Professor Robert Clancy has found similarities between long covid and long post covid vaccination syndrome. Here he shares new findings on the theory and practical medical management of these two conditions. Thank you, Professor, as always for sharing your time and expertise.
Well a warm welcome to this talk and a particularly warm welcome back to Professor Robert clany all the way from Sydney Professor welcome back and thank you for coming my great pleasure John as always now Robert Clans is well known to the the channel he’s a consultant physician a professor of immunology and
Holds qualifications in Medicine Science and pathology and is a holder of the Australia medal so great to great to have him back now you’ve been doing quite a lot of work recent L Robert on uh long Co and I think we should say that one of the big advantages of being
Shall we say at our stages in later stages in our careers is you don’t have to worry about publication so much so quite a lot of what we’re going to talk about now is fairly original work so thank you for sharing that with us so we
Want to talk about um post vaccine and post infection long covid um now both of these syndromes you you you’ve been seeing you’ve been seeing patients with these can you just tell us roughly roughly roughly what you see patients with long covid patients with long covid vaccine injury what are what are you
Seeing well I think the first point uh John is that uh there’s no great mystery to to these conditions uh what happened was with the infection uh initially people were seeing ongoing symptoms and came up with a diagnosis that was vague and confusing and it was called long
Coov now long coov was anybody who had symptoms following Co infection that persisted for more than 3 months and the confusion for this is that it it included a number of different problems and every patient had a different mix of these problems and so uh for people who
Uh were working outside of say Immunology and related um related disciplines it it was incredibly difficult but to simplify there there are basically two different components uh it’s been known really since the late 1800s that people who get particular infections uh have a chance of getting a persistent fatigue illness that follows
It and that’s quite it’s nothing different about Co and so the essential component of long Co is what is essentially post viral infection fatigue and it has two Central components the first is what I call Energy activated fatigue which means that if you do something uh then you pay for it you get
More fatigue and the way I discuss that with patients is I talk about a ceiling I say we’ve all got a ceiling and uh in people with post viral fatigue syndrome long Co that ceiling comes down and if you try to push yourself with energy then you hit that ceiling that ceiling
Pays you back and you suffer for hours or days with of increased fatigue uh and um Associated characteristics the the second character the second feature of this uh chronic inflammatory state is cognitive defects and most people don’t say I’ve got a cognitive defect they say I’ve got brain fog
And uh it comes in many different forms I always have I had a I worked at McMaster University in Canada for some years and set up the Immunology Department there and I I remember I had this wonderful patient uh who was always late for appointments and um I once said
Why is it that you’re always late you know I’m seeing you at the end of the clinic when you’re actually supposed to be here 2 hours ago she said well it’s it’s part of my my problem I stand at the bus stop and I see the bus coming
Along and it says mcmas University and by the time it’s sort of registered the bus is gone and I’ve got to wait for the next one and so there are all sorts of variations I had other patients who were Math teachers who had to give up because
They they couldn’t sit and look at the board and do simple mathematics so brain fog is a terribly a terribly incapacitating problem but when we came to Long co uh patients had these symptoms but they had other sets of symptoms which were more structural damage and so while in classic chronic
Fatigue illnesses you don’t have so much in the way of structural damage to tissues the brain the heart in Long Co you did and that’s because uh if you look at the underpinning cause of all of these it’s the antigen is persistent uh in classic chronic fatigue it’s commonly
Not always but commonly the epstar bar virus which is the virus in my country we call glandular fever I’m not sure what you call in in England is it glandular fever or infe nucleo well the Americans like yeah we would say glandular fever or if you’re feeling a bit more correct
Infectious mononucleosis yeah there’s a lot of confusion of but there’s no question that a number of patients will have that incarcerated into their cells and under various stresses uh the virus escapes and you get fatigue illness maybe a sore throat big lymph nodes uh things like that and so we’ve known a
Lot about that but long um long Co and the patients had damage to their peripheral nerves often uh small fiber neuropathy with burning feet burning legs uh major problems in the brain uh cardiac issues a whole range of structural abnormalities and they got all thrown in together and you can
Understand the the confusion of people saying well how do I sort this out you know there’s no obvious treatment um what’s going on here and that’s the way I know it’s interesting I knowing that we were going to talk today I I just printed out uh the latest paper that I
