Long Covid

Stan: Hello everyone and welcome to health chatter today's show is as long as COVID which is a show that's probably overdue, but we finally got to it and we've got two great experts with us today that will be sharing their thoughts about it. We've got a great crew that always puts, our shows in really good shape. And they include Maddie Levine-Wolf and Erin Collins. Sheridan Nygard, Deondra Howard, and Matthew Campbell, thanks to all of you guys. They either are involved in research for the background for the show, or marketing or production. So it's a great, wonderful crew. And thank you very, very, very much. Clarence Jones is my partner in crime on this show. It's a great, great honor to work with him during these episodes this is Episode 68, which is amazing. We've been at it that long. So, Clarence, it's always great. So thank you. And then of course, there's Humana Partnership, which is a community organization involved in health issues in our community. They're a great organization. They help sponsor, our health chatter broadcast for you the listening audience to thank you. You can check them out at huepartnership.org  So thank you to everybody. So all right. Today we have two great guests, colleagues of mine that I have worked with for a long time, J. Desai, and Kate Murray Jay, head up the chronic disease epidemiologist at the Minnesota Department of Health. He received his doctorate in Epi, Epidemiology from the University of Minnesota and currently leads the Minnesota Department of Health long COVID program, along with other things Sickle Cell Data Collection, the Minnesota cancer reporting system, et cetera. He's been involved in a lot of things I worked with Jay when he was at the health department, and it’s the first round when he was involved with the diabetes unit. And we were great, great colleagues. I've always been impressed with Jay, because somehow or other he always asks the good, hard questions, and we don't always have the answers. But at any rate, he always asks great questions. So Thanks, Jay, for being with us, Kate Murray, Program Manager for lawn COVID and post-COVID conditions at the Minnesota Department of Health. She She spent a long time dealing with with COVID when at the Department of Health, a 20-month assignment. At the Department of Health, when everything was going kind of crazy. And everything was there were a lot of a lot of things to do for sure. She holds a master's in public health and Administration and Policy from the University of Minnesota, and a Bachelor of Science in Biology and health sciences from South Dakota State University. So I want to thank you both sincerely for being on health chatter. So I'm going to start this out by asking this simple question. Long COVID So here we go. It's like I don't understand why we don't have long flu. long, cold, long, allergies, long, whatever. So what is this deal with long? What is it just something that was dubbed for for COVID? Or what's what's the deal here? Where did this long idea come from Casio? People get sick and they have the symptoms afterward Alliant lot of different a variety of different diseases and entities but why long specifically for COVID? Do you think one of you has an idea for that one? 

Kate Murray: Yeah, that's a great question, Stan. And actually, this is not a new phenomenon. There is a long flu there is. So yeah, so postinfectious acute infection chronic disease is not is not unique to COVID. In fact, a lot of the communities of folks who are disabled after things like influenza or other SARS viruses, MERS, a lot of viruses, and some bacterial infections can result in these chronic diseases. So these advocacy groups when the pandemic started, were The first to say, hey, you need to keep an eye out for these long-term impacts of this virus, especially as kind of a novel virus new to our bodies. And indeed, it looks like some of the earliest waves of COVID have resulted in some of the biggest waves of blonde COVID as well, we are still seeing it with the more quote unquote, milder variants like Omicron. But again, it's it's not a new a new phenomenon, but just the magnitude of infections and the number of people who have been impacted and even disabled by this, is getting more attention than than it has ever before.

Stan: So this idea of long is not new, but maybe it's more in front of our faces just because of what COVID did for for all of us. Alright, so Jay, take this off. What exactly is long? COVID?

Jay Desai: Oh, my, that's that's the question that we're still trying to figure out. Right. And so there are a couple of definitions that get used out there. One is by the CDC. And it is a definition of people still experiencing symptoms after a COVID infection. So you have to have had COVID, four weeks or longer after a COVID infection. So after the acute phase and those symptoms, there's a whole variety of symptoms. So we can get into that later. I mean, there's probably over 200 different symptoms that have been reported. And in some are more common than others and things that you hear about loss of taste, loss of smell, brain fog fatigue, are some of the more common ones that you hear. But there's still a variety of symptoms. So that's, you know, four weeks or longer is the CDC is definition, the World Health Organization has a definition of 12 weeks or longer, so about three months, where the symptoms are persistent for that length. So in general, those are sort of the predominant definitions of long COVID what we've been looking for. But again, it is a symptom-based condition. Right now, there isn't a biological test that you can take that tells you whether you have it or not. It's just how these different symptoms present, and how long they last. So who tells you in other words, and I'll talk about that, because I have one of them. And it's an interesting one. Clarence, go ahead.

