Since the pandemic started, coronavirus has been considered as a pathogen that damages the lung tissue and function, but it seems like the virus seriously affects other parts of the body as well.
Scientists from Columbia University have published their findings in Nature Medicine, which provides a detailed view on how coronavirus damages the most essential systems of human body.
Our review now published @NatureMedicine . We brought together an interdisciplinary team of physicians on the front lines of COVID-19 to provide a concise review of how COVID-19 can affect several organ systems besides the lungs. https://t.co/5fCZMsq2AE pic.twitter.com/XgWBQiYsiw
— Aakriti Gupta MD MS (@aakriti_15) July 10, 2020
This is the first extensive review of COVID-19’s effects on all affected organs outside the lungs. Scientists have concluded that this is a multisystem disease.
“There’s a lot of news about clotting but it’s also important to understand that a substantial proportion of these patients suffer kidney, heart, and brain damage, and physicians need to treat those conditions along with the respiratory disease”, says Aakriti Gupta, MD, a cardiologist who has battled the disease at front lines.
When Gupta was treating patients in the beginning, she realized that this disease is doing so much more damage outside the lungs as well.
She quickly began accumulating evidence from all over the world regarding how extensive the damage really is. She looked at research being published from all around the globe, with help of her colleagues and found a ton of evidence to support her hypothesis.
Blood Clotting and Inflammation
The first symptom that the scientists have noted outside the lungs are the blood clots. Patients suffering from coronavirus often present with abnormal amount of blood clot formation in their blood. blood clots are a serious condition and can cause a heart attack or stroke in a patient when left untreated.
The Columbia scientists think that the blood clots are the result of the virus’s attack on cells that line the blood vessels. When this lining is attacked by the virus, inflammation in the body increases and blood clots form. They can be different in sizes from small to big. These clots can travel through out the body and damage many organs in a vicious cycle of thromboinflammation.
Scientists at Columbia university have started work on a randomized clinical trial to investigate the optimal dose and timing of anticoagulation drugs in critically ill patients with COVID-19.
An Immune System in Overdrive
The uncontrolled inflammation in the body due to the virus, can then also overstimulate the immune system as well.
All over the world, researchers are rushing to see how this overdrive can be controlled. Though doctors and scientists initially did not want to purse the use of steroids to calm the immune system, in a new finding a steroid dexamethasone has shown promise and reduced deaths in ventilated patients.
Many other clinical trails are also being conducted to see if specific components of thromboinflammation and the immune system, such as interleukin-6 signaling can be targeted to calm the immune system.
Complications of the Heart
The first major complication is as previously stated, the clots which can increase incidence of heart attack in the patients.
Exactly how heart is directly affected is till unclear and the virus is not consistently being found in the heart tissue where autopsies are conducted. But there have been serious indications of heart damage in many patients.
Scientists think that the heart damage in many cases might be resulting from systemic inflammation and the accompanying cytokine release. A cytokine release or storm is a flood of immune cells in the body. These cells normally clear up infected cells in infections but in cases of COVID-19, they can spiral out of control and cause more damage.
Another serious complication when caring for patients with heart damage is that the extent and nature of it cannot be fully gauged through the normal diagnostic and therapeutic strategies, including heart biopsies and cardiac catheterizations because of the need to protect other patients using that equipment and the personnel handling them.
However, this trend has at least changed in New York, as disease prevalence has gone down.
Many neurological symptoms like headache, dizziness, fatigue, and loss of smell, can occur in about a third of patients.
Patients who have clots can have strokes in 6 percent of the cases and in 8 to 9 percent of the patient’s delirium and confusion can occur.
In most of the critical patients, intubation for two to three weeks is common and ¼ of them can require ventilators for 30 or more days.
These prolonged intubations can cause issues as well. Patients need a lot of sedation and ICU delirium can also occur. Hallucinations that may be caused by the prolonged sedation are also a reality of this disease.
A surprising effect of the disease is the high proportion of COVID-19 patients in the ICU with acute kidney damage.
Scientists think that ACE2 receptors that the virus uses to gain entry into the cells and are prevalent in kidney cells, may be the cause of this extensive damage. In New York, physicians saw that 50 percent of the patients in ICUs had some sort of kidney damage.
About 5 to 10 percent of all patients with kidney damage then require dialysis, which is a very high number. According to Columbia Scientists, many of them are likely to end up needing permanent dialysis.
The scientists working on this report also highlighted the need of more research into the subject as this is an evolving disease and there are still many unknowns.