108 - Dr Vass & Dr Vicky - Cardiologists & Long Covid Researchers

Episode 108 of the Long Covid Podcast is a chat with Cardiologists and researchers, Vassilios Vassilou & Vicky Tsampasian. We discuss cardiac-related things they have seen in Long Covid patients as well as their research into risk factors of Long Covid and why this is important.

https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0001188

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2777978

https://link.springer.com/article/10.1007/s11883-020-00880-6

The paper discussed in the episode:

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2802877

For more information about Long Covid Breathing, their courses, workshops & other shorter sessions, please check out this link

(music - Brock Hewitt, Rule of Life)

Transcript

Jackie Baxter  
Hello, and welcome to this episode of the long COVID Podcast. I am super excited to be joined today by Vass and Vicky. And they are going to introduce themselves to save me the pronunciation issues. But we're going to be talking about their research into long COVID and all sorts of other things I'm sure, so a very warm welcome both of you to the podcast today. Thank

Vicky Tsampasian  
Thank you very much indeed. My name is Vicki Tsampasian. I'm a cardiology registrar and research fellow at the University of East Anglia.

Vassilios Vassiliou  
And I am a senior professor of cardiology and a consulting cardiologist at the University of East Anglia.

Jackie Baxter  
Thank you so much. So this is really exciting, because you have published a paper quite recently, which I will drop into the show notes. And I'm sure that is going to form quite a lot of today's discussion. But I would love to hear a little bit more about what you both do, within what you've just introduced yourself as, I suppose.

Vicky Tsampasian  
So as a cardiology registrar, I'm doing my training to become a cardiology consultant. I need a couple more years for that. But I passed my clinical training to do a PhD. And that is also in cardiology, and cardiovascular imaging. but alongside that, we've been doing some research on COVID. And obviously, because the world paused a few years ago, and everything stopped, and so we focus purely on COVID. Obviously, that attracted some research interests, and including our interest. So we've been doing some research on that alongside our cardiology studies.

Vassilios Vassiliou  
As a consultant and on a day to day I look after patients with heart problems. And 50% of my time is dedicated to research. And during the lockdowns, we were not able to [continue with what we were doing at the time] and the only research we were able to start doing research on COVID. And whereas now we have been able to reopen this lab again and start doing our research on cardiac imaging, heart failure & valve conditions. We have kept some research on COVID and particularly Long COVID at the moment, because it affects so many people. And we hope that every little bit that we can do can help research and help patients in the longer term. 

Jackie Baxter  
Sure, yeah. And then my next question was going to be what brought you into kind of COVID and long COVID research? And I think you've sort of just answered that. But I mean, the cardiac side of COVID and long COVID possibly is worth talking about a little bit, isn't it? Because I mean, I think there are people that actually are showing up - abnormalities, maybe would be the right word - on imaging and stuff. Are these things that you have actually seen in your kind of clinical practice?

Vassilios Vassiliou  
And this is exactly how we started the initial work on Covid, by having patients asking questions that we didn't have the evidence, or the research to be able to answer. So we were in a position to go out and do the research and provide answers. And that's how some of our initial papers on COVID. And  hypertensive medication that came about. 

But at the moment, it seems that a lot of the questions about COVID have been answered. But questions about long COVID remained unanswered. And in particular, why do people get Long COVID? Which people are more likely to get long COVID? And once we are able to address those questions, we could then focus our energy and time into developing treatments for long COVID. 

And coming back to the question, do we see patients with abnormalities in the heart that relate to long COVID? And the answer is yes. We know that long COVID does break the heart, people get palpitations, and they get some small degree of scarring in the muscle of the heart which we can detect with a cardiac MRI. People get chest pains and they sort of feel sometimes they might collapse. And those are the sort of extreme cases of cardiac involvement in Long Covid.

Vicky Tsampasian  
Indeed, and it's important to, I think add to that, you don't have to have one to have the other. So you may have normal tests, but have palpitations and symptoms for weeks or months. And this can be quite troubling and may affect people's quality of lives. And so it's quite important to try and address those as best as we can. 

