"We are now almost six months into this pandemic, which began in November in Wuhan, with 50,000 Americans dead and 200,000 more around the world. And yet we still don't really know how the disease is killing us." (1/x) https://nymag.com/intelligencer/2020/04/we-still-dont-know-how-the-coronavirus-is-killing-us.html

"Early in the epidemic, the coronavirus was seen as a variant of a familiar disease, not a mysterious ailment. And if each of those 200,000 deaths is a data point, together they represent a quite large body of evidence from which to form a clear picture of the pandemic threat."

"But while uncertainties at the population level confuse and frustrate public health officials, the disease has proved just as mercurial at the clinical level..."

"...with doctors revising their understanding of COVID-19’s basic pattern and weaponry — indeed often revising that understanding in different directions at once."

"The clinical shape of the disease, long presumed to be a relatively predictable respiratory infection, is getting less clear by the week. Lately, it seems, by the day."

"As Carl Zimmer, probably the country’s most respected science journalist, asked virologists in a tweet last week, 'is there any other virus out there that is this weird in terms of its range of symptoms?'" https://twitter.com/carlzimmer/status/1253135696472276993?s=11

"You probably have a sense of the range of common symptoms: fever, dry cough, and shortness of breath. But while the CDC does list fever as the top symptom of COVID-19, as many as 70% of patients admitted to New York’s largest hospital system for covid-19 did not have a fever."

"As for shortness of breath, the estimate in the Brigham and Women’s treatment guidelines runs as low as 11 percent. The high end is only 40 percent, which would still mean that more patients hospitalized for COVID-19 do not have shortness of breath than do."

"That the ranges are so wide themselves tells you that the disease is presenting in very different ways in different hospitals and different populations of different patients...."

"...leading, for instance, some doctors and scientists to theorize the virus might be attacking the immune system like HIV does, with many others finding the disease is triggering the opposite response, an overwhelming overreaction of the immune system called a 'cytokine storm.'"

"For a while, ventilators were seen so much as the essential tool in treating coronavirus that shortages (and the president’s unwillingness to manufacture them quickly) became a scandal. But 80% of New York patients put on ventilators died. In China, the figure was 86%."

"Last week, scientists reported finding that the ability of the disease to mutate has been 'vastly underestimated,' and that “the most aggressive strains could generate 270 times as much viral load as the weakest type... These strains also killed the cells the fastest.'”

"That same day, the Washington Post reported on another theory gaining traction—that one key could be the way COVID-19 affects the blood of patients, producing much more clotting. 'Autopsies have shown that some people’s lungs are filled with hundreds of microclots.'"

"In a fantastic survey published April 17 ('How does coronavirus kill? Clinicians trace a ferocious rampage through the body, from brain to toes')... Science magazine took a thorough, detailed tour of the ever-evolving state of understanding of the disease..."

“'Despite the more than 1,000 papers now spilling into journals and onto preprint servers every week,' Science concluded, 'a clear picture is elusive, as the virus acts like no pathogen humanity has ever seen.'”

"In a single illuminating chart, Science listed the following organs as being vulnerable to COVID-19: brain, eyes, nose, lungs, heart, blood vessels, livers, kidneys, intestines. That is to say, nearly every organ."

"Heart damage was discovered in 20% of patients hospitalized in Wuhan, where 44% of those in ICU exhibited arrhythmias; 38% of Dutch ICU patients had irregular blood clotting; 27% of Wuhan patients had kidney failure, with many more showing signs of kidney damage."

"Half of Chinese patients showed signs of liver damage; and, depending on the study, between 20 percent and 50 percent of patients had diarrhea. In New York and Wuhan, between 14 and 30 percent of ICU patients had lost kidney function, requiring dialysis."

"On Saturday, the Washington Post reported that 'young and middle-aged people, barely sick with COVID-19, are dying from strokes.' Many of the patients described didn’t even know they were sick."

"These strokes, several doctors theorized, could explain the high number of patients dying at home—four times the usual rate in New York, many or most of them, perhaps, dying quite suddenly."

"According to the Brigham and Women’s guidelines, only 53 percent of COVID-19 patients have died from respiratory failure alone."

"It’s not unheard of, of course, for a disease to express itself In complicated or hard-to-parse ways, attacking or undermining the functioning of a variety of organs."

"And it’s common, as researchers and doctors scramble to map the shape of a new disease, for their understanding to evolve quite quickly."

"But the degree to which doctors and scientists are, still, feeling their way, as though blindfolded, toward a true picture of the disease cautions against any sense that things have stabilized, given that our knowledge of the disease hasn’t even stabilized."

"Perhaps more importantly, it’s a reminder that the coronavirus pandemic is not just a public-health crisis but a scientific one as well."

"And that as deep as it may feel we are into the coronavirus, with tens of thousands dead and billions in precautionary lockdown, we are still in the very early stages, when each new finding seems as likely to cloud our understanding of the coronavirus as it is to clarify it."

"In the space of a few months, we’ve gone from thinking there was no 'asymptomatic transmission' to believing it accounts for perhaps half or more of all cases..."

"...from thinking the young were invulnerable to thinking they were just somewhat less vulnerable..."

"...from believing masks were unnecessary to requiring their use at all times outside the house..."

"...from panicking about ventilator shortages to deploying pregnancy massage pillows instead."

"Six months since patient zero, we still have no drugs proven to even help treat the disease. Almost certainly, we are past the 'Rare Cancer Seen in 41 Homosexuals' stage of this pandemic. But how far past?" (x/x)