Clarence Jones: Yeah. So I just like to say I'd like to go back again, J to what you was trying to talk about some of the symptoms of of long COVID. Now, so when you get COVID, can you tell the difference? Can you tell if you don't have just regular COVID are longtime COVID.

Jay Desai: You know, some of the symptoms that you have during the acute phase. So within four weeks after being infected, some of those continue to persist beyond those four weeks, or even beyond the three months. So often those symptoms can be very similar. But then there could be symptoms that come up that you didn't have during the acute phase as well. And so that's what also makes it kind of challenging as you could have some new symptoms that are presenting, or that just, you began paying attention to and recognizing after your acute symptoms have gone away that you've still got some of these lingering things like fatigue that you don't expect to have. So they can be similar. Do they just carry on?

Clarence Jones:  But they had some other kinds of strange things happening during this period of time, where there are other other viruses that came up during this period that we don't talk about as much.

Kate Murray: Go ahead, okay. Certainly, some people we know had co infections with influenza and COVID. We also know there were probably a lot of people who did have COVID, and maybe didn't get it confirmed by a test either because, you know, testing wasn't available. They didn't have access to testing. Maybe they tested once with rapid antigen tests, but it was too early for their viral load to actually be detected. So we do hear a lot of people who are saying, well, I've got these complications, these issues that are happening, but I haven't had COVID But I did have this really bad cough and respiratory infection and it just went on for weeks, you know. So that is one of the trickiest pieces. As Jay said, you know, one of the only things we know for sure about long COVID Is that you had we've had a code infection first and it can be really hard to actually confirm and measure who has had COVID at this point plus reinfections. You know, people are getting COVID Two, three more times at this point.

Jay Desai: Yeah, and you know, this is a concern that is probably going to be growing, as we aren't testing as often. And so people are going to be feeling the symptoms, right? They may be mild, moderate, may even be asymptomatic, but could still be related to COVID, we're just not testing for them anymore. And so just trying to be more aware that if you feel bad at some point, and then it continues that maybe there was something COVID related that happened.

Stan Shanedling: So let's talk about testing a little bit. Because, you know, I certainly remember when I was at the health department, all the different types of testing everything from the tests, not being available yet to tests, where you would go to a clinic, or a particular site, all the way down to, you know, at home, at home tests. And, you know, one of the things that really was curious to me was, you know, access, you know, this whole, this whole idea of access to the tests, you know, like, I remember, you know, schlepping to the airport, because, you know, my wife and I, we had to get over to Israel, because a family member had passed away, we had an oh my god, the testing that we had to go through, before traveling, and then when we were there, and then before we came back, and I also remember, and this is me talking now, I also remember, at the very, very front end of COVID, I had a cough, that I swear to God, it must have lasted forever, it just seemed like would not go away. And this is before COVID really started hitting the scene, so to speak. And so that so now I reflect back, and I'm thinking, wow, my mind, I have had it back there. Alright, so let's, let's talk about long COVID as it relates to testing, okay, so it's like, for instance, if I were to have long COVID, should I continue to test every once in a while just to see if I'm harboring anything? Or should I just go with the flow at this point?

Kate Murray:  That's a good question. And there are still questions around sort of persistent positive tests, because we know that for some folks, there's a window where it seems like it's resolved, but they're testing positive. So that said, we are seeing one of the going theories for long COVID is viral persistence, now, particularly in the gut, and in some other tissues, where it might not even necessarily be replicating, but those proteins are still causing an immune response. And this inflammation and kind of over response may be what's causing some of these subtypes of long COVID. So in terms of testing, I mean, you may not be still able to spread the infection, if you know it's gotten better. But I know that some of the guidelines for when to test and when to stop testing have shifted.

Stan: Okay, so Kate, so for our listening audience, if you have symptoms of any of the syndrome, we'll get into that in a moment here. Any of the symptoms of long COVID? But you're over that acute stage? Is it fair to say that you are not contagious?

Kate Murray: I don't know if we know the answer to that yet. I think I'm okay. You know, most people with long COVID do not generate enough virus that they could infect other people. It's interesting, they've experimented with even like COVID sniffing dogs, and they have found that these dogs can detect COVID In people with lung COVID. But they test negative at that point. So they're not producing enough virus to spread the infection. But there's still some reaction going on inside their body. And indeed, these dogs are picking up on it as well.

