Renewable Revolution

Why Some People Get Sicker Than Others
COVID-19 is proving to be a disease of the immune system. This could, in theory, be controlled.

James Hamblin April 21, 2020



The COVID-19 crash comes suddenly. In early March, the 37-year-old writer F. T. Kola began to feel mildly ill, with a fever and body aches. To be safe, she isolated herself at home in San Francisco. Life continued apace for a week, until one day she tried to load her dishwasher and felt strangely exhausted.

Her doctor recommended that she go to Stanford University’s drive-through coronavirus testing site. “I remember waiting in my car, and the doctors in their intense [protective equipment] coming towards me like a scene out of Contagion,” she told me when we spoke for The Atlantic’s podcast Social Distance. “I felt like I was a biohazard—and I was.” The doctors stuck a long swab into the back of her nose and sent her home to await results.

Lying in bed that night, she began to shake, overtaken by the most intense chills of her life. “My teeth were chattering so hard that I was really afraid they would break,” she said. Then she started to hallucinate. “I thought I was holding a very big spoon for some reason, and I kept thinking, Where am I going to put my spoon down?”

An ambulance raced her to the hospital, where she spent three days in the ICU, before being moved to a newly created coronavirus-only ward. Sometimes she barely felt sick at all, and other times she felt on the verge of death. But after two weeks in the hospital, she walked out. Now, as the death toll from the coronavirus has climbed to more than 150,000 people globally, Kola has flashes of guilt and disbelief: “Why did my lungs make it through this? Why did I go home? Why am I okay now?”COVID-19 is, in many ways, proving to be a disease of uncertainty. According to a new study from Italy, some 43 percent of people with the virus have no symptoms. Among those who do develop symptoms, it is common to feel sick in uncomfortable but familiar ways—congestion, fever, aches, and general malaise. Many people start to feel a little bit better. Then, for many, comes a dramatic tipping point. “Some people really fall off the cliff, and we don’t have good predictors of who it’s going to happen to,” Stephen Thomas, the chair of infectious diseases at Upstate University Hospital, told me. Those people will become short of breath, their heart racing and mind detached from reality. They experience organ failure and spend weeks in the ICU, if they survive at all.

Meanwhile, many others simply keep feeling better and eventually totally recover. Kola’s friend Karan Mahajan, an author based in Providence, Rhode Island, contracted the virus at almost the same time she did. In stark contrast to Kola, he said, “My case ended up feeling like a mild flu that lasted for two weeks. And then it faded after that.”

“There’s a big difference in how people handle this virus,” says Robert Murphy, a professor of medicine and the director of the Center for Global Communicable Diseases at Northwestern University. “It’s very unusual. None of this variability really fits with any other diseases we’re used to dealing with.”

This degree of uncertainty has less to do with the virus itself than how our bodies respond to it. As Murphy puts it, when doctors see this sort of variation in disease severity, “that’s not the virus; that’s the host.” Since the beginning of the pandemic, people around the world have heard the message that older and chronically ill people are most likely to die from COVID-19. But that is far from a complete picture of who is at risk of life-threatening disease. Understanding exactly how and why some people get so sick while others feel almost nothing will be the key to treatment.

Hope has been put in drugs that attempt to slow the replication of the virus—those currently in clinical trials like remdesivir, ivermectin, and hydroxychloroquine. But with the flu and most other viral diseases, antiviral medications are often effective only early in the disease. Once the virus has spread widely within our body, our own immune system becomes the thing that more urgently threatens to kill us. That response cannot be fully controlled. But it can be modulated and improved.

One of the common, perplexing experiences of COVID-19 is the loss of smell—and, then, taste. “Eating pizza was like eating cardboard,” Mahajan told me. Any common cold that causes congestion can alter these sensations to some degree. But a near-total breakdown of taste and smell is happening with coronavirus infections even in the absence of other symptoms.

Jonathan Aviv, an ear, nose, and throat doctor based in New York, told me he has seen a surge in young people coming to him with a sudden inability to taste. He’s unsure what to tell them about what’s going on. “The non-scary scenario is that the inflammatory effect of the infection is temporarily altering the function of the olfactory nerve,” he said. “The scarier possibility is that the virus is attacking the nerve itself.” Viruses that attack nerves can cause long-term impairment, and could affect other parts of the nervous system. The coronavirus has already been reported to precipitate inflammation in the brain that leads to permanent damage.

Though SARS-CoV-2 (the new coronavirus) isn’t reported to invade the brain and spine directly, its predecessor SARS-CoV seems to have that capacity. If nerve cells are spared by the new virus, they would be among the few that are. When the coronavirus attaches to cells, it hooks on and breaks through, then starts to replicate. It does so especially well in the cells of the nasopharynx and down into the lungs, but is also known to act on the cells of the liver, bowels, and heart. The virus spreads around the body for days or weeks in a sort of stealth mode, taking over host cells while evading the immune response. It can take a week or two for the body to fully recognize the extent to which it has been overwhelmed. At this point, its reaction is often not calm and measured. The immune system goes into a hyperreactive state, pulling all available alarms to mobilize the body’s defense mechanisms. This is when people suddenly crash.

