There are so many perplexing questions about COVID-19 but the one that seems to stump everyone is why some people are dropping dead when they get this virus and others are completely asymptomatic. It seems to come down to how strong a person’s immune system is when it comes to fighting this vicious virus, however, new research is now showing that over-activation of the immune system, known as a “cytokine storm,” is resulting in more deaths.
First of all, let’s look at how the immune system works. The immune system is made up of specialized white blood cells that fight off viruses, bacteria, and pathogens by using inflammation or increased blood flow (which comes out in the form of a fever, pains, and swelling) and communicating with other immune cells.
The calm before the storm
The way the white blood cells communicate and fight is via molecules called cytokines which are the ones actually coordinating the body’s response effort. They bind to receptors on neighboring cells or on the ones that released them and they can actually release more cytokines.
This all seems good, right? Well, it can be until in some cases an excess of cytokines is produced and then they enter the bloodstream which causes increased inflammation leading to fever, vascular leakage, tissue damage to multiple organs, or even death. Cytokines can also enter blood vessels cutting off the blood supply to your heart, lungs, brain, and kidneys also. This is known as a cytokine storm. And these storms are being seen in patients with COVID-19 and they come on quite fast and suddenly.
A recent study by Dr. Pavan Bhatraju, an assistant professor at the University of Washington who works in the intensive care unit at Harborview Medical Center in Seattle, looked at patients who had the virus for about a week and even appeared to be feeling better and then suddenly crashed. Patterns showed that the crash usually happens seven days into the virus and can occur in COVID-19 patients that didn’t seem that bad and are often young and healthy. The crash is now being attributed to cytokine storms.
Dr. Carl Fichtenbaum, a professor in the division of infectious diseases at the University of Cincinnati College of Medicine, described the storm to Health.com. “Imagine that you put your foot on the accelerator and it gets glued to it. You can’t get your foot off the gas to slow down your car,” he said. He added that the mortality rate is higher for COVID patients with this condition.
Making it even worse is the detection of a cytokine storm is tricky. Blood workups can indicate if a hyper-inflammatory response is happening but it isn’t a sure thing.
Treatment of cytokine storms in COVID-19 patients is another issue. Researchers are looking at anti-inflammatory drugs or blockers of the production of these molecules or the pathways that rely on cytokines. However, immunosuppressive treatments could make it harder for these patients to fight off other infections because essentially this would be weakening their immune systems. But doctors are also using ventilators to treat these patients as well as stem cell therapy and protein building medications.
It is hard to imagine that the system that is supposed to be fighting off this virus could end up making us sicker than the virus itself.