And the way long COVID is defined at the moment, and you have to have persistent symptoms for three months or more. It's quite prolonged, quite persistent symptomatology that we're talking about and affects people quite a lot. And it's very understandable when people come and they're frustrated. Because they have the symptoms. Nobody can find anything abnormal in their tests and they're kind of in a conundrum, sitting there, what is wrong with me? Is there something wrong with me? 

But this is why we need I think everyone doctors, patients and the public to be educated that it may happen. We have ways of dealing with them - symptomatic management, but most of all, it's education. You have to know about it, be prepared how to deal with it. And, you know, it's not that you're crazy. It's that it's there. And we can definitely deal with it together as a team, I guess. 

Jackie Baxter  
Yeah, definitely. I think I mean, certainly from my own experiences, a lot of my kind of, you know, there was there was a lot around, I had an awful lot of palpitations, but Oh, you're fine. Everything's normal. And I'm thinking well, clearly not. But I think one of my big worries was at what point is it really bad? 

So like palpitations, like they're not good. But they're not on the kind of like, about to drop dead scale. But are they a signal that there might be something worse? And at what point do I worry? At what point do I like, check myself into a&e, for example? And I think this is a kind of common concern, isn't it? What if there is something worse there? How do I know? At what point do I sort of start really panicking?

Vassilios Vassiliou  
I think that's very correct. And indeed, what the patients are worried about - Is something bad happened to me? And how long will it take before I can go back to normal? So the vast majority of people with long COVID palpitations will get better. It could take a year, it could take 18 months, but the vast majority do see a substantial improvement, actually within three, four months. So that in itself is intuitive. And the second thing to say is, yes, people get palpitations. And again, in the vast majority of cases, the palpitations are what we call benign. In other words, you do get them. But they're not indicating any harm to the heart. 

Of course, as cardiologists, we're very reassured if we find normal tests. And what that suggests, if you have a normal trace of your heart, if you have a normal ultrasound of your heart. If you monitor your heart for, you know, 24 hours or 48 hours, and you have not seen any palpitations of concern. That is reassuring. Of course, it doesn't mean that these palpitations are not happening. Of course, they're happening, the patients feel them. And of course, they create concerns. 

However, what we can say to the individuals is we're not actually worried about these palpitations. They're there. And we should acknowledge the fact that they're there. Because the last thing we would want people with palpitations secondary to long COVID is that we don't believe them. We do. But there is a limit of which patients are we worried about, and which patients we're not worried about. And the ones that have normal structure and function of the heart, usually we're not worried about. So we can be more, we can discharge them back to the care of the GP. And we can advise perhaps some medications that will help reduce the burden of palpitations. 

But what actually helps a lot this time. So if we take time, assuming that the palpitations were secondary to long COVID, they will get better. But I definitely want to get the message out there that even if everything is normal, that's actually the best scenario. Individuals still get the palpitations, but they are more likely to improve compared to somebody that has abnormal tests.

Jackie Baxter  
Yeah, absolutely. And I think, you know, the word anxiety is one that we have to be very careful about using because that definitely can be quite triggering for a lot of People. But at the same time, if you are getting palpitations, then you are probably going to worry about it. And the more worried about it you get, the worst the palpitations are then going to be. So if we can at least be kind of reassured that - it's not comfortable, and it's not nice, and it's probably not something that should be happening. But at the same time, it's not sort of super worrying, then at least we can maybe try and be slightly reassured and not sort of make them worse. 

Vicky Tsampasian  
No, I definitely agree. And I've had myself palpitations, not because of COVID, but a few years back, and it was extremely worrying, and definitely didn't feel very comfortable.

Jackie Baxter  
It's terrifying isn't it?

Vicky Tsampasian  
Those 10-15 minutes, I can't remember how exactly it lasted. But I felt it was going to die. But I do understand. And I think at that point, what I wanted to know, is that, okay, it ended eventually. But I wanted to know, is my heart normal? And if my heart was normal, then I knew that, you know, prognostically, I had a lot less chances of that happening again, and obviously, like a lot less chances of anything bad happening. 

