Doctors are finding that the COVID-19 novel coronavirus is damaging more organs than just the lungs in some patients, according to multiple international sources.
At the start of the pandemic, doctors described the primary symptoms of the coronavirus as a fever, dry cough and shortness of breath that eventually, when the illness grew severe, led one into a hospital and sometimes on to a ventilator. Damage to the alveoli – the small, elastic air sacs in the lungs – was often the result, according to numerous accounts that followed.
Slime in the Alveoli
It is certainly true that when it is fatal, the virus kills by creating inflammation and clogging those tiny sacs with a kind of slime which then chokes off the oxygen supply to the body’s organs, according to researchers at the Cleveland Clinic.
Dr. Sanjay Mukhopadhyay, director of pulmonary pathology at the Cleveland Clinic, reported the results of two autopsies, including one of a 77-year-old Oklahoma man whose alveoli were found to be coated with a slime or paint-like substance in the lungs. Mukhopadhyay had been asked to review the autopsy findings by the Oklahoma Office of the Chief Medical Examiner. The second patient, a 42-year-old man, did not have the slime in his lungs and although he had the virus, he actually died of bacterial pneumonia and not from COVID-19. The study was subsequently published in the American Journal of Clinical Pathology.
It’s already known that the virus causes a “cytokine storm” that eventually shuts down the ability of the lungs to function, and the ability of the body to withstand an assault from its own immune system.
Now clinicians are also seeing evidence that the virus may also be causing similar inflammation in the heart, the kidneys, the intestines and the liver, as well as neurological damage.
Virus Targets the Kidneys
Nearly half of patients currently hospitalized with COVID-19 present with blood or protein in their urine, according to a report published by The Washington Post, which quoted Dr. Alan Kliger, a nephrologist at Yale School of Medicine.
Kliger, who co-chairs a task force assisting dialysis patients diagnosed with COVID-19, said the blood test result indicates early kidney damage. He added there is also early data showing that 14 to 30 percent of ICU patients in New York and Wuhan, China lose kidney function and require dialysis – or continuous renal replacement therapy (CRT), the in-hospital version.
Chinese researchers who published a paper April 9 in the journal Kidney International wrote that nine out of 26 COVID-19 patients who died were found to have acute kidney damage, and seven were found to have particles of the novel coronavirus in their kidneys.
Acute kidney injury was identified in patients who were being studied in the very first research cohort in Wuhan, China in January, 2020, by a group of doctors who published their findings in The Lancet, as well as in a number of other studies as well. Virus-related continuous renal replacement therapy was required in three patients and acute kidney injury was documented in three patients as well. Six patients died.
Cardiac Injury An Unwelcome Outcome
Virus-related cardiac injury was identified as one of the outcomes in five of the 41 COVID-19 patients. Five out of 41 patients hospitalized with COVID-19 in Wuhan – 12 percent – had signs of cardiovascular damage in the findings of a research study carried out in January 2020. That report was also published in The Lancet. These patients had both elevated levels of cardiac troponin — a protein released in the blood by the injured heart muscle — and abnormalities on electrocardiograms and heart ultrasounds.
A separate retrospective study of 138 hospitalized patients with COVID-19 in Wuhan