0:00

I'm Dr. Carl coming to you from

0:02

the lands of the Gadigal people of

0:04

the Eora nation. I acknowledge Aboriginal and

0:07

Torres Strait Islander peoples as the first

0:09

Australians and traditional custodians of the lands

0:11

where we live, learn and work. G'day

0:14

Dr. Carl here with Professor Steven Foe on

0:17

part two of Long Covid. Welcome to

0:19

the microphone again. Oh, thanks Carl. Great

0:21

to see you and great shirt. Oh

0:23

wow, this is my duty. So

0:26

we've been through what is Long Covid and

0:28

can we prevent it and we've also been

0:30

through the causes. Now we've

0:32

got two more things coming up at least,

0:35

diagnosing and

0:37

managing. And the bottom line is

0:39

where I was completely wrong. I thought that once

0:41

you got Long Covid, that was it. Your days

0:43

were numbered. You're just not going to get better.

0:46

And you're saying that you can get better, but

0:48

you've only got you've got a waiting list of

0:50

one year on your clinics. And we're talking here

0:52

around middle 2024 ish. Is

0:55

that right? Yeah, yeah. So we've got two

0:58

clinics, respiratory clinic, which is a shorter waiting

1:00

time. And that's in Sydney, Australia, in

1:02

St. Vincent's Hospital. Yeah, that's right. That's

1:04

about four or five months. And the

1:07

rehabilitation one is about nine, nine or

1:09

ten months. Let's get into the diagnosing

1:11

then. You've got a

1:13

list of things here, red flags, symptoms,

1:15

risk factors, primary diagnostic criteria. You measure

1:17

the severity, certain personality times. Take it

1:19

away. The first thing is when you

1:21

get symptoms straight after your Covid, you

1:24

do need to see your GP because

1:26

some of them could be completely unrelated.

1:29

So you might have chest pain. You might

1:31

think, oh, that's just from Covid. But then

1:33

you'll see your GP and you'll say, no,

1:35

you're actually having a heart attack. You have

1:37

to go to the hospital. So. So

1:39

the first thing is make sure you don't

1:41

have what we call red flags or, you

1:43

know, issues that need immediate treatment. Generally,

1:46

what we do is run

1:48

tests because the definition of

1:50

long Covid is that you

1:52

cannot have the symptoms if they're explained

1:55

by another cause. Sounds reasonable.

1:57

So it might be if you're a

1:59

diabetic. and you've had COVID and you're

2:01

parable after that your

2:03

diabetes is out of whack. In which

2:05

case you've got to see the GP

2:07

and have that excluded. However, once all

2:10

that's excluded, if you're still having long

2:12

symptoms after three months, that's

2:14

the diagnosis. We

2:16

know that early rehabilitation decreases the length

2:19

of time you have symptoms and improves

2:21

your function. And early

2:23

rehabilitation can improve long

2:25

COVID. Yes. That is such

2:27

a surprise to me. Yes. What we

2:30

do is we try to start

2:32

people learning about pacing, how to

2:34

pace themselves. So you're right

2:36

about that a lot. Yes.

2:38

You might be not quite what you used to be,

2:40

but hey, once you're over 15, you're not what you

2:42

used to be anyway. That's right. And

2:45

so I think, you know, if you know, for

2:47

instance, that you're very good in the morning and

2:49

you're not so good in the afternoon, you might

2:51

have to change what you're doing so that the

2:53

energy sapping activities are in the morning and the

2:56

less energy sapping activities are in the afternoon. Like

2:58

when I was feeling that brief tightness, I had

3:00

no control of it. That's the gear that came

3:02

out of me. I just had to lie down

3:04

and go to sleep. I had no control. It

3:07

was weird. Yes. So you've got

3:09

to actually accept that that might be

3:11

happening and then rearrange your life. Now,

3:14

some people do that easily. They're

3:17

on their work and their life and

3:19

family. That's right. That's right. And

3:22

their personality. And I

3:24

want to make it clear that no, there's no

3:26

personality type that gets long covered. Okay. Let's

3:29

get that out of the way. It's not as though the uniquely

3:31

cheerful or uniquely depressed person, sad

3:34

person, there's no relationship

3:36

between long covered and personality type.