So yes, as you say, is that reassurance that we kind of need, so that not to get into a vicious circle in our brains, that something would go wrong. So I totally understand. And that's why, as I guess, as doctors, we do like to do tests to reassure both the patients and ourselves that there's something else going wrong. So that's why when we do see that the tests are okay, doesn't mean that we don't believe you, we do believe that the symptoms are there, of course. But we do have the reassurance that prognostically, they don't have an impact, they don't have an effect. They're benign. So

Vassilios Vassiliou  
Once we see normal tests, were actually quite relieved. And sometimes, in our practice, we try to find the ones that will have recurrent palpitations, and will have more adverse palpitations, let's say. And once we see that the tests are normal, then we're quite reassured and relieved. And it is important to make sure that that is communicated well to the patients, that we're not dismissing them, we're not saying you don't get palpitations. But what we're saying is that the concern that we have for you is now low. And that's a good position to be in. 

And in that sense, we have to then put out priorities for the patients that we are worried about. It we be a small proportion of the long Covid patients, and a bigger proportion of people with coronary disease, valve disease, myocardial disease, so we try to restrict by the individuals. And if you're low risk, that's the best news. 

But I do appreciate that sometimes this is not communicated or related well to individuals who might have never been in the hospital before, because long COVID can affect young people as well as old people. So in an ideal world, we would have been able to have a lot of time and sit down and discuss with the patients. But unfortunately, the state of the NHS at the moment where we see patients for 15 minutes, it's actually difficult for us as well to be able to spend the time that we want with the patients.

Jackie Baxter  
Yeah, definitely. And I think you know, as patients, we can sort of slip into the kind of place where we almost want the tests to come back abnormal, because that would mean that there is something that could be quote, unquote, treated. And, you know, when you think about it logically, like that's not a particularly sensible thing to want. You know, normal tests is obviously a good thing. But I think as a frustrated patient, it's kind of like, well, I know that there's something wrong with me, and all my tests are coming back normal. So it's almost like they're accusing me - the tests are accusing me of making it up. So it's this kind of paradox, isn't it? Where you know, you know that normal tests are a good thing. But like, well, so what is wrong with me then? Like, what is causing all of this stuff that we both know is here?

Vicky Tsampasian  
Yeah, it's, we have, I think, for that specific point, we have to remember that we are clinicians, and for diagnosis we don't necessarily need tests. We do need them for sometimes, but not necessarily. And long COVID is one of those conditions that it's a clinical diagnosis. You may have symptoms, but you don't have to have abnormal tests. That doesn't mean that the diagnosis is not there, cannot be made. 

And I think that's one thing that has to be distinguished between clinical decisions, clinical diagnosis and tests. The tests are very important in terms of our management plan, and our prognostic implications, let's say. So if we, for example, have someone with a very high burden of ectopic beats in the Holter monitor from a 24 hour heart monitor, then we may need to, for example, start some medication. But if their burden of the act of the ectopic beats are low than we wont. 

So that's where the tests help. It doesn't mean that the palpitations are not there. It's just the how do we act on them? And what do they mean for their long term prognosis? Or their health or the future? And I think that's what it has to be distinguished. It's not that clinically something's not there. It's just how do we go about it? And what do we do about it in the future? 

Jackie Baxter  
Yeah, I think that's a really good point, actually. You know, we don't have a test for long COVID specifically. So it's a, you know, it's done on the basis of all the information you have, isn't it? And some of that is from tests. And some of that is from observations and what the patient is telling you, I suppose. And you're putting it all together into this big pot and going, huh? I'm gonna call this Long COVID in this instance.

Vicky Tsampasian  
Yes, exactly. It's a clinical diagnosis. As it stands from the NICE. And the World Health Organization, long COVID is a clinical diagnosis. It's symptoms, persistent symptoms for more than three months, and not attributed to any other diseases. And it's very clear and obvious that for many people that have had debilitating symptoms that you may not necessarily have abnormal tests. But you do have the symptoms. So there are two separate things. And we have to make decisions and management plans based on these two separate things. 

Jackie Baxter  
Yeah. And that allows you to do it in a way that is more individual to each patient as well, doesn't it, which is extremely important, because everybody is so different. 

Vicky Tsampasian  
Absolutely. Exactly.

