We thought it was just a respiratory virus

https://www.ucsf.edu/magazine/covid-body

by thereare5lights • 6 years ago

265 98 6 years ago

ucsf.edu

yread• 6 years ago

Dear reader, it's ok, you can skip the comments here. Just read the article and move on

self_awareness• 6 years ago

This applies to most of the stories on HN nowadays

swebs• 6 years ago

It's only been an hour, and insightful comments take more time to type out than ignorant speculation. Have some faith that this community isn't just another Reddit.

DoreenMichele13• 6 years ago

But the virus hadn’t wrecked Dowd’s lungs. In fact, she had only mild pneumonia. Instead, SARS-CoV-2 had ruptured her heart.

A lot of the early part of the article rehashes basics, like how viruses replicate. If you have basic knowledge of that sort, you can kind of skim until the mid point, where we find the above factoid.

I have been reading less about the virus of late, but this fits with everything I know. It causes blood clots. Ventilators aren't really fixing it. The lack of oxygen is probably more about what it does to the blood (than what it does to the lungs).

Later in the article, it talks about impacts on the feet suspected to be a side effect. Feet issues are commonly associated with blood/circulation issues. This is why diabetes can lead to feet being amputated.

The blood issues are well established and this has been known for some time. I'm somewhat aghast to see this article talking like we don't already know that detail.

simonh• 6 years ago

This is the feature article in a special series of articles on combating the virus. As such it's presenting a summary of what we know about it so far, and references a lot of sources, some going back several months. Given that context I think that's exactly what I'd expect it to do.

Not everyone has done as much research as you, and the public perception and debate is still awash with "just a bad flu" disinformation, so its really important a clearer and more accurate picture is put out as widely as possible.

DoreenMichele13• 6 years ago

Thank you.

The stuff about blood clots began coming out about the time I concluded I probably had it and had been mostly asymptomatic and about that same time I ran into a researcher on HN who said something about the blood that I didn't follow and I asked questions and that went weird places and then they said something else about zinc.

And that led to an epiphany for me and I turned to my son and kind or recounted the exchange with the researcher and then I said "We've been eating a lot of zinc-rich foods. I am going to go get a cheese pizza because cheese has zinc." So I got a pizza and then he felt vastly better.

So the whole blood angle is cemented in my mind like "Clearly, this is a hard fact and everyone knows it." But it's probably just me in my little bubble and that's it.

I'm still aghast. But what you say makes sense.

credit_guy3• 6 years ago

If I get Covid19, my plan is to take aspirin wile at home. If I need to go the Emergency Room, then I'll leave it to the doctors to decide what I should get, but before I need urgent care, I'll use aspirin.

JanSt• 6 years ago

Any scientific backing for this?

huffmsa• 6 years ago

Coronaviruses in cats primarily attack the blood.

Has been speculated on since as early as March (that I've seen) with more evidence in support since then that this strain of human coronavirus is behaving like that.

Explains the majority of symptoms. Low pulse ox, feet, brain, lung, kidney, etc etc.

coldtea• 6 years ago

I'm somewhat aghast to see this article talking like we don't already know that detail.

It's an article, not a news story or a scientific paper. So it's neither about breaking news nor innovative research results.

So, they don't presume what the public knows at any substantial level (heck, many still don't know/believe the virus is not real).

I, on the other hand, am more aghast for the use of the word aghast for such a trivial matter :-)

jfoster• 6 years ago

Mainstream (and that includes many politicians) still think of it as respiratory. All the other effects are not yet mainstream knowledge.

newacct583• 6 years ago

Ventilators aren't really fixing it. The lack of oxygen is probably more about what it does to the blood (than what it does to the lungs).

That's not right. It causes cytokine storms just like any other major repiratory virus. Ventilators do help, lots of people survive on them. They are a critically important piece of the treatment puzzle.

I don't think statements like that are very helpful. It's on the spectrum toward conspiracy nonsense.

I'm somewhat aghast to see this article talking like we don't already know that detail.

It's not a scientific study, it's a review piece for general readers.

titzer2• 6 years ago

If you have basic knowledge of that sort, you can kind of skim until the mid point, where we find the above factoid.

Well maybe you skimmed a little too much, because the article clearly talks about the negative effects of an overactive immune system response being characteristic in some patients, and there was plenty of evidence of that in some people's wrecked lungs. Part of the therapy is to guide and even suppress the complex immune system response to keep people's bodies from destroying themselves.

Your comment didn't mention any of that and might be read by some as a "move along, nothing to see here." I think this is definitely not the case and people would be better served to read the article itself instead of your comment dismissing it and instructing them to skip over the section about immune system response.

