COVID-19 Cytokine Storm: Based on observations in the USA, Spain, Italy, France, and the UK, and from postmortem of lung involvement in COVID 19, all revealed pulmonary thrombosis, which is not typical ARDS. More alarming, was that patient hypoxemia was not responding to PEEP but high oxygen flow[1].

A Chinese scientist[2]  described the hypothesis of COVID 19, as methemoglobin, where COVID 19 virus structural protein, sticks to heme – displaces oxygen – which alters the iron-free ion, that leads to inflammation of alveolar macrophages which culminate to the systemic response ending in a cytokine storm. They suggested that free radical’s scavengers and iron-chelating agents if are added to the protocol of management might ameliorate the inflammatory response.

COVID 19, SARS2 is not ‘pneumonia’ nor ARDS. Invasive ventilation is the last resort, as emergency intubation from the Chinese, Italian and American experience had higher mortality, not to mention complications from tracheal scarring and stiff lung during the duration of intubation.  Furthermore, a new treatment protocol needs to be established in order to control the prolonged and progressive hypoxia of COVID19¹.

People are desaturating due to the failure of the blood to carry oxygen. This will lead to multi-organ failure and high mortality. The lung damage seen on CT scans is due to the oxidative stress released from the hemolysis red blood cells, which in turn overwhelm the natural defenses against pulmonary oxidative stress and cause Cytokine storm. There is always-bilateral ground-glass opacity in the lungs. Recurrent admission for post-hypoxic leukoencephalopathy fortifies the findings of the Italians, Spanish, and Americans³ that COVID-19 patients are suffering from metabolic hypoxia due to blood capacity failure.

The Chinese hypothesis² that had been publicized that the following cascade might explain the vicious circle theoretically that the patient goes through

1) Without the iron ion, hemoglobin can no longer bind to oxygen. Once the hemoglobin is impaired, the red blood cell is essentially none functioning in carrying and delivering oxygen to any tissues. This leads to the destruction of the red blood cells and the patient’s oxygen saturation levels drop significantly.

COVID 19 patients, unlike CO poisoning in which eventually the CO can break off, the affected hemoglobin is permanently stripped of its ability to carry oxygen where the body compensates by secreting excess erythropoietin to stimulate the bone marrow to secrete new red blood cells.

References:

[1] https://time.com/5818547/ventilators-coronavirus/

[1] COVID-19: Attacks the 1-Beta Chain of Hemoglobin and Captures the Porphyrin to Inhibit Human Heme Metabolism Wenzhong Liu 1,2,*, Hualan Li2