British Columbia (B.C.) physicians and scientists are learning more about the links between the body’s immune system and the new coronavirus after the recovery of a 32-year-old who nearly died from acute COVID-19. Physicians and researchers at Vancouver General Hospital and the University of B.C. are hoping that what they’ve learned may help them determine what drugs are best to treat patients whose immune systems go into overdrive and start attacking their internal organs.
Dr. Mypinder Sekhon said it appears that the immune system’s response to the new coronavirus differs from one patient to the next. “What the early results are telling us is that the response is very different in individual patients,” said Sekhon, an intensive care physician at VGH. “We need to treat patients as individuals instead of as a big cohort.”
A team led by Sekhon and Dr. Cheryl Wellington, a professor in UBC’s department of pathology and laboratory medicine, are studying blood samples taken from 67 critically ill COVID-19 patients at VGH and Surrey Memorial.
Wellington’s lab can identify more than 10 types of blood markers for inflammation using a Simoa HD-1 Analyzer, an automated digital instrument that identifies proteins and antibodies. Working closely with the UBC lab means physicians at VGH can find what’s happening with a patient’s immune system within 24 hours instead of waiting for up to four weeks.
One of the patients in the study is Zee Rahiman.
Zee Rahiman’s Story
Before COVID-19, Rahiman went to the gym two to three times a week. He had no existing conditions such as diabetes or heart problems which often characterize older patients hospitalized with COVID-19. On a Friday in late March, Rahiman said he was trying to go to sleep when he felt like he “literally hit a brick wall…I had a crazy fever. I started to vomit. I was coughing, had a sore throat.”
As Rahiman started to get sick in early days of the COVID-19 pandemic in B.C.., he was told by public health officials to self-isolate. He did and his symptoms worsened. He became extremely weak and lethargic. He had a non-stop, dry cough. When a cardiac surgeon friend saw him online, he told Rahiman to call an ambulance immediately.
In hospital, a physician said his body wasn’t absorbing oxygen and he would have to go on a ventilator. Rahiman knew what that meant. Some studies have shown a death rate of more than 80 per cent of patients with COVID-19 who are placed on ventilators.
“It’s the last resort,” he said. “I had a few moments to think about what I’ve been thankful for and grateful for. I texted my mom. I texted my girlfriend. I said I didn’t know what was going on but they’re putting me on the ventilator.”
When he came out of the induced coma, he had a tube down his throat, another up his nose, and a third in his groin. He was in hospital for more than three weeks. He said he was incredibly thankful for the treatment he received from nurses and doctors. He’s just glad to be alive.
“I’m putting it out there that this virus goes after anybody. It doesn’t matter if you’re 10 years old or 90, it affects you in a very, very negative way,” he said. “People think it is just a flu. I’m a living example of what the harshest things are it can do to your body.”
The Danger of Cytokine Storm Response
Rahiman likely experienced a cytokine storm. Cytokines are messenger proteins that can trigger or suppress an immune response. “It strongly appears that’s what happened in his case is that he developed cytokine storm syndrome which is related to how sick he got,” Sekhon said. “It appears that the virus triggers the immune system to attack the body. We don’t know why.”
That information led physicians to treat Rahiman with a whole range of medications designed to tame the immune system’s overreaction. Sekhon said Rahiman and the other 66 patients in the study are demonstrating a link that’s still not fully understood between the immune system and COVID-19.
“I can’t tell you for sure that he only got better because of what we did,” Sekhon said. “I don’t want to give the wrong message that there’s a silver bullet because we kind of threw the kitchen sink (of immune system drugs) at him. What I can be very sure of: what did save his life was the level of intensive care, absolutely.”