Two Phases


Anchor lead: COVID-19 disease seems to have more than one phase, especially in those who have severe illness, Elizabeth Tracey reports

COVID-19 disease is so mild in some that they show no symptoms, while those who go on to develop severe disease seem to have at least two phases to the illness. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, comments.

Garibaldi: I think it probably is true that there’s the initial injury that happens because of the virus replicating, directly damaging the epithelial cells and other parts of the body, and then there’s the immune system’s response to it. Whether or not we find out down the road if there’s even some component of autoimmunity, that’s driving some of the inflammation we’re seeing after initial injury, I think that remains to be seen. But it certainly would make sense that in that setting, an anti-inflammatory like a glucocorticoid, could potentially shut down that secondary inflammation, and calm things down.  :29

Garibaldi says this observation may explain why the patients who seem to benefit from dexamethasone treatment are those with severe disease requiring mechanical ventilation, while those with more mild disease didn’t, as a recent study found. At Johns Hopkins, I’m Elizabeth Tracey.