Doctors are learning about the new symptoms of COVID-19: the virus is very unpredictable

“He was thought to be suffering from the so-called stomach flu.” He walked easily and spoke very clearly, ”said Catherina Coleman, Coughlin’s daughter.

But while Mrs. Coughlin, 67, was talking to her daughters on the phone, the oxygen level in her blood dropped so low that most patients were already on the verge of death. Now the woman lies on Hartford Street. At Francis Hospital, she is connected to a lung ventilator, her condition is critical. This is another patient who experienced a strange set of symptoms. Doctors try to recognize, explain, and treat these symptoms.

“At first, we didn’t know who we were dealing with,” said Valentin Fuster, chief physician at Sinai Hospital in New York, which has become the epicenter of the coronavirus in the United States. “It just came to our attention then. It all happened suddenly, we were in a whole new situation and we didn’t understand what was going on,” said the doctor.

As he writes washingtonpost.com, it is now widely accepted that the new coronavirus is significantly more unpredictable than the simple respiratory virus. It usually attacks the lungs, but it can also hit any part of the body, from the brain to the toes. Many doctors focus on treating virus-induced inflammatory reactions and their ability to cause blood clots, while trying to help patients breathe.

Doctors have to hurriedly gain knowledge about the new disease when more than 78,000 people in the United States are linked to the pandemic. deaths, and there are few reliable studies that can help them. The World Health Organization database already contains more than 14,600 articles on COVID-19. Even the world’s leading public health services, including the US Centers for Disease Control and Prevention. In the USA, they have constantly changed their advice and guidelines to coincide with new discoveries.

“We don’t know why the disease has so many symptoms. The bottom line is that everything is very new and we don’t know much,” says Angela Rasmussen, a virologist at the Center for Infectious Diseases and Immunology at the Mailman School of Public Health, Columbia University.

More than four months of clinical experience in Asia, Europe, and North America have shown that the pathogen not only attacks the lungs, but also does much more. “No one expected a disease that did not fit any pattern of pneumonia and respiratory disease,” explains David Reich, a cardiovascular anesthesiologist and president of Sinai Hospital in New York.

The virus attacks the heart, weakens the muscles, and disrupts the rhythm. It attacks the kidneys so severely that some hospitals have run out of dialysis equipment. It slowly affects the nervous system, suppresses changes in taste and smell, and occasionally reaches the brain. This can cause blood clots that lead to sudden death and inflammation of blood vessels throughout the body.

The disease can start without any symptoms or there will be only a few, and after a couple of days it will suddenly start compressing the air in the lungs. This is especially true in the elderly, weakened by previous illnesses, and obese people. Men suffer more than women, but there are also signs that the disease can complicate pregnancy.

Symptoms of COVID-19:

• Brain: stroke due to blood clots, neurological disorders,
• Eyes: infectious conjunctivitis
• Nose: loss of taste and smell,
• Blood – blood clots, damaged blood vessel walls,
• Digestive system, intestines: some people experience vomiting and diarrhea,
• Lungs: fragile air pockets in the lungs, shortness of breath, pulmonary embolism (blocked blood vessels in the lungs),
• Heart: weakened heart muscle; small clots can cause dangerous heart arrhythmias and heart attacks,
• Kidney – vulnerable structures that filter toxins from the blood, patients often require dialysis.
• Skin: May cause a purple rash due to damaged blood vessels.
• Immune system: The effects on the immune system are extensive, and an overactive immune response can also occur when healthy tissues are attacked.

The virus overlooks children, but it’s too early to rejoice: Last week, doctors reported a rare inflammatory reaction in several children with heart complications. Last Friday, New York Governor Andrew M. Cuomo reported that 73 children in New York State were seriously ill and 5 years old. A boy in New York became the first boy to die of a coronavirus. Two more children died last Saturday.

This news surprised many doctors who thought that they had finally managed to stop the reach of the disease among adults. “We all think the disease killed only adults, not children,” said Reich.

Five infected children were treated at the Sinai Hospital. According to D. Reich, everyone initially had indigestion, then inflammatory complications began, leading to a sharp drop in blood pressure and dilation of blood vessels. The above symptoms caused heart disease, from which the first child died.

“The course of the disease was different from other cases of the virus,” he said.

Of the millions or even billions of coronaviruses, six were infected in the past.

Four cause colds that occur every winter and go virtually unnoticed. Another virus in 2003 caused an acute respiratory syndrome that killed 774 people. Another virus in 2012 caused acute respiratory syndrome in the Middle East, 34 percent died. of people infected with the virus.

Seventh in the coronavirus family, SARS-CoV-2. He reconciled the infectivity of his cold-causing cousins ​​with some lethal aspects of SARS and MERS. The virus spreads before people have symptoms, making it difficult to control, especially without accurate testing. Currently, the only effective measure is to respect social distance.

According to the Johns Hopkins University Coronavirus Research Center, the virus has infected around 4 million people worldwide. About 280,000 people died. Only in the United States: 1.3 million. infected and 78,000 dead.

According to Rasmussen, if SARS or MERS had been so widespread, perhaps their effects would have been even more dangerous. Still, those viruses were suppressed fairly quickly, causing relatively few people to get sick or die.

