A Pulmonary Pathologist’s Perspective on COVID-19

ARDS, diffuse alveolar damage and hypoxia

In this video recorded in March 2020, Sanjay Mukhopadhyay, MD, Director of Pulmonary Pathology in the Department of Anatomic Pathology, presents an overview of COVID-19, starting with the global numbers and ending with what he and other pathologists are seeing under their microscopes. He explains the histology of acute respiratory distress syndrome (ARDS) as it relates to COVID-19 and other respiratory illnesses. He also highlights the diffuse alveolar damage that pathologists see in patients who are infected with the virus by comparing a normal lung and a lung impacted by diffuse alveolar damage. Finally, Dr. Mukhopadhyay offers a patient-friendly explanation of alveolar function and hypoxia from the cellular level to symptom presentation.

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“I decided to do this talk at the suggestion of a doctor… who made an impassioned plea on YouTube to people to take the pandemic seriously,” says Dr. Mukhopadhyay. He makes his own impassioned plea at the end of the video: “My take-home message to you is not to take COVID-19 lightly. Please don’t dismiss this as just another… viral infection that will pass. The most severe forms of COVID-19 can cause ARDS. As I’ve shown you, this is a very highly dangerous and potentially fatal form of lung damage. Please take all the precautions that the CDC is outlining.”

While Dr. Mukhopadhyay created the video in the very early days of the pandemic, his explanations of the relationship between COVID-19, ARDS, severe lung damage and death remains pertinent for at-risk patients and may be interesting to clinicians in other specialties. Dr. Mukhopadhyay draws upon the experience of Cleveland Clinic’s pulmonary pathology service, which handles 5,000 cases per year and supports a large group of pulmonologists and thoracic surgeons as well as one of the busiest lung transplant services in the world. In 2020, Dr. Mukhopadhyay was featured in a New York Times video on COVID-19 and ARDS that has been viewed more than 2 million times.