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  

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