3:38

No. It's completely

3:40

non-discriminatory. But what happens is

3:43

as you get used to pacing and doing

3:45

things, there are some people who will find

3:47

that very difficult and challenging and there are

3:49

other people who find that easy. So if

3:51

you're the type that burns a candle at

3:53

both ends and you work very hard and

3:55

you sort of exercise very hard and you

3:57

have a lot of responsibilities. having

4:00

to cope with fatigue and changing what

4:02

you're doing, it'd be quite challenging. So

4:05

what we found in our clinic was

4:07

many of the people were completely stressed

4:10

by the fact that they had to

4:12

accommodate for these symptoms. So psychological help

4:14

or occupational therapy or the

4:16

clinical nurse can help people adjust. And

4:19

then the other thing is, of course, as

4:21

you pointed out, a lot of people get

4:23

very exhausted on very limited exercise. And

4:26

we found that there was a lot of people who

4:28

had what we call

4:30

post-exertional malaise or post-exertional symptom

4:33

exacerbation. So what that means is

4:36

they feel okay one day. So they think, well, I used

4:38

to go for a 15K jog before

4:41

the COVID. I'm just going to do that

4:43

again. And then they just are wrecked. Okay.

4:45

So that does not make things better, but

4:47

in fact makes things worse. Yes. And

4:50

so what you're saying is you've got to realise that

4:52

something's going to make you better and something's going to

4:54

make you worse. You've got to work out what they

4:56

are and go with what makes you feel good. So

4:58

sometimes you need a physiotherapist to sort of help you

5:00

with activity and movement and to say, this is what

5:02

we're going to do this week. You're not going to

5:04

do more than this. And

5:06

then slowly increase your exercise

5:08

and activity level until you

5:11

feel you can do what you need to do. So

5:13

we're kind of drifting into the managing

5:16

the symptoms. Can we go back to

5:18

the diagnosing? You mentioned the red flag

5:20

and the risk factors for long COVID,

5:23

not getting vaccinated, I guess is one.

5:25

Yes. And having severe COVID, being hospitalised,

5:27

also having a lot of what we

5:30

call co-morbidities. So other illnesses like diabetes,

5:32

obesity, high blood pressure. The

5:34

other risk factor is being a

5:36

woman. And we found that. What?

5:39

Yeah. We found. Is that a patriarchy? Come on. I

5:41

wish it wasn't true. And what we're finding is in

5:43

the clinic it's paying 60% of women. In

5:46

our clinic it's 55%. There's

5:48

a few theories as to why that might

5:50

be the way. One of them is a

5:53

social, which means is because we

5:55

put women in harm's way a lot.

5:57

They do caring roles. done

6:00

on a plane is done overwhelmingly

6:02

by women and unpaid and unrecognized.

6:04

Yes and they care for children

6:07

who often have covered etc. So

6:10

that's one theory about why there's more women.

6:12

The second theory is that there's a group

6:14

of women from 40 to 60 that

6:16

are very commonly affected. So

6:18

there's a question as to are

6:20

there some perimenopausal factors. Okay. So

6:22

that needs to be excluded but

6:24

I think the most interesting theory

6:26

is the one by an American

6:29

immunologist. Doctor I always get her

6:31

name wrong with something like a Kika

6:34

Kawasawa. She's in a book which

6:36

is your final book called Longovid

6:38

by Professor Steven FAUX pronounced

6:40

FOE. Right. Thank you.

