Introduction
The Lancet: Endothelial cell infection and endotheliitis in COVID-19 (April 20, 2020)
- A Swiss study analyzing tissue samples of three Covid-19 patients from postmortems of the two who died and from an intestinal resection of the male patient that survived.
- Viral inclusion structures (spots visible at locations where a virus enters a cell) are found in endothelial cells of blood vessels (cells of one layer of the inside wall of blood vessels).
- Endotheliitis (inflammation of these cells of the endothelium) was discovered in the small intestine of the patient that survived (patient 3) and in patient 2; in the lung, heart, kidney and liver of patient 2; and evidence thereof in the heart, small bowel and lung of patient 1.
- A resulting endothelial dysfunction can lead to organ ischaemia (inadequate blood supply that can cause necrosis, death of at least part of the organ, observed in this study), inflammation with oedema (collection of fluid), and a pro-coagulant state (capable of clotting blood).
Science: How does coronavirus kill? Clinicians trace a ferocious rampage through the body, from brain to toes (April 17, 2020)
- A very well written article providing excellent insight into the current theories of how the virus spreads throughout the body, damages organs and kills.
Pathophysiology with Dr. Mike:
Clinical presentation
April 10, 2020: “Wu and McGoogan reported that, among 72,314 COVID-19 cases reported to the Chinese Center for disease Control and Prevention (CCDC), 81% were mild (absent or mild pneumonia), 14% were severe (hypoxia, dyspnea, >50% lung involvement within 24-48 hours), 5% were critical (shock, respiratory failure, multiorgan dysfunction), and 2.3% were fatal.”
April 6, 2020: “SARS-CoV-2 causes a respiratory infection with a highly variable clinical course that is dependent on host and organism factors. Mild disease, observed in 81% of patients in the initial Wuhan report, manifests as self-limited respiratory symptoms typical of a viral pneumonia, including fever, cough, dyspnea, sore throat but also, interestingly, anosmia and dysgeusia.7 Severe disease, accounting for 14% of the cases in the same cohort, includes florid pneumonia which may progress to acute respiratory distress syndrome (ARDS) along with cardiogenic or distributive shock.”
April 12, 2020: “[Wuhan] patients presented with a constellation of symptoms such as fever, dyspnea, dry cough, and radiological findings showed bilateral lung glassy opacities.”
March 20, 2020: “Among the severe clinical manifestations, there are severe pneumonia, ARDS, sepsis, and septic shock.”
March 18, 2020: Symptoms in children • Cough-49% • Pharyngeal erythema-46% • Fever-42% (>39C in 9%) • Diarrhea-9% • Vomiting, rhinorrhea, congestion • 16% were asymptomatic
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COVID-19 cytokine storm: The anger of inflammation
New clinical evidence confirms the hypothesis of scientists of BAS for the role of NLRP3 inflammasome in the pathogenesis of complications in COVID-19 (April 29, 2020)
COVID-19 coronavirus spike holds infectivity details (February 21, 2020)
ACE Inhibitors & ARBs: Wading Into the Unknown of COVID-19 (March 26, 2020)
The pivotal link between ACE2 deficiency and SARS-CoV-2 infection (April 20, 2020)
Understanding pathophysiology of hemostasis disorders in critically ill patients with COVID-19 (May 15, 2020)
