COVID-19 is a 'one-two-three-punch' disease: Doctors describe how the coronavirus severely damages the lungs

However, certain patients are more prone to severe lung damage from the novel coronavirus.
Doctors break down how the coronavirus can severely damage the lungs and explain why they're calling COVID-19 a one-two-three-punch disease.
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Last week, George Washington Hospital released a video that used Virtual Reality (VR) technology to show the lung damage suffered by a 59-year-old patient with severe COVID-19 symptoms. The video shows "rapid and progressive damage to the lungs," said Dr. Keith Mortman, Chief of Thoracic Surgery at George Washington Hospital on the hospital's podcast .

While it's hard to predict who will get severe symptoms of COVID-19, "some people, especially those who already had underlying lung issues, may end up with some kind of long-term damage," Mortman told Business Insider.

To understand how COVID-19 can severely damage the lungs, it helps to understand the way SARS CoV-2 enters the body, said Dr. Osita Onugha, MD, Chief of Thoracic Surgery at John Wayne Cancer Institute at Providence Saint John's Health Center in Santa Monica. "The virus has a way of attaching to a specific receptor on lung cells called the ACE2 receptor," he said. "It's like the ACE2 receptors are the lock, and coronavirus SARS CoV-2 has a key that allows it into the lung tissue."

As the virus takes hold in the lung cells, the body tries to fight it off. "We're starting to think of the disease as a one-two-three punch," Mortman said. "The first inciting event is the virus, and the second step is the way the body deals with the virus in the lungs, which is to create an inflammatory process to contain the virus, flooding the lungs with inflammatory cells."

That combination of infection and inflammation is what causes the breathlessness that patients experience as the disease worsens. "The shortness of breath can cause oxygen levels to drop, which can lead to the need for a ventilator and it can progress from there," Mortman said.

The third punch, which can happen in the most severe cases, is the release of cytokines in the bloodstream, which can damage vital organs. "Most of these patients are really dying of systemic organ failure the first effect is the strain on the heart, then the kidneys can start to fail, then the liver can fail," Mortman said.

The reason that ventilators are proving so critical in COVID-19 treatment is that they assist with lung function, preventing the drop in oxygen levels that can damage vital organs. That said, being intubated and on a ventilator takes a significant toll on long-term health.

"If you're younger and healthier, you're likely to survive COVID-19, but you still may end up on a ventilator for some period of time, and when that happens, your muscles begin to atrophy," said Onugha. Just a few days on a ventilator can mean up to 6 months of recovery before you're back to where you were, he added.

Patients at greater risk of severe COVID-19 symptoms

Lung conditions like chronic bronchitis and COPD (chronic obstructive pulmonary disease) raise the risk of severe symptoms because the lungs are already weakened, said Mortman.

But inflammation also raises the risk of those with less severe conditions, such as asthma, according to the Centers for Disease Control (CDC) .

And while there's little data as of yet, allergies to dust, pollen, and other airborne particles can increase sensitivity, also providing possible pathways to inflammation, said Onugha. "Anyone with asthma or allergies should try to keep their condition under control with medication."

Smoking is another risk factor. The American Lung Association (ALA) on Friday released a warning to people who smoke and vape that they have an increased risk for developing more severe COVID-19 symptoms and should consider quitting. Other conditions, like asthma and allergies, may also exacerbate symptoms in patients with COVID-19. According to the ALA , both smoking and vaping have been linked to lung inflammation and lowered immune function.

"There is data to show that e-cigarettes and vaping cause very similar changes in lung cells to regular cigarettes," said Mortman.

Smoking marijuana should be included in the risk factors as well, according to the National Institute on Drug Abuse . Onugha echoed this and explained like this: "If you think about the COVID-19 pandemic as a marathon, you're injuring the muscles you need in that race when you vape or smoke anything. If you already have inflammation present when the coronavirus goes into your lungs, you've started with a tank half empty."

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