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Dr. Fauci Says This is the Weirdest COVID-19 Side Effect

The top infectious disease specialist spoke out about the cytokine storm.
Sick young woman at home on the sofa, she is covering with a blanket, taking temperature and blowing her nose with a tissue

As coronavirus cases spike across America, the country's top infectious disease specialist, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, has been sharing his thoughts on how to get the virus under control—wear your mask, avoid crowds, don't go to bars. And in an interview with Medscape's Eric J. Topol, MD, and Abraham Verghese, MD, he discussed one of the more alarming side effects of COVID-19: the "cytokine storm." Doctors, including him, have observed that many patients who managed to survive COVID-19 feel better only for a short time. After that time their confused immune system reacts out of proportion causing dangerous organ inflammation—or a "storm." It can be deadly.

"The one thing that we do know is, and I don't even think this clarifies it anymore, is that when they were first looking at people who progressed rapidly — the ones who got sick, went to the hospital, they look like they're okay, and then all of a sudden, dramatically, they just crash and go on ventilators — that was felt to be a hyperactive, aberrant immunologic and inflammatory response," Fauci says. "And actually, I think it's at least partially true, based on the data from the UK study in which dexamethasone in individuals on ventilators and those requiring oxygen — but not in early patients — significantly diminished the death rate. So we do know that there's a lot of cytokine secretion. If you measure IL-1 beta, IL-6, TNF, they're all sky-high." 

How a Cytokine Storm Rages

"One of the great mysteries of the new coronavirus is why it causes only mild disease in most people, but turns fatal for others," reports WebMD. "In many cases, it seems the worst damage may be driven by a deranged immune response to the infection, rather than the virus itself. In many of the sickest patients with COVID-19, their blood is teeming with high levels of immune system proteins called cytokines. Scientists believe these cytokines are evidence of an immune response called a cytokine storm, where the body starts to attack its own cells and tissues rather than just fighting off the virus."

As a cytokine storm is similar to the immune response seen in people with a type of arthritis, the scientists are investigating several anti-inflammatory drugs used to treat this disease as possible treatments for COVID-19.

In the interview, Fauci went on to wonder: "What is the nature of the protective immune system? Is it clearing virus and you have a hyperimmune and aberrant cytokine storm that's giving you pathogenic symptomatology at the same time that you're suppressing the virus? We don't know. I have to tell you, I'm humbled by it that we don't know. We have so many people who have gotten sick, and we can't write a really good paper on delineating A-B-C-D or what's going on…[and] I'm not so sure that gives you much insight because we know, prior to COVID, that when you get people in dire straits with a lot of inflammation, you get a bit of a cytokine storm anyway. We just don't know."

The storm joins an ever-growing list of COVID-19 side effects, including neurological damage, blood clots and chronic fatigue syndrome, that are frightening patients and doctors alike.

How Protective Equipment Makes a Difference

Fauci also said we need to produce more of our own products in our country, to help fight the coronavirus. "It is extraordinary how much of PPE is not produced in the United States of America," he said. "I was stunned when I first heard that a high percentage of it has to be shipped in, so you don't have immediate control over it. If there are ever lessons learned from this — and it's something that we have spoken about in the past when we've spoken about pandemic preparedness — it is that we really need to get in our own geographic boundaries, things that were absolutely essential to the health of our country. It has to do with everything from PPE to the ingredients of many of the pharmaceuticals we use, which currently come from the outside."

Timeline for a Vaccine

Fauci was also asked about when we might get a vaccine. He said: "Whenever you do vaccine research — you guys know as well as I — you never can guarantee anything because there are always potholes and bumps in the road….As we all know, the gold standard for a vaccine is to induce a response that's at least as good as natural infection. So if we could mimic that in the field and have a comparable clinical efficacy, I think by the end of this year, the very beginning of 2021, we could have one or more vaccines available for distribution of doses. That's what I'm hoping for."

As for yourself: To stay healthy no matter where you live, do what Fauci advises: avoid crowds (and bars, and house parties), wear a face mask, practice social distancing, only run essential errands, wash your hands regularly, and to get through this pandemic at your healthiest, don't miss these 37 Places You're Most Likely to Catch Coronavirus.

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