1 00:00:01,040 --> 00:00:04,560 Speaker 1: It's the early days of the pandemic in and doctor 2 00:00:04,640 --> 00:00:08,479 Speaker 1: Daniel Cherto has a new patient, a twenty six year 3 00:00:08,480 --> 00:00:11,400 Speaker 1: old male who was hospitalized with chance pain. He did 4 00:00:11,440 --> 00:00:14,640 Speaker 1: not present with the typical COVID symptoms, you know, the 5 00:00:14,680 --> 00:00:17,120 Speaker 1: shortness of breath, for fever and all this other stuff. 6 00:00:17,160 --> 00:00:20,639 Speaker 1: It was justice comfort and he tested negative on on 7 00:00:20,720 --> 00:00:24,919 Speaker 1: multiple occasions. Dan runs the Emerging Pathogen Section at the 8 00:00:25,000 --> 00:00:28,920 Speaker 1: National Institutes of Health in Bethesda, Maryland, and if you're 9 00:00:28,960 --> 00:00:32,199 Speaker 1: a COVID case his lab, you're not there for treatment, 10 00:00:32,640 --> 00:00:36,520 Speaker 1: you're the subject of an autopsy. Dan and his team 11 00:00:36,520 --> 00:00:38,440 Speaker 1: are studying this young man as part of a big 12 00:00:38,440 --> 00:00:41,519 Speaker 1: emission to figure out where in the body the coronavirus goes. 13 00:00:42,040 --> 00:00:45,240 Speaker 1: He thinks that by tracing the virus's path and seeing 14 00:00:45,280 --> 00:00:48,720 Speaker 1: what it does, it can understand why it's causing disease 15 00:00:49,120 --> 00:00:52,560 Speaker 1: and how to stop it. Think of it like he's detective, 16 00:00:52,680 --> 00:00:55,200 Speaker 1: trying to collect evidence and looking for the m O 17 00:00:55,280 --> 00:00:59,000 Speaker 1: of a killer before it can strike again. Primary questions 18 00:00:59,160 --> 00:01:03,520 Speaker 1: that were I to address the initial questions are really 19 00:01:03,920 --> 00:01:09,520 Speaker 1: the cellular distribution of the virus across the body and 20 00:01:09,640 --> 00:01:13,520 Speaker 1: the brain. So, in other words, exactly where does the 21 00:01:13,600 --> 00:01:17,480 Speaker 1: virus go, what cell types does it back and really, 22 00:01:17,520 --> 00:01:27,520 Speaker 1: really importantly, how long does the virus stay there. Dan 23 00:01:27,600 --> 00:01:30,280 Speaker 1: and his technique to work fast to get participants like 24 00:01:30,440 --> 00:01:33,520 Speaker 1: his new patient. They have about twenty four hours after 25 00:01:33,560 --> 00:01:36,640 Speaker 1: someone has dyed to study them certain tissues to grate 26 00:01:36,720 --> 00:01:40,959 Speaker 1: quickly after death, destroying the evidence. Getting these patients in 27 00:01:41,040 --> 00:01:45,319 Speaker 1: that time has become a massive logistical undertaking. They first 28 00:01:45,319 --> 00:01:48,520 Speaker 1: talked to the family to get their approval. From there, 29 00:01:48,560 --> 00:01:51,760 Speaker 1: they make arrangements with a funeral home to transport the 30 00:01:51,800 --> 00:01:55,040 Speaker 1: remains to the NIH Clinical Center and Bethesda at least 31 00:01:55,080 --> 00:01:58,760 Speaker 1: set up a call schedule where I might hear about 32 00:01:58,760 --> 00:02:00,920 Speaker 1: these cases. At two o'clock in the morning, communicate with 33 00:02:00,960 --> 00:02:04,880 Speaker 1: our amazing, amazing admissions department, who would facilitate our contract 34 00:02:04,880 --> 00:02:06,320 Speaker 1: funel home and going out in the middle of the 35 00:02:06,480 --> 00:02:08,480 Speaker 1: night bringing bodies here so that my team would be 36 00:02:08,520 --> 00:02:10,880 Speaker 1: suited up. At nine o'clock in the morning on this 37 00:02:11,040 --> 00:02:14,160 Speaker 1: spring day in twenty Dan and his team are in 38 00:02:14,200 --> 00:02:18,079 Speaker 1: a secure along chamber wearing astronaut and spied protective gear 39 00:02:18,560 --> 00:02:22,320 Speaker 1: as they examine their new patient. The man died at 40 00:02:22,360 --> 00:02:26,200 Speaker 1: the hospital and tests were negative for the coronavirus, so 41 00:02:26,320 --> 00:02:30,560 Speaker 1: he doesn't fit the definition of a COVID related fatality. Instead, 42 00:02:30,760 --> 00:02:34,680 Speaker 1: he died of something called viral myokiditis or inflammation of 43 00:02:34,720 --> 00:02:37,360 Speaker 1: the heart muscle. But dances there was a reason he 44 00:02:37,520 --> 00:02:40,240 Speaker 1: still wanted to study him. And at that time you 45 00:02:40,320 --> 00:02:43,160 Speaker 1: probably remembered there were a number of reports in the literature, 46 00:02:43,280 --> 00:02:46,560 Speaker 1: and there were some articles coming out and of imaging 47 00:02:46,600 --> 00:02:50,200 Speaker 1: of the hard and some autopsies, you know, and but 48 00:02:50,360 --> 00:02:55,440 Speaker 1: case reports of viral mild cardiitis being an unusual but 49 00:02:55,440 --> 00:02:59,960 Speaker 1: but present complication of COVID. As they examine his body 50 00:03:00,000 --> 00:03:04,000 Speaker 1: and heart, Dan says there's good evidence COVID is the culprit. 51 00:03:04,560 --> 00:03:07,680 Speaker 1: Not only that the patient offers clues about another condition 52 00:03:07,760 --> 00:03:11,760 Speaker 1: link to the coronavirus. It's called multi system inflammatory syndrome. 53 00:03:12,200 --> 00:03:15,480 Speaker 1: It occurs mostly in children after a saska v TO infection, 54 00:03:15,840 --> 00:03:19,240 Speaker 1: but it's been reported in adults as well. Dan says 55 00:03:19,360 --> 00:03:23,040 Speaker 1: it's a condition that can arise unexpectedly after a mild 56 00:03:23,120 --> 00:03:27,360 Speaker 1: case of COVID. They show up later with sometimes life 57 00:03:27,360 --> 00:03:30,480 Speaker 1: threatening inflammation in different oregans. So in a way he 58 00:03:30,520 --> 00:03:34,200 Speaker 1: fits into that category. And so well, what's driving and 59 00:03:34,280 --> 00:03:37,480 Speaker 1: that is the point of Dan's work performing these autopsies 60 00:03:37,600 --> 00:03:40,640 Speaker 1: is like recreating police sketches and more and more detail. 