Causes of mortality uncovered in patients with milder infections of coronavirus

Experts pinpoint reason as form of systemic inflammatory response syndrome called "cytokine storm"

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(AP Photo/David Goldman)

(AP Photo/David Goldman)

Experts have blamed a form of systemic inflammatory response syndrome called "cytokine storm" for killing some novel coronavirus (2019-nCoV)-infected patients who were not very sick in the early stage of infection but eventually died of multiple organ failure, according to Chinese media reports.

The epidemic, which started mid-December in Wuhan, in China's Hubei Province, had claimed more than 800 lives in China as of Feb. 8, including Li Wenliang (李文亮), a 34-year-old ophthalmologist at Wuhan Central Hospital who tried to issue the first warning about the deadly coronavirus outbreak late last year but was silenced by the Chinese authorities.

Li was confirmed Feb. 1 to have been infected after treating a patient who later tested positive for coronavirus. He died on Friday.

While most victims have been middle-aged, elderly or suffering from chronic disease according to official Chinese data, Li's death, as well as that of a 39-year-old man in Hong Kong, drew media attention as the epidemic has attacked more than 37,000 people in 28 countries around the world.

According to Chinese media reports, Zhong Ming (鍾鳴), a physician at the department of critical care medicine of Zhongshan Hospital in Shanghai, warned that in some novel coronavirus cases, patients who developed only moderate symptoms at the onset of the disease later fell seriously ill and died of multiple organ failure.

He termed the condition a "storm of inflammations." Once patients are in that situation, "it is very difficult for them to recover," said the doctor who was sent to Wuhan's Jinyintan Hospital soon after the epidemic broke out last year.
The hospital was among the first medical centers in Wuhan to receive and treat novel coronavirus patients and is now one of the main hospitals in the city for severe cases.

Zhou Zheng (周正), an expert in respiratory medicine at the Second Affiliated Hospital of Zhengzhou University in Hunan Province, said one feature of 2019-nCoV infection is that patients can develop moderate symptoms in the first two days of infection but can become seriously ill on the third day or later.

Attributing this to the phenomenon of cytokine storm -- a high level of circulating inflammatory cytokines -- Zhou said the novel coronavirus can stimulate the body's immune system, which can further damage the cells. "A normal immune system protects, but an over-active immune system can not only damage the lungs but also other organs, including the kidneys, liver and heart," he said.

A recent Lancet publication titled "Clinical Features of Patients Infected with the 2019 Novel Coronavirus in Wuhan, China," also describes the correlation of the cytokine storm and the severity of illness in patients infected with 2019-nCoV.