Vassilios Vassiliou  
I think it's not just that everybody is so different. Long COVID is also not one thing. We're still learning what is causing Long COVID. And from what we know is that it's not one thing that is causing you this, it could be an autoimmune failure, it could be small clots that form in the vessels, it could be a persistence of the virus, it could be an exaggerated response of the inflammation. And it could well be a problem with the inside of the vessels that we have in the body, something called endothelial dysfunction. 

Therefore, we know that all of these different pathologies can lead to long COVID. And the difficulty with having lots of pathologies leading to long COVID is twofold. Firstly, we don't have a diagnostic test, we cannot do a blood test to identify what is, you know, is this long COVID, or is this not? And we come back to what Vicky was saying, that it's a clinical diagnosis. 

And you don't need to have abnormal tests to have Long COVID. But we do need to do the test, if nothing else, either to show they're normal or they might indicate pathology, that could have potentially pre existed that the long COVID and has nothing to do with long COVID - there was an abnormality on the heart or any other organ in the body that we identified coincidentally, because the symptoms of that are similar to the long COVID. 

And it also causes difficulties with the treatment, because it is unlikely that we will have one tablet that cures Long COVID. Because Long COVID is caused by a variety of things going wrong. And we could potentially target each one of them separately. But until we know what is causing it in one individual, we wouldn't be able to to get it right 100% of the time. 

Of course there are studies that are using various medication but also other non-medical therapies for example, mindfulness, gradual exercise rehabilitation, different nutrition, as well as a plethora of tablets that are being used to see whether they help in long COVID. At the moment we don't have something solid that we can recommend for all the patients. 

Jackie Baxter  
Yeah yeah, definitely. I think that's that's a really good point. You were just talking about the, you know, people who might have had pre existing things before COVID that they weren't aware of, you know, and I guess some people may have had certain things that were triggered by COVID. And I suppose it's very difficult to tell which of those two, it would be in a certain person unless they had pre existing Labs, which they wouldn't do if it was a condition they didn't know about? So I guess that's quite difficult to do. And that's going to happen in all areas of the body, I suppose. 

I think when we come to sort of cardiac issues, there's a certain extra level of concern with patients, I think. You know, if someone told me, Oh, your gut isn't working that well, I'd be like, well, that's not great. But that's not going to kill me tomorrow. Whereas if my heart isn't working right, that potentially could. And that is, you know, a bit higher up the list of things that's going to concern me. So I suppose, not that either of those situations are a good one. But I think, yeah, there's definitely that extra kind of worry factor, when you come to heart issues, I think. 

Vassilios Vassiliou  
Yeah. And that's very, very understandable. Because as you say, when your heart runs into problems, that can be of concern. But at least when it comes to the heart, using particularly imaging, for example, an ultrasound of the heart, called echocardiogram, or an MRI scan of the heart, we can identify any conditions that would have pre-existed the COVID infection in a lot of the cases. But also we can quantify the, let's say, abnormalities that we can see on the heart. And we can be a bit more reassuring. If we see, you know, a small abnormality that we know will not cause problems in the longer term. Yes, it might cause palpitations, might cause some breathlessness. But if will find something we can deal with it.

Jackie Baxter  
Yes, yeah, absolutely. And I guess this comes back to the, where we were talking earlier about tests, if something did come back abnormal on any test, then at least you have somewhere to start targeting treatment or management or whatever, you know, you have something that you can do. Whereas when you've got this massive big pile of symptoms, that aren't really showing anywhere on a test, I think this is maybe where the frustration comes in. Because it's like, well, you and I both know that there's something not right here, but because we can't put our finger on it there's actually not really a lot we can do. So yeah, I suppose this is where people are actually like, "Yay, my test came back abnormal" being a really kind of slightly bizarre thing to be celebrating.

Vassilios Vassiliou  
Yeah, I mean, it's understandable. But it is bizarre. So if individuals patients were allowed to have the choice of having a slightly abnormal or a very abnormal or an absolutely normal test, I hope that they would choose to have the absolutely normal test. Their symptoms will be the same, you know, but what we want for our patients is to see them living to a very old age with a good quality of life. 

And, yes, if there is an abnormality on the scan, we might be able to provide a short term fix. But in the longer term, you would be better off having an entirely normal scan. So I understand what the patients would be saying if they have a slightly abnormal scan in a way they would feel that yeah, this is causing my problems. We are not making it up. But we wouldn't say that the patients are making it up, and a normal test is by far more reassuring.

