you may have seen some or all of the videos i made about autopsies that were done
on coronavirus patients this video is essentially a summary of all the significant takeaways from
all the published autopsies that have been done on patients with covid 19. this is based on eight
different published studies or case reports of autopsy findings which includes 188 autopsies
in total i'll put the links to the published studies in the description below you can also
check out my other autopsy videos for more details of those previous studies so covid 19 is still a
very mysterious disease autopsy is an important tool helping to elucidate how the disease causes
organ damage which can help us learn how to treat the disease so what we learn from someone who has
diet from an illness helps us to better manage the people that have yet to contract that illness
autopsies are done by pathologists a pathologist is a physician who specializes in examining bodies
and body tissues for example a medical examiner is a pathologist pathologists have completed not
only medical school but also a minimum of three years of advanced medical education
in a residency training program they're board certified through the american board of pathology
i am not a pathologist my specialties which i'm board certified in are internal medicine pulmonary
disease and critical care medicine most hospitals and pathologists initially avoided conducting
autopsies on those who died of covid 19. this is because they didn't want to get the virus but also
because of insufficient equipment to safely perform them fortunately there haven't been
any reported cases of sars kobe transmission from a corpse to any pathologist morgue technician or
assistant with time more and more autopsies have been carried out and there have been some expected
findings and some unexpected findings one thing that is clear is that obesity predisposes those
infected to have worse outcomes now worse outcomes might mean death or it might mean a prolonged stay
in the intensive care unit or it could mean someone needs a tracheostomy or someone who
has extensive lung damage long after the infection has passed i have lots of patients that required
long stays in the hospital some of them required a breathing tube with a ventilator some of them died
some survived but now have a tracheostomy some required hospitalization and now follow up with me
in pulmonary clinic and they now need supplemental oxygen some of them need it part of the day while
others need it the entire day so some people have worse disease than others when you look at
who is more likely to have worse disease older age is one of them but also obesity is another
major risk factor obesity in and of itself is actually a pathological state where it leads
to atherosclerosis heart disease strokes increased risk of having blood clots fatty liver disease and
type 2 diabetes obesity can also increase the risk of some types of cancers like cancer of the uterus
of the cervix ovary breast colon and others people with obesity are more likely to have sleep apnea
which leads to other health problems so older age obesity in addition to high blood pressure
other forms of heart disease diabetes these are all risk factors for more severe covid also seems
that males have worse outcomes compared to females there's also a correlation between vitamin d
deficiency and severity of covid and whether it's just correlation versus actual causation is yet to
be determined and there are other factors at play too like genetics and also most likely the amount
of virus that infects the body all of these are risk factors that are still being studied
sars cov2 exhibits selectivity for the lungs specifically type 2 pneumocytes meaning type 2
alveolar cells alveoli are the tiny microscopic ear sacs of the lungs which is the part of our
lungs that is responsible for gas exchange air is brought down into the lungs to the alveoli
and the oxygen diffuses from the alveoli into our tiny blood vessels there called capillaries at the
same time carbon dioxide a waste product from our body travels from the capillaries into the alveoli
and then we exhale out that carbon dioxide alveoli are made up of mainly type 1 alveolar cells but
to a lesser degree they're also made up of type 2 alveolar cells and these guys are sort of like the
maintenance guys for the alveoli they play a part in making surfactant it's sort of lubricant for
the alveoli but these cells also play a part in defending against foreign pathogens like viruses
and bacteria well as it turns out these type 2 alveolar cells have the ace2 receptors on them
and sars cov2 binds to this receptor and that's how it gains entry into these cells and into our
body which is the same way the first sars virus gained entry into our body interestingly on may
21st a report from the cdc's covid 19 pathology working group found that the viral antigen in lung
tissue was higher compared to sars the first stars virus but also compared to merge as well when the
sars cov2 invades the type 2 alveolar cells it precipitates a cascade of reactions that causes
the body to react to the virus with inflammation and lots of damage to the alveoli and this is
known as diffuse alveolar damage clinically this is what we know as ards acute respiratory distress
syndrome this is what causes oxygen levels to go down and what causes the so-called cytokine storm
when people have severe covid this is what's going on also there's a propensity for blood clots
to develop and some people with covid died as a result of pulmonary emboli meaning blood clots in
their lungs the capillaries in the lung surround the alveoli here they serve to bring red blood
cells in close proximity to the alveoli to allow gas exchange to occur like i mentioned earlier
the lining of these capillaries is called the endothelium the cells that make up the endothelium
here also have h2 receptors the virus at least in those with severe disease seems to be infiltrating
the endothelium and causing inflammation and injury to the capillaries not just the alveoli
this likely at least partially explains why this virus is causing blood clots to develop here
now there's also been some talk about covid patients having myocarditis so what is myocarditis
myo means muscle card refers to the heart and itis means inflammation so myocarditis means
inflammation of the heart muscle this is overall a pretty rare condition it's usually caused by
different viruses there are some covid 19 cases that have occurred where patients
