Short Wave - The "7 Day COVID-19 Crash"

Episode Date: April 10, 2020

Some patients with COVID-19 are experiencing a crash after about a week of showing symptoms of the disease. The cause?Well, as NPR's Geoff Brumfiel explains, doctors are starting to think it might not be the virus.For more reporting on the coronavirus and other science topics, follow Maddie and Geoff on Twitter. They're @maddie_sofia and @gbrumfiel.Email the show at [e-mail] pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences.NPR Privacy Policy

Oh, okay, so good news is that it's sounding way better. Bad news is there is a considerable amount of rust in my microphone. Wait. What do you mean in the microphone? I don't know. What's the producer? Like, it's butt part. The XLR cable.

Like in its butt, like in the little prongs. You're listening to Shortwave from NPR. Maddie Safai here. And today I'm joined by science correspondent Jeff Brumfield. Hi there, Maddie. Hey, Jeff. So you've been looking into a really. puzzling feature of some cases of COVID-19.

Yeah, I don't think there's really a medical term for it, but we'll just call it the seven-day crash. Basically, what happens is this. When somebody gets COVID, at first they may not feel sick at all. But pretty soon, most people start to develop these symptoms we've been hearing about. Fever, chill, maybe a dry cough. And this stuff can go on for days, and it can get pretty bad. But for a subset of these patients, they may start to feel a little better like they're turning a corner. And then suddenly they get worse.

Their lungs start to deteriorate really quickly. And they can end up in the ICU on a ventilator or even dying. And what you found in your reporting is that in some of these cases, it might not be the virus directly that's causing this crash. That's right. It may actually be the immune system. an overreaction to this deadly virus that makes people even sicker. So today on the show, we're going to talk about why some people with COVID-19 go downhill so quickly and how a certain set of drugs might be able to help.

Okay, Jeff, so we're talking about how the immune system can make some cases of COVID worse. Where do we start? Well, I think we should start with a disclosure, which is that you're the one with a PhD in microbiology and immunology, and I, on the other hand, report on stuff like nuclear physics. This is not my strong suit. But, Jeff, you are trying so hard and you've learned so much. Well, I have. I've learned a lot.

I mean, like every other reporter in NPR, I've been drafted into covering the coronavirus. And as I started talking to doctors, I started hearing about this sudden seven-day crash that we are talking about. We do see a kind of variable course where some people, they come in, they get, better, and then they go home, and then there are others who come in, they get stabilized, okay, and they may do okay, but then they worsen again at about the five to seven-day mark. So that's Michelle Ngong. She's chief of critical care at the Montefiore Medical Center in the Bronx. She's right there on the front lines. And in some of these patients, we're seeing very high fever is as high as 109.

Wow. At 109? Like, I legitimately didn't know that that was possible. That's like 42, 42 degrees Celsius? That's no joke. No, and a lot of these patients end up on a ventilator and some don't make it. So I started looking into what's going on. Like, as I said, I'm a physics nerd, not a biologist.

And as someone who doesn't really know this stuff, it just seemed weird that people could stabilize, maybe even start to feel better for little while, and then suddenly have such a catastrophic term for the worst. And pretty soon, I started hearing this term from researchers and doctors. Some of these patients, they think, are suffering from something called a cytokine storm. Yes, cytokine storm. Okay, fun fact, for a not-fun situation, Jeff, cytokine storm was almost the name of my immunology department softball team. I honestly didn't know there were enough immunologists out there to have like a softball league. Okay. There are many of us, and we're very athletic, surprisingly, I'll say. Uh-huh, uh-huh.

Well, look, since you're the one who knows about cytokine storms, why don't you explain it? Okay, okay. So basically, and I mean, basically. Basic is good. Yes. When the body gets infected by a virus, your immune system is activated. And sometimes the first immune cells on the scene, they need backup. And so they release these little messenger proteins called cytokines. It's like a little cry for help that brings other immune cells in to fight the infection, like T cells, for example, white blood cells that are particularly good at killing cells infected with virus. You still with me, Jeff? Yeah, yeah. So basically, you're just saying that like the cytokines are like the key to how all these immune cells talk to each other.

Basically, yeah. Normally the coordination of these little signals, these cytokines are really, really tightly controlled. But sometimes, for reasons that we don't totally understand, immune cells kind of get stuck in this cycle, putting out more and more cytokines, calling more and more other immune cells to an area. Lots of inflammation that in this case really messes up your lungs and makes you even sicker than you were before. Right. And, you know, an immunologist that I spoke to, Jessica Hammerman at the Beneroria Research Institute in Seattle. It's been my lifelong dream. to be on NPR. She laid out this nice analogy.