Jackie Baxter  
Yeah, it's that kind of validation, I suppose, isn't it? That, you know, patients shouldn't need validation, because their symptoms should speak for themselves, and their doctors should be listening to them. And in a lot of cases they are, but unfortunately, and in some cases there aren't. And I think that is yeah, as you say why sometimes patients do feel like they want the validation of something that's abnormal, even though actually in the longer term that's not the better option. 

Vassilios Vassiliou  
Mmm. Yes. 

Jackie Baxter  
So should we move on and start talking about your paper? And can you maybe just tell us a little bit about it? And maybe what led you to head in that direction? 

Vicky Tsampasian  
Yes. So our paper is essentially a, is what we call a meta analysis and systematic review. So basically, we searched in the medical databases worldwide. And we looked at all the available published studies and evidence that have investigated long COVID. And particularly, we looked at the potential factors that may increase someone's risk of getting long Covid. And we identified 41 studies, that included in a total of close to a million patients, more than 850,000 patients. So we identified quite a few things that may increase someone's risk of getting Long COVID. 

And the reason we did that is because, as we said, long Covid has been very vague, and we just wanted to not exclude or include, but perhaps identify those that are at highest risk. And that's important to perhaps clarify, we're talking about relative risk, so nobody's risk will ever be zero. So it's just a matter of who's at high risk of developing long COVID, after they've had their acute infection, who has higher chances of having these persistent symptoms for three months or more. 

And, and our results showed that there are certain things that may make someone more vulnerable to long COVID. So for example, we found that older people, women, patients that have higher BMI that are overweight or obese, Patients who smoke and patients who have had required hospitalization or admission to intensive care unit during their acute infection. So those are factors that increase someone's risk of long COVID. 

And again, that is not to say that these people, you know, cannot have a normal life, cannot recover completely, they can, it's just that their risk of developing persistent symptoms is higher compared to someone in their peer group who has not had these specific characteristics. And on top of the others, I think that we also identified certain comorbidities, pre existing co-morbidities, so for example, coronary artery disease, chronic kidney disease and diabetes, they may also increase the risk of long COVID. syndrome. 

Jackie Baxter  
Yeah, that's very interesting what you say about there not being anyone with no risk. Because, you know, there, there's somebody like, Well, I mean, if I were to put myself as an example, I would not fit into any of those categories that you have just mentioned. And yet, I had long COVID for three and a bit years. And I think there are quite a lot of other people in that category as well. So exactly, it's kind of like, I think that's probably an important message, isn't it? You know, nobody has zero risk. 

Vicky Tsampasian  
And that that applies to all diseases. Even in cardiology, we always say that when we talk about risks and patients, it's not that they have zero risk. For example, if a 50 year old man comes, who smokes and does not have healthy diet or does not exercise regularly, his risk will be higher, compared to a 50 year old man who has a healthy lifestyle. Not saying though, that the healthy lifestyle man will have zero risk. 

We all have genetics, we all have a DNA, and that did not change and that in itself, and also the environmental factors as well. So we are in the middle of a multifaceted risk profile, and we can modify certain things and we cannot modify other things.

Vassilios Vassiliou  
And certainly that is the message we want to get across. Because, you know, when we started, when we said to do this, we couldn't know what we have identified. But our paper - it's really not a risk score for an individual and as you say, there are many people with long COVID that do not appear to have any of the risk factors that we that we have identified. But these would apply more at the population level. 

So if I could break that a bit more simply, we know that that women have 15 percent more having long covid than men. And lots of debate and discussion about what, why that could be the case. And one possibility could be the difference in hormones that women have. But it would not be correct to take one woman on her own and say your risk is X, Y, and Z. But if we were to take, let's say, 100 people that were to develop long COVID, then we could say that out of those 100 people, 60 would be women and 40 would be men. 

And at that population level, we know that women are more likely, elderly people are more likely to have long COVID. People with higher body mass index, or smoking are likely to have COVID. People that have comorbidities, or require hospitalization during the acute COVID infection are more likely to develop long covid. 