6:42

Her theory is that women's

6:44

immunological response is based on

6:46

a potential or real

6:48

child being protected as a fetus and

6:51

what that means is that the immune

6:53

response is quite aggressive and

6:55

quite rapid but then quite

6:57

quickly exhausted and so that

7:00

if you've got any reservoirs of COVID

7:02

in your system and you need an

7:04

ongoing immune system to keep fighting that

7:07

that's weaker than in men. Why? Because

7:09

the aim was to try and protect

7:11

the unborn child or the

7:13

potential unborn child. So the woman

7:17

is not as highly protected as a baby. That's

7:20

right and in fact exhausts

7:22

her immune system by being so rapid

7:24

and aggressive early on. Because evolution wants

7:26

the next generation to come through. That's

7:29

right and then they it weakens over

7:31

time and we think one of the

7:33

other theories or hypotheses of

7:35

Longovid is that there's reservoirs of the

7:37

virus still floating around your

7:39

system. They're exhausting the immune system of

7:42

the mother? Yes and so the mother

7:44

doesn't have enough technological power to

7:46

manage their Longovid symptoms and one

7:49

of the interesting things that more

7:51

men died of COVID than

7:54

women. So there's a

7:56

hypothesis that that might be

7:58

the case and in the United Kingdom United States

8:00

they're using AI to look at

8:02

the responses of women to immunological

8:04

disorders and to infections compared to

8:06

men. Now I didn't quite get

8:08

the one, can you

8:10

tell me through that hypothesis again

8:13

about the women exhausting their immune

8:15

by supposedly protecting the

8:17

baby? Yep so essentially. There's no

8:19

baby in this case when they're

8:21

40 to 60? No but there's

8:23

always a potential and a response,

8:25

a wide in response that if

8:27

a woman gets infected because of

8:29

the potential of saving a

8:31

child the immune response is

8:33

incredibly aggressive and fast. Against

8:36

the infectious agent? Against the infectious

8:38

agent at the time of infection.

8:40

But then quickly exhaust? But then

8:43

is exhausted. And so therefore not

8:45

able to manage any long-term symptoms

8:47

or long-term viruses. So as we

8:49

go to women versus men for

8:51

long COVID is the risk higher

8:53

for women by? I think it's

8:55

something like 60-40 or 65-35.

8:58

Okay so it's about 1.3 or something. Yeah. Okay

9:00

so it's not like triple

9:04

but it's about 60-40, it's just a bit higher.

9:06

Yeah I've had some people comment that men don't

9:08

tend to go and seek help for the medical

9:10

conditions as well and that might be a factor

9:13

as well. Okay and one thing before we dive

9:15

into the managing which I love, measuring

9:17

the severity of long COVID. Yeah

9:20

so there's a few tools that

9:22

we have. One of them is

9:24

developed at Leeds University quite shortly

9:27

after the recognition

9:29

of long COVID. It's called the Yorkshire C19

9:32

questionnaire and it's a

9:34

questionnaire, quite a detailed questionnaire, takes about

9:36

15 minutes to do and that gives

9:38

you a sense of severity and a

9:40

score. We've been using that to monitor.

9:42

There's other measures that you can use

9:44

to just look at a particular symptom

9:46

but because COVID is a

9:49

systemic disease and affects every system

9:52

in the body we need measures

9:54

that will allow us to record

9:56

symptoms in all the systems.

9:58

Why is it such a system? I

10:01

think it's because attacks particularly

10:04

what we call ACE receptors,

10:06

angiotensins, and coving enzyme

10:08

receptors which are critical to the management

10:11

of blood pressure but are also present

10:13

in almost every organ of the body.

10:16

Really? I had no idea. Yes, so that

10:18

was one of the initial

10:20

assessments of what COVID

10:23

attacked. We think that

10:25

that's why it's become so systemic. OK, let's get

10:27

to the good bit now in terms of if

10:29

I've got long COVID, how things will be for me.

