CYTOKINE STORMS.

Recently:

In the 2019–20 coronavirus pandemic, a number of deaths due to COVID-19 have been attributable to cytokine release storms.

About:
 As Covid-19 cases fill the hospitals, among the sickest and most likely to die are those whose bodies react in a
signature, catastrophic way.
 Immune cells flood and attack the lungs they should be protecting. Blood vessels leak; the blood itself clots. Blood
pressure plummets and organs start to fail.

 Normally, when the human body encounters a germ, the immune system attacks the invader and then stands down. But
sometimes, that orderly army of cells wielding molecular weapons gets out of control, morphing from obedient soldiers
into an unruly, torch- and pitchfork-bearing mob.

 Cytokines play an important role in normal immune responses, but having a large amount of them released in the body
all at once can be harmful.
 A cytokine storm can occur as a result of an infection, autoimmune condition, or other disease. It may also occur after
treatment with some types of immunotherapy.

Symptoms:
 Symptoms include fever, fatigue, loss of appetite, muscle and joint pain, nausea, vomiting, diarrhea, rashes, fast
breathing, rapid heartbeat, low blood pressure, seizures, headache, confusion, delirium, hallucinations, tremor, and loss
of coordination
 Lab tests and clinical monitoring show low blood oxygen, widened pulse pressure, increased cardiac output (early)
potentially diminished cardiac output (late).

Chronology:
 The first hints that severe Covid-19 cases included a cytokine storm came out of Chinese hospitals near the outbreak’s
epicenter. Physicians in Wuhan, in a study of 29 patients, reported that higher levels of the cytokines IL-2R and IL-
6 were found in more severe Covid-19 infections.
 IL-6 was also an early indicator of a cytokine storm-like condition in an 11-patient analysis by physicians in
Guangdong. Another team, analyzing 150 cases in Wuhan, found that an array of molecular indicators for a cytokine
storm — including IL-6, CRP and ferritin — were higher in those who died than in those who survived.
 And immunologists in Hefei reported similar results among patients who died, as well as high levels of active,
damaging immune cells spewing dangerous cytokines in the blood of Covid-19 patients who required intensive care.
 Cytokine storms are also raging among US patients. “I’ve seen plenty of it,” says Roberto Caricchio, chief of
rheumatology at Temple University in Philadelphia storm,”

 This is not the first time a cytokine storm has been linked to a pandemic. Scientists suspect that cytokine storms caused
many of the fatalities in the 1918 flu pandemic and the 2003 outbreak of SARS, a virus related to the one that causes
Covid-19.

Taming the storm

 Steroids are often the first choice of treatment. They act broadly to dampen the immune system — but, of course, that
system is needed at a lower intensity to fight invaders.
 In the case of Covid-19, it’s not yet clear if steroids are beneficial or harmful, Cron says.
 There are also medications that interfere with specific cytokines. If steroids are an atom bomb, these drugs are targeted
missile strikes. The idea is that they’ll leave the good immune response intact.
 Researchers are initiating several clinical trials of cytokine blockers for Covid-19. Tocilizumab is under further study in
Italy and China; tocilizumab and sarilumab (Kevzara), another antibody to the IL-6 receptor used for rheumatoid
arthritis, are both being tested in Denmark; and emapalumab and anakinra are undergoing trial in Italy.
 Interim guidelines from the US Centers for Disease Control and Prevention, updated April 3, mention that high CRP
and ferritin levels may be correlated with more severe illness; World Health Organization guidelines make no mention
of markers for a cytokine storm.
 The sooner doctors can treat the raging storm, the better the results will be.