How does COVID-19 kill? Uncertainty is hampering doctors’ ability to choose treatments

[Sushi]

I think the picture is going to get more complicated. The fact that people turn blue (cyanotic) before dying is a clue. It might not just be the lungs able to function properly...there may be problems with red blood cells delivering oxygen. New articles are discussing that ventilators are not necessarily helping and their extended use with COVID-19 patients may be causing more harm.

Here is another approach that is being trialed at several medical centers--hyperbaric oxygen to help oxygenate the tissues:

This is a single center prospective pilot cohort study to evaluate the safety and efficacy of hyperbaric oxygen therapy (HBOT) as an emergency investigational device for treating patients with a novel coronavirus, disease, COVID-19. Patients that meet inclusion criteria will be consented by the hyperbaric physician. They will then be transported from the ED or other unit to the hyperbaric unit maintaining airborne precautions based on the most current hospital protocol.

https://clinicaltrials.gov/ct2/show/NCT04332081
Here is another critical care doc trying hyperbaric oxygen:

I am a Critical Care physician trained in Hyperbaric Medicine. Sadly, my ICU is currently full of critically ill patients with COVID-19 pneumonia, most of them intubated. My colleagues and I have been caring for them for several days, so I have some insight into the issue of critically ill patients with COVID-19 Pneumonia. In COVID-19 pneumonia, the lungs are not able to allow oxygen to diffuse to the bloodstream. I have read the article by Chen and colleagues. At least one hope is that the significant elevation in inspired oxygen during HBOT would enable oxygen to reach the arterioles even though the air sacs of the alveoli are damaged....I think HBOT is a viable option for COVID-19 hypoxia. I am unsure whether it is a PRACTICAL option. We are finding that a cytokine storm occurs around “day 7” of infection. About 6-10 days into the illness, this storm and its consequences can be quite severe. This cytokine storm can lead to severe Adult Respiratory Distress Syndrome (ARDS) and profound hypoxemia.

https://www.hbotnews.org/hyperbaric-oxygen-therapy-for-severe-covid-19-pneumonia/

 

[Judee]

What I don't understand is why the elderly, with the weakest immune systems are dying, if it's really a cytokine storm doing it. Why would weak immune systems cause the strongest immune system reactions, through a massive increase in cytokines?

This has been bugging me for a couple of weeks now.

And would the SARs patients have been treated by respirators too. I have heard that too high of pressure on those units can do that same thing.

Edit: This was actually the post I meant to quote in reference to the respirators:

According to the WHO, SARS punched holes in the lungs, giving them “a honeycomb-like appearance". In COVID, the effect is very similar, and is described as looking like "shattered glass". The holes are most likely created by the cytokine storm's aggressive, frenzied response, creating scar tissue that simultaneously protects and stiffens the lungs

At the same time, the inflammation created also makes the membranes between the air sacs and blood vessels more permeable, causing an effect described as "bleeding from the blood vessels", which would certainly impede effective oxygenation, and which can also fill the lungs with fluid and affect their ability to oxygenate blood, on top of losing huge quantities of it thru that leakage in a kind of perfect storm effect.

 

[Gingergrrl]

Scientists at Stanford are wondering if the virus came earlier to California and if that is why they have fewer cases than NYC.

https://www.ksbw.com/article/new-st...-possible-herd-immunity-to-covid-19/32073873#

Could that mean it is possible to build up "herd immunity" to this thing?

Thank you for sharing that @Judee and I hadn't heard this before but it is very interesting. It is certainly possible that the virus came earlier to CA (Nov & Dec) which increased herd immunity. I also think it is combined with our very early stay-at-home order and the fact that our population has very different topography than NY (we are very spread-out and don't have people packed together in a public subway system).

 

[pattismith]

Thank you for sharing that @Judee I also think it is combined with our very early stay-at-home order and the fact that our population has very different topography than NY (we are very spread-out and don't have people packed together in a public subway system).

Ginger, you pointed the two main factors that explain different outcome of the epidemic. When serologies will be available, we should find much more positive people in NY

 

[raghav]

What I don't understand is why the elderly, with the weakest immune systems are dying, if it's really a cytokine storm doing it. Why would weak immune systems cause the strongest immune system reactions, through a massive increase in cytokines?

This has been bugging me for a couple of weeks now.

@ljimbo423 When Indian parents bring their child to India from US for the first time to show to their grandparents the infant suddenly goes into immune hyper drive and it gets boils and blisters all over its body and its very painful. Indian doctors immediately recognize this and give the parents some topical cream to apply just to keep the pain and irritation under control. Usually it subsides after a week or two. But those are infants and toddlers but oldies get whacked so hard by the cytokine storm that they dont recover. The immune system goes from one extreme to the other extreme just like in Delhi belly.

 

[YippeeKi YOW !!]

I have seen reports saying some people have been re-infected.

I've seen those too ..... disheartening ....

My own personal opinion is that is unlikely and it may just be a false positive test result.

Drs aren;t sure, but seem to skew towards negative ....

Why would weak immune systems cause the strongest immune system reactions, through a massive increase in cytokines?

The virus invades the ACE2 cells while remaining invisible to the cell. They then dismantle the cell's ability to signal the immune system for help while the virus unfurls a huge snake-like chain of viral genetic coding and starts duplicating itself almost edlessly util capacity is exceed. When that escapes frm the cell, the signals to the immune system are on DEFCON 1, no matter how strong your immune system is.

The antiviral immune response (the TH1 arm) is pro-inflammatory and is first to attack viruses.

TH1 doesn't even know the virus is there til too late ....

because of a weak or lacking th2 response or anti-inflammatory response. Leading to out of control inflammation, from a cytokine storm.

See above .....

 

[YippeeKi YOW !!]

What I don't understand is why the elderly, with the weakest immune systems are dying, if it's really a cytokine storm doing it.

Because the elderly, even those in pretty good shape, and not all that many are, have more compromises health wise, so even tho the cytokine storm their system produces may be much weaker than that of a younger, less compromised patient, the landscape it's unleashed on is rife with the kind of weaknesses that would make for a dramatically bad outcome ....

Why would weak immune systems cause the strongest immune system reactions, through a massive increase in cytokines?

Partly because of the Trojan Horse nature of the COVID virus, partly because ' .... strongest immune reactions ..." is relative to the strength of the system experiencing it ....

 

[Hopeful2021]

Just last week, one hospital published its use of HBOT in covid19 patients and lots of success.