61 00:03:41,120 --> 00:03:44,440 Speaker 1: With every autopsy, the picture gets clearer of what COVID 62 00:03:44,520 --> 00:03:47,760 Speaker 1: is capable of doing across our bodies and what impact 63 00:03:47,800 --> 00:03:50,080 Speaker 1: it may have on them in the long run. Is 64 00:03:50,080 --> 00:03:53,000 Speaker 1: there going to be, you know, some low level or 65 00:03:53,080 --> 00:03:57,600 Speaker 1: subclinical injury to your heart that then may manifest differently 66 00:03:57,920 --> 00:04:01,280 Speaker 1: later in life. I don't know. Is there going to 67 00:04:01,360 --> 00:04:05,920 Speaker 1: be some subclinical effect on your brain that are going 68 00:04:05,960 --> 00:04:10,040 Speaker 1: to cause nerve cognitive issues later in life that perhaps 69 00:04:10,080 --> 00:04:15,160 Speaker 1: are not immediately noticeable or detectable. If you're going to 70 00:04:15,320 --> 00:04:22,960 Speaker 1: begin to conceive of ways to prevent or treat those manifestations, 71 00:04:23,800 --> 00:04:26,560 Speaker 1: either in the group that the next group that might 72 00:04:26,600 --> 00:04:29,680 Speaker 1: be exposed or among the group that are suffering, you, 73 00:04:29,680 --> 00:04:32,159 Speaker 1: you need to understand mechanism. You need to understand what 74 00:04:32,279 --> 00:04:34,760 Speaker 1: the drivers are. But this work has a long way 75 00:04:34,760 --> 00:04:38,000 Speaker 1: to go. Scientists like Dan are just starting to learn 76 00:04:38,040 --> 00:04:41,200 Speaker 1: the biological means by which siskov two managers to affect 77 00:04:41,480 --> 00:04:45,440 Speaker 1: virtually every organ system in the body. Those infected and 78 00:04:45,600 --> 00:04:51,000 Speaker 1: experience symptoms lasting months and potentially years. The condition is 79 00:04:51,040 --> 00:04:54,960 Speaker 1: called long covid, and Dan's research could help us understand 80 00:04:54,960 --> 00:05:00,599 Speaker 1: how to better combat it. But science is an iterative process. 81 00:05:01,040 --> 00:05:05,000 Speaker 1: New information or clues have to be checked and validated 82 00:05:05,040 --> 00:05:08,719 Speaker 1: before they're accepted as proof, and right now there's a 83 00:05:08,720 --> 00:05:12,400 Speaker 1: ton of information but not a lot of admissible evidence. 84 00:05:13,160 --> 00:05:15,920 Speaker 1: Conflicting theories have popped up over the last year and 85 00:05:15,960 --> 00:05:19,360 Speaker 1: a half, which only shows how much more fact gathering 86 00:05:19,520 --> 00:05:23,200 Speaker 1: needs to be done and resources for critical research like 87 00:05:23,360 --> 00:05:27,560 Speaker 1: autopsies that help us understand new diseases have been stretched 88 00:05:27,600 --> 00:05:31,400 Speaker 1: in It means disease detectives have fewer tools to use 89 00:05:31,440 --> 00:05:34,400 Speaker 1: in that pursuit of the killer. I'm not here to 90 00:05:34,480 --> 00:05:37,040 Speaker 1: service of fear manger. I mean that's not that's not much. 91 00:05:37,320 --> 00:05:45,920 Speaker 1: It's just that these are some under answered questions. I'm 92 00:05:46,000 --> 00:05:49,800 Speaker 1: Jason Gale, chief biosecurity correspondent and a senior editor at 93 00:05:49,800 --> 00:06:08,680 Speaker 1: Bloomberg News. From the Prognosis podcast. This is breakthrough. Pathology 94 00:06:08,680 --> 00:06:11,000 Speaker 1: is one of the sort of fundamental building blocks of medicine. 95 00:06:11,440 --> 00:06:14,039 Speaker 1: This is Dr Linda Isles. She's the head of Forensic 96 00:06:14,040 --> 00:06:18,200 Speaker 1: Pathology Services at the Victorian Institute of Forensic Medicine. It's 97 00:06:18,240 --> 00:06:21,080 Speaker 1: like a medical examiner's office, but this one in Melbourne 98 00:06:21,200 --> 00:06:24,240 Speaker 1: is the largest of its kind in Australia. Linda is 99 00:06:24,279 --> 00:06:27,880 Speaker 1: as heat bespectacled woman with short, salt and pepper hair. 100 00:06:28,400 --> 00:06:31,680 Speaker 1: She finished medical school at the University of Tasmania more 101 00:06:31,720 --> 00:06:34,480 Speaker 1: than twenty years ago and then went on to train 102 00:06:34,520 --> 00:06:39,080 Speaker 1: in anatomical pathology. She estimates she probably did two hundred 103 00:06:39,480 --> 00:06:43,640 Speaker 1: three d autopsies during her training, which if you compare 104 00:06:43,680 --> 00:06:46,919 Speaker 1: that to kind of really old school back in the day, 105 00:06:47,279 --> 00:06:50,120 Speaker 1: then that might not seem like very many. But if 106 00:06:50,160 --> 00:06:53,880 Speaker 1: you compare that to anaton called pathology trainees now, then 107 00:06:53,920 --> 00:06:58,680 Speaker 1: that is a very large amount. These days, pathology trainees 108 00:06:58,720 --> 00:07:03,680 Speaker 1: aren't even required to do autopsies. Fundamentally, autopsies are expensive procedures. 109 00:07:03,920 --> 00:07:07,960 Speaker 1: I think autopsies have been slightly undervalued by clinicians over 110 00:07:08,040 --> 00:07:12,800 Speaker 1: a number of years, even decades perhaps, and as less 111 00:07:12,840 --> 00:07:17,960 Speaker 1: autopsies are requested, less pathologists have experience with autopsies. This 112 00:07:18,080 --> 00:07:22,160 Speaker 1: points to a big problem happening in modern medicine. Autopsies 113 00:07:22,280 --> 00:07:25,480 Speaker 1: have been the bedrock of medical science since at least 114 00:07:25,480 --> 00:07:30,120 Speaker 1: the fifteen hundreds, but today sophisticated imaging and other modern 115 00:07:30,120 --> 00:07:33,720 Speaker 1: diagnostic tools and hospital cost cutting have turned them into 116 00:07:33,760 --> 00:07:37,640 Speaker 1: a dying science. Linda says there are a few reasons 117 00:07:37,640 --> 00:07:40,680 Speaker 1: why autopsies have started to go out of style. One 118 00:07:40,720 --> 00:07:43,880 Speaker 1: of them is that facilities are expensive to maintain at 119 00:07:43,880 --> 00:07:49,640 Speaker 1: a safe standard. So it's this spiral of decreased experience 120 00:07:49,760 --> 00:07:53,440 Speaker 1: and therefore decreasing confidence and then under utilization of the 121 00:07:53,480 --> 00:07:58,160 Speaker 1: facilities to some of the facilities essentially being mothballed, and 122 00:07:58,200 --> 00:08:00,840 Speaker 1: then when you want to reinstat to them, then they're 123 00:08:00,840 --> 00:08:03,360 Speaker 1: no longer really safe for modern practice. So it's sort 124 00:08:03,360 --> 00:08:06,600 Speaker 1: of like this catch twenty two, and now we really 125 00:08:06,680 --> 00:08:10,040 Speaker 1: left with the generation of pathologists that have really quite 126 00:08:10,120 --> 00:08:14,720 Speaker 1: limited autopsy experience, and therefore their confidence in performing autopsies 127 00:08:15,080 --> 00:08:25,239 Speaker 1: safely is significantly diminished. This lack of expertise was only 128 00:08:25,320 --> 00:08:28,440 Speaker 1: exacerbated during the pandemic. In the first few months of 129 00:08:28,480 --> 00:08:32,160 Speaker 1: the outbreak, health authorities warned that doctors would become infected 130 00:08:32,160 --> 00:08:36,800 Speaker 1: while performing autopsies and handling virus laden tissues. That led 131 00:08:36,840 --> 00:08:39,160 Speaker 1: to half of these units shutting down. In the US, 132 00:08:39,760 --> 00:08:42,720 Speaker 1: the same sort of scenario played out across the world. 