The Looming Disaster of Underestimating Covid Autoimmunity
Summary
TLDRDr. 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
🧬 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.
📈 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.
🔍 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.
🚨 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.
Mindmap
Keywords
💡Autoimmunity
💡SARS-CoV-2
💡Spike Protein
💡Ace2 Receptor
💡Incident Autoimmune Diseases
💡Severe COVID-19
💡Viral Mediated Autoimmune Disease
💡Autoantibodies
💡Clinical Rheumatology
💡Matched Cohort Study
💡Long-term Risks
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]
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