In the Intensive Care Unit of  Barcelona’s storied Hospital Clínic yesterday were 484 Covid-19 patients, as told by clinic director Dr. Alex Soriano to one of the city’s local newspapers. A third of them were 70 and older, another third recently retired-- in their early to mid sixties. The rest in their fifties or younger.

“The eighth day after symptoms first appear seems to be a turning point,” he remarks, in which the health of the person affected by the coronavirus changes dramatically. To be sure, most recover-- either to go home or to remain isolated in place until they may do so-- but between 15% and 20% suffer a dramatic inflammation of the lungs and their health deteriorates, which can lead to the need for mechanical ventilation, multi-organ failure, and death. The race now at Hospital Clínic, and throughout Spain, and all those counting on murder mystery minded clinicians throughout Europe’s top hospitals, is to figure out how to recognize the earliest possible signposts of this oftentimes irremediable advance, and how and with what to prevent it.

“Inflammation occurs when the immune system is aberrantly activated. We have seen it in other situations, such as in immunosuppressed HIV patients many years ago who started newly available HAART regimens [in 1998, 1999, 2000+] and suffered what was then called Immune Reconstitution Inflammatory Syndromes (IRIS)," explained Soriano.

But here yet no one knows why.

Why does a part of the infected generate such an exaggerated response in their immune system that puts the lungs on the edge? They assume there may be genetic causes, unknown predispositions. Everything is going too fast to have conclusions, although inflammatory and other markers on patients are now being collected in order to look for commonalities among them.

Partly due to the unprecedented demand on the hospitals, many if not most of Spain’s Covid-19 patients are being encouraged to tough it out at home. They spend their week of body aches, malaise and fever at home, treating symptoms with Tylenol or chicken soup, or tequila, as the case may be. “Most of them have a cough and minor problems in the upper ways,“ says Soriano. But within the group that initially experiences only a slight fever and respiratory discomfort lies a subgroup where the lower lungs are being affected. You can only pick it up on xray. Breathing can become difficult. ”Those we need to see."

Treatment is first directed against infection. They are testing antivirals of various kinds, recently made available via Compassionate Use programs that harken back to the early days of AIDS. Proposed protocols change daily-- sometimes within hours. But they are finding now that they need to almost anticipate-- and pre-treat against-- the inflammation. Only there aren’t that many effective agents. Once the aveoli are drowning in fluid there is little they can do. "We have to treat that before they get to the ICU," he cautions.

Mike Barr is a long time Poz contributor, scribe for the Act Up/T+D Committee & Treatment Action Group, and pharmaceutical ghost writer  alternative health aficionado. He is a licensed acupuncturist and herbalist in NY and NJ, tending to folks in Union Square, Boerum Hill and Hoboken. Reach out to him at evacupuncturist at that Google mail service or at rootresolutionhealth.com.