How COVID Kills Some People But Not Others - Doctor Explaining COVID

Doctor Mike Hansen・2 minutes read

Dr. Mike Hanson explains COVID-19 transmission through respiratory droplets and ACE2 receptor attachment, leading to lung damage, inflammation, and pulmonary hypertension, impacting oxygenation and lung function. The complex pathology of COVID-19 includes cytokine storms, clot formation, and vasoconstriction in the lungs, with potential treatments involving ventilator adjustments, pulmonary vasodilators, and ACE inhibitors to improve outcomes for ARDS patients.

Insights

  • COVID-19 primarily spreads through respiratory droplets and contact, with potential aerosol transmission, targeting cells in the mouth, nose, throat, and lungs via the ACE2 receptor, leading to severe lung damage, inflammation, and fibrosis.
  • The intricate lung pathology in COVID-19 patients involves a cascade of events, from viral entry to cytokine storm, ACE2 downregulation, clot formation, and pulmonary hypertension, severely impacting oxygenation and lung function, with potential treatment avenues like ACE inhibitors and personalized ventilator settings for ARDS management.

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Recent questions

  • How does COVID-19 primarily transmit?

    COVID-19 mainly transmits through respiratory droplets and contact, with the possibility of aerosol transmission in enclosed spaces. Dr. Mike Hanson, a specialist in pulmonary medicine, critical care, and internal medicine, explains that the virus attaches to cells in the body through the ACE2 receptor, primarily found in the mouth, nose, throat, and lungs, specifically on type II alveolar cells.

  • What are the impacts of COVID-19 on the lungs?

    COVID-19 impacts the lungs by entering type II alveolar cells through the ACE2 receptor, triggering a cytokine storm, downregulating the ACE2 receptor, leading to inflammation and fibrosis. This destruction results in fluid seepage, protein deposition, bleeding, scarring, and ARDS, as seen in microscopic images of COVID-19 patients. Chest X-ray comparisons and CT scans reveal reduced air, increased haziness, ground glass opacities, and pulmonary hypertension, making oxygenation challenging.

  • How does COVID-19 affect blood circulation?

    COVID-19 affects blood circulation by causing pulmonary vasoconstriction in ARDS patients, reducing oxygenation due to decreased blood flow to the lungs. Blood from the lungs, oxygenated in the pulmonary vein, flows to the left atrium, left ventricle, and is pumped out to the body through the aorta. The complex interplay of factors in COVID-19 lung pathology significantly impacts lung function and oxygenation, affecting various body parts like the brain, intestines, kidneys, legs, arms, and muscles during physical activity.

  • What treatments can help COVID-19 patients with ARDS?

    COVID-19 patients with ARDS may benefit from personalized ventilator settings, including adjusting tidal volume and PEEP, trying different modes like APRV, proning patients, and using pulmonary vasodilators. ACE inhibitors like captopril and angiotensin receptor blockers such as losartan can help dilate pulmonary arteries, reduce inflammation, and fibrosis, improving oxygenation in ARDS patients.

  • What factors influence the mortality rate of COVID-19 patients with ARDS?

    The mortality rate of COVID-19 patients with ARDS is influenced by factors like ACE 2 receptor distribution, viral load, genetic polymorphisms, inflammatory reactions, and estrogen levels. ARDS develops in 4-5% of COVID-19 patients, with a mortality rate of 1-2%, highlighting the importance of understanding these factors in managing and treating severe cases of the disease.

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Summary

00:00

COVID-19 Lung Pathology: A Detailed Overview

  • Dr. Mike Hanson, a specialist in pulmonary medicine, critical care, and internal medicine, explains the transmission of COVID-19 mainly through respiratory droplets and contact, with the possibility of aerosol transmission in enclosed spaces.
  • The virus attaches to cells in the body through the ACE2 receptor, primarily found in the mouth, nose, throat, and lungs, specifically on type II alveolar cells.
  • Detailed explanation of the structure of the lungs, including the trachea, bronchus, alveoli, type I and type II alveolar cells, macrophages, surfactant, fibroblasts, and capillaries.
  • The coronavirus enters type II alveolar cells through the ACE2 receptor, replicates its RNA, triggers a cytokine storm, and downregulates the ACE2 receptor, leading to inflammation and fibrosis.
  • The cytokine storm releases IL-1, IL-6, and other chemicals, while the downregulation of ACE2 affects the conversion of angiotensin, leading to vasodilation and constriction, causing chaos in the lungs.
  • The destruction caused by the virus in the lungs results in fluid seepage, protein deposition, bleeding, scarring, and ARDS, as seen in microscopic images of COVID-19 patients.
  • Chest X-ray comparisons between a normal and COVID-19 patient show the impact of the virus on lung function, with reduced air and increased haziness due to inflammation and fluid accumulation.
  • CT scans of COVID-19 patients reveal ground glass opacities, indicating partial or complete filling of alveoli with fluid and inflammation, along with tiny clots that impede blood flow and pulmonary hypertension due to angiotensin II.
  • Pulmonary hypertension leads to constriction of pulmonary arteries, making oxygenation more challenging, exacerbating the already compromised lung function in COVID-19 patients.
  • The complex interplay of factors in COVID-19 lung pathology, including viral entry, cytokine storm, ACE2 receptor downregulation, inflammation, clot formation, and pulmonary hypertension, significantly impacts lung function and oxygenation.

13:23

Blood circulation and oxygenation in the body

  • Blood from the lungs, oxygenated in the pulmonary vein, flows to the left atrium, then the left ventricle, and is pumped out to the body through the aorta.
  • Blood circulates to various body parts like the brain, intestines, kidneys, legs, arms, and muscles, aiding in oxygenation during physical activity.
  • Blood returning from the body enters the vena cava, leading to the right atrium, then the right ventricle, and finally to the pulmonary artery for reoxygenation in the lungs.
  • Pulmonary vasoconstriction in ARDS patients can reduce oxygenation due to decreased blood flow to the lungs, leading to lower oxygen levels.
  • ACE inhibitors like captopril and angiotensin receptor blockers such as losartan can help dilate pulmonary arteries, reduce inflammation, and fibrosis.
  • COVID-19 patients with ARDS may benefit from personalized ventilator settings, including adjusting tidal volume and PEEP, trying different modes like APRV, proning patients, and using pulmonary vasodilators.
  • ARDS develops in 4-5% of COVID-19 patients, with a mortality rate of 1-2%, influenced by factors like ACE 2 receptor distribution, viral load, genetic polymorphisms, inflammatory reactions, and estrogen levels.
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