what are the most common symptoms of covid fever cough shortness of breath it's also common to have
body aches but covid 19 is sometimes more than just a respiratory disease or sometimes not a
respiratory disease at all it can mimic just about any illness sometimes it looks like a common cold
sometimes it looks like influenza sometimes it looks like a stomach bug with belly pain diarrhea
maybe some nausea vomiting loss of appetite it can cause pink eye everybody knows loss of taste and
smell sometimes even whole body rashes or areas of swelling and redness of the skin in just a few
spots it's also kidney damage heart damage this is a section of a heart of a patient who had severe
covid disease this patient had inflamed lungs with ards and tiny clots in his lungs and that made it
hard for his right ventricle to pump blood to his lungs and that's what caused his right ventricle
to weaken and become dilated so like i mentioned severe disease is causing blood clots to form in
a lot of patients when blood clots are found in the lungs they're called pulmonary emboli
some covid patients have presented with a stroke as a result of having blood clots in their brain
covid has also presented in other ways sometimes with seizures also guillain-barre syndrome
this makes it incredibly difficult to diagnose and even harder to treat
this disease can present in so many ways there's never been a disease in the history of mankind
that's presented in so many different ways when it comes to how this virus invades our body
and causes disease there are some things we know some things we think we know
and then some things we just don't know how about we start with what we know
when the virus lands in our eyes nose or mouth or sometimes when we inhale into our lungs
the spike proteins of the virus bind to the h2 receptor on the surface of certain cells
and that's how it gains entry these h2 receptors are found in many different parts of the body
once the virus gains entry not only does it make millions of copies of itself
but it also alters the cell's ability to call for help it's like the cells that get infected they
can't call the police at least not initially once the virus is deeply embedded in our body it begins
to cause more severe disease this is where direct attack on other organs that have h2 receptors
can occur including heart muscle kidneys blood vessels liver and the brain early findings
including those for multiple autopsy and biopsy reports show that viral particles can be found not
only in the nasal passages and throat but also in tears stool kidneys liver pancreas and the heart
one case report found evidence of viral particles in the csf meaning the cerebral spinal fluid
that's the fluid around the brain the patient ended up having meningitis
oh i forgot to mention that one earlier so this virus can also cause meningitis
which is inflammation of the membranes that encapsulate the brain and spinal cord
and here is an electron microscopic picture of the virus and kidney cells and to give you perspective
one nanometer is one ten millionth the size of a centimeter the red arrows point to the virus and
the green arrows point to the spikes of the virus and the virus altogether is about 65 nanometers
in diameter so the virus is sometimes going to all these different organs by means of attaching
to the ac2 receptors that are there but that's not even the whole story because in some cases by the
time the body's immune system figures out that the body is being invaded it's like unleashing
the military to stomp out the virus and in that process there's a ton of collateral damage this
is what we refer to as the cytokine storm rantes is a chemokine that is thought to play a large
role in the covid 19 cytokine storm which binds to the ccr5 receptors on cd4 and cd8t lymphocytes
essentially propagating further inflammation and possibly propagating further clotting
when the virus gets into the alveolar cells meaning the tiny little air sacs within the lungs
it makes a ton of copies of itself and then it goes on to invade more cells the alveoli's next
door neighbor is guess who yeah the thinnest blood vessels in your body the capillaries
so the lining of those capillaries is called endothelium which also have h2 receptors and once
the virus invades those capillaries boy oh boy that's when the immune system gets triggered af
as in paf paf stands for platelet activating factor also known as acetylglycerol ether
phosphoryl choline whatever but this paf is a big deal because it's a potent phospholipid activator
so what does that mean it means that it serves as the trigger for the onslaught of inflammation and
and clotting in early autopsy results are also showing widely scattered clots in multiple
organs in one study from the netherlands one third of hospitalized patients with covid 19
got clots despite already being on a prophylactic dose of blood thinner and the real number is
likely higher than that because i promise you most doctors are not looking for clots in cova patients
until recently so not only are you getting the inflammation with the cytokine storm
but you're also forming blood clots that can travel to other parts of the body and cause
major blockages effectively damaging those organs so wait a minute doc you're telling me that this
can cause organ damage by one directly attacking organs by their h2 receptors yeah two indirectly
attacking organs by way of collateral damage through the cytokine storm yeah three indirectly
cause damage to organs by means of blood clots yep four indirectly cause organ damage by
low oxygen levels or improper ventilator settings or side effects from the medications that we give
yeah and back to the whole blood clot thing if you saw my video on blood clots and covid patients
you'll know that anti-phospholipid antibody syndrome or aps that just might be the link to
explain why so many covid patients are getting blood clots like what this autopsy showed in the
lungs with blood clots here not only did it have blood clots but these lungs are inflamed
and showed findings consistent with ards when it was looked at underneath the microscope