Stan: Yeah, well, my dog has not picked up on it for sure. Okay, Clarence. 

Clarence Jones: So you know, this is really kind of the overwhelming topic. Okay. Let me tell you why. Because j is already said, Katie, probably to have said, You got over 200 symptoms, you know, that that would indicate this and, and, you know, was so much going on? I mean, it seemed like well, even if a bunk comes up on my nose, I mean, she had to be testing but COVID I mean, it's, you know, I'm saying I mean, it's like, it gets to be very, very overwhelming. And so my question to you, is, in very simply, I am and I come from a community perspective. is, you know, really what should we be doing? I mean, you know, you know, saying we know that they exist, we know that it impacts us. I mean, what should we really be doing? I mean, there's so much fake news going out here. You know, it's good to hear from you. What we, you know, bottom line, kind of sort of what we should do? Yeah,

Kate Murray: absolutely. And, of course, that is what people always ask like, well, then what if I think I have this or if I test positive for COVID, which should I be doing. And one, we do hope people keep testing because it is to confirm if you have a COVID infection or not, and to tell the provider that you've tested positive, so they can put it in your medical record. But also then just keeping an eye on symptoms as you recover. And if you have what seems like symptoms of lung COVID, to talk to a provider if you can, because of like this nebulous nature of lung COVID, you know, a lot of these symptoms overlap with other chronic conditions. And so it is important that a provider rule out other things like diabetes, or a thyroid issue, or something else going on as well, I think the most extreme dramatic case of that we've heard was somebody who thought they had long COVID And kind of avoided care, but then it turned out to be a brain tumor. So you don't want to miss something really serious that's going on underneath if you're having these symptoms. And also, you know, providers are still learning about lung COVID. You know, MDH, is really trying to help spread the word about lung COVID, including two providers, but there are providers out there who can help manage and even relieve some of the symptoms of long COVID. There are some medications, different therapies, even changes in diet that people can do that can help alleviate some of the symptoms, or just learned to manage them better, and figure out how they can still thrive while they're having these symptoms. So really, just to believe that this is a real thing and take it seriously. And particularly if you find yourself struggling with this brain fog or fatigue, not to seek care, but also to seek support. So for a lot of people, you know, help with childcare or household tasks, potentially workplace accommodations can really be a game changer for them as they recover. Because one of the other tricky parts of this too, and you you know, alluded to this with the definition is that it's very nebulous, and there probably are going to be a lot of people who get COVID, or some other infection, and it's going to take them several weeks, or maybe even a few months to get all the way better. But they may ultimately eventually return to baseline health. There is a subset of folks who is who are being disabled by these infections in their symptoms. They may even seem like the acute infection resolves, and they start having these new symptoms several weeks or even a few months later. And that's kind of this used to be called chronic fatigue syndrome, they now call it my allergic and Cephalo, myelitis or MECFS. For those folks, their symptoms do not get better, and they may even get worse to the point of disability. And what can hasten that trajectory is trying to push through those symptoms and trying to return to normal. Go back to your exercise routine. You know, we've got we see this in a lot of overachievers, frankly, they tried to push through it, and then they ended up getting worse and worse. So definitely just pay attention and take it seriously. Stay up to date on your vaccinations. And then seek that care and support if you need it.

Stan: So Alright, so here's a personal story. So listening audience, I my wife and I both got COVID when when we were on vacation of the end in Alaska, and you know, of course, you gotta go through the whole the whole nine yards of isolating and that whole thing for my wife, she got she got over it now. And that was it for me. I lost my sense of taste and smell. Okay, so now, at first I asked myself, Well, geez, you know, this isn't so unusual because I have allergies to you know, and sometimes when you have allergies, you can't always smell really well or taste very well. But now it's been it's been lingering on. And it's an interesting phenomenon because you still feel hungry. Okay, you have you know, you want to eat, but you know, you could be eating, you know, garbage for all that matter because you can't taste anything. Okay. There are certain things though. You know, for those of you who might be suffering from this, there are certain things that have a tendency to help lemon drops, believe it or not, because it has a stronger taste to it helps and it also helps to create more saliva. And also ironically I can taste pickles of all things. And also, between lemon drops and pickles, I'm having a really hell of a good time. But it is, for those of you who have these, though these particulars of it is getting better, it's slow. But it's getting better. The other thing that I've noticed, and this would be something to maybe look into is what your brain remembers, like, my brain remembers a good chocolate bar. It really remembers that. And so even though I might not taste it, you know, physically, per se, when I chopped down that a good chocolate bar, I can kind of taste it because I think my brain is telling me what I should remember. Okay, so I think it works hand in hand with these things. The one thing you have to be careful of though, with, certainly with tastes and smells, if you can't smell, that's for sure. It's like if all of a sudden you have a gas leak or something in your home, you have to be really careful. Okay, because I I'll tell you right now, I wouldn't, I wouldn't smell that. Okay, Clarence, taken away that chance to talk to you about research.