133 00:08:43,320 --> 00:08:46,200 Speaker 1: In Germany, initially it was like, no, we will definitely 134 00:08:46,280 --> 00:08:49,120 Speaker 1: not autopsy these COVID patients, and then a bunch of 135 00:08:49,160 --> 00:08:51,200 Speaker 1: pathologist said no, we have to do this. Because this 136 00:08:51,280 --> 00:08:54,160 Speaker 1: is a new disease process. And then they just did 137 00:08:54,160 --> 00:08:57,160 Speaker 1: a complete switchero and funded the autopsy program, which is 138 00:08:57,440 --> 00:08:59,800 Speaker 1: where a lot of the really valuable data has actually 139 00:08:59,840 --> 00:09:02,959 Speaker 1: come out of Among the first four million fatal COVID 140 00:09:03,000 --> 00:09:08,080 Speaker 1: cases worldwide, only several hundred were autopsied and the findings 141 00:09:08,160 --> 00:09:11,720 Speaker 1: reported in medical journals. That delayed getting answers to some 142 00:09:11,800 --> 00:09:15,240 Speaker 1: crucial questions about COVID nineteen and its effects in the body. 143 00:09:15,960 --> 00:09:19,760 Speaker 1: The good news is that detailed post mortem investigations are 144 00:09:19,800 --> 00:09:23,080 Speaker 1: picking up now. Linda says this could also bring greater 145 00:09:23,160 --> 00:09:27,040 Speaker 1: awareness the value of autopsy research, whether it's just going 146 00:09:27,040 --> 00:09:28,640 Speaker 1: to be a sort of short term thing or whether 147 00:09:28,679 --> 00:09:31,160 Speaker 1: it's going to translate into something kind of more meaningful. 148 00:09:31,200 --> 00:09:32,640 Speaker 1: I mean, I can only hope that it's going to 149 00:09:32,679 --> 00:09:35,679 Speaker 1: be the ladder. But you know this, the idea that 150 00:09:35,960 --> 00:09:38,400 Speaker 1: novel infectious diseases are a thing of the past is 151 00:09:38,840 --> 00:09:40,640 Speaker 1: you know. I think this has kind of brought this 152 00:09:41,040 --> 00:09:44,400 Speaker 1: certainly front and center for people. Not all doctors waited 153 00:09:44,480 --> 00:09:48,920 Speaker 1: so long before returning to autopsies. Disease detectives like Dancerto 154 00:09:49,280 --> 00:09:52,000 Speaker 1: accepted the risk early on in the pursuit of answers. 155 00:10:03,480 --> 00:10:06,640 Speaker 1: Most of the SHOTS team he's made up of trainees, 156 00:10:07,320 --> 00:10:09,320 Speaker 1: and at the start of the pandemic, he wanted to 157 00:10:09,320 --> 00:10:12,240 Speaker 1: give them the chance to contribute from home if they 158 00:10:12,240 --> 00:10:15,200 Speaker 1: felt more comfortable working that way. I said, we're an 159 00:10:15,200 --> 00:10:18,240 Speaker 1: emerging pathoge in his lab, like there's a pandemic. If 160 00:10:18,280 --> 00:10:20,480 Speaker 1: you want to work remotely, that's okay. But for those 161 00:10:20,520 --> 00:10:22,920 Speaker 1: of you that want to be present on SAITE, these 162 00:10:22,920 --> 00:10:25,199 Speaker 1: are the things we're going to be focusing on. Selectives 163 00:10:25,280 --> 00:10:29,040 Speaker 1: stick around and with rare exception, you know, everybody's like 164 00:10:29,640 --> 00:10:32,560 Speaker 1: we're on deck. Dan himself is used to working in 165 00:10:32,640 --> 00:10:38,400 Speaker 1: dangerous environments. He was in Liberia during the Ebola crisis, 166 00:10:38,720 --> 00:10:43,040 Speaker 1: caring for patients and later studying the virus. Before that, 167 00:10:43,120 --> 00:10:46,360 Speaker 1: he worked on the nineteen eighteen Spanish flu pandemic virus. 168 00:10:47,120 --> 00:10:50,920 Speaker 1: His experience provided a grounding in bio safety that's carried 169 00:10:50,920 --> 00:10:54,840 Speaker 1: through to his personal life. Dan says he takes precautions 170 00:10:54,880 --> 00:10:57,600 Speaker 1: like wearing a face mask when he can't physically distance 171 00:10:57,920 --> 00:11:01,880 Speaker 1: to prevent getting SANSKOVI two. I'm not a risk averse person. 172 00:11:02,000 --> 00:11:06,160 Speaker 1: I'm a believer in calculated and controlled risk, right, but 173 00:11:06,360 --> 00:11:11,400 Speaker 1: I know that my absolute preference for myself, my family, 174 00:11:11,480 --> 00:11:13,840 Speaker 1: my loved ones, my colleagues, my kids. I got an 175 00:11:13,840 --> 00:11:16,160 Speaker 1: eight year old and a twelve year old, my preferences 176 00:11:16,200 --> 00:11:19,280 Speaker 1: for them not to be infected. Dan says he applied 177 00:11:19,320 --> 00:11:22,120 Speaker 1: one hey and I was learned from the Ebola outbreak 178 00:11:22,400 --> 00:11:27,040 Speaker 1: to understanding kinvid nineteen. It started with this idea that 179 00:11:27,480 --> 00:11:29,920 Speaker 1: first we gotta go find where this virus is going, 180 00:11:30,400 --> 00:11:32,480 Speaker 1: what it's doing in those places, and then we got 181 00:11:32,520 --> 00:11:34,560 Speaker 1: to try to link it back to what we're seeing 182 00:11:34,600 --> 00:11:39,200 Speaker 1: clinically and what is coming out with volumes and volumes 183 00:11:39,200 --> 00:11:43,880 Speaker 1: of evidence that we're all struggling to assimilate and trying 184 00:11:43,920 --> 00:11:47,839 Speaker 1: to put those pieces together to to tell a cohesive 185 00:11:48,040 --> 00:11:53,080 Speaker 1: story about the mechanisms that are contributing to severe acute illness, 186 00:11:53,120 --> 00:11:57,760 Speaker 1: to some mild or asymptomatic disease and others, and in 187 00:11:58,200 --> 00:12:01,480 Speaker 1: a reasonable portion of the popular sation of survivors long 188 00:12:01,600 --> 00:12:05,880 Speaker 1: term symptoms that are really distressing. Dan and his group 189 00:12:05,960 --> 00:12:08,640 Speaker 1: are also trying to figure out how the virus and 190 00:12:08,679 --> 00:12:12,040 Speaker 1: the body interact, which is another way of saying, in 191 00:12:12,320 --> 00:12:16,000 Speaker 1: all those locations that you found evidence of RUS, what 192 00:12:16,160 --> 00:12:19,920 Speaker 1: was the body's response. Is there an infiltration of immune 193 00:12:19,920 --> 00:12:23,000 Speaker 1: cells even in the absence of immune cells, is their 194 00:12:23,040 --> 00:12:27,240 Speaker 1: evidence of damage within those tissues or organs, etcetera, etcetera. 