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Low back pain, disorientation, extreme tiredness, and the sinister lack of oxygen are now among the symptoms of coronavirus infection. New and unrelated at first glance, these and other disorders are capable of tricking doctors, even when they get sick themselves. Two months after the detection of the first case of Covid-19 in Brazil, they are manifestations of a more dangerous and different disease than imagined.
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The Covid-19 symptom list has only grown, shows the “British Medical JournalIn recent weeks, Brazilian and foreign medical societies have added new manifestations to the disease, as well as the US Center for Disease Control and Prevention (CDC).
The first symptoms detected, such as shortness of breath, fever and cough, remain. But, among the manifestations that are observed, in addition to the total loss of smell and taste, are the so-called “Covid’s fingers“(Of the feet, swollen and inflamed), conjunctivitis, skin rashes, all kinds of muscle and joint pain and neurological signs, such as loss of balance.
It was not the virus that changed, but the scale of the pandemic. The fact that the coronavirus has infected millions has led to more varied symptoms, reflecting the fuller picture of the disease.
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And what we are facing “is not just pneumonia. It’s something we’ve never seen before, “the Swiss cardiologist told the Lancet medical journal. Frank Ruschitzka, which treats patients with Covid-19 at the University of Zurich hospital.
Unexpected evolution
Before research on the treatment of Covid-19 in Brazil, the doctor Patricia Rocco, who heads the Pulmonary Research Laboratory at UFRJ and is a member of the Brazilian National Academy of Medicine and Academy of Sciences, says that, in fact, everything has changed:
– Two months ago, I would say that Covid-19 was a viral disease causing respiratory failure, with severe cases marked by acute respiratory distress syndrome. Today, I see it as a viral disease of completely unexpected evolution. You are facing a great vascular compromise.
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She says that the patient with confirmation or suspicion of Covid-19 should have a series of tests to detect vascular and inflammatory changes, be they images, such as tomography or blood, where inflammatory markers and risk of thrombosis are sought.
Patricia Rocco investigates specific biomarkers, substances present in the blood that may indicate a risk of worsening Covid-19. “Today we do not have a rapid evaluation protocol, and that costs lives,” says the researcher. Coronavirus infection was associated with the formation of microthrombi by the body, including the brain.
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One hypothesis for this is that the receptors used by the coronavirus to invade cells exist in many organs, mainly in the blood vessels. The cells that line the lungs are full of them, but they are also in the intestines, kidneys and heart, for example.
– What was seen as a respiratory disease turned out to be a predominantly vascular syndrome – emphasizes hematologist and oncologist Daniel Tabak, from the National Academy of Medicine, who monitors the evolution of Covid-19 in Brazil.
These vascular complications have been associated with strokes and serious cardiac changes even in young patients.
– How does Covid-19 cause strokes in young people? There are hypotheses.But the honest answer is: I don’t know! – emphasizes Rocco.
The disease remains a source of uncertainty and surprises. Tabak says that a possible explanation for low back pain would be the presence of microthrombi and inflammation. Another is that pain is a sign of silent pneumonia. The first convalescent plasma donor in Brazil, Rio de Janeiro hematologist Ruddy Dalfeor, for example, suffered from severe pain in his lower back:
– At first, I thought you had kidney stones. But the back pain was excruciating. I went to a CT scan and discovered pneumonia. The coronavirus is misleading.
Muscle pain could have several causes, but the first non-invasive autopsies of people who died of Covid-19 in São Paulo, performed by USP, revealed direct damage to the muscles. Poor circulation, on the other hand, is behind Covid’s fingers. The disturbances caused by the coronavirus in the olfactory nerve would explain the loss of meaning. Skin rashes, or viral rashes, are not uncommon in viruses, but the mechanism that triggers them in Covid-19 remains unclear.
Zombie gaze
Disorders like mental confusion could indicate encephalitis caused by Covid-19, assumes the American infectologist Daniel Griffin, coordinator of the response for the coronavirus in New York hospitals. It also adds Covid-19’s association with encephalopathies, the result of which would be a “zombie gaze” and a hallucination. In a virtual conference for virologists, he said, “There are people who come to hospitals with chest pain. It is not yet clear, but the coronavirus can affect the heart. In some cases, it looks like a heart attack. ”
According to Griffin, in the first week of symptoms, viral infection predominates. However, in cases that get worse, in the second week something like an immune storm appears. But then there are complications in the blood, related to inflammation.
The scientist considers that the diversity of manifestations allows that the cases of illness and death by Covid-19 are not associated with the coronavirus. And that many “asymptomatic” people are, in fact, simply undiagnosed.
– Every day we learn from new cases and we have an urgency that we never had, because people die like never before – highlights Patricia Rocco.
