Science Cafe, Special Topic: COVID-19

March 25, 2020
moran and goodwin
Dr. William Moran (left) and Dr. Andrew Goodwin (right)

As we all continue to follow the guidelines and mandates that responsible public health requires of us during this pandemic, we want you to know that MUSC continues to do the research to find answers and discoveries that may mitigate the coronavirus, COVID-19.

Below are two of our great faculty scientists, Dr. William Moran and Dr. Andrew Goodwin, providing information we hope will aid your efforts to be and remain healthy.  

Dr. Moran why are those 60 and older so vulnerable to COVID19, and what are the best practices to follow to curtail its impact on older adults?

As we get older, our immune system, the way we fight infections, gets less responsive and takes longer to identify and attack foreign viruses like Coronavirus. This is one reason we vaccinate older adults for flu, for example – we give the immune system a “head start” by injecting inert material derived from the flu virus so when we are exposed to flu later, our immune system is better prepared and can respond faster and more thoroughly. But we don’t have a vaccine for Coronavirus yet, so we can’t jump-start older people’s immune system.

Second, we lose organ system reserves as we age – we have a lower heart output, our lungs are less efficient – so smaller alteration in our heart and lung function from a virus can cause us to get symptoms quicker. COVID can progress rapidly, so older people are more likely to have complications or even die.

Finally, we collect chronic conditions as we age – high blood pressure, diabetes, lung disease – and these conditions predispose us to complications from infection.

The best practice is: wash hands frequently and thoroughly, especially after touching objects outside. Don’t touch your face (mouth nose eyes), and avoid getting close to people, especially sick people (including sorry to say, grandchildren). Stay in touch using technology: FaceTime or skype. Avoid going out - This is ‘social distancing,’ and at the extreme, staying home. This strategy HAS worked in other countries – we should learn from them!

This will pass – let’s all live through it by being careful!

William Moran, MD, MS
Director, Division of Internal Medicine
Department of Medicine
Specialty: Geriatrics

 

Dr. Goodwin what are the immediate and long-term respiratory concerns of COVID19, and how exactly does it affect the lungs?

The COVID-19, also named SARS-CoV-2, virus can create a wide spectrum of clinical illness. On one end of spectrum, COVID-19 frequently causes a mild respiratory illness quite similar to the common cold or a mild influenza infection. Based on published case series, fever (43-98%) and cough (68-82%) are the most common symptoms whereas headache (6-34%), shortness of breath (3-64%), and runny nose/sore throat (5-24%) are more variable and less commonly seen.

Based on current estimates, approximately 80% of people infected with the virus experience this form of mild illness and do not require hospitalization. The remaining 20% can experience a more severe form of infection, that often includes pneumonia, or complications of pre-existing lung disease such as asthma or chronic obstructive pulmonary disease (COPD). These patients typically require hospitalization and a small subset of them can progress to a very severe form of disease known as the Acute Respiratory Distress Syndrome (ARDS). ARDS is a whole-body, hyper-inflammatory response to an infection resulting in the lungs filling with fluid and almost always requires the use of mechanical ventilation (a.k.a. ventilator or respirator) for breathing support.

Historically, approximately 35-45% of patients who develop ARDS from other conditions do not survive despite optimal life support in an intensive care unit. The mortality rate from COVID-19-induced ARDS is unclear at this time but may be higher than historical rates. This estimate is, in part, based on preliminary reports from centers caring for critically ill patients with COVID-19, which describe many of these patients developing abrupt declines in heart function leading to cardiac arrest. The exact cause of this cardiac complication is undetermined at this time although some have speculated that the virus may be directly infecting the heart, a condition called “Myocarditis”. However, more information is needed to more definitively understand the nature of this complication.

At this time, we do not know if there are long-term respiratory complications specific to COVID-19. However, prior research has identified that a subset of patients who survive ARDS can suffer long-term physical (weakness, easy fatiguability), cognitive (reduced mental acuity), and psychological (anxiety, depression, post-traumatic stress disorder) complications which may persist for months to years. As the medical community begins to care for increasing numbers of COVID-19 survivors, we will learn more about any long-term complications specific to this disease.

Andrew Goodwin, MD. MSCR
Associate Professor, Department of Medicine, Division of Pulmonary and Critical Care Medicine
Specialty: Acute Respiratory Distress Syndrome