The Looming Disaster of Underestimating Covid Autoimmunity

Summary

Dr. Philip McMillan emphasizes the underestimation of autoimmunity in the context of severe COVID-19, which he describes as a viral-mediated autoimmune disease. He discusses a significant German study that found a 42.63% higher likelihood of developing autoimmunity in patients with a history of COVID-19, particularly those with more severe cases. The study, which analyzed healthcare data of millions, identified conditions like Hashimoto thyroiditis, Graves disease, psoriasis, and rheumatoid arthritis as being associated with post-COVID autoimmunity. Dr. McMillan stresses the importance of understanding autoimmunity for proper treatment and future health implications, comparing it to a 'silent disease' like hypertension. He calls for more research and a targeted approach to treatment, especially considering the potential long-term risks of the pandemic.

Takeaways

• 🧬 Autoimmunity is a critical aspect of severe COVID-19, which is considered a viral-mediated autoimmune disease.
• 🔬 The immune system in autoimmunity mistakenly targets normal proteins in the body, similar to friendly fire in a war.
• 📉 The risk of autoimmunity is linked to the body's response to the spike protein of the SARS-CoV-2 virus, particularly its receptor binding domain.
• 📚 A study out of Germany found a 42.63% higher likelihood of acquiring autoimmunity in patients who had COVID-19, with more severe cases at greater risk.
• 📈 The study highlighted an increased incidence of autoimmune diseases such as Hashimoto thyroiditis, Graves disease, psoriasis, and rheumatoid arthritis post-COVID-19.
• 👥 The research involved a large cohort, examining over 38 million insured individuals to identify 641,000 COVID-19 cases.
• 📊 The excess risk for any newly diagnosed autoimmune disease was 4.5 per 1,000 person-years, a significant figure across a large population.
• 🧐 Autoimmunity often goes undetected unless actively sought, making it a 'silent disease' similar to hypertension.
• ⚠️ The long-term implications of underestimating autoimmunity in the context of COVID-19 are severe and not easily resolved.
• 🧐 There are significant questions regarding the treatment of COVID-19 in the context of autoimmunity that need further research.
• 🌟 The scientific community is beginning to recognize the importance of autoimmunity in the pathogenesis of COVID-19, although this recognition has been slow.

Q & A

What is Dr. Philip McMillan's primary focus regarding autoimmunity and COVID-19?

Dr. Philip McMillan's primary focus is on the concept that severe COVID-19 is a viral-mediated autoimmune disease, which has implications for treatment and the types of diseases to look out for post-COVID-19 infection.

Why is autoimmunity in the context of COVID-19 considered critical?

Autoimmunity is critical because it affects how the immune system targets normal proteins in the body, which can lead to complex, difficult-to-treat conditions and needs to be actively sought out and understood to prevent long-term health impacts.

What is the main point of the paper discussed by Dr. McMillan?

The paper discusses the association between SARS-CoV-2 infection and the incidence of autoimmune diseases, highlighting a higher likelihood of autoimmunity post-COVID-19 infection, especially in patients with more severe cases.

What is the significance of the spike protein in the context of autoimmunity?

The spike protein is significant because it is what the virus uses to enter cells. The immune system may mistakenly recognize parts of the spike protein as foreign, leading to the production of autoantibodies and potentially triggering an autoimmune response.

What was the study design of the paper published in Clinical Rheumatology?

The study was a matched cohort study that analyzed routine health care data from Germany, comparing individuals with a positive PCR-confirmed COVID-19 diagnosis to a control group, and followed them up to June 30, 2021.

What did the study find regarding the risk of autoimmune diseases post-COVID-19 infection?

The study found a 42.63% higher likelihood of acquiring autoimmunity for patients who had suffered from COVID-19, with patients who had a more severe course of the disease being at greater risk for incident autoimmune disease.

What are some of the autoimmune diseases that were found to be associated with COVID-19 in the study?

Some of the autoimmune diseases associated with COVID-19 in the study include Hashimoto thyroiditis, Graves disease, psoriasis, and rheumatoid arthritis.

How does the size of the study cohort impact the relevance of the findings?

The size of the study cohort, which included millions of individuals, makes the findings extremely relevant from a scientific point of view, as it provides a broad and significant dataset for understanding the potential autoimmune implications of COVID-19.

