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The coronavirus not only spreads to the lungs but to the entire body. Professor Tobias Huber already demonstrated this in a study in May. In the interview, he explains what other findings were made from autopsies of deceased corona patients and what might work better with a second wave.
It is now known that the coronavirus can cause a loss of smell and taste, for example. However, when the investigation carried out the autopsy of the first corona patients who had died in the spring, it was not yet clear that it was SARS-CoV-2 It can also spread to other organs besides the lungs.
Meanwhile, the team led by Professor Tobias Huber at the Hamburg-Eppendorf University Medical Center (UKE) has published two autopsy studies of deceased crown patients. In an interview with t-online.de, the kidney specialist explains what further studies are planned and what conclusions the scientists draw from the study results so far. It also delves into the knowledge acquired in the course of the pandemic they have changed and what could go better with a second wave of infections than in spring.
t-online.de: Can you briefly summarize the approach and results of your studies for our readers?
Prof. Dr. with. Tobias Huber: Basically, our investigations are autopsy studies. That’s because our forensic specialists in Hamburg probably do the most autopsies in the world. COVID-19Patients have performed. Basically all the patients who, unfortunately, died in Hamburg from Covid-19 had an autopsy performed, which was able to provide important information in the fight against Corona. In these deceased patients we have the opportunity to look inside the organs and take organ samples. This is the only way to see which organs are infected by the virus, for example. This cannot be determined in patients who are still alive. What we found is that about 60 percent of those who died have the virus in their kidneys. But also in other organs such as the heart, liver, brain and also in the blood and, of course, always in the lungs.
What was the goal of your second study?
In our second study, we specifically looked at how virus in the kidney correlates with potential organ sequelae. We were able to see that 70 percent of the patients in whom SARS-CoV-2 was detected in the kidneys suffered from acute kidney failure. In summary, it can be said: The result of the first study was that SARS-CoV-2 is not a pure lung virus, but a multi-organ virus that affects many organs. The second study shows the consequences when the kidney is infected and the virus actively reproduces in the tissue.
As you examined in your study, the coronavirus is not a pure respiratory virus. In which organs did you find the most severe damage?
We know, first of all, that the central organ is the lungs. This is the gateway: this is where the virus multiplies, there is the most severe damage, which is also decisive for mortality. In addition, we see that the virus spreads from the lungs to the other organs. What this means for individual organs, especially in the long-term consequences, is being investigated in studies that are still ongoing. For the kidney, we can at least say that there is a connection to acute kidney failure. In the case of the heart, for example, we can see that there is an increase in myocardial inflammation or sudden cardiac death. In addition, there are many neurological symptoms such as taste disorders, smell disorders, tiredness, or difficulty concentrating that could be related to the detection of viruses in the brain. But here too, more studies will have to be done.
Prof. Dr. with. Tobias B. Huber
(Those: t-online.de/UKE)
Prof. Tobias Huber is Director of the Center for Internal Medicine at the University Medical Center Hamburg-Eppendorf (UKE) and also Director of III. Medical Clinic and Polyclinic – Nephrology, Rheumatology and Endocrinology. As a leading international kidney expert, he has already conducted two successful autopsy studies of deceased patients with Covid 19.
Are there other particular diseases or viruses that spread throughout the body in this way?
That is a very good question. Tropism, that is, the affinity of a virus for a specific location in the body, is known to many viruses. For example, polioviruses that attack neurons or papillomaviruses or the skin and mucous membranes. HIVIt attacks the immune white blood cells. Many viruses have a special and privileged residence in the body. Also about the Influenza you know that viruses are mainly localized in the respiratory tract and lungs.
It is also interesting that it was before the new coronavirus SARS gave – the virus also had a wide distribution in the body. Why is this so? Basically, it depends on how the virus enters the organs and cells. Usually there are receptors that absorb the virus in cells. In SARS-CoV-2, this is called ACE-2, a special protein molecule that mediates absorption in cells, and this molecule is widely distributed in the body. It is found in the heart, liver, kidneys, and many other organs. That requires wide distribution. And by the way, this is not just the case for humans, but for all animal species. And that is rarely the case for other viral diseases.
According to your study, what influence do the above diseases have on the course of Covid-19?
Our first study and many other studies from China, Europe or the US have shown: The above diseases have a very significant influence on the severity of the course. These are the main switches of the course. The deceased examined by us had a mean of 3.3 serious comorbidities such as Diabetes, hypertension, Obesity, lung or kidney disease. This means that the above diseases play a decisive role. Whether you have the virus or not, the risk is likely to be the same for everyone. But because of the impact that the virus has on the body. This is why young, healthy people rarely have symptoms.
There has been much debate about how much life the Covid-19 has taken from the deceased patient: what is the current assessment of this question?
At first it was like this: It was noted that most of the patients who had died from Covid-19 sometimes had serious pre-existing diseases. At first, this led to the error of judgment that these people would have died quickly anyway if the prognosis was critical. Today we know this better, by looking at a large number of cases in countries and continents, and statistical calculations now show that many deceased patients with Covid-19 have lost a few years of life. You don’t die immediately from diabetes, high blood pressure, or being overweight.
For example, one study speaks of an average of eight years of life lost. In fact, with regard to the exact time, it must be said that the comparability of the life of the constellations with different previous diseases with and without a crown always depends on some estimated variables. But yes: Covid-19 unfortunately has a significant mortality rate. And yes: in many patients, the virus unfortunately leads to a significant shortening of the lifespan.
What long-term consequences should Covid 19 patients expect?
We know that the virus can affect many organs, but we do not yet know what that means in detail. That is why we are building registries and databases. We will only discover the real consequences over time. The lungs are the most severely affected: among other things, it remains to be seen to what extent permanent scars will affect the subsequent functionality and susceptibility of the lungs. For all other organs, reliable prognoses cannot yet be established unless long-term studies are available. However, I think the long-term effects will mostly apply to the severe courses and not the easy ones.
How can organ damage from SARS-CoV-2 be prevented?
First, of course, we should all prevent the spread of the virus and also get Covid-19 ourselves. Second, we need one to be implemented quickly vaccination and thus the production of a immunity. Third, there are no organ-specific effective ways to contain the spread of the virus in the body. For example, there are therapies in development that aim to limit the spread of the virus or the severity of the body’s immune response to the virus. These are approaches that are still being explored. But in essence, preventing the virus from spreading and building immunity through vaccination are the best options.
What is the next step in your research? Are there other studies and what other findings do you expect?
Yes, there are many other studies. One thing that interests us now regarding the kidney is that there are often changes in the urine as well. That is why we are specifically investigating whether early changes in urine in Covid-19 patients can be a good indicator of the severity of the later course and the likelihood of intensive care. This is a study that is currently ongoing and we are very curious about the results. The other studies we are doing look in more detail at direct organ damage caused by Covid-19.
Aside from your studies: How well is UKE prepared for a new wave of infections?
Very good. On the one hand, we were able to build very good structures in exchange with networks of national and global experts during the first wave and we have all learned a lot in this pandemic. Teams have been trained, processes have been optimized; the interaction between the hospital and resident physicians and all other facilities that care for the sick and those in need of care has also developed further. We have also created registries, created new communication channels, and created an inter-divisional working group.
There is sufficient capacity for intensive care, dialysis, quarantine and normal hospitalized patients. We feel very well armed with all this, but surprises like these always come up. So it is crucial that the team always create new solutions and anticipate challenges through careful observation. Of course, prevention is even better, we want to help prevent the virus from spreading again so quickly, that effective vaccines are found, and that the effects of the virus on the body are reduced.
Thanks for the interview, Prof. Huber.
