ZT is a 61 year old man, presenting to the emergency room with fever, cough and weakness
on December 20, 2019.
Several years ago, he was diagnosed with liver disease.
Over the next 7 days, ZT was monitored in the respiratory unit at the Wuhan hospital,
and he started to develop trouble breathing.
A throat swab tested positive for the coronavirus, SARS-CoV-2 infection, meaning he has COVID19,
the disease caused by the virus.
A CT scan of his chest confirmed viral pneumonia.
On the eight day of hospitalization, December 28th, ZT was transferred to the intensive
care unit.
A tube was placed down his throat so that a machine could help him breathe.
3 days later, on New Year’s eve, ZT was transferred to the infectious disease hospital
in Wuhan city so he could be more closely monitored.
On new year’s day, ZT fell unconscious.
His blood pressure started to drop.
The next day, he entered respiratory failure.
He was hooked up to life support.
A second infection was found in ZT.
This time, bacteria.
Other germs were starting to grow inside him.
Acids were found in his blood, as his organs started shutting down.
At 8:47pm, on January 9th 2020, 8 days after he was moved to the infectious disease hospital,
ZT’s heart suddenly stopped beating.
A code was announced in the hospital, and doctors rushed to resuscitate him, but at
11:13pm, 2 and a half hours later, the code was called.
ZT could not be resuscitated.
Pneumonia, fever, life support, acids in blood.
These are all things that are dealt with in hospitals everyday.
Nothing new here.
Problems with the lungs, can cause critical illness quickly, BUT can be even quicker when
the heart gets involved.
BM is a 69 year old man, presenting to the emergency room with fever, cough, and breathing
trouble on January 3rd, 2020.
At the Wuhan Red Cross Hospital on the day of presentation, BM was intubated because
he was actually in respiratory failure and had hypoxemia.
Hypo meaning low.
Ox referring to oxygen, and emia meaning presence in blood.
Low oxygen presence in blood because of respiratory failure.
But this wasn’t his only problem.
Parts of his heart muscles were floating around in his blood.
This is something you find when someone has a heart attack.
But BM didn’t have a heart attack.
A throat swab confirmed SARS2 infection and COVID19 disease.
The next day, January 4th 2020, BM was transferred to the infectious disease hospital in Wuhan
city, when he became unconscious.
A CT scan found pneumonia.
BM was moved into the intensive care unit.
He was turned over on to his stomach, to help get more oxygen in his lungs during machine
ventilation.
And this brings us to why this is happening in BM, and why is he being treated this way.
The COVID19’s main feature is pneumonia.
But how does the virus cause this?
The spikes on the virus surface, are protein.
The viral genome dictates how every protein is made.
We have the genome fully sequenced, so we know these spikes are similar to the ones
on the first SARS virus, that had an outbreak in 2003.
These spikes interact with something called Angiotensin Converting Enzyme 2 or ACE2 in
humans.
It looks like this is how it enters cells of the lower lung.
When it enters, it injects its RNA and hijacks the lung cell to create viral materials instead
of letting the cell live its normal life.
It kills the cell while creating more virus.
But the lungs aren’t the only place where humans have ACE2.
The stomach and the intestines have it.
Specific parts of the male anatomy have it.
It’s on the kidneys.
And, it’s in the heart, which could explain BM’s damaged heart.
Problems in the stomach probably won’t kill someone immediately.
Problems in male anatomy probably won’t kill someone immediately.
But a problem of the heart or lungs, can kill someone in minutes, which brings us back to
pneumonia.
When the body’s immune system detects viral damage in the lungs, it reacts.
It expands the blood vessels, so more immune cells can enter, but this also means fluid
fills BM’s lungs.
This makes breathing harder, because now the lungs can’t exchange oxygen and carbon dioxide
with the blood.
But high pressure in, lowers the movement of air out
What’s the air going out?
Carbon dioxide.
So, Carbon dioxide levels increase in the blood when the pressure is high.
This is uncomfortable and patients will instinctively try to breathe against the ventilator.
That might knock things off sync, so medicines were given to temporarily paralyze BM’s
respiratory muscles, so he can’t fight the machine.
Medicines were given to sedate him so that he wouldn’t be fully conscious while paralyzed.
All of these things, low tidal volume ventilation, muscle paralysis and sedation, and early prone
position, that’s turning him on to his stomach, have been shown to decrease mortality in patients
with acute respiratory distress syndrome, just like BM
Dialysis was started because his kidneys were starting to fail.
A viral infection in the lung can cause other germs to start growing, and in BM, bacteria
was starting to grow.
Why this happens is not really clear.
It could be that a viral infection reduces the body’s available resources to fight
a bacterial co-infection.
But it also could be that viruses directly sabotage the immune system’s ability to
fight off a co-infection.
Whatever the case is, BM was started on multiple antibiotics to cover many kinds of bacteria.
He was treated for his symptoms in intensive care.
But it wasn’t enough.
5 days later on January 9th 2020, the bacteria that was in his lungs, was floating around
in his blood.
His blood pressure started to drop because his immune system was reacting to that bacteria
by dilating all the blood vessels.
Tiny clots were forming in his bloodstream that were lodging into the blood vessels of
his organs, blocking blood flow and causing them to shut down.
At midnight on January 15 2020, BM’s heart stopped beating.
A code was announced in the hospital, as doctors rushed in to try to resuscitate him.
By 12:45 am, the code was called.
BM could not be resuscitated.
These 2 critically ill cases of COVID19, are cases of severe pneumonia.
That is how the virus affects humans.
If these were isolated cases that happened months apart from each other in different
parts of the country, maybe no one would have thought twice about it.
