COVID complications

 Covid Complications and Deaths (from a note of an emerging young MD)

Cytokine storm, ARDS, Microthromboembolism are the three commonest reasons which directly or indirectly contribute to death.

Covid infection triggers immune system of the body. There are two possibilities: response by Good Immune System and response by Poor Immune System. 

The GOOD immune system slowly and gradually contains the virus, patient gets better and is cured. Majority of the patients are self resolving the illness.  

In POOR immune system, multiple factors get involved. There are two possibilities: Slow escalation of the disease or Rapids escalation of the disease. In Slow escalation of disease (not improving), due to wide spread complications, large majority of patients die but few survive. 

Rapid escalation attributed to Cytokine Storm, ARDS and MicroThromboembolism. 

Cytokine Storm is a condition where reaction of immune apparatus is very exaggerated. Body mounts overwhelming response. Elevation of immune markers: Interleukins (esp IL-6) Ferritin, LDH, etc. Cytokine leads to complications and death. 

ARDS (Acute Respiratory Distress Syndrome): Imagine lungs as balloon. Lungs can be having good compliance or bad compliance. In good compliance, the doctors role is to improve oxygenate alone. In bad compliance, improve oxygenation plus increase work of breathing. During this process, it gets challenging to address oxygenation of ventilation parameters in view of timing of individual person’s response to doctor’s efforts. In good response, patient improves and in bad response, patient doesn’t improve and die.

MicroThromboembolism: Normal human body has balance between anti clot mechanism and clotting mechanism. Covid disturbs this balance on some patients (not all).  Covid causes damage to the small caliber blood vessels mainly in the lungs, leg vessels, few instances in blood vessels of brain, etc. Entire body is in the state that favours clot formation. Can lead to death if not addressed. Timely bed side test, d-Dimer is important for these patients to start medication. Simple anticoagulant drug like heparin and aspirin can save life. 

And most important to add that vital organ parameters of the patient are to be maintained with proper medications till the patient comes out of Corona. Smart use of Methylprednisolone turns the table (IF NO CONTRAINDICATION) 

Moral of the story, Covid doesn’t read the textbooks of any pathy, and doesn’t follow any thumb rule. And if it does, then we don’t know yet. 

Punamchand

30 April 2020