10:32

I'm thinking of you, beloved audience members, managing

10:35

the main long COVID symptoms through

10:37

rehab and you talk here in

10:39

four sections, the role of rehabilitation

10:41

medicine, fatigue, breathlessness,

10:43

exercise intolerance. One

10:45

of the reasons that we're particularly interested

10:48

in this was that when COVID started,

10:50

a group of academic rehab

10:52

physicians were concerned about the

10:54

chronic phase. We knew

10:56

from polio and from HIV

10:58

that there would be a chronic phase to

11:01

any pandemic or epidemic but

11:03

we felt that the government was not

11:05

acknowledging that or preparing for it. So

11:08

we wrote an article to the Medical Journal of

11:10

Australia in about June 2020 saying, look, are

11:13

we ready for the aftershocks? Great

11:16

forward thinking. Well, it's just that I knew

11:18

that if we didn't do something, all the

11:20

patients would end up requiring rehab

11:22

and that's exactly what happened. So

11:25

rehabilitation medicine is an area of

11:27

medicine that looks at helping people

11:29

manage and cope with ongoing disability

11:31

and that's the model that I'm

11:34

demonstrating in that we're getting people

11:36

back to functioning, we're getting people

11:38

back to their lives. Some

11:41

of them still have symptoms but they're managing

11:43

them and we've talked a little bit about

11:45

that today. So that was the importance of

11:47

rehab medicine. In terms of fatigue, we

11:49

have to teach people pacing. Some people take

11:52

it up easily, some people don't for a

11:54

whole variety of reasons. Sometimes

11:57

Responsibilities to their family is

11:59

more important. Horton than their own

12:01

health and so they get much more

12:03

for to use it. Veers do they

12:05

look after their children year so sometimes

12:08

they need advice from Paypal about how

12:10

to do two things at once and

12:12

cope with that in terms of breathlessness

12:14

this been very good evidence to show

12:17

that are a large number of people

12:19

get improvements from doing was spear tree

12:21

rehabilitation and only talk about that the

12:23

was easy breezy out versus the breezy

12:26

in your nice little rectangle. Ref can

12:28

you run through their soda. Yeah through

12:30

post lips year. So breathing out

12:32

three personally seen as slowly see

12:34

it tends to allows the time

12:37

that the oxygen stays in your

12:39

lungs to be longer. And we

12:41

know that the diffusion of oxygen

12:43

during cove at any long cove

12:45

it can be delayed. The

12:47

decision across the alveolar membrane can

12:50

be delayed. Yes, can be delayed

12:52

or decrease. We do this. D

12:54

C L O one of the

12:56

series and Mars Victory. Code.

12:58

Laid A is much more interest in

13:00

this is some small a wise limitations.

13:02

What we sound is a lot of

13:04

people who had childhood asthma or what

13:07

we called allergic renata so hi seva

13:09

or rashes that tends to reform and

13:11

recruit this for long cause of paypal

13:13

So it's not unusual that he'll say

13:16

paypal and say look i know you

13:18

haven't used to spray is your forte

13:20

achieve shall beautiful puffer or something even

13:22

not a version versions with Stewart in

13:24

but you will need this and they

13:27

do a number of tests including one

13:29

code or salaam a tree that actually

13:31

looks at whether the small a wise

13:33

started to close down a bit. he's

13:36

been using those surprise in a lot

13:38

more paypal, improving the management of Esa

13:40

which I think they don't have to

13:42

manage anymore as a background check out

13:44

what part coming down his throat as

13:47

yet the Us and a your twenty

13:49

eight lives of Bracey which is huge

13:51

guess and you endeavors something abyss that

13:53

city square meters as area we you've

13:56

got a very thin membrane. To

13:58

a the guess diffuse. Okay I

14:00

guess when when carbon dioxide sarkozy other

14:03

way better if is use airways. In

14:05

the last couple of levels that twenty

14:07

eight blocks he's getting the air with

14:09

a sweet sit oxygen making his way

14:12

to kiss up a good set seventy

14:14

square meters which is a bit smaller

14:16

than half of singles court that's beautifully

14:19

put. Our wealth? Some

14:21

of that Macys I'm afraid of. Can

14:23

I enjoy that? This place or was

14:25

I remember that? Also, plagiarize. Plagiarize that

14:28

nobody else is work. Evade your eyes.

