The Outlook for Cardinal Burke Is Bleak. By Dr Geoffrey Brushwood MD
(Gloria.tv) I am sorry to hear that His Eminence Leo Cardinal Burke is in intensive care receiving ventilatory support after contracting Covid-19. There was speculation about his illness, when Deacon Donnelly in his blog reported that the Cardinal was fine and suffering merely from a sinus infection. However, the Cardinal himself tweeted on the same day that he had tested positive for Covid-19 but was well, with the grace of God.
It seems however that events have taken a turn for the worst and His Eminence is now in respiratory distress and managed in intensive care with ventilator support.
For those of who are still skeptical about Covid-19, perhaps this would be a potent reminder that it’s is in fact a real disease, and with a greater mortality than common flu. The virus responsible for Covid-19 has clearly mutated, as most respiratory viruses do, and has produced several virulent strains, and yet there’s currently no known treatment of any kind for any viral illness afflicting mankind. Despite the plethora of conspiracy theories and attempts to downplay its impact, this is a very significant problem for many vulnerable people. One doesn’t realise who is in fact vulnerable, until overcome by the disease.
From practical experience of treating Covid -19 patients, the first clinical signs of an adverse progression of disease occurs around day 8 to 11 with the patient being unable to maintain normal oxygen levels on room air. Commonly a disease free person will have approximately 98% oxygen saturation in their blood at rest on room air. This may reduce to around 95% for the elderly. However, with Covid-19 pneumonitis, oxygen levels rapidly drop to around 88% or less, needing continuous high flow oxygen support, to maintain basic bodily function.
Without adequate oxygen, muscle contraction, specifically cardiac muscle contraction, can suffer, and as a result the cardiac output decreases. This in turn further reduces blood oxygen circulation and a vicious cycle of negative feedback begins, depriving the brain and other organs of oxygen.
With respiratory function already compromised with pneumonitis (multiple pockets of fluid in lungs that appear as a snow storm on a routine chest X-Ray), the secondary organ failure produces a poor prognostic outcome. With more than one organ failing, the chances of recovery become less, until finally the patient’s organs begin to irreversibly fail.
Maintaining oxygen supply and kidney and cardiac function is the only support intensive care can provide, together with immune suppressants, some anti-virals and medication to prevent blood clots from forming, however the ‘cure’ must come from the patient’s own body’s ability to remove the virus without causing too much collateral damage.
Cardinal Burke has two obvious medical problems facing this virus, he is old and is obese.
In the elderly, with reduced metabolic reserves, any infection can cause a dramatic decrease in function. Often the patient never regains pre morbid functional status.
People with obesity have an increased prevalence of diseases such as renal insufficiency, cardiovascular diseases, Type 2 diabetes mellitus, certain types of cancers, and a significant degree of abnormal immune function. These conditions are major risk factors for disease severity and mortality associated with COVID-19. However, it has been reported that obesity per se is an independent risk factor for poorer outcome of Covid-19 infection.
Both, prevalence of other diseases and as an independent risk factor, makes obesity, particularly ominous in COVID-19.
The physiological mechanisms that create an adverse outcome for obese patients are numerous, but the most important factor in encountering the SARS-Cov-2 virus in an obese body is the poor immune modulation around adipose (fatty) tissue.
Until recently adipose tissue was merely considered to be an inert organ that stored energy in the form of lipids, which could be utilized in the state of fasting/starvation. However, adipose tissue is now being recognized as a key endocrine organ that secretes a number signaling molecules that profoundly impact metabolism and the immune system.
Within the immune system a number of key players perform different functions to maintain bodily defenses. The balance of which is vital to reduce the impact of collateral damage from an uncontrolled response. Much like a dreaded visitor from the Vatican to a traditional community these days, Macrophage cells cause total chaos in the midst of an inflammation. The immune cells most associated with adipose tissue are macrophages, like a modernist Jesuit with a twitter account macrophages send out a variety of pro inflammatory signal molecules and creates chronic inflammation, both at local as well at the systemic level. This chronic inflammation creates conditions suitable for Viral replication, and poor immune response against the threat.
In contrast ordinary tissue, produce signaling molecules that activate a particular subset of white blood cells called T cells, which are the true workhorses and heroes of the immune system, much like the ordinary traditional parish priest, or a congregation of traditional Catholic priests untied in a common front and working alone or in synchrony to defeat the enemy, they simply get on with the job at hand until they are spent, and die. These are the cells most useful at fighting an infection such as Covid-19.
Besides an altered immune response, obesity induced adipose dysfunction plays a central role in the development of systemic insulin resistance, a complex phenomenon with multiple factors involved. This is much like a resistance to the Traditional Latin Mass by modernists. Insulin resistance often leads to type 2 diabetes in obese people. At the cellular level, Insulin signaling exerts a critical immune-stimulatory effects on T-cells, positively controlling their growth and proliferation. Just as celebrating the Traditional Latin Mass would allow a priest to flourish in his ministry. However insulin resistance hampers the function of T cell metabolic function. The same T cells that are the true work horses of the body’s defense mechanism now have to fight the enemy neutered. This creates a positive environment for unfettered viral replication and a greater viral load, effecting a poorer outcome in Covid-19 infection.
In addition to the aberrant signaling to the immune system and hampering its work, adipose tissues open doors for the SARS-Cov-2 virus to get in. Angiotensinogen Converting Enzyme (ACE-2) acts as a docking port for entry of SARS-Cov-2 virus into the cells. ACE-2receptors are expressed on cells in the nose lining, the lungs, kidneys, in the heart muscle and adipose tissue in great abundance. It is assumed that increased expression of ACE-2 receptors boost the entry of the virus into the cells and a greater viral load causing severe disease with worse clinical outcomes. Emerging evidence indicates that ACE2 expression is increased in adipocytes of individuals who are obese and overweight.
Furthermore, several studies have shown that obese people have elevated levels of prothrombin factors and reduced levels of anti-thrombin molecules which are associated with a hypercoagulable state. Severely ill COVID-19 patients who are often associated with coagulopathy and blood clot formation, are potentially worse off if obese.
These pathophysiological conditions are all of them certainly present in Cardinal Burke’s current situation. Although I have no access to his medical notes, and his current clinical observations, baring a miracle, I fear that Cardinal Burke would die from this illness. In my experience, less than 50% of young fit patients survive requiring ventilator support in severe Covid-19 infection.
If His Eminence survives, it’s only through a suspension of the above detailed pathophysiological process, a clear sign that God has further plans for him in this world. If he in fact dies, the Church would gain a powerful intercessor.
We are, facing a win-win situation. In God’s great mercy, the best outcome will happen. We must all pray and trust in God. Source
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