195 00:12:27,360 --> 00:12:31,120 Speaker 1: To begin to better understand that relationship between the virus 196 00:12:31,160 --> 00:12:33,720 Speaker 1: and the host the host response. The more you understand 197 00:12:33,800 --> 00:12:37,000 Speaker 1: that relationship, theoretically, the better equip you will be to 198 00:12:37,559 --> 00:12:41,680 Speaker 1: design therapies and interventions that might mitigate aspects of the 199 00:12:41,720 --> 00:12:46,360 Speaker 1: disease course. These postmoneum exams do carry risk, but the 200 00:12:46,480 --> 00:12:51,079 Speaker 1: pathologists from the National Cancer Institute actually performing the autopsies 201 00:12:51,320 --> 00:12:55,480 Speaker 1: have decades of experience. These are the gentlemen of physicians 202 00:12:55,840 --> 00:12:59,040 Speaker 1: and their trainees that that we're here doing autopsies during 203 00:12:59,040 --> 00:13:01,440 Speaker 1: the AIDS era, and these guys were in there doing 204 00:13:01,480 --> 00:13:04,640 Speaker 1: autopsies on hundreds of patients with this new disease, HIV AIDS. 205 00:13:05,280 --> 00:13:07,440 Speaker 1: So we have now the benefit of working with that 206 00:13:07,480 --> 00:13:12,720 Speaker 1: group here now decades later, lots of experience. These aren't 207 00:13:12,760 --> 00:13:16,720 Speaker 1: typical autopsies though they're done over three hours in a 208 00:13:16,800 --> 00:13:20,640 Speaker 1: secure facility. That's required for work involving microbes that can 209 00:13:20,679 --> 00:13:25,800 Speaker 1: cause serious and potentially lethal disease. So our group, the 210 00:13:25,840 --> 00:13:30,240 Speaker 1: pathologists they design home design a grain box, which is 211 00:13:30,320 --> 00:13:33,520 Speaker 1: basically plexiglass with a glove it's like a glove box. 212 00:13:34,000 --> 00:13:37,920 Speaker 1: Bio Engineers on the NIH campus custom build an enclosure 213 00:13:38,000 --> 00:13:40,360 Speaker 1: that fits over the head and shoulders of the deceased 214 00:13:40,640 --> 00:13:44,120 Speaker 1: to contain aerosols when the brain is removed, to cut 215 00:13:44,160 --> 00:13:48,080 Speaker 1: through the skulls. A little bit morbid, but there's aerosolization, right, 216 00:13:48,120 --> 00:13:51,280 Speaker 1: So you don't want to overly contaminate the environment. So 217 00:13:51,440 --> 00:13:54,720 Speaker 1: implementing this thing and working, and this takes some time. 218 00:13:55,400 --> 00:13:58,840 Speaker 1: The seven also doctors, scientists, and technicians working inside the 219 00:13:58,880 --> 00:14:03,920 Speaker 1: autopsy suite, where multiple layers of personal protective equipment, usually 220 00:14:04,040 --> 00:14:08,839 Speaker 1: a plastic apron over a surgical gown, over an impermeable cover, 221 00:14:08,960 --> 00:14:13,439 Speaker 1: all over surgical scrubs. Sometimes arm sleeve protectors are worn. 222 00:14:14,000 --> 00:14:16,640 Speaker 1: They also donned three pairs of gloves and two pairs 223 00:14:16,679 --> 00:14:20,200 Speaker 1: of shoe coverings, and instead of ninety five masks. They're 224 00:14:20,240 --> 00:14:25,040 Speaker 1: breathing through controlled air purifying respirators, which provide heaper filtered 225 00:14:25,080 --> 00:14:28,120 Speaker 1: air under a hood that fits over the head and shoulders. 226 00:14:28,760 --> 00:14:31,960 Speaker 1: It's cumbersome, but it's not the only aspect of these 227 00:14:31,960 --> 00:14:37,040 Speaker 1: COVID autopsies that makes the work painstaking. We're sampling way 228 00:14:37,080 --> 00:14:38,600 Speaker 1: above in the yard. What has done in any sort 229 00:14:38,640 --> 00:14:43,120 Speaker 1: of diffical We sampled almost a hundred different regions within 230 00:14:43,160 --> 00:14:45,800 Speaker 1: the body across the whole body and brings a hundred 231 00:14:45,840 --> 00:14:49,120 Speaker 1: different areas. And for each one of those areas, we 232 00:14:49,280 --> 00:14:53,400 Speaker 1: collected and preserved adjacent pieces of tissue in different ways 233 00:14:53,560 --> 00:14:57,360 Speaker 1: that are amenable to various down stream analysis that preserve 234 00:14:57,440 --> 00:15:00,760 Speaker 1: the tissues in a better way. It's a ton of 235 00:15:00,800 --> 00:15:04,520 Speaker 1: time and energy to analyze these samples, but time is important. 236 00:15:05,040 --> 00:15:07,520 Speaker 1: The first cases of long COVID happened over a year 237 00:15:07,520 --> 00:15:11,280 Speaker 1: and a half ago, and only more developing. The sooner 238 00:15:11,320 --> 00:15:14,600 Speaker 1: we get results from autopsies like Dan's, the Sinner will 239 00:15:14,640 --> 00:15:17,480 Speaker 1: begin to address the long term effects of COVID nineteen. 240 00:15:18,160 --> 00:15:20,600 Speaker 1: Dan's are research will not only help us understand what 241 00:15:20,640 --> 00:15:33,120 Speaker 1: the courses are, but how to counter them. There are 242 00:15:33,120 --> 00:15:35,480 Speaker 1: many theories on white people continue to suffer from a 243 00:15:35,560 --> 00:15:39,880 Speaker 1: multitude of symptoms long after a coronavirus infection. Some are 244 00:15:40,000 --> 00:15:44,400 Speaker 1: easy to explain, others are a mystery. For example, it's 245 00:15:44,440 --> 00:15:46,800 Speaker 1: known that if COVID gave you a severe case of pneumonia, 246 00:15:47,160 --> 00:15:50,119 Speaker 1: your lungs could have scarring that might reduce lung capacity. 247 00:15:50,720 --> 00:15:54,680 Speaker 1: That's an unfortunate consequence of acute respiratory distress syndrome that 248 00:15:54,760 --> 00:15:57,960 Speaker 1: can also occur with the flu. If you were unlucky 249 00:15:58,040 --> 00:16:01,360 Speaker 1: enough to need intensive care, that slinked to muscle weakness, 250 00:16:01,520 --> 00:16:04,840 Speaker 1: memory problems, and a raft of other conditions referred to 251 00:16:04,880 --> 00:16:08,400 Speaker 1: as post intensive care syndrome. And if you were really 252 00:16:08,480 --> 00:16:13,400 Speaker 1: unfortunate and needed mechanical ventilation that's long been associated with 253 00:16:13,480 --> 00:16:17,720 Speaker 1: post traumatic stress disorder. But these aren't the problems baffling 254 00:16:17,760 --> 00:16:22,360 Speaker 1: doctors and researchers. The biggest surprise of COVID is that 255 00:16:22,920 --> 00:16:26,640 Speaker 1: people who are not in the intensive care unit, people 256 00:16:26,760 --> 00:16:30,040 Speaker 1: actually who are never needed to be hospitalized, are still 257 00:16:30,080 --> 00:16:34,560 Speaker 1: having persistent symptoms. This is Dr Walter Kaschatz, who we 258 00:16:34,680 --> 00:16:37,640 Speaker 1: heard from in our last episode. He heads the National 259 00:16:37,720 --> 00:16:41,600 Speaker 1: Institute of Neurological Disorders and Stroke and Bethesda. Walter says 260 00:16:41,760 --> 00:16:45,320 Speaker 1: it's this group of patients, the ones with unexplained fatigue, 261 00:16:45,600 --> 00:16:49,240 Speaker 1: brain fog, weird heart palpitations, and body aches and pains, 262 00:16:49,320 --> 00:16:52,720 Speaker 1: who also represent the largest pool of patients who are 263 00:16:52,760 --> 00:16:57,040 Speaker 1: persistently unwell as a result of the pandemic. The long 264 00:16:57,160 --> 00:17:02,680 Speaker 1: COVID have fatigue. That's the primary, very complaining factor. That's 265 00:17:02,680 --> 00:17:05,680 Speaker 1: true about the post ice use cases, as well, fatigue 266 00:17:06,000 --> 00:17:10,440 Speaker 1: is a major problem, but the long COVID symptom complex 267 00:17:10,680 --> 00:17:15,800 Speaker 1: of fatigue, trouble with memory, travel with thinking quickly, executive function, 268 00:17:16,760 --> 00:17:23,960 Speaker 1: trouble as sleep pain syndromes sometimes, and exercise and tolerance. 269 00:17:24,720 --> 00:17:28,920 Speaker 1: Those are the features of this syndrome that we don't 270 00:17:28,960 --> 00:17:33,600 Speaker 1: have good explanations for at this point. In some ways, 271 00:17:33,680 --> 00:17:37,160 Speaker 1: the disease pattern many long COVID suffers experience resembles mono 272 00:17:37,680 --> 00:17:41,880 Speaker 1: or infectious mononucleosis. It's called glandular fever where I am 273 00:17:41,920 --> 00:17:44,600 Speaker 1: in Australia, and some people refer to it as the 274 00:17:44,680 --> 00:17:48,240 Speaker 1: kissing disease, possibly because it's spread through saliva and often 275 00:17:48,240 --> 00:17:52,880 Speaker 1: occurs in teenagers. The culprit is usually the epstein bea virus. 276 00:17:53,080 --> 00:17:56,080 Speaker 1: It can cause fever, swollen glands in the neck and armpits, 277 00:17:56,280 --> 00:17:59,359 Speaker 1: and a sore throat. Most cases of mono were mild 278 00:17:59,400 --> 00:18:01,800 Speaker 1: and resol of in their own in one to two months, 279 00:18:01,840 --> 00:18:06,000 Speaker 1: but Waltera says that's not always the case with infectious 280 00:18:06,000 --> 00:18:10,040 Speaker 1: mono nucleosis. There is another syndrome which you've probably heard 281 00:18:10,040 --> 00:18:15,160 Speaker 1: about well, realogic can cephalomi elitis chronic critique syndrome and 282 00:18:15,560 --> 00:18:20,080 Speaker 1: symptoms are very overlapping between what long COVID folks are 283 00:18:20,119 --> 00:18:24,400 Speaker 1: complaining of and what happens in NBCFS. It's just that 284 00:18:25,080 --> 00:18:28,960 Speaker 1: MBCFS has a six month period. You have to had 285 00:18:28,960 --> 00:18:32,160 Speaker 1: those symptoms for six months, But it looks like people 286 00:18:32,200 --> 00:18:36,399 Speaker 1: are moving into that space. Waltera says. Researchers have been 287 00:18:36,440 --> 00:18:39,320 Speaker 1: trying for years to figure out the causative driver of 288 00:18:39,400 --> 00:18:42,879 Speaker 1: that longer term illness after infectious morning. Now with the 289 00:18:42,960 --> 00:18:47,480 Speaker 1: thirty four million people with COVID, it's a tremendous challenge 290 00:18:47,560 --> 00:18:49,359 Speaker 1: now that we have to take up to try to 291 00:18:49,440 --> 00:18:53,280 Speaker 1: figure that out. There is now a greater chance that 292 00:18:53,320 --> 00:18:57,199 Speaker 1: we're going to figure it out now because we have 293 00:18:57,320 --> 00:19:00,920 Speaker 1: this opportunity to study so many people and to try 294 00:19:00,920 --> 00:19:05,960 Speaker 1: and understand what differentiates those who get better quickly versus 295 00:19:05,960 --> 00:19:10,080 Speaker 1: those who have these persistent symptoms. So the hope is that, 296 00:19:10,240 --> 00:19:13,639 Speaker 1: you know, we can get some answers that would allow 297 00:19:13,760 --> 00:19:17,960 Speaker 1: us to try different treatments to see what helps and 298 00:19:18,000 --> 00:19:24,600 Speaker 1: then potentially also learns something about what causes NBCFS as well. 299 00:19:25,119 --> 00:19:28,200 Speaker 1: Congress is giving the National Institutes of Health one point 300 00:19:28,280 --> 00:19:32,080 Speaker 1: one five billion dollars over four years to find answers 301 00:19:32,920 --> 00:19:36,160 Speaker 1: Ault along with Dr Anthony Felchi from the National Institute 302 00:19:36,160 --> 00:19:39,479 Speaker 1: of Allergy and Infectious Diseases and Dr Gary Gimmons from 303 00:19:39,520 --> 00:19:43,600 Speaker 1: the National Heart Institute are co directing the research. There's 304 00:19:43,600 --> 00:19:46,240 Speaker 1: a clinical team, that's an autopsy team, that the electronic 305 00:19:46,320 --> 00:19:50,960 Speaker 1: health record team, I know, there's a big data team, 306 00:19:51,000 --> 00:19:53,600 Speaker 1: and there's probably a couple of others, So there's I 307 00:19:53,640 --> 00:19:56,919 Speaker 1: think the estimate was three hundred people have been working 308 00:19:56,960 --> 00:20:01,320 Speaker 1: on this project since November. The amount of money Congress 309 00:20:01,320 --> 00:20:04,200 Speaker 1: has set aside to study long COVID seems a lot, 310 00:20:04,400 --> 00:20:06,919 Speaker 1: but it pales compared with the trillions of dollars the 311 00:20:06,960 --> 00:20:10,600 Speaker 1: pandemic has cost already and the economic toller will have 312 00:20:10,720 --> 00:20:14,240 Speaker 1: decades into the future. Some estimates suggest that more than 313 00:20:14,359 --> 00:20:17,119 Speaker 1: one billion people around the world have been infected with 314 00:20:17,119 --> 00:20:20,720 Speaker 1: the coronavirus. We don't know yet what proportion of them 315 00:20:20,720 --> 00:20:23,920 Speaker 1: will develop long COVID or the duration of their symptoms. 316 00:20:24,600 --> 00:20:27,439 Speaker 1: My gut feeling is that you're probably close to a 317 00:20:27,520 --> 00:20:30,480 Speaker 1: ten percent figuring out about six months out. This is 318 00:20:30,600 --> 00:20:33,960 Speaker 1: Dr RV. Nath He's the clinical director at the National 319 00:20:34,000 --> 00:20:38,480 Speaker 1: Institute of Neurological Disorders and Stroke. The one waterheads people 320 00:20:38,520 --> 00:20:41,119 Speaker 1: do recover or a period of flame on spontaneous people. 