Found on cause of um long Co which came out just last month and um it’s a very interesting paper because it’s full of detail but not full of message and it’s whole list of different things that people see without saying wait a second what’s the big picture here what’s
Really going on and unless you approach it in that way you can’t really really help the patient because the patient wants to understand what’s going on and wants to have some logic in terms of what they can do about it uh and I I think that’s where an immunologist
Basically looks after these patients I mean people with chronic fatigue illness have usually fallen into the basket of clinical Immunology because um most people who work in vertical systems like chest or heart or lung or brain um look at a particular disease in that system whereas immunologists look at a
Mechanism across the different systems and so we try to understand a process that’s going on in a a person with autoimmune disease chronic fatigue illness various conditions like that and then address the diagnosis uh in that form uh look at tests that might help understand that process and medications
Or processes that can help uh the patient with those issues so I I think that’s the broad sort of difference that underpins this now so that was chronic that was chronic fatigue in the context of um of U the covid infection and then more recently people are saying wait a
Second I’m seeing people uh who have had vaccination who have never had uh uh uh Co and these people are developing very similar symptoms uh and I I see in I don’t see a lot of patients these days but I certainly see a number and I I have a number of
Patients who have uh had vaccines never had Co um but they’ve got essentially long Co syndromes and again it’s a mixture of classic um energy activated fatigue brain fog together with certain structural problems uh so and the reason that it’s very similar is that the persistent antigen is the same antigen
It’s Spike protein so you’re getting Spike protein from the infection Co and that can persist at least 12 months maybe a lot longer in some of these patients whereas uh with vaccine we know that the spike protein the messenger RNA vaccine that is given uh disseminates through the body uh it provides
Expression of the spike protein on potentially any cell in the body and that can go on for months or year at least a year and remember the these are new syndromes we we didn’t know about them until the the last couple of years so we don’t know how long these
Conditions go but the bottom line is that there’s the same cause for the Post vaccine long Co if you like and the post infection long Co and this is incredibly important to understand and sadly it is not understood very widely because if you go and have I’ve got a patient at
The moment who had uh postvaccine uh long Co and then got Co infection and of course um people said who dear me all those terrible symptoms you’ve got of long they’ve got worse um we thought if you’d had a vaccine you’d get um much less problem with with with Co but of
Course uh it’s a totally different situation when you’re looking at a small proportion of people who get postvaccine long Co to the average person who might get uh a a vaccine which reduces the intensity of covid and therefore is linked to a degree of less chance of
Getting severe long Co disease and so there’s this commonality of persistent antigen that underpins both those conditions and we need to understand that if we’re going to apply effective management strategies it’s it’s really quite hard to understand this so when someone’s vaccinated if they get this long vaccine covid
Situation instead of producing the antigen for a few hours they’re producing the antigen chronically over o over a year or or more um what what is what is happening there how can the vaccine which is a single dose go on and produce Spike protein for a year or
More well I think that’s that’s the big question isn’t it and the answer is fairly straightforward that if you have a messenger RNA vaccine that messenger RNA we know um in the way in which it’s packaged and presented will go throughout the body and can uh be taken
Up into essentially any cell in the body now when it does that it the messenger RNA uh expresses through the ribosomal system in the cell the factory for proteins it it it expresses Spike protein which is represented on the surface of the cell and can be detected
In blood uh for a length of time now when it’s expressed on the uh length of um uh on on the cell surface uh in most people it’s probably only a relatively short period of time but in some people in fact a significant number of people
They’ll express it for a long period of time and they get an immune response because that remember that’s what you’re trying to to do with messenger RNA vaccine you’re trying to stimulate an immune response but what uh was not understood and and sadly had not been properly tested right at the beginning
Uh was that this antigen um Can persist for a long period of time and be the focus of a self-destructive immune response very similar to autoimmune disease and that’s exactly what’s causing one of the two main causes of the structural damage I’m talking about remember I I said you get a chronic
Inflammatory situation due to the Persistence of the antigen and an ineffective immune response that’s not clearing it which leads to lowlevel inflammation which leads to the exercise induced fatigue and the brain fog but now you can also Express this antigen uh as a foreign antigen on the cell surface
