Ministry of Health document: how coronavirus affects blood vessels, heart, brain and other organs

A voluminous 225-page document is publicly available at this link. It is clear that the recommendations are not intended for patients, but for doctors who are able to understand special vocabulary and accurately understand what is written. Fortunately, among the famous bloggers of LiveJournal there is also a practicing doctor under the nickname Sovenok, who popularly explains the main points of the document - in particular, how covid-19 affects not only the lungs, but also other organs.

"This time, the recommendations are much better written than the earlier versions. - the specialist notes. - Everything is clear and to the point, there is little spread of thought along the tree. What seemed interesting. About the stability of the virus".

The virus remains stable over a wide pH range (up to 6 days at pH 5 to 9 and up to 2 days at pH4 and pH11). At a temperature of +4 ° C, the stability of the virus is maintained for more than 14 days. When heated to 37 ° C, the complete inactivation of the virus occurs within 1 day, at 56 ° C - within 45 minutes, at 70 ° C - within 5 minutes.

The virus is sensitive to ultraviolet irradiation with a dose of at least 25 mJ / cm2 and to the action of various disinfectants in working concentration. An interesting section on pathophysiology and pathology. There, at last, 2 paths of damage to the lungs and other organs by the virus are clearly formulated and divided. Two paths implemented at the same time:

1. Alveolar damage from the airways. Very similar to that of the H1N1 swine flu. Diffuse lesion that can involve almost all lung tissue. Unlike bacterial inflammation, when one specific area is captured. There are also bacterial "screenings" - small foci. They can also be diffusely located, but they look completely different from viral ones. This is me about the CT picture.

If you understand at the level of cells, then macrophages rule the ball there - those very borderline cells from the army of innate immunity, whose job is to recognize a stranger, eat it and demonstrate part by part to lymphocytes so that they start producing antibodies. And while the lymphocytes are working, macrophages send the signal "get up, strangers!" and they organize a war called inflammation, the purpose of which is to localize and clean up the invasion site, not sorting out who is their own, who is a stranger.

The situation when macrophages go off the rails and organize a war to destroy the whole organism is called macrophage activation syndrome - CAM. In principle, CAM can happen without any viruses, within the framework of rheumatic diseases, but in this case it is the virus that launches it. At the same time, a large number of specific molecules circulate in the blood - inflammatory mediators.

2. Damage to blood vessels, primarily lungs, but not only. This is initially an inflammation of the inner layer of the vascular wall (endotheliitis), which inevitably leads to thrombosis and hemorrhage . At its core, what is happening resembles a severe and rapidly developing antiphospholipid syndrome. Large and small vessels are affected. At the final stage, DIC syndrome develops.

As you remember, the lungs are the meeting point of the respiratory tract and the bloodstream, the border between air and blood there is so thin that it makes gas exchange possible. It is there, on this thin border, that everything happens, and the damage comes from both sides at once.

Pathologists find, in addition to quite understandable inflammation of the entire lung tissue, hemorrhages and thrombosis of almost any vessels, but most often - branches of the pulmonary veins.

In addition to the lungs, the intestines (catarrhal and hemorrhagic gastroenterocolitis), the brain (encephalitis and meningitis), heart (myocarditis), pancreas, kidneys, liver, spleen, in general, everything are affected. Direct viral lesions of the placenta are highly likely.

A whole section is devoted to the description of skin changes. The leading route of transmission of SARS-CoV-2 is airborne, which is realized when coughing, sneezing and talking at a close (less than 2 meters) distance. Contact transmission route: during handshakes and other types of direct contact with an infected person, as well as through surfaces and objects contaminated with the virus. Fecal-oral transmission of the virus is possible, as SARS-CoV-2 RNA is found in fecal samples".