May 2020At present, there has been a lot of debate within the professionals as to what cascade of event actually takes around the course of disease to the end as fatality in terms of pathophysiology.
- Capillary congestion
- Hyaline membrane formation
- Interstitial edema
- Pneumocytes hyperplasia
- Reactive a-typia
- Platelet-fibrin thrombi
- Necrosis of pneumocytes
- The inflammatory infiltrate with macrophages in alveolar lumens and lymphocyte within the interstitium.
- Viral particles within cytoplasmic vacuoles of pneumocytes.
As such the overall presentation fits in to the clinical context of coagulopathy that dominates in these patients.This “coagulopathy is one of the main targets of therapy in Covid -19 disease”It is said that lungs of most COVID -19 patients retain their mechanical capacity to function despite severe hypoxia.It is also been observed that patients put on ventilators do extremely badAs such the modality of treatment to put all Covid -19 patients on ventilator is a mere criminal treatment that puts unwanted deaths on score board.It is again negligently criminal to put patients on intubation/ endotracheal tube which again increase the number of run in death board.One of the bloom blessing in disguise or a bad omen whatever, in Covid -19 clinical presentation is a, “Happy hypoxia” the name being given to the condition for these patients do not have sudden air hunger to collapse them rather a late presentation of collapse in spite of low oxygen saturation.As such the initial paradigm of intubating patients as soon as oxygen saturation begins to drop is drawing skeptics and to my recommendation it must be cautiously consider before institution hence to me the same is a last irreversible slot of treatment which shall ever be tried.It is now believed that suspected patients with COVID-19 have a unique lung disease, and not the classical ARDS.Clinicians have realized that modalities that courses treatment to intubation and further to ventilators take patient farther towards mortality ranging from 30% to almost 100% this is in case they are put on ventilators. One enhanced mortality explanation is physiological reason being discussed among critical care doctors that air pushed in at high pressure by ventilators may be causing more harm to lungs thereof further damaging than providing relief vice versa.It is again a parted and impartial observation that patient with severe hypoxia that are conscious do better with oxygen provided by a tube in the nostril as compared to sedated with intubation or on ventilators.Since the main bunch of required treatment has a scoop of oxygen requirement with reference to anoxic episode many ‘layman techs and tricks have been in run to enhance oxygen delivery one being tilting patient to turn to the left or right or even prone (on the tummy)’.The same has dramatically improved oxygen saturation within minutes of applying this simple technique.It is said that the prime minister of England was treated with similar simple oxygen delivery.At the most and at if necessitate patient may be given oxygen by continuous positive airway pressure.A form of (PAPV) positive airway pressure ventilation applies mild air pressure on a continuous basis.The COVID-19 lungs have revealed that they are more like as if they’re suffering from high-altitude sickness that causes pulmonary edema.This is like dropping someone on to the peak of Mount Everest without any time to acclimatize which is a key to any one climbing the mountain above the sea level.The other qualitative characteristic of SARS-CoV-2 virus, unlike conventional pneumonia is; it attacks both lungs. The patients come to the hospital though with low oxygen levels yet not in distress.It is a clinical customary that the usual patient who attend clinics in acute distress become anxious with air hunger once oxygen drops below 80%, but not the COVID-19 patient therefore masking acute necessity.In my opinion this masking of symptom in spite of derangement can be manage easily by Pulse oximeter if at all such positive cases with symptomatic mild or moderate presentation are to be monitored for concealed derangements.In addition autopsies have revealed a strange slime in air sac (alveolar sac) that surely plays a role preventing oxygen exchange in the lungs.Due to this slimy gel and the use of ventilator support; it is a possibility that ventilator might Increase the force with which the air enters the block alveoli.The first (Covid-19 + ive)(RT-PCR) patient who died from the virus in New York was an obese 77-year-old hypertensive man, whose autopsy showed that the lung sacs were smeared with a substance that resembled thick paint.Since mechanical ventilation can pump in air with a force that may rupture the already compromised alveolar sac, it is presumed and recommended that ventilators shall work at lower pressures in selective cases but this will need a randomized controlled trial to ascertain.It is now being recommended by many critical care specialists that simple oxygen administration to the patient in a prone position is a better alternative to allow nature to takes its course.There has been a substantial reduction in the recommendation and use of ventilators in COVID-19 patients in recent choice of treatment.The current mantra is to use ventilators in selected cases and to push in oxygen less aggressively. It should be noted here that the new corona virus SARS-CoV-2 is called so because of its similarity to the SARS virus, which caused an outbreak of severe acute respiratory syndrome (SARS) in 2002-2003. Genes and Genetic:Specifically, the new virus’s genome is a 70% match to that of the