ZT is a 61 year old man, presenting to the
emergency room with fever, cough and weakness on December 20, 2019. Several years ago, he was diagnosed with liver
disease. Over the next 7 days, ZT was monitored in
the respiratory unit at the Wuhan hospital, and he started to develop trouble breathing. A throat swab tested positive for the coronavirus,
SARS-CoV-2 infection, meaning he has COVID19, the disease caused by the virus. A CT scan of his chest confirmed viral pneumonia. On the eight day of hospitalization, December
28th, ZT was transferred to the intensive care unit. A tube was placed down his throat so that
a machine could help him breathe. 3 days later, on New Year’s eve, ZT was
transferred to the infectious disease hospital in Wuhan city so he could be more closely
monitored. On new year’s day, ZT fell unconscious. His blood pressure started to drop. The next day, he entered respiratory failure. He was hooked up to life support. A second infection was found in ZT. This time, bacteria. Other germs were starting to grow inside him. Acids were found in his blood, as his organs
started shutting down. At 8:47pm, on January 9th 2020, 8 days after
he was moved to the infectious disease hospital, ZT’s heart suddenly stopped beating. A code was announced in the hospital, and
doctors rushed to resuscitate him, but at 11:13pm, 2 and a half hours later, the code
was called. ZT could not be resuscitated. Pneumonia, fever, life support, acids in blood. These are all things that are dealt with in
hospitals everyday. Nothing new here. Problems with the lungs, can cause critical
illness quickly, BUT can be even quicker when the heart gets involved. BM is a 69 year old man, presenting to the
emergency room with fever, cough, and breathing trouble on January 3rd, 2020. At the Wuhan Red Cross Hospital on the day
of presentation, BM was intubated because he was actually in respiratory failure and
had hypoxemia. Hypo meaning low. Ox referring to oxygen, and emia meaning presence
in blood. Low oxygen presence in blood because of respiratory
failure. But this wasn’t his only problem. Parts of his heart muscles were floating around
in his blood. This is something you find when someone has
a heart attack. But BM didn’t have a heart attack. A throat swab confirmed SARS2 infection and
COVID19 disease. The next day, January 4th 2020, BM was transferred
to the infectious disease hospital in Wuhan city, when he became unconscious. A CT scan found pneumonia. BM was moved into the intensive care unit. He was turned over on to his stomach, to help
get more oxygen in his lungs during machine ventilation. And this brings us to why this is happening
in BM, and why is he being treated this way. The COVID19’s main feature is pneumonia. But how does the virus cause this? The spikes on the virus surface, are protein. The viral genome dictates how every protein
is made. We have the genome fully sequenced, so we
know these spikes are similar to the ones on the first SARS virus, that had an outbreak
in 2003. These spikes interact with something called
Angiotensin Converting Enzyme 2 or ACE2 in humans. It looks like this is how it enters cells
of the lower lung. When it enters, it injects its RNA and hijacks
the lung cell to create viral materials instead of letting the cell live its normal life. It kills the cell while creating more virus. But the lungs aren’t the only place where
humans have ACE2. The stomach and the intestines have it. Specific parts of the male anatomy have it. It’s on the kidneys. And, it’s in the heart, which could explain
BM’s damaged heart. Problems in the stomach probably won’t kill
someone immediately. Problems in male anatomy probably won’t
kill someone immediately. But a problem of the heart or lungs, can kill
someone in minutes, which brings us back to pneumonia. When the body’s immune system detects viral
damage in the lungs, it reacts. It expands the blood vessels, so more immune
cells can enter, but this also means fluid fills BM’s lungs. This makes breathing harder, because now the
lungs can’t exchange oxygen and carbon dioxide with the blood. But high pressure in, lowers the movement of air out What’s the air going out? Carbon dioxide. So, Carbon dioxide levels increase in the
blood when the pressure is high. This is uncomfortable and patients will instinctively
try to breathe against the ventilator. That might knock things off sync, so medicines
were given to temporarily paralyze BM’s respiratory muscles, so he can’t fight the
machine. Medicines were given to sedate him so that
