Causes of Covid-19 lethality and possible new therapies
As you all know, Italy is one of the countries most affected by the Covid-19 epidemic.
To date, there are about 160,000 total cases since the start of the pandemic and over 20,000 people have died.
One of the most discussed topics is certainly that of the virus mortality rate, which has proved to be much higher than expected or estimated.
There was talk, in fact, of a data that would have been between 2% and 5%, but as you can read from the data I reported above, here we are even at 12.5%.
Public opinion is split on these numbers: someone says that few swabs have been made and that therefore the number of infected people would be much higher (and the mortality index much lower).
Others explain the phenomenon motivating it with the high average age of the population. The unfortunate contingency of the virus diffusion in the clinical and hospital setting, has been repeatedly underlined, and this is a factor that would have accelerated the infections and put the hospital structures in great difficulty.
There are also those who try to understand if the therapies implemented so far are the most effective possible, beyond the fake news and sensationalisms, of which the web is full.
In this regard, a few days ago, a very interesting thesis formulated by Dr. Giampaolo Palma, has been circulating on online medical journals and among some doctors who are discussing it. He is a hemodynamic cardiologist who studied Cardiology and Cardiovascular Diseases at the University of Parma and who heads a Thrombosis, Coagulation and Decompensation Center in Salerno.
His analysis explains in a completely new way the reason for the disease lethality index and provides new insights into the treatment of the hospitalized and home patients.
Dr. Palma claims that patients go to ICU for Generalized Venous Thromboembolism, especially Pulmonary Thromboembolism (PTE). In cases like this, intensive care and intubations are useless because, first of all, you have to dissolve the thrombus, or rather prevent these thromboembolies. Ventilating a lung where blood doesn't arrive is not needed. In fact 9 out of 10 patients die.
According to the Cardiologist, who points out that he has twenty years of experience in Vascular Echocolordopplergraphy on more than 200,000 patients, Covid-19 first of all damages the blood vessels and the cardiovascular system, only after reaching the lungs.
It's venous microthrombosis, not pneumonia that determines fatality.
But why are thromboses formed?
Palma explains that this occurs because inflammation induces thrombosis through a complex but well-known pathophysiological mechanism.
Scientific literature, especially Chinese, said until mid-March, was that anti-inflammatories should not be used. Now in Italy anti-inflammatories and antibiotics are used (as in the flu) and the number of inpatients collapses.
Many deaths, even 40 years old, had a history of high fever for 10-15 days that was not treated properly. Here the inflammation destroyed everything and prepared the ground for the formation of thrombi. Because the main problem is not the virus, but the immune reaction that destroys the cells where the virus enters. In fact, in all departments COVID have rarely entered patients with rheumatoid arthritis and this is because they are on cortisone therapy.
This is the main reason why hospitalizations in Italy begin to decrease and it's becoming a curable disease at home.
By taking care of her well at home, you avoid not only hospitalization, but also the thrombotic risk.
It was not easy to understand it because the signs of microembolism have faded, even to the eye of echocardiographist cardiologists. Comparing the data of the first 50 patients between those who breathe badly and those who don't, the situation has appeared very clear to all doctors in Italy, from cardiologists, radiologists, to anatomical pathologists and to doctors of Intensive Care too.
In the USA, where anti-inflammatories are still banned, the data are now more tragic than in Italy. Those that can help us save many lives could be drugs that cost a few euros. Medicines we normally take to prevent malaria when we go on vacation.
This series of vasculitis with pulmonary thromboembolism outcomes appears to be confirmed by the protocols of some other hospitals: at the Sacco hospital in Milan, they administer Clexane to everyone, with predictive D-dimer: the higher it's, the less it will respond. At San Gerardo in Monza patients are being treated with Clexane and cortisone. At Sant'Orsola in Bologna, Clexane to all and protocol shared with family doctors who prescribe Plaquenil to all symptomatic patients and in home isolation.
Dr. Palma also states that the anti-inflammatory drugs such as Brufen, Naproxene and Aspirin, which inhibit COX-1 as well as COX-2, should not be used, while for example Celecoxib, which is a selective inhibitor of Cox-2, seems to be giving good results.
In short, this analysis highlights the benefits deriving from the use of low molecular weight and high dose heparin in the intermediate phase of the disease (beginning of the cough and before breathing difficulties).
In an interesting testimony of an anatomo-pathologist of the "Papa Giovanni XXIII" hospital in Bergamo, we read that the hospital structure performed 50 autopsies and the "Sacco" of Milan performed 20 of them. Numbers that seem small compared to deaths registered, but which have already somehow fully confirmed Palma's theories.
Even the international journal Jama Cardiology has confirmed that cardio-vascular complications can be a lethal factor in the clinical situation of a patient suffering from Covid. I quote verbatim: "Covid-19 determines a rapid and significant increase in the inflammatory response, which can also involve the blood vessels and the heart"
This would lead to the concrete risk of events such as vasculitis and myocarditis. In addition, elevated troponin levels have been reported in some patients, a sign of damage to cardiac tissue cells with possible lethal consequences, such as myocardial infarction. But the consequences for the cardiovascular system would not be just these. The excessive inflammatory response would also act as a decompensation for the cascade of reactions that lead to blood clotting. And the result would be the increase in the formation of "lumps" of blood, from which the increased detection of episodes such as thrombosis and pulmonary embolisms.
In a nutshell, death would be caused by a Disseminated Intravascular Coagulation triggered by the virus. Interstitial pneumonia would be coronal damage resulting from hypercoagulation at the level of the pulmonary terminal vessels. By analyzing the findings of the lung tissue attacked by the virus, cases of hypercoagulation at the level of the pulmonary vessels were confirmed. Hence, the anticoagulant improves in the second phase of the disease.
Palma concludes by explaining that the final solution will only be the vaccine. But he points out that doctors are mainly trying to find ways to keep patients from assisted ventilation. At this moment all the best possible solutions must be found to relieve the pressure on the intensive care units and to save lifes.
Thanks for reading
I await your observations about the post in the comments section
GM
