A Study about Covid-19 Pneumonia Patients
Last month, the Lancet described the patients sick with the Covid-19 that are confined at Wuhan Jinyintan hospital from January 1 to January 20, 2020. Of the 99 patients with Covid-19 pneumonia, 67 are men, and 32 are women. About half of patients infected by 2019-nCoV had chronic diseases, mainly heart and strokes, and diabetes.
Covid-19 is previously known as the 2019-novel Coronavirus or 2019-nCoV. It is novel because it is a new strain. New virus strains mean there is no immunity developed by anyone anywhere, which leads to rapid multiplication and spread of the virus and disease.
Covid-19 prefers to multiply in the lungs. As they increase, the body tries to fight back, and pneumonia develops. Most survive. Others do not. Especially the smokers.
Smoking
Smoking is a risk factor for cardiovascular and cerebrovascular disease. In China, 68% of men and 3.2% of women are smokers. That is from a study by Lancet in 2015. Based on this, we can infer that most of the men who got sick were smokers.
Why is smoking a big deal? What happens when someone smokes?
1. Covid-19 Sticks to Smokers Lungs More Easily
Before a virus causes damage to the lungs, it has to attach to lung tissue. Specifically, the alveoli. The alveoli are the smallest unit of the lung. They are responsible for oxygen and carbon dioxide exchange. The alveoli have ACE2 (angiotensin-converting enzyme 2) receptors. Receptors are where the SARS coronavirus and the Covid-19 sticks to. Once the virus sticks to the alveoli, tissue damage begins.
In an unpublished study called Tobacco-Use Disparity in Gene Expression of ACE2, the Receptor of 2019-nCov, done at the University of South Carolina, the investigators found that smokers have more ACE2 receptors in their lungs compared to non-smokers. The more the ACE2 receptors, the higher the chance of the Coronavirus adhering to a smoker’s lungs.
Noteworthy is that the investigators did not see any racial differences between the number of ACE2 receptors in their lungs.
2. Smoking Plus Covid-19 Equals Acute Lung Injury and ARDS
Tobacco smoke damages the inner lining of the respiratory tract. This prevents the body from mechanically clearing any virus that are inhaled. As the Coronavirus attaches to the alveoli, it allows fluid to abnormally enter the spaces that should be occupied by air for oxygen and carbon dioxide exchange. That is called acute lung injury.
Because fluid occupies the air spaces, there is no room for air and oxygen. The blood oxygen level then drops dangerously, even at high oxygen flow rates. The carbon dioxide also accumulates in the body to produce an abnormally acidic environment.
Acute lung injury can progress to ARDS or Acute Respiratory Distress Syndrome. Frequently, this necessitates inserting a tube down the throat to force air into the lung using a ventilator machine. Artificial ventilation usually requires several days of stay in the intensive care unit.
ARDS is the most common cause of death for the deadly coronaviruses SARS, MERS, and Covid-19.
Smoking is one factor that determines if someone will make it out of the Intensive Care Unite alive. It is part of the MuLBSTA Score that critical care doctors calculate to assess the risk and guides clinical decisions.
MuLBSTA Score means Multilobular infiltration, hypo-Lymphocytosis, Bacterial coinfection, Smoking history, hyper-Tension, and Age.
Smoking increases the MuLBSTA Score and predicts a high-risk patient who has a higher chance of death.
Going back to the study about the 99 patients in Wuhan that were admitted for Covid-19, here is what they say, the patients who smoked had a higher MuLBSTA Score and had a higher chance of death.
3. Smoking Leads to Heart and Lung Diseases
Smoking damages the blood vessels all over the body, including the heart. It also destroys lung tissue and leads to chronic lung diseases. Patients with heart and lung diseases have minimal reserves when severe illnesses like pneumonia happen. The heart and lungs cannot meet the high demands of a sick body.
In this time of uncontrolled Covid-19 epidemic, if you smoke or know someone who does, this may be a good time to quit.
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Don’t Get Sick!
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References:
- Chen et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet VOLUME 395, ISSUE 10223, P507-513, FEBRUARY 15, 2020
- Guoshuai Cai. Tobacco-use disparity in gene expression of ACE2, the receptor of 2019-nCov. Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208
- Carolyn S. Calfee, Michael A. Matthay, Kirsten N. Kangelaris, Edward D. Siew, David R Janz, Gordon R. Bernard, Addison K May, Peyton Jacob, Christopher Havel, Neal L. Benowitz, Lorraine B. Ware. Cigarette Smoke Exposure and the Acute Respiratory Distress Syndrome. Crit Care Med. Author manuscript; available in PMC 2016 Sep.
- Jeffrey Koplan and Michael Eriksen. Smoking cessation for Chinese men and prevention for women. Lancet, VOLUME 386, ISSUE 10002, P1422-1423, OCTOBER 10, 2015. Open AccessPublished: October 10, 2015DOI:https://doi.org/10.1016/S0140-6736(15)00416-X
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Maximillian Ragaller, Torsten Richter. Acute lung injury and acute respiratory distress syndrome. J Emerg Trauma Shock. 2010 Jan-Mar; 3(1): 43–51. doi: 10.4103/0974-2700.58663
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DrJesseSantiano.com does not provide medical advice, diagnosis or treatment
That unpublished study examined the tissue from the lungs of people who died from lung cancer, as was stated in the report, which they admitted could be a confounding factor. When I see young whites dying at the same rate as young East Asians, I’ll believe that this is an equal opportunity virus.