COVID-19's rampage through the body

In serious cases, SARS-CoV-2 lands in the lungs and can do deep damage there. But the virus, or the body’s response to it, can injure many other organs. Scientists are just beginning to probe the scope and nature of that harm.

On rounds in a 20-bed intensive care unit (ICU) one recent day, physician Joshua Denson assessed two patients with seizures, many with respiratory failure and others whose kidneys were on a dangerous downhill slide.

Days earlier, his rounds had been interrupted as his team tried — and failed — to resuscitate a young woman whose heart had stopped. All shared one thing, says Denson, a pulmonary and critical care physician at the Tulane University School of Medicine. “They are all COVID positive.”

Clinicians and pathologists are realizing that although the lungs are ground zero, COVID-19’s reach extends to many organs including the heart and blood vessels, kidneys, gut, and brain.

The COVID-19 virus acts like no microbe humanity has ever seen.

Understanding the rampage will help doctors on the front lines treat people who become desperately and sometimes mysteriously ill.

As the immune system wars with the invader, the virus marches from nose and throat into the lungs. The battle itself disrupts this healthy oxygen transfer, leaving a stew of fluid and dead white blood cells — pus — behind: pneumonia, with its corresponding symptoms: coughing; fever; and rapid, shallow respiration.

But other organ systems, beyond the lungs, are driving some patients’ rapid deterioration: the heart and blood vessels.

In Brescia, Italy, a 53-year-old woman walked into the emergency room of her local hospital with all the classic symptoms of a heart attack. But when doctors injected dye in the coronary arteries, looking for the blockage that signifies a heart attack, they found none. Another test revealed why: The woman had COVID-19.

The disease seems to extend to the blood itself. Among 184 COVID-19 patients in a Dutch ICU, 38% had blood that clotted abnormally. Blood clots can break apart and land in the lungs, blocking vital arteries — Clots can also lodge in the brain, causing stroke.

Brain inflammation encephalitis, with seizures, and with a “sympathetic storm,” are also associated with COVID-19 Some people with COVID-19 briefly lose consciousness. Others have strokes. Many report losing their sense of smell.

And the new coronavirus, like its cousin SARS, can infect the lining of the lower digestive tract. Up to half of patients experience diarrhea, says Brennan Spiegel of Cedars-Sinai Medical Center in Los Angeles.

The intestines are not the end of the disease’s march through the body. For example, up to one-third of hospitalized patients develop conjunctivitis — pink, watery eyes — although it’s not clear that the virus directly invades the eye. Other reports suggest liver damage, possibly as a by-product of treatment and medications.Circulatory damage can reach into the extremities, including fingers and toes.

It will take years of painstaking research to sharpen the picture of its reach. The hope is for treatments more wily than the virus that has stopped the world in its tracks.

This article was excerpted from Science Magazine, (Am. Assoc Advancement of Science) 17 April with permission.

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