Clarence Jones: But okay. Is there a certain demographic that that is experiencing long COVID More than other people? Um, well, I think we probably first came out, you know, it was the older people they get, you know, they got it, kind of thing. But now with long COVID, is there a demographical shift? Or is it the same? Or is it all over the board? What what do you say space? Exede?

Jay Desai:  Well, so everybody can get COVID. Right. So people talk about COVID is just like the flu, but it's not like the flu, right, the flu. And some of those other respiratory viruses tend to impact young, you know, much younger children, and much older adults, people whose immune system is probably not fully developed or compromised. COVID affects all age ranges. And in protecting them, perhaps in different ways, because of underlying mechanisms. So the you know, the working age adults are also the ones who are really feeling it, we don't, with long COVID. You know, there may be symptoms in younger children. But we don't see a lot of that. But we do see it within adolescence. So people who are 1112 and going on up, they tend to recover more quickly, but some of them can still be really impacted, particularly those who are involved in different kinds of sports activities really need to be careful and pay attention to that. So I mean, generally speaking, I would say yes, it impacts everybody across the ages, but some may have more significant impacts. Probably also, because of the kinds of activities they do and the work that they do. And, and, and I want to get back a little bit to the question about symptoms, and that there's a lot of different symptoms, as Kate mentioned, really, the key is not ignoring, you know, not trying to ignore that if you're feeling more tired than usual, if you've maybe can't concentrate, that, you know, really paying attention to that. And those symptoms, and then talking to your doctor about those because often people don't, because they might be more mild or moderate, but they are still impactful on your everyday life. So paying attention to those.

Stan: Alright, so. So, Kate, chime in here a little bit. Okay, cuz I know that you've been involved with this, you know, with everything public health oriented wise, and the response to it. Why? So? chime in here? All right, what is it that the essence of what we really need to know around this whole thing at this point?

Kate: But I did want to follow up a little bit on clearances question. If I made knowledge that, you know, we know the pandemic had a disproportionate impact across communities for certain types of long COVID People who have underlying conditions may be more susceptible to long term complications. So there is a big equity piece that we think this is really kind of at the intersection of. It's interesting. We've heard anecdotally from a lot of our providers who work at the long COVID specialty centers that they're serving a very homogenous group of patients, by and large, it's sort of the better educated, wealthy, kind of suburban white folks who probably have more access to those resources. We do not think it's because they are being uniquely impacted by long COVID. We just know we are missing a lot of the folks who are being impacted by this. So that is part of why awareness is just a big priority for us. because we know this is happening across communities, but because it's unfamiliar, because of various stigmas around disability and how it's hard to talk about, maybe if your abilities have shifted, we're probably missing a lot of people. But we're certainly interested in understanding better how long COVID is impacting different communities across our state.

Clarence Jones: I appreciate that. Because I think that part of what you just said was that for a lot of folks, and I think you want to you mentioned this before, a lot of people are so interested in just pushing through it. You know, it's just like, well, you know, life is tough anyway, you know, so I mean, I'm already I'm already feeling foggy brain, you know, you know, just just those kinds of things, but in terms of experiencing those things, you know, we want to know that if we are experiencing those things, is it it? Can we can we spread it? You know, I mean, I mean, it's, we just don't know. And I think that that's what's good about this conversation, is that we're just chatting about this, and we understand the uncertainty about a lot of stuff. I mean, you talk about a lot of things that, you know, even now you're uncertain about a, we're uncertain about what the scientists are uncertain about. And it's good to be able to say that, absolutely,

Kate Murray: we, we are learning a lot every week, even there's more research coming out, there's still a lot that we don't know, and definitely want to be real about that. So that we aren't saying, Oh, we're sure that this is this is the cause or this is the trajectory, and then we have to change that.

Stan: So J, your eye, you know, grants, you know, so I don't know where the grants are coming from, to like the department, or the CDC oriented grants, or NIH or both. But my question is, what are the questions that we are really, really focusing on on the front end here, research wise? And hopefully getting some answers? So like, in the research that the two of you are involved in right now? What's, I guess one of the defining questions, cuz apparently, there are a lot of them. But what are the defining questions for the grants and the research that you guys are doing?

