Cape Town — In Part 1 of the interview Juanita Williams from allAfrica had with Professor Resia Pretorius from Stellenbosch University, Pretorius spoke about her extensive research on blood clots, inflammation, and their implications, particularly in the context of acute Covid-19 and Long Covid. Pretorius' research team was among the first to identify inflammatory microclots in the blood samples of Covid-19 patients, which led to prolonged symptoms, sometimes lasting years.
Pretorius also explained how diseases like diabetes, high blood pressure, and cardiovascular conditions cause an excess of specific molecules in the bloodstream, leading to abnormal clotting. This pathological clotting increases blood viscosity and the risk of severe complications such as deep vein thrombosis, heart attacks, and strokes. Chronic inflammation from these diseases exacerbates clotting issues, leading to abnormal clots.
The professor told allAfrica about the importance of understanding clotting mechanisms to develop strategies for managing chronic inflammatory diseases. Her research aims to reveal how these conditions cause abnormal clotting and find ways to mitigate these risks, which is particularly relevant for acute and Long Covid cases.
A 2023 study published in Nature, involving over 29,000 patients, highlighted that nearly half exhibited Long Covid symptoms, with fatigue being the most debilitating. This finding underscores the ongoing burden of Covid-19, as millions continue to suffer from persistent symptoms, straining healthcare systems worldwide.
Part 1 of the interview also shared that there is a lack of specific treatments for Long Covid due to the complexity and variability of the syndrome. Pretorius said effective treatment regimes are still in development, with research focusing on understanding disease phenotypes and identifying biomarkers.
For individuals with pre-existing conditions like diabetes and high blood pressure, managing Long Covid symptoms can be particularly challenging. Pretorius said clinicians must look at individual symptoms rather than a one-size-fits-all approach, as Long Covid involves over 200 different symptoms.
In cases like the Williams’ mother (more details in Part 1 - 'No, Long Covid is Not a Thing in Your Head, You're Sick') , who experienced severe post-Covid symptoms, it is essential to manage each symptom individually due to the lack of specific treatments for Long Covid.
Pretorius said Long Covid is a genuine and serious condition, often misunderstood or underestimated by some doctors. It requires a comprehensive and patient-specific approach to treatment, recognizing the diverse and complex nature of the syndrome.
This is Part 2 of Williams' interview with Pretorius, focusing on diagnosing Long Covid, healthcare access and government responsibility, the ongoing threat of Covid-19, and patient advocacy as more and more people go to their doctors with Long Covid symptoms.
Excerpts of interviews are edited for clarity
Returning to diagnosing Long Covid, let's consider an example. A friend has a family history of diabetes and hypertension. Despite not being diagnosed with these conditions, he tested positive for Covid a year ago. Recently, he's been experiencing recurrent symptoms resembling stomach flu. Given his situation, living in an African country where healthcare is not accessible, what steps could he take to address these symptoms, especially considering the overlap with potential long-term effects of Covid?
Unfortunately, there is very little to do. You need to find a clinician who wants to listen to you and wants to look at the research, read more, and be informed.
The only thing to do is find a condition that they can treat the symptoms and treat the person who experiences the various symptoms. Unfortunately, we don't have any treatment regimes that have been clinically tested and trialed. It's up to the clinician to do a clinician-initiated treatment.
That's it.
Considering this individual's limited access to government-run public hospitals, it's a challenging scenario. What measures or strategies do you think African governments should adopt, given that a significant number of Covid cases on the continent were asymptomatic or went undiagnosed, to address the potential long-term health impacts and provide adequate support, especially for those with constrained healthcare access?
The problem is not an African problem. It's a global problem, the things that you asked me now, you could just as well ask what can the U.S. or the UK or Europe do. It's the same thing.
Governments need to fund more research, they need to be cognizant of the fact that researchers are saying there is Long Covid and then need to plan.
They need to have Long Covid clinics where there are clinicians who can look after these patients and look at them in a holistic way, to treat them and the symptoms that arise.
That's not going to be an easy thing to do.
You might have now survived two or three bouts of acute Covid with being fine. But your next infection might just be the one that pushes you over the limit.
However, if the governments don't do that, they will feel it two, three, or five years from now when the economy is suffering. Because if you think that if 10%, never mind 20, 30, or 40% of your population can't function properly, how on earth are you going to get to keep your country economically stable? So globally, it's a problem. It's not an African problem, but probably more in Africa. People are putting their heads in the sand about the economic impact of this.
And the issue is Covid has not gone. It's not patients who got Covid in 2020-21 that now are suffering from it. With every single infection that you get, you are a step nearer to Long Covid. You might have now survived two or three bouts of acute Covid with being fine. But your next infection might just be the one that pushes you over the limit.
It means that we need to be aware that Covid is not gone, people still have new infections, and every single day new, Long Covid patients, hundreds of thousands worldwide, are reporting Long Covid.
It might be just as simple as I didn't feel well for three, four, or six months, and then I recovered. But that’s still three or four, six months out of the economy. People have lost their houses, they've lost their jobs, and they are bedridden. Governments need to take into consideration that if we don't fund research if we don't look into clinical trials, we're going to have a massive problem.
And the issue is our public sector hospitals cannot cope with the current load of patients.
What now, if we do in a few years sit with an additional lot of chronic inflammatory disease patients suffering from Long Covid? A lot of our research is now our research community.
It's not myself saying that alone, it's all over the world that we have been saying and predicting and showing now that there is an increase in cancer. There is an increase in diabetes. There are increases in all inflammatory-type diseases. And there's an excess death rate that we have. If we compare 2018, and 2019 levels of excess death rate to now.