But if multiple cases come through in a short time, in the same place, with an illness this
serious, then it’s cause for concern.
In America, in 1981, there was an outbreak of 11 cases of rare fungal pneumonia.
This ended up being the first description of AIDS.
Because that fungus that caused their pneumonia, is everywhere in the air.
You might be breathing it right now, but your immune system handles it no problem.
An AIDS patient though, has a weak immune system.
When these 11 cases were identified back then, no one knew what AIDS was, meaning these patients
were in end-stage disease.
The fungus was growing all over their lungs, causing that rare pneumonia.
So, “rare pneumonia” coming up often, can trigger an alarm of an outbreak of communicable
disease, but you have to be careful.
You don’t want to cry wolf, but you also don’t want to not tell anyone something
bad could be spreading.
So here’s what we know.
Fever and pneumonia are present in almost all cases of COVID19.
Other problems like with the heart and kidneys and stomach, it depends.
There could be people who are infected, and don’t have symptoms.
It looks like those people can spread the virus through respiratory droplets from their
lungs.
Surface contamination?
The data is not conclusive, so wash your hands.
Asymptomatic spread is the scarier scenario because those people may not get isolated
or quarantined immediately, and infect others unknowingly, so that’s why it would be best
if we could do a serology, or a testing method to find antibodies in someone to the SARS2
virus.
But on the flip side, if someone is held in isolation, with maybe some of the potentially
more subjective symptoms, are they really short of breath, or do they think they’re
short of breath now that they know they’re being held in isolation?
What happens when don’t have symptoms, but insist they do and demand treatment that they
don’t need?
Nobody wants that tube down their throat, trust me.
But If the illness keeps getting worse: pneumonia, fever.
Secondary infection.
Bacteria breaks off and starts floating around in the blood.
Organs start to shut down because blood pressure is too low from the immune system trying to
attack the bacteria in blood.
Metabolic waste and acid build up in the blood, causing the heart to stop beating.
BUT, the good news is that ZT and BM aren’t the majority of patients.
Unfortunately, they died.
The official number says mortality for COVID19 is somewhere between 2-5%.
Ok, assume we take that with a grain of salt.
The cases that are confirmed here in the United States, show the same pneumonia and respiratory
described by doctors in China.
So ZT and BM were older patients who had prior medical histories.
Severe pneumonia is going to hit that demographic pretty hard
What does it look like when a younger, healthy person is infected?
ZW is a 35 year old man, presenting to the emergency room at Wuhan General Hospital with
a 3 day fever.
December 5th 2019.
He had no past medical history and was not taking any medications.
A chest CT found viral pneumonia.
Keep in mind this is before there were global announcements of an outbreak.
Over the next four days, ZW’s kidney and lung function slowly worsened.
On day 5, ZW started on supplemental oxygen and was given symptomatic treatment.
ZW’s condition worsened over the next 5 days, but started to stabilize by day 11,
when he tested positive for SARS2 virus.
Several weeks later on January 20th, ZW was placed for surveillance, and eventually discharged.
ZW’s case is similar to the one that happened in Washington State, which was published in
the New England Journal of Medicine on January 31, 2020.
This was the first case confirmed in the US.
This patient, also 35 years old.
Also no past medical history.
He presented to urgent care with a 4 day history of cough and fever.
Which isn’t out of the ordinary for mid January cold and flu.
He had a confirmed COVID19 infection done by a throat swab.
How was he treated for fever?
Tylenol and ibuprofen.
How did he get treated for his cough?
Cough syrup.
As the days went by, blood tests started showing some abnormalities related to his liver, but
it didn’t seem like anything too bad was really happening at that point.
But on hospital day 5, his chest CT showed an atypical pneumonia.
They already knew at that point he had the SARS2 infection, so this probably wasn’t
too surprising to them, but on that day, the patient started having trouble breathing.
He wasn’t getting enough oxygen from the air, so he was given supplemental oxygen.
Since he had been at the hospital so long by this point, was this decline in breathing
from SARS2 virus?
Or was it from hospital bacteria?
Antiviral medicine won’t work on bacteria.
Antibiotic won’t work on a virus.
If he’s not treated with the right medicine for the right pathogen, he’s going to get
sicker, so the medical team started him on antibiotics.
The next day, pneumonia was still found in both lungs and the medical team was able to
get a medicine that’s in research, remdesivir.
This medicine confuses the virus.
By looking like one of the genetic backbones of the viral genome, the virus uses it reproduce.
But because it’s not actually the right backbone, the virus can’t reproduce properly.
This could be one way to could treat COVID19, because it appeared to work for this patient
as his condition improved over the next few days.
The medicine appears to be in China now for use in a trial, along with many others.
So focus on what’s going on where you are at the moment.
In America, not even 50 cases, it’s actually 35 at the time of me recording this.
If you feel fever and chills, shortness of breath, and fatigue over the last few days,
get that checked out.
It’s more likely to be flu than SARS2 if you’re in USA, but if it is SARS2, you’re
going to get good care for it here.
Wash your hands when you come home from a public place, or if you touch something in
your house that came from the outside.
If you’re young and healthy, non smoker, no past medical history, and you feel ill,
don’t panic cause you have every advantage on your side in the US.
If you’re older with past medical history, don’t take any chances with any fever, in
general.
#alertnotanxious
Because I can’t create a new video every time something new develops, I’ve created
a playlist with other medical you tubers on there.
In the context of medicine and medical treatments, these are all great resources to learn more
about the SARS2 virus and resulting COVID19 disease.
Again, #alertnotanxious and I hope these videos help you find the resources that you need.
Take care of yourself.
And Be Well.