English subtitles

← 12 COVID Autopsy Cases Reveal the TRUTH How COVID Patients Dying - Doctor Explains

Get Embed Code
10 Languages

Showing Revision 6 created 07/21/2021 by Hannah Mendenilla.

  1. Before I say anything,
    I just want to say
  2. that if you are squeamish
    you might not want to watch this video
  3. because there will be some pictures 
    of lungs that have a blood clot in them
  4. and other organs of the body.
    In my opinion it's nothing that bad

  5. but I wanted to give you a warning,
    regardless.
  6. This video is a follow-up
    to my last video which was called,
  7. "What Doctors Are Learning From Autopsy
    Findings of COVID Patients. "
  8. Just after I published that video,
    not even a day later, this study came out,
  9. published in the
    Annals of Internal Medicine

  10. which I'll put a link in to the description below.
  11. And what makes this study such a big deal
    is that it's the first study that
  12. looked at this many autopsies of
    patients who died of COVID.
  13. Not only do they do complete autopsies,
    but they use CT scans
  14. to scan the entire body for blood clots.
  15. All 12 of the deceased had tested
    positive for SARS Coronavirus-2
  16. by means of RT-PCR.
  17. Now, I want to say something.
    Not everyone on this planet is
  18. going to get COVID.
    For those who do get the virus,
  19. 80% of them will either have mild
    or no symptoms.
  20. Roughly 15%-20% of them will 
    have pneumonia.
  21. Roughly 4% will develop ARDS, or Acute
    Respiratory Distress Syndrome
  22. and/or shock with
    multi-organ failure.
  23. And about 1% will die of
    the infection.
  24. When I'm in the ICU and 
    someone dies it's obviously horrible.
  25. Sometimes autopsies have to be done
    irrespective of family consent
  26. when it's a legal matter.
  27. Rarely, depending on the
    circumstances,
  28. we ask familys' permission to 
    do an autopsy.
  29. Most families decline the option for
    autopsy,
  30. but during this pandemic, it's especially 
    important for autopsies to be done
  31. because they often provide
    incredibly valuable information,
  32. especially when we still know so little
    about COVID.
  33. Especially when it can present in so many 
    different ways.
  34. So in this study that was
    done in Germany,
  35. autopsies were mandated for patients 
    who died of COVID.
  36. And to the families of those victims
    of COVID, my condolences.
  37. And we're still trying to figure out
    why some people do so poorly
  38. when they get the virus,
    while others do just fine
  39. and then there's everyone in between.
  40. So, the point of this video
    is not to scare people.
  41. The point is to learn about
    the disease,
  42. and to ultimately benefit from that
    learning
  43. with the hope of developing treatment
    options
  44. and ultimately reduce morbidity and mortality in other 
    words to save lives and by making this video the
  45. goal is to educate myself and others about what 
    we're learning and getting the medical truth out
  46. there to the public so in this study there were 
    12 patients total nine men three women and the
  47. median age was 73 all patients had some type of 
    pre-existing medical condition most of them had
  48. obesity and/or underlying heart disease such as 
    coronary heart disease some had type 2 diabetes
  49. hypertension peripheral artery disease asthma 
    COPD initial lab tests revealed elevated levels
  50. of d-dimer lactate dehydrogenase meaning LD H 
    and C reactive protein or CRP all of these are
  51. nonspecific markers of inflammation there is also 
    mild thrombocytopenia in some patients meaning low
  52. platelet counts this isn't an unusual finding in 
    patients who are critically ill they also looked
  53. at levels of viral RNA using rt-pcr studies all 
    twelve patients had the SARS-CONORA-VIRUS 2
  54. RNA in their lungs nine out of the twelve had it 
    in their throat and six had in their bloodstream
  55. in five patients they had viral RNA in other 
    tissues like heart liver brain and kidney not
  56. only did they have the virus there but the levels 
    were higher in those tissues compared to the blood
  57. here's a picture from a different autopsy that 
    was not part of this study where the virus was
  58. actually visualized in the kidney using electron 
    microscopy so what is this telling us it tells us
  59. that the virus is binding to those h2 receptors 
    in those organs so in some people who die of COVID
  60. they had the virus in other organs besides the 
    lungs. But, and this is a big BUT, they did not die
  61. as a result of that virus being in those different 
    organs they died as a result of lung complications
  62. also an important takeaway from this is that all 
    twelve had in their lungs and nine out of the 12