DoreenMichele13• 6 years ago

I wasn't instructing anyone to do any such thing. Another way to frame my point: If the start of the article bores you to tears, hang in there. It gets meatier.

danesparza• 6 years ago

Blood clots might be caused by a change in angiogenesis that appears to be correlated with COVID-19. I found this autopsy analysis by an MD to be very enlightening:

https://youtu.be/1HTionnTT9I

hartator• 6 years ago

Yes, COVID-19 is a bad one but it’s just another virus at the end of the day. I feel they act as we rediscovering everything about viruses for sensationalism.

mohamedattahri• 6 years ago

Yes, but downplaying the fact that it’s new and that there’s a lot of unknown unknowns about it and its effects mid/long term is dangerous. Not all viruses are the same, and it takes time to observe and study them.

This is IMO the other important reason why it’s important to stop the spread, besides overloading hospitals.

jmcqk6• 6 years ago

Another way to look at it is that many people who were previously ignorant regarding most things we know about viruses are learning quickly and because they are novel to them, they find them sensationable.

Balgair• 6 years ago

Nasim Taleb had a good point on the most recent EconTalk [0] about covid: We kinda know what the morality rate is, but we have no idea what the morbidity of covid looks like.

All the co-morbidities are essentially unknown and are likely to stay that way for a while. These side effects take time to suss out; more than the nine months we've had with covid.

With the unknown and potentially unbounded risks we are staring at, Taleb says that over-reaction is the best strategy. He and Russ Roberts go on to talk about the basic issues with statistics in these cases, a good trip back to the first week of any stats course that everyone promptly ignores.

[0] https://www.econtalk.org/nassim-nicholas-taleb-on-the-pandem...

giardini• 6 years ago

Balgair says: >"We kinda know what the morality rate is, but ..."<

"Morality rate", hmmm...I like it, but maybe for another article!8-))

specialist• 6 years ago

I'd previously read that COVID-19 might be a cardiovascular disease, which would account for the blood clots and heart stuff.

From the OC:

Marcus plans to also start collecting data from wearable devices, including Fitbits and Zio patches, which wirelessly monitor heart rhythms. “There may be large numbers of people who are suffering from cardiovascular effects of COVID-19 in the absence of other symptoms,” Marcus says. “I’m worried we’re missing those cases.”

I have no idea what it means to regard COVID-19 in cardiovascular vs respiratory terms. I'm just repeating what I think I've read. I really don't understand this stuff.

twic3• 6 years ago

Influenza does this stuff too, and we happily refer to influenza as a respiratory virus.

CraigJPerry• 6 years ago

[citation needed]

twic3• 6 years ago

Maybe i can dig out the MRI scans of my heart, so you can see the scar tissue that an influenza infection left.

makomk• 6 years ago

Yup. For example, there's a well-established effect where influenza causes heart attacks and strokes, big enough that the severity of the influenza season has a noticable effect on heart attack deaths. This is, naturally, taken into account when calculating the number of influenza deaths. The differencce is that instead of this being spun as proof that influenza is more deadly than people think, since Covid the press has been spinning it as proof it's leas deadly and that the official flu stats are overstating the number of deaths. For instance, this article - which was quite popular on HN - outright claimed that widespread flu deaths didn't exist because doctors didn't see people dying because of the flu and the CDC was misleading the public by claiming otherwise: https://blogs.scientificamerican.com/observations/comparing-...

graeme5• 6 years ago

But on an apples to apples comparison, aren’t there very few flu deaths confirmed by testing?

And what you cite can’t be proof that the flu is more deadly than people think. If what you say is true, those deaths are in the numbers used for the death rate of the flu.

The point of that article is that perhaps our algorithms for estimating flu deaths are wrong.

Edit: Can someone explain the downvotes? Any error in my reasoning is not obvious to me. The claim above was that:

1. Heart attacks are included in flu death estimations

2. This should make the public think the flu is more deadly than they believe

That seems contradictory, as the public’s belief about the deadliness of the flu comes in stats from point #1. As for the article, the author made no real attempt to rebut its central claim.

thedrbrian• 6 years ago

Project FEAR has crossed the Atlantic.

WhompingWindows• 6 years ago

Direct quote from the article:

"Clinicians, too, were seeing surprising numbers of COVID-19 patients develop heart problems – muscle weakness, inflammation, arrhythmias, even heart attacks. “We’re not used to respiratory viruses having such dire consequences on the heart in such apparently high numbers,” says cardiologist Gregory Marcus, MD. Many patients whose hearts acted up also had failing lungs. But others had no other symptoms or, like Dowd, only mild ones."

hellofunk2• 6 years ago

If we did a mass testing campaign on 300 million Americans right now, I think the rate of asymptomatic infection would be somewhere between 50% and 80% of cases

Wow that’s incredible. 200 million Americans could have the virus.

sebiche• 6 years ago

They mean 50-80% of cases, not 50-80% of Americans.

cataflam• 6 years ago

That's not what it says. It says if you tested everyone, out of those who tested positive, 50-80% would be asymptomatic, not 50-80% of the whole population.

hellofunk2• 6 years ago

Ah, thanks for the clarification. That was indeed not obvious to me the way they worded it.