And that’s destroyed by t-lymphocytes as that’s the job of the T it’s not supposed to do that because it’s someone’s injected messenger RNA into you uh and so you get structural damage uh one of the commonest ones I see are people with um small fiber neuropathy um which is terribly
Disconcerting uh Burning uh feet uh disbalance um neurological issues flare up of demyelinating diseases uh cardiac issues uh all of these structural damages and they’re different in every person which makes understanding and analyzing postco either postco syndrome extremely complicated and extremely difficult I mean it’s it’s probably getting into the pathophysiology a bit
But if you’re going to go on produce producing Spike protein for a year after vaccine do you think that means that the RNA has somehow gone into the DNA and there’s an ongoing process of transcription here I think there are probably two ways of answering that firstly I don’t think
There’s any doubt that you can reverse transcribe into DNA that’s been shown in human cells uh at least to my knowledge on three occasions um and and that is a worry in its own and quite different to the problems we’re talking about here uh that’s looking at how I can change DNA
Expression in the individual uh it ra it raises all the questions of um um Progressive and expanded cancer uh it looks at transgenerational defects if it gets into the germline cells uh so that’s that’s a different issue here we’re talking about messenger RNA without necessarily going to DNA just working
Doing what messenger RNA does and that’s code for the amino acid sequence in a protein on the ribosomal Factory in the cell and so you’re making all a spike protein don’t need the DNA for that uh you’ve got the the DNA normally makes messenger RNA but we’re actually giving
Messenger RNA so we’re we’re we’re adding to to to the pool and so you’ve got all these cells making Spike protein for God only knows how long uh we don’t know how long a long time and um that’s creating uh and one of the factors that conditions a very important factor
Because not everyone gets postco not everyone gets fatigued uh it would seem that there is a subset of people who are more prone to develop um persistent nonresolved antigen in other words the messenger RNA keeps producing antigen and the body’s immune response doesn’t effectively clear it um if we had a lot
Of time I could run through the the the background information for this but let me just summarize and say in my view about 20% of people are fatigue prone uh there’s a phenotype um you know you look at kids who go to university and say how
Many of you you uh have ever had fatigue at the time of exams and whatever bit of a sore throat about 20% will say that about 20% of athletes um get uh um essentially overtraining syndrome which is a a form of chronic fatigue it’s a form that most people with chronic
Fatigue would love to have means they just drop their their time for 100 yards by 0. one of a second but it gets them out of the final um but but it is a very good model system that we we looked at very closely some years back the uh so
You’ve got this situation where is a a group of people who appear to be prone and they’re the ones who will get postvaccine fatigue and probably the the ones who have got the persistent formation of um the spike protein and get um long coed with both the fatigue
And the structural uh defect problem using different mechanisms totally different mechanisms for the two so it sounds like we’ve got two mechanisms going on well the main mechanism whether it’s long Co or postvaccine long Co is Persistence of the spike protein the spike protein is still produced for whatever reason
Whether it’s long covid or postvaccine injury chronically being produced sometimes the features are as as a result of specific tissue damage because the tea cells are beaten up these cells would You’re expect ing the spike protein wherever that is and of course we know that can be anywhere in
The body now because the vaccine is systemically distributed so we’ve got the tissue damage but we’ve also got the ongoing inflammatory effects the the effects of the chronic inflammation that we’re seeing as long covid or long postvaccine long covid that’s are they the two sort of main causes of the
Clinical features exactly but keep in mind there is one underpinning common denominator and that is persistent antigen production which is a feature of all the chronic fatigue illnesses going back to influenza and all the other issues that that we um and this may this is just my view might I often turn out
To be wrong but it’s my view is that there’s a phenotypic um uh uh proness if you like to developing uh fatigue illness when they’re stressed with and they’re more likely for some reason to get a persistent antigen because they have uh a less effective immune response than other
People so most chronic fatigue syndromes can be explained in terms of the ongoing Persistence of some virus presumably mostly a virus causing these these chronic features so in theory if you could like wave of magic wand and eradicate all the virus from the body the patient would get better
Apart from the pathology that’s caused by the tissue damage the irreversible tissue damage that’s absolutely right and in fact um um when we were dealing with the uh Institute of sport in Australia with the elite swimmers uh you might remember they they win gold medals uh but some of
