1/ #COVID19 Update:

The more I read about COVID19 and discuss with experts in the field, the more I am convinced that the cytokine storm is driving death.

Why?

Patients on immunomodulating drugs, are not getting the symptomatic disease or only contracting mild forms of Dz.

2/ I have now spoken to a number of rheumatologists who claim their patients are not dying from disease and have close to zero cases of severe disease.

Why is this? Most of the patients are on some kind of immunomodulating therapy, which decreases specific inflammatory signals.

3/ While these drugs, which often block pro-inflammatory cytokines or alter the immune system in other ways do not prevent disease, they may be key in attenuating the severity of it. This is where the early use of HCQ may be beneficial (waiting for these studies).

4/ So who is dying? I can tell you anecdotally elderly patients and patients with obesity fare far worse than others. The former makes more sense than the latter.

Does obesity predispose to cytokine storm (via underlying immunopathy)? Only more time and more data will tell.

5/ Lastly, based on what I am seeing locally and from the reports I am reading, I have hope that early immunomodulating tx can disrupt the course of the inappropriate immune response (cytokine storm) and can curb the incidence of severe disease and death.

What do you all think?