COVID-19 is not just a problem for the elderly population - young and healthy individuals can also end up hospitalized, or even on a ventilator, depending on their genetics.

There are reports of marathon runners under the age of 50 almost dying from COVID-19. I personally am aware of a case of a woman in her early 20s on a ventilator from COVID-19 complications. What is the reason why healthy people in addition to the elderly can succumb to COVID-19?

One key reason is cytokine storm.

What is a cytokine storm?

The term “cytokine storm” encompasses a multi-factorial hyperinflammation associated with increased expression of different cytokines including but not limited to interleukins (IL), chemokines, granulocyte colony-stimulating stimulating factors (G-CSF), and tumor necrosis factor-1a (TNF).

Cytokines are small proteins secreted by cells that have a major impact on the normal communication system between cells. Cytokines is a blanket term. There are many different cytokines, including named after the cells that secrete them such as monokines, the type of cytokines released by a type of white blood cell called monocytes.

I am aware of at least 14 different cytokines that have been reported to be significantly elevated in COVID-19 patients. This number will vary and change. Regardless, it is concerning.
According to recent published studies the body of available evidence suggests that a subgroup of patients with severe COVID-19 might have a cytokine storm syndrome. The culmination of this “storm” is a massive immune system response that actually ends up negatively impacting normal pulmonary function, in some cases leading to death.

The Cytokine Network and the Lungs

Different cell types such as B cells (which create antibodies to help our immune system remember enemies and threats), T cells, macrophages, eosinophils and basophils work in concert, communicating with each other using the language of cytokines.

For example, the phagocytes macrophages will use specific cytokines to create specific responses by B and T cells, and so on. This broad communication network uses many “dialects” of the language of cytokines. Meaning, many different cytokines are stimulated resulting in a chronic, always on alert immune system response.

Immunologically, the lungs are highly dependent on a vigilant immune system and inflammatory response because of their constant exposure to a wide variety of infectious agents, particulates and gases as per the process of respiration. In classic immunology we learn that as part of homeostasis living in a modern world the lungs mount a protective service by deploying cytokines that regulate host defense mechanisms.

One could say cytokines play a crucial role in immune homeostasis in the lungs. There is a law to cytokines in the lungs. First, they need to categorize friend from foe. Second, cytokines help the immune system ignore or attack. Third, cytokines must act as a conductor of a fine orchestra, and govern or regulate the symphony of that decision - to activate an all out immune attack, or calm the immune response, considering tolerance instead, and cease the attack once the battle is being won.

In cases of COVID-19 cytokines in the lungs react in an all-out war, first against the coronavirus that is behind the COVID-19 symptomatology and secondly against healthy lung tissue due to an exaggerated immune response. This infection is linked to cells in the lungs committing suicide (a process known as apoptosis) as part of the defense mechanism to prevent the spread of this virus.

Additionally, there is solid evidence of a pro-inflammatory response that leads to capillary leakage and the stimulation of lymphocytes, neutrophils and macrophages that secrete cytokines targeting the vascular endothelial cells in the lungs, reducing the ability to breathe. That’s just one pathway in a highly complex process that can lead to the urgent need for a ventilator.

Treatments

Clinical studies on treatments to address the cytokine storm include drugs such as Fingolimod, which is a sphingosine 1-phosphate receptor modulator. It is in a class of drugs used as immunomodulators. Other medications that directly address the cytokine storm include the anti-inflammatory medications sarilumab, anakinra, emapalumab and tocilizumab.

These medications offer a calming influence on the immune system. Combining immunomodulators and or anti-inflammatory medications with antiviral medications and other palliative care methodologies are logical treatment paths to taming the storm and granting recovery.

I cover such research in my article titled An Overview of Treatment Research for COVID-19.

You can find my podcast covering some key aspects of COVID-19 here - https://drrobertpastore.com/podcasts/058-coronavirus-covid19