Summary of "Ologies with Alie Ward" – Episode: Intensive Pulmonology (LONG COVID) Part 1 with Dr. Wes Ely
Introduction to Long COVID
In this compelling episode of Ologies with Alie Ward, released on March 12, 2025, host Alie Ward explores the intricate and persistent challenges posed by Long COVID. Alie sets the stage by reflecting on March 11, 2020—the day when the SARS-CoV-2 virus began its global impact, leading to the COVID-19 pandemic that has since claimed up to 36 million lives worldwide. Recognizing the pervasive presence of Long COVID in public consciousness, Alie aims to demystify the condition, discuss its symptoms, underlying causes, and share personal stories from those affected.
Introducing the Expert: Dr. Wes Ely
Alie introduces Dr. Wes Ely, a distinguished pulmonologist and intensivist from Vanderbilt University Medical Center. Dr. Ely boasts an impressive resume with over 450 peer-reviewed publications and more than 100,000 citations. He is also the author of the critically acclaimed book, Every Deep Drawn Breath, which delves into improving patient outcomes post-ICU care. Dr. Ely is recognized as one of the foremost specialists in Long COVID, bringing both expertise and personal passion to the discussion.
Legitimizing Long COVID (00:31 – 07:05)
The episode begins with Alie addressing the skepticism surrounding Long COVID. She introduces the critical question: Is Long COVID real?
Dr. Wes Ely [05:26]: "I'm a good person to ask, because I didn't. And I was wrong. And I had to learn and wake up and say, wait a minute, Wes, look in the mirror. You're a fraud. You don't think this is real, but it is real."
Dr. Ely candidly shares his initial disbelief, rooted in traditional medical training that did not thoroughly acknowledge chronic fatigue syndrome (CFS) as a legitimate condition. He recounts how encountering patients who never were hospitalized yet exhibited severe Long COVID symptoms forced him to confront his biases and recognize the validity of their experiences.
Differentiating Long COVID from Post-Intensive Care Syndrome (07:05 – 10:11)
Alie elaborates on Post-Intensive Care Syndrome (PICS), a well-documented condition affecting patients after ICU stays, characterized by fatigue, muscle weakness, anxiety, depression, and cognitive impairments. However, Dr. Ely highlights a crucial distinction:
Dr. Wes Ely [08:20]: "This is way more pronounced than just a post viral malaise, just a few weeks of recovery. This is something that's going on weeks and months and there's no recovery in sight on their own."
He points out that unlike typical post-viral recovery, where symptoms gradually improve, Long COVID patients often experience a prolonged decline after an initial phase of feeling better—a pattern not observed in other post-viral illnesses. Additionally, the sheer number of Long COVID cases globally far exceeds previous post-viral conditions, necessitating a reevaluation of how chronic conditions post-infection are understood and treated.
The Vascular and Immune Impact of COVID-19 (10:15 – 16:11)
Dr. Ely delves into the biological mechanisms behind Long COVID, emphasizing its vascular nature:
Dr. Wes Ely [12:01]: "COVID is a very vascular problem. This is a viral illness that is extremely vascular. So the endothelium of our blood vessels gets infected with this virus and it also does something to our immune system whereby it basically turns on a light switch."
Alie supplements this explanation by referencing Dr. Herman Taylor’s previous discussions on endothelial dysfunction and clot formation. They discuss how COVID-19 damages blood vessels, leading to both macro clots (like deep venous thrombosis and pulmonary emboli) and micro clots in capillary beds. These clots can impair blood flow to vital organs, contributing to the multifaceted symptoms of Long COVID, including cognitive deficits and organ dysfunction.
Alie Ward [15:29]: "That garbage to the blood passing by, which sort of sees it as this disruption in the artery and then sends all sorts of things to fix this break in the artery."
Challenges in Diagnosis and Treatment (17:55 – 24:23)
The discussion transitions to the diagnostic and therapeutic challenges associated with Long COVID. Dr. Ely outlines two primary theories:
- Viral Persistence: The idea that remnants of the virus continue to reside in the body, perpetuating symptoms.
- Immune System Dysregulation: The virus may trigger an overactive immune response, leading to autoimmunity where the body attacks its own tissues.
Dr. Wes Ely [17:55]: "The main two theories of long Covid, it's probably a little of both end but in fact we just published a paper two days ago on viral persistence, which is one leading theory."
Alie draws parallels between Long COVID and other autoimmune diseases like lupus and rheumatoid arthritis, noting the increased incidence of these conditions post-COVID infection.
Despite ongoing research, there remains a lack of definitive biomarkers for Long COVID, complicating both diagnosis and treatment. Dr. Ely mentions recent studies exploring potential biomarkers but acknowledges that no commercially available tests exist as of the episode's release.
Dr. Wes Ely [23:55]: "We don't have immune markers like that for long Covid. In fact, there are no really beautifully proven blood tests and or biomarkers for long Covid."
Personal Stories and the Human Impact (25:02 – 36:17)
To illustrate the profound impact of Long COVID, Dr. Ely shares poignant anecdotes:
- Young Engineer: A mid-20s athlete and engineer experiences extreme fatigue and cognitive decline, rendering him incapable of sustaining his active lifestyle or professional responsibilities.
- Diana Cowern: A teenager bedridden for over a year, relying entirely on her caretaker, illustrating the severe physical and mental toll of Long COVID.