14:31

Are his own an hour and the

14:33

other thing that we sound also is

14:35

that dumb people will have often have

14:37

marker clots in the lungs and as

14:39

a stupid microcosm we should not just

14:41

places but a whole different complicated. He

14:43

nails a thief and that can also

14:45

affect the to fusion the oxygen. So

14:47

there's also this other thing called dysfunctional

14:49

breathing. Where people get so worried about

14:51

the breathing which is normally unconscious the

14:54

become conscious of the breathing. ah and

14:56

so that can he can be trained

14:58

out of that. A lot of the

15:01

rehabilitation focuses on yo good habits with

15:03

respect to breathing taking big breath scene

15:05

and long breaths out with this with

15:08

it's ah I was looking at this

15:10

initially seemed breathlessness of exercise intolerance a

15:12

kind of the cynthia did not because

15:15

one is you say you the small

15:17

he was just before you get to.

15:19

The twenty eight levels of breaking people

15:22

are often build exercise into. The loss

15:24

was a walk to work or they

15:26

might cycle to work with i might

15:29

try not to his car or you

15:31

know so that they get a bit

15:33

of exercise and what the findings are

15:35

they getting very short breaths a one

15:38

and one of the spiritual bread but

15:40

not because of the airways the developers

15:42

something else because allocate they can't tolerate

15:45

the exercise and caught recently with this

15:47

been a study all Vom people who

15:49

great. to have muscle biopsies worth less

15:51

a big deal says this big deal of

15:53

a needle straight through a holiday to the

15:56

pulitzer muslim look at etc microscope and what

15:58

they sounds of them people who had long

16:00

COVID, it was a small number but it's

16:03

been reported at Nature magazine, indicated

16:05

that they had amyloid deposition in

16:07

the muscles and that those muscles

16:09

might have actually not be functioning

16:12

as they should and so indicates

16:14

that they're intolerant, you know, those

16:16

muscles aren't working as they should

16:19

and means that your ability to do the

16:21

exercise might be affected on a muscular level.

16:23

Right, that's your physiological basis,

16:25

the molecular basis for the exercise

16:28

intolerance that this chemical which

16:30

has been amyloid, which has been supposedly

16:32

implicated in a few other things, now

16:34

it's turning up in your muscle. Yeah

16:36

and of course you know if you're

16:38

not transfusing oxygen enough you'll get fatigued.

16:41

Part of the long COVID response

16:43

is that people do develop this

16:46

boom-bust cycle. So

16:48

they feel good and then they exercise

16:50

as much as they can, then they're

16:52

exhausted for a few days and we

16:54

call that crashes and we have

16:56

a lot to thank the chronic fatigue population

16:58

for that because they've taught us a

17:01

little bit about how to manage that.

17:03

So sometimes you need a

17:05

physiotherapist to do some measurements, see how

17:07

much movement you can and activity you

17:09

can do and then measure it out

17:11

so that you don't overdo it or

17:13

get caught up in that cycle. Those

17:16

are the three major symptoms

17:19

and just a quick

17:21

cook's tour about how we manage them.

17:23

Chapter 5 in your fine book Long

17:25

COVID by Professor Stephen F.T.E.V.E.N.

17:28

F.A.U.X. He's then talking about

17:30

managing other long COVID symptoms and then

17:33

you run through a list of anxiety

17:35

and depression which is real, the brain

17:37

fog, the coughing, the heart palpitations, the

17:39

pain, the loss of smell, the sleeplessness,

17:41

take us away. Well I think you

17:43

know anxiety and depression is a common

17:45

response to developing a disability of any

17:47

sort and people with long COVID sort

17:49

of have a disability because they're not

17:51

able to function like they normally did.

