Glossary

• Virus– a type of germ that consists solely of a bit of genetic material (DNA or RNA) wrapped in a protein coat.  The coat gets the genes into the target cell where the genes force the cell to make zillions of new viruses, and on it goes.
• Coronavirus– a species name of a number of different viruses.  Called corona because its protein coat is studded with spike shapes that form a crown, halo, or corona of spikes
• SARS–CoV-2– the specific name of the new coronavirus
• COVID-19-the name of the illness that the new coronavirus is causing
• Endemic– an illness always present in a region.  One could say strep throat is endemic in the US
• Epidemic– a sudden burst of an illness that comes and goes over a limited time
• Pandemic– an epidemic that bursts across the world not just one region
• Spreadability– how contagious is the disease, how many people will end up infected
• Severity– what harm does the disease cause, in terms of  how sick you get and how many it will kill
• Mask- a mask is a loose-fitting cloth or textile that covers the mouth and nose loosely.  A surgical mask is a mask used in surgery
• Respirator-  for the purposes of the COVID-19 pandemic and other respiratory illnesses, a respirator is a mask that fits very snugly or tightly to the user’s face.  An N95 mask is a respirator.
• Personal Protective Equipment (PPE)- PPE are any item that covers any part of the body with the design and intent of keeping viruses in the environment from infecting the wearer of the PPE. PPE’s include all masks (which includes respirators), face shields, eye shields, gloves, gowns.
• Ventilator- a ventilator is a machine that can force a person unable to breathe to inhale and exhale and control both effectively.  They are sometimes called respirators, but during this pandemic the word respirator is now reserved for reference to a tightly fit mask.

Severity

Three recent developments give the impression that this virus is causing more severe disease, in a pattern that also includes different troubles:

1. More organs are being damaged
2. Stranger failures of lung failure are appearing
3. Children are now amongst those killed by the virus

More organs

When I began posting observations of doctors caring for people infected with the SARS-CoV-2 virus some weeks ago, it appeared that this virus targeted the lung.

It seemed as though most of the deaths from COVID-19 were deaths from people’s lungs swelling and failing to deliver air in and out of the body.

But now we know far more parts of the body have proven to be attacked or harmed by the SARS-CoV-2 virus.   We have discussed the heart, clotting system, and kidney, now we must add the liver and the toes.  Here is the growing list:

• Lung- we know the SARS-CoV-2 virus attaches to a particular protein that is found on the surface of lung cells, and devastation of the lung has been a known catastrophe from this virus from the first cases.
• Heart- it was not that long ago that we found the SARS-CoV-2 virus attacks the heart, leaving it weak and flabby, and unable to pump well, a condition called viral myocarditis leading to congestive heart failure
• Clots- again, not that long ago, reports of people with COVID-19 suffering clots appearing in their legs (DVT), lungs (pulmonary embolus), and/or brain (strokes) and since then such events continue to be reported.
• Kidneys- just this week a surge of people infected with COVID-19 suddenly suffering cessation of kidney function has been observed, and enough people are suffering this that NYC is concerned about possible shortages of dialysis machines.
• Liver- it turns out the liver has the same protein on its cells as the one in lungs that the SARS-CoV-2 virus attacks, and there are reports of liver damage in people with COVID-19
• Toes-  very recently, reports are appearing of people presenting with a purplish discoloration of their toes as the only sign they have come down with COVID-19
• Brain and spinal cord- reported yesterday in a child, with COVID-19 meningitis, see below

Over time, a picture is emerging that this virus really is quite dangerous in the number of ways it can cause devastating harm.

The Peculiar Presentation of People with Severe COVID-19 disease of the Lung

A doctor who came to NYC to help with care of COVID-19 patients has reported the very, very unusual observation that many people have come to his ER, looking fine, with a bit of a cough, walking around fine, talking on their cell phones.  But when the doctors measure the percentage of their hemoglobin holding oxygen molecules, which usually is about 95% or more (I just measured mine, it is a normal 97%), they find many measure at only 50%.

