A new autopsy study which investigated lung changes in response to coronavirus down to the genetic and molecular levels has revealed startling new details about damage from the infection. The small study that compared the lungs of seven patients who died of the flu, the lungs of seven patients who died of coronavirus, and tissue from people who died with healthy lungs, confirmed two things research previously hinted at.
Firstly, the spiky coronavirus that causes COVID-19 invades the lining of the blood vessels, a tissue called the endothelium. Secondly, injury to the endothelium induces blood clots and makes it so these vessels don’t work well.
Doctors have reported that the blood of coronavirus patients congeals easily, which makes it difficult to keep medical tubing open to deliver fluids and drugs. Blood clots in coronavirus patients also seem to put them at higher risk for problems such as strokes and heart attacks. In fact, when viewed under a microscope, the lungs of Covid-19 patients were peppered with tiny dark micro clots.
Patients who had died of the flu had these clots as well, but they were 9 times as common in the patients who died of Covid-19.
In addition to the infection of blood vessels and the legions of tiny clots, researchers discovered a third phenomenon occurring in the blood vessels of patients with COVID-19 that showed how severe their illnesses were. The vessels blocked by these clots were thinner than the width of a human hair, and they were critical for gas exchange in the lung.
With clots choking off the lung’s blood supply, these tiny vessels seem to make a desperate move, splitting down the middle in an attempt to get blood to these compromised areas, a phenomenon called intussusceptive angiogenesis.
What should the people with lung diseases know?
There have been several reports that steroids are contraindicated in coronavirus disease, so many people are wondering what people with lung diseases do if their controller medication is a steroid, inhaled or oral. The short answer is continue taking your controller medications and do not stop taking them. The data suggesting that steroids may increase the shedding of SARS-CoV-2 comes from treating hospitalized patients with systemic steroids only for the viral illness.
The use of steroids for treating other diseases such as asthma, was not studied. However, people with asthma are placed on controller medications to keep their disease under control. In the current pandemic, the best thing a person with asthma or lung disease can do is to get and keep their asthma or lung disease under control.
Stopping a controller medication would put the person at risk for developing an asthma exacerbation, especially as we enter the spring allergy season. In the current pandemic, treatment of an exacerbation would most likely require going to the emergency department or urgent care unit, where the individual has a much higher risk of being exposed to someone with coronavirus disease.
So, in a way, by continuing to keep the lung disease under control, the person with the disease is actually reducing their chances of exposure to the deadly virus.
It is worth noting that there are certain seasonal versions of coronaviruses that have been proven to cause asthma exacerbations. The SARS-CoV-2 virus, like SARS-CoV and MERS-CoV, the two other pandemic coronaviruses, do not seem to cause an asthma exacerbation.
Nonetheless, it is always important for the asthma patients to keep their asthma under the best possible control. This way their lungs would be best prepared if any allergies or infection leads to an exacerbation of their asthma.
The bottom line for people with lung diseases during this pandemic is to keep doing what you have been doing all along, and that is continue taking your controller medication and inform your healthcare provider of any symptoms that you may develop.
And of course, remember to practice social distancing and keep washing your hands frequently. Other than taking the prescribed medications for the lung disease, the patients can take several precautions to avoid getting in contact with the virus.
Before going on to the precautions and the effects of coronavirus, we must go through the different types of lung diseases and their symptoms.
Lung disease is any problem in the lungs which prevents the lungs from functioning properly. There are three main kinds of lung diseases:
- Airway diseases — These diseases affect the tubes, i.e. the airways which carry oxygen and other gases into and out of the lungs. They usually cause a narrowing or blockage of these tubes. Airway diseases include COPD, asthma and bronchiectasis. People with airway diseases often say that they feel as if they are “trying to breathe out through a straw.”
- Lung tissue diseases — These diseases affect the structure of the tissues in the lungs. Scarring or inflammation of the tissue makes the lungs unable to expand fully, and this is known as restrictive lung disease. This makes it difficult for the lungs to take in oxygen and release carbon dioxide. People with this type of lung disease often say that they feel as if they are “wearing a too-tight sweater or vest.” As a result, they can’t breathe properly. Pulmonary fibrosis and sarcoidosis are some examples of lung tissue diseases.
- Lung circulation diseases — These diseases affect the blood vessels that are present in the lungs. They are caused by scarring, clotting, or inflammation of the blood vessels. They affect the ability of the lungs to take in oxygen and then release carbon dioxide. These diseases may even affect the functioning of the heart. One good example of a lung circulation disease is pulmonary hypertension. People with these conditions very frequently feel short of breath when they exert themselves too much.
The most common lung diseases include:
- Collapse of part or all of the lung (pneumothorax or atelectasis)
- Swelling and inflammation in the main passages (bronchial tubes) that carry air to the lungs (bronchitis)
- COPD (chronic obstructive pulmonary disease)
- Lung cancer
- Lung infection (pneumonia)
- Abnormal build-up of fluid in the lungs (pulmonary edema)
- Blocked lung artery (pulmonary embolism)
Lung diseases symptoms:
Early signs of lung disease are easy to overlook or avoid. Knowing the warning signs coud help you get treatment before the condition becomes too critical or serious. If you have any of these symptoms, make an appointment with your doctor or your healthcare provider:
- Trouble in breathing or shortness of breath: It’s not regular to have shortness of breath for no reason, or which doesn’t go away after a bit of exercise.
- Feeling like you’re not getting enough air: Laboured breathing, when it’s hard to breath in and out, is a warning sign of trouble and you may be developing a lung disease.
- Chronic cough: Coughing for more than a month could be a signal that something is wrong with your respiratory system.
- Coughing up blood: The blood may be coming from your lungs or your upper respiratory tract, signalling that there is a health problem.
- Chronic mucus production: Mucus can defend against irritants or infections. But increased mucus production for more than one month can indicate a lung disease.
- Chronic chest pain: Unexplained chest pain which lasts for more than one month, and worsens when you breathe in or cough, is a warning signal by your body.
Viruses work by hijacking the cells in the human body. They enter the host cells and reproduce. They can then spread out to the new cells around the body.
Usually, the immune system would identify and respond to the coronavirus early by sending special antibodies or proteins, to fight the infection. The immune response to infection has certain side effects on the body, such as fever. During an infection, the white blood cells release pyrogens, a substance that causes fever. A temperature of greater than 100.4°F from an oral thermometer indicates that the individual has a fever.
Sometimes other symptoms will occur alongside a fever, including:
- sore throat
- muscle pain
- a headache
- loss of taste or smell
These symptoms would usually last until the body fights off the coronavirus. Symptoms might not show up immediately. For example, people infected with the virus may get symptoms 2 to 14 days after getting infected.
According to a guideline issued by the Ministry of Health & Family Welfare, all non-essential movement and travelling must be avoided. If travel is unavoidable, follow the given measures:
- Practice frequent handwashing with soap
- Avoid close contact with people who are not well or showing symptoms of illness, such as cough, runny nose etc.
- Observe good personal hygiene
- Follow respiratory etiquettes such as covering your mouth while coughing or sneezing.
- Avoid contact with animals and consumption of raw or undercooked meats.
- Avoid travelling to farms, live animal markets or where animals are slaughtered.
- Wear a mask if you have respiratory symptoms such as cough or runny nose.
- Monitor your health closely.