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COVID-19 cytokine storm: Possible mechanism for the deadly respiratory syndrome

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Research into how the SARS-CoV-2 virus induces death is suggesting potential treatments for its most destructive complications.

Leading immunologists in Japan are proposing a possible molecular mechanism that causes a massive release of proinflammatory cytokines, or a cytokine storm, leading to the acute respiratory distress syndrome (ARDS) in COVID-19 patients. Their suggestions, published in the journal Immunity, are based on recent findings that explain how SARS-CoV-2 enters human cells.

ARDS is a life-threatening condition in which lungs become so inflamed and filled with fluid that they struggle to provide enough oxygen to the body. “To rescue the patients from this condition, it is vital to understand how SARS-CoV-2 triggers the cytokine storm, that leads to ARDS,” explains Masaaki Murakami, the head of immunology laboratory at Hokkaido University’s Institute for Genetic Medicine.

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Murakami, together with his collaborator Toshio Hirano from the National Institutes for Quantum and Radiological Science and Technology, reviewed two recent studies by Zhou et al. and Hoffmann et al. in order to understand their implications for finding effective therapeutic strategies for ARDS in COVID-19 patients.

Together, the studies suggest that SARS-CoV-2 enters human cells by attaching to a cell surface receptor called ACE2 and utilizing a human enzyme called TMPRSS2.

“Drugs that block the ACE2 receptor or that inhibit the enzyme could help treat the initial stages of the disease,” says Murakami.

“However, ARDS with cytokine storm starts to appear in the later phase of infection even when the number of virus decreases. So, there must be another pathway that causes the cytokine storm.”

SARS-CoV-2 is known to be engulfed into the human cell along with the ACE2 receptor it had combined with.

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“This reduces the number of ACE2 receptors on cells, leading to an increase of a polypeptide, called angiotensin II, in the blood,” says Murakami. Angiotensin II triggers an inflammatory pathway involving NF-κB and IL-6-STAT3 particularly in nonimmune cells including endothelial cells and epithelial cells.

“This pathway forms a positive feedback cycle, named IL-6 amplifier, resulting in its excessive activation and therefore the cytokine storm and ARDS,” says Hirano, a pioneer in IL-6 research.

“Part of this pathway involving NF-κB or IL-6-STAT3, or the both, is enhanced with age, which could be why older people are more at-risk of death following COVID-19 infection compared to other age groups,” explains Murakami. “Targeting these pathways, such as with the anti-IL-6 receptor antibody called tocilizumab, could disrupt this life-threatening inflammatory reaction in COVID-19 patients,” Hirano added.

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Doctors down tools, abandon COVID-19 patients in Ondo

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Medical doctors at the Infectious Disease Hospital, IDH, Akure, Ondo State have stopped attending to patients admitted at the facility.

The development followed the increasing figures of confirmed COVID-19 cases in the Sunshine State.

The doctors under the aegis of the National Association of Government General Medical and Dental Practitioners, NAGGMDP, blamed the state government led by Rotimi Akeredolue, on the manner at which the COVID-19 pandemic was being handled in the state.

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Newsmen observed that IDH is where patients with infectious diseases such as LASSA fever and COVID-19 are treated.

The State Secretary of NAGGMDP, Dr. Olasakinju Tunde, who announced the doctors’ withdrawal of service in a statement made available to DAILY POST on Monday, said it was due to failure of the government to accede to their demands.

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The association hinged their reason on government’s failure to conclude negotiations on the erstwhile suspended Minimum Wage and Consequential Adjustments already enjoyed by the Non-Medical Staff Since January 2020, inadequate supply of personal protective equipment (PPE) and the general welfare of our members which include Life Insurance for frontline doctors.

The doctors had during a congress requested that members who are the COVID19 specialists at the IDH continue to work till Thursday morning, 2nd July 2020 in the interest of the general public and particularly confirmation of the COVID19 Status of Mr. Governor.