Full article: https://www.theatlantic.com/health/archive/2020/04/coronavirus-immune-response/610228/

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Are we Great yet?

Lysol manufacturer warns against internal use after Trump comments
A spokesperson for the cleaning product company said it had a responsibility to give accurate info to the public.



April 24, 2020, 6:50 AM EDT / Updated April 24, 2020, 7:28 AM EDT

WASHINGTON — The manufacturer for Lysol, a disinfectant spray and cleaning product, issued a statement warning against any internal use after President Donald Trump suggested that people could get an "injection" of "the disinfectant that knocks (coronavirus) out in a minute."

"As a global leader in health and hygiene products, we must be clear that under no circumstance should our disinfectant products be administered into the human body (through injection, ingestion or any other route)," said a spokesperson for Reckitt Benckiser, the United Kingdom-based owner of Lysol, in a statement to NBC News.

"As with all products, our disinfectant and hygiene products should only be used as intended and in line with usage guidelines. Please read the label and safety information," the statement continued, adding that the company believes it has a "responsibility in providing consumers with access to accurate, up-to-date information as advised by leading public health experts."

At the White House coronavirus briefing on Thursday, Trump suggested that people could be treated with "ultraviolet or just a very powerful light" to kill the virus after a presentation from a medical expert showed that the virus might not live as long in warmer and more humid temperatures. Trump then also mentioned an "injection" of "disinfectant" to deter the virus.

"I see the disinfectant that knocks it out in a minute, one minute. And is there a way we can do something like that by injection inside or almost a cleaning? As you see, it gets in the lungs, it does a tremendous number on the lungs, so it would be interesting to check that."

Trump did not specify the kind of disinfectant.

Medical professionals were quick to dispute Trump's claims as "irresponsible" and "dangerous."

“This notion of injecting or ingesting any type of cleansing product into the body is irresponsible and it’s dangerous," said Dr. Vin Gupta, a pulmonologist, global health policy expert and an NBC News and MSNBC contributor.

"It’s a common method that people utilize when they want to kill themselves," Gupta added.

Posted April 22, 2020 by UVM Medical Center

SNIPPETS:

Three days after he was put on a mechanical ventilator, Richard Pritsky awakened to see members of his care team assembled around his bed at UVM Medical Center, the unmistakable look of relief in their eyes. He had been successfully extubated, brought out of deep sedation, and was breathing on his own.

At 74, Pritsky realized he would survive the severe case of COVID-19 that had taken him by surprise. “They got me through, it’s pretty amazing,” he says. “This is a crazy disease. Anyone who says it’s like the flu – this is nothing like any bad flu I’ve ever had.”

The symptoms started around March 19, and were mild at first. “I was feeling a little weird,” he recalls. “I thought maybe I was coming down with my usual spring sinus infection.” In the mornings, his nose was a bit stuffy, he felt slightly feverish and he was a tad short of breath. But by afternoon, he felt fine. This went on for 10 days, and it never crossed his mind he’d been infected with the new coronavirus – he had not traveled or been in close contact with anyone who was sick.

Everything changed on March 29. “I woke up and it was like I’d dropped off the end of a cliff. Suddenly, I could barely breathe,” says Pritsky, an IBM retiree who leads an active lifestyle cycling, taking dance lessons and acting in community theater. “And then I made a stupid decision and drove myself to urgent care.” In retrospect, he says, he should have followed the guidelines for people experiencing severe respiratory distress and called 911. ... ...

“It’s never a done deal that they will recover at that point. There’s still a risk of them developing another pneumonia and other patients have had to be intubated again,” says Dr. Gardner, adding that Pritsky also suffered a pneumothorax, or collapsed lung, while on the ventilator and required a chest tube.

ICU Director Mary Ellen Antkowiak says there is still a lot to learn about this new disease, there is no proven effective treatment, and guidelines have been variable about treatment approaches to try. “We haven’t found that there’s one magical thing we’re doing that helps more than others,” she explains. “But it’s really important to be able to look at each patient and see how they’re responding to a certain mode or therapy, and then be able to adapt.

Dr. Antkowiak adds: “We’ve been really fortunate that the people of Vermont have listened and abided by social distancing, and because of that we have been able to focus our care on fewer patients.”

While in the ICU, Pritsky was treated with steroids and, antibiotics. He was also given the antimalarial drug hydroxychloroquine, which may help reduce inflammation in certain patients, Dr. Gardner says. He was also given blood thinners to prevent clotting.

After the ICU, he was put on a relatively high level of nasal cannula oxygen support, which was ratcheted down over the five or six days he was on the COVID-19 step-down unit under Dr. Gardner’s care. As his mobility improved, Pritsky was able to stop taking the blood thinners.

“Mr. Pritsky was the first really sick patient that I’ve been able to discharge to go home,” Dr. Gardner continues. “My initial experience treating these patients was demoralizing, we lost several patients early on. We’ve since had a handful of patients who have been on a ventilator that have come off and recovered. Seeing really sick patients get better, it provides a sense of relief.”

Full article:

https://www.uvmhealth.org/Pages/Coronavirus/Staying-Healthy/Surviving-Serious-Case-COVID-19.aspx