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Death From Covid-19 is Not From the Coronavirus:

An Interview With NYU Langone Health Professor & Rheumatologist Dr. Gary Solomon

· Health,Biotechnology,Science,Interview,Coronavirus

Death From Covid-19 is Not From the Coronavirus:

An Interview With NYU Langone Health Professor & Rheumatologist Dr. Gary Solomon

The following are concepts conveyed by Dr. Solomon.

When you get a respiratory infection, the organism, whether it be a bacteria, virus or fungus, typically attacks the patient’s mucous membranes in the mouth or back of the throat. From there, it spreads to the lungs.

The common cold is caused by a different Coronavirus. The Covid-19 virus is new, but other Coronaviruses have been around forever.

When you get a viral respiratory infection, it's like a football game.

It is a back and forth between the spreading virus and your first line of defense, your white blood cells in the mucous membranes. In many cases you will have a stuffy nose or feel nothing at all.

But for other people, such a large number of viruses attack their body that they need their 2nd line of defense, their immune system.

This is when you have flu-like symptoms. Your body will produce specialized white blood cells that make cytokines and antibodies to kill the virus.

Then if you win that battle you may be sick for 10 or 14 days and then you get better.

So with Covid-19 we have 2 stages. The first one is like a flu or common cold and your body deals with it. The 2nd stage is when the immune system has responded in full and there is a cytokine storm.

In some cases the immune system gets activated, does not kill the virus, and releases too many of these cytokines and the cytokines kill the patient.

When people die of Covid-19, what pathologists are seeing is too many white blood cells in the lungs.

When people die of Covid-19, what pathologists are seeing is too many white blood cells in the lungs.

Why do some people get overwhelmed by Covid-19? We don’t know. Clearly there is a skew towards more obese patients and those with weaker immune systems succumbing to Covid-19.

Another way patients are dying is by blood clotting due to Covid-19. Tiny little clots in the blood vessels happen to some patients but not to all. We don’t know if it's a question of the dose of the virus or some other factor that causes the clots.

In fact, this is similar to Lyme disease. Some people are relatively unaffected by this disease while others go on to have chronic problems of arthritis for the rest of their lives.

So antiviral strategies are the ones that are used early on. And for the patients who get very sick, we need to dampen the immune system. The Gilead medication Actemra, the Genentech medication Tociluzamb, and the Regeneron medication Kevzara all work by blocking activation of the immune system.

At NYU right now we have a number of clinical trials including Plaquenil, (the brand name of hydroxychloroquine, the anti-malarial and anti-inflammatory medication that President Trump has repeatedly advocated) and Gilead’s remsedevir, an antiviral, a drug that works against the virus.

My feeling on Plaquenil is that I don’t know. A month ago I brought it home and I am telling my patients that if they get Covid-19, they should take it for 7 days. The data out of China is good for shortening the sickness. But for someone with an immune system that is out of control, plaquenil is useless.

The role of Plaquenil in Covid-19 is analogous to the role of Tamiflu for treating the flu. Both medications are useful when you first get symptoms. But if treatment is begun later in the course of the disease, they may not be effective.

In a month we may have answers to these questions. Studies that would normally take months to get approved were approved in a weekend. We will know Plaquenil’s ability to fight Covid-19 within a month. It might not prevent deaths in advanced cases, but it could mitigate symptoms in earlier, milder cases.

I think the social distancing measures are working since hospital discharges are now exceeding hospital admissions.

However, I think we will have isolation measures for a long period of time. I think Africa will explode with Covid19 soon. I think there may be a second wave of the virus.

To open up the country we are going to need the ability to test anyone who wants to be tested to see if you have the virus or the antibodies to the virus.

It’s possible that people will have an infection, handle the acute infection and recover, but still have reservoirs of the virus in their body for a period of time after recovery.

With polio, once you have made antibodies, you can’t get infected. We don’t know if that is true with Covid19.

The influenza virus that causes the flu changes every year. Therefore the antibodies that work well this year won’t work as well next year. However, with Covid19, we think the antibodies will work going forward.

I don’t think this virus was engineered in the lab. I think it came from bats.

I think this virus was transmitted to humans at a Chinese wet market, but the NY strain came from Europe. However, it might have mutated in Europe after coming there from China.

What we are seeing in NY has much in common with what happened in Italy and Spain than what happened in China. Chinese scientists have been enormously generous in sharing their information and I have concluded that the NY strand is quite different from the Chinese strand.

The bad news is that this pandemic could go on for years, until we develop a vaccine, (and I am confident that medical science will come up with a vaccine to work against this virus as well as the next one that comes along.)

The good news is that the public is now more interested in supporting science.

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Written by Alexander Fleiss, Edited by Michael Ding, Bryan Xiao & Kevin Ma

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