It is not easy to identify a pathogen in the context of a still expanding epidemic.

According to experts, it will take many years to understand how the disease affects organs and how medications, genetics, diet, lifestyle, and social distance affect its course.

“It is a virus that literally did not exist in the human world until six months ago,” said Geoffrey Barnes, a professor at the University of Michigan who works on cardiovascular disease. – We urgently need to discover, in a matter of weeks, how this virus affects the human body and how to overcome it. It took decades to understand most of the other diseases. “

At the beginning of the outbreak, the focus was on lung treatment.

SARS-CoV-2 damages both the upper and lower respiratory tracts, eventually penetrating deep into the lungs and filling the alveoli with cells and fluids that interrupt the flow of oxygen.

However, several scientists believe that the greatest damage to the body is caused by two interrelated causes.

The first is virus-induced vascular damage that results in clot formation (microscopic to large in size). The shed clots enter the bloodstream and, when they travel to the brain or lungs, can cause stroke and pulmonary embolism. A study published in the British medical journal The Lancet indicates that this is because the virus directly damages the endothelial cells that line the walls of blood vessels.

The second reason is the exaggerated response of the body’s own immune system: cytokine-induced cell killers, which attack not only the virus but also the body’s own cells to protect it from the invading virus.

Research and treatment focus on these phenomena. Anticoagulants are used more widely in some hospitals. Published in the Journal of the American College of Cardiology. A review of data from 733 patients indicated that these medications may help more seriously ill patients.

“Scientific data is constantly changing: theories are raised and denied, hypotheses are improved. That does not mean we do not understand what we are doing. That means we are learning,” says Deepak Bhatt, chief of interventional cardiology at Brigham and Women’s Hospital in Boston.

Mandeep Mehra, a professor at Harvard Medical School, one of the authors of a study published in The Lancet on the effects of COVID-19 on blood vessels, explained that the virus affects many areas of the body, probably due to inflammation of endothelial cells within blood vessels. This means that antiviral therapy alone will not help cure COVID-19, he says.

“This virus causes a viral infection that disrupts the entire immune system and damages blood vessels, which is the cause of death,” explains Mehra. “Our hypothesis is that COVID-19 initially acts as a respiratory virus, but causes death as a cardiovascular virus.”
Theories of kidney disease specialists have evolved similarly. At first, they thought common severe kidney disease was caused by lung ventilators and certain medications administered to patients in the intensive care unit, says Daniel Batlle, professor of medicine at Northwestern University’s Feinberg School of Medicine.

They then detected injuries to the body’s filtering kidney cells before the patients needed intensive care. Furthermore, the pathogen was detected in the kidneys in studies conducted in Uhane, leading to speculation that the new coronavirus is also damaging this organ.

“We didn’t notice anything unique at first,” said Batlle. However, new information suggests that “these acute kidney injuries are significantly different from what we commonly find.”

Like other coronaviruses, SARS-CoV-2 enters the body by binding to the receptor angiotensin-2-converting enzyme, which is found on the surface of some cells. However, the protein peaks in the new coronavirus have a slightly different composition, and the virus may bind better. As a result, fewer virus particles are needed to infect the body. This feature may also help explain why the new coronavirus is so much more virulent than SARS, Rasmussen said.

As for virus transmission, other factors cannot be ruled out, the virologist said, including the amount of virus left by infected people and the peculiarities of adhering to the rules of social isolation.

Once in the cell, the virus begins to multiply and cause chaos. The 2 receptors for the angiotensin-converting enzyme, which help regulate blood pressure, are abundant in the lungs, kidneys, and intestines, and in many patients these organs are severely damaged by the infectious agent. Perhaps this is why high blood pressure is one of the most common prior health conditions among people with severe COVID-19.

The receptors in different people are different, so genetics is supposed to help explain the variety of symptoms and severity of the disease. Cells that contain receptors “are virtually ubiquitous, so it stands to reason that the virus damages the entire body,” said Mitchell Elkind, professor of neurology at the College of Physicians and Surgeons at Columbia University and president of the American Heart. Association.

The inflammation causes the blood to clot as the white blood cells fight the infection. They interact with platelets and activate them in a way that increases blood clotting, Elkind explained. Such reactions have been reported in severe infections such as sepsis, but in the case of COVID-19, “they occur in large numbers of people in a very short time and are seen immediately.”

“The virus can attack different parts of the body, and we don’t understand why the damage it does is different and why many people don’t have any symptoms,” said Elkind.

Ms. Coughlin, who was taken to the Connecticut Hospital Emergency Department, has deteriorated rapidly and is now in critical condition. Her body temperature reached 40.5 ° C and inflammation began in her lungs.

She interacted with her six daughters on Wednesday using the FaceTime app and said doctors advised connecting a lung ventilator.

“I came to terms with the idea that something could happen to me and that I would not survive,” he said. These words saddened the daughter of Ch. Coleman

“I decided to help her prepare for the lung ventilator connection. It is very possible that she will die connected to him, said the daughter. “Maybe that was my last conversation with my mother.”