The new coronavirus attacks the body in similar ways to Sars and Mers, according to Chinese researchers involved in a new medical study based on an autopsy of one of the ongoing outbreak's victims, who had suffered lung and liver damage.
The report, published this week in British medical journal The Lancet by experts from the Fifth Medical Centre of the People's Liberation Army's General Hospital in Beijing, obtained biopsy samples from the autopsy of a 50-year-old man who died in late January of Covid-19 - the formal name for the pneumonia-like disease caused by the coronavirus outbreak discovered in December in Wuhan, central China.
A review of the patient's lung, liver and heart tissue showed "the pathological features of Covid-19 greatly resemble those seen in severe acute respiratory syndrome (Sars) and Middle Eastern respiratory syndrome (Mers) coronavirus infections", the authors said.
The Sars outbreak of 2002-03, which originated in southern China, killed more than 800 people in more than two dozen countries, while the 2012 Mers outbreak, first identified in Saudi Arabia, led to 860 deaths globally.
The man featured in the Beijing study, who showed initial symptoms on January 14 and died two weeks later, was found to have damage to the alveoli in both of his lungs and injury to his liver that may have been caused either by infection by the coronavirus or by the drugs used to treat him, the report said. There was less substantial damage to the heart tissue, suggesting that the infection "might not directly impair the heart", it said.
The researchers said that corticosteroid treatment - the use of anti-inflammatory drugs that the World Health Organisation (WHO) has recommended should not be routinely used outside clinical trials - should be considered with ventilator support for coronavirus patients in a severe condition, given the study's findings of lung damage in the 50-year-old man.
Wang Fu-sheng and Zhao Jingmin, two of the co-authors, did not respond to a request for further comment. They noted in the study that no pathology had been reported previously for Covid-19 cases "due to barely accessible autopsy or biopsy".
The outbreak had caused more than 74,000 confirmed cases across China by Thursday, killing more than 2,000 people, prompting the Chinese government to impose unprecedented measures such as mass quarantines and lockdowns to try to contain its further spread. More than 25 other countries have reported infections, sparking concerns that the outbreak, which the WHO has classed as a global public health emergency, could become a worldwide epidemic, or pandemic.
A separate study published in The Lancet by specialists from the University of Edinburgh on February 7 argued that, although corticosteroids - a class of steroid hormones - were widely used during the Sars and Mers outbreaks and had been tried on novel coronavirus patients, observational studies suggested their use to reduce inflammation could cause complications including diabetes, death of bone tissue and delayed removal of viruses.
"In a review of treatments for acute respiratory distress syndrome of any cause, based on six studies with a total of 574 patients, 19 concluded that insufficient evidence exists to recommend corticosteroid treatment," the study said.
Five Chinese scientists led by Lianhan Shang, from the Beijing University of Chinese Medicine, published a response to that study encouraging corticosteroid use in certain cases. The response acknowledged risks in using high-dose corticosteroids against the coronavirus, including the potential for other infections, but said it may be justifiable for critically ill patients with significant inflammation in their lungs.
"Corticosteroid treatment is a double-edged sword," they wrote. "In line with the expert consensus, we oppose liberal use of corticosteroids and recommend short courses of corticosteroids at a low-to-moderate dose, used prudently, for critically ill (coronavirus) patients."
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