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Comment by sgtnoodle | Hacker News Reader

Lol, I've been saying this since July. Severe covid is due to organ inflammation from overaggressive immune system response, and nicotine is an immune system suppressant. The one episode of Dr. House where is was actually sarcoidosis (a systemic inflammatory disease), the patient didn't have any symptoms because of his use of chewing tobacco to manage his weight for wrestling.

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You'd probably be interested in

https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9...

This paper points out that patients on infliximab (trade name Remicade: immune system modulator used by people with chronic autoimmune diseases, particularly IBD and rheumatoid arthritis) don't seem to be at elevated risk of severe COVID – which is surprising because these are powerful immune system suppressants.

I had to start taking immunosuppressants earlier this year, and after reading up on it I've convinced myself that it's an effective treatment for severe covid. As it happened, I essentially had a severe covid experience, but for auto-immune/ideopathic reasons. It's like my body had 2020 FOMO.

All diseases cause inflammation, it's the bodies basic response to everything, like cuts and whatnot. That said, this may also be why they figured out certain steroids helped COVID patients by reducing this hyper reaction. I rememebr reading some steroids became a frontline treatment at some point mid way through the year at certain medical centers.

But any pathologist would have known immediately about the risks of inflammation and that being the auto-response. It would have been evaluated is what I'm assuming.

I have colitis which similarly causes artificial immune response in the digestive tract and they used steroids to help reduce the inflammation which was causing other serious problems in my body. But only during a very serious episode. Other lighter approaches are available to keep it under control.

Note: I'm not a medical expert at all and could be talking out of my ass. Just basing this on personal experience and some personal reading into pathology.

For sure, but severe covid seems to involve a disproportionate amount of inflammation that itself causes organ damage. I think the medical term is a cytokine storm?

Indeed. It appears Cytokine Storms [1] are a big threat with Covid-19.

[1] https://en.m.wikipedia.org/wiki/Cytokine_storm

Do we currently have no medications that can stop that inflammation from occurring?

Corticosteroids, hydroxychloroquine, methotrexate, and I'm sure dozens of others. Immune system suppression isn't something one should do without supervision of a doctor, though. Notably, most effective drugs have non-trivial side effects or cause their own long term damage.

I am not the right sort of doctor, and you should ask a medical professional. My knowledge comes from very out-of-date experience working in a computational drug discovery lab, which gives one a very narrow view of a very small number of things.

Seriously, ask a doctor, but these might give you starting points for the discussion:

This is a very high-value part of pharma research, because inflammation is at the root of a lot of lifelong chronic disease and is basically only manageable rather than curable. But because inflammation is a systemic response, all drugs which modulate the immune system are serious business.

For short-term use: corticosteroids (eg prednisone), and I think best-current acute Covid pneumonia protocols involve quite a lot of these, particularly dexamethasone (https://www.covid19treatmentguidelines.nih.gov/immune-based-...). Corticosteroids are extremely powerful drugs. Some of them are used topically for acute local inflammation (hydrocortisone is the best known of those and is available OTC from pharmacists for rashes), but that's basically the only context you're likely to encounter them taken as lightly as, eg, aspirin or acetaminophen.

Long-term use; there are some small molecules, eg methotrexate, which modulate the immune system – hydroxychloroquine is one of these used in lupus treatment, but there is plenty of evidence that it harms rather than helps in the Covid case.

That leaves you some of the second-line treatments used for chronic immune system diseases like rheumatoid arthritis, Crohn's disease, and ulcerative colitis, and there the Lancet paper I linked up-thread suggests these may have some utility/protective value against Covid, found by studying correlations in patients undergoing these therapies for pre-existing conditions.

But: these are not easy options. They're "biologics" (big proteins). You've had or know people who've had some of these. The ones you've probably encountered are vaccines and insulin, but the big growth area has been monoclonal antibodies. Some of these can directly modulate specific signalling pathways, particularly inflammation pathways, which is why they are effective against the diseases of systemic inflammation above. But: these drugs are extremely expensive to develop (so the US prices are ungodly high), difficult to transport, store and deliver - often requiring IV infusion (I think Humira has a self-injectable formulation, but none of them are oral medications) - and have systemic side effects basically by design.

Two new monoclonal antibody therapies of this class have US EUAs (emergency use authorizations) for Covid; https://www.fiercepharma.com/pharma/regeneron-following-lill.... One of them (the Regeneron one) is the one Donald Trump had.

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