Jay Desai: Um, so, you know, there's, there's, there's similar for a lot of things, right, first of all, can we even is there even a clinical definition? Can we even identify what long COVID truly is? And, you know, we gave you a definition. That was time based between months or whatever? Yeah. But other than that, it's really broad, because there's so many different symptoms, there's just so much we don't know. And so since we don't really have a clear clinical definition, or from a public health perspective, what we call a definition where we can monitor it on a population based basis, we also don't have a solid sense of what's the real burden of long COVID in our communities. You know, we hear numbers ranging from anywhere from 5% to 30%, of people may be experiencing these longer term types of post COVID symptoms. But, you know, from a researcher perspective, that depends on the kind of study that was done, who years, the population you're studying? I mean, there's all kinds of other factors so that, that since there's not a test, we just don't have a clear idea of what the real burden is yet. So we're still working on that. So that's the first question. The second question is, what is the underlying cause? You know, what's going on with long COVID? And can talk a little bit more about this. But right now, there's at least three different kinds of it may be multiple things going on multiple underlying causes. And so it's not just one thing, right? We know that it gets triggered by COVID, with the infection, but it could cause different pathways within the body that lead to different symptoms. And so we're trying to tease that out, the providers that we work with are trying to tease that out, because then it gets on to the next question. What do you do about it? Yeah. Right. And so that, so those, that's the next question. And right now, you know, you have to understand sort of the Cause right now you're treating symptoms that people are having and using methods to treat different symptoms. And so there's still a lot we don't have a cure, or anything like that prolonged COVID yet, so that's where research is going on to trying to figure out what kinds of treatments are out there that can maybe minimize the symptoms that people are feeling and, and help it go away? You know, other than, at least for the beginning part, making sure people rest and those kinds of things, but So there's these research questions that you're talking about that are driving interest. We don't have answers to those Yeah, we're still working on that, trying to figure some of those pieces out. So this gets back, Clarence, to your comment about transparency and just being honest about what we know and what we don't know. Yeah, you know something about this. 

Clarence: I appreciate that. Let me ask them. Let me do a follow up question the on Covid versus the vaccination rates. Okay, people that have that are, they're experiencing long covid. How many vaccines did they take, or do they? Is it, I mean, do people who have taken less vaccine, get long, covid more than people that have taken more vaccines. I mean, I don't know. I'm just. I'm just trying to figure it out. I mean, we up to 5. I think we have to 5 vaccines now, right? So if you get 5, maybe won't get it. I don't know but I'm just. But those are kind of questions people gonna ask like, well, if I take enough vaccines that I won't get it. You know what I mean. So can you help? Yeah, helping.

Kate Murray: Certainly. The the prevention piece is, of course, for public health. So that is top of mind. And yeah, evidence continues to emerge, indicating that vaccination is protective against long, Covid. It's not a magic bullet, it is not 100%. If you're up to date on your boosters, you're definitely not gonna have long Covid, but it does show to have some protective factors and the biggest waves of long covid that we see are from the time before there were vaccines available.

And so several studies have come out even in the last few months, showing that having those boosters is important as well. And it's really unvaccinated folks and folks who maybe only had one or 2 vaccines are having more long term complications. So that is definitely one of the best tools in our toolbox to prevent long Covid is to continue staying up to date on vaccinations.

Stanton Shanedling: So do you think that you know it? You know, from a prevention standpoint. Vaccinations hopefully will prevent you from getting it, or if you do get it, your your case hopefully will not let itself to you, being hospitalizer, or the severity of it would be reduced significantly. Do you anticipate that vaccines down the pike will focus on some of these symptoms that we're seeing for long, covid as well. and put that put those, whatever they're able to do into the vaccine, so that not only can you prevent from getting it, but if you do get it, you're not gonna have a severe case, and hopefully, you won't experience some of the the long Covid experiences and use me as a guinea pig. For God's sakes, I mean, you know, I'd be up to date on vaccines in the whole 9 yards. I get Covid. Okay, fortunately, wasn't severe in my estimation, and but yet I have a long covid symptom. So I'm I'm I'm just wondering. Might the research lend itself to preventing the disease altogether, or and if you get it mild and addressing symptoms, do you think that that's down the pike, or who knows?