were suspected of having myocarditis in some cases where they were diagnosed as having such
even though overt myocarditis has been reported in some patients with covid overall this is not the
main way that this sars cov2 kills we know this one because most if not all covid autopsies
show that they died as a result of lung pathology but also too because they looked
at autopsies of covid patients who were suspected of having myocarditis for most of these autopsies
decadents did not have the virus in their heart for some of these autopsies they did have the
virus in their heart tissue but they didn't have the corresponding inflammatory changes
to make the diagnosis of viral myocarditis so in other words even if you find the virus there
that's not enough to say that that virus is causing damage to that organ
you need to have corresponding inflammatory changes in order to do so now in a different study
60 out of 100 patients who had recovered from covid 19 had ongoing myocardial inflammation
meaning inflammation of their heart muscle this was determined by using cardiac mri
now something to keep in mind is that it's possible that the myocarditis is related to the
effects of the cytokine storm it's also possible that the virus attaches to the h2 receptor
located on the endothelial cells of the heart which can cause blood clots to form there only
biopsies can give the most concrete answers in living people but biopsies are an invasive
procedure and carry a lot of risk so they're rarely done even before covid so more studies
are needed with respect to myocarditis and covid but what we can say for sure right now is that
when people dive covet it's a result of damage in the lungs and or blood clots in the lungs
the impact of the coronavirus on the brain is somewhat peculiar as patients have had various
neurologic manifestations such as confusion loss of taste or loss of smell and sometimes strokes or
seizures there is a study done in march that was published in the bmj the british medical journal
where they looked at 113 coveted patients and 22 percent of them had neurological issues ranging
from excess of sleepiness to coma in june french researchers found that 84 of patients in the icu
had neurological issues and one-third were confused or disoriented at the time of discharge
also there's a study done in the uk that found that 57 out of 125 coveted patients with a new
neurologic symptom had a stroke due to a blood clot in the brain then there was a study published
in the new england journal medicine this was done at brigham and women's in boston these researchers
conducted autopsies of 18 covid patients specifically examining several key areas of the
brain namely the cerebral cortex which is the gray matter responsible for your mind that's where your
thinking and sensations occur they also looked at the thalamus which modulates sensory inputs
they also looked at the basal ganglia which is responsible for motor control and they looked at
other areas of the brain as well the researchers found snippets of virus in only some areas
and only in some of the autopsies were these dead remnants of the virus or were they active viruses
when the patient died very few of the areas of the brain and some of the decadence actually
had inflammation what they did find was that these patients had hypoxic brain injury so their biggest
takeaway from all these brain autopsies was that there's lots of brain damage as a result of not
getting enough oxygen this is hypoxic brain injury when the brain doesn't get enough oxygen
individual neurons die and they don't come back to life these findings suggest that damage had
been happening over a longer period of time which raises the question for people who had coveted
and experienced low oxygen levels for a certain amount of time do these people if they survive
do they end up with lingering effects on the brain did they sustain some degree of brain damage
well we do know that lots of patients who've recovered from covid do have memory loss a team
of researchers from mount sinai health in new york city took tissue samples from 20 brains they also
didn't find much in the way of inflammation in the brain what they did find was a lot of microthrombi
meaning tiny clots so these microthrombi were seen in conjunction with corresponding patchy
areas of tissue death in other words the tiny clots caused tiny blockages of blood vessels
in various parts of the brain essentially causing a bunch of mini strokes if you will
these micro infarcts are the likely reason for the neurological and or psychological manifestations
seen in some covid 19 patients so we're seeing a common theme here and that is
microthrombi that are being found in blood vessels of pretty much all the organs including brain
kidneys heart liver and of course the lungs this is likely all because of endothelial damage that
occurs as a result of the virus binding to ace2 receptors that are located there after all in
some of these autopsy studies they used electron microscopy to find what appeared to be viral
particles in the endothelial cells not only in the lungs but also in the heart and the kidneys this
endothelial damage serves to trigger the clotting process something known as a coagulation cascade
but it's also possible that the endothelial damage is mainly occurring in the lung capillaries and
that's where the tiny clots first develop and then they end up traveling to other parts of the body
eventually lodging in blood vessels of other organs or it could be both of these things it's
interesting to note that 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 and obesity so overall organ damage that occurs in
severe covid is likely a result of a multitude of factors such as for one direct viral invasion
by means of the h2 receptor two indirect damage that occurs as a result of the cytokine storm
three indirect damage by means of blood clots and four indirect damage that occurs as a result of
oxygen deprivation as well as toxic effects of various drug treatments and other factors as well
the body is extremely complex and we still have so much to learn about so many diseases
not just covid regardless in order to be healthy that means eating healthy exercising and getting
good sleep and not smoking and not drinking too much alcohol all of these were important before
covid and even more so now and this is going to be the focus of my upcoming videos so if you haven't
done so already hit that subscribe button and bell notification and i'll see in the next one