before I say anything I just want to say that if you are squeamish you might not want to watch this
video because there will be some pictures of lungs that have a blood clot in them and other
organs of the body and my opinion is nothing that bad but I wanted to give you a warning regardless
this video is a follow-up to my last video which is called what doctors are learning from autopsy
findings of COVID patients just after I published that video not even a day later this study came
out published in the annals of internal medicine which I'll put a link in the description below
and what makes this study such a big deal is that it's the first study that looked at this
many autopsies of patients who died of COVID not only do they do complete autopsies but they use
CT scans to scan the entire body for blood clots all 12 of the deceased had tested positive for
SARS coronavirus - by means of rt-pcr now I want to say something not everyone on this planet is
going to get COVID for those who do get the virus 80 percent of them will have either mild or no
symptoms roughly 15 to 20 percent of them will have pneumonia roughly 4 percent will develop
ARDS or a few respiratory distress syndrome and/or shock with multi-organ failure and about 1 percent
will die of the infection when I'm in the ICU and someone dies it's obviously horrible sometimes
autopsies have to be done irrespective of family consent when it's a legal matter rarely depending
on the circumstances we ask family's permission to do an autopsy most families decline the option for
autopsy but during this pandemic it's especially important for autopsies to be done because they
often provide incredibly valuable information especially when we still know so little about
COVID especially when it can present in so many different ways so in this study that was done in
Germany autopsies were mandated for patients who died of coded and to the families of those
victims of COVID my condolences and we're still trying to figure out why some people
do so poorly when they get the virus while others do just fine and then there's everyone in between
the point of this video is not to scare people the point is to learn about the disease and to
ultimately benefit from that learning with the hope of developing treatment options in
ultimately reduce morbidity and mortality in other words to save lives and by making this video the
goal is to educate myself and others about what we're learning and getting the medical truth out
there to the public so in this study there were 12 patients total nine men three women and the
median age was 73 all patients had some type of pre-existing medical condition most of them had
obesity and/or underlying heart disease such as coronary heart disease some had type 2 diabetes
hypertension peripheral artery disease asthma COPD initial lab tests revealed elevated levels
of d-dimer lactate dehydrogenase meaning LD H and C reactive protein or CRP all of these are
nonspecific markers of inflammation there is also mild thrombocytopenia in some patients meaning low
platelet counts this isn't an unusual finding in patients who are critically ill they also looked
at levels of viral RNA using rt-pcr studies all twelve patients had the Stars quarter virus to
RNA in their lungs nine out of the twelve had it in their throat and six had in their bloodstream
in five patients they had viral RNA in other tissues like heart liver brain and kidney not
only did they have the virus there but the levels were higher in those tissues compared to the blood
here's a picture from a different autopsy that was not part of this study where the virus was
actually visualized in the kidney using electron microscopy so what is this telling us it tells us
that the virus is binding to those h2 receptors in those organs so in some people who dive COVID
they had the virus in other organs besides the lungs but and this is a big but they did not die
as a result of that virus being in those different organs they died as a result of lung complications
also an important takeaway from this is that all twelve had in their lungs and nine out of the 12
in their throat so when you go to do a throat swab with someone who has COVID the virus might
not even be there and that's just another reason why you can get a false negative test okay so they
also did post-mortem CT scans of these patients which demonstrated mixed patterns of reticular
infiltrations in severe dense consolidations in both lungs this CT scan is a patient with covid
pneumonia in erred yes not from this study that we're talking about now but basically
demonstrating the exact same thing both lungs have extensive consolidations ground-glass opacities
which represent an extensive inflammation these are also known as pulmonary infiltrates and you
can see the difference compared to a normal CT scan of the chest which doesn't have any
pulmonary infiltrates in four cases out of the 12 massive pulmonary embolism meaning massive blood
clots in the pulmonary arteries was the cause of death in another three cases out of the 12 they
had blood clots in their large veins of their legs meaning DVT without having pulmonary embolism so
in six of the nine men they had clots in the veins that surround the prostate gland in all 12 cases
the cause of death was found within the lungs or the pulmonary vascular system meaning within the
pulmonary arteries for the ones who didn't die of having a large pulmonary emboli they died of the
extensive inflammation within the lungs meaning pneumonia with ARDS in these cases the lungs were
wet and heavy much like a sponge that is saturated with water the surfaces of the lung often had
a distinct patchy pattern with pale areas alternating with slightly protruding and firm
deep reddish blue hyper capitalized areas this is indicative of areas of intense inflammation
with endothelial dysfunction that can be seen at the microscopic level when they look at slices
of the lungs under the microscope they found diffuse alveolar damage in eight cases out of 12
specifically they saw hyaline membrane formation tiny clots in the capillaries and capillaries
that were engorged with red blood cells and other inflammatory findings all these findings
represent ARDS they also found lymphocytes a type of a white blood cell that infiltrated
these specific tissues this fits the picture of a viral pathogen ASIS they also look at the pharynx
of these patients meaning the throat the lining of the throat where the mucosa was hyperemic meaning