But we also identified a very important modifiable risk factor that was beneficial. And that was people who are vaccinated. And if you were vaccinated, you have half the risk of developing long covid. And following our work, there has been a further study supporting this. So if people are looking for something they could do to prevent long COVID, and then being vaccinated is a relatively easy thing to do for the individuals that have not been able to receive any vaccinations. 

Jackie Baxter  
And I realized when you were speaking just then that actually I did have one of the risk factors because I am in fact, female. *laughs* But you know, again, you know, thinking about again, this is very anecdotal. But in you know, support groups, if you're on Facebook, for example, you know, yes, most of the people are female, and I'm sure there are other factors, you know, contributing to, you know, are females more likely to reach out for support than males? I don't know, that's a question. But you definitely do seem to see more women. I'm not sure about any of the other factors. But that definitely is one that you tend to see.

Vicky Tsampasian  
I think, as you say, with public groups and support groups, it's also important to acknowledge that, I think they're very good, because it's very nice to see that you're not alone. And obviously, to acknowledge and to be acknowledged and to identify other people in the same position, same place with you. But there's also, as with every, I think, with every group, there's also the limitation that they can only be a certain number of people. 

So findings of a group, for example, of 100 people cannot be necessarily generalized to the whole population and the public. And this is why these studies like systematic reviews, and meta analysis would take a lot of studies and they match a very big number of patients, perhaps are what we call a higher level of evidence. So important for like clinical practice, because they have higher sample - a lot more people, a very much higher number of individuals that are included in these studies. So the findings are more likely to be generalizable in the general population. 

So I think that's another thing just to keep in mind that social media, for example, is nice, but I don't know many 80 year old people who are! Exactly. So that's one factor that could not be ever identified, I guess, from there. So actually don't know, many older people can be on social media, but also, many will not be, isn't it? So there are limitations to everything we do. And that includes the study that we do. So these mutations have to be just acknowledged.

Jackie Baxter  
Yeah, that's a really good point. But - I'm not a researcher. And I think many people listening to this also are not researchers. So this is probably still relevant. But what you were saying about you're a study, but you're looking at a load of other studies, so you're sort of taking data from all of these and then adding it into yours? And then kind of like re-analyzing stuff that's been analyzed? And are you using like some of the conclusions that other studies have made? And then making your own conclusions from all of that, as well as the data itself? 

Vassilios Vassiliou  
We're not actually using conclusions from other studies. What we do is we use the data from the others studies and use some powerful statistical methods effectively to merge the data. So we then study - If you do small studies, including 1000, 5000, 10,000 people, they provide useful information, but they cannot provide conclusive information. Whereas if you combine all the studies together, you can get close to 1 million patients, which is what our study had. And therefore, we have the power to be convincing in a way that what we have shown, it's likely to be real, because we had so many patients. 

And indeed, what we have shown, where subsequently confirmed by other studies, which is always nice to see. But part of our study, it's important to identify the risk factors. But it also highlights a potential mechanism of why people get long COVID. And therefore, you can target treatments at individuals, for example, if we know for example, that people who get long COVID have not been vaccinated. There are studies now running in vaccinating people who have developed long COVID and see whether it improves long COVID symptoms. 

Likewise, if we know that people who are female, there might be a treatment, trying to address the differences in the hormones between women and men. And people who smoke - and it might be that trying medications that try to counterbalance that effect will be more productive in long COVID. Therefore, identifying the different risk factors that individuals have, could also potentially lead to a group of differential treatment for individuals. And that was one of the important reasons as well that we wanted to do this, because it can help other researchers fine tuning the way the research they're doing.

Jackie Baxter  
Yeah, and that's really interesting, because those three things that you just mentioned there, so vaccination, and femaleness and smoking. I mean, some of the treatments or potential treatments that are floating around at the moment, people are using things like HRT, and you know, hormone related stuff, which is seeming to have some results. And there's also this thing, which I've come across, not very much called the nicotine test, which I don't know a lot about, but again, it's gaining a bit of traction in certain areas. So that that is kind of a case in point of exactly of what you just said, wasn't it? 

And then on top of that the fact that some people did, I think it's small numbers, but some people have reported improvement in their long COVID symptoms following vaccination. So that is interesting. 