What is the excess risk for any newly diagnosed autoimmune disease found in the study?

The excess risk for any newly diagnosed autoimmune disease was 4.5 per 1,000 person-years in the study.

Why is it important to actively seek out autoimmunity in clinical work?

Autoimmunity is important to actively seek out because it is often silent and can have a significant impact on health over time if undetected. It requires specific autoantibodies to be targeted for diagnosis, and without this proactive approach, the condition may go unnoticed.

What does Dr. McMillan suggest is the responsibility of the scientific community regarding autoimmunity and COVID-19?

Dr. McMillan suggests that the scientific community has a responsibility to study autoimmunity in the context of COVID-19 thoroughly, understand its implications, and focus on mitigation strategies based on a good understanding of the disease's pathophysiology.

Outlines

00:00

🧬 Autoimmunity and COVID-19: An Underestimated Link

Dr. Philip McMillan introduces the topic of autoimmunity in the context of COVID-19, emphasizing the importance of recognizing the disease as a viral-mediated autoimmune condition since April 2020. He discusses a German study on incident autoimmune diseases associated with SARS-CoV-2 infection, highlighting the paper's significance for treatment approaches and post-COVID-19 disease surveillance. The doctor also mentions upcoming presentations on long-haul COVID, vaccination, and diabetes in relation to autoimmunity, urging viewers to register for more information.

05:00

📈 Study Insights: Autoimmunity Post-COVID-19 Infection

The summary delves into a study published in Clinical Rheumatology that examines the link between COVID-19 infection and the subsequent development of autoimmune diseases. The research, conducted in Germany, analyzed healthcare data of individuals with PCR-confirmed COVID-19 until the end of 2020 and followed up until June 2021. The study found a 42.6% higher likelihood of acquiring autoimmunity in patients with COVID-19, especially those with more severe cases. Dr. McMillan stresses the importance of cautious treatment to avoid exacerbating autoimmune responses and the need for targeted approaches to vaccination and treatment based on risk assessment.

10:02

🔍 Prevalence and Risks: Autoimmune Diseases Post-Infection

This section provides a detailed look at the findings from the German study, which identified a significantly higher risk for newly diagnosed autoimmune diseases among COVID-19 patients. The study involved a vast cohort, making its results highly relevant from a scientific perspective. It found that the excess risk for any newly diagnosed autoimmune disease was 4.5 per 1,000 person-years, with conditions like rheumatoid arthritis, Sjogren's disease, Graves' disease, and Hashimoto's thyroiditis being particularly associated with increased risk. The study underscores the often silent nature of autoimmunity and the necessity for active detection and research.

15:04

🚨 The Call for Action: Addressing Autoimmunity in COVID-19

Dr. McMillan concludes with a call to action, emphasizing the need for further research and understanding of autoimmunity in the context of COVID-19. He discusses the implications of underestimating autoimmunity and the importance of considering it in long-term risk assessments related to the pandemic. The doctor also warns against ignoring the aspect of autoimmunity when discussing future strategies and the importance of actively seeking out and addressing autoimmune diseases to mitigate their impact on public health.

Keywords

💡Autoimmunity

Autoimmunity refers to a condition where the immune system mistakenly attacks the body's own proteins or tissues. In the context of the video, it is a critical concept as it is suggested that severe COVID-19 can trigger an autoimmune response, which has implications for treatment and long-term health outcomes for patients who have recovered from the disease.

💡SARS-CoV-2

SARS-CoV-2 is the virus responsible for the COVID-19 disease. The video discusses how this virus, through its spike proteins, can potentially lead to an autoimmune response, especially when the immune system mistakenly identifies normal body proteins as foreign, which is a central theme of the discussion.

💡Spike Protein

The spike protein is a key component of the SARS-CoV-2 virus, which it uses to enter human cells. It is highlighted in the video that the spike protein can bind to various human proteins, potentially leading to the production of autoantibodies and the development of autoimmune diseases post-COVID-19 infection.

💡Ace2 Receptor

The Ace2 receptor is a protein on the surface of human cells that the SARS-CoV-2 virus primarily uses to gain entry into the cells. The video discusses the risk of autoimmunity because the body might recognize Ace2 as foreign, leading to an autoimmune response.

