The COVID pandemic has been raging for the last 1.5 years. The second surge of COVID in India is really critical and massive. But now we know much more about the virus, how it works, what are the implications to the human body from the infection. Now we have several types of vaccines for the Coronavirus disease. The current surge is huge and to save yourself from the devastating consequences of an infection, understanding of the disease is very crucial.

 

 

The coronavirus lodges in the throat and enters these cells in our pharynx as we call it medically the throat and it becomes a part of this cell. It becomes a part of the cell because it overcomes the cell metabolism to its own advantage and uses the cell to multiply and make its own replicas. So within a short span of one or two days you have millions of viruses within the cells that are infected and once this invasion has happened into the cells and the numbers are multiplied. We have the body recognizing there is an invasion. The body then fights body fights by producing what are known as antibodies which recognizes that foreign virus and attacks it and kills it. That’s the normal process in which all viruses that infect our body are eliminated. They are not eliminated by drugs, but by our own body’s immune system producing antibodies and attacking and killing the viruses. This is true for your common cold and a lot of other viral illnesses usually.

 

It’s about the fourth day when the antibodies are sufficient in number, the viruses are in large number and there is a fight between the two. This fight releases chemicals into the bloodstream which are known as cytokines. These chemicals cause the body to have a higher temperature (fever), myalgia, body aches etc. If it is a throat infection, they have sore throat because the cells there in the throat have the maximum number of viruses. It causes a little cough from that irritation there. So, these are consequences of the virus being there in the body in large numbers and the fight going on during the incubation period for the virus. From the entry of the virus to the first symptom is on an average about five days plus minus two days. But today in this surge of viruses no one knows where they got the infection from. During first wave, a lot of people knew they went to a public place, gathering or party and they got infected there. But in this surge, no one knows where they got it from. So, it’s difficult to calculate the incubation period. Hence this incubation period should be kept aside and look at the first symptom that happened. The first symptom that happened may be as simple as:

 

 

In most cases COVID patients are considering the first day of symptoms, on the day when they are troubled the most, which is wrong. You must be precise to the extent of a single day to identify your first day of symptoms. Because calculation error of a day or two can lead to a difference between you being happily up and cured and you being on a ventilator. In 80% of cases, the result is full infection. And 80 – 85% of people with the virus infection have only minor symptoms which settle in three four days’ time and they’re happily moving around. However, for the remaining 15-20% COVID patients, it is taking a dangerous turn.

 

There are primarily four key symptoms that warn you that the disease is going to a dangerous turn. Watch for these signs –

 

We have to understand this phase clearly, because a lot of people think the virus has caused pneumonia and that is the biggest mistake which happened in the early understanding of the disease. The x-ray picture looks like a pneumonia until in Italy researchers did a post-mortem. They found that it was not pneumonia rather clotting of blood in the veins of the lungs. This incredible research has helped us understand this process and that research has guided the medical community into understanding the pathology.

 

The immune system of our body recognizes the special spike protein on the surface of the virus. It’s like a unique signature for the virus to the antibodies generated by our immune system. However, there are some pre-existing cells in normal human body which have some proteins with similar appearance and structure to the virus spike protein. Cells with such protein structures are specifically seen in the blood vessels within our lungs, in the intestine, liver and kidneys. The antibodies which our body has produced to fight against the virus now recognizes this similar signature on these cells and attacks them and damages the cells. Now we have a situation where the normal smoothness of the inner linings of blood vessels is lost. The inner surface of the blood vessels is rough now and blood starts getting stuck there and forms clots. These clots in turn clog the passage of the blood vessel and no more blood can pass. This prevents normal exchange of oxygen between the air in alveoli and your blood stream. Lack of oxygenation brings our Blood Oxygen saturation down and the stage arises when you become breathless. So, what looks like pneumonia is not an actual pneumonia; it is clotting of blood within your blood vessels because these blood vessels have been attacked by the antibodies thinking that the cells are the viruses. Whereas, they only have slight protein receptor which is similar to the surface protein of the virus. In some people this damage is catastrophic; perhaps due to other contributory factors like Environment, Generic Predilection etc. If this clogging continues to happen you would reach a state where you need to have oxygen given externally and the oxygen flow rate will go on increasing till you reach the level that is sufficient to maintain the brain from functioning. Volumetrically 2 to 3 litres can suffice, sometimes more 5, 10, 15 or even 60 litres. Even if at 60 litres your body fails to manage then you need to go for what are known as bi-paps and c-paps followed by ventilators. That’s like nearing the dead end of the story.

