Cytokine Storm Syndrome: What Do You Need To Know About This Potential Cause Of Death In COVID-19 Patients?

COVID-19, which first emerged last December, is different from any disease humans have fallen victim to so far.

This isn't the first pandemic our civilization has encountered, and it's actually far from the worst. This isn't even the only global disease we're fighting at this moment, since the HIV pandemic has been among us for decades. There are a lot of way deadlier viruses around, too.

But — the ease with which COVID-19 spreads, the not-so-low mortality rate, the symptom severity and range, and the impact the disease has on the economy, human interaction, and our daily lives makes it one of the biggest events in human history since the Second World War.

What we do know so far is this:

• Although previously believed to be a new species of virus, it was later discovered that this virus is a strain of the SARS-COV virus, which caused an epidemic in 2002.
• The disease is spread via droplets, from coughing and sneezing.
• While some COVID-19 patients are asymptomatic, most cases are accompanied by flu-like symptoms — fever, shortness of breath, dry cough and fatigue. In some cases, diarrhea, or loss of smell, are present.

The mortality rate of COVID-19 is changing from day to day, depending on the number deceased and those who recover. Keep in mind that this is an ongoing epidemic, and that we'll have the right number only after we've beaten it, but let's say that around five percent of those who contract the virus die from it.

What are cytokines?

Cytokines are molecules our cells use to communicate with each other. There are a bunch of them, and they are produced by a bunch of different cells. That story is way to long and complicated to be explained in this text (or in a single textbook) and, really, it doesn't hold much practical relevance to your average person.

The first thing about inflammation (save for the definition) you'll find in every pathology textbook are the five cardinal signs (in Latin). Those signs are:

• Rubor (redness)
• Tumor (swelling)
• Calor (heat)
• Dolor (pain)

And, the most important one for this story:

• Functio laesa (loss of function)

So, what is Cytokine Storm Syndrome?

So, imagine the following situation. A single white blood cell encounters SARS-COV2. That white blood cell wants to inform its colleague white blood cells that an intruder has been discovered, and must be dealt with. At the same time, it informs the surrounding cells that they must protect themselves from the possible invasion.

Other white blood cells pick up the signal and do the same. More and more white blood cells start producing cytokines, setting off a chain reaction that causes a positive feedback loop. This in turn boosts the production of cytokines even more and causes a widespread inflammation of tissue. And the more widespread the inflammation, the more severe the resulting functio laesa (loss of function).

Why is this important?

Although the symptoms (and the sad end result) might be the same, the approach to management is a complete opposite.

While there still is no anti-viral treatment for this virus (nor a vaccine, for that matter), symptoms can be managed and eased with supportive care, such as fluid therapy, paracetamol or, in some cases, mechanical ventilation.

The good news is that there are ways we can diagnose Cytokine Storm Syndrome in laboratories, by measuring levels of certain molecules, platelets or by measuring sedimentation time. It is recommended that all COVID-19 patients with severe symptoms should have these parameters tested, for it might make a difference between life and death.