ATLANTA (CNN) – Coronavirus not only damages the lungs, but also the kidneys, liver, heart, brain and nervous system, skin and gastrointestinal tract, doctors said on Friday in a review of reports on COVID-19 patients.
The team at Columbia University’s Irving Medical Center in New York City – one of the hospitals flooded with patients in the spring – went through their own experiences and gathered reports from other medical teams around the world.
Their comprehensive picture shows that the coronavirus attacks practically every important system in the human body, directly damages the organs and clots the blood, the heart loses its healthy rhythm, the kidneys shed blood and protein and the skin breaks out rashes. It causes headaches, dizziness, muscle aches, abdominal pain and other symptoms, as well as classic respiratory symptoms like cough and fever.
“Doctors have to imagine COVID-1
Much of the damage caused by the virus appears to be due to its affinity for a receptor – a type of molecular entry into cells – called ACE2. Cells that line the blood vessels, kidneys, liver passages, pancreas, intestines, and respiratory tract are all covered with ACE2 receptors that the virus can use to attack and infect cells, the Columbia team wrote in their review, published in the journal Nature Medicine.
“These results suggest that multiple organ injury can occur at least in part due to direct viral tissue damage,” the team wrote.
Coronavirus infection also activates the immune system. Part of this reaction involves the production of inflammatory proteins called cytokines. This inflammation can damage cells and organs and the so-called cytokine storm is one of the causes of severe symptoms.
“This virus is unusual and it is difficult not to take a step back and not be impressed by how many manifestations it has on the human body,” said Dr. Mahesh Madhavan, another cardiologist who worked on the review, in a statement.
Blood clotting effects appear to be caused by various mechanisms: direct damage to the cells that line the blood vessels and disruption of the various clotting mechanisms in the blood itself. Low levels of pneumonia caused by pneumonia can increase the likelihood of blood clotting, the researchers said.
These clots can cause strokes and heart attacks, or stick to the lungs or legs. They clog up the kidneys and interfere with the dialysis treatments required for the sickest patients.
Damage to the pancreas can make diabetes worse, and it has been shown that patients with diabetes are at the highest risk of serious diseases and coronavirus death.
The virus can directly damage the brain, but some of the neurological effects are likely due to the treatment. “COVID-19 patients can be intubated for two to three weeks. A quarter need ventilators for 30 or more days,” said Gupta.
“These are very long intubations and patients need a lot of sedation. Delirium in the intensive care unit was a well-known condition before COVID, and the hallucinations may be less an effect of the virus than an effect of prolonged sedation.”
The virus affects the immune system and exhausts the T cells that the body normally uses to fight off viral infections. “Lymphopenia, a marker of compromised cellular immunity, is a cardinal laboratory finding that has been reported in 67-90% of COVID-19 patients,” the researchers wrote.
Doctors need to treat all of these effects when coronavirus patients show up in the hospital, the Columbia team said.
There is some good news.
“Gastrointestinal symptoms may be associated with prolonged illness, but have not been associated with increased mortality,” the researchers wrote. Many of the skin effects such as rashes and purple, swollen “covid toes” also subside by themselves.
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