WEBVTT

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before I say anything I just want to say that if 
you are squeamish you might not want to watch this

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video because there will be some pictures of 
lungs that have a blood clot in them and other

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organs of the body and my opinion is nothing that 
bad but I wanted to give you a warning regardless

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this video is a follow-up to my last video which 
is called what doctors are learning from autopsy

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findings of COVID patients just after I published 
that video not even a day later this study came

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out published in the annals of internal medicine 
which I'll put a link in the description below

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and what makes this study such a big deal is 
that it's the first study that looked at this

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many autopsies of patients who died of COVID not 
only do they do complete autopsies but they use

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CT scans to scan the entire body for blood clots 
all 12 of the deceased had tested positive for

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SARS coronavirus - by means of rt-pcr now I want 
to say something not everyone on this planet is

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going to get COVID for those who do get the virus 
80 percent of them will have either mild or no

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symptoms roughly 15 to 20 percent of them will 
have pneumonia roughly 4 percent will develop

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ARDS or a few respiratory distress syndrome and/or 
shock with multi-organ failure and about 1 percent

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will die of the infection when I'm in the ICU and 
someone dies it's obviously horrible sometimes

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autopsies have to be done irrespective of family 
consent when it's a legal matter rarely depending

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on the circumstances we ask family's permission to 
do an autopsy most families decline the option for

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autopsy but during this pandemic it's especially 
important for autopsies to be done because they

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often provide incredibly valuable information 
especially when we still know so little about

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COVID especially when it can present in so many 
different ways so in this study that was done in

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Germany autopsies were mandated for patients 
who died of coded and to the families of those

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victims of COVID my condolences and we're 
still trying to figure out why some people

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do so poorly when they get the virus while others 
do just fine and then there's everyone in between

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the point of this video is not to scare people 
the point is to learn about the disease and to

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ultimately benefit from that learning with 
the hope of developing treatment options in

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ultimately reduce morbidity and mortality in other 
words to save lives and by making this video the

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goal is to educate myself and others about what 
we're learning and getting the medical truth out

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there to the public so in this study there were 
12 patients total nine men three women and the

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median age was 73 all patients had some type of 
pre-existing medical condition most of them had

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obesity and/or underlying heart disease such as 
coronary heart disease some had type 2 diabetes

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hypertension peripheral artery disease asthma 
COPD initial lab tests revealed elevated levels

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of d-dimer lactate dehydrogenase meaning LD H 
and C reactive protein or CRP all of these are

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nonspecific markers of inflammation there is also 
mild thrombocytopenia in some patients meaning low

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platelet counts this isn't an unusual finding in 
patients who are critically ill they also looked

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at levels of viral RNA using rt-pcr studies all 
twelve patients had the Stars quarter virus to

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RNA in their lungs nine out of the twelve had it 
in their throat and six had in their bloodstream

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in five patients they had viral RNA in other 
tissues like heart liver brain and kidney not

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only did they have the virus there but the levels 
were higher in those tissues compared to the blood

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here's a picture from a different autopsy that 
was not part of this study where the virus was

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actually visualized in the kidney using electron 
microscopy so what is this telling us it tells us

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that the virus is binding to those h2 receptors 
in those organs so in some people who dive COVID

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they had the virus in other organs besides the 
lungs but and this is a big but they did not die

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as a result of that virus being in those different 
organs they died as a result of lung complications

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also an important takeaway from this is that all 
twelve had in their lungs and nine out of the 12

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in their throat so when you go to do a throat 
swab with someone who has COVID the virus might

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not even be there and that's just another reason 
why you can get a false negative test okay so they

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also did post-mortem CT scans of these patients 
which demonstrated mixed patterns of reticular

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infiltrations in severe dense consolidations in 
both lungs this CT scan is a patient with covid

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pneumonia in erred yes not from this study 
that we're talking about now but basically

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demonstrating the exact same thing both lungs have 
extensive consolidations ground-glass opacities

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which represent an extensive inflammation these 
are also known as pulmonary infiltrates and you

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can see the difference compared to a normal 
CT scan of the chest which doesn't have any

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pulmonary infiltrates in four cases out of the 12 
massive pulmonary embolism meaning massive blood

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clots in the pulmonary arteries was the cause of 
death in another three cases out of the 12 they

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had blood clots in their large veins of their legs 
meaning DVT without having pulmonary embolism so

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in six of the nine men they had clots in the veins 
that surround the prostate gland in all 12 cases

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the cause of death was found within the lungs or 
the pulmonary vascular system meaning within the

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pulmonary arteries for the ones who didn't die of 
having a large pulmonary emboli they died of the

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extensive inflammation within the lungs meaning 
pneumonia with ARDS in these cases the lungs were

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wet and heavy much like a sponge that is saturated 
with water the surfaces of the lung often had

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a distinct patchy pattern with pale areas 
alternating with slightly protruding and firm

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deep reddish blue hyper capitalized areas this 
is indicative of areas of intense inflammation

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with endothelial dysfunction that can be seen at 
the microscopic level when they look at slices

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of the lungs under the microscope they found 
diffuse alveolar damage in eight cases out of 12

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specifically they saw hyaline membrane formation 
tiny clots in the capillaries and capillaries

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that were engorged with red blood cells and 
other inflammatory findings all these findings

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represent ARDS they also found lymphocytes 
a type of a white blood cell that infiltrated

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these specific tissues this fits the picture of a 
viral pathogen ASIS they also look at the pharynx

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of these patients meaning the throat the lining of 
the throat where the mucosa was hyperemic meaning

