We’ve known for a while now that the coronavirus works by inflaming and clogging the air sacks in the victim’s lungs, thus preventing them from breathing and causing ARDS or Acute Respiratory Distress Syndrome. But what if the damage wasn’t limited to just your lungs?
Clinicians around the world are seeing cases where the coronavirus is responsible for causing heart inflammation, various neurological malfunctions, acute kidney disease, intestinal damage, blood clots, liver problems, and more. These additional problems don’t only complicate the treatment of the virus but are often deadly on their own.
So far, many of these complications were attributed to the so-called “cytokine storm” – a strong immune-system response caused by the lung inflammations that attacks the body and deals severe damage. However, more and more scientists are now coming to the conclusion that cytokine storm alone can’t explain all the complications found in Covid-19 patients.
Clinicians have noticed that in a subsection of Covid-19 patients, the immune system tends to go in hyperdrive. This leads to the release of a substance called cytokines which is capable of damaging organs when it’s released in excess.
In some patients, doctors have also found abnormally high amounts of a pro-inflammatory cytokine called interleukin-6, also known as IL-6.
The unfettered response is also problematic. It’s called “cytokine release syndrome” and has been seen in patients with autoimmune diseases such as rheumatoid arthritis and in cancer patients going through certain immunotherapies.
Jeffrey S. Weber, deputy director of the Perlmutter Cancer Center at NYU Langone Medical Center is also of the belief that cytokine storms are a big reason why Covid-19 patients often require extra care and ventilation.
“When your cytokines are systemically out of control, bad stuff happens,” Weber said. “It can be a complete disaster.”
It’s not yet clear why cytokine storms occur in some patients and not in others. To treat them, many doctors are using anti-IL-6 drugs such as tocilizumab – a drug approved for cancer patients who develop cytokine storms during their immunotherapies.
One of the many recent and worrying findings is that close to 50% of the hospitalized Covid-19 patients have been found to have protein or blood in their urine which is a clear sign of early kidney damage. Alan Kliger, a nephrologist at the Yale School of Medicine shared this statistic as he’s also a co-chair of a task force assisting dialysis patients.
Dr. Kliger also added that 14% to 30% of early-data patients from both New York and Wuhan, China have lost kidney function and have required dialysis or continuous renal replacement therapy. As a result of that, the state of New York is experiencing a stark shortage not only of ventilators and respiratory therapists but dialysis volunteers and sterile fluids.
“That’s a huge number of people who have this problem. That’s new to me,” Kliger said. “I think it’s very possible that the virus attaches to the kidney cells and attacks them.”
Still, most medical professionals point out that the Covid-19 pandemic is in its early stages and we can’t draw concrete conclusions yet, only make observations. There are still other possible causes of the organ damage experienced by the victims and those causes are yet to be ruled out – high fever, respiratory distress, the various medications patients receive, or even just the stress of the whole experience.
Nevertheless, the evidence piles on in favor of Covid-19 causing such problems directly. One study published in the Kidney International medical journal showed that 9 out of 26 of autopsies were found to have acute kidney injuries and seven had Covid-19 particles inside their kidneys.
Paul M. Palevsky, a University of Pittsburgh School of Medicine nephrologist and president-elect of the National Kidney Foundation said that “It does raise the very clear suspicion that at least a part of the acute kidney injury that we’re seeing is resulting from direct viral involvement of the kidney, which is distinct from what was seen in the SARS outbreak in 2002.”
And the devastating results of Covid-19’s kidney complications are getting more and more unmanageable. Hospitals all across the country and especially in New York are forced to ration their kidney treatment machines as they have more patients in need of 24-hour care than they have devices.
Clinicians from both New York and China have reported Covid-19 patients with myocarditis – a heart muscle inflammation – as well as irregular heart rhythms that tend to lead to cardiac arrest.
Mitchell Elkind, a Columbia University neurologist and president-elect of the American Heart Association said that “They seem to be doing really well as far as respiratory status goes, and then suddenly they develop a cardiac issue that seems out of proportion to their respiratory issues. This seems to be out of proportion to their lung disease, which makes people wonder about that direct effect.”
Elkind also said that according to data from ill patients in China, ~40% of the patients suffered from arrhythmias and ~20% had some form of cardiac injuries.
“There is some concern that some of it may be due to direct influence of the virus,” Elkind said.
There’s a lot of suspicions that the Covid-19 virus uses the same ACE2 receptors that it latches on in the lungs to also invade other organs. The gastrointestinal tract is one place scientists are looking at as it has a hundred times more of the same ACE2 receptors than the lungs, while also being much larger. This could help explain the large number of patients with digestive and gastrointestinal symptoms.
“If you unfurl it, it’s like a tennis court of surface area — this tremendous area for the virus to invade and replicate itself,” said Brennan Spiegel, co-editor in chief of the American Journal of Gastroenterology.
“The question is, is it kind of behaving like a hybrid of different viruses?” Spiegel said. “What we’re learning is, it seems anyway, that this virus homes in on more than one organ system.”
Taste and smell
This isn’t anything new but some Covid-19 patients lose their sense of taste and smell as they get sick but it’s not yet clear why. Claire Hopkins, the president of the British Rhinological Society has said that many of the studied patients have lost their sense of taste and smell even before showing any other symptoms.
“The coronavirus can actually attack and invade olfactory nerve endings,” Hopkins said. In other words, the aroma-detecting fibers are left unable to send information to the brain.
The medical term for a loss of smell is anosmia. However, while it was well-known as a common problem for Covid-19 patients, it wasn’t officially recognized as a symptom for a long time. According to Hopkins, the doctors on the field were just so overwhelmed by the respiratory symptoms of the disease that “they didn’t ask the question.”
Yet, data has shown that up to 60% of hospitalized Covid-19 patients have also experienced varying degrees of anosmia. What’s also interesting to Hopkins is that people with severe anosmia tend to have milder respiratory problems.
On the other hand, some anosmia Covid-19 patients have also experienced confusion, lower blood oxygen levels, and even loss of consciousness – a worrying sign that the virus may be able to travel through the olfactory nerve endings directly to our brains.
“Why you get this different expression in different people, nobody knows,” Hopkins said.
The virus also seems to occasionally attack the liver, according to some reports. A 59-year-old woman in Long Island was hospitalized with dark urine which lead the doctors to discover an acute hepatis. Later the woman developed a cough as well, and the hepatitis was attributed to the coronavirus for which she tested positive.
Spiegel has said that such reports are common and he sees more every day.
Covid-19 patients have also been seen to develop blood clots. These clots often break off from the veins they form in and travel to the lungs where they can cause pulmonary embolisms.
One study published in the Journal of Thrombosis and Hemostasis, examined 81 Covid-19 patients and found blood clots in 20 of them. The clots were the cause of death for 8 of the patients.
Sanjum Sethi, an interventional cardiologist and assistant professor of medicine at Columbia University’s Irving Medical Center says that blood thinners are getting widely used in New York in attempts to protect Covid-19 patients from developing deadly blood clots.
“We’re just seeing so many of these events that we have to investigate further,” Sanjum said.