R0 and cytokine storms revisited

What it feels like to survive COVID-19’s dreaded “cytokine storm”

A doctor and coronavirus patient in recovery describes his experience surviving COVID-19's worst side effect

The cytokine storm affects a substantial number of severe COVID-19 patients, enough that it has become the subject of a subset of medical research into COVID-19. Those unlucky enough to experience cytokine storm will have their bodies and especially lungs flooded with cytokines, immune system helper molecules, as their immune system struggles to fight off the invading virus and the dead lung cells it produces en masse. The overreaction results in the immune system building up too many of these kinds of cells, which can lead to respiratory distress or bacterial pneumonia and, ultimately, death.

Not everyone who experiences a cytokine storm will die, fortunately. Such is the case of Jonathan Raskin, a 69-year-old pulmonologist who practices medicine in New York City, and who contracted coronavirus a few weeks ago and is currently in recovery. After self-isolating at home, Dr. Raskin's temperature swelled to 102.8°; he spent several days in the hospital in a very bad state (by his own admission) before slowly recovering. As a pulmonologist, Dr. Raskin's insights into what was happening to his own body are particularly keen, as he had a medical understanding of what was happening as it happened to him.

My lab work was stunningly bad. A normal white count might be between 4.5 and 10. My white cell count was at 2,000. My lymphocytes — which are the cells that fight in a virus, normally fall somewhere between 1000 and 1,500 — they were under 200. I don't know if you know the term but the early cells that fight infection are called "bands," and you don't have [them] normally — I had 20% bands. My platelet count was around 100,000, which is low, and I knew I was in trouble.

In the current context, we believe we have a biomarker of this condition, a serum level of a non-specific but is an acute phase reactant called serum ferritin. It looks like it may be to be one of the more reliable biomarkers of cytokine dysregulation. A serum ferritin is normally below 400 in our lab, mine was 18,000!