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.
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5 thoughts on “Covid”
Thank you Calvin and Nina for this excellent summary! We still have so much to learn about this novel and nasty virus.
I thought this was a relevant and interesting article, below, highlighting the possible impacts on the brain, post-viral infection. Hopefully short-lived.
I’m not suggesting flu brain fog has the same root cause as COVID. I suspect flu brain fog has a much different physiological mechanism than COVID’s brain fog, due to brain micro-circulation/clotting/perfusion issues.
Yahoo Life: The flu may affect the health of your brain (March 1, 2018)
When people talk about influenza, a general focus of the conversation is the physical symptoms — fever, congestion, muscle aches, and chills. In the vast majority of flu cases, these subside within a few weeks, and the virus disappears. But if you’ve ever felt the mental fog that comes with illness linger after physical symptoms disappear, there might now be science to explain why.
A study released this week in the Journal of Neuroscience found evidence that certain strains of influenza can cause neurological changes in the brain long after the illness is gone. With research performed on mice, the study is a look at an aspect of influenza that has been largely overlooked in this current epidemic, which has killed dozens of children in the United States since October and has infected tens of thousands of people nationwide.
For this particular examination, researchers from Germany’s Braunschweig University of Technology chose to infect mice with three different strains of influenza. The first, H1N1, was the culprit in 2009’s swine flu pandemic; the second, H7N7, is a version that’s rare in humans; and the third, H3N2, is the current strain spreading through the United States.
The goal was to find out what, if any, lingering effects all three would have on the brain.
After the mice recovered from their respective influenza strains, the researchers put their navigation skills to the test — and found obvious differences in performance based on which strain of the flu the mice had. In the first 30 days, mice infected with either H3N2 or H7N7 had more trouble locating the hidden platform — signaling neurological damage to their hippocampal region. In some of the mice, this damage persisted for 60 days. For reasons that are still unclear, no changes were recorded in the mice infected with H1N1.
One of the lead researchers on the study, Martin Korte, a neurobiologist at Braunschweig University of Technology, says it’s not unlikely that these symptoms are mirrored in humans. “In terms of single brain neurons and immune cells in the brain, humans and mice are very much alike,” Korte tells Yahoo Lifestyle. “So, overall, we believe that the cognitive defects we observed in young mice are also very relevant for humans.”
Thank you Calvin and Nina for this excellent piece. It’s the kind of concise and clear information we all need more of.
It’s easy to say for Trump that the virus is “no big deal” after getting treatments and a level of care that very few people have access to (yet). My husband, who was in a hospital in Upstate NY with Covid in March (and credits hydroxychloroquine for the speedy reversal of his illness), has been giving plasma ever since. The Red Cross loves his antibodies! It makes total sense that these are less effective in very ill people — but there is not enough to give to everybody who is just coming down with it and we don’t know how bad it’s going to be for them.
One of many dilemmas!
I’d love to know your thoughts on what causes the lingering effects, especially the “brain fog,” and I’m hoping you will publish some follow-up notes as you learn more!
Editor’s reply: I’ll ask Nina to elaborate on the brain fog and, yes, I’ll lean on her to add to this article from time to time. And, 1000 thanks to your husband for donating his plasma! We are all indebted to people like you folks!!
Dr Pierpont and Calvin continue to educate us clearly, visually–I LOVE VISUALS!–and with explanations with pencil thin precision. Thank you, both of you. This piece and the notes from Rand are extremely useful to anyone suffering from COV19, or loved ones caring for patients.
I have to admit, having taught high school and other teaching for over 30 years, and having been acclimatized to regular flu seasons, several bouts of walking pneumonia, worse after the flu shot; and we could pretty much tell which kids or colleagues infected the room or school, I was slightly leaning to the “downsizing” side of the information curve and thinking COV is just a really bad flu. I see with Nina’s explanation and hearing from a friend of mine about her recent COV experience, this is much more serious.
I am going to reconstruct my daily routine using Rob Rand’s concoction. Already take C, D, zinc, will certainly add Elderberry syrup. THANKS!
Thank you Calvin and Nina. This is very clearly written. No surprise!
I had likely Covid-19 in early February. Being from Maine with decades of experience with strong flus, I noticed this was very different. At the first signs of bone-shaking fever and deep fatigue, like I have never felt before, I isolated and started taking Elderberry syrup, zinc, C, D3, and six drops of Oil of Oregano per day. I hydrated and slept 16-20 hours per day.
The fourth day I woke up right as rain. No lung impact, no loss of smell or taste, no mental fog. I treated it early and crushed it. Research confirmed: Elderberry has a zinc ionophore, quercetin, and Oil of Oregano has carvacrol, a potent anti-inflammatory, anti-biotic, and anti-viral.
The state locked down hydroxychloroquine. (Yes, the same state that permitted the Mars Hill wind farm to run their turbines 7 dB over regulatory limits and ultimately did nothing for turbine noise impacts on neighbors at Freedom and Vinalhaven.)
So the family takes quercetin, zinc, C, D3 daily as prophylactic.
My best wishes to you both.
Editor’s note: Mr. Rand is a professional noise engineer.
I think this is the most understandable scientific information and detailed explanation of what COVID-19 actually can do to the human body.
These “notes” explain in simple detail what the symptoms are, how they are caused and possible solutions to this virus.
Thank you Calvin & Nina! As always, impressive!