17:54

As well as that we think that the

17:57

impact of the COVID on the

17:59

brain might actually induce anxiety

18:02

and depression. So there's

18:04

both organic and adjustment

18:07

issues but often people respond

18:09

to psychological treatments. Some

18:11

people who are not psychologically minded or

18:13

don't want to see a psychologist often

18:16

do have to respond to medications and

18:19

we talk about the other options. In

18:22

terms of the cognitive impairment we find

18:24

that very challenging. People say

18:26

that they can't perform their jobs. We had a number

18:28

of people who said they can't look at a screen

18:30

for very long. They become

18:32

overwhelmingly fatigued. So what

18:34

we're finding is that we need to

18:36

do a number of things

18:38

that OTs do. They have to do

18:40

task breakdowns. Occupational therapists do task breakdown

18:43

and so they break down the task

18:45

you do at work into the simplest

18:47

things and then the complicated things

18:49

they break down into little chunks that you

18:51

can do. And then we actually contact the

18:53

employers. That's one of our major roles to

18:56

say to the employer, look, long COVID they're

18:58

not going to be back to their normal

19:00

level of work for at least six

19:02

months and they're going to have to

19:04

have allowance to do work from home

19:06

so they can pace themselves and

19:09

they need you need to understand that

19:11

it will take some time for them

19:13

to get back. Now some employers are

19:15

you know receptive to that and

19:18

some of them aren't and so we've had about 23% of

19:22

people lost jobs or yeah but they've got

19:24

so much other stuff locked up in their

19:26

brains you don't want to throw that away

19:28

just from a simple mechanistic being an

19:30

employer getting the best out of your people

19:32

and vice versa. And also some of them

19:34

ran businesses of their own and felt that

19:37

they couldn't take on clients because they weren't

19:39

able to function there at the level they

19:41

expected. So there's been a huge number of

19:43

people who are unemployed as a result and

19:46

we advocate for them, speak to the employers.

19:48

Some of them are on workers

19:50

compensation because they got long COVID

19:52

while they were at work and

19:55

so they're in a better place because

19:57

they can get access to what we

19:59

call those educational rehabilitation. Everybody should

20:01

have access to it. I

20:03

know but silly. Well, what an artificial

20:05

division. Yes, you can get access

20:08

to it, but it's incredibly expensive. So

20:11

the insurers will pay taxes and

20:13

apart from the fossil fuel companies.

20:16

Yes. I mean, I think that's one

20:18

of the reasons we need long COVID

20:20

clinics because if you manage

20:22

it in the community you'll often have to

20:24

pay out-of-pocket expenses to see doctors or allied

20:26

health professionals. Whereas in public clinics we all

20:29

sort of covered. And one of the other

20:31

interesting things is a loss of smell. I

20:33

think I found this the most fascinating. They

20:35

have to one of my extended family

20:37

members. Yeah. It came good. We

20:39

had a patient who was a

20:41

cook in an Indian restaurant. She

20:43

couldn't buy fish. She said she'd

20:45

stop having confidence to buy fish.

20:48

So she had to get her husband to go

20:50

and buy the fish with her and then not

20:54

much to her chagrin, her mother-in-law into the

20:56

kitchen to help her taste the food

20:58

that she was serving for

21:00

about three months. But during that time we introduced

21:02

it to a smell

21:06

rehabilitation program. Can you take us

21:08

through that? Yeah, so it's available on

21:11

the internet. I quote it in the book. And

21:13

what it is is you get three or four

21:15

smells. I think one has to be floral, one

21:17

has to be something to do with

21:19

food and one has to be a mineral. You

21:22

train yourself to smell it for 15 seconds

21:25

and imagine, you have

21:27

to actually visually imagine the flour

21:29

or the salt or the slightly

21:34

grilled steak or something like that. You have

21:36

to actually imagine that because we

21:39

and you do that every

21:42

day for around about 10

21:45

minutes and then after

21:47

three weeks you change the smells and you

21:50

do a second set of smells and then the third

21:52

one you do it again.

21:55

So after 12 weeks most people Have

21:57

their smell returned. Well You can train your muscles.

