Why some COVID-19 patients have more intensified symptoms than others

Since coronavirus is proving to be an immune system disease, in theory, it could be controlled.

However, in many ways, COVID-19 can be considered as a disease of uncertainty. For instance, a recent study from Italy states that around 43% of people infected by the virus show no symptoms of it. On the other hand, the ones that feel the symptoms, experience severe heart racing and breathing difficulties. Most of them spend weeks in ICU. In the meantime, many others simply keep feeling better and eventually fully recover.

The chair of infectious diseases at Upstate University Hospital, Stephen Thomas, told The Atlantic:

“Some people really fall off the cliff, and we don’t have good predictors of who it’s going to happen to.”

For instance, after feeling mildly ill for a week, the 37-year-old writer F. T. Kola was told to go to Stanford University’s drive-through coronavirus testing site. When they found out she was coronavirus positive, doctors stuck a long swab into the back of her nose and sent her home to await results. Kola shares:

“I remember waiting in my car, and the doctors in their intense [protective equipment] coming towards me like a scene out of Contagion. I felt like I was a biohazard—and I was.”

The night she was sent home, she was overtaken by the most intense chills of her life. Her teeth were chattering so hard, she was afraid they would break. Moreover, she even started to hallucinate. Then, the writer spent three days in ICU, before being transferred to a newly created coronavirus-only ward.

Luckily, after two weeks of hospitalization, Kola recovered and was ready to go home. However, many questions occurred in her mind:

“Why did my lungs make it through this? Why did I go home? Why am I okay now?”

In comparison, Kola’s friend, Karan Mahajan, an author based in Providence, Rhode Island, who contracted the disease at the same time, claims his case felt like mild flu. The only thing that concerned him was the loss of smell and taste, which can also be considered as coronavirus symptoms.

As the professor of medicine and the director of the Center for Global Communicable Diseases at Northwestern University, Robert Murphy says, “There’s a big difference in how people handle this virus.” Additionally, Murphy admits the virus has been behaving extremely unusual than the diseases we know. This uncertainty, withal, is not about the virus itself, but how different people react to it.

We have all heard the warnings about how elderly and chronically ill people are vulnerable to COVID-19. However, these are not the only two groups of people at high risk of dying from the virus. Furthermore, gaining the knowledge of who exactly how and why some people get severely ill while others feel almost nothing might be the key to treatment.

Our immune system is what urgently threatens to kill us once the virus has spread widely in our body.

Although this response cannot be entirely controlled, it can be regulated and improved.

The New York-based ear, nose, and throat doctor, Jonathan Aviv, confirms that the loss of smell and taste can be deemed COVID-19 symptoms. However, he’s often unsure of what to tell his patients:

“The non-scary scenario is that the inflammatory effect of the infection is temporarily altering the function of the olfactory nerve. The scarier possibility is that the virus is attacking the nerve itself.”

If coronavirus is indeed attacking the nerves, it can cause long-term damages and affect other parts of the nervous system. As a matter of fact, this novel virus has already been told to trigger inflammation in the brain that leads to permanent impairment.

Once coronavirus hooks on the cells, it breaks through and starts to replicate. Not only it acts on the cells in the lungs, but it can also affect the ones of the liver, bowels, and heart. The sudden crash that infected patients experience comes as their immune system goes into a hyperreactive state, in an attempt to awake and mobilize the body’s defense mechanisms.

Pamela Sutton-Wallace, the regional chief operating officer claimed that half of the COVID-19 patients admitted in the ICU at the New York-Presbyterian Hospital remain there for 20 days, while the national average is a little over 3 days. The majority of these patients arrive at the medical center in life-threatening conditions. What their blood tests have shown is increased levels of inflammatory markers, one of which is the D-dimer protein. Having high levels of this protein can be ‘an early and helpful marker’ according to Wuhan doctors.

Randy Cron, the director of rheumatology at Children’s of Alabama, in Birmingham explains that these and other markers can often indicate a highly fatal immune-system process known as a cytokine storm. These processes are life-threatening and extremely hard to treat, but not beyond the potential for cure.

Scientists have been searching for patterns among people who have survived cytokine storms and those who haven’t.

One of the promising approaches appears to be blocking cytokines once they have already been released into the blood. According to Benjamin Lebwohl, director of research at Columbia University’s Celiac Disease Center, people with immune conditions like celiac and inflammatory bowel disease may be at higher risk of COVID-19.

Patients in danger of a storm could be closely monitored throughout their illness. Moreover, they can be offered treatment immediately as signs begin to show.

Usually, patients would be urged to seek help from hospitals as soon as possible, but now, they are being asked to wait until they experience breathing difficulties. This way the authorities believe to be keeping the people safe since they are ordered not to leave their homes unless it’s absolutely necessary.

White House Coronavirus Task Force’s official line has been that ‘high-risk’ people are elderly and chronically ill. However, this estimation is proven to be limited. For example, Latinos and African Americans have died at significantly higher rates than white Americans, according to the Centers for Disease Control and Prevention. In addition, more than half of the coronavirus positive patients in Chicago were African American. These statistics may demonstrate that the disease spreads several times higher among racial minorities and people of low socioeconomic status.

Most importantly, variation in immune responses in people is caused by much more than age or chronic disease.

From the food we eat to the air we breathe, and the environment we live in, many factors affect our immune systems. Having this in mind, although some COVID-19 cases may be unpredictable, most of them aren’t. They are the same people who are usually vulnerable to other viruses.

These are the people who don’t have access to nutritious food and clean air or the ones who cannot take time off of work when they fall ill. In general, the likelihood of the novel disease is not as uncertain and unclear as some may believe.

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