And I suppose the flip side of this, as well is, you know, for people in the wider world, who are maybe lucky enough to not have long COVID. Or maybe who have recovered from long COVID, you know, are able to look at this and go right, I don't want this, like I really don't want this. So what could I potentially do to decrease my risk of getting long COVID. And knowing things that are risk factors? 

I mean, you know, there are some things that you can't do things about like your femaleness in my case. But you know, there are other things that maybe people could do to decrease their risk. And that, again, as we said earlier, is not going to give you a zero risk. But a decrease in risk has got to be a good thing, hasn't it?

Vassilios Vassiliou  
Absolutely, absolutely

Vicky Tsampasian  
Exactly. And I think these modifiable things, these modifiable factors that can be changed by us are important. And these are important not just to prevent long COVID, but perhaps to help with its management. So for example, there have been studies in other chronic inflammatory conditions to say that healthy nutrition does reduce the level of chronic inflammation in the body and regular exercise, so why not do something that may put us at the you know, the benefits and reduce that chronic inflammation that potentially goes on in our body because of long COVID.

Vassilios Vassiliou  
And likewise, if we look at the greater picture, we know that smoking is bad, to the heart, to the lungs. We know that obesity causes significant problems to the heart, brings blood pressure up. And something else - it actually affects the liver as well. And if we look across the Atlantic to the US, at the moment they're doing more liver transplant because of obesity than any other inherent liver disease. We are a few years behind but unfortunately we're catching up. 

So if I'm allowed the expression to say that if the fear of Long Covid makes even a few individuals to start living a healthier lifestyle, trying to cut down smoking, trying to reduce their weight, eating healthily, start exercising, and yes, get vaccinated if they have been unvaccinated so far, that we have them live a healthier and longer lives for longer. So if our study even influences a small proportion of people in the UK and across the world to achieve that, that is quite a bonus.

Jackie Baxter  
Yeah, definitely. And I think this taps into something that although I didn't fit into any of your risk groups, other than my gender, going through this journey of long COVID, has made me realize that some of the things I was doing in my life before I got sick, maybe weren't that healthy, in that I was very stressed. And I was doing far too much, which is, you know, not a particularly healthy way to live. So I've - Well, I've been forced into this position where I've had to kind of change some things in my life. And having now come out the other side, I'm very much more conscious of how important and how valuable health is. 

So, you know, I think I'm now looking for more ways to be more healthy, because I've been kind of forced into that situation. But you know, I think a lot of people maybe are now more aware of health, you know, things like Long COVID has hit the news a bit, you know, not as much as maybe we would want it to, but it has made more waves than than we think. So I think, you know, it comes down to what can we do doesn't it?  You know, when we're very, very sick, there are some things we can't do. You know, if you're bed bound, you can't exercise, you know, even if someone says, oh, exercise, it's really good for you, it's good for your heart. Well, that's not very useful if you can't actually get up. 

But there are things that maybe could help. Could you work on your breathing? For example? Are there certain supplements that might help you know, all of these things? So it's so yeah, you know, there are things that can be done. And if they are able to improve things a little bit, then maybe you're then able to access, you know, other things. 

I'm really interested in what you were saying about vaccination. I mean, obviously, in the UK, and I think, mostly worldwide, you know, the vaccine was kind of rolled out, was early 2021, wasn't it, when it all kind of really kicked off there. And a lot of people did go and get their vaccinations initially. And you know, since then, you know, it's been, what, two and a half years maybe, and some people have had access to boosters since then. 

But some people haven't, you know, and I think the case now is that actually, it's very difficult to get a recent booster, unless you are of a certain age, or have a comorbidity or something. And I don't know if you have an answer to this, but I would be curious to your thoughts on things like keeping vaccinations up to date, and how that has an impact on the risk of long COVID?

Vassilios Vassiliou  
So I'm going to try and answer that in two ways. One, on the basis of the evidence that we have today, and the second one on the way, sort of my personal projection. So when somebody gets an infection, then there needs to be at least 3 months before we know that they will have, they will not have long covid. So we don't actually have evidence now, as we speak, to know whether if people get a fourth booster or a booster, it will reduce long COVID. Because we don't actually know what the effect is of having had two or three vaccinations already. 