💡Incident Autoimmune Diseases

Incident autoimmune diseases refer to new onset cases of autoimmune conditions that arise after a certain event, in this case, a SARS-CoV-2 infection. The video emphasizes that there is a higher likelihood of developing such diseases following COVID-19, which is a significant finding from the German study discussed.

💡Severe COVID-19

The term 'severe COVID-19' is used in the video to describe the more serious cases of the disease that require hospitalization or intensive care. It is suggested that patients with severe COVID-19 are at a greater risk of developing autoimmune diseases, which is a key point in the discussion about the long-term health implications of the virus.

💡Viral Mediated Autoimmune Disease

This concept from the video describes a type of autoimmune disease that is triggered by a viral infection. The video argues that severe COVID-19 is an example of such a disease, which is important for understanding treatment strategies and the potential for long-term autoimmune issues post-infection.

💡Autoantibodies

Autoantibodies are antibodies that are produced by the immune system to attack the body's own cells or proteins. The video discusses how the immune system's response to the SARS-CoV-2 spike protein can lead to the production of autoantibodies, which can then target various human proteins and contribute to autoimmune diseases.

💡Clinical Rheumatology

Clinical Rheumatology is a medical specialty that deals with the diagnosis and treatment of rheumatic diseases, which are often autoimmune in nature. The video references a study published in this field, which investigated the link between SARS-CoV-2 infection and the subsequent development of autoimmune diseases.

💡Matched Cohort Study

A matched cohort study is a type of observational study design where groups of subjects are matched on certain characteristics to compare outcomes between them. In the video, this study design is used to compare individuals with COVID-19 to a control group to assess the risk of developing autoimmune diseases post-infection.

💡Long-term Risks

The long-term risks discussed in the video refer to the potential health complications that may arise many months or years after the initial COVID-19 infection, particularly the risk of developing autoimmune diseases. The speaker emphasizes the importance of considering autoimmunity in any assessment of the pandemic's long-term impact on health.

Highlights

Dr. Philip McMillan emphasizes that severe COVID-19 is a viral-mediated autoimmune disease, which is crucial for treatment and post-COVID health monitoring.

Autoimmunity in COVID-19 is likened to a war scenario where the immune system mistakenly attacks the body's own proteins.

The spike protein of the virus is detailed, showing how it can lead to autoimmunity by binding to various human proteins.

A German study is discussed, which found a 42.63% higher likelihood of developing autoimmunity post-COVID-19 infection.

Patients with more severe COVID-19 are at a greater risk for incident autoimmune diseases.

The study focused on the impact of COVID-19 infection on autoimmunity, not the vaccine, and found significant results.

The research was based on a large cohort of 38 million insured individuals, making the findings highly relevant.

Autoimmune diseases such as Hashimoto thyroiditis, Graves disease, psoriasis, and rheumatoid arthritis were associated with COVID-19.

The study found an excess risk of 4.5 per 1,000 person-years for newly diagnosed autoimmune diseases post-COVID-19.

Dr. McMillan stresses the importance of targeted treatment and caution in managing COVID-19 due to its autoimmune implications.

Autoimmunity is often silent and requires active seeking out, similar to hypertension, to prevent long-term health impacts.

The scientific community has underestimated autoimmunity in the context of COVID-19, with significant implications for long-term health.

Autoimmunity post-COVID-19 is supported by evidence linking viral infections to autoimmune diseases and persistent autoantibodies.

The long-term risks of the pandemic must include autoimmunity as a central aspect of risk assessment.

Dr. McMillan calls for more research and understanding of autoimmunity in COVID-19 to develop effective mitigation strategies.

The implications of ignoring autoimmunity in COVID-19 are severe and difficult to resolve, necessitating immediate and thorough scientific attention.