he wouldn’t be fully conscious while paralyzed. All of these things, low tidal volume ventilation,
muscle paralysis and sedation, and early prone position, that’s turning him on to his stomach,
have been shown to decrease mortality in patients with acute respiratory distress syndrome,
just like BM Dialysis was started because his kidneys were
starting to fail. A viral infection in the lung can cause other
germs to start growing, and in BM, bacteria was starting to grow. Why this happens is not really clear. It could be that a viral infection reduces
the body’s available resources to fight a bacterial co-infection. But it also could be that viruses directly
sabotage the immune system’s ability to fight off a co-infection. Whatever the case is, BM was started on multiple
antibiotics to cover many kinds of bacteria. He was treated for his symptoms in intensive
care. But it wasn’t enough. 5 days later on January 9th 2020, the bacteria
that was in his lungs, was floating around in his blood. His blood pressure started to drop because
his immune system was reacting to that bacteria by dilating all the blood vessels. Tiny clots were forming in his bloodstream
that were lodging into the blood vessels of his organs, blocking blood flow and causing
them to shut down. At midnight on January 15 2020, BM’s heart
stopped beating. A code was announced in the hospital, as doctors
rushed in to try to resuscitate him. By 12:45 am, the code was called. BM could not be resuscitated. These 2 critically ill cases of COVID19, are
cases of severe pneumonia. That is how the virus affects humans. If these were isolated cases that happened
months apart from each other in different parts of the country, maybe no one would have
thought twice about it. But if multiple cases come through in a short
time, in the same place, with an illness this serious, then it’s cause for concern. In America, in 1981, there was an outbreak
of 11 cases of rare fungal pneumonia. This ended up being the first description
of AIDS. Because that fungus that caused their pneumonia,
is everywhere in the air. You might be breathing it right now, but your
immune system handles it no problem. An AIDS patient though, has a weak immune
system. When these 11 cases were identified back then,
no one knew what AIDS was, meaning these patients were in end-stage disease. The fungus was growing all over their lungs,
causing that rare pneumonia. So, “rare pneumonia” coming up often,
can trigger an alarm of an outbreak of communicable disease, but you have to be careful. You don’t want to cry wolf, but you also
don’t want to not tell anyone something bad could be spreading. So here’s what we know. Fever and pneumonia are present in almost
all cases of COVID19. Other problems like with the heart and kidneys
and stomach, it depends. There could be people who are infected, and
don’t have symptoms. It looks like those people can spread the
virus through respiratory droplets from their lungs. Surface contamination? The data is not conclusive, so wash your hands. Asymptomatic spread is the scarier scenario
because those people may not get isolated or quarantined immediately, and infect others
unknowingly, so that’s why it would be best if we could do a serology, or a testing method
to find antibodies in someone to the SARS2 virus. But on the flip side, if someone is held in
isolation, with maybe some of the potentially more subjective symptoms, are they really
short of breath, or do they think they’re short of breath now that they know they’re
being held in isolation? What happens when don’t have symptoms, but
insist they do and demand treatment that they don’t need? Nobody wants that tube down their throat,
trust me. But If the illness keeps getting worse: pneumonia,
fever. Secondary infection. Bacteria breaks off and starts floating around
in the blood. Organs start to shut down because blood pressure
is too low from the immune system trying to attack the bacteria in blood. Metabolic waste and acid build up in the blood,
causing the heart to stop beating. BUT, the good news is that ZT and BM aren’t
the majority of patients. Unfortunately, they died. The official number says mortality for COVID19
is somewhere between 2-5%. Ok, assume we take that with a grain of salt. The cases that are confirmed here in the United
States, show the same pneumonia and respiratory described by doctors in China. So ZT and BM were older patients who had prior
medical histories. Severe pneumonia is going to hit that demographic
