Wells: Can we identify who is going to crash and who’s not? Or what the risk factors are?
Hamblin: We’re looking at those patterns right now. And we have basic ideas of that. But we can’t tell anyone with 100 percent certainty that it’s not going to happen to them.
Wells: What do we know about what actually makes someone crash?
Hamblin: There’s a phenomenon called the “cytokine storm.”
Wells: You’ve told me about this. It’s where your immune system basically freaks out and goes into overdrive, and your immune system actually kills you, not the virus.
Hamblin: Right, specifically by releasing these molecules called cytokines, which are like a fire alarm and which are telling your whole immune system, Hey, bring out everything you’ve got.
With a virus, your body’s immune system is trying to kill the virally infected cells and not kill the uninfected cells, which requires some precision.
This coronavirus seems pretty stealthy. It can sneak around your body for quite a while without setting off these alarm bells. That’s when you’re feeling a low-grade illness, and your body knows something’s wrong, but is not quite sure what.
And then there’s a tipping point where the immune system realizes, We know how to identify these cells now. Oh no, these virally infected cells are everywhere.
It’s that recognition process that causes this sudden decline we see in some patients. If we could detect the beginning phases of that response, people could theoretically be helped.
Wells: How many people are dying because of this cytokine storm, this overreaction of the immune system?
Hamblin: That storm is part of something that causes acute respiratory failure. It’s inflammation throughout the body, centered in the lungs, but it can affect all kinds of different places. There have been reports of brain hemorrhages, heart conditions, liver failure, kidney failure. Those effects may be initiated by the virus being in those organs, but they are ultimately accomplished by the body attacking its own cells and not knowing which ones have the virus in them and which ones don’t.
The hopeful news is that this virus is new to us. We don’t know exactly how it works. But the immune system is not new. People have been studying the immune system for quite some time. There aren’t new cells; there aren’t new cytokines or new processes that we don’t know about that are happening here. What I’ve been told by immunologists is that we may be able to reverse-engineer this process and identify it earlier and address it with medications that we already have to help people get through it.
Wells: We might be able to treat the immune system rather than the virus?
Hamblin: That cytokine-storm process happens in a lot of infectious diseases, and we can tamp it down. While we’re trying to find a drug that kills the virus itself, which could take a very long time, doctors are finding promise in targeting those signaling molecules that send the body into crash mode, and shutting them down.