It's very likely that there will be some effects from those original vaccinations. That's why the boosters have not rolled out on a national basis. But personally, I do believe that, you know, if you've had your booster 18 months ago, you were given the opportunity to have another booster. That might not be a bad thing, because we don't actually know whether the booster from 18 months ago will still protect you from an acute infection and will still protect you from long COVID. And what we have seen is that there milder the acute infection it is, the less the risk of long covid. 

So we come to the second part of the question here is - it's only been, in the UK at least, boosters are given to over 65, or with comorbid conditions or health care professionals. But they exclude important groups. And one group that I would like to focus on is people with asthma. So whilst we know that people with asthma do have a significant risk of developing long COVID, at the moment, they are not eligible for boosters, unless they're over the age of 65. 

So personally, I think they should be. And personally, I would have allowed more groups of people to have the boosters. Because we know you know, a 50 year old with asthma, especially the females, they do have a higher risk than, let's say, a 20 year old man with no medical condition. So I'm not sure of the evidence the UK Government is basing their decision on, because there is a paucity of evidence in the phase we are in at the moment, it's a difficult concept. But we will only know if the decision the government has made was the right one, probably 12 months down the line. And personally, I would have heard a bit more on the on the cautious side and offered vaccinations. But the truth is, we don't know. 

And I see two types of people. Unfortunately, the ones that do not believe in vaccines, and we have a lot of evidence to suggest that on balance, they're very safe and very effective. And millions of people are still alive because of the vaccination. We also have the second group of people that have received some of their vaccines. And they're worried because of some comorbidities that are not currently being picked up by the UK Government, that then they are ineligable for boosters. And those people are actually very worried that they will have acute covid, they will develop long COVID. And they would have enjoyed the opportunity to to receive vaccination. 

Jackie Baxter  
Yeah it's a difficult one, isn't it? And I think the sort of other point is, the vaccine should reduce your chances of getting COVID in the first place. And the best way to not get long COVID is to not get COVID. 

Vassilios Vassiliou  
Absolutely

Jackie Baxter  
That's probably a whole different podcast. 

Vassilios Vassiliou  
Yeah. There are other things we should have done. We could have mandated air filters, in hospitals, in gyms, in schools. You know, we are one of the richest nations in the world. And apart from rolling out the vaccination program, initially, we have not followed this up. We've not clean the air, we've not looked after to make the quality of the better in any place. So we could and we should have done better. 

Jackie Baxter  
Yeah, definitely, 

Vassilios Vassiliou  
I think, to try and put a positive conclusion. The vast majority of people with long COVID will get better. And they will be able to go back to their normal lives, to normal activities. It will not be tomorrow, it will take time. So I think when people get very upset and worried and depressed, comparing the quality of life they have at the moment compared to what they could have before, we know the difference, we know that this happens. 

We might not be able to have therapy that will help them get better all of a sudden. But I would like to reassure people that the vast majority of people with long COVID will get better over the period of time. And even if they can do a little bit more today, you know, some breathing exercises, some walking, gentle running when the time comes, looking after their nutrition and you know, stopping smoking or cutting it down. Every little bit helps. But what I would like to remind people is you know, we can beat long COVID. It will take time. But they will get better. 

Vicky Tsampasian  
Absolutely. I completely agree. And just to reinforce that is that, we didn't talk about it - probably is a different podcast, but mental health is also important. And yes, as Vass said, it's important not to give up on yourself, or on life. Every little thing helps. And even if it's like five minutes more of walking or 20 minutes meditation every day, it helps and it will get better eventually. And it's important just to look after ourselves and our bodies, so that it looks after us, in the end.

Jackie Baxter  
Yeah, absolutely. I think like you say it's very easy to get kind of, you know, stuck in how awful things are, because they are, they are absolutely awful when you're really really unwell. But just being able to kind of celebrate those little wins, because little wins add up to bigger wins in time and, you know, there are things that we can do. 

So, thank you both of you so much for joining me today. It's been an absolute pleasure. So thank you for all that you've done and all that you're doing, and maybe we can catch up again sometime.

Vicky Tsampasian  
Thank you for the invite

Vassilios Vassiliou  
and for taking the time to set this up. It's important for patients and they do appreciate it.

Transcribed by https://otter.ai