Professor on what happens when a coronavirus enters the lungs: there are three options

During a COVID-19 pandemic, various lung diseases can also become a major and sometimes fatal factor. So, on what damages the lungs and how to avoid diseases: a conversation on the “Prescription” with Professor Edward Danila, director of the Center for Pulmonology and Allergology at the Santara Clinics.

– Professor, are the lungs really that vulnerable?

Yes, you are right, because the lungs are probably the only organ that is in constant contact with the outside, with what is in between. They can be various infectious agents, very important at this time, as well as harmful, professional and domestic factors. Also, of course, smoke tobacco. Everything in the immediate environment enters the lungs and can settle on them, damage them.

– How can lung disease affect the course of COVID-19 if a person with one of the lung diseases becomes infected with coronavirus?

– All chronic lung diseases, that is, chronic obstructive pulmonary disease, tuberculosis, chronic bronchitis, bronchial asthma and some other diseases, show that the lungs are already damaged and their ability to defend themselves against infections is different, slightly less. If COVID-19 is severe, it is also much more likely to cause severe lung damage.

– The coronavirus affects not only the lungs but also other organs. Still, how unique is lung damage due to this virus, how is it different from complications from flu or other viruses?

– There are not so many differences when we look at all respiratory viruses. Like the coronavirus, the flu virus can damage the lungs. There are all kinds of varieties. It can also be caused by a known runny nose virus. It all depends on how deep a virus enters the lungs, how well the immune system is prepared to accept it, and how the immune system responds, either too much or normally. All of these viruses can damage the lungs in various ways. It is possible that they simply settle on the mucous membrane and are destroyed by the human immune system. Everything ends with a mild cough, a simple bronchitis. All viruses also have a more serious form, which is pneumonia. The most serious form is respiratory distress syndrome. To make it even clearer, a person is not sterile, the bacteria that live in the stomach, genitals and mucous membranes are a normal part of the body. When the virus enters the upper respiratory tract, it disrupts a certain balance between natural bacteria. Then the conditions are created for the bacteria in the bronchi to begin to multiply. Therefore, the injury can be caused by both viral and bacterial injuries such as a secondary lung infection. And the third violation, the most serious, as I said, is respiratory distress syndrome. Fortunately, it is very rare.

– We hear about daily deaths from coronavirus, as well as the fact that most of these people have had comorbidities. But how does a coronavirus kill people, destroy their lungs, or damage other organs?

– Then we should talk a little more in detail. Once the virus enters the lungs, there are 2 options if we speak in more serious ways. The first option is the appearance of a bacterial infection due to a viral imbalance in the bacteria. The defense mechanisms of the lungs are disrupted and bacteria that are naturally present in the human nasopharynx begin to multiply. Because there is a certain competitive battle between bacteria, the virus distorts that competition and some bacteria emerge that cause pneumonia. The chance of dying from this condition is about 10 percent. However, mortality in the elderly and those with comorbidities can reach up to 30 percent. Therefore, death can be caused by the virus itself, which damages the lungs, or by bacteria. The most serious injury is respiratory distress syndrome, in which the virus in the alveoli damages the membrane that separates the alveoli from the blood vessel. When this happens, the liquid part of the blood and erythrocytes, the leukocytes, begin to flow into the alveoli, the blisters that should contain air. As soon as the blood elements cover most of the alveoli, they can no longer exchange gas. The blood is not saturated with oxygen, the respiratory muscles begin to work intensely, they tire, and the person no longer has enough strength.

– Lung ventilators are often required for the treatment of coronavirus. How do the lungs work in this case?

– The lungs are an air-filled organ. Imagine a sponge, in its normal state it is swollen and has a lot of air. But if we fill it with water, there is no air left. The lung ventilator helps push as much air into the lungs as possible. When a part of the lungs is damaged, the respiratory muscles work very hard and breathing becomes “too expensive” for the body because the oxygen given to the whole body only travels to the respiratory muscles to continue to perform their function. It is very harmful to the body. When the lungs are ventilated, the person falls asleep artificially and the machine makes sure that oxygen enters the entire body.

– What is lung regeneration? Suppose that even a severely damaged liver recovers after a while. And the lungs? If they are affected by smoking or an infection, is it possible that they will ever recover?

– Let’s divide the question into two parts. Smoking does not usually cause very clear and rapid changes in the human body, the violation occurs gradually, and in some cases, irreversible changes occur. As for lesions of infectious origin, fortunately, in many cases, these lesions are not permanent. Lung regeneration is not bad enough either, but all cells are highly specialized, so regeneration takes a long time, 2-3 months. When you have a simple cough, it is often expected to go away within a week. However, that’s not true. Regeneration takes 2-3 months. And when the lung damage is greater, the healing involves two aspects: the healing of the lungs and the healing of the whole body. The cure depends on what the violation was. If it was a bacterial injury and no structural changes occurred, recovery usually occurs within a few weeks, but a person may feel weak for several months. Even a simple pneumonia can make a person feel like they have not been as physically fit for half a year as before. If it is the most serious form, such as respiratory distress syndrome or an injury that has been caused by suffocation or drowning in salt water at sea, the injury will last for a long time. In rare cases, when the form is more severe, scars may appear on the lungs. Another important thing is that a person lies in bed when he is ill, his muscles are not trained or weakened. Several studies show that after a very severe respiratory syndrome, a functional condition in which a person says they lack strength or cannot do something can only recover after a year or two.

– What about electronic cigarettes and incandescent tobacco? I know it will be at least 10 years before we know how they really work, but is the evil itself a process of tar and burning, or carcinogens that are contained in cigarettes?

– Different factors work. Today, it is not even a debatable topic that e-cigarettes and smoking tobacco are not a safe alternative to smoking. Studies unequivocally show that smoking has not only not decreased, it has only increased. All e-cigarettes damage the lungs and bronchial tubes. The inflammation induced by smoking damages the microenvironment of genes.

– Can it be said that if a person smokes for decades, in any case, they will develop one or another lung disease?

– It is estimated that out of 100,000 non-smokers, 5 will develop cancer and that cancer is due to genetics and, for example, second-hand smoke, because a woman has smoked. Of the 100,000 people who smoke, 300 will develop cancer. Of the 10 smokers, at least one will definitely develop cancer, 2 will develop chronic obstructive pulmonary disease, and in any case, all will have a life expectancy of 10-15 years, such as old age and related diseases.

– Professor, summing up our conversation, what symptoms should you look for and go for a check-up?

– A distinction should be made between 2 groups of people: those who are completely healthy and those who smoke. A person who does not smoke and his work environment is not dangerous should be alarmed if the vague cough does not last more than 3 months. You need to go to the doctor, take a picture, and listen to the lungs. People at risk are those who smoke for many years and those who work in hazardous environments. They should be tested periodically even without receiving such signals. A typical example is a patient who comes to me for shortness of breath or for some other reason. When I ask if he is coughing, the patient is surprised and replies that he is coughing of course. Therefore, these people should be tested once a year for chronic bronchitis and lung cancer. When the cancer is already larger than 3 cm, the chances of a complete cure are very slim.