Rx REPORT: How COVID-19 can damage lungs

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By Marie Y. Lemelle, Contributing Writer

As a radiologist for the Medical Center Radiologist serving the Sentara Hospital System and Bon Secours Hospital System, Dr. Jose Morey is an integral part of the care team that helps manage COVID-19 patients.

“Since the onset of the virus, our practice has seen hundreds of patients admitted in our hospital systems,” Dr. Morey said. “Unfortunately, too many patients to personally count.”

Dr. Morey help with the placement of percutaneous drains in the sickest patients who require fluid to be drained from their lungs. The care team evaluates the patients’ progress every day through sequential imaging, typically chest radiography and computed tomography (CT) or magnetic resonance imaging (MRI) for patients that have manifestations outside of the lungs.

The World Health Organization states that coronavirus, an infectious disease, primarily attacks the lungs. Some of the ways that the virus penetrates the lungs occur when viral particles pass through interconnected air ducts especially between older apartment units and talking face-to-face with someone who is not wearing a protective face mask and the possibility of inhaling contaminated air which is why the six-foot social distancing rule is critical.

Dr. Morey, who is also an artificial intelligence expert, talks about how COVID-19 can damage the lungs.

ML: How common has COVID-19 caused inflammation and infection in the lungs?

JM: For some people, inflammation and infection can be minor or not at all. In most cases where people may have pre-existing conditions such as obesity, diabetes, high blood pressure or other co-morbidities, the lung damage is like bacterial pneumonia. A dangerous infection replaces large portions of the lung and fluid can accumulate in the lungs.

In these cases, the patient will have difficulty with breathing that can result in being transferred to the ICU and placed on a ventilator to help them breath. Even when people recover, there is long-term damage and scarring in the lungs.

ML: What has changed with the COVID-19 symptoms from three months ago that you have seen?

JM: In radiology we often see all the manifestations of the coronavirus through our imaging lens. We see the ground glass opacities in the lungs or the confluent lung damage and fluid buildup. We can even catch the diagnoses, even when there may be a false negative blood test.

We provide different treatments for patients. As time has passed and more data and studies are performed, we know that certain treatments and preventions work. We know that masking has shown to make a difference as well as social distancing. We have seen that Remdesivir, an intravenous drug, can decrease mortality and length of stay by a statistically significant margin.

We have seen that Dexamethasone and other steroids appear to reduce mortality by a significant margin in the most severe cases. We are understanding how to better manage the most severe cases through appropriate mechanical ventilation.

Originally, it was believed that it was just a respiratory pathogen that affected the small airways. Therefore, we were mainly looking for pneumonia-type symptoms or upper and lower respiratory symptoms. We now know that the onset presentation can be diverse and affect multiple organs. Some patients present with GI symptoms particularly if the pathogen entered through the gastrointestinal tract. Patients can present with a plethora of clotting disorders and vasculopathies, which can lead to deep vein thrombosis (clots in the venous systems such as in the legs), heart attacks, strokes, brain infections, COVID toe or end organ damage.

ML: Explain COVID toe and end organ damage.

JM: COVID toe is a red blotch, almost like a rash, that happens in some patients who are infected with COVID. It doesn’t happen to everyone. We believe it occurs mainly due to the inflammation in the small arteries in the toes that COVID can cause and in clots in the vessels. This causes a red appearance to the skin in the toes.

End organ damage, similar to the inflammation and clots that COVID can cause in the vessels in the toes, can occur in the vessels in other organs such as the heart, brain and kidneys. Therefore, some people with COVID present with clots in their lungs and legs. Some clots can affect kidneys, brain, liver, and other organs.

Just like the heart can have damage from a clot which can cause a heart attack, other organs can have similar types of damage. When you have a clot, oxygen can’t get to the tissue and that can cause damage.

ML: What is most alarming to you about COVID-19?

JM: Anyone at any age can be infected with this disease and can face serious short-term and long-term sequelae, meaning a chronic condition that is a complication of an acute condition that begins during that acute condition.

Our patients in the hospital are getting younger. Initially, patients were the average age of 50s and 60s but now they are in their 20s and 30s. The youngest patient I saw that required emergent tracheostomy (tube in their throat) due to respiratory failure was in their 30s.

Marie Y. Lemelle, MBA, is the founder of www.platinumstarpr.com and a film producer. She can be reached at MarieLemelle@platinumstarpr.com. Follow her on Instagram @platinumstar.


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