Hacker News Reader

Comment by DocSavage | Hacker News Reader

Stage of disease also is important. In the first symptomatic stage, makes sense to try antivirals and HCQ to reduce or eliminate the virus, and prevent a cascade into the next stage. The problematic second stage - ARDS, a subset of patients who really go critical, seems to call for different approach because at that time, it’s the cytokine storm and our own immune reaction killing us.

View on HN

Cytokine storm is generally observed with young patients. Their immune system is "too strong for their own good".

My understanding is that most deaths are in the elderly, and that those deaths are due to pneumonia.

source on cytokine storm age differences? all resources I can find indicate that it's more prevalent in older patients.

Either of you have links on this?

That's my understanding too, younger ones get it harder.

If this helps https://en.wikipedia.org/wiki/Cytokine_storm

"It is believed that cytokine storms were responsible for the disproportionate number of healthy young adult deaths during the 1918 influenza pandemic, which killed 50 to 100 million people.[16] In this case, a healthy immune system may have been a liability rather than an asset."

Do you have a source for the last part?

A good synopsis of current understanding (as of last Friday) was a UCSF Medicine Grand Rounds broadcast. I've bookmarked the most relevant slide to our discussion in particular: https://youtu.be/bt-BzEve46Y?t=2349

Significant lung and myocardial injury and papers have honed in on ARDS as a real problem.

This is a wonderful resource. Thank you for pointing it out.

Not OP, but here's a Lancet correspondence on the topic (includes references):

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

Last night I watched a YouTube video about COVID-19 symptoms and stages of the disease and it did touch on the points brought up by OP.

Could you share the url ?

Not GP but this video gives a good overview: https://www.youtube.com/watch?v=BtN-goy9VOY

Maybe OP is referring to this one?

https://www.youtube.com/watch?v=BtN-goy9VOY

This is specifically the video I watched yesterday.

https://www.youtube.com/watch?v=OOJqHPfG7pA

oh I should have guessed :)

if you want some interesting details from American MDs there's this podcast

http://www.microbe.tv/twiv/twiv-593/

lots of subtle details that you can't get on simplified stats

This doesn't need a source. It's common clinical knowledge and OP is right. Unfortunately, preliminary results using our usual immunomodulatory drugs have been catastrophic.

No, sorry, you still need a source. In fact cytokine storms aren't the only driver of pneumonia and we don't know yet exactly what the mechanism(s) behind ARDS is. Immunology is outrageously complicated, and not well suited to that kind of pronouncement.

You just have to do the science, there's no way around it. And realistically we may not have time.

I will reformulate, then.

In the current state of knowledge about both ARDS and Covid and given the time available, clinicians rely on traditional teachings to care for covid-related ARDS until solid evidence can be provided.

Reply on news.ycombinator.com