  63. had it in their throat so when you go to do a throat 
    swab with someone who has COVID the virus might
  64. not even be there and that's just another reason 
    why you can get a false negative test okay so they
  65. also did post-mortem CT scans of these patients 
    which demonstrated mixed patterns of reticular
  66. infiltrations in severe dense consolidations in 
    both lungs this CT scan is a patient with covid
  67. pneumonia in ARDS not from this study 
    that we're talking about now but basically
  68. demonstrating the exact same thing both lungs have 
    extensive consolidations ground-glass opacities
  69. which represent an extensive inflammation these 
    are also known as pulmonary infiltrates and you
  70. can see the difference compared to a normal 
    CT scan of the chest which doesn't have any
  71. pulmonary infiltrates in four cases out of the 12 
    massive pulmonary embolism meaning massive blood
  72. clots in the pulmonary arteries was the cause of 
    death in another three cases out of the 12 they
  73. had blood clots in their large veins of their legs 
    meaning DVT without having pulmonary embolism so
  74. in six of the nine men they had clots in the veins 
    that surround the prostate gland in all 12 cases
  75. the cause of death was found within the lungs or 
    the pulmonary vascular system meaning within the
  76. pulmonary arteries for the ones who didn't die of 
    having a large pulmonary emboli they died of the
  77. extensive inflammation within the lungs meaning 
    pneumonia with ARDS in these cases the lungs were
  78. wet and heavy much like a sponge that is saturated 
    with water. The surfaces of the lung often had
  79. a distinct patchy pattern with pale areas 
    alternating with slightly protruding and firm
  80. deep reddish blue hyper capitalized areas this 
    is indicative of areas of intense inflammation
  81. with endothelial dysfunction that can be seen at 
    the microscopic level. When they look at slices
  82. of the lungs under the microscope they found 
    diffuse alveolar damage in eight cases out of 12
  83. specifically they saw hyaline membrane formation 
    tiny clots in the capillaries and capillaries
  84. that were engorged with red blood cells and 
    other inflammatory findings. All these findings
  85. represent ARDS they also found lymphocytes 
    a type of a white blood cell that infiltrated
  86. these specific tissues this fits the picture of a 
    viral pathogen ASIS. They also look at the pharynx
  87. of these patients meaning the throat. The lining of 
    the throat where the mucosa was hyperemic meaning
  88. very red and irritated and at the microscopic 
    level they saw lymphocytes invading there as well
  89. again which is consistent with a viral infection 
    in one case a patient had lymphocytes invade his
  90. heart muscle findings that are consistent with 
    what we call viral myocarditis. In other words the
  91. heart muscle had evidence of viral infection more 
    than half the patients in this study had large
  92. blood clots. 1/3 of the patients had pulmonary 
    embolism as the direct cause of death. All the
  93. others died of intense inflammation in their lungs 
    related to pneumonia and ARDS. Recently there's
  94. been studies showing that about 1/3 of patients 
    with severe COVID have blood clots. Another study
  95. of 191 patients with Covid 19, half of those who 
    died had clots compared with 7% of the survivors
  96. and levels of d-dimer that were greater than 
    1,000 were associated with a fatal outcome so
  97. it's pretty clear now that sars-covid-2 virus 
    is causing a lot of clots to form and moderate
  98. to severe COVID disease. But how is this happening?
    it's likely a combination of reasons they have
  99. to do with down regulation of the h2 receptor in 
    the lung alveoli with a subsequent shift towards
  100. having more angiotensin 2 in the lungs and less 
    angiotensin 1:7 and less in angiotensin 1:9 in
  101. the lungs and when this happens this leads to 
    more cytokine storm with more inflammation more
  102. constriction of pulmonary arteries and more 
    clots that develop. That in turn leads to more
  103. endothelial dysfunction in the capillaries that 
    surround the alveoli. Also there's evidence that
  104. the virus attaches to the ACE 2 receptors of the 
    endothelial cells that line those capillaries
  105. which further propagates inflammation in clotting 
    and in the cytokine storm that develops there
  106. Randy's Okemo kine bind to the ccr5 receptor 
    of cd4 and cd8 lymphocytes and that causes
  107. those lymphocytes to infiltrate those areas of 
    inflammation and in doing so further contributes
  108. towards the inflammatory reaction. This is why 
    we're seeing low levels of cd4 and cd8 lymphocytes
  109. and severe COVID. Endothelial damage can also lead 
