The coronavirus destroys the lungs. But doctors find its damage in the kidneys, hearts and elsewhere.


The prevalence of these effects is too great to attribute them solely to the “cytokine storm,” a powerful immune system response that attacks the body, causing serious damage, according to doctors and researchers.

Even more alarming, he added, the first data show that 14 to 30% of intensive care patients in New York and Wuhan, China – the birthplace of the pandemic – have lost kidney function and require dialysis, or his cousin in the hospital, continuous renal replacement therapy. New York’s intensive care units are treating so much kidney failure, he said, they need more staff capable of dialysis and have made an urgent call for volunteers from other parts of the country. They also dangerously lack sterile fluids used to administer this therapy, he said.

“There are a huge number of people who have this problem. This is new to me, “said Kliger. “I think it’s very possible that the virus will attach to kidney cells and attack them. “

But in medicine, logical inferences often don’t turn out to be true when research is conducted. Everyone interviewed for this story pointed out that with the pandemic still raging, they speculate with far less data than is normally necessary to draw solid clinical conclusions.

Many other possible causes of organ and tissue damage need to be investigated, they said, including respiratory distress, medication received by patients, high fever, stress from ICU hospitalization and the impact now well described cytokine storms.

“This raises the very clear suspicion that at least part of the acute kidney injury that we see is the result of direct viral involvement of the kidney, which is distinct from what was observed during the SARS epidemic in 2002, “said Paul M. Palevsky, nephrologist at the University of Pittsburgh School of Medicine and president-elect of the National Kidney Foundation.

A New York hospital recently had 51 intensive care patients who needed 24-hour kidney treatment, but only had 39 machines to do it, he said. The hospital had to ration care, keeping each patient on therapy for less than 24 hours a day, he said.

The virus can also damage the heart. Clinicians in China and New York have reported myocarditis, inflammation of the heart muscle, and, more dangerously, irregular heart rhythms that can lead to cardiac arrest in Covid-19 patients.

“They seem to be doing very well when it comes to breathing, then suddenly they develop a heart problem that seems out of proportion to their breathing problems,” said Mitchell Elkind, neurologist at Columbia University and president-elect of American Heart. Association. “It seems to be out of proportion to their lung disease, which causes people to question this direct effect. “

A review of critically ill patients in China found that about 40% had arrhythmias and 20% had some form of heart injury, said Elkind. “It is feared that some of them are due to the direct influence of the virus,” he said.

The new virus enters the cells of infected people by locking on the ACE2 receptor on the surface of the cells. It undoubtedly attacks cells in the airways, but it is increasingly suspected that he is using the same door to enter other cells. The gastrointestinal tract, for example, contains 100 times more of these receptors than other parts of the body, and its surface is huge.

“If you deploy it, it’s like a surface tennis court – this huge area for the virus to invade and reproduce,” said Brennan Spiegel, co-editor of the American Journal of Gastroenterology.

In a subset of cases of covid-19, the researchers found that the immune system fighting infection goes into hyperdrive. The uncontrolled response results in the release of a flood of substances called cytokines which, in excess, can damage several organs. In some seriously ill Covid-19 patients, doctors have found elevated levels of a pro-inflammatory cytokine called interleukin-6, known by the medical shortcut IL-6.

The unhindered response, also called “cytokine release syndrome”, has long been recognized in other patients, including those with autoimmune diseases such as rheumatoid arthritis or in cancer patients undergoing certain immunotherapies.

For Covid-19 patients, cytokine storms are a major reason why some require intensive care and ventilation, said Jeffrey S. Weber, deputy director of the Perlmutter Cancer Center at NYU Langone Medical Center.

“When your cytokines are systematically out of control, bad things happen,” he said. “It can be a complete disaster.” Some physicians say that cytokine storms do not occur clearly in some patients and not in others, although genetic factors may play a role.

To treat cytokine storms, some doctors use anti-IL-6 drugs such as tocilizumab, which is approved for cancer patients who develop cytokine storms as a result of immunotherapy.

Another strange and now well-known symptom of covid-19 is the loss of smell and taste. Claire Hopkins, president of the British Rhinological Society, said studies in patients in Italy and elsewhere have shown that some lose their sense of smell before showing signs of illness.

“The coronavirus can actually attack and invade the olfactory nerve endings,” said Hopkins. When these aroma sensing fibers are disrupted, they cannot send odors to the brain.

Anosmia – the medical term for inability to feel – was not initially recognized as a symptom of covid-19, said Hopkins. Doctors were so overwhelmed by patients with severe breathing problems, she said, “that they didn’t ask the question.”

But later data from a symptom tracking app showed that 60% of people diagnosed with covid-19 later reported losing their sense of smell and taste. About a quarter of participants had anosmia before developing other symptoms, suggesting that this may be an early warning sign of infection.

Oddly, Hopkins said, people who lose their sense of smell don’t seem to develop the same serious breathing problems that have made Covid-19 so deadly. But a very small number of patients have experienced confusion, low blood oxygen levels, and even loss of consciousness – a sign that the virus may have traveled along their olfactory nerve endings directly to the central nervous system. .

“Why you get this different expression in different people, nobody knows,” she said.

It has also been reported that covid-19 can make people’s eyes red, causing pink eyes or conjunctivitis in some patients. A study of 38 patients hospitalized in Hubei province, China, found that a third had pink eyes.

But like many of the non-respiratory effects of the virus, this symptom can be relatively rare – and can only develop in people who are already seriously ill. The fact that the virus was found in the mucous membrane that covers the eye in a small number of patients suggests, however, that the eye may be a gateway for the virus – and this is one of the reasons for this. which face shields and goggles are used. to protect healthcare workers.

The virus also has a clear impact on the gastrointestinal tract, causing diarrhea, vomiting and other symptoms. One study found that half of Covid-19 patients have gastrointestinal symptoms, and specialists have invented a Twitter hashtag, #NotJustCough, to raise awareness.

Studies suggest that patients with digestive symptoms will also develop a cough, but one may occur several days before the other.

“The question is, does it behave like a hybrid of different viruses? Said Spiegel. “What we are learning is, it seems, anyway, that this virus lodges in more than one organ system. “

Reports also indicate that the virus can attack the liver. On Long Island, a 59-year-old woman arrived at the hospital with dark urine, which was eventually caused by acute hepatitis. After developing a cough, doctors attributed the liver damage to Covid-19 infection.

Spiegel said he saw more such reports every day, including one in China out of five patients with acute viral hepatitis.

A particular danger of the virus appears to be its tendency to produce blood clots in the veins of the legs and other vessels, which can rupture, travel to the lungs, and cause death from a condition known as pulmonary embolism.

Across New York City, anticoagulants are used much more than expected with 19 patients, said Sanjum Sethi, interventional radiologist and assistant professor of medicine at Irving Medical Center at Columbia University.

“We are just witnessing so many of these events that we need to investigate further,” he said.


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