Them didn’t and um uh we found that what was happening uh at the time the stress of international competition is in a number of these people start excreting epara virus in their throat so normally it’s contained by a wall of tea cells and under the stress in the people who
Have got a partial immune deficiency so they’ve got a predisposition of not having a really effective immune response when they’re expressed and people with long Co will say the same where under psychological or physical stress um I get worse and um we looked at this very carefully with the elite
Swimmers and we were able to uh completely obliterate that expression of epstar bar virus coming out in a condition which used to be called overtraining syndrome by doing one of two things uh the first is we we actually treated them with highly potent antivirals and prevented this and
Maintained their swimming capacity uh or we identified that the main precipitating factor was a particular type of physical stress which was um high high energy training and so we changed their training program and the Olympics uh in 2000 uh every Australian Elite swimmer swam to their predicted
Best which had never been before and it gave our physiology colleagues a very good jobs for the English Olympics which came next because the English wanted to know why our swimmers were doing so well uh and partly was because they didn’t get subjected to uh fatigue induced impaired performance um by changing
Their training program so all of these issues um come together with this Persistence of of antigen and control of that antigen uh epstar virus as you know gets integrated into the DNA of cells uh and it should stay there and the tea cells are critical for that uh with
Spike protein uh they should never it should never uh be expressed systemically and should never um have a persistence uh of expression but in some people of course it is and they’re the ones prone to developing these fatigue illnesses so you’re going to be getting in and dat with the emails from Olympic
Committees from around the world now Robert asking for your assistance I’m sure I’m sure about that all that work’s been published a couple of years back and and sadly our competitors know about it so um so this means that basically everyone has been exposed to Epstein bar
Virus just that some people managed to eliminate it and some people don’t exactly uh 80% of people um with the the athletes uh was pretty much 95% of the athletes uh had been exposed had Mar a IG antibody and this is the interesting thing that the the people who um have
Glandula have the epstar bar virus uh and who are prone to getting fatigue never quite make the right sort of te- cell response and I I’ll give you two quick examples and these relate exactly to the situation in uh that I’m certainly seeing and has recently been published to some extent
Uh with long Co um if you look at antibody production the antibodies are made by a cell given the very imaginative title of a a b cell a b lymphocyte requires T lymphocytes to help them so we have these helper tea cells now it appears that there’s a
Defect in the tea helper cells in people with long Co and this has been identified in different studies and certainly exact L the same in people with other chronic fatigue illnesses and the way the te cell deficiency expresses itself is that the B cell has markers of
Not working as well as it should now if you get a virus infection you make what’s called an IGM antibody the IGM antibody is the first antibody but it’s not a particularly High Affinity good effective antibody and so what the body does it replaces it with an IGG antibody
So you go from IGM to ig now uh which is a much higher Affinity antibody and you make different subclasses of IGG and there’s four sub IGG 1 2 3 and four now two things I noticed over the years looking after literally hundreds of people with chronic fatigue illnesses is that number one
Many of these patients never switch from the IGM to the IG anybody and so when you do a routine epstar bar virus in antibody and every Doctor Who who’s watching this will know you look for IGM antibody because that tells you you’ve got a current infection you’ve just got
The infection and suddenly and I I used to get a phone call every couple of weeks from General Practitioners that I work with saying hey this is confusing I got a patient who’s got IGM and IG antibodies and they’ve had them for weeks and months and of course these are the
People who have got ongoing chronic fatigue and they’re not actually eliminating or controlling their epstar bar virus by virtue of the fact they’re not making a particularly effective immune response and the response defect goes back to the te- cell because it’s not helping the B efficient effective IGG response and so
When you do a routine test the IGM which should tell you it’s a recent infection but it’s not it’s been there for weeks or years and an IG and and the second and this is really interesting because only just a month or so ago uh this was
Found for long Co that in people with chronic fatigue syndrome one of the things that uh we noticed uh in our Clinic was that a number of these patients have IGG subclass deficiency particularly an igg2 subclass and it didn’t initially it didn’t make much sense and I started seeing both the IGM
IGG confusion plus the IGG subclass deficiency both of which depend on good te cells working um now different subclasses have different jobs and so ig2 has a particular job and if it’s very low then you’ve got a defective antibody response by virtual of this so
What a wonderful study I saw I think it was about a month ago John um where they looked at IGG subclasses in Long Co and lo and behold there’s a highly significant reduction across the long Co something that’s never really been done for chronic fatigue syndrome uh the
Classics um significantly lower igg2 so exactly the same things is occurring in Long Co which brings all of these chronic fatigue illnesses collect ly together so moving on to the sort of um management strategies that we going to use Robert I mean I mean the question is
Of course what the heck do we do we do about this so um do we need to promote a more effective immunity within the respiratory tract and how would we do that well uh I don’t have all the answers no one has all the answers but I
I think that if you understand the process that’s going on you can see some sense in going forward now I can run through there there are five things that that uh I do with with my my patients uh or I I’m thinking about uh the first is
That we we we’ve developed the idea and I I’ve talked briefly about this with you before of what I call immune resilience and that is um and I think in the context we discussed it before I said why is it 99% of people who get long co uh inconvenience for a few days
They feel a little sick a fever sore throat and then they get better whether you treat them or not but 1 or 2% get very sick H and some may die and yet you look at that Collective group and of course there are predisposing factors for getting very sick but many of them
Are just like you and me uh that we all look the same we think we’re the same and yet we handle the virus differently and this has been an area that my group’s been interested in for a long period of time and um we developed the idea that there’s a thing called immune
Resilience and that there are ways of Shifting that immune resilience so that that 1% behaves like the 99% now that that’s something that that that my own we’ve been certainly working on and uh not available yet but but I I think is the way one of the ways to go in the
Future so in other words people who uh get uh Airway infections uh handle it more effectively and don’t run into the complications which obviously include long Co because of a defective immune response so I I think that’s uh for the soon future not not a long term uh the
Second is to understand the process as being persistent antigen uh now the spike protein um is I think without our question the persistent antig both these cases uh and this is a practical area uh and there are two approaches currently uh being used um uh our friends and
Colleagues in America uh have developed various enzyme packages uh based on ninas which is a long St very interesting um uh orally uh an ingested enzyme that has specificity for Spike protein and I know studies are being done uh in uh in America uh using these um substances uh and we’re really
Looking for forward to seeing uh how how they come out uh the second thing you can do about the expression of Spike protein is blocking its effect um really really exciting work has come out in the last few months about how icton works and there’s a complete relook now at
Iaon uh about time I may add but um and I think I think one of the things that’s bridged from the The Narrative that that was very unkind to iaon and the reality of science is the demonstration by uh a combination French and American groups showing that ican blocks
The uh blocks Spike protein so it blocks the spike protein getting into the cell and it blocks it aggregating red cells which is the reason that you get low oxygen tension uh low oxygen saturation in patients who get significant co uh and I I was on one of the three papers
That that showed that it was amazing within 24 hours of taking icton oxygen desaturation reversed now that’s not suppressing inflammation and now by virtue of these studies it’s shown that uh you disaggregate the cells and so the oxygen can return very quickly now I’ve been treating some of my own patients
With moderately high dose of ivaan for a month I think I’ve treated five or six and every one of those has improved now that doesn’t mean a thing it’s not a randomized control trial uh it’s it’s it’s what I call clinical medicine you you look uh at at a problem you say this
Is a process uh what logically can be done now it’s not necessarily going to change all the structural damage that’s been done but certainly there’s been some improvement not not necessarily dramatic Improvement some improvement uh in a month or so of taking icton I I think what really is needed is people
Who um have access to um academic uh um academic situations where they can study and do these a randomized control of icton in Long Co properly done uh would be the most important thing that can happen uh in in Long Co um the third thing that um that I think is really
Really interesting in Long Co is that uh and particularly a couple Chinese groups have been promoting this and that is that people who get long Co get a disturbance of the microbiome in the bow now you might say how on Earth can that relate to something that’s going on in
The airway well um I was lucky enough years ago to work with John benstock in Canada uh who came up with the idea of the common mucosal system which has been underpinning my work over many years uh in humans and uh it it’s just suddenly I realized that all our focus on this
Common mucosal system was the immune expression not the microbial drive and when you think that the the architecture of this common system that expresses control over all the different mucosal surfaces of the body the architecture involves sensor systems all the way down the gut not just the small bow with pair
