What is normal progression of chronic diseases? Chances are high that its due to viral infiltrates or systemic factors but scientists have struggled to determine which of these processes are responsible for the vast majority of lung disease progression in sickest COVID-19 patients. Now methods to identify viral circulating factors and their effect on the propagation of the common but frequently severe infection are described in a study by researchers at the Perelman School of Medicine at the University of Pennsylvania. Now that findings will be available to the scientific community worldwide. The studys corresponding author is Herbert S. Gutman MD PhD of the Department of Sports Medicine Penn State Health and the James C. McDonnell Department of Dermatology and colleagues.

In the study published June 2 in Nature Communications scientists identified possible viral and cell-cell (cell non-immune) factors involved in COVID-19 lung disease. When the study was performed hospitals around the world were reporting hundreds of patients getting lung transplants. The patients with COVID-19 are not immune. They were received either non-leukimically damaged or a fully functioning airway. What surprised the researchers was that in sickest cases the viral load was the same regardless of whether the airway was completely normal or if there were scarring to the outside of the airways. So far researchers have not been able to determine a linear progression of COVID-19 lung disease progression due to viral infiltrates or systemic autoimmune diseases.

We were surprised this quickly said Gutman who is also director of the Penn State Sports Medicine Program for Paediatric and Peripheral Allergic Disease. When we started doing this work we had up until now been unsure as to how common severe and often catastrophic viral infections on the lungs happen.

Sudden Whooping Injuries.

Right now we are seeing a huge increase in cases of sudden whooping in the lungs of COVID-19 patients in critical care settings studied Gutman. Sudden in-hospital death due to a missed drug dose is a common occurrence for COVID-19 patients. Remarkably most (96) of the deaths were either due to viral pneumonia or drug-induced hyperglycemia. However based on this chart it appears the number of viral in-hospital deaths could be much larger as well as the possibility of other issues.

Pathophysiology of Lung Disease Fibrosis.

Though the capillaries and lymph nodes are easily affected by viral infections gut and spine have the least affected skin system and the front region of the lung is also relatively spared. However the patients with COVID-19 rarely show such symptoms even in hospital intensive care units.

Stunningly the researchers also noted a striking difference in the progression of chronic obstructive pulmonary disease (COPD) in relation to companion viruses. About 75 of COPD patients hospitalized with COVID-19 showed leakage from the alveoli leading to loss of airway barrier function. Similar findings were observed in patients with end stage renal disease an incurable disease of the kidneys. Both findings are very important for patients who may be able to keep their COPD on a needle.

An important concern Gutman said is the possibility of chronic inflammatory and autoimmune lung diseases (CALCR) affecting the integrity of the airways. We have no current therapies to affect major lung endothelial cell (ELc) cells migrating into the lungs and causing this cell damage. In theory CAR-T cells could be developed he said. But as with all personalized medicine approaches many factors from family history to genetic predisposition to inflammatory diseases need to be taken into account said Gutman.

With the current study scientists believe they can identify and distinguish COVID-19 cells with virus-specific expression of their COVID-19 Antibody Proteins9103336383940414243444546474855506507ethe SARS-CoV-2-specific virus-specific expression in the alveoli and viral loads in the spleens with a specific viral strain. With these markers in hand they said they can filter some patients who are infected less frequently such as COVID-19 patients with less advanced disease as they might distinguish some people who are more severely ill and who may never develop a positive infection from those who could have a mild infection.

Two basic processes can assist in that Gutman said. The first is excretion of