Feature

How does the Wuhan coronavirus cause severe illness?


Allen Cheng


6/02/2020 4:29:20 PM

There are four key ways the virus can cause severe disease, some of which can occur at the same time.

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While around 2% of those infected are reported to have died, the true mortality is unknown.

We usually think of viral respiratory infections, like the common cold, as mild nuisances that pass in a few days. But the Wuhan coronavirus has proven to be different.
 
Around 2% of those infected are reported to have died, but the true mortality is unknown.
 
There is much we are yet to learn about this new virus, but we know it often causes pneumonia.
 
Of the first 99 people with severe infection, three-quarters had pneumonia involving both lungs. Around 14% appeared to have lung damage caused by the immune system, while 11% suffered from multi-organ system failure, or sepsis.
 
Others are at risk of complications from being treated in hospitals, such as acquiring other infections.
 
At this stage, we know some people develop only a mild infection, while others become critically ill, but the exact proportion of each is not yet clear.
 
Overall, there are four key ways the Wuhan coronavirus can cause severe disease – and some can occur at the same time.
 
Direct viral damage
For the SARS (severe acute respiratory syndrome) coronavirus, direct viral damage was probably the most common way the infection caused disease. This is likely the case with the Wuhan coronavirus.
 
Early studies have found the Wuhan coronavirus attaches to a particular receptor found in lung tissue. This is like a lock-and-key mechanism allowing the virus to enter the cell, and is the same receptor the SARS coronavirus used.
 
Viruses ‘hijack’ the host cell’s mechanisms to make more copies of itself. Damage results from either viruses taking over the cell completely and causing it to die, or immune cells recognising the viral infection and mounting a defence, triggering cell death.
 
If large numbers of cells die, then the affected organ cannot function effectively.
 
Studies from patients who died from SARS coronavirus showed the virus caused damage to not only the lungs, but also other organs in the body. Early research suggests the Wuhan coronavirus can also damage other organs, including the kidneys.

Pneumonia
While we are still piecing together the relationship between the Wuhan coronavirus and pneumonia, there is much we can learn from influenza.
 
Influenza is a virus but it commonly leads to bacterial pneumonia – a secondary infection.
 
It is thought the influenza virus weakens the usual protective mechanisms of the lung, allowing bacteria to establish and multiply. This is especially true in children, older people and those with compromised immune systems.
 
Secondary bacterial pneumonia is more severe than influenza alone – around 10% of hospitalised patients with influenza and pneumonia die, compared to around 2% of those who do not have pneumonia.
 
The Wuhan coronavirus appears to cause pneumonia in two ways: when the virus takes hold in the lungs and through secondary bacterial infections; however, the first way appears to be more common.
 
Sepsis
Sepsis is a serious condition that can be caused by many infections.
 
When we get an infection, we need to mount an immune response to fight off the pathogen. But an excessive immune response can cause damage and organ failure. This is what happens in the case of sepsis.
 
Although it can be difficult to determine whether organ damage from the Wuhan coronavirus is a result of direct viral infection or indirect ‘collateral damage’ from the immune system, initial reports suggested around 11% of people severely ill with the Wuhan coronavirus experienced sepsis with multi-organ failure.
 
So far, no drugs or interventions have been able to dampen this immune response. Although several treatments have been proposed for Wuhan coronavirus, none has yet been shown to work.
 
Complications of hospital care
Patients who require hospital care may have complications. These include infections from intravenous lines or urinary catheters, pneumonia, or non-infectious complications such as falls or pressure sores.
 
Studies have found 10% of patients in hospital have some sort of healthcare-acquired infection, and around 5% have a pressure sore.
 
Hospitals work hard to try to prevent these complications, by making sure healthcare workers disinfect their hands and other equipment. However, complications still occur, particularly in patients who are debilitated from long hospital stays.
 
While most respiratory viral infections are mild, some can trigger serious complications, either directly or indirectly. It is too early to tell how often this occurs with the Wuhan coronavirus. While we have initial data on those who were severely affected, many others may not have required medical care.
 
This article was first published in The Conversation. Read the original article. The Conversation



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A.Prof Christopher David Hogan   7/02/2020 9:41:14 AM

I was involved as a GP, a flu researcher & in pandemic planning for many years & there is little news in what is so succinctly elucidated here in hospitalised patients. However, only a fraction of those infected are hospitalised.
It is incredibly frustrating that in the initial phase of response to large scale infections that there is much confusion, conflicting information & uncertainty.
Facebook & the twitterververse are full of a diversity of statements of very variable
reliability what people do not know, they make up.
So in the face of such chaos it is almost disconcerting when we have such detailed clinical reports. It leads us to expect that there is someone out there who has all the answers that grassroot GPs need. Errh no
There is much to learn & we need forums to share our learnings as GPs deal with amazing challenges. To paraphrase "our answers are no found in our star (performer)s but in ourselves".


Dr Greg Saville   7/02/2020 9:57:17 AM

Does 2019-ncoV cause pneumonia or ARDS? These are quite different entities with different approaches to treatment. I understand it causes ARDS and not pneumonia.


Dr Mark Robert Miller   7/02/2020 11:05:02 AM

Our colleagues at the Hong Kong College of family physicians have a succinct hyperlinked page last updated on the 30th Jan with links to various reference material updates for those wishing to read more.
http://www.hkcfp.org.hk/