed and performed by Hannes Brown. 457 00:29:23,720 --> 00:29:26,480 Speaker 1: Rick Shine is our editor. Francesca Levy is the head 458 00:29:26,480 --> 00:29:30,400 Speaker 1: of Blemburg Poadcasts. Be sure to subscribe if you haven't already, 459 00:29:30,760 --> 00:29:33,640 Speaker 1: and if you like this episode, please leave us a review. 460 00:29:33,960 --> 00:29:36,640 Speaker 1: It helps others to find out about the show. Thanks 461 00:29:36,640 --> 00:29:37,160 Speaker 1: for listening.