these lungs were heavy filled with fluid and much stiffer than normal lungs all these factors make
it hard for the lungs to move air in and out it makes it hard to get oxygen from that air into
the blood and this was another autopsy here where they sliced up small pieces of lung and looked
at it underneath the microscope these are tiny little blood clots within the lung capillaries
in the lining of these lung capillaries is called the endothelium and this endothelium
is destroyed by the virus and by inflammation this is a picture of the endothelial cells
undergoing apoptosis so apoptosis is a process where the cell programs itself to die which is
what sometimes happens when a cell gets infected and endothelial cells are more vulnerable to
dying in people with pre-existing endothelial dysfunction which is more often associated with
being a male being a smoker having high blood pressure having diabetes having obesity and
if all these sound familiar maybe that's because these are all the associated risk factors
for worse outcomes in covid 19. but let's get back to blood clots because these blood clots can
form and or travel to other parts of the body when blood clots travel to the toes and cause
blockages and blood flow there meaning ischemia or infarction that can cause gangrene there and lots
of times patients with gangrene require amputation so here's a picture of what we call coveted toes
and it doesn't just affect toes it also affects other areas of skin this is a picture of something
we call purpra which results of capillaries bursting open which is a result of the clots that
are forming there so is anti-phospholipid antibody syndrome or aps is that the cause of all these
blood clots in patients with severe covid maybe it's a tricky diagnosis some patients with aps
have what's called catastrophic aps or caps caps with caps these patients can have strokes seizures
heart attacks kidney failure ards skin changes like the ones i mentioned earlier in this video
so this begs the question is this what's going on in patients with severe covid 19 it sure does look
like it viral infectious diseases particularly those of the respiratory tract have been reported
as being the triggers for caps the pathogenesis is complex and it might involve the activation
of toll-like receptor 4 tlr4 which triggers a cytokine storm followed by alterations to the
endothelium of lung capillaries which serves as the trigger for reducing the cytokine storm
when you take a step back and think about it there aren't a lot of diseases that cause clots to form
in the arteries usually it's when we have plaques in our arteries and then those plaques rupture
and they travel downstream and cause a blockage this is what happens when we have a heart attack
when someone has atrial fibrillation the atria are fibrillating so quickly meaning they're quivering
when this happens the pool of blood sitting there becomes stagnant and that's why people
with atrial fibrillation are at higher risk of developing clots there that clot can then
travel to other organs and cause a blockage of blood flow there when it goes to the brain
it can cause a stroke when it goes to the leg it can cause gangrene when it goes to the arteries
of the gut it can cause mesenteric ischemia or infarction where the gut tissue can then die off
there's various factors that increase the risk of developing arterial thrombosis meaning arterial
clots classically the cardiovascular dependent risk factors implicated in clotting have been high
blood pressure meaning hypertension high levels of cholesterol smoking diabetes age chemotherapy
and the degree of infection so all of these contribute toward developing arterial thrombosis
you know what these same risk factors also sound a lot like the same risk factors for
people who have severe covert disease yeah so it seems like there's some correlation there
and you know something else there's really only one other medical condition that is well known
to cause clots in both veins and arteries and that's aps the other medical conditions
that are known to cause clots such as factor v liden prothrombin gene mutation heparin induced
thrombotic thrombocytopenia or hit for short also other conditions like pnh which is paroxysmal
nocturnal hemoglobinuria these conditions don't really cause clots to form in arteries
the blood clots that form in these conditions almost always form clots in veins but with aps
they often form clots in both or at least are more likely to form clots and arteries
when you combine that knowledge with what we saw just published in the new england journal medicine
with these patients having covid 19 and developing blood clots in their arteries and
all of them being positive for anti-phospholipid antibodies it really makes you wonder if this is
the reason that's causing some covid patients to die so we'll need more studies looking into
these and i'm going to make a video where i deep dive into aps and caps and we're going to discuss
how we make that diagnosis because it is a tricky diagnosis but also i'll talk about how we treat it
part of the reason why it can be tricky is because it can be confused with something called dic
or disseminated intravascular coagulation but they're not the same thing see a lot of patients
with severe covid 19 have certain labs that resemble dic such as increased pt inr increase ptt
decreased levels of platelets but the reason why these covid patients who develop clots in
the study i mentioned earlier the reason why they don't have dic is actually two reasons
one they weren't having extensive bleeding and two they didn't have low fibrinogen levels and if it's
truly dic you'd have both of these things anyway you can probably glean from this video why it's
so hard for doctors to figure out what is going on with the virus between the variable ways this
disease can present in different patients in the different ways that organs can suffer damage yeah
this is really really really complicated and we still are just scratching the surface with just
how much we know about it there's so many pieces of the puzzle that we're still putting together
but at least it's starting to form a picture thanks for watching this video
you