IAmGraydon• 6 years ago

No. 50-80% of cases are asymptomatic, not 50-80% of the nation is infected asymptomatically.

tomohawk2• 6 years ago

Interesting explanation for why children rarely get sick or transmit this disease:

Fattahi’s team has found evidence suggesting that male sex hormones such as testosterone may increase the number of ACE2 receptors that cells produce, which could help explain why SARS-CoV-2 seems to wreak greater havoc on men than on women and why kids rarely get sick.

zspade• 6 years ago

This is only true for Children under 10. Children over 10 transmit contract and transmit at similar rates. Considering 11 is when puberty kicks in for many kids, this appears to support Fattahi's findings.

(https://www.nytimes.com/2020/07/18/health/coronavirus-childr...)

tomohawk2• 6 years ago

That article puts people in 10 year bins, so it is not useful to determine what the cutoff age should be with more granularity than 10 years of age.

However, Sweden did not close school for children through 14 years of age.

https://www.sciencemag.org/news/2020/05/how-sweden-wasted-ra...

And their excess mortality rates for that age group are indistinguishable from other European countries:

https://euromomo.eu/graphs-and-maps

When you go to that link, near the bottom select graphs by age and see that Sweden ages 0-14 looks like all the other countries shown there. I think that is a pretty good indication. We have a country that kept their schools open and a number of countries that did not, and the results look the same.

EDIT: in fact, the excess mortality for that age group looks indistinguishable from other years.

stanski2• 6 years ago

If a lot of the damage is often caused by an overreacting immune system, why isn't this disease harder on younger people who presumably have stronger immune systems? Kind of like the Spanish flu? This doesn't add up for me and this article doesn't dwell on that either.

0xB31B1B• 6 years ago

The issue with young people and the Spanish flu wasn’t “they have stronger immune systems so they cytokine storm harder and die in greater rates”, it was that there was an earlier endemic flu like 40 years before and basically everyone over like ~40 had been exposed to it and they had immunity, and anyone under that age had not been exposed so they lacked immunity.

roaur• 6 years ago

The article suggests a lack of ACE2 cell receptors in young people could contribute why the disease isn't as hard on them.

stanski2• 6 years ago

That's for the very young, ie children, at least from what I gathered.

thdrdt• 6 years ago

There is still no proof for this but some scientists suggest people over 80 years old came in contact with a similar virus when they were young and now their immune system is overreacting (like when the second sting of a wasp can be much worst that the first).

In the Netherlands they found out by coincidence that some people who have a broken TLR7 gene don't fight the virus so the virus hits them very hard.

So there may be multiple reasons.

gnusty_gnurc• 6 years ago

I've seen the idea of cross-reactivity and T-cell immunity being passed around.

I think the idea is that younger, healthier people with better immune systems are able to prevent the virus from replicating as much, whereas sluggish immune systems and bodies that are highly inflamed like overweight ppl, diabetics, etc. (high leptin, also related to il-6) get overwhelmed.

T-cell immunity/cross-reactivity meaning that most people have the ability to fight the virus from exposure to other coronaviruses.

I think a major component of the death toll from the pandemic is basically a consequence of obesity. I'm suspicious that govt interventions, planning, etc make that much difference when the US is an order of magnitude more obese than Japan, for example.

bart_spoon3• 6 years ago

That hasn't really been seen in the data though. Yes, obesity has been linked to more severe cases, but some of the hardest hit, highest mortality rate areas, like NYC and Italy, are markedly lower in their rates of obesity that other areas with lower mortality rates.

g3houdini• 6 years ago

The article based on studies by UCSF is a good read for many who are not understanding the basics of what is happening. I would suggest giving this out to friends and family who have concocted their own version of science and are refusing to wear a mask.

gbasin• 6 years ago

This is potentially concerning, but it's worth playing devil's advocate. What are the confounders? Most people have been more sedentary than usual this year. What impact does that have on circulation?

LinuxBender2• 6 years ago

I will get beat up for bringing this up, but I think that these facilities are operating in bubbles / silos. The reason I believe this, is that for months everything discussed in the article has also been discussed by an ER doctor in Riverside, CA that makes Youtube videos in his down time. [1] He is just reading the research available on nih.gov and a few other sites. What would it take to get all of the medical research groups to start collaborating on a common platform? Is the issue that they do not have a platform to share findings, theories, tests, or is everyone depending on the scientific review process and waiting for peer reviewed papers? Should we set up a forum for all the medical groups to share findings, theories, debate theories, etc?