very red and irritated and at the microscopic level they saw lymphocytes invading there as well
again which is consistent with a viral infection in one case a patient had lymphocytes invade his
heart muscle findings that are consistent with what we call viral myocarditis in other words the
heart muscle had evidence of viral infection more than half the patients in this study had large
blood clots 1/3 of the patients had pulmonary embolism as the direct cause of death all the
others died of intense inflammation in their lungs related to pneumonia and ARDS recently there's
been studies showing that about 1/3 of patients with severe COVID have blood clots another study
of 191 patients with Kovan 19 half of those who died had clots compared with 7% of the survivors
and levels of d-dimer that were greater than 1,000 were associated with a fatal outcome so
it's pretty clear now that stars curve to virus is causing a lot of class to form and moderate
to severe COVID disease but how is this happening it's likely a combination of reasons they have
to do with down regulation of the h2 receptor in the lung alveoli with a subsequent shift towards
having more angiotensin 2 in the lungs and less angiotensin 1:7 and less in angiotensin 1:9 in
the lungs and when this happens this leads to more cytokine storm with more inflammation more
constriction of pulmonary arteries and more clots that develop that in turn leads to more
endothelial dysfunction in the capillaries that surround the alveoli also there's evidence that
the virus attaches to the ACE 2 receptors of the endothelial cells that line those capillaries
which further propagates inflammation in clotting and in the cytokine storm that develops there
Randy's Okemo kine bind to the ccr5 receptor of cd4 and cd8 lymphocytes and that causes
those lymphocytes to infiltrate those areas of inflammation and in doing so further contributes
towards the inflammatory reaction this is why we're seeing low levels of cd4 and cd8 lymphocytes
and severe COVID endothelial damage can also lead to the development of antiphospholipid antibodies
and these antibodies are bad because they trigger the formation of blood clots and that's why
patients who have clots with the diagnosis of antiphospholipid antibody syndrome they
need to be on blood thinners also 11 out of the 12 patients in the study had underlying heart disease
and were obese these are known risk factors not just for cardiovascular disease but also known
risk factors for endothelial dysfunction in our known risk factors for COVID the endothelium is
more susceptible to damage based on cardiovascular risk factors such as men age 45 or older women
age 55 or older smoking high blood pressure high cholesterol diabetes obesity and lack of physical
activity so the big takeaways from the findings in this study is that most people who die of kovat
it's primarily a lung problem either related to inflammation with ARDS and/or blood clots even
though blood thinners are not a cure for kovat per se they do have the potential to save lives the
hard part is figuring out who is likely to develop clots and who should we give blood thinners to and
which blood thinners should we give and should we give high doses of blood thinners or just the
low-dose prophylactic doses to further complicate matters it's often hard to diagnose blood clots in
hospitalized patients even before COVID came along usually it's easy to diagnose large blood clots in
the veins of the legs meaning DVT by doing an ultrasound of the legs even though ultrasound
isn't a hundred percent accurate the way we typically diagnose pulmonary emboli is by getting
a CT scan of the chest while at the same time giving IV contrast and this is called a CT angio
or CT a of the chest the downsides of doing this well there's several one you have to transport a
patient to the CT scanner and sometimes patients aren't stable enough to do that to you risk
spreading the virus to others in the hospital by transporting that pay and this will also require
more PPE use 3 CT scans require larger doses of radiation for giving someone IV contrast has some
risks such as the risk of serious allergic reaction in the risk of causing some kidney
damage on top of that the CTA of the chest can only visualize bigger clots so you might not see
the small clots that are there right now more and more hospitals are giving high-dose blood thinners
to COVID patients who have severe disease even if they haven't been diagnosed as having blood
clots but what about patients without moderate or severe Kovich should they take a blood thinner or
maybe a low dose blood thinner or should they take an antiplatelet medication like aspirin either 81
milligrams of aspirin or 162 milligram dose or 325 milligrams os-- or should the general public take
a low dose aspirin like 81 milligrams in order to help prevent blood clots from forming if they do
get COVID or should it just be certain people in the population who are at higher risk of getting
severe COVID should they take aspirin these are the questions we don't know the answers to at
this point it's going to take a lot of studies to answer these questions because not only do
we need to know that there's a benefit in doing so we have to know that these benefits will outweigh
the risks such as the risk of bleeding and then there's all the other drugs that are being looked
at right now and randomized control trials we should start seeing some of these results pretty
soon what we do know is that in order to improve the capillary endothelium and also to minimize
your chances of having severe disease if you were to get COVID you want to do several things
this includes exercise eating healthy getting good sleep minimizing stress not smoking what
about vaping generally not good either but not as bad as smoking too much alcohol not good either
have your medical conditions under control whether that's diabetes high blood pressure
COPD asthma allergies whatever the case may be now what about vitamin D probably a good thing
but that's a whole nother topic which I should make my next video on because there's a lot to
say about that and possibly other vitamins too if you're deficient in certain vitamins anyway
to catch that video subscribe to this channel and hit that Bell notification so you know when I post
here on YouTube so many topics I want to cover in so little time but I will see you in the next one