321 00:20:41,400 --> 00:20:43,800 Speaker 1: But most often if you're not better by six months, 322 00:20:43,960 --> 00:20:48,120 Speaker 1: then the chances of getting better are become really less. Obviously, 323 00:20:48,119 --> 00:20:53,280 Speaker 1: says the impact on individuals, families, and societies will be 324 00:20:54,960 --> 00:20:56,840 Speaker 1: I mean, nobody's gonna do with the calculations for you, 325 00:20:58,240 --> 00:21:01,080 Speaker 1: but it's a dream on society to get every single level. 326 00:21:01,119 --> 00:21:03,800 Speaker 1: I mean, it affects women more than then. It affects 327 00:21:03,920 --> 00:21:07,240 Speaker 1: people and their average ages forty that's the most productive 328 00:21:07,320 --> 00:21:10,600 Speaker 1: years of your life. And so you can see that 329 00:21:11,040 --> 00:21:15,600 Speaker 1: the impact worldwide impact of this is unbelievable. You couldn't 330 00:21:15,640 --> 00:21:20,760 Speaker 1: translate it to money. The impact is I mean the 331 00:21:20,800 --> 00:21:25,200 Speaker 1: economic toll, the psychological toll. Every aspect of society is 332 00:21:25,240 --> 00:21:29,679 Speaker 1: kind of touched. It's why figuring out the cause and 333 00:21:29,760 --> 00:21:34,360 Speaker 1: waste to treat and prevent long COVID are so critically important. Obviously, 334 00:21:34,600 --> 00:21:38,320 Speaker 1: there could be two main driving forces behind the clinical manifestations. 335 00:21:38,800 --> 00:21:41,560 Speaker 1: One is that the coronavirus manages to persist in the 336 00:21:41,600 --> 00:21:46,200 Speaker 1: body somewhere somehow, and that it's lingering presence is damaging 337 00:21:46,200 --> 00:21:50,200 Speaker 1: the body directly, or it's triggering an immune response that's 338 00:21:50,240 --> 00:21:54,800 Speaker 1: causing the damage. Another hypothesis is that the coronavirus has 339 00:21:54,800 --> 00:21:58,920 Speaker 1: sent the immune system haywire, and it's this disregulated immune 340 00:21:58,920 --> 00:22:03,640 Speaker 1: response that's drive long COVID. I think they're all reasonable hypotheses, 341 00:22:03,720 --> 00:22:07,600 Speaker 1: but they're not exclusive. They could be interrelated. Have He's 342 00:22:07,680 --> 00:22:11,640 Speaker 1: been researching chronic fatigue for years and now he's also 343 00:22:11,680 --> 00:22:15,000 Speaker 1: trying to understand it as well as other elements in 344 00:22:15,080 --> 00:22:18,960 Speaker 1: long COVID patients. One of the interesting features about this 345 00:22:19,080 --> 00:22:21,600 Speaker 1: illness is that if you look at it, the people 346 00:22:21,600 --> 00:22:24,479 Speaker 1: who had were these long haul symptoms are often not 347 00:22:24,560 --> 00:22:27,200 Speaker 1: the individuals who are hospitalized and we're sicking on and 348 00:22:27,280 --> 00:22:30,560 Speaker 1: went later and stuff like that. These are individuals who actually, 349 00:22:30,640 --> 00:22:33,120 Speaker 1: most often they never went to the hospital. They were 350 00:22:33,160 --> 00:22:37,200 Speaker 1: at home and during that time they had relatively mild 351 00:22:37,240 --> 00:22:41,280 Speaker 1: illness in the acute phase and they recovered from it. Obviously, 352 00:22:41,280 --> 00:22:43,480 Speaker 1: says that the people who were sick enough to require 353 00:22:43,560 --> 00:22:47,840 Speaker 1: hospitalization probably mounted a strong immune response that helped them 354 00:22:47,880 --> 00:22:52,280 Speaker 1: to eventually recover and importantly get rid of the virus. 355 00:22:52,520 --> 00:22:55,840 Speaker 1: But if you had a mild illness, perhaps you never 356 00:22:55,920 --> 00:22:59,439 Speaker 1: mounted a strong enough immune response. You thought, oh, you know, 357 00:22:59,520 --> 00:23:02,280 Speaker 1: I escaped, but in reality you've never got rid of 358 00:23:02,280 --> 00:23:06,159 Speaker 1: the virus. Viruses can remain in their infectious form and 359 00:23:06,200 --> 00:23:09,359 Speaker 1: a range of diseases from AIDS to chicken box to 360 00:23:09,480 --> 00:23:13,160 Speaker 1: a bowler. Some sortists say that the coronavirus may cause 361 00:23:13,200 --> 00:23:15,640 Speaker 1: a persistent infection in places like the gas and wind, 362 00:23:15,680 --> 00:23:19,920 Speaker 1: testinal tract, and the nose, but there's no consensus among 363 00:23:20,000 --> 00:23:25,040 Speaker 1: scientists that that's the case, obviously, says Another possibility is 364 00:23:25,080 --> 00:23:28,600 Speaker 1: that what's persisting are viral particles. They may not be 365 00:23:28,600 --> 00:23:32,840 Speaker 1: completely replicating, butter instead expressing some features of the virus. 366 00:23:34,040 --> 00:23:36,320 Speaker 1: Now what the body is going to see it as 367 00:23:36,359 --> 00:23:38,119 Speaker 1: a foreign object, is going to try to mount an 368 00:23:38,119 --> 00:23:42,320 Speaker 1: immune response against. So you've got this conic immune activation 369 00:23:42,400 --> 00:23:44,960 Speaker 1: that persists in these individuals, but it's never good enough 370 00:23:45,000 --> 00:23:46,480 Speaker 1: to get rid of it because they never got river 371 00:23:46,520 --> 00:23:48,840 Speaker 1: in the first place, but it's enough to start causing 372 00:23:48,840 --> 00:23:53,199 Speaker 1: collateral damage. Obviously, the same pattern of immune activation and 373 00:23:53,200 --> 00:23:57,520 Speaker 1: exhaustion in chronic fatigue or m ec effast patients. They 374 00:23:57,560 --> 00:24:00,639 Speaker 1: look very much like these long hold COVID patients, and 375 00:24:00,720 --> 00:24:02,800 Speaker 1: they had the similar problems. They usually start off with 376 00:24:02,960 --> 00:24:05,760 Speaker 1: some violent infection, then they had cover from it, and 377 00:24:05,760 --> 00:24:09,560 Speaker 1: then this thing persists. Whatever. The field of researchers working 378 00:24:09,560 --> 00:24:13,520 Speaker 1: to unravel COVID's mysteries is growing, and it's bringing in 379 00:24:13,640 --> 00:24:19,919 Speaker 1: expertise from all kinds of areas neurology, cardiology, horminology, and 380 00:24:20,040 --> 00:24:31,680 Speaker 1: infectious diseases that includes HIV. Medicine Professor Steve Deetz has 381 00:24:31,720 --> 00:24:35,560 Speaker 1: been researching a cure for HIV for almost thirty years 382 00:24:35,600 --> 00:24:40,120 Speaker 1: at the University of California, San Francisco. When the pandemic hit, 383 00:24:40,520 --> 00:24:43,520 Speaker 1: Steve took notice. We had no idea what was going 384 00:24:43,560 --> 00:24:45,280 Speaker 1: to go on with Sariskoby too, but we knew it 385 00:24:45,280 --> 00:24:47,440 Speaker 1: was a big deal, and we had a good sense 386 00:24:47,480 --> 00:24:50,800 Speaker 1: that they're probably going to be some long term content places. 