[1] https://www.youtube.com/user/MEDCRAMvideos/videos

rpearl2• 6 years ago

The article is a summary of research findings over the course of the pandemic. What makes you think the research is happening in a silo? it's not. Medical researchers, just like, uh, that guy you saw on YouTube, are quite capable of reading the research on nih.gov and capable of discussing and sharing findings with each other.

The article even says "By June, clinicians were swapping journal papers, news stories, and tweets describing more than three dozen ways that COVID-19, the disease the coronavirus causes, appears to manifest itself."

LinuxBender2• 6 years ago

I see each group reaching the same or similar conclusions, but months apart. This suggest to me they are not collaborating with one another. It feels to me like there is a gap.

Think of it this way. If there were a giant asteroid heading towards earth and we have a limited time to solve this problem, would I want 500 teams all operating by themselves and using the incredibly slow process of sharing data via NIH / NIST and other research paper repositories, or would I want them all in a war room (virtual or physical) and someone coordinating the effort to risk rank all the solutions and quickly form action plans? My vote is the latter. It feels like the scientific community may have artificially painted themselves into a corner because of something like the banana ladder conundrum. [1] meaning, doing it that way because that is the way it has always been done.

[1] https://security.stackexchange.com/questions/33470/what-tech...

oxymoron• 6 years ago

This article claims that they are able to isolate live virus from stool, which seems to contradict the observations here: https://www.nature.com/articles/s41586-020-2196-x

notJim• 6 years ago

I'm surprised to read the stuff about asymptomatic cases. I thought the current thinking was that asymptomatic people are really pre-symptomatic, because of the incubation period. In other words, truly asymptomatic cases are rare. Am I wrong about that?

DanBC• 6 years ago

Some people just have very mild symptoms that they don't recognise. A lot of people don't notice their temperature is raised for a day or so.

Some lists of symptoms don't include anosmia or diarrhoea, so people have symptoms but don't think these are covid-19 symptoms.

graeme5• 6 years ago

Hard to know without widespread testing, and it depends how people define asymptomatic.

But cruise ship cases seem to indicate people with no true visible symptoms. There was a cruise ship with universal masking and a 80+% asymptomatic rate after 28 days.

Now, these patients may well have symptoms such as ground glass opacities in the lungs. But you can’t exactly feel that, so that’s some of the ambiguity.

bart_spoon3• 6 years ago

Yes you are wrong, though I suppose what you consider "rare" could be arbitrary. It seems that asymptomatic cases are anywhere from 20-40% of cases, although even that could be low, given that you are more likely to be missed if you have no symptoms prompting you to get tested.

rhacker• 6 years ago

Zinc

gentleman11• 6 years ago

Every other source online says that you can’t get Covid from eating, but this one says your stomach cells are particularly susceptible.

Gut specialists are finding that 20% to 40% of people with the disease experience diarrhea, nausea, or vomiting before other symptoms, says gastroenterologist Michael Kattah, MD, PhD, a UCSF assistant professor. If you swallow virus particles, he says, there’s a good chance they will infect cells lining your stomach, small intestine, or colon. As in the lungs and heart, these cells are studded with vulnerable ACE2 portals.

In that case, is the info about not getting it from eating as thoughtless and parroting as saying masks don’t work, or is this article fake news? It makes a huge life changing difference to know for high risk people

graeme5• 6 years ago

So there are a few unknowns:

1. Does the virus remain infectious in food? In particular, does hot or reheated food affect it?

2. The digestive process produces more acid. Will that kill the virus?

3. Will the virus even touch the wall of the stomach? It may be in food after chewing, rather than directly on the stomach wall

There are some reasons to think that swallowing virus replicating in your throat is different than having some inside a chewed up piece of food surrounded by saliva.

We don’t know of course, and someone super high risk should perhaps avoid takeout salads. But as of yet we haven’t had any case cluster reports where a superspreader cook spread the virus to their colleagues + customers via food. No country has reported a single instance of a traced infection via takeout.

This doesn’t mean it’s impossible, as contact tracing is not perfect. But the lack of any evidence so far is suggestive.

digibri• 6 years ago

Does this mean that it's possible blood thinners could help some patients with covid-19?

sharken• 6 years ago

Always interesting to learn more about the virus and that there is a lot of knowledge about handling ventilators. But even so, the numbers from New York say that 80% of people over 80 years do not make it once they are on the ventilator.

Source: https://www.google.dk/amp/s/www.washingtonpost.com/health/el...

I do hope that more attention will be focused on telling that this virus is both causing respiratory issues and heart issues. The leading comorbidities data from New York says it very clearly.

Source: https://www.the-hospitalist.org/hospitalist/article/220457/c...

We thought it was just a respiratory virus

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