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Why some COVID-19 patients suddenly deteriorate after 7-10 days? (3)
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COVID-19 coronavirus patients often seem to be on the path to recovery 7 to 10 days after first symptoms. I think British Prime Minister Boris Johnson is an example of that. But then suddenly COVID-19 coronavirus patients can go into the acute respiratory failure. They show extreme difficulties in breathing. Why does this happen? Yes. So you know I’ll caveat this by saying I don’t think anyone knows why. But I think this feature is is true. And it’s probably true in other cytokine storms as well. But we we have been so flooded with data or experiences with this COVID-19 coronavirus. We are learning the features of COVID-19 unfortunately day by day. A colleague of mine, Dr. Michael Saag, who’s head of our Center for AIDS research here at UAB. He is a pretty well-known individual. He shared a story of his COVID-19 coronavirus infection with National Public Radio. He describes this. He was sick for about 3 or 4 days. Then for a couple days he felt like he had recovered. He felt he was doing well. And then at day five or six his COVID-19 coronavirus disease just worsened. It made him very sick. Like the worst flu you’ve ever had. He did not need to be hospitalized, thank goodness for him. But he said for eight or nine or ten days he felt bad. COVID-19 particularly bothered him at night when the fevers really spiked. You have joint aches, muscle aches. He just felt miserable really. And he had a bad cough obviously. And the high fevers have just been a misery. Why that happens is unclear. But maybe initially, when you get infections, you have kind of an older adaptive immune system. The innate immune system is a kind of more primitive cells of the immune system. But innate immune system is critically important. They’re the first ones to arrive at the site of infection. These are immune cells like neutrophils or monocytes or macrophages. These cells are already there in the tissues. They’re there to fight off the infection as best they can. But it is those cytokines that immune cells generate/ Cytokines signal the adaptive immune system to get involved in immune response. Adaptive immune cells are slightly more involved. These cells are primarily lymphocytes, like your T-cells and your B-cells, which make antibodies eventually as plasma cells. These immune cells will come later. I’m not sure they would come five days later. If you adaptive immune cells should have come a little bit sooner. But maybe because COVID-19 coronavirus is such a completely foreign infection to us as a human race. We don’t have any memory for this infection. That’s one of the beauties of your adaptive immune system. If you’ve been exposed to a pathogen in the past, you remember it. Your immune system remembers it. That’s why if you get a certain type of an infection and you get it again, you typically will mount a quicker immune response and be less sick. Or not be sick at all if you get the same virus or bacterial pathogen again. But because this particular pathogen this COVID-19 coronavirus is brand-new to all of us, we don’t have a preset adaptive immune response. If it is the adaptive response when these lymphocytes are coming after several days. It would make sense if this particular cytokine storm from COVID-19 coronavirus resembles some of the other cytokine storm syndromes. In them you may have a predisposition by a mild genetic defect. So you are killing the infected cells not that well. And it ultimately your lymphocytes, these adaptive immune cells, that spew out these nasty pro-inflammatory cytokines like gamma-interferon. These cytokines get a lot of people into trouble. So that’s my best guess about COVID-19 coronavirus. It is just a educated guess.
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