Peter Lederman in Second Bout With COVID-19


I saw on Facebook late last night that Mike Fremer told one of his Audio Friends that he heard from Peter Lederman of Soundsmith that he is suffering his second round with COVID.  Peter said he has blood clots on his lungs. That is all the post said.  Here is hoping that Peter pulls through with a full recovery. 
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@retipper glad you are climbing out of the hole. For the love of a good dog and music we will do much. I also hope you can find a way to take time to heal.

autoimmune is a nefarious Bastard. It runs in my wife’s family - Lupus and nonspecific... so my empathy as you fight that

My best to you

jim
Dear Peter, In my opinion, your own rheumatologist did a good job dissecting the issues in your case. Of course, I like what he wrote, by and large, because he agrees with me, (1) even if you’ve had COVID, it is still a good idea to get vaccinated, and (2) ADE is unlikely to play an important role in the genesis of severe COVID, with or without vaccine. When you told us about your recent medical history, I was struck by the fact that, were it not for your telling us you had a positive PCR test for virus in association with your acute illness, I would have doubted that you actually had a second infection, which is to say that it is not necessary to postulate that you had a second infection in order to explain your recent pulmonary emboli. For one thing, what you described are major thromboembolic phenomenon that blocked some of your major vessels. Although that probably can happen in COVID, COVID more typically causes "microthrombi" of the capillary bed that feeds pulmonary alveoli, the air sacs responsible for gas exchange in the lungs. Similarly, small clots can also form in other organs where the ACE2 receptor protein required by the virus for cell entry is expressed (heart, brain, etc), by a similar mechanism. Those are not "embolic"; they don’t come from somewhere else in the body. They are thought to be caused by direct infection of endothelial cells that line the pulmonary capillary wall. Those cells efficiently express ACE2. When they get infected, they release a clotting factor that alone can start the cascade that leads to microthrombi. Having very elevated D-dimers is not proof of COVID per se. Elevation of D-dimers in blood (and fibrin consumption) can occur in several other pathologic states. For another thing, you don’t describe much in the way of other symptoms that characterize COVID, except that you felt lousy for a few days before going to hospital. However, those who took care of you know much more about your case than I ever will, and if they say you had a second illness from COVID, I am in no position to doubt it.
I would take issue with only one point your doctor made: In COVID, absent vaccination, autoantibodies are not implicated in clotting abnormalities. See above for the accepted pathogenesis of "micro" clots in lungs and other organs. Autoantibodies are definitely implicated in the very rare cases of severe and often fatal thrombo-embolic disease in those who received either of the two vaccines that use adenovirus as a vector (AstraZeneca and J&J). The mechanism is very recently described (last week) and seems to be due to the fact that adenoviruses bind to platelets. In rare cases, this results in the generation of antibodies that recognize platelets, and that results in platelet destruction. The resulting very low platelet concentration in blood heralds the clotting problems that ensue. (It’s paradoxial that low platelets leads to clotting, but that is another story.) The incidence is very very low, probably lower than one case per million vaccine doses, but the consequences have been grave for those who contract this problem. When an adverse event is that rare, (and there is no prior basis to suspect it, because there have never been any other adeno-vectored vaccines in widespread use), there is no way to design a clinical trial to detect the problem prior to release of the vaccine. Fortunately, the recent reports also describe effective treatment regimens, if they are implemented promptly.
Thank you for your medical response and perspective. To be clear; I had sniffles and mild cough on a Monday (infected by a co-worker who did NOT get a Covid test for jaw/sinus pain started the prior week) and they infected everyone @ Soundsmith. By Wednesday, symptoms were mostly gone, so I got the 2nd shot Thursday at 2PM. Withing 4 hours was racked with pain, fever and headache. Friday Am was unable to breathe well, (hurt upon any kind of deep breathing) and Saturday/Sunday same. Monday AM got rapid test (positive) and PCR. Tuesday am got PCR positive test result, and called ambulance at noon due to not breathing well and all other symptoms. There you have the beginning of the sage, and transferred after 12 hours to a larger medical center for possible surgery for saddle PE. I think folks should consider getting a PCR test 4 days before 2nd shot - to be "safer".

Peter (still here..... ) For every Covid insight, there are 10 new questions. - I am very moved by the good wishes of those on this forum. As I live alone, this was very deeply frightening at a number of levels both in the hospital and when I came home alone and quarantined to "try" to care for myself. .
Thank you. Too interesting. This should really be published as a case report and more. For really good reason.
I got my bloodwork reports from the second hospital;  many aspects are way out of the "norm". 

I am hoping that the specialists I need to see can explain them to me.

Thank you again - one and all. Peter and Azul (the "wonder" dog")