pretty hard What does it look like when a younger, healthy
person is infected? ZW is a 35 year old man, presenting to the
emergency room at Wuhan General Hospital with a 3 day fever. December 5th 2019. He had no past medical history and was not
taking any medications. A chest CT found viral pneumonia. Keep in mind this is before there were global
announcements of an outbreak. Over the next four days, ZW’s kidney and
lung function slowly worsened. On day 5, ZW started on supplemental oxygen
and was given symptomatic treatment. ZW’s condition worsened over the next 5
days, but started to stabilize by day 11, when he tested positive for SARS2 virus. Several weeks later on January 20th, ZW was
placed for surveillance, and eventually discharged. ZW’s case is similar to the one that happened
in Washington State, which was published in the New England Journal of Medicine on January
31, 2020. This was the first case confirmed in the US. This patient, also 35 years old. Also no past medical history. He presented to urgent care with a 4 day history
of cough and fever. Which isn’t out of the ordinary for mid
January cold and flu. He had a confirmed COVID19 infection done
by a throat swab. How was he treated for fever? Tylenol and ibuprofen. How did he get treated for his cough? Cough syrup. As the days went by, blood tests started showing
some abnormalities related to his liver, but it didn’t seem like anything too bad was
really happening at that point. But on hospital day 5, his chest CT showed
an atypical pneumonia. They already knew at that point he had the
SARS2 infection, so this probably wasn’t too surprising to them, but on that day, the
patient started having trouble breathing. He wasn’t getting enough oxygen from the
air, so he was given supplemental oxygen. Since he had been at the hospital so long
by this point, was this decline in breathing from SARS2 virus? Or was it from hospital bacteria? Antiviral medicine won’t work on bacteria. Antibiotic won’t work on a virus. If he’s not treated with the right medicine
for the right pathogen, he’s going to get sicker, so the medical team started him on
antibiotics. The next day, pneumonia was still found in
both lungs and the medical team was able to get a medicine that’s in research, remdesivir. This medicine confuses the virus. By looking like one of the genetic backbones
of the viral genome, the virus uses it reproduce. But because it’s not actually the right
backbone, the virus can’t reproduce properly. This could be one way to could treat COVID19,
because it appeared to work for this patient as his condition improved over the next few
days. The medicine appears to be in China now for
use in a trial, along with many others. So focus on what’s going on where you are
at the moment. In America, not even 50 cases, it’s actually
35 at the time of me recording this. If you feel fever and chills, shortness of
breath, and fatigue over the last few days, get that checked out. It’s more likely to be flu than SARS2 if
you’re in USA, but if it is SARS2, you’re going to get good care for it here. Wash your hands when you come home from a
public place, or if you touch something in your house that came from the outside. If you’re young and healthy, non smoker,
no past medical history, and you feel ill, don’t panic cause you have every advantage
on your side in the US. If you’re older with past medical history,
don’t take any chances with any fever, in general. #alertnotanxious Because I can’t create a new video every
time something new develops, I’ve created a playlist with other medical you tubers on
there. In the context of medicine and medical treatments,
these are all great resources to learn more about the SARS2 virus and resulting COVID19
disease. Again, #alertnotanxious and I hope these videos
help you find the resources that you need. Take care of yourself. And Be Well.
He’s a well known youtuber doctor fwiw
was just looking to post this. Love his channel, very informative. Feel like this was a good video for him to post since a lot of people are worried.
Some of the best and easiest to understand info I've seen. Looks more reliable than the A'Hats shouting anything down that doesn't fit their ideology.
very informative. Thanks
Very interesting case study thanks poster.
Seen it , is a great video quite concerning how it effects the lungs
Wow. This guy is great!
Good video. I like the formatting as well.
I really wished he had podcasts! I usually have to play his youtube videos and let it drain my phone battery most of the time :(