Kate Murray:

You know, I think, actually reformulating the vaccine to prevent long Covid. I'm not sure that that's necessarily the direction you're right, that it definitely can help reduce that severe infection which will help reduce your chance of long term complications. But there may be other means of prevention, and there are some clinical trials and other researchers exploring this, but things like text loaded during the acute infection may be protective against long term complications. There have been some other studies showing potentially metformin during the acute infection can help prevent long covid. So there are some other pieces in terms of treatment. That may be protected as well, and that is one more reason why it's good to keep testing and keep those like rapid tests on hand, because that can, you know, help increase access to those treatments and talk to a provider.

Stanton Shanedling: Yeah, yeah, Clarence.

clarence jones I'll ask this question.

So there are a lot of people that are not dealing with Covid or long Covid. Right? I mean, they just they just taking it through. What are the health issues that will emerge besides death. For people that don't address this issue. because I'm telling you this. People there that say fake news and all this kind of stuff, you know, I mean, and so what you know by not by not addressing this issue. Not being, you know, open about it. You know what are some of the major issues that will emerge health issues that will emerge as a result of not taking care of this issue. Zach's death.

Kate Murray: Well, we do see, and Jay feel free to tack on. You know again, these these many symptoms that can crop up one tricky thing about long Covid is that it's really an umbrella term that covers not only these symptoms, but some people will use it to describe other conditions that crop up after a covid infection. So we are seeing some hints that people may be more susceptible to developing diabetes after a covid infection. There may be other kidney issues dementia. We also don't know the long term consequences of of covid infection. You know, you think of something like chicken pox later, resulting in something like shingles. For how polio 10 years later, could have these chronic disease impacts. So we don't know what those really long term impacts of the covid virus are. Yet and also just from, you know, a non clinical standpoint. There's research around some of the economic and just quality of life issues that people may experience. If they have complications after Covid. So we know that for some people it's decreasing their quality of life. Stan, I'd argue, you could be one of those people, you know, losing your sense of smell and taste that that erodes your quality of life for people who just don't quite get back to baseline health that impacts things like the economy. Ultimately, we know a lot of people with long Covid lose their jobs or have to reduce their work hours. That impacts. You know your wages and lost wages. And then, finally, there's also just health care costs. You see, people having more health care exponentials after a covid infection. So there's also that impact. And potentially people just needing more care down the road. So it is from, you know, there's the individual level. But then we can also think of it on kind of a system in a societal level. And even potentially impacting the global economy those estimates from Harvard are in the trillions

Stanton Shanedling: I think one of the symptoms that I I've noticed is that I'm adverse to mowing the lawn.

Jay Desai:  you know, if you are experiencing some of these, you know, within shortly after the acute infection, some of these issues around not being able to think about getting tired. and you're pushing through it because you have to work right. We have a certain populations that can't afford not to work. They don't have paid leave right and and so, but they go, and by the end of the day they're just exhausted, or even in their work, it could be dangerous, right, if you're not thinking straight anymore, and so you do need to pay attention to that. And we're working. you know, to help providers recognize that, too. because then you may need some documentation to work with your employer to get some accommodations, whether it's shorter hours, some breaks, some other things right. These are real life issues that people are experiencing some of these symptoms, even though they may resolve after a while. During that short term period. These are still significant things. They have to take care of and then and then for the long term stuff, as as Kate knows, because we get testimonies from people writing in to us all the time. There are people who just have to stop working period. The disability is so bad because of this that that's a whole. Another group, you know, who are severely impacted that we have to think about. How do we support them? Clinically and and at home? Moving forward. I don't know. Kate may have more to add to that.

Kate Murray: Yeah. And that group is again not a new phenomenon. Folks have experienced this after influenza as well, but it is debilitating fatigue, or even flu, like symptoms that crop up after any physical exertion, or even mental and emotional exertion. Some people have what's called pots, which is postural, or the static tachycardia syndrome, meaning every time you change positions. your heart rate skyrockets, and your blood pressure drops, and you can even get dizzy to the point of fainting. And so that's a result of your autonomic nervous system. Having dysfunction, and that could be you know, damaged from this ongoing inflammation from the virus. We're still understanding some of kind of those underlying mechanisms. But these are really debilitating conditions. And so that's definitely of interest to us. That whole group of folks who have been largely ignored or even dismissed by medical establishments, and really not part of public health so much. We cannot ignore them any longer.

clarence jones: And whatever the next pandemic is going to be, because, you know, there's gonna be another one in some of our lifetimes. This is gonna come up again ongoing studies around long Covid. I mean, I'm just interested in in what's being studied about it.