 

So, at onset of a cytokine shower and you must identify and prevent this to become a cytokine storm. In order to prevent the cytokines from being released in large numbers we have a very old and proven method of using steroid administered either orally or parentally. Unfortunately, it’s observed that steroids alone don’t stop the clotting of blood within the lung blood vessels and for that reason an anticoagulant has to be combined with the steroid. Note that these drugs should not be taken lightly. So do not do this on your own. Recommendation of a physician is must have here. Many COVID patients who have carelessly taken steroids from day one has suffered prolonged viral fever. Essentially the early presence of steroids has prevented the immune system of the body to fight against the virus during first four/five days and the entire disease cycle is prolonged. Therefore, timing becomes critical of not starting steroids in the first five days of the disease during viremia phase.

 

Many believes Aspirin might work instead of anticoagulants, but study suggests it doesn’t. The viral phase damages the body so much so that the platelet count of the COVID patients becomes very low along with other impacts. So, merely administering aspiring doesn’t work in anti-coagulation of blood.

 

The major mistake COVID patients are doing in India and around the world is, not anticipating the dangerous turn at the right time. We have two lungs like just like a pair of kidneys. One can donate a kidney and still leave a healthy life. Patients with cancer, tuberculosis often get one of their lungs removed through surgery, they still survive with 100% oxygen saturation. We have excess lungs which only comes into use during physical exercise, exhaustive works etc. So, these patients gasps only when they overburden their single lung. Breathlessness, arise way later than we assume, when most part of the lungs are affected. In case of COVID patients also, similar concept is applicable. Measuring oxygen level at home with the digital sensors are ok, but one should not wait and watch until they reach the condition of breathlessness. Because, by then, most part (> 2/3rd) of the lungs is affected. Then you would rush to the hospital, have to be on oxygen and invariably you go on to the ventilator. So, the advice is crystal clear – do not wait at home depending solely on the digital oximeter. If you believe you are in 2nd phase of the disease based on the symptoms described above, take immediate medical attention. Reach to the hospital or consult a doctor to say the least.

 

 

After administering steroids and anticoagulants, COVID patients might dramatically feel better. But that may not be the real end of the story, because steroids suppress immunity. Especially in the elderly and people with generally low immunity, the chances of a common bacterial or fungal infection rises several folds during this period. The normal bacteria in our lungs can cause pneumonia this time (bacterial pneumonia). Now antibiotics come into picture. Antibiotics can suppress the bacterial infections and pneumonia occurring at this phase of the disease. To re-emphasize, steroids do benefit in a huge life-saving way, but it has a downside because it encourages opportunistic infection by bacteria within our lungs and other parts of the body which are already exists in normal human body. Steroids are also diabetogenic. Which means those who are pre-diabetic become diabetic when they’re on steroids and those who are already diabetic, their blood sugar level might rise as high as 500 mg/dL. Stay in touch with your doctor or your dermatologist who can control that part. Unless you control that well you will have problems from the diabetes getting worse. Therefore, it is said that the people with comorbidities have poorer outcome because they don’t cope well with the end phase of the infection. They face complications of diabetes and kidney disease with fluid balance getting impacted. All these are the aftermath of steroid based treatments.

 

So, to summarize the key points:

 

Drugs like Remdesivir and Ivermectin are special drugs. Only your doctor will prescribe these if they find it would be beneficial. However, there is no proven evidence that these drugs can positively and uniformly cure the disease. Even there is no evidence that Plasma Therapy can make a difference to the outcome in any way. In most cases need for hospitalization comes when you miss the bus of recognizing the red flags of the dangerous turn of auto immune attacks on the blood vessels. Hope this information helps save lives.

 

Note: The author is not a medical professional, he is an IT Professional and Electronics Hobbyist. This blog post is articulated based on the insightful video interview of Dr. Mathew Varghese from St. Stephen’s Hospital, Delhi. A very special thanks to Dr. Varghese for making us aware of the facts of COVID Treatment