SUMMARY: Current COVID treatments for the seriously ill are largely ineffective because they are not treating the correct illness. Seriously ill COVID patients are suffering from severe cases of "hypersensitivity pneumonitis".
Other research teams are beginning to come to the same conclusion:
The proposed treatment does not treat the virus, itself, but rather hopes to prevent the more serious side effects that occur as a result of the viral infection. It can and should be used in conjunction with any anti-viral medications that may be deemed effective.
DETAILS:
Pneumonitis is a broad term that describes inflammation of the lungs and its associated symptoms.
Hypersensitivity pneumonitis (HP) is a more defined type of pneumonitis. Traditionally, HP results as a response to an inhaled allergen or chemical; it causes fever, cough, shortness of breath, hypoxia at rest, ground-glass opacities on CT, pulmonary edema, and a number of other symptoms which seriously ill COVID patients also exhibit.
The following whole-lung biopsy of a COVID patient provides even more insight to the similarities between HP and COVID presentation. Though acute HP biopsy presentation is difficult to come by (most patients with acute HP rarely undergo biopsy), sub-acute cases are fairly well documented and show a number of similarities:
COVID:
HP:
(Scroll down to histopathology for the HP biopsy information)
I propose that the cause of HP in the case of COVID patient is not in response to an allergen, but rather by histamine released within the lung tissues by neutrophils responding to the viral infection.
The discovery that human neutrophils release histamine in response to pathogens in the lungs is a recent one and is critical to the effective treatment of seriously ill COVID patients. The higher the viral load, the more severe the resulting symptoms of acute HP.
It has also been demonstrated by numerous studies that all cases of HP have markedly increased levels of neutrophils present in biopsied tissues and that development of more serious complications from HP (such as fibrosis) were associated with higher levels of neutrophils:
In animal studies with mice, the same neutrophilic production of histamine was verified - but they also discovered that intentionally afflicted pneumonitis symptoms were relieved proportionally to the amount of antihistamine that was administered:
PROPOSED TREATMENT:
Similar to the prevention and treatment of of radiation pneumonitis or chemical pneumonitis (well-known side effects of many cancer therapies), COVID patients should be treated prophylactically with antihistamines and anti-inflammatory drugs over the course of their illness. This should prevent the inflammation-derived pneumonitis from occuring in the first place and we should see far fewer hospitalizations with far fewer complications.
I specifically propose the use of diphenhydramine, cimetidine, and ibuprofen as they were shown (in animal studies) to effectively treat acute respiratory distress syndrome (which is a serious complication of pneumonitis and COVID patients):
This treatment could absolutely be improved upon as it is over 30 years old. Second or third-generation antihistamines would probably be as or even more effective and corticosteroids would likely be a better choice than ibuprofen, but require a doctor's prescription.
WHY ARE THERE 'AT-RISK' GROUPS?
The elderly, on average, have weaker immune systems than younger individuals. This means that while they will likely still fight off a COVID infection, their remaining viral load is going to be much higher than that of a more competent immune system. The higher the viral load, the more severe the symptoms of HP.
People who take ACE inhibitors are more likely to have more ACE receptors than other patients. As COVID binds to ACE receptors, it replicates more quickly in those patients. Again, they will likely fight off the virus, but will have a higher viral load in the end - resulting in a more severe expression of HP symptoms.
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