David Joffe MBBS(Hons), PhD, FRACP

Respiratory and Sleep Physician
Long COVID patient advocate

[David Joffe MBBS(Hons), PhD, FRACP @DavidJoffe64_2]

@SarahJadeHunter @aparachick @DavidJoffe64 Hi 👋🏻👋🏻👋🏻😊

[David Joffe MBBS(Hons), PhD, FRACP @DavidJoffe64_2]

@CassandrainCan @OliveSiffleur @aparachick @HealthMusicPerf @DavidJoffe64 Actually, it was from a fellow Cövid Science colleague... Not Wendy

[David Joffe MBBS(Hons), PhD, FRACP @DavidJoffe64_2]

Perhaps death is contagious??

Just a thought 💭💭

[Ron Filipkowski @RonFilipkowski]

A few days ago, Lindsey said he was going to check on Mitch McConnell.

[David Joffe MBBS(Hons), PhD, FRACP @DavidJoffe64_2]

You're not alone, Jonathan

Correcting the misinformation, addressing the Hopium Merchants, and Wellness Grifters comes with a substantial personal cost

We should not be bowed not deterred

Truth is our best weapon🙏🏻
@jonathanstea

[Dr. Jonathan N. Stea @jonathanstea]

For promoting evidence-based patient care, I receive countless hateful messages daily.

I receive death threats.

I’ve dealt with frivolous complaints.

I’ve been called the "face of evil."

I’m lied about and constantly harassed.

I’m also not alone.😊✌️

https://t.co/YUb5e0oeqk

[David Joffe MBBS(Hons), PhD, FRACP @DavidJoffe64_2]

Outstanding , Manuel
@manruipa

The perfect summary and rebuttal of those who still cling to the idea that

Persistence = Visibility

It's ability to persist is a reflection of the fact it's not in plain sight

Adipose tissue hasn't received the attention required @ZdenekVrozina

[Manuel Ruiz @manruipa]

⚠️‼️Some opinions circulating about this paper are not correct.

This study does not show that viral persistence cannot matter in Long COVID.

It shows something much narrower:

circulating SARS-CoV-2 antigens in plasma are not a reliable standalone biomarker for Long COVID.

That is very different.

The study measured viral antigens in blood.

At 6–12 months, antigens were detected in some people with Long COVID, but also in some people who had fully recovered.

By 18–24 months, detectable antigens had almost disappeared.

And antigen presence did not correlate well with symptom severity.

So the correct conclusion is not:

“viral persistence is dead.”

The correct conclusion is:

plasma antigenemia alone does not explain all Long COVID.

That matters because blood is not the whole body.

A virus can be absent from plasma and still be present, active or biologically relevant in tissues.

We already know this from other infections.

In herpes labialis, HSV can reactivate locally in oral mucosa, skin and sensory ganglia.

You do not need a persistently positive blood PCR to have a real localized herpes reactivation.

In shingles, VZV reactivates from sensory ganglia and produces a localized skin eruption.

Diagnosis is usually based on the lesion, not because VZV is continuously detectable in blood.

So “not detected in blood” does not mean “no local viral activity.”

The same logic applies to tissue reservoirs.

Plasma is not gut mucosa.

Plasma is not lymphoid tissue.

Plasma is not epithelium.

Plasma is not the nervous system.

Plasma is not every possible viral niche.

So why would a negative plasma antigen test rule out SARS-CoV-2 reservoirs in gut, mucosa, epithelial niches, lymphoid tissue or nervous-system-related compartments?

It does not.

Another example is EBV and multiple sclerosis.

The strongest evidence links EBV infection to MS risk, and some studies have reported EBV-infected B cells or plasma cells in MS brain tissue and meningeal follicles.

That does not mean every relevant EBV process must be obvious from a simple blood test.

Immune and viral processes can be compartmentalized.

And this is the key point:

persistent antigen does not need to be continuously detectable in blood to remain biologically relevant.

The reservoir may still be present, localized in tissues, below the detection threshold of blood tests.

And that reservoir may fluctuate.