Transcripts

hi good evening I'm Dr Philip McMillan

thank you for joining me as I continue

on my journey talking about

autoimmunity there's one thing about me

is that I am relatively boring in

focusing on the same issues over and

over again I've been saying the same

thing since April 2020 severe coid 19 is

a viral mediated autoimmune disease and

it's important because it has relevance

to how we treat the disease and what we

do and the kinds of diseases we look out

for after having coid 19 or as some

people say the elephant in the room so

what am I going to be talking about very

quickly today is this paper here and

this paper is talking about incident

autoimmune diseases in association with

with SARS COV to infection very

important paper out of Germany and um so

it's in it's a critical point for us to

understand and I'd want everybody to

know a little bit more about it before I

start as usual I'd like to remind you if

you're interested in terms of coid L

haul infection and vaccination I'll be

doing that presentation coming up

shortly there's a link in the

description where you can register

additionally just after coincidentally

I'll be talking about diabetes coid and

vaccines why autoimmunity is so critical

so again I'll be expanding on some of

those thoughts but let's get back to the

point

today why is it that coid autoimmunity

is underestimated and why is it so

important so let's see if I can give you

a little bit of context about what it is

that I'm FOC focused on so autoimmunity

in Co or autoimmunity generally is just

speaking about the immune system okay so

this is your immune system

targeting normal proteins in your body

okay so it's kind of like in a war where

you have troops supposedly attacking the

enemy but if you imagine the enemy put

on the

uniforms or the tags for the troops that

are attacking them suddenly they're not

sure who is their enemy and anybody

shooting could be an enemy so they start

shooting at everyone that's kind of like

what happens in an autoimmune disease

the body is no longer

recognizing normal proteins as being

part of the body and they think they

could be part of a bacteria or a virus

or something else and that's technically

an autoimmune disease it's complex not

easy to treat and something that we need

to try and avoid at all

costs So within that framework this is

why autoimmunity is so critical to try

and understand and so here are just some

basic points around the virus itself so

I've got here an image of the virus and

you can see there so in the Blue Points

here are the spike proteins and they

have been expanded to look something

like this so this is a closeup look of

the spike protein that is sitting in the

viral envelope here this gray part here

this ball is the virus and then the

spike protein is what the virus uses to

enter cells and at the top here is the

receptor binding domain where it usually

binds ace2 to get inside a cell perfect

now all viruses will use some kind of

ENT receptor just so happens this virus

uses primarily A2 as the Entre receptor

so very early on we were looking at the

risk of

autoimmunity because you can have the

body recognizing A2 as being foreign and

that's Technic an autoimmune response

and when you look carefully at what can

happen to the spike protein you can have

here this is A2 it binds to the receptor

binding domain but guess what there are

a number of other proteins that bind to

different parts of the spike um protein

and theoretically almost anyone or all

could get caught up if the immune system

picks up this Spike protein with these

proteins attached

then you could get autoantibodies to

neuropilin 1 DC sign ace2 furin and

that's the principle about autoimmunity

in coid 19 now we've been saying the

same s thing since

2020 and that concern is why I say that

you have to be so careful with how you

treat coid 19 so that's the background

how does it fit in with this paper that

I'm talking about here here so this

paper is an important one and I'll show

you here some details about it so this

was uh done in clinical Rheumatology

talking about incident autoimmune

diseases in association with SARS COV to

infection and I repeat infection a

matched cohort study it was actually

published in June

2023 and the authors are primarily from

Germany uh so this person here is Dres

in in Germany is the the main author and

um and so there was a slight correction

but not to worry about that what they

were doing they were looking at routine

Health Care data in Germany and they

were looking at people who were

identified with a positive PCR confirmed

coid 19 through December

31

2020 okay and so they match them a

control group and the people who had

coid 19 and they followed them up until

June 30th

2021 an important point in this here is

that this was just purely about coid 19

there was nothing in here that mentioned

anything about vaccination and they

didn't actually discuss if there was an

overlap in any of the cohort with

regards to that it's possible but I

think that they were trying to say that

was a low probability before vaccines

were rolled out to the general

population so this is primarily focused

on coid 19 infection itself that was

triggering potentially

autoimmunity so as I said let's look at

this in a little bit more

detail so here is the paper again and

I've highlighted some areas that I

thought were very important and you can

see here that they found a

42.6

3% higher likelihood of acquiring

autoimmunity for patients who had

suffered with coid

19 and patients who had a more severe

course of coid 19 were at greater risk

for incident autoimmune

disease this is very important and it

fits in with exactly what I've been

saying so and the the point is is not