22:00

He wasn't got sloppy and if nobody

22:02

gets he must say to was his

22:04

sense of smell yes smell in particular

22:06

oils and particular since that are available

22:09

online and so this woman did it

22:11

and then she was able to tell

22:13

her mother in law that see no

22:15

longer have to be in the kitchen

22:17

with a special pick up other lozada

22:20

and a killer I say wow what

22:22

a happy ending those experiences made A

22:24

big thing is that you can come

22:26

out of long cause it isn't as

22:28

good and ito vet adjust. Was yesterday

22:30

as pay seek a swell Yep pisces a

22:33

big things that he was you tables they

22:35

were people have jobs and he worked there

22:37

with a different six o'clock the morning to

22:39

nine o'clock at night lists. Of

22:42

those has also is to have a

22:44

user due to run his thoughts. they

22:46

still it up the same place practically

22:48

but they they should do things differently.

22:50

I drop a few things that have

22:52

a few more breaks and you've gotta

22:54

you know have a an employer is

22:56

able to be flexible why put out

22:58

there what I think should occur? I

23:00

realized everyone will be different. Things will

23:02

occur completely differently and sometimes he won't

23:04

be able to get that sort of

23:06

person because your employer won't be on

23:08

the same page this efforts to hear

23:10

am so that's that's another ahead of

23:12

us who we haven't quite comes the

23:14

and we have to sort of come

23:16

to the end and a stuff immense

23:18

your mindset. Experimental. Long

23:20

cause it's treatments which is sad. Like

23:23

to talk to about that because I

23:25

think I think that's a real thing

23:27

of great interest to people who fum

23:30

cessna by science. A lot of studies

23:32

have shown that damn most doctors are

23:34

using off label drugs to. Experiment

23:37

with treatments along cause it and a

23:39

good example of an off label drug

23:41

is as Mp which is used for

23:43

weight loss but when I just feel

23:45

like you're full say on whitner most

23:47

that's right which is actually drug for

23:49

diabetes. Such. it's a this a long

23:51

tradition of doing this and is even

23:54

an international arm ethic. Ah god learn

23:56

from the Wi job, what to say

23:58

to people and when it's when it's

24:00

appropriate to do this. So we've encouraged

24:02

the J pays who might be reading

24:04

this book of patience to encourage that

24:07

a place to ask for what we

24:09

call and in on one Trial In

24:11

on what. Get In on one. So

24:13

it's a trial with just yourself as

24:15

the controls. Ah to go on and

24:18

off and on and I'll get on

24:20

of to the way you get to

24:22

some degree. Visit see both. Thick Yes,

24:24

the idea is to try and challenge

24:26

the placebo or know saber effect so

24:29

the idea is safer. Insists a lot

24:31

of people are trying a drug called

24:33

Metformin Spain shine in one study that

24:35

if you go on to it shortly

24:38

after covered that your chance of getting

24:40

long cause at a reduced what mitt

24:42

forward cause squads over reduces earning takes

24:45

a while but urges as he can

24:47

improve Yep so doesn't hurt. A lot

24:49

of people suggest that particular people have

24:52

got symptoms of i try that. So

24:55

we say to them or I will watch

24:57

You gotta do is first I'm a come

24:59

up with an outcome measure and if it's

25:02

fatigue that you're looking at and should have

25:04

a fatigue measure and of ethical putting the

25:06

book this one called the fatigue severity scaled

25:08

a citizen questions very quick and say should

25:11

do that then he should go on the

25:13

metformin or whatever drug it is so you

25:15

have level drug you try it for two

25:18

weeks and then repeat that score again to

25:20

see if you fatigues improved see assume it

25:22

was a different different sized screwing around his

25:24

writing. It down that's right and also to

25:27

measure measure to visit but I doubt the

25:29

hip so then I you should stop them.