This is a devastatingly low number.  The percentage of hemoglobin occupied by oxygen is called the oxygen saturation, or SaO2 or SpO2, or most commonly, the O2 sat.   It is a funny number, you would think that at 50% the blood has half as much oxygen being carried around.  But it doesn’t work that way.  Instead, our blood has a good amount of oxygen when the O2 saturation is at 95% or above.  As it drops below 95% most people sense something is terribly wrong and begin trying to breathe bigger amounts with deeper breaths and faster breaths.  By the time you hit 80% you are starting usually to look a bit blue, and at 70% the situation becomes dire.   If I took my O2 saturation from my usual 97% to 50% right now I would certainly either slip into coma or die.

And yet, here are all these people coming to the ER feeling perfectly fine but for a little fever and cough, and their O2 saturation is 50%.  Another puzzle, their lungs are breathing out the waste gas we make, carbon dioxide just fine, which is not how it goes when lungs usually stop working, at least failing enough for the O2 saturation to dip to deadly failed levels.

The doctor noted that no one  has ever seen this situation before ever, no known disease leads to this sort of picture.  He says the only place you see such a pattern is in people on top of Mt. Everest with healthy lungs but very little oxygen in the air.  The lungs breathe well there, the carbon dioxide clears out fine, but the oxygen level drops because there is too little in the air.

But these comfy people are not 5 miles in the sky, they are at sea level, with plenty of oxygen.  It is a new puzzle from this virus that keeps getting more puzzling in what it does.

Tragically, at least two young children are now among those that have died by COVID-19

The SARS-CoV-2 virus began infecting humanity on November 17, 2020, and since that time, for at least 5 months, there was little or no evidence of children under the age of 10 losing life to this infection.

But now two reports tragically prove it can happen.

One is a letter published in the April 23, 2020 edition of The New England Journal of Medicine, which reports a review of 72,314 cases of COVID-19 in China through March 8, 2020 by the Chinese CDC.  Of these 72,314 cases, 171 of them were children.  The median age was 6.7 years old.   About 40% had fever.  About 15% had no symptoms and had normal chest X-rays.  Of the 171 children of China found to have the infection, only 3 required ICU level care.  All 3 of the few children sick enough to need an ICU had a serious pre-existing condition:  leukemia and on chemo, a ongoing congenital kidney obstruction, and a sudden bowel obstruction.  As of March 8, 2020, one of the children had died, but no more than one.

The child was 10 months old and was the child with an acute bowel obstruction.

The other known death in a child under 10 years old is the tragic loss of Skylar Herbert a 5 year old whose parents were on the police and fire forces.  No other medical conditions have been reported in Skylar’s case.  And Skylar’s SARS-CoV-2 virus did something to Skylar we have not seen much of, direct infection of the brain and spinal cord, in an infection called meningitis.

A terrible barrier has been breached, one that we thought could never be permanent or absolute, but so tragic that it is broken through now, children under 10 years of age can die of this terrible infection.

Fortunately, the vast, vast, vast majority of those who have died from COVID-19 are over 19 years old, and the vast majority of these adults are over 60 years old.  In fact, in our Cleveland area, as of last week, Rainbow reported no child admitted for COVID-19, and the Clinic has admitted 2 children neither requiring the ICU and both recovering.

BOTTOM LINES

1. The SARS-CoV-2 virus, at least right now, is becoming more dangerous, causing an expanding number of problems across the body, as the above list demonstrates.  It can no longer be considered an infection of only the lungs.
2. The SARS-CoV-2 virus is showing a striking and disturbing ability to drop one’s oxygen level in one’s blood to dangerously low levels without much sense that one is very ill at all.  This is a second very disturbing pattern of this disease.
3. Now we must know that young children, even under 10 years old can lose their life to the SARS-CoV-2 virus.  The only good news here is that the virus really does seem to still only hurt young children very, very, very rarely.

The SARS-CoV-2 virus, right now, is getting far more dangerous- spreading far more rapidly (remember, now up to an average of 5.7 people rather than 2.5 people infected by each person infected), and is causing a depressingly wider range of dangerous illnesses and paths to harm and death.

As the virus worsens, let us hope one day that it turns a different direction, less catchy, less dangerous, but as of now it is turning worse.

The only tool to protect we have is to stay away from each other, and that is what we must do for now.

To your health,
Dr. Arthur Lavin