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very red and irritated and at the microscopic 
level they saw lymphocytes invading there as well

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again which is consistent with a viral infection 
in one case a patient had lymphocytes invade his

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heart muscle findings that are consistent with 
what we call viral myocarditis in other words the

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heart muscle had evidence of viral infection more 
than half the patients in this study had large

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blood clots 1/3 of the patients had pulmonary 
embolism as the direct cause of death all the

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others died of intense inflammation in their lungs 
related to pneumonia and ARDS recently there's

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been studies showing that about 1/3 of patients 
with severe COVID have blood clots another study

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of 191 patients with Covid 19 half of those who 
died had clots compared with 7% of the survivors

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and levels of d-dimer that were greater than 
1,000 were associated with a fatal outcome so

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it's pretty clear now that stars curve to virus 
is causing a lot of class to form and moderate

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to severe COVID disease but how is this happening 
it's likely a combination of reasons they have

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to do with down regulation of the h2 receptor in 
the lung alveoli with a subsequent shift towards

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having more angiotensin 2 in the lungs and less 
angiotensin 1:7 and less in angiotensin 1:9 in

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the lungs and when this happens this leads to 
more cytokine storm with more inflammation more

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constriction of pulmonary arteries and more 
clots that develop that in turn leads to more

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endothelial dysfunction in the capillaries that 
surround the alveoli also there's evidence that

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the virus attaches to the ACE 2 receptors of the 
endothelial cells that line those capillaries

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which further propagates inflammation in clotting 
and in the cytokine storm that develops there

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Randy's Okemo kine bind to the ccr5 receptor 
of cd4 and cd8 lymphocytes and that causes

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those lymphocytes to infiltrate those areas of 
inflammation and in doing so further contributes

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towards the inflammatory reaction this is why 
we're seeing low levels of cd4 and cd8 lymphocytes

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and severe COVID endothelial damage can also lead 
to the development of antiphospholipid antibodies

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and these antibodies are bad because they trigger 
the formation of blood clots and that's why

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patients who have clots with the diagnosis 
of antiphospholipid antibody syndrome they

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need to be on blood thinners also 11 out of the 12 
patients in the study had underlying heart disease

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and were obese these are known risk factors not 
just for cardiovascular disease but also known

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risk factors for endothelial dysfunction in our 
known risk factors for COVID the endothelium is

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more susceptible to damage based on cardiovascular 
risk factors such as men age 45 or older women

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age 55 or older smoking high blood pressure high 
cholesterol diabetes obesity and lack of physical

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activity so the big takeaways from the findings 
in this study is that most people who die of Covid

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it's primarily a lung problem either related to 
inflammation with ARDS and/or blood clots even

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though blood thinners are not a cure for Covid per 
se they do have the potential to save lives the

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hard part is figuring out who is likely to develop 
clots and who should we give blood thinners to and

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which blood thinners should we give and should 
we give high doses of blood thinners or just the

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low-dose prophylactic doses to further complicate 
matters it's often hard to diagnose blood clots in

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hospitalized patients even before COVID came along 
usually it's easy to diagnose large blood clots in

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the veins of the legs meaning DVT by doing an 
ultrasound of the legs even though ultrasound

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isn't a hundred percent accurate the way we 
typically diagnose pulmonary emboli is by getting

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a CT scan of the chest while at the same time 
giving IV contrast and this is called a CT angio

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or CT a of the chest the downsides of doing this 
well there's several one you have to transport a

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patient to the CT scanner and sometimes patients 
aren't stable enough to do that to you risk

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spreading the virus to others in the hospital by 
transporting that pay and this will also require

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more PPE use 3 CT scans require larger doses of 
radiation for giving someone IV contrast has some

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risks such as the risk of serious allergic 
reaction in the risk of causing some kidney

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damage on top of that the CTA of the chest can 
only visualize bigger clots so you might not see

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the small clots that are there right now more and 
more hospitals are giving high-dose blood thinners

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to COVID patients who have severe disease even 
if they haven't been diagnosed as having blood

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clots but what about patients without moderate or 
severe Covid should they take a blood thinner or

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maybe a low dose blood thinner or should they take 
an antiplatelet medication like aspirin either 81

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milligrams of aspirin or 162 milligram dose or 325 
milligrams os-- or should the general public take

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a low dose aspirin like 81 milligrams in order to 
help prevent blood clots from forming if they do

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get COVID or should it just be certain people in 
the population who are at higher risk of getting

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severe COVID should they take aspirin these are 
the questions we don't know the answers to at

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this point it's going to take a lot of studies 
to answer these questions because not only do

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we need to know that there's a benefit in doing so 
we have to know that these benefits will outweigh

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the risks such as the risk of bleeding and then 
there's all the other drugs that are being looked

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at right now and randomized control trials we 
should start seeing some of these results pretty

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soon what we do know is that in order to improve 
the capillary endothelium and also to minimize

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your chances of having severe disease if you 
were to get COVID you want to do several things

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this includes exercise eating healthy getting 
good sleep minimizing stress not smoking what

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about vaping generally not good either but not as 
bad as smoking too much alcohol not good either

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have your medical conditions under control 
whether that's diabetes high blood pressure

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COPD asthma allergies whatever the case may be 
now what about vitamin D probably a good thing

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but that's a whole nother topic which I should 
make my next video on because there's a lot to

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say about that and possibly other vitamins too 
if you're deficient in certain vitamins anyway

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to catch that video subscribe to this channel and 
hit that Bell notification so you know when I post

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here on YouTube so many topics I want to cover in 
so little time but I will see you in the next one