SARS virus.It is being prelude that using the SARS virus’s genome as a reference, scientists could use genetic sequencing to determine if the virus causing the current outbreak is the earlier SARS virus or a new strain.Initially, scientists in China were able to sequence the full genome of the virus only four days after the first case of infection was reported, thus paving the way for scientists around the world to design rapid molecular genetic tests for COVID-19.Using a technology and sequencing, scientists are today able to sequence multiple DNA fragments in random, which are then aligned on a reference genome from a related organism to build a full genome sequence.The genomes of most organisms are made of DNA, but some viruses – like the new corona virus – have genomes of RNA. The SARS-CoV-2’s RNA genome has 32,000 nucleobases.Tracts of nucleobases make up genes.The combinations of genes make up a genome. Genes carry the instructions for the virus to synthesize different proteins, including those that make the virus infectious.DNA is usually double-stranded while RNA is usually single-stranded. Both DNA and RNA are made of four nucleobases; three of them – adenine, cytosine and guanine – are common. In DNA, the fourth is thymine and in RNA, uracil. Virus mode of attachment, action and replication:After locking on human cells, the virus first releases it’s RNA inside the cell and uses the cell’s resources to transcribe an enzyme called RNA-dependent RNA polymerase (RdRP).RNA-dependent RNA polymerase (RdRP) replicates the virus’s genetic material inside the cell which is subsequently used to produce a bunch of proteins.The newly reproduced genetic material and protein combine with new viral particles that ooze out from the host cell hence ready to infect neighboring cells.This way, the virus perpetuates itself within our cells at the expense of the human cellular machinery.Diagnostic testing:The fulcrums of modern medicine are suspended on the molecular diagnosis of infectious diseases.And one test that makes this possible is the reverse transcriptase real-time polymerase chain reaction (rRT-PCR) test.The reverse transcriptase real-time polymerase chain reaction (rRT-PCR) test is currently used to diagnose the presence of SARS-CoV-2 in a sample.If the organism SARS-CoV-2 is present in a sample, it means the person from whom the sample was obtained likely has COVID-19 which is the name of the disease caused by the new corona virus.Procedural Sampling Covid-19:
- First, a technician isolates the genetic material of the virus from a nasopharyngeal sample (obtained from a person by a swab of the upper respiratory tract).
- This RNA is then converted to complementary DNA or (cDNA), using an enzyme called reverse transcriptase.
- The diagnostic panel for COVID-19 comprises four target genes.
- Three genes are specific to the new corona virus and one is a human gene, used as an internal control.
Many of the health care workers are of the testament that they are not sure how many decomposed because of COVID-19 and how many with it. The US Centre’s for Disease Control are also flexible regarding the cause of death in connection with the COVID-19 pandemic. Confirmation of presence of SARS-CoV-2 is not mandatory when the death certificate is filed. It has been concluded that patient may die with COVID-19 and not from COVID-19Many autopsy report highlights that a person can die from a condition other than SARS-CoV-2 whereas the virus can be a bystander or vice versa yet the tag remains the wearing of Covid -19. Thus this distinction cannot easily be made by clinical judgment alone as the symptoms have pretending double standard display that fits along season disease as well.It is reported that once a person with Covid -19 remained symptomatic for six days with fever and chills and died before he could be put on a ventilator.His lung sacs were inflamed and damaged with full of lymphocytes.On the contrary there was a 42 years old man who was infected by SARS-CoV-2 but did not die from it but bacterial pneumoniaHe was admitted in critical condition for fever, cough and chills.CT scan revealed ground glass opacities in both lungs.Nasopharyngeal swabs tested positive for SARS-CoV-2 but lung swabs were negative.There were food particles in the lung and the bacteria could be grown on culture. The final autopsy listed COVID-19 as a condition but not the cause. The patient had died of bacterial pneumonia because of aspiration.Besides, the CT findings noted (ground-glass opacity, consolidation) are not specific for COVID-19 and can be observed with numerous pathogens (for example during an epidemic influenza) and in many noninfectious etiologies.The almost constant presence of ground-glass opacity and the high incidence of the crazy-paving pattern meant that the chest CT features of COVID-19 patient have “ground-glass opacities may be due to mild edema of the alveolar septi, hyperplasia of the interstitium, partial filling of air spaces, or a combination of these features.Besides, the crazy-paving pattern may correlate with hyperplasia of interlobular and intralobular interstitia”.All these features are very similar to those seen in SARS and MERS-corona virus infections and such patients were labeled as having “interstitial pneumonia” at least in the early stages.Autopsies on COVID-19-positive patients in Italy have highlighted the presence of thrombotic formations and also of a thrombofilic vasculitis in the lung, brain, and other organs culminating in to multi organ failure.Receiving influenza vaccination may increase the risk of other respiratory viruses, a phenomenon known as virus interference.