Kate Murray: you mean, for, like, are you talking more? The clinical side of things? Some of the researchy kind of things NIH  had over a billion dollars allocated for the recovery studies, which, are kind of 3 part, they're doing observational studies of sort of the trajectory after covid infection, but also looking at those underlying biological mechanisms. And there are several kind of going theories. It's probably kind of a both. And for some of these, because long Covid is not just one condition. So they're trying to understand the viral persistence or the inflammation for some folks it's kind. It's more like an autoimmune disorder. It seems to trigger the immune system to attack the body. There's series around microclass. And so they're trying to find those potential causes, but then also exploring some treatments for hopefully, not just symptoms, but, as Jay mentioned, more upstream, what are the actual causes? So some clinical trials going on as well? And there are folks who are looking at things like the economic impact, the workforce impact impact on quality of life and disability claims. And from a public health perspective. As mentioned, we're just really interested in seeing how this is impacting communities and people after their covid infection.

Stanton Shanedling: You know, one thing that's really struck me is the effect that that Covid overall has had on our our lifestyles. So think about just how we go about doing work. Now. Okay, we're not. We're not interacting in person. I mean everything, you know. A good portion is done via, you know. Zoom, for instance. And I just wonder whether or not that might be studied as well. The the social impact that Covid in the long term has on has or will have on on all of us going forward. There are occupations that obviously require person to person contact. But you know, it's like, if I were at the Health Department now, and if I had a question, you know, for for either one of you, I just you know it'd be nice to just be able to, you know. Run over to your office and say, Hey, you know, JA. Kate, what do you think that doesn't exist, or it doesn't exist in the same way? And I just wonder whether or not long Covid will address that type of thing as well.

Jay Desai: So, Stan, you know what you're bringing up is probably a podcast in and of itself. How people are, you know, being, you know, the whole hybrid teleworking situation, and how that's impacting on so many different levels. Not just sort of the the biologic level. And so yeah, that that's that's a great podcast topic, and and it probably isn't a lot to talk about yet, cause we don't know the answers yet. Well, you know, I mean, we talk about stuff right? I mean, when we were young, growing up and starting our careers. It was having those mentors that you could be in person with. It was your colleagues that were young like you that you would start networking with right. All that kind of stuff is changing in terms of you know the role of long covid in that I you know I'm not that I think that's kind of a separate issue.  And you know how Covid has changed our health behaviors, I think, and how that might impact long covid As, as you mentioned earlier, we still are struggling with this idea of misinformation around covid difference, access and awareness within particular communities. issues around whether people should get vaccinated or not. Right? So those kinds of things that have come upbecause of the Covid pandemic. We're still trying to figure out how to address those and what the impact of that is going to be on long. Covid. Right? If people aren't getting vaccinated, if people can't go in not only to get tested, but they get vaccinated, and then to perhaps even talk to a provider about this, where even providers may not be fully aware of what's going on with long Covid. I think those are all things that. And then and then. Covid fatigue. All right, the pandemic fatigue. All these things are significant public health and individual level issues that we have to combat, and that could result in, you know more long covid than there needs to be right, more covid than there needs to be more long than there needs to be, unless we can start figuring out ways to bring it back into people's frame, that it's still a significant issue.

clarence jones: you know. I thought it was interesting when you talked about Covid fatigue. It just kinda name my mind just went to different places. Yeah, we we do have fatigue from Covid. We also are fatigued by all the Covid information. So it's like man, you know, at at some point like, you know. Let me just die. I don't know. I'm not that die. But you know what I'm saying. Let me just you know you know what I'm saying is this, it's it's it's it's but I but I think I think it's important to to continually try to find ways to engage people in in the. in a positive information, so that they can understand how important and how vital this information is, you know, I mean, so, yeah.

Jay Desai (MDH): yeah. And there, I mean, there's still there's still things that came out of the pandemic that we're slowing down on right. We're we're behaving as if we did before the pandemic. Not that, you know, this might be the season when everybody's getting together and big family get togethers or going out to concerts or events. And you know, you might wanna think twice about some of that. Still, the idea of masking, if not, you know. for others, at least you know well for others. Right? If you feel like you're getting sick, or something staying away from others masking. You know, those things are still gonna be helpful. But we're not really thinking about that stuff as much anymore. And from a long Covid perspective. Those are things that can help reduce or prevent the onset of more long, you know, Covid, and then, long Covid Stan, you're on mute.

