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By Lenny Bernstein, Carolyn Y. Johnson, Sarah Kaplan, Laurie McGinley 
3h ago
The new coronavirus kills by inflaming and obstructing the small air sacs in the lungs, obstructing the body’s oxygen supply until it turns off the essential organs of life.
But doctors around the world are seeing evidence that suggests the virus may also be causing heart inflammation, acute kidney disease, neurological malfunction, blood clots, intestinal damage, and liver problems. That development has complicated treatment for the more severe cases of covid-19, the disease caused by the virus, and makes the course of recovery less safe, they said.
The prevalence of these effects is too great to be attributed solely to the “cytokine storm,” a powerful immune system response that attacks the body and causes serious harm, doctors and researchers said.
Almost half of people hospitalized for covid-19 have blood or protein in their urine, indicating early kidney damage, said Alan Kliger, a nephrologist at Yale University School of Medicine who co-chairs a group of work that helps dialysis patients who are 19)
Even more alarming, he added, are the first data showing that 14 to 30 percent of intensive care patients in New York and Wuhan, China, the birthplace of the pandemic, have lost kidney function and require dialysis, or her cousin in the hospital continues renal replacement therapy. New York intensive care units are treating so much kidney failure, he said, that they need more staff to be able to perform dialysis and have issued an urgent call for volunteers from other parts of the country. They are also falling dangerously short of the sterile fluids used to administer that therapy, he said.
“That’s a lot of people who have this problem. That’s new to me,” said Kliger. “I think it is very possible that the virus will bind to kidney cells and attack them.”
But in medicine, logical inferences are often not true when conducting research. All interviewees for this story emphasized that with the pandemic still ongoing, they speculate with far less data than is normally needed to reach solid clinical conclusions.
Many other possible causes of organ and tissue damage need to be investigated, they said, including respiratory distress, the medications the patients received, high fever, the stress of ICU hospitalization and the now well-described impact of cytokine storms.
Still, when researchers in Wuhan performed autopsies on people who died of covid-19, they found that nine of 26 had acute kidney injuries and seven had coronavirus particles in their kidneys, according to an article by Wuhan scientists published on 9 September. April in Kidney International Medical Magazine.
“It raises a very strong suspicion that at least part of the acute kidney injury we are seeing is the result of direct viral involvement of the kidney, which is different from what was seen in the SARS outbreak in 2002,” said Paul. Palevsky, nephrologist at the University of Pittsburgh School of Medicine and president-elect of the National Kidney Foundation.
Recently, a New York hospital had 51 ICU patients who needed 24-hour kidney treatment, but they only had 39 machines to do it, he said. The hospital had to ration care, keeping each patient on therapy less than 24 hours a day, he said.
The virus may also be damaging the heart. Doctors in China and New York have reported myocarditis, an inflammation of the heart muscle, and more dangerous irregular heart rhythms that can lead to cardiac arrest in patients with covid-19.
“They seem to be doing very well when it comes to respiratory status, and they suddenly develop a heart problem that seems out of proportion to their respiratory problems,” said Mitchell Elkind, a neurologist at Columbia University and president-elect of the American Heart. Association. “This appears to be out of proportion to his lung disease, which makes people wonder about that direct effect.”
A review of seriously ill patients in China found that about 40 percent suffered from arrhythmias and 20 percent had some form of heart injury, Elkind said. “There is some concern that part of this is due to the direct influence of the virus,” he said.
The new virus enters the cells of infected people by latching onto the ACE2 receptor on cell surfaces. It unquestionably attacks cells in the respiratory tract, but there is a growing suspicion that it 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 area is huge.
“If you deploy it, it’s like a surface tennis court – this tremendous area for the virus to invade and replicate,” said Brennan Spiegel, co-editor-in-chief of the American Journal of Gastroenterology.
In a subset of covid-19 cases, according to the researchers, the immune system that fights the infection goes into hyperdrive. The uncontrolled response leads to the release of a flood of substances called cytokines that, in excess, can cause damage to multiple organs. In some severely ill covid-19 patients, doctors have found high levels of a proinflammatory cytokine called interleukin-6, known by the medical abbreviation IL-6.
The unrestricted 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 one of the main reasons some require intensive care and ventilation, said Jeffrey Weber, deputy director of the Perlmutter Cancer Center at NYU Langone Medical Center.
“When your cytokines are systemically out of control, bad things happen,” he said. “It can be a complete disaster.” It is unclear why cytokine storms occur in some patients and not in others, although some genetic factors may play a role, some doctors say.
To treat cytokine storms, some doctors are using anti-IL-6 drugs like 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 loss of smell and taste. Claire Hopkins, president of the British Rhinology Society, said studies of 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 olfactory nerve endings,” said Hopkins. When these aroma detector fibers are disrupted, they cannot send odors to the brain.
Anosmia, the medical term for the inability to smell, was not initially recognized as a symptom of covid-19, Hopkins said. Doctors were so overwhelmed by patients with severe respiratory problems, he said, that “they didn’t ask the question.”
But subsequent data from a symptom-tracking app has shown that 60 percent of people later diagnosed with covid-19 reported having lost their sense of smell and taste. About a quarter of the participants experienced anosmia before developing other symptoms, suggesting that it may be an early warning sign of infection.
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 its olfactory nerve endings directly to the central nervous system.
“Why you get this different expression on different people, nobody knows,” he said.
There are also reports that covid-19 can redden people’s eyes, causing eye eye or conjunctivitis in some patients. A study of 38 hospitalized patients in Hubei province, China, found that one third had a porthole.
But like many of the non-respiratory effects of the virus, this symptom can be relatively rare and can develop only in people who are already seriously ill. However, the fact that the virus has been found in the mucous membrane covering the eye in a small number of patients suggests that the eye could be an entryway for the virus, and is one of the reasons why protectors are used. facials and glasses. to protect health workers.
The virus is also having 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 coined a Twitter hashtag, #NotJustCough, to raise awareness of them.
Studies suggest that patients with digestive symptoms will also develop a cough, but one may occur days earlier than the other.
“The question is, is it behaving like a hybrid of different viruses?” Spiegel said. “What we are learning is, apparently, that this virus is found in more than one organ system.”
Reports also indicate that the virus can attack the liver. A 59-year-old woman on Long Island came to the hospital with dark urine, which was ultimately caused by acute hepatitis. After developing a cough, doctors attributed the liver damage to a covid-19 infection.
Spiegel said he has seen more such reports every day, including one from China on five patients with acute viral hepatitis.
A particular danger from the virus appears to be its tendency to cause blood clots in the veins of the legs and other vessels, which can break loose, travel to the lung, and cause death from a condition known as pulmonary embolism.
An examination of 81 hospitalized patients with pneumonia caused by covid-19 in Wuhan found that 20 had such events and that eight of them died. The peer-reviewed data was published online April 9 in the Journal of Thrombosis and Hemostasis.
Across New York City, blood thinners are used with covid-19 patients far more than expected, said Sanjum Sethi, an interventional cardiologist and assistant professor of medicine at Columbia University Irving Medical Center.
“We are seeing so many of these events that we have to investigate further,” he said.
The Washington Post
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