09/04/2020
منشور للأطباء فقط.
نعم ؟!!!
To summarize
* *COVID* doesn't cause pneumonia or ARDs .. We are treating a presumed wrong disease
* *SARS2* Corona Virus binds to hemoglobin in a certain way that releases the *iron* ion into the circulation
* *Hb* looses its capacity to bind with oxygen thus oxygen is not supplied to major organs. Which is why we see resistant hypoxia coupled with very rapid multi-organ failures.
* To simplify it more, we can take the example of CO-poision where Hb is unable to carry oxygen.
* The free *iron* released into the circulation is so toxic as it causes a powerful *oxidative damage* to the lungs (which explain the bilateral -and always bilateral- ground glass opacities seen on Chest CT of those patients, that was mistakenly treated as bilateral pneumonia)
* The body try to compensate by elevating the rate of Hb synthesis which explains why HB is high in those patients
* Other compensatory mechanisms to deal with the iron load such as increasing *ferritin* level explain the very high ferritin observed in those patients
* *Chloroquine* as antimalarial drugs is working by protecting HB against invasion by malaria parasites .. it is doing the same here but just protecting the Hb against invasion by the virus
* This theory could explain why we are loosing patients so rapidly and why mechanical ventilation is not so much effective in treatment and using ARDS mechanical ventilatio protocol is not causing any benefit. actually it could be futile and causing more lung damage
* Sure more research is needed to understand the exact pathogenesis because this is the only hope for proper treatment .. You can not treat what you do not actually know.
This also could explain
* why the high *ferritin* is bad prognostic marker (too much iron means too much Hb lost its O2 carrying capacity)
* Why there is *monocytosis* as the body needs excess macrophages to engulf the excess iron load .. Also why there is *Lymphopenia* as the WBCs differentiation is favored twards monocytes line rather than lymphocytes line.
* Why *liver* injury with high *ALT* level happens and why it carries a worse prognosis
Time Line of COVID19 (lab wise); a very useful must know for all docs
Day 0: infected
Upto Day 5: Onset of symptoms
Day 7: IgM positive (D7- D 21)
Day 14: IgG positive
Days 1-28: SARS CoV2 RNA & Antigens will be positive
Day 21: IgM disappears
Day 28: SARS CoV2 RNA & Antigens disappear
D0 - D5: ASYPMPTOMATIC PHASE
D0 -D7: WINDOW PERIOD (ONLY PCR IS POSITIVE IN THIS PHASE)
D 14- D21: DECLINE PHASE (STILL INFECTIVE)
D 21- D28: CONVALESCENCE PHASE (STILL INFECTIVE)
