COVID-19: On initial autopsies and lung transplants

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Dr. Daniel Lucey, who has responded to, and monitored information on outbreaks since 2001, has provided a series of updates and analysis on the outbreak, now linked global epidemics of COVID-19. He continues to respond to and break down developments and data on the continued spread of the virus. He has just returned from a trip to Shanghai, Hong Kong and Egypt. This is his 14th update on questions raised by the continued spread of, and responses to the virus that causes COVID-19.

While still preliminary and unpublished, what has been the interpretation of the initial nine autopsies, especially with regard to pulmonary fibrosis?

These nine autopsies have been overseen by Dr. Liu Liang from the Tongji Medical College at Huazhong University of Science and Technology. After the Intensive Care Unit director of Zhongnan Hospital of Wuhan Univeristy, Dr. Peng Zhiyong, talked with Dr. Liu Liang about the autopsies, Dr. Peng said: “Based on the results, I think the most important thing now is to take measures at an early stage of the disease to protect patients’ lungs from irreversible fibrosis.” Global Times Feb. 29, 2020.

When were the initial bilateral lung transplants performed for COVID-19?

On Feb. 29, a 59-year-old man who had been on a ventilator and ECMO (extracorporeal membrane oxygenation) had a bilateral lung transplant performed by the team led by Dr. Chen Jingyu of Wuxi People’s Hospital in Jiangsu province. It was implied, but without lung tissue pathology verification, that he had “irreversible pulmonary dysfunction.”

On March 1 a 66 year-old woman who had been on a ventilator and ECMO had a bilateral lung transplant performed by a team in Zhejiang University School of Medicine in Zhejiang Province. She was said to have “irreversible pulmonary dysfunction.

Are autopsy results being included in the latest (March 3) National Health Commission (NHC) diagnosis and treatment plan for COVID-19?

Yes. See Xinhuanet, March 4, 2020.

On March 7, what update did the NHC provide on IL-6R Ab therapy?

In an initial clinical trial, tocilizumab was used in 20 severe COVID-19 cases. And the body temperatures of all the patients dropped within one day. Nineteen of the patients were discharged from the hospital within two weeks, and one got better, according to Zhou. Currently, the drug is under clinical trials in 14 hospitals in Wuhan, the epicenter of the epidemic, Zhou said. As of March 5, a total of 272 severe patients had been treated with tocilizumab.

Daniel Lucey, M.D. MPH, FIDSA, FACP, is an infectious diseases physician and adjunct professor of infectious diseases at Georgetown University Medical Center, a senior scholar at the Georgetown University O’Neil Institute, Anthropology Research Associate, Smithsonian Museum of Natural History and a member of the Infectious Diseases Society of America Global Health Committee.He has served as a volunteer medical responder to outbreaks that included the West Africa Ebola crisis. He has collected information on outbreaks starting in 2001 with cases of anthrax in 2001, and including smallpox vaccination 2002, SARS 2003, H5N1 Flu 2004, MERS in 2013, and Ebola in April, 2014, He has gathered, and  updated information on the spread of the coronavirus Jan. 6.

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