The big mystery about COVID-19 is why some people — even young ones — get seriously ill and even die from the virus while others experience much milder symptoms, if any.
Statistics from Italy reveal that 43% of people with the virus were symptom-free. Still others feel sick and appear to be getting better, when suddenly they take a deadly turn for the worse.
"Some people really fall off a cliff," Stephen Thomas, the chair of infectious diseases at Upstate University Hospital, told The Atlantic. Those people become short of breath, their heart races, and they may experience organ failure, sending them to the ICU where they could spend weeks, if they survive.
The uncertainty about the severity of COVID-19 may not be due to the virus itself but instead, to the host.
Statistics show that older people and those who are chronically ill have an increased risk of dying, but that's not always the case, according to The Atlantic. Antiviral drugs to slow the replication seem to work only in the early stages of the disease. When the disease has spread throughout the body, it is the immune response that appears to play a vital role in survival.
According to CNN, an early report from the Centers for Disease Control and Prevention reveals that for 2,449 patients with the disease, 18% were between the ages of 45 and 54 and 29% were between the ages of 20 and 44. Among those hospitalized, 18% were ages 45 to 54 and 20% were ages 20 to 44.
"It has become clear that the young and healthy are by no means immune to this infection and could become sick enough to require hospitalization," said Dr. Sanjay Gupta, CNN's chief medical correspondent.
Gupta said one possibility for the reason some get sicker than others is that a critical ingredient produced by the body called surfactant becomes depleted in certain individuals, leaving the lungs vulnerable and stiff.
The expert added that another avenue to examine is how the immune system responds to viruses and bacteria. Even in young, healthy people, the immune system can become overly reactive.
Doctors are now looking at ways to control the immune response, especially in severe cases when the system goes into overdrive and releases a tsunami of molecules called cytokines that attempt to kill the attacking virus but can actually cause life-threatening inflammation called a "cytokine storm." Some experts are looking at drugs that block cytokines, such as biologics and steroids, to put the brakes on a runaway immune system, reports The Atlantic.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, says that because of the diversity in symptoms, "there's something we are missing from a pathogenesis standpoint."
He tells CNN: "I don't think it's only if you're elderly or if you have underlying conditions. There's something else going on there that hopefully we'll ultimately figure out."
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