During periods of better immune control, local viral replication or antigen release may decrease.

During periods of poorer immune control, viral activity in those tissues may increase, together with local inflammation, antigen exposure and immune activation.

That could contribute to symptom flares.

And in susceptible patients, those flares may also reinforce autoimmune activity.

So the model is not:

no antigen in plasma
→ no persistence.

The model may be:

SARS-CoV-2 reservoir persists in tissue
→ local immune control fluctuates
→ local viral activity or antigen release increases
→ tissue inflammation increases
→ herpesvirus reactivations may also fluctuate
→ immune activation rises
→ autoimmune activity may worsen
→ symptoms flare.

Then immune control may improve again.

Circulating antigen may become undetectable.

But the tissue-level process may still not be fully resolved.

That is why a negative plasma antigen test cannot tell us the whole story.

Blood may be negative while tissue reservoirs, local inflammation, immune dysregulation or autoimmune flares continue.

A better model is:

tissue reservoir or persistent antigen
→ chronic immune activation
→ herpesvirus reactivation
→ B/T cell dysregulation
→ mast cell activation
→ endothelial dysfunction
→ dysautonomia
→ loss of tolerance
→ autoimmunity in susceptible hosts.

This paper is useful.

But it challenges only a simplified version of the hypothesis:

persistent viral antigen floating in blood
= Long COVID symptoms.

That was never the only serious model.

(1/2)🧵👇🏻

[David Joffe MBBS(Hons), PhD, FRACP @DavidJoffe64_2]

Perfect summary of our Clinical dilemma,

We cannot even control bad BP with a single med. No complex single organ disease is addressed by one Rx

Why on earth do we think we will diagnose or treat LC with one test or one silver bullet?

@resiapretorius back with my tribe 😊

[Resia Pretorius @resiapretorius]

@surf4children you are right. We should move on from thinking: “1 biomarker” for complex disorders like #longCOVID. Why would we think “1 medication” would work. We need to understand what exact biological pathway drives the disease in a specific patient. We need personalised and precision care. We need single proteomics analysis for every patient. Even then it will not be 1 magic pill.

[David Joffe MBBS(Hons), PhD, FRACP @DavidJoffe64_2]

Viro-static

NOT

Viro-cidal

Doesn't prevent Long Cövid
Won't fix Long Cövid

We will require a HAART regime to keep it silent. Like HIV... It may never clear

No two patients are alike. We must do better

My 10 cents 🙏🏻

[Covid Institute @Covid_institute]

Paxlovid was the antiviral many people hoped would finally treat Long COVID. It was put to a real test in people who already had the illness, and the result is worth understanding before you bring it to your own doctor.

[David Joffe MBBS(Hons), PhD, FRACP @DavidJoffe64_2]

@timritchie @AngusTaylorMP 😂😂😂

WINNER 🏆

[David Joffe MBBS(Hons), PhD, FRACP @DavidJoffe64_2]

@LePapillonBlu2

He didn't win the World Cup...

He simply won the WORLD🏆🏆

What an aspirational Human and sportsperson 😊

Whatever the outcome, his kindness, decency, incredible skills and humour will outlast the finals

Humanity needs more of this‼️

[ᗰᗩƳᖇᗩ @LePapillonBlu2]

There are still amazingly good people amongst us. Cherish them.

[David Joffe MBBS(Hons), PhD, FRACP @DavidJoffe64_2]

Seems I've become more intolerant during my absence...

Oh Well🤷🏻‍♂️

Starting over means doing better 😎💪🏻

[David Joffe MBBS(Hons), PhD, FRACP @DavidJoffe64_2]

@GoSatvik Fuck you're stupid ‼️‼️

If you think Kirsch is right about vaccines... You should wipe your arse with your PhD....

You've got acute syndromal vaccinitis

Try Ivermectin... I hear it works for that 🤡

[David Joffe MBBS(Hons), PhD, FRACP @DavidJoffe64_2]

@IntegralAnswers @HarrySpoelstra Honestly, Buddy,

I would be happy with my old personna!
Phishing scam targeted at Cövid Science

Twitter are incompetent and have no interest in providing the protection they claim to uphold

I have countless saved threads and comms with colleagues

At least I've found my tribe

[David Joffe MBBS(Hons), PhD, FRACP @DavidJoffe64_2]

The "Cost of Doing Nothing" @HarrySpoelstra

Is becoming unavoidably expensive...