whether or not I am right or whether

somebody else is wrong it's the

implications of this being an autoimmune

disease that are so important to

understand because it highlights what

you can treat it with how you treat it

and critically what you look for in the

future when it comes to people who have

had coid 19 and what you do critically

I've always said that was why I was so

careful and cautious when we were doing

the roll out I was saying listen Target

it because if it's autoimmunity as the

primary mechanism you don't want to risk

that in people who are in the lowrisk

cohort

anyway that was one of the reasons why I

was always focused on targeted very

targeted you know who's high risk you

target them if they have had infection

no point you only focus on your highrisk

cohort who had not been exposed that was

my perspective from 2020 and I think

that autoimmunity being on estimated is

one of the great reasons why we've made

a big mistake in the pandemic but time

will tell as I always say I don't mind

being wrong my responsibility is to ask

the question so when they looked at the

kinds of autoimmune diseases that would

occur um first onset of uh autoimmune

disease they incident rate there was

about

15.05 top of the list are things like

Hashimoto thyroiditis Graves disease

psoriasis rheumatoid arthritis so these

are some of the conditions that have

been Associated and that they found in

this cohort and what was very important

about this cohort was the numbers so

they were looking at a huge number of

people and when you look in a bit more

detail at their cohort their insurance

group in the insured individuals you're

talking about 38 million that they were

um trying to identify and when they went

down to the postco cohort we're talking

about

641 th000 individuals this is one of the

biggest studies of its kind and so the

information that comes out of it is

extremely relevant from a scientific

point of view and should not be

ignored um and so this is this is big

stuff so when they looked as I said and

they studied this in detail and they

looked at all the associated autoimmune

diseases then we come to the discussion

and as I said the link is in the

description if you want to look at the

paper yourself see the points and go

into finer detail this is just a

highlight of the paper here is the

discussion point and they were pointing

out that the excess risk for any newly

diagnosed autoimmune disease was

4.5 per 1,000 person years in the study

that's big that's quite significant and

the highest estimates for diseases were

rheumatoid arthritis Trojan's disease

Graves disease Hashimoto thyroiditis

with an approximately 40% higher rate

compared to the match cohort who were

not

infected and even with those who had a

prior autoimmune disease they had a

43% higher likelihood of developing uh

another incident autoimmune disease more

than controls these are Big Numbers

especially across a population of

millions of people autoimmunity here has

been grossly

underestimated the thing about

autoimmunity is that it is often silent

and so for people who aren't looking for

it you're not going to find it

autoimmunity is something you have to

actively seek out to try and find and if

you're not doing that you're not doing

the proper science when we think of

clinical work when you're looking for an

autoimmune disease you have to even know

which autoantibody to Target it's not

just general for each autoimmune disease

there are different autoantibodies that

give you a clue to the diagnosis you

don't stumble into it

autoimmunity is one of those hidden

diseases that can have significant

impact on the health of people over a

long period of time I like I lighten it

to the silent disease like hypertension

if you don't look for

hypertension by the time it has caused

its damage it's too late it's the same

with autoimmunity you need to actively

seek for it in order to understand and

find it final point on this

here you have this is in the conclusion

the autoimmunity hypothesis is supported

by a body of evidence linking viral

infections to the pathogenesis of

autoimmune diseases as well as results

from recent clinical and a basic

research de demonstrating persistent

autoantibodies and serological

autoactivity following infection in a

subset of patients

so they are recognizing that

autoimmunity is extremely important it's

sad that it has taken almost three years

for the scientific Community to focus on

this because as I said the implications

for the long term if we miss this are

horrific it's not easy to resolve and I

haven't even touched on what do you do

in the context of autoimmunity and

stimulating the immune system I haven't

touched that because that in itself is a

frightening concept and that's where we

are at the moment there are big

questions to be answered no easy answers

here and for anyone who ignores this

point and I say this categorically if

you are listening to anybody speaking

about the longer term risks around the

pandemic

and they don't have

autoimmunity as a central aspect of that

risk

assessment I don't think that they're in

a position to be giving any kind of

directions

autoimmunity needs to be understood we

need to be studying this with every

amount of research that we could it's

sad that it has been missed for so long

and the implications are not easy to fix

so again as I said to people before

there are no easy answers here there is

no easy way out we still have a lot of

work to do but it's not a time for us to

focus on the mistakes that have been

made because we can still learn how to

find mitigation strategies with a good

thorough understanding of the

pathophysiology of the disease have a

great evening everyone

[Music]