A Conversation with Nina Pierpont, MD, PhD
How serious is Covid and what is its pathology?
November 10, 2020
The following are notes taken by Calvin Martin during a dinner conversation with Dr. Pierpont, when I asked her to explain the most salient pathological issues currently surrounding the disease. Her remarks are based on extensive reading in the clinical and science literature.
- Covid reproduces in the respiratory tract, both upper (nose & throat) and lower (bronchi & lungs). It is carried and transmitted in respiratory secretions from both places.
- Most viruses, especially those that cause fevers, have a viremic phase, where they circulate in the bloodstream. In Covid’s case, the receptors for the virus are also in the vasculature – all the arteries & veins – and in kidneys & heart as well as the lungs & airways.
- Severe Covid is more than pneumonia; it’s a vascular infection and inﬂammation that causes problems in multiple organs, including heart, brain, and kidneys. It causes excessive clotting. (When someone has a stroke, the usual clot is approx. 1 cm long. Nina described a clot removed from a Covid stroke patient that was 30 cm long. That’s 1 foot long!) Also, the average age of stroke in people with Covid is 10 years younger than the average age of people with strokes without Covid.
- Many of the severely ill people with Covid have acute kidney failure and need to go on temporary dialysis.
- Treatment has changed with the experience of people who take care of Covid patients. They have discovered that ventilators don’t necessarily help with survival, which may be in part because Covid is both a vascular problem and a pneumonia, so that there can be other issues contributing to hypoxemia (e.g., ventilation with perfusion mismatch from vasculitis in pulmonary vasculature).
- In addition, it’s been found that steroids are extremely helpful in severe Covid, because they reduce inﬂammation. People with severe Covid are also treated with anti-coagulants, because infection and inﬂammation in vasculature causes lots of clotting, resulting in strokes and other multi-organ difﬁculty.
- Pres. Trump received a monoclonal antibody (technically bi-clonal) of the antibodies which neutralize the virus in the bloodstream. This is given by direct infusion into the bloodstream. The medication is currently in trial in severely ill Covid patients, though it may be this is where it’s least useful. Its best use may be the way it was used in Trump: in early illness in a person with risk factors for severe illness. Thus, in Trump’s case, it was caught and neutralized by antibodies in the early viremic phase. (Trump had a fever the day he went into the hospital.) In the blood, the intravenous medication would circulate to all the lung tissue, thus neutralizing virus in lungs.
- Cardiologists studying post-Covid patients have found evidence of cardiac inﬂammation. There is, as well, a post-Covid syndrome of fatigue and brain fog. So far, no one knows how long the fatigue and brain fog last.