The biology of coronavirus COVID-19 - including research and treatments

Notably, https://en.wikipedia.org/wiki/Icatibant leads to vasodilation.

There seems to be two opposite hypotheses and a great deal of disagreement as to what is going on in the pulmonary capillaries.

The classical hypothesis based on typical ARDS is the following:

https://twitter.com/user/status/1246543343347253249


and this:

https://twitter.com/user/status/1248288124104564737


Classical ARDS also described here: https://www.ncbi.nlm.nih.gov/pubmed/29430449

Yet some emergency physicians have been reporting that they are seeing a different syndrome in COVID patients. This presumably includes those Nijmegen physicians, given that they are trialling Icatibant. (and similarly those physicians who report morphine helps)

The strongest risk factor for mortality of COVID patients is hypertension. There is a great deal of speculation as to whether it is the medication that is the risk factor.

I don't think it is the medication (and I don't think patients should, but rather hypertension itself that is the primary risk factor. This would contradict the hypothesis presented by Victor Tseng above, and instead suggest that the virus (including spike protein fragments) is causing blockage of the ACE2 receptor causing excessive vasoconstriction and hypoxemia similar to the pattern seen in high-altitude pulmonary edema. The fluid build up is due to lung damage, and isn't necessarily cardiogenic as in regular pulmonary edema. Relative vasoconstriction also inhibits fluid clearance. I suspect ACE2 receptor blockage is also a key contributor to anosmia in COVID patients as well.

 

Do you know if this only applies where the hypertension is poorly managed? Or whether just having the condition is the issue, irrespective of management?

 

Hard to say at this point in time. I suspect there is still high risk irrespective of management.

 

There is a good article on Stat News that noninvasive breathing support devices perhaps should be used more before switching to ventilators, and then don't use ventilators on the high setting if possible.
https://www.statnews.com/2020/04/08/doctors-say-ventilators-overused-for-covid-19/

 

My daughter is a nurse on covid19 wards. She says they are going to be trained to use CPAP machines as they are simpler than ventilators so don't need specialised training.

 

"the air sacs of the lungs become filled with a gummy yellow fluid"

Is this the sort of thing @Jonathan Edwards that some kind of inhalant might help with? Something that might help liquefy the gummy fluid so that it might be easier removed? Obviously liquid in the lungs is problematic, but presumably the lower the viscosity of that fluid the better the chances of removing it?

 

I couldn't find this webpage posted but apologies if I'm duplicating anything.

https://www.cam.ac.uk/research/news...nalysis-provides-snapshot-of-pandemic-origins

 

This possible aspect of Covid-19 seems to be gaining traction....

Neurological Implications of COVID-19 Raise Concerns
Brain infection may contribute to respiratory failure in COVID-19.

https://www.psychologytoday.com/us/...ological-implications-covid-19-raise-concerns

 

preprint paper referred to
Neurological Manifestations of Hospitalized Patients with COVID-19 in Wuhan, China: a retrospective case series study

https://www.medrxiv.org/content/10.1101/2020.02.22.20026500v1

 

Coronavirus could attack immune system like HIV by targeting protective cells, warn scientists

"Further investigations to the coronavirus infection on primary T cells would evoke “new ideas about pathogenic mechanisms and therapeutic interventions,” the researchers said in a paper published in the peer-reviewed journal Cellular & Molecular Immunology this week."

https://www.scmp.com/news/china/soc...uld-target-immune-system-targeting-protective

 

Inhalants are useful for clearing bronchial secretions - which are composed of thick fluid coating the larger air tubes that can be coughed up. Fluid in the alveoli is a different matter. There is no air behind the fluid to push it out during a cough. I also think the idea of a yellow gummy fluid may be a bit poetic. The alveoli are so small that fluid flow is not really relevant.

 

Interesting video of cat scan of a 59 yr old patient in the usa. Commentary by the Thoracic surgeon saying this is nothing like the flu or bacterial pneumonia.
https://www.washingtonpost.com/science/2020/04/12/storm-inside/?arc404=true

 

Any way to access this without a subscription?

 

Clear cookies and site data for that particular site. On Firefox I can do this by clicking on the padlock in the web address box and then clicking on "Clear cookies and site data" at the bottom of the box that comes up. If there is more than one page in an article you may have to repeat this for every page.

 

You learn something new every day . Thanks.

 

Even easier option: use incognito mode. You can right-click on a link and choose open insafe/incognito/private browsing.

 

Dear Barry, so very sorry; I am a subscriber of a number of newspapers, and I completely forgot that one might need to be subscribed. Very sorry. I just don't know how to get the video to you. But the doctor basically shows the Cat scan and points out that the virus lodges in many places, not just in one area, and he wants to stress that this Covid infection does not resemble the flu or pneumonia.

 

Many thanks. No worries, @Arnie Pye and @rvallee have fixes - see above .

 

I have found that some sites recognise when private browsing is being used and they then cover part of the page with a sign saying "Get a subscription" which doesn't have a close option and they disable scrolling. This wasn't always true, and I used to use incognito mode. But getting rid of cookies and site data is, for now, the most reliable method I've found.