387 00:24:50,840 --> 00:24:54,840 Speaker 1: Everybody was focused on short term. Steve began enrolling patients 388 00:24:54,960 --> 00:24:58,879 Speaker 1: in a study aimed at identifying how saskov two affects 389 00:24:59,040 --> 00:25:03,000 Speaker 1: long term health. Subset have long COVID and some don't, 390 00:25:03,560 --> 00:25:06,040 Speaker 1: and we're beginning to do the biology. And one of 391 00:25:06,040 --> 00:25:10,000 Speaker 1: our leading hypotheses is that the virus does persist in 392 00:25:10,080 --> 00:25:14,400 Speaker 1: some people for some reason, and that that persistent virus 393 00:25:14,480 --> 00:25:17,960 Speaker 1: initiates an inflammatory process. At the heart of all this 394 00:25:18,040 --> 00:25:22,320 Speaker 1: has always been the concern that there is something that 395 00:25:22,440 --> 00:25:27,480 Speaker 1: persists and stimulates that a normal response. Steve thinks the 396 00:25:27,520 --> 00:25:31,920 Speaker 1: coronavirus might be leaving traces behind. It could be viral protein, 397 00:25:32,440 --> 00:25:36,320 Speaker 1: strands of its genetic material, or even bits of antigen 398 00:25:36,480 --> 00:25:40,000 Speaker 1: that the immune system responds to. We don't think it's 399 00:25:40,080 --> 00:25:42,680 Speaker 1: virus replication, but I guess it could be virus that's 400 00:25:42,720 --> 00:25:46,360 Speaker 1: replicating in target cells and tissues. We always thought that 401 00:25:46,359 --> 00:25:50,000 Speaker 1: that was a potential reason for why this symptoms persists. 402 00:25:50,560 --> 00:25:54,719 Speaker 1: Steve says Dan's research when it's published, could have significant 403 00:25:54,760 --> 00:26:00,359 Speaker 1: implications for treatment. If the experts out there tell me, yes, 404 00:26:00,640 --> 00:26:07,159 Speaker 1: we think that there is a persistent repository of virus protein, 405 00:26:07,320 --> 00:26:11,119 Speaker 1: nucleic acid, or even virus replication, then for me it's 406 00:26:11,160 --> 00:26:15,080 Speaker 1: easy to say, okay, well then thousand ways and that 407 00:26:15,119 --> 00:26:17,760 Speaker 1: can cause long COVID. We need to give people an 408 00:26:17,760 --> 00:26:20,119 Speaker 1: anti virus. We need to get people antibodies or therapy 409 00:26:20,240 --> 00:26:22,720 Speaker 1: vaccine and see if they get better. And that's what 410 00:26:22,760 --> 00:26:26,080 Speaker 1: we're planning on doing. But we need more rational. We 411 00:26:26,160 --> 00:26:30,240 Speaker 1: need a paper from the NIH saying, you know, with 412 00:26:30,440 --> 00:26:33,840 Speaker 1: ni H level standards, yes, indeed some people have virus. 413 00:26:33,920 --> 00:26:36,399 Speaker 1: And if they tell me that these people virus also 414 00:26:36,480 --> 00:26:40,480 Speaker 1: had symptoms, well, that would be helpful. Steve says. Circumstantial 415 00:26:40,520 --> 00:26:45,000 Speaker 1: evidence supports the concept that there's something persistent that's causing 416 00:26:45,080 --> 00:26:48,080 Speaker 1: long covids. All these ancdotes out there about people who 417 00:26:48,080 --> 00:26:50,080 Speaker 1: have long COVID and get a vaccine and get better, 418 00:26:50,520 --> 00:26:52,800 Speaker 1: and the only way to explain that is that there's 419 00:26:52,840 --> 00:26:56,760 Speaker 1: persistent virus that's not being cleared by the immune system, 420 00:26:56,800 --> 00:26:59,399 Speaker 1: and the vaccine makes the immune system better and the 421 00:26:59,480 --> 00:27:01,960 Speaker 1: virus goes away and they're healthier. And if we can 422 00:27:02,000 --> 00:27:04,480 Speaker 1: prove it, then me as a as a clinical trial, 423 00:27:04,520 --> 00:27:06,280 Speaker 1: as can do all the clinical trials, we can look 424 00:27:06,320 --> 00:27:09,680 Speaker 1: at any of these anthem virals, any of these antibodies, 425 00:27:09,800 --> 00:27:12,600 Speaker 1: and these vaccines, they all should help. Well. It's a 426 00:27:12,680 --> 00:27:14,760 Speaker 1: very important study and I hope it comes out soon. 427 00:27:20,000 --> 00:27:23,160 Speaker 1: Deep in his lab, Dancoto and his team have amassed 428 00:27:23,200 --> 00:27:27,960 Speaker 1: more than ten thousand autopsy specimens for meticulous study. Their 429 00:27:27,960 --> 00:27:31,280 Speaker 1: analysis is beginning to yield some answers to the many 430 00:27:31,359 --> 00:27:35,040 Speaker 1: questions around long COVID and what causes it. They know 431 00:27:35,119 --> 00:27:37,760 Speaker 1: that the research tools will have in years from now 432 00:27:38,000 --> 00:27:41,360 Speaker 1: will provide even greater insight, which is why a big 433 00:27:41,400 --> 00:27:44,280 Speaker 1: part of their work as involved careful preservation of the 434 00:27:44,320 --> 00:27:48,199 Speaker 1: samples collected from each patient. For instance, some tissues go 435 00:27:48,240 --> 00:27:52,240 Speaker 1: into a solution that preserves nuclinic asset. The virus is 436 00:27:52,320 --> 00:27:55,800 Speaker 1: genetic material, and then we use a highly sensitive PCR 437 00:27:56,040 --> 00:27:59,240 Speaker 1: essay to query presence or absence of all orn and 438 00:27:59,280 --> 00:28:02,639 Speaker 1: those tissues, and Dance group is going further to see 439 00:28:03,040 --> 00:28:05,639 Speaker 1: if the virus that's collected from different areas of the 440 00:28:05,680 --> 00:28:11,959 Speaker 1: body is still infectious. Can we actually get viable virus? 441 00:28:12,000 --> 00:28:15,639 Speaker 1: Can we grow virus from from these different sites we've done, 442 00:28:15,880 --> 00:28:19,280 Speaker 1: you know, simply put a much more extensive sampling than 443 00:28:19,400 --> 00:28:23,439 Speaker 1: than others have. The data from the biospecimens are also 444 00:28:23,560 --> 00:28:28,000 Speaker 1: matched with patient records, including genetic tests used to identify 445 00:28:28,280 --> 00:28:32,000 Speaker 1: certain individual variations in a person's immune system. You have 446 00:28:32,440 --> 00:28:35,800 Speaker 1: individuals as young as six years old, very very sad 447 00:28:35,920 --> 00:28:40,640 Speaker 1: to beyond ninety years old. It's diverse, you know, across 448 00:28:40,720 --> 00:28:45,240 Speaker 1: gender and raise and ethnicity. It's diverse across a really 449 00:28:45,280 --> 00:28:51,680 Speaker 1: important parameter, which is when we perform the autopsy relevant 450 00:28:51,840 --> 00:28:56,000 Speaker 1: to symptom on set from COVID. There have now been 451 00:28:56,160 --> 00:28:59,840 Speaker 1: dozens of studies