We do have a phenomenon of vaccine injury - we do have a phenomenon Long Covid. Sometimes they're intertwined.
That's just mad.
There are so many more people dying for no reason. And it might be Covid-related symptoms that might have triggered cancer or a disease or the patient has just had a false track of symptoms.
It's a real significant worry for researchers and I don't think governments are taking it seriously enough.
It appears that there's a need for advocacy from both researchers and the scientific community, as well as from patients who have to advocate for their health. In my community, the norm is to visit the doctor, receive medication, and leave without much discussion about symptoms. There's an assumption that the doctor will handle everything. How would you address this dynamic where individuals might not be accustomed to actively discussing their symptoms or expressing ongoing concerns about their health during medical visits?
I think it's very important for advocacy, not only from researchers but from patients. So there's a whole big group of patient advocates from the U.S., the UK, from Africa, as well, patient-led initiatives that tried to focus on getting the information out there. Many researchers work closely together with patient advocate groups. We must do that because the patient has a symptom. So we don't want to "research A and complain about B."
We need to take hands with researchers, clinicians, governments, patients, with patients' advocates, and look at this as a holistic disease. Patients that still have the symptoms, go back to the doctor and ask for an explanation.
As you mentioned, many clinicians face challenges with patient adherence to medication, especially those in informal work environments. I've personally observed this where individuals get diagnosed with a condition like diabetes, receive medication, and then express hesitation or even fear surrounding taking it.
They might ask, 'What am I supposed to do with all of these pills?' They might still be able to go back and they ask what's wrong with me?
We need advocates to tell patients that they've got the right to ask questions and to insist that the clinician explains to them, even if it takes two or three times of explanations over and over again.
If you don't understand to ask, what is wrong with you? How must you treat it? How much do you change your diet? How much do you try to sleep patterns? You don't just get a box of pills and go away?
I hate to ask this question, as I don't align with the belief that vaccinations cause issues, and I want to make that clear. However, when individuals report post-Covid symptoms after being vaccinated, how does your research account for or consider the potential side effects of the vaccination in such cases?
I must unequivocally say I am pro-vaccination because it saves millions and millions of lives. However, there have been reports by clinicians and researchers that if you get some individuals, not many, in a very few percentage of individuals, you do get vaccine damage. That's a fact.
Vaccine damage can look very much the same as Long Covid because of the fact of spike protein. Spike protein has a role to play in Long Covid and it is inside some of the vaccines. Not all of them, but some of them. mRNA vaccinations make spike protein, so it triggers your immune system.
So yes, there are vaccine injuries that we see.
The issue is that many people in 2021 when we first in South Africa got the vaccination unfortunately got Covid while standing in the vaccination rows. I know a few of those. So then is it a vaccine injury? Is it acute Covid that delayed too long? What do we have?
We do have a phenomenon of vaccine injury - we do have a phenomenon Long Covid. Sometimes they're intertwined. When you have perhaps had Long Covid symptoms, and then you got vaccinated and then the vaccine produced significantly more symptoms or your Long Covid looks worse. So where is the vaccine? Was it before acute, during acute, or after Long Covid? So all of those scenarios, you could just think it's a million possibilities.
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However, vaccination still prevents death as a result of acute Covid. Therefore we need to promote vaccination. If you're healthy, and you can have a vaccine, and you don't have symptoms that the doctor might feel perhaps you shouldn't get a vaccine because there are such cases, then I think still we need vaccination. However, we do find vaccination damage in some individuals, but it is a small percentage.
I'm sharing anecdotal observations, so my observations are not evidence-based. After recovering from her acute bout of Covid, my mother received her first vaccine after isolating, minimising the chance of being Covid-positive at that time. Surprisingly, she improved after the first dose. In their studies, have researchers observed similar instances of improvement following vaccination?
So some people who have Long Covid get a vaccination and get better because it's another spike for your immune system to wake up, but some people don't get better but will get worse. Then some people get the vaccination during Long Covid and don't get worse or better. So yes, there are various scenarios, and it's different for everyone.
I just want to clarify. So when I say side effects, and you say injuries, in terms of vaccines, is that the same?
I think side-effects or injuries of vaccine, or vaccine side-effects are the same thing.
As someone advocating for vaccination, would you recommend, on a general basis, that individuals without any current Long Covid symptoms still consider getting vaccinated?
I would not suggest anything because I'm not a clinician. So I cannot suggest that, however, the best would be to discuss with your clinician and look at your symptoms, because you don't want to worsen your symptoms. Vaccination can cause more clotting. So if you are clottable, during your Long Covid journey, and you get vaccination, it might impact that.
We are working on such methods to diagnose clotting pathology in Long Covid
You previously highlighted the existence of novel diagnostics for Long Covid. Could you provide more insight into what these novel diagnostic methods entail?
Yes, so it's not diagnosing Long Covid per se. We've developed a method to diagnose clotting pathology in Long Covid and we discovered that people can have in the blood what we call micro clots.
And these micro clots are found in platelet-poor plasma. Currently, it's a novel method to look at platelet-poor plasma or plasma in which all the cells have been removed and respond down blood, so it's the fluid part of the blood.
In that portion, we have these microclots and we've been studying it for a very long time, but in getting Long Covid there are many more of these microclots and novel methods aren't microscopy or a method called Flow cytometry, which all pathology labs have. We are working on such methods to diagnose clotting pathology in Long Covid.
