The results of the latest research could upset (again) everything we know about the coronavirus. And what about diagnoses and therapies, which seem to have reached a possible turning point?

A few days ago, the news began to spread that, following autopsies performed on approximately 50 patients who had died of COVID-19, the cause of death was stated as thrombosis and not interstitial pneumonia. How did this happen?

So what is the actual role of the virus in this tragic pandemic?

Let’s start by remembering that COVID-19 spread rather quickly and with symptoms very similar to a flu-like syndrome, and that in a number of cases (initially very high), it led to interstitial pneumonia. People were already flooding into Emergency Rooms with a serious acute respiratory syndrome, and due to a lack of scientific data; health-care professionals treated the patients to the best of their abilities and knowledge at the time. The result was an assault on intensive care because the problem of respiratory failure had to be immediately solved.

After almost three months of experience, Doctors and Researchers identified two main phases of COVID-19.

The viral phase

The virus comes into contact with the person, and by locating itself in the upper respiratory epithelium of the upper airway, it begins to replicate and produce the first symptoms. Cold, fever, conjunctivitis in some cases, and difficulty in recognizing odors.

In many cases, SARS-CoV-2 does not progress and the person heals spontaneously, especially if they are in good health. In other cases, the virus reaches the lungs, causing coughing and shortness of breath — which causes the person to become alarmed. Even with this progression of the disease, you can be cured, especially if you’re healthy and even better — still young.

However, if the person’s body reacts to SARS-CoV-2 with a very strong immune reaction, such as in autoimmune diseases, the immune system produces molecules called cytokines, and the patient enters the next phase.

The inflammation phase

At this stage, the immune reaction, through the release of cytokines, destroys the cells into which the virus has penetrated and causes multi-organ damage, due to the micro-coagulation of blood in different organs such as the kidney, heart, brain, intestine and of course, the lungs.

Specifically in the circulatory system, the inflammation damages the tissue of the blood vessels and causes the formation of clots that obstruct the passage of blood. The result is that even ventilating the pulmonary system, oxygen cannot reach the blood, and hence the rest of the body.

This is much like blowing air into a clogged straw.

The overall state of health comes into play with thrombosis

So back to the initial question: if the cause of death in many cases is thrombosis (and not interstitial pneumonia), then what role did SASR-CoV-2 play?

It’s clear that the action of the virus is at the root of the inflammatory process and the so-called “cytokine storm”. Hence, the formation of clots that otherwise would not occur, especially in young and otherwise healthy patients.

In addition, the state of health of the person who has been infected with SARS-CoV-2 should be taken into strong consideration. On the website of the Istituto Superiore di Sanità, in particular on the page of Epicentro (ISS), we find a table, updated to April 29 (and presented in Italian), which clearly shows that patients with high blood pressure or heart problems are at high risk, as well as having more pathologies, exposes the patient to a higher risk of death.

All this is often associated with age, of course; in fact, the average age of a person upon their death in Italy is 79 years, but we know that even much younger people have died. However, how many? On the same site, you can find data sorted by age, and just over 1% of deaths are in the age range from 0 to 49 years (284 people). This means that the virus can prove lethal, even in the youngest population group — but to a much lower extent, and probably precisely because of the exaggerated response of the immune system that determines the multi-organ damage.

Heparin and other new therapies

The evidence accumulated in recent weeks has led to the publication of many scientific studies, which, although still carried out on a limited number of patients, have led to the development of new therapies to prevent thrombosis, thromboprophylaxis. These therapies are based on the use of anti-inflammatory drugs and molecules such as low molecular weight heparin (an anticoagulant drug), whose use has been known for a long time and is used in the case of bacterial or viral pneumonia.

However, it should be made clear that low molecular weight heparin for prophylactic use, should be administered to hospitalized patients, and by an experienced Doctor, and certainly not at home; in order to prevent side effects such as bleeding risk, which would lead to a worsening of the patient’s condition.

In conclusion, the knowledge of the scientific community on SARS-CoV-2 is much more in-depth and has, in turn, led to the identification of the causes of virus lethality and the application of known therapies. The battle is not won but we know better the enemy’s weapons and how to defend ourselves.

This post is also available in: Italiano

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