25:31

It former know the drug for two weeks

25:33

and and are down what you sit and

25:35

write down what you fail at the end

25:37

of it and then you need to reintroduce

25:39

that again for two weeks is and write

25:41

down at the end how you feel and

25:44

east each time you're on the drugs you're

25:46

fatigued does. Why would they don't think you've

25:48

got a fairly good indication that the thing

25:50

is that the drugs working for you for

25:52

you yet though The sorry for your next

25:54

door. neighbor but cu yeah so i

25:56

think people if they can to try

25:58

stuff including our natural treatments as

26:01

well, you should try it in that format

26:03

so that you get a good idea as

26:05

to whether it's working and you also need

26:07

to measure the risks and benefits. So for

26:10

instance if you had to

26:12

do treatment that required you to pay

26:15

$5,000 to travel to the

26:17

other side of Sydney or the other

26:19

side of Melbourne to do it, you'd

26:22

have to really be certain that that

26:24

worked because the cost of

26:26

it is huge. Whereas if you were

26:28

just going to the local chemist

26:30

and buying something cost you

26:33

$30 for a few

26:35

months supply, you could you could run that study

26:37

at home without too much

26:39

risk. So you've got to measure

26:42

the risks to the benefits.

26:45

Okay, thank you for taking us on

26:47

this two-part wonderful trip through long

26:49

COVID which really blew my mind. How

26:51

can people, and we do more

26:54

clinics, we've said that several times, how can

26:56

people contact you they'd have to go to

26:58

St. Vincent's and then go through that but how can

27:01

somebody wants to be academic or

27:03

clinical, how can they follow

27:05

you in your fine work and

27:08

become perhaps one of your students?

27:10

Sure, well I've got a LinkedIn

27:12

page but I'm also available through

27:14

email at St. Vincent's Hospital. S-T-E-V-E-N-F-A-U-X.

27:17

Yeah and so I think

27:19

you'll find my email available

27:21

from there, any email

27:24

that goes to St. Vincent's gets redirected to

27:26

me. We do need

27:28

more clinics, it's just not good enough. GPs

27:30

are being trained up and we're hoping

27:32

most people will be managed in general practice

27:35

but we need to support GPs with places

27:37

for them to refer complex cases and for

27:39

them to be able to call a friend

27:41

and say I've got this case, you know,

27:43

what should I do? And I remember a

27:46

case just like that from Tasmania where a

27:48

GP called us and said I've got this

27:50

guy, these are the blood results, just

27:53

not sure of what I'm doing, do

27:55

you recommend, what would you recommend? Can

27:57

he see you online? And so

27:59

I I took it back

28:01

to our group, we discussed it and

28:03

then one of us was a hematologist

28:05

said, no that's completely disordered. That guy

28:07

might be developing a myeloma. So then

28:09

we rang the GP back and said...

28:11

So he put a bunch of specialists

28:13

together. And so we rang the GP

28:15

and said, look can you repeat the

28:17

test? He said, I did. Oh and

28:19

I fancy that he's got myeloma. So

28:22

you know, I think just

28:24

having that conversation and me

28:27

saying, look that's not what we

28:29

normally see. I'll take it back to

28:32

our group. Actually gave that general practitioner

28:34

enough confidence to say, right, well maybe

28:36

this isn't long COVID, maybe this is

28:38

something else. But I

28:40

think there are so many cases where people

28:43

are emailing. I got another

28:45

email from another general practitioner who said,

28:47

the insurance company say

28:50

long COVID doesn't exist and this person can't

28:52

get back to work and what do we

28:54

do about this? And so I was able

28:56

to send her all the articles about

28:59

the existence and the pathology and

29:01

all of that. What a wicked

29:03

insurance company. Now that is wicked. We're

29:05

entering what I call the chloroquine phase

29:07

of long COVID and I

29:10

think it'll be very politicised. Hopefully

29:12

rationality in science and books like your

29:14

fine book Long COVID, which you

29:16

can read in an evening and

29:19

you will get so much from. Thank

29:21

you very much, Carl. Thanks so much for

29:23

the opportunity to chat to you and for

29:25

being able to take in that splendid shirt.

29:28

Thank you Professor Stephen for the author of Long

29:30

COVID. Thank you. Bye bye. Shirtloads

29:33

of Science is washed, spun and

29:35

aired by the University of Sydney.