Dr. Wes Ely [25:22]: "This is what they're suffering from is this massive amount of PEM or post exertional malaise, or like the first patient, I told you, tremendous cognitive difficulties even in a young, very otherwise brilliant mind. Life changing."
Alie introduces the Spoon Theory, a metaphor used by chronic illness sufferers to describe the limited energy reserves they have for daily activities.
Alie Ward [28:31]: "The Spoon Theory was coined in a 2003 essay by American writer Christine Miserandino. And folks who are dealing with chronic illness sometimes refer affectionately to themselves as spoonies."
These stories underscore the urgent need for effective treatments and robust support systems for both patients and their caregivers.
Caregiver Perspectives and Support Systems (34:33 – 36:17)
Alie highlights the caregiver burden through the story of Kyle, husband to Diana Cowern. Kyle describes the immense emotional and physical strain of supporting a partner with debilitating Long COVID symptoms.
Dr. Wes Ely [36:17]: "I absolutely believe that patients who suffer long Covid meet the criteria of ME CFS. And if ME CFS is new in onset after the COVID pandemic, many of those patients actually have long Covid or both."
Dr. Ely emphasizes the importance of support groups and community resources in alleviating caregiver stress and providing emotional support.
Approaches to Patient Care (36:17 – 40:09)
Dr. Ely outlines his patient-centered approach to treating Long COVID:
- Empathy and Listening: Prioritizing understanding the patient's personal experiences and suffering.
- Individualized Treatment: Tailoring interventions based on specific symptoms, whether they be cognitive, gastrointestinal, or cardiovascular.
Dr. Wes Ely [37:16]: "I don't have all the answers for you, but I'm gonna stay with you and we'll start this process together."
He advocates for clinicians to suspend judgment, actively listen, and meticulously document patient histories to inform personalized care plans.
Interventions and Prevention Strategies (40:09 – 45:10)
When discussing treatment options, Dr. Ely acknowledges the lack of a universal solution for Long COVID. Instead, he emphasizes the necessity of customized treatments:
- GI and Cognitive Symptoms: Addressing digestive issues and cognitive impairments tailored to individual needs.
- POTS (Postural Orthostatic Tachycardia Syndrome): Implementing specific strategies like salt loading for some patients while others may require medication to manage heart rate.
Dr. Wes Ely [45:11]: "So that's the reason that your listeners are probably frustrated right now. There's not any one blanket treatment which is best treatment, because this Treatment has got to be individualized."
Prevention is straightforward yet crucial:
Dr. Wes Ely [40:09]: "The best evidence about prevention of long Covid is to not get Covid, obviously. And so that kind of sounds stupid, like a duh statement, but, you know, do what you think is right or what your doctor or healthcare professional advises you to avoid exposure."
Dr. Ely strongly endorses vaccination as the most effective method to prevent Long COVID, while also acknowledging and supporting those who experience vaccine injuries.
Future Directions and Hope (45:10 – 54:53)
Looking ahead, Dr. Ely shares insights into ongoing research and clinical trials aiming to find effective treatments for Long COVID, including trials mirrored after ME/CFS studies.
Dr. Wes Ely [43:16]: "I absolutely believe in vaccine injury... we have patients in our clinic who have vaccine injury, and the symptom complex is basically identical to what our long COVID patients have experienced."
Alie teases the upcoming part two of the episode, promising more in-depth discussions on treatments, caregiver advice, and new research developments.
Conclusion and Call to Action (54:53 – End)
Alie concludes by summarizing the key takeaways and encouraging listeners to support the Critical Illness, Brain Dysfunction and Survivorship center, co-directed by Dr. Ely. Donations will fund support groups and community resources essential for Long COVID patients and their caregivers.
She also shares upcoming content, including a lightning round of listener questions and previews of the next episode, which will feature firsthand advice from patients and caregivers.
Notable Quotes
- Dr. Wes Ely [05:26]: "I'm a good person to ask, because I didn't. And I was wrong. And I had to learn and wake up and say, wait a minute, Wes, look in the mirror. You're a fraud. You don't think this is real, but it is real."
- Dr. Wes Ely [08:20]: "This is way more pronounced than just a post viral malaise, just a few weeks of recovery. This is something that's going on weeks and months and there's no recovery in sight on their own."
- Dr. Wes Ely [12:01]: "COVID is a very vascular problem. This is a viral illness that is extremely vascular. So the endothelium of our blood vessels gets infected with this virus and it also does something to our immune system whereby it basically turns on a light switch."
- Dr. Wes Ely [37:16]: "I don't have all the answers for you, but I'm gonna stay with you and we'll start this process together."
- Dr. Wes Ely [43:16]: "I absolutely believe that patients who suffer long Covid meet the criteria of ME CFS."
Final Thoughts
This episode of Ologies with Alie Ward offers an in-depth and empathetic exploration of Long COVID through the expertise of Dr. Wes Ely. By blending scientific insights with heartfelt personal stories, Alie and Dr. Ely shed light on the profound and multifaceted impact of Long COVID, emphasizing the urgent need for effective treatments, comprehensive support systems, and ongoing research. Listeners gain a nuanced understanding of Long COVID, its differentiation from other post-viral conditions, and the compassionate approaches necessary for patient care.
Resources Mentioned:
- Every Deep Drawn Breath by Dr. Wes Ely
- Critical Illness, Brain Dysfunction and Survivorship center: icudelirium.org
- Spoon Theory by Christine Miserandino
For more information and to support ongoing efforts, listeners are encouraged to visit the provided links and share the episode with those who may benefit from its insights.