Stanton Shanedling: I put it on the mute cause. Murphy was barking. So here's an important thing for all of us. It's we as human beings who don't get sick just from Covid, or we don't continue to get sic because of just because of long Covid. We get sick from other things, too. Okay? And we shouldn't ignore those things. you know. I certainly was aware of that, you know, working in the cardiovascular unit. It's like, you know, people didn't show up at the emergency room with, you know, potential stroke or heart attack because they were. They were thinking that, you know, I don't wanna get close to anybody who's got Covid. But we, as human beings, get sick from other things, too. What I think is encouraging. I mean, there's always a silver lining here, you know for years and years. When you work in the health Department, there's kind of like the infectious disease unit is over here, and a chronic disease unit is over here, right? And you know, it's like, Yeah, you know, they're great colleagues. But you don't talk that much. Okay, this would be perhaps a way that we really do talk because COVID certainly has implications. If you're diabetic, or if you have heart disease or chronic disease, it can complicate that. And so this might be a true opportunity to really link all the different health entities that we deal with together.

clarence jones: and, you know, use Covid as the excuse. I don't care, but you know, maybe you know the time has come that that we do do that. You know, saying, let me say it's real quick, you know, Jay when you were introduced, you were you the epidemiologist, and I couldn't spell that word for a long, long time, anyway. but you know you all chronic diseases. How is this? You know? So you said sickle sale. I mean, you just started. You know, Sam is a whole lot of things that you that I need your leadership? How has it affected those issues or those diseases? Is there anything that has merged that you want to. I mean that you can talk about any particular disease.

Jay Desai (MDH): Well, not a disease in particular, you know. I mean, we did mention earlier that it looks like the virus itself may be impacting issues around diabetes. Blood pressure kidney disease stroke. Kate mentioned microclots potentially what it has done. And then a lot of these other conditions. Obviously, cancer asthma diabetes, blood pressure, sickle cell disease. You know, these are all conditions, chronic conditions that make you more susceptible to infection into other things. Right? So there's more hopefully, more attention to that right. One of the things for diabetes has always been getting an annual flu shot and getting a pneumonia vaccination on a more regular basis. But people don't do it. even though you know it's an issue. So maybe Covid can help raise the profile. Can is going to be added to that But what it has allowed I do think, both in our public health world is to have more conversations across conversations around the relationships between chronic disease and infectious disease, post infectious disease and so I think there's a real opportunity for us  to grow that kind of connection moving forward. And by the same token. I think that's gonna be happening within, you know, hopefully, the healthcare provider system, too, cause you know that. Still, just as we are in public health. when you're looking at something like an infectious disease. You're not necessarily thinking about other chronic conditions or potential longer-term chronic conditions. But now you need to. Yeah. So I'm not sure that that's what you know here are's obvious changes yet, but I can see it as an opportunity to grow some of the more collaborative, more thinking about that together. Moving into the future.

Clarence Jones: you know I never heard the connection between the shots that you mentioned in diabetes.

Jay Desai: Oh, I mean, I think that's that's that's quite interesting information for me. Yeah. And you know, I started working in diabetes in 1995. And it was a recommendation back then, and it's now almost 2,025, and you haven't heard about it. I don't know what to say. Last thoughts

Kate Murray (she/her): stay up to date on your vaccination. You know. Keep an eye out for long term symptoms after you're sick with Covid or any infectious disease, and seek that help and support where you can. The last thing I will also add is, we have a ton of good information on our website. We've got more background information there. We've got lots of links to resources and support for folks, including clinics who have providers who know what's up about long covid. So please do check out those resources. And one last plug for testing there is the State of Minnesota currently still is sending free antigen tests to folks on a monthly basis. So you can go to say, Yes, home test.org and order those tests.

Stanton Shanedling: Great. Great. Well, you know, I thank you both. This is an ongoing subject. I hope that we can put some of the information from the Health Department on our website. So people have access to that information through another venue. II hope that, Kate and Jay, you'll be in contact with us with a simple email. Stan, we gotta do another podcast quick cause. We got some really good information that I think the public could really be would be interested in. So we reserve that right one way or the other to circle back to you on Covid with regards to vaccinations. I've been. I've been reminding people to get vaccinated. People are spending more time like they like, Jay had said indoors now, because it's starting to get a little cooler. which increases the the possibility of spread of illness. So now is a good time to get vaccinated. Cross check with your with your physician on flu covid Rsv vaccination, and also pneumococcal vaccinations as well.II do encourage you. Check with your with your your physician beforehand. With that, I would like to say thank you to everybody for listening to our show. Our next show will be on the cancer plan. From the State of Minnesota. We talked about some of the various other plans. And now we're gonna be focusing on cancer. That's the next show for health chatter. So everybody keeps health chatting away.