MORE READING!  Doctors down tools, abandon COVID-19 patients in Ondo

Following the non-compliance with the earlier directive, the association directed that “it is imperative that our members be withdrawn immediately (from midnight today 6th July 2020) due to lack of the human face expected from the government.”

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COVID-19: Kwara, NCDC train healthcare workers

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The Kwara Government in collaboration with the Nigeria Centre for Disease Control (NCDC) has organised training for healthcare workers across the state on COVID-19 prevention measures.

Dr Fakayode Oluwatosin, the state Director of Public Health, Ministry of Health, during the training on Monday in Ilorin said it was aimed at sensitising health workers from public and private hospitals in the state on COVID-19.

He said the training tagged:

“Train the Trainers Workshop”, would also assist participants on how to attend to patients without discrimination and sceptical thinking.

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According to him, the trained health workers are expected to also organise a step-down training for their staff on COVID-19 prevention measures.

Fakayode enjoined participants to ensure they organise step-down training in their respective healthcare centres and hospitals.

He said this would adequately equip other health workers in the state with the necessary measures to observe while attending to their patients.

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Also, the NCDC team leader, Dr Ita Okonkwo, commended the Kwara Government for inviting the centre to conduct the training.

He described the training as very apt, as the Federal Government was gradually expanding the reopening of the economy.

According to him, NCDC is doing all within its power to ensure the safety of all Nigerians.

Dr Abdulrasheed Odunola, the Director of Health Services, University of Ilorin, also commended the State Government for the training.

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He said the training was well detailed and important to healthcare providers, considering the state of healthcare in the country, which he described as a trying moment for the country.

He said that the Vice-Chancellor of the University of Ilorin, Prof. Sulyman Abdulkareem, had also given the go-ahead to the university’s health services to organise a step-down training for its staff.

 

 

 

 

 

 

 

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2,430 virus patients decline showing up for treatment

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The fear of the further spread of the COVID-19 pandemic has heightened following refusal by 2,430 people, who tested positive, to report at the isolation camp or present themselves for treatment.

In a series of tweets at the weekend, Lagos State Commissioner for Health Prof. Akin Abayomi said:

“Two thousand four hundred and thirty active cases in the communities are yet to turn up for admission in care centres, either due to fear of stigmatisation or preference for home care treatment.”

The commissioner added that 42,348 tests had been conducted in the state till date, of which 10,926 turned out positive.

“Of the confirmed cases 1,695 patients have since been discharged from care centres following full recovery.

“Six thousand two hundred and fifty-nine of the cases monitored in communities by #COVID19 Lagos response team have either fully recovered or positively responding to treatments.

He added:

“As at July 3, the number of COVID-19-related deaths in Lagos State had risen to 177.”

Lagos is the epicentre of the pandemic in the country.

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Besides, 11 of the 20 local governments in the state are among the 18 local governments across the country carrying over 60 per cent of the cases.

Prof. Abayomi admonished Lagosian that the time to take responsibility is now.

He urged residents to observe physical distancing and regularly wash their hands.

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Abayomi also advised residents to stay at home when unnecessary to go out, adding that they should wear face masks when going out to reduce the risk of infection.

The state has criminalised non-wearing of face masks from this week, according to Governor Babajide Sanwo-Olu.

In a statement on Sunday, he said:

“Remember, it is now a criminal offence in Lagos State to go out without using a facemask. Let’s continue to adhere strictly to all public advisories given by government #ForACOVID19FreeLagos.”

He also announced the discharge of 45 patients — 18 female and 27 male including four foreign nationals from Isolation facilities to reunite with the society.

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The patients; 19 from Eti-Osa (LandMark) 11 from Onikan and 15 from LUTH Isolation Centres were discharged after full recovery and testing negative to COVID19.

“This brings to 1740, the number of #COVID19 confirmed cases that have been successfully managed and discharged from our isolation facilities,” he explained.

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