    to the development of antiphospholipid antibodies
  110. and these antibodies are bad because they trigger 
    the formation of blood clots and that's why
  111. patients who have clots with the diagnosis 
    of antiphospholipid antibody syndrome they
  112. need to be on blood thinners also 11 out of the 12 
    patients in the study had underlying heart disease
  113. and were obese these are known risk factors not 
    just for cardiovascular disease but also known
  114. risk factors for endothelial dysfunction, and are
    known risk factors for COVID the endothelium is
  115. more susceptible to damage based on cardiovascular 
    risk factors such as men aged 45 or older, women
  116. age 55 or older, smoking, high blood pressure, high 
    cholesterol, diabetes, obesity, and lack of physical
  117. activity. So the big takeaways from the findings 
    in this study is that most people who die of Covid
  118. it's primarily a lung problem either related to 
    inflammation with ARDS and/or blood clots even
  119. though blood thinners are not a cure for Covid per 
    se they do have the potential to save lives. The
  120. hard part is figuring out who is likely to develop 
    clots and who should we give blood thinners to and
  121. which blood thinners should we give and should 
    we give high doses of blood thinners or just the
  122. low-dose prophylactic doses? To further complicate 
    matters it's often hard to diagnose blood clots in
  123. hospitalized patients even before COVID came along 
    usually it's easy to diagnose large blood clots in
  124. the veins of the legs, meaning DVT by doing an 
    ultrasound of the legs even though ultrasound
  125. isn't a hundred percent accurate. The way we 
    typically diagnose pulmonary emboli is by getting
  126. a CT scan of the chest while at the same time 
    giving IV contrast and this is called a CT angio
  127. or CT A of the chest the downsides of doing this,
    well there's several. One, you have to transport a
  128. patient to the CT scanner and sometimes patients 
    aren't stable enough to do that. Two, you risk
  129. spreading the virus to others in the hospital by 
    transporting that patient. And this will also require
  130. more PPE use. Three, CT scans require larger doses of 
    radiation. Four giving someone IV contrast has some
  131. risks such as the risk of serious allergic 
    reaction and the risk of causing some kidney
  132. damage. On top of that the CTA of the chest can 
    only visualize bigger clots so you might not see
  133. the small clots that are there. Right now more and 
    more hospitals are giving high-dose blood thinners
  134. to COVID patients who have severe disease even 
    if they haven't been diagnosed as having blood
  135. clots. But what about patients without moderate or 
    severe Covid, should they take a blood thinner or
  136. maybe a low dose blood thinner, or should they take 
    an antiplatelet medication like aspirin either 81
  137. milligrams of aspirin or 162 milligram dose or 325 
    milligrams dose, or should the general public take
  138. a low dose aspirin like 81 milligrams in order to 
    help prevent blood clots from forming if they do
  139. get COVID or should it just be certain people in 
    the population who are at higher risk of getting
  140. severe COVID should they take aspirin? These are 
    the questions we don't know the answers to at
  141. this point. It's going to take a lot of studies 
    to answer these questions because not only do
  142. we need to know that there's a benefit in doing so, 
    we have to know that these benefits will outweigh
  143. the risks such as the risk of bleeding and then 
    there's all the other drugs that are being looked
  144. at right now and randomized control trials we 
    should start seeing some of these results pretty
  145. soon. What we do know is that in order to improve 
    the capillary endothelium and also to minimize
  146. your chances of having severe disease if you 
    were to get COVID you want to do several things.
  147. This includes exercise, eating healthy, getting 
    good sleep, minimizing stress, not smoking, what
  148. about vaping? generally not good either but not as 
    bad as smoking. too much alcohol not good either
  149. have your medical conditions under control 
    whether that's diabetes, high blood pressure,
  150. COPD, asthma, allergies, whatever the case may be. 
    Now what about vitamin D? probably a good thing
  151. but that's a whole another topic which I should 
    make my next video on because there's a lot to
  152. say about that and possibly other vitamins too 
    if you're deficient in certain vitamins. Anyway
  153. to catch that video subscribe to this channel and 
    hit that bell notification so you know when I post
  154. here on YouTube so many topics I want to cover in 
    so little time but I will see you in the next one