This archive report was first published on 11 July 2020.
Coronavirus: A Multisystem Disease ¶
Published on July 11, 2020, a review of reports about Covid-19 patients by doctors at Columbia University Irving Medical Center in New York City revealed that the coronavirus damages not only the lungs but also the kidneys, liver, heart, brain, and nervous system.
The team, led by Dr. Aakriti Gupta and Dr. Mahesh Madhavan, cardiology fellows at Columbia, collected reports from medical teams around the world and found that the virus attacks virtually every major system in the human body, directly damaging organs and causing the blood to clot, the heart to lose its healthy rhythm, the kidneys to shed blood and protein, and the skin to erupt in rashes.
“Physicians need to think of COVID-19 as a multisystem disease,” Dr. Gupta said. “There’s a lot of news about clotting, but it’s also important to understand that a substantial proportion of these patients suffer kidney, heart, and brain damage, and physicians need to treat those conditions along with the respiratory disease.”
The researchers found that the virus’s affinity for a receptor called ACE2, which is found on cells lining the blood vessels, kidneys, liver ducts, pancreas, intestinal tract, and respiratory tract, allows it to grapple and infect cells, leading to direct viral tissue damage.
Coronavirus infection also activates the immune system, producing inflammatory proteins called cytokines, which can damage cells and organs and lead to severe symptoms.
“This virus is unusual, and it’s hard not to take a step back and not be impressed by how many manifestations it has on the human body,” Dr. Madhavan said.
The researchers noted that blood clotting effects appear to be caused by several different mechanisms, including direct damage of the cells lining the blood vessels and interference with the various clotting mechanisms in the blood itself.
These clots can cause strokes and heart attacks or can lodge in the lungs or legs, clog the kidneys, and interfere with dialysis treatments needed for the sickest patients.
Damage to the pancreas can worsen diabetes, and patients with diabetes have been shown to be at the highest risk of severe illness and death from coronavirus.
The virus can directly damage the brain, but some of the neurological effects likely come from the treatment, including prolonged intubation and sedation.
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, however: gastrointestinal symptoms may be associated with a longer duration of illness but have not been associated with increased mortality, and many of the skin effects, such as rashes and purplish, swollen “Covid toes,” also clear up on their own.
