Read on Twitter
This video is essential to understanding the differences in SOB in COVID - namely, it seems what we’re seeing is hemoglobin impairment by the virus and subsequent issues in oxygen carrying capacity and gas transfer in the lungs. We must consider that this is hemoglobin prob https://twitter.com/viss4x/status/1246919869372620800
There’s all this discounting over the last HQN study because it only seemed to help in exceptionally mild and early cases. If it were protecting hemoglobin not yet damaged, that would be expected behavior. If the hemoglobin is already damaged it cannot be brought back by HQN.
Yes, when we must use a vent it needs to be at a low pressure setting, but if we should have learned anything from China, it was how important the transfusions patients received were.
Perhaps it was only partially the antibodies of recovered patients. It’s quite likely that it was also because they received new hemoglobin. In that circumstance advanced patients who got HQN had another variable - fresh hemoglobin to protect.
Recent research absolutely shows that hemoglobin is being affected. COVID attacks hemoglobin. https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surface_Glycoprotein_Inhibit_Heme_Metabolism_by_Binding_to_Porphyrin/11938173
AI tools have predicted with a high level of accuracy which patients go on to “ARDS” or pseudo-ARDS... those with higher hemoglobin counts. https://www.sciencedaily.com/releases/2020/03/200330152135.htm
This very well may be because the body is producing more hemoglobin to try and increase oxygen delivery resulting from hemoglobin destruction or impairment.
The latest information on COVID and hemoglobin disorders is available here. https://www.thalassemia.org/boduw/wp-content/uploads/2020/03/COVID-19-pandemic-and-haemoglobin-disorders_V3.pdf. We need to be looking at data to determine if patients with hemoglobin disorders are being represented in a statistically expected fashion.
Additionally, it would make sense to try some of our patients on hyperbaric oxygen and transfusions as a treatment, particularly if no respirator or standard care could be made available to them or we were out of respirators to give.
Anecdotally, doctors are reporting right-shifted O2 sat curves - higher partial pressure of oxygen (how much O2 dissolved in blood) with low O2 sat. This makes a lot of sense of hemoglobin is being impaired and releasing its O2.
last point - the ^ hemoglobin in severe patients could also be due to impairment of hemoglobin breakdown after the damage, regardless, there's a ton of signal around the role of hemoglobin in this illness, and perhaps it's not HQN as an antiviral, but in heme metabolism.