Imagine your body is like a big building, and the virus is like a fire that breaks out in that building. And the cytokines are kind of like the fire alarm. So in a cytokine storm... It's like the smoke alarm never turns off. And you keep having... Firefighters are coming, coming, coming. They're spraying water everywhere,

knocking down doors with their axes, doing all this damage. And they can keep doing damage even after the fire. is out, even if the virus is nearly extinguished. So viruses can cause storms like this. It's rare, but the common flu can cause some patients to experience cytokine storms. Right. And there's some evidence that happens during other coronavirus infections, like the original SARS patients. It also looks like it may be happening with this coronavirus that causes COVID. Okay, Jeff. These are very

interesting ideas, but this is shortwave, so give me some data. Okay. So as we've discussed before on this show, coronavirus research is moving really, really quickly. And a lot of it is still in unpeer-reviewed places like even Twitter. But we do have case reports out of Europe and China. And Hammerman says that in those reports, patients do show signs of a storm. So some of those are very high levels of some of these cytokines in the blood of patients. But there's also other clinical laboratory measures of, of cytokine storm that are looked at that have been associated with this disease that are also being seen. And Hammerman says another clue may actually be those weird seven-day crashes. So it turns out it takes about a week for the body to really build up its T cells, those cells you talked about earlier.

They're really good at fighting viruses. And so it may be that you need to wait until actually there's a sufficient immune response going on that they can drive this cytokine storm. Okay. All right. This sounds like it could be real to me, Jeff. Circumstantial, but may be real. Yeah. And I mean, look, I'm a journalist. I'm not a scientist. But I'll tell you the other thing I find really compelling is that all the scientists I've spoken to say this just kind of makes sense. Like, they really think it's happening.

In fact, there's a long-running theory that the 1918 flu actually killed young and healthy people in the same way with these cytokine storms. Wild. Okay. So is there some way to stop these storms from happening, Jeff? Yes. Or at least there might be. So it turns out that one of the types of cytokines, one of the types of proteins that appears to be showing up a lot in these patients is called interleukin-6, or IL-6 for short. Oh, yeah, that's a famous one. Like, you know, in immunology circles. It does all kinds of stuff. Your body makes it when you have an infection. or when you damage a tissue, like if you had a really bad burn. But when IL-6 production is out of whack, it can lead to autoimmune diseases,

which also involve the body kind of attacking itself. Right. And that's why people have developed drugs that can block that cytokine IL-6. Basically, it's to treat those autoimmune diseases, like rheumatoid arthritis, for example. Randy Kron is at the University of Alabama at Birmingham, and he treats autoimmune diseases and kids. These drugs, in my opinion, have been one of the greatest achievements in medicine in the last couple decades, is the ability to target individual or few pro-inflammatory cytokines

that cause disease. Now, these drugs are officially just for autoimmune disorders, but Kron thinks they can be used in some patients who have COVID-19. It's not going to help the 85-year-old with hypertension and diabetes. It's just not. but for those who don't have chronic underlying diseases, and even for some of those who do, it's just maybe not a severe who have a cytokine storm.

It could potentially help them. Kron thinks that other medicines like corticosteroids will help as well, and he thinks there's some combination of these drugs that will calm the immune system down and potentially save lives. I think in a month or two, we're going to be able to help patients with COVID-19 who are dying from cytokine storms and potentially bring the mortality rate down. Okay, but wait, Jeff, I just want to take a step back here because what you're talking about in giving these powerful drugs is kind of turning down the immune system or part of it.

And we know that this is a really nasty virus that we need our immune system for. That's exactly right, Maddie. I mean, I'm not disagreeing with you at all. I mean, this is the big risk of these therapies. honestly, the best defense humans have if they catch coronavirus, at least right now, is the immune system. Most of us, who will get sick, will stay at home, we'll let our bodies work to clear the virus and we'll get better on our own. So the idea that you'd turn down that system, just when people are at their sickest, it's really, really dangerous. And that kind brings us to the last scientist I want you to hear from. His name is Tobias Hall.

He's at Memorial Sloan Kettering Cancer Center in New York City, and he is really worried. about what could go wrong. One risk and in the lungs. Another one, Hall says, is the possibility of a secondary infection, like a bacteria or a fungus that takes advantage of the weak immune system and ends up making the patient even sicker. Right, right. And so basically, Jeff, what this means is we need more science, right?

We need rigorous studies to see when these drugs can help and who they can help, right? I'm nodding from my pillow for, Maddie, exactly. The good news is that there are. studies. They're well underway and they should give results in months rather than years. Wow. But I also have to tell you I've spoken to doctors who are going ahead and trying to treat patients with these drugs now because, you know, they don't have a lot of options. So they're being as selective as they can and as careful as they can. And one of those doctors is actually the guy you just heard talking about how dangerous this treatment could be, Tobias Hull. He's there in New York

where hundreds of people have been dying each day, and despite his fears, he is giving patients these drugs, because the alternative is a ventilator and maybe even death. Wow, okay, Jeff, I appreciate you. Thank you for bringing us this story. You're welcome, Maddie.

This episode was produced by Rebecca Ramirez and edited by Viet Leigh. Emily Vaughn checked the facts. I'm your host, Maddie Safaya, and this is Shortwave from NPR. See you next week.