In a new study from NYU Grossman School of Medicine, researchers found a buildup of coronavirus in the lungs is likely behind the steep mortality rates seen in the pandemic.
The results contrast with previous suspicions that simultaneous infections, such as bacterial pneumonia or overreaction of the body’s immune defense system, played major roles in a heightened risk of death.
In the study, the team collected bacterial and fungal samples from the lungs of 589 men and women who were hospitalized in NYU Langone facilities in Manhattan and on Long Island. All required mechanical ventilation.
For a subset of 142 patients who also received a bronchoscopy procedure to clear their air passages, the team analyzed the amount of virus within their lower airways and identified the microbes present by studying small pieces of the germs’ genetic code.
The team also surveyed the type of immune cells and compounds located in the lower airways.
They showed that people who died of COVID-19 had on average 10 times the amount of virus, or viral load, in their lower airways as did severely ill patients who survived their illness.
Meanwhile, they found no evidence implicating a secondary bacterial infection as the cause of the deaths, although they cautioned that this may be due to the frequent course of antibiotics given to critically ill patients.
These findings suggest that the body’s failure to cope with the large numbers of virus infecting the lungs is largely responsible for COVID-19 deaths in the pandemic.
Current guidelines from the Centers for Disease Control and Prevention do not encourage the use of antivirals such as remdesivir for severely ill patients on mechanical ventilation.
But the new study results suggest that these medications may still remain a valuable tool in treating these patients.
Despite previous concerns that the virus may prompt the immune system to attack the body’s own lung tissue and lead to dangerous levels of inflammation, the researchers found no evidence that this was a major contributor to COVID-19 deaths in the group studied.
In fact, the team notes that the strength of the immune response appeared proportionate to the amount of virus in the lungs.
The team cautions that the investigators only studied coronavirus patients who survived their first two weeks of hospitalization.
It is possible that bacterial infections or autoimmune reactions may play a greater role in COVID-19 mortality than occurs earlier.
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The study is published in Nature Microbiology. One author of the study is Imran Sulaiman, MD, Ph.D.
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