If you needed another reason to be scared straight into practicing impeccable sterile technique in an effort to reduce your risk of COVID-19, read on. For those of us who are immunocompromised (raises hand) or over sixty (reluctantly raises hand again) this is sobering stuff. I think I'll go wash my hands again.
Of all the possible compounding effects of COVID-19, the disease caused by the novel coronavirus, the cytokine storm is one of the most feared. An immune system overreaction in which the body is flooded with the eponymous signaling molecules, those who suffer a cytokine storm are at risk of dying at the hand of their own immune system, as an indirect effect of the virus they are fighting.
My lab work was stunningly bad. A normal white count might be between 4.5 and 10. My white cell count was at 2,000. My lymphocytes — which are the cells that fight in a virus, normally fall somewhere between 1000 and 1,500 — they were under 200. I don't know if you know the term but the early cells that fight infection are called "bands," and you don't have [them] normally — I had 20% bands. My platelet count was around 100,000, which is low, and I knew I was in trouble.
In the current context, we believe we have a biomarker of this condition, a serum level of a non-specific but is an acute phase reactant called serum ferritin. It looks like it may be to be one of the more reliable biomarkers of cytokine dysregulation. A serum ferritin is normally below 400 in our lab, mine was 18,000!
It was stunningly high. When a resident told me the result they were looking at me like, "dude, this is crazy." I agreed, but again felt like the deer in the headlights.
But I was coughing up jet black sputum — obsidian black, as black as your cell phone. I thought about it for a moment and then I turned to a physician, whomever was there at the moment and I said, "It's necrotic lung." And they looked at me and went, "Oh my god." That's the only good answer, yes it must be necrotic lung. I love being a teaching attending.
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Photo by Olga Guryanova on Unsplash.