Is Coronavirus Lung and Heart Damage Permanent?

One of the things that you brought up that I wanted to discuss is the damage that this virus does to the lungs and to the heart as well. What there's scarring on people's lungs. Talk about that and what, if anything, can be done to try to heal those people post-infection. Well, so what happens is the virus gains entry into the deep passages of the lungs, all the airway spaces. And then it has, if you ever see a cartoon, a schematic drawing of a coronavirus, it looks like a little ball with spikes sticking out of it. And those spikes are called the S protein. And actually the vaccine that we're making interferes with the binding of a part of that S protein called the receptor binding, made for binding into the receptor. So it uses those spikes, the tip of the spikes to get entry to bind to the receptors in the lung, which is actually an enzyme called Nacetylcholinesterase and it gets into the lung cells. So the first thing that happens is a large amount of virus is getting into the lungs. And that triggers what's called the innate immune system, meaning your natural first line body of defense. And it signals something called toll-like receptors, which cause a lot of inflammation. And so you're seeing a big inflammatory response to the virus. So the two components are a lot of virus causing direct damage and then the host, all the inflammatory response. And that's one of the reasons why, you know, when I heard about hydroxychloroquine, I had some enthusiasm because it can maybe suppress the inflammatory component, whether it clinically has the ability to make a difference. I think the jury's still out yet. But so you've got those two things going on. The other thing that's happening besides, and that's causing severe lung disease, and there's all that inflammation. And it causes a condition known as ARDS, acute respiratory distress syndrome, where there's so much inflammation and scarring that it becomes difficult to oxygenate the lungs. And people go into shock because of this ARDS syndrome. So that's why a lot of people are dying. The other thing that happens, though, and we don't really understand the mechanism, is there's been a lot of reports. And by the way, you can, anybody can download this. There's this fantastic preprint server called BioArchive and MedArchive. It's put up by Cold Spring Harbor Laboratories. And I check it every morning. It's called BIORXIV and MedArchive is M-E-D-R-X-I-V. It's put up by Cold Spring Harbor Laboratories. So scientists have been great about sharing information. They're putting all their stuff up on these preprint servers. They're not peer reviewed yet, but just so we can get information into the hands of the scientists, and anybody could look at them. But one of the other things we're seeing with that is a lot of heart injury, whether people are having heart attacks because they're intubated in the ICU and under stress, and they're in shock so they're not perfusing the heart. Or, and we know that the old SARS virus, SARS-1, had the ability to go into the heart tissue and cause what's called myocarditis, actual infection of the heart. So it's really the heart and lungs that are getting knocked out. There's also some evidence that the virus can go into the intestinal tract as well. And so that could actually be a potential route of transmission, being fecal oral transmission as well. So this is why people are getting so hammered is this direct damage from the virus and the inflammatory component to the heart and the lung. Is there any understanding of what, if anything, can be done to try to heal these people post-infection, particularly like damage to the lungs? Yeah, I think, you know, there are, and there's a question of whether steroids actually help or hurt. Steroids are always a mixed bag because steroids can suppress inflammation and help the inflammatory component, but they also suppress the immune response to the virus. So you can have an increased number of virus particles potentially. So people are definitely looking into steroids, other anti-inflammatory drugs. But, you know, those who survive this, and fortunately most do, you know, you'll find that they'll probably tell you they've been hacking and coughing for a long time afterwards. And a lot of that is, and we see this with flu as well and other viral pneumonias, it's not because they're still infected with the virus. It's all that scarring. It takes the body a long time to remodel all the scar tissue and before the coughing stops. So we can anticipate that happening as well. Do we think it's possible to fully recover from this for people that do experience these lung scarring issues? Yeah, I think so, especially for younger people, for older people, you know, they may have some permanent pulmonary deficits, but we don't know. It's still too early in this epidemic to know. Is that a big part of what's going on? Is it just really too early for so many of these things, the treatments, the cures, dealing with the immune systems, finding out which people are genetically more predisposed to the virus? Just by time. And, you know, typically it can take years and years to figure all of this out. And we're all, you know, everybody's working overtime trying to make a contribution and figure this out. The great news is the data sharing among scientists has just been amazing. Everyone's, you know, putting aside their eco, putting all their stuff up on bio-archive, med-archive and the major journals are doing incredible things. There's also expediting publication of paper. So, you know, the flagship journals like New England Journal of Medicine, Lancet, JAMA, they're all putting that stuff out there as fast as they can, you know, ensuring quality and a level of peer review are plus family journals, public library science. So, you know, if you look at the good stories that are happening around this, definitely the data sharing, the, you know, journals not conducting business as usual, recognizing that their, the stuff that they're publishing could be life-saving and responding to a public health crisis. I think that that's been a nice part of the story.