But... Brunch and the Economy 🙄🙄

In NSW, we would personally like to thank the Pubs & Clubs Gambling Lobby... And the Barista Lobby... Go us ☠️

[Harry Spoelstra @HarrySpoelstra]

🚨Even a full year after infection, COVID-19 is still driving dramatically higher healthcare costs, 27% more for adults and a shocking 42% more for children, according to a large new U.S. study of nearly 2 million people.

➡️“These findings underscore the substantial long-term healthcare burden that follows a COVID-19 diagnosis and the importance of preventive public health measures”
#AvoidSars2 #AvoidReinfections #Mitigation
https://t.co/SgbqTD5CA9

[David Joffe MBBS(Hons), PhD, FRACP @DavidJoffe64_2]

@deborahdavigdor @RageSheen Apologies to my many friends...

They come up in order of "followed"... Without a paid account, you only get so many tokens🙄🤦🏻‍♂️

[David Joffe MBBS(Hons), PhD, FRACP @DavidJoffe64_2]

You're very kind, My Friend 😊🙏🏻🙏🏻

[Henry Madison @RageSheen]

@DavidJoffe64_2 is consistently one of the leading global voices cutting through the BS that circulates through social media sewers about Covid, and medical care more generally.

Follow and learn.

[David Joffe MBBS(Hons), PhD, FRACP @DavidJoffe64_2]

@Allapatria @DavidJoffe64 😊🙏🏻🙏🏻👋🏻

[David Joffe MBBS(Hons), PhD, FRACP @DavidJoffe64_2]

To the many wonderful people who have followed me from my old handle @DavidJoffe64

Thank you from the bottom of my heart
😊😊💕👋🏻

I can only re-follow a limited number at a time... Please don't feel offended..

This App is FUBAR 🤬🤬

[David Joffe MBBS(Hons), PhD, FRACP @DavidJoffe64_2]

@RageSheen @deborahdavigdor Yep.... Unless I pay for this account whilst I'm still paying for the one in Gitmo

[David Joffe MBBS(Hons), PhD, FRACP @DavidJoffe64_2]

@RageSheen @deborahdavigdor I would be delighted if I could refollow more than 10 people a day 😡😡

Great shit... If it works, Henry 🤦🏻‍♂️

[David Joffe MBBS(Hons), PhD, FRACP @DavidJoffe64_2]

@knityarn @DavidJoffe64 Happy to have a presence, Renee

I'm not finished with my work here.

[David Joffe MBBS(Hons), PhD, FRACP @DavidJoffe64_2]

Should be compulsory reading for both Hopium salesmen from the treating fraternity... And a cautionary tale for those sufferers claiming "X...Y... Z.... Worked for me, why has your doctor not prescribed it for you?"

@SalvMattera FYI 🤷🏻‍♂️

[Matthew Halma @MatthewHalma]

1/

A new review in Frontiers in Medicine did something most long COVID papers don't:

It asked patients and clinicians which treatments they actually cared about, then went and checked what evidence existed for each one.

The mismatch is the whole story. 🧵

[David Joffe MBBS(Hons), PhD, FRACP @DavidJoffe64_2]

@GoSatvik Fuck you're stupid ‼️‼️

If you think Kirsch is right about vaccines... You should wipe your arse with your PhD....

You've got acute syndromal vaccinitis

Try Ivermectin... I hear it works for that 🤡

[David Joffe MBBS(Hons), PhD, FRACP @DavidJoffe64_2]

@IntegralAnswers @miki_fern For those that were tuned in... Bad JuJu was already coming out of Wuhan in late November 2019...

One of my very risk averse British SAS soldiers gave me a heads-up.... He was buying toilet paper 💪🏻 Still a LEGEND in retirement🫡