published based on autopsy findings that have 452 00:29:00,040 --> 00:29:02,680 Speaker 1: added data points to a map showing where the virus 453 00:29:02,760 --> 00:29:06,240 Speaker 1: is going and what it's doing across the body. Others 454 00:29:06,240 --> 00:29:09,680 Speaker 1: have done a very good job of creating the outline 455 00:29:09,760 --> 00:29:12,760 Speaker 1: of that map of where the virus goes, what cell types, 456 00:29:13,160 --> 00:29:15,680 Speaker 1: you know, how long it sticks. We intend to put 457 00:29:15,680 --> 00:29:17,680 Speaker 1: some more spots on that map, you know, to help 458 00:29:18,000 --> 00:29:19,840 Speaker 1: to help kind of fill it in both as far 459 00:29:19,880 --> 00:29:24,080 Speaker 1: as different locations, different cell types, period of time. You 460 00:29:24,080 --> 00:29:28,160 Speaker 1: know that that researchers can then use moving forward. It's 461 00:29:28,280 --> 00:29:31,760 Speaker 1: already clear to day that Sasko vie too spreads through 462 00:29:31,800 --> 00:29:35,320 Speaker 1: the body wider than previously thought in patients with mild 463 00:29:35,480 --> 00:29:39,200 Speaker 1: or even no symptoms. I think we're operating under the 464 00:29:39,240 --> 00:29:43,320 Speaker 1: impression that for the most part, the virus is contained 465 00:29:43,480 --> 00:29:46,080 Speaker 1: in the respiery track, perhaps just the upper row story track, 466 00:29:46,200 --> 00:29:48,240 Speaker 1: never makes it to its lungs and then doesn't go 467 00:29:48,320 --> 00:29:50,920 Speaker 1: past that right like, it doesn't get into the bloodstream, 468 00:29:50,960 --> 00:29:53,200 Speaker 1: it doesn't distribute to other parts of the body, and 469 00:29:53,200 --> 00:29:55,240 Speaker 1: then you clear it, you know, you're better. I'm not 470 00:29:55,320 --> 00:29:57,880 Speaker 1: sure that's the case. There's not a lot of evidence 471 00:29:57,920 --> 00:30:01,360 Speaker 1: in this space, and says some of the patients who 472 00:30:01,480 --> 00:30:06,120 Speaker 1: died with rather than rome COVID will provide some insight 473 00:30:06,200 --> 00:30:10,480 Speaker 1: into that. Those are issues that we cannot just assume. 474 00:30:10,640 --> 00:30:14,800 Speaker 1: One thing and the implications of that are important because 475 00:30:15,120 --> 00:30:18,800 Speaker 1: if you are mildly symptomatic or asymptomatic, but you actually 476 00:30:18,880 --> 00:30:21,719 Speaker 1: do have a period of iramia or the virus tropes 477 00:30:22,040 --> 00:30:24,360 Speaker 1: to different parts of your body and then you know, 478 00:30:24,480 --> 00:30:27,680 Speaker 1: you feel better, but actually the virus is persisting for 479 00:30:27,720 --> 00:30:31,200 Speaker 1: a certain period of time and causing injury or the 480 00:30:31,200 --> 00:30:34,160 Speaker 1: body's response to clear that virus is contributing to some 481 00:30:34,720 --> 00:30:39,600 Speaker 1: you know, pathogenic mechanism that is, you know, manifesting as 482 00:30:39,680 --> 00:30:43,120 Speaker 1: long COVID symptoms. We gotta we gotta know that, right, 483 00:30:43,560 --> 00:30:46,440 Speaker 1: We got we gotta know that because without knowing it, 484 00:30:46,480 --> 00:30:48,920 Speaker 1: how are we going to address it? Right? And so 485 00:30:48,920 --> 00:30:50,600 Speaker 1: so we got to begin to kind of turn these 486 00:30:50,600 --> 00:30:52,680 Speaker 1: pages of the book, like peel the layers off the 487 00:30:52,680 --> 00:30:56,400 Speaker 1: onion and try to answer some of these questions. Dances. 488 00:30:56,480 --> 00:30:59,560 Speaker 1: A manuscript based on the young man with Manadas is 489 00:30:59,640 --> 00:31:03,000 Speaker 1: under a valuation by a scientific journal. A paper on 490 00:31:03,080 --> 00:31:06,240 Speaker 1: what his team found looking specifically at the eye is 491 00:31:06,360 --> 00:31:10,280 Speaker 1: undergoing co author review and will be submitted shortly. His 492 00:31:10,560 --> 00:31:13,400 Speaker 1: larger project, providing a map of where the virus is 493 00:31:13,440 --> 00:31:17,400 Speaker 1: going in the body, is pending more data across anatomical sites. 494 00:31:18,080 --> 00:31:21,160 Speaker 1: Dan says he expects this last bit of information shortly 495 00:31:21,600 --> 00:31:24,960 Speaker 1: and then can finish your manuscript. But evidence pointing to 496 00:31:25,000 --> 00:31:28,000 Speaker 1: the causes of long COVID are of little help to 497 00:31:28,080 --> 00:31:50,920 Speaker 1: patience unless the findings in yield ways to help them. 498 00:31:50,960 --> 00:31:53,880 Speaker 1: Next week on Breakthrough, doctors and physical therapists in New 499 00:31:53,960 --> 00:31:56,719 Speaker 1: York are working on strategies to help long haulers manage 500 00:31:56,760 --> 00:32:00,160 Speaker 1: their symptoms. Even though a cure remains a loop us 501 00:32:00,880 --> 00:32:04,120 Speaker 1: thinking outside the box. It's bringing a variety of innovative 502 00:32:04,440 --> 00:32:09,320 Speaker 1: and successful therapeutic options. Some of our patients who have 503 00:32:09,360 --> 00:32:13,240 Speaker 1: been discharged for the longest, they're experiencing relapses. So is 504 00:32:13,280 --> 00:32:16,560 Speaker 1: this something you're gonna have to manage for your entire life, 505 00:32:16,800 --> 00:32:18,480 Speaker 1: or is this something that you're gonna have to manage 506 00:32:18,520 --> 00:32:20,960 Speaker 1: for the next five to ten years. Or is this 507 00:32:21,120 --> 00:32:24,160 Speaker 1: something that we can rehabilitate and we'll discharge you and 508 00:32:24,200 --> 00:32:26,000 Speaker 1: you will never have to think about it again. So 509 00:32:26,080 --> 00:32:43,960 Speaker 1: these are all open questions right now. This episode of 510 00:32:43,960 --> 00:32:47,800 Speaker 1: Prognosis Breakthrough was written and reported by me Jason Gale 511 00:32:48,160 --> 00:32:51,560 Speaker 1: So for four Heads is our senior producer. Carl Kevin 512 00:32:51,640 --> 00:32:55,960 Speaker 1: Robinson Jr. Is our associate producer. Theme music was composed 513 00:32:55,960 --> 00:33:00,160 Speaker 1: and performed by Hannes Brown Rich Shiners editor Franchise get 514 00:33:00,240 --> 00:33:03,400 Speaker 1: Leavy is the head of Bloomberg Podcasts. Be sure to 515 00:33:03,440 --> 00:33:06,800 Speaker 1: subscribe if you haven't already, and if you liked this episode, 516 00:33:06,960 --> 00:33:09,640 Speaker 1: please leave us a review. It helps others find out 517 00:33:09,640 --> 00:33:11,560 Speaker 1: about the show. Thanks for listening.