I found this interview in Die Welt of two pathologists, one a specialist in lung pathology, very interesting. I’ll try to provide a few translations. They say that infection is via nose and throat and suggest that ventilator support may actually be causing the deaths of at least some of the patients receiving it.
Jonigk: Blood clotting occurs in the lung [capillaries], which are in the walls of the lung alveoli that serve to absorb oxygen and remove CO2. The damage causes protein to escape from the blood into the alveoli. Oxygen must somehow be transported from the air we breathe into the capillary network. That’s how we breathe. Anything that lengthens that route ensures that the patient can no longer supply himself with sufficient oxygen. It’s like playing soccer when you’ve skinned your knee: First a brown-red crust of protein and blood develops. We have a similar situation in the air bubbles. And breathing through them is massively difficult. The patient has a feeling of breathlessness, too little oxygen gets into the organism. It is more likely to be secondary to an inflammatory reaction. A downward spiral begins, which ends in a so-called shock lung. The lung and with it the patient fight for their lives.
In response to a question about which pre-existing conditions predispose a patient to worse outcomes:
Older people with previous damage to the lungs. Patients who are dependent on medication that diminishes the immune system. And smokers, for example. Or people who live in an area with high particulate matter pollution and therefore already have pre-damaged lungs. So they are already not well before that. If an acute infection such as SARS-CoV-2 is then added, this can be enough to put the already sick patient’s life in danger.
which makes me wonder if it’s not population density per se but air quality. That could be very bad news for India, for example, whose cities have some of the worst air quality in the world.
Classic pneumonia is a bacterial infection with purulent sputum. The pus is yellow because it is made up of fatty granulocytes. Their task is to fight the enemy, the pathogen, in the body. But SARS-CoV-2 is a virus. It attacks cells directly and reprograms them. After an initial unspecific reaction, the response to this infection consists of specific T-lymphocytes, a subtype of white blood cells. These can recognize and attack virus-infected cells. We now have a large number of lymphocytes in the basic structure of the lung, which collect in the walls of the alveoli and develop their inflammatory activity there.
I found these remarks about the dysregulation of clotting interesting:
Up to 25 percent of intensive care patients have disorders of liver and kidney functions. In addition, blood coagulation often appears to be permanently disturbed. Small, local blood clots form at many sites because the inflammatory cells beat around to destroy the virus-infected cells, which include vascular cells. No matter where this occurs, it always has considerable consequences for the organ — strokes occur and sometimes extremities have to be amputated. In many organs, the occlusion of a blood vessel can be compensated. But if you have many occlusions, the blood does not flow properly, organ damage occurs, inflammatory cells do not get where they actually want to go, and the heart is also put under strain.
There’s also a lengthy suggestion that the sudden deaths on the part of young people are being caused by over-exertion, as in working out. They also point to the peculiar demographic issues in Germany as I have and have this observation:
It’s not enough to say, “This patient had something.†Rather, the previous illnesses must be systematically uncovered in relation to the population.
About Italy:
As far as we know, in Italy a corona test was carried out on every person who died and everyone who was found to have the virus was considered to have died of corona. In the case of pre-existing conditions, a distinction must also be made between diseases that generally shorten life expectancy and diseases that specifically increase the risk of corona infection and possible complications. This is somewhat muddled in the public discussion.
which would increase the reported number of deaths due to SARS-CoV-2, wouldn’t it? I’ll try to find a version that isn’t firewalled and is translated in full for you.
My German isn’t so good. No one needs to hear another medical lecture, but we are designed to be negative pressure breathers. We have known for quite a while that positive pressure ventilation causes lung damage. We also know that high concentration of Oxygen damage the lung. So we dont generally do either unless we think we have no choice. Sometimes we have no choice like when a pt stops breathing or when we need to protect an airway, but in general we are weighing the disadvantages of being on a ventilator vs end organ damage or death. That is often a judgment call with a lot of factors going into it including how difficult it will be to intubate the pt.
Steve