Patches but all sorts of little patches with specialized M cells they’re called over them that allows bacteria to come in and so I I think the important thing to understand here is that the commonality of mucosal immunology and expression involves the microbiomes at the different sites and so uh what
Happens uh in the airway by swallowing and affecting P patches can distort the microbiome in the gut and the microbiome in the gut can equally influence what’s going on in the airway and I’ll just give you one exciting um observation and that is a group was looking at uh in
Mice they were looking at csel pneumoni which is a nasty bacteria that causes pneumonia and they couldn’t understand why on Earth when they gave pneumonia to the mouse by putting the the bug in the airway their microbiome changed uh this is in the gut and of course um the
Reason is this commonality this communication system that’s so effective so what they found was and this is exactly what was found in the patients with long Co a particular type of bacteria was depressed and these bacteria well bacteria that produce short chain fatty acids butyric acid um acetic acid propionic acid those three
Main one two and three um carbon short chain fatty acids um now the people working with the mice and ciella said well what happens if we um reduce these bacteria uh in the gut then the the main product from the bacteria uh is things like butc acid and so they measured butc
Acid and found it was very low so very sens they just started feeding butc acid to these these mice and the eclips and pneumoni became much much uh improved uh didn’t completely cure them but it certainly improved showing there was this connection between the two so you
Have two ways in which the microbiome can change the expression of any form of chronic fatigue one is by metabolic transfer of of receptors of um molecules that can move around through the blood seam and secondly by changing the cell Delivery Systems through the aggregated infid issue of P patches um sequel
Patches and the various ones in the column so that to me is very exciting and again if you can bear with me for 20 seconds I I’ll I’ll give you a very very important example many years ago Tom Baro who was the guy who discovered the
Uh the treatment for peptic ERS to which eradicated them uh he also was the person who um really developed the idea of feal microbiome transplants by changing the microbiome by washing you out and giving you some healthy ones um Tom Tom is uh quite extraordinary um he
Tom treated patients who came to him with fatigue and non-specific gut symptoms and was surprised to find not only did the gut symptoms improve with this fmt but so did the fatigue now uh no one quite believed it so he went back 10 years later 10 years later and found
Something like 60% of the patients and most of those patients still had a resolution of their symptoms including their fatigue now you don’t see that in chronic fatigue illnesses in other words by having a specific intervention there was some resetting of the system which we don’t understand very well and so um
I’m I I do a clinic in in in Tom’s practice uh and uh he was is my PhD student and um he Tom uh I’m I’m actually if he’s watching this or I’m going to send him an email Tom uh you’ve got to go back and start looking at uh
How we can manipulate the microbiome and have outcomes in Long Co um so um I I think the the next thing that I think is really important so we there are the three things that I think are really important the next thing is don’t feed the syndrome don’t keep giving people vac
Who have got long Co syndrome because um you look at the literature and I I just did a review for a journal last week on a metaanalysis of all the studies done on vaccination and and long Co and it blew me away I mean it was a very well
Done study and and 20 there was a 20% reduction of long covid in people who have been vaccinated but I looked at the number of people was 1 million if you’re looking at probably a 100,000 or a couple hundred, thousand people they get lost in they’re very different they’re
The people who have got a fatigue illness maybe phenotype that have develop this uh in the context of the vaccine and you give them more vaccine or they get Co and they get worse this is a concept that I find nobody really or or most people have great trouble
Grasping I just noticed this morning while I was waiting to hear from you John that Peter McCulla wrote one of his um uh reviews and it was making exactly the same point you know you don’t vaccinate people with chronic fatigue syndrome you’re just putting petrol on
The fire and of course yeah the final thing is you address the issues the person has um uh I noticed that some of my colleagues say a lot of these people have got in the morning uh you can’t work you lose your job you’re broke um
You’re going to have a touch of reactive depression and anxiety and um it’s not that they have a primary mental health problem they’ve got serious responses mental health responses of a normal type to a uh to a very uh incapacitating problem so that’s that’s our approach anyway to uh to chronic fatigue
Illnesses excellent updates and uh we’ll um certainly keep an eye on this one but I I think gives us real cause for for Hope here Robert that there is potential ways ahead for people that are suffering in this way yeah but for now thank you very much as always okay
