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Miller School Researchers on the Trail to Unraveling Long COVID-19


          Long COVID-19 syndrome, in which   begins with virus-induced lung inflamma-
        symptoms last a year or longer beyond   tion and defective cholesterol homeosta-
        infection, impacts about 30 percent of   sis, and ultimately leads to endothelial
        survivors of the coronavirus. It is a mul-  dysfunction.
        tifaceted systemic condition character-  The team is investigating evidence that
        ized by fatigue, “cognitive fog,” and often   there is an overzealous inflammatory
        heart, lung and neurological complica-  response from the mating of protein
        tions.                               spikes on the SARS-CoV-2 virus with
          Lina Shehadeh, Ph.D., professor of   low-density lipoprotein receptors (LDLr)
        medicine in the Interdisciplinary Stem   on the infected cells. Central to this
        Cell Institute and Division of Cardiology   response is the formation of neutrophil
        at the University of Miami Miller School   extracellular traps (NETs), which are
        of Medicine, received a $1 million grant   net-like structures composed of DNA-
        from the American Heart Association to   histone complexes and proteins. These
        study long COVID. Recognizing the sub-  form as the immune system activates an
        stantial public health impact and burden   overabundance of neutrophils in the
        of this syndrome, the American Heart   lungs.
        Association awarded three-year grants to   While they form as an overreaction to
        10 research programs in the nation with   real pathogens like the SARS-CoV-2
        proposals for unraveling long COVID’s   virus, they are also complicit in a num-
        etiology and molecular mechanisms.   ber of autoimmune diseases, coagulation
          “When you have an impact that is sys-  disorders and thrombus, diabetes, ather-
        temic — not confined to certain organs   osclerosis, vasculitis, sepsis and cancer.   (l-r) Dr. Leo Tamariz, Dr. Shathiyah Kulandavelu, Dr. Lina Shehadeh, and Dr. Jose Condor
        — you think about the circulatory sys-  “In COVID-19, when these neu-      Dr. Shehadeh is working with Jeffrey   ble vessel anomalies.
        tem, since its function affects everything   trophils are overwhelmed or defeated by   Goldberger, M.D., M.B.A., professor of   “This ties in with work we have done
        else,” Dr. Shehadeh said. “We have   the virus, they burst in the lungs, releas-  medicine and chief of the Cardiovascular   for years in studying battle fatigue in vet-
        observed signs that the endothelial func-  ing their DNA material [netosis],” Dr.   Division, and Leonardo J. Tamariz, M.D.,   erans, which can persist long after they
        tion of the blood vessels is abnormal in   Shehadeh explained. “From there we   an internist in the COVID-19 Long-  return from the field,” Dr. Tamariz said.
        preclinical models of long COVID. Now,   think the NETs are carried through the   haulers Clinic at the Miami Veterans   Other key team members are
        we are working to connect the dots and   systemic circulation and become stuck   Affairs Healthcare System. Dr. Tamariz is   Shathiyah Kulandavelu, Ph.D., a junior
        explain this cascade.”               and then embedded in the vessel walls in   obtaining blood samples and heart and   faculty member at the Interdisciplinary
          As part of her research, Dr. Shehadeh is   the limbs and in the organs. This would   lung MRI images of 150 or so patients   Stem Cell Institute whose expertise is in
        using a mouse model and human blood   explain the loss of normal homeostasis in   from the clinic to sample the neutrophils   endothelial function, and Jose Manuel
        samples to interrogate a chain of events   the vascular walls and the tendency   and check for markers of netosis, while   Condor Capcha, Ph.D, a postdoctoral
        that may account for symptoms seen in   toward thrombus we see so often in   Dr. Goldberger is examining the MRIs   associate who is spearheading the lab
        people with long COVID. This chain   COVID long-haulers.”                 and other cardiac readouts to assess visi-  work.



        Cover Story:  Severity of Jury Verdicts Should Concern Florida Physicians


        Continued from page 1                seek payment for mental pain and suffer-  carriers, we now discuss ways to prepare   ly suggest that they consider a separate
                                             ing,” explained Danna. “This new law   ourselves to work with the millennial   policy for the corporation and put the
        despite the fact that Florida is already
        one of the highest in the nation for med-  allows parents of adult children who   mentality versus a jury of our peers. You   allies under that. Doctors need a pure
        ical malpractice insurance costs.”    have no spouse or children to seek pay-  have to consider how that age group   policy for themselves, where they are not
          Danna notes that while plaintiffs’ attor-  ment of those non-economic damages as   thinks when sitting on a jury panel, and   sharing their limits.”
        neys used to pursue more lawsuits, caus-  well.                          how to go to court with the younger gen-  Danna advises physicians to carry a
        ing a frequency problem, courts are now   “This is going to cause even more   eration making decisions.”      $500,000 per claim/$1.5 million aggre-
        facing a severity problem, with attorneys   opportunity for lawsuits; attorneys going   While many Florida doctors have cho-  gate per year limit to meet the national
        going for fewer cases that will result in   after this money are going to cause chaos   sen to carry low policy limits of   threshold. “We are seeing a lot of surgical
        much higher awards.                  in Florida,” she added.             $250,000/$750,000, believing that attor-  groups going for $1million/$3 million,”
          An added concern for physicians is   Court cases are also being influenced   neys wouldn’t pursue them if there   she added.
        House Bill 6011, which will allow par-  by changing jury demographics, which   wasn’t as much of a reward, with out-of-
        ents of adult children to recover damages   now include younger millennials.   court claims settling at an average of
        for mental pain and suffering in a med-  “Back in the day we had a jury of our   $400,000, this still leaves them at risk.   For more information on policy limits,
        ical negligence suit. The bill will take   peers, but now these younger millenni-  “A lot of doctors share their $250,000     contact Julie Danna at
        effect on July 1, 2022.              als, who are very compassionate, tend to   limits with their corporations and allied   julie@dannagracey.com, call
          “Before when a child died due to loss,   be more willing to award plaintiffs   professionals, which leaves them even        (850) 530-3924 or visit
        the immediate family was allowed to   money,” said Danna. “At meetings with   more vulnerable,” said Danna. “I strong-        www.dannagracey.com.









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        South Florida Hospital News                                                              southfloridahospitalnews.com                                                              June 2022                           11
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