Part 1:

Could #ventilatorinducedlunginjury be worsening COVID19 patient health?

Potential #COVID19 drugs include #IL6inhibitors #tocilizumab and #sarilumab — #biologics that may improve lung tissue damage caused by #cytokinerelease in patients with *severe* viral infection.

When reading #pharmacological studies, don’t ignore the population description — “critical” #COVID19 patients are more likely to be hooked up to #ventilators.

Are these “miracle drugs” treating the #primarycause or mitigating the iatrogenic effects of mechanical ventilation?

#COVID19 part 3:

(I’m speaking from the perspective and experience of a student with a curious mind. I’m not a conspiracy theorist, nor would I ever withhold ventilation from a patient in respiratory distress.
However, I believe injury-reducing strategies should be considered).

#COVID19 part 4:

Among several targets of developing #pharmaceutical agents are: #interleukin8, #tnfalpha, #interleukin6, #interleukin1, and other inflammatory mediators.

Interestingly, ventilation-induced lung injury causes the release of IL1, IL6, IL8, and TNF-alpha...

#COVID19 part 5:

Though drugs that target these mediators already exist, novel therapies (including #biologics) are now in development.

And while I’m proud of this progress, creating these treatments will be incredibly costly, both in terms of money as well as time.

#COVID19 part 6:

I’ve heard many people say, “when ‘this’ is all over...” as if “this” is something that will just end.

A “miracle drug” is unlikely. I know we all want one.

But we can’t just wait for “this” to pass. We need to adapt & compromise, in the safest ways we can.

#COVID19 part 7:

I am not a doctor, but I have a degree in #moleculargenetics and #publichealth.

I think we could focus on #ventilation strategies — O2 via nasal cannula (mild cases), #ECMO (severe cases), etc.

We’re providing O2 but not eliminating CO2 at a fast enough rate.

#COVID19 part 8:

This virus affects the blood. Its mechanism involves “hijacking” heme (higher prevalence in males? Males have naturally higher hemoglobin levels & iron levels).

Blood pH is another factor— there’s a correlation between blood acidity & infection rate.

#COVID19 part 9:

Another interesting finding: drugs that have been found to be useful are also drugs that make blood more acidic (lower pH, raise anion gap, etc.)

Also, several drugs increase the concentration of #methemoglobin and decrease concentration of #hemoglobin...

#COVID19 part 10:

I’d be interested to see if there has been work done studying the prevalence/severity of cases in #anemic populations or in groups with #hemoglobinopathies like #sicklecellanemia or #hereditaryhemochromatosis

Any #hematologists who could weigh in?

#COVID19 part 11:

Continuing from the #hematology side... could #erythropoeitin be of any use in certain cases? I’ve read that anemia develops as a complication of this virus, but could increasing red blood cell production be a possible treatment?

#COVID19 part 11.5:

https://onlinelibrary.wiley.com/doi/pdf/10.1002/jmv.25839

Here’s a paper citing the use of recombinant human erythropoietin ( #rhEPO). Though as it was co-administered with an anti-viral, the effects of rhEPO alone can’t be entirely elucidated from this study.

#COVID19 part 12:

This virus has also been said to present similarly to altitude sickness or carbon monoxide poisoning (in blood arterial gas results and general symptoms)— of course #ecmo is a last-line treatment, but removing CO2 should remain a focus. O2 alone is not enough.

#COVID19 part 13:

I’ll end this thread by again stating that all I’ve said is speculation, based on reading papers & studying the mechanisms of this virus.

If anyone has the expertise to weigh in on any of these thoughts, please go ahead— I’d appreciate your insight.