More than four months of clinical experience across Asia, Europe and North America has shown the pathogen does much more than invade the lungs. “No one was expecting a disease that would not fit the pattern of pneumonia and respiratory illness,” said David Reich, a cardiac anesthesiologist and president of Mount Sinai Hospital in New York City. That news has shaken many doctors, who felt they were finally grasping the full dimensions of the disease in adults.
Symptoms of covid-19 appear to include:
Brain: Strokes from blood clots, neurological issues
Nose: Loss of smell and taste (anosmia)
Blood: Unexpected blood clotting; attacks the lining of blood vessels
Gastrointestinal system: Vomiting and diarrhea in some people
Lungs: Clogs and inflames alveoli (air sacs), hampering breathing; pulmonary embolism from breakaway blood clots and micro clots
Heart: Weakens heart muscle; causes dangerous arrhythmias and heart attacks due to small clots
Kidneys: Damage to structures that filter waste from blood; patients often require dialysis
Skin: “COVID toes,” or fingers, a purple rash from the attack on blood vessels
Immune system: Widespread impact, including overactive immune response that attacks healthy tissue
“This is a virus that literally did not exist in humans six months ago,” said Geoffrey Barnes, an assistant professor at the University of Michigan who works in cardiovascular medicine. “We had to rapidly learn how this virus impacts the human body and identify ways to treat it literally in a time-scale of weeks. With many other diseases, we have had decades.” Research and therapies are focused on these phenomena. Blood thinners are being more widely used in some hospitals.
The first is the harm the virus wreaks on blood vessels, leading to clots that can range from microscopic to sizable. Patients have suffered strokes and pulmonary emboli as clots break loose and travel to the brain and lungs.
The second is an exaggerated response from the body’s own immune system, a storm of killer “cytokines” that attack the body’s own cells along with the virus as it seeks to defend the body from an invader.
“Things change in science all the time. Theories are made and thrown out. Hypotheses are tweaked. It doesn’t mean we don’t know what we are doing. It means we are learning,” said Deepak Bhatt, executive director of interventional cardiology at Brigham and Women’s Hospital in Boston.
Trying to define a pathogen in the midst of an ever-spreading epidemic is fraught with difficulties. Experts say it will be years until it is understood how the disease damages organs and how medications, genetics, diets, lifestyles and distancing impact its course.