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COVID-19: A tale of two conditions


AS COVID-19 CONTINUES TO CAUSE HAVOC AROUND THE WORLD, STEVE WALTON, MSC, FIBMS, TELLS SP HOW THE VIRUS AFFECTS PATIENTS…


T


he virus coronavirus SARS CoV- 2 (severe acute respiratory syndrome coronavirus 2) which


causes COVID-19 may have been named prematurely. As more has become known about the infection, the severe disease does not appear to be a respiratory syndrome at all. Patients, who only have a respiratory illness, tend not to have a severe condition, while patients who develop a severe condition tend to have non- respiratory conditions, primarily thrombotic or hyper-immune states. Why should this be?


Although scientists and clinicians still do not fully understand what COVID- 19 does to a patient, several facts have emerged over the last six months that at least allow us to speculate, or allow the scientists to hypothesise about what is happening.


42 - SCOTTISH PHARMACIST


It appears that, when first infected with the virus, patients suffer no symptoms (asymptomatic) for the first 48 to 72 hours. During this period, they are contagious and capable of spreading the infection to others. After this initial lag phase, the patient then progresses down one of two paths: either they remain asymptomatic or they develop a cough and fever which may require them taking to their beds as with flu.


The patients who remain symptom free pose a large threat to the rest of the population, as they tend to carry on with normal life; unaware that they are passing on the virus to people they meet; on the bus, at the shops, at work, in the park etc. Identifying these carriers is difficult and requires back tracing from patients who develop symptoms.


Patients who develop symptoms again divide in to two groups, those who, after nine or ten days, start to get better, and those who, after nine to ten days, get markedly worse. The patients, who start to improve after this time, tend to fully recover like after flu.


Up to this point patients can be classed as having one condition - a respiratory illness - albeit not acute. It is the patients who deteriorate after about a week to ten days, who develop a second condition.


This second condition, although initiated by becoming infected with SARS Cov-2, does not appear to be directly related to viral activity, but is more probably due to the patient’s body being unable to control its defence mechanisms.


When a human body becomes infected, several distinct but interactive defence systems are activated. These include the coagulation system; the immune system - both cellular and chemical - the complement system (a system which can puncture bacteria) and a little known or understood system called the Kinin-Kallikrein system, which controls inflammation, blood pressure control, coagulation and pain. All of these systems are delicately controlled by a series of activators or inhibitors, which work through a series of positive and negative feedback loops to by and large maintain the status quo for the body to continue to function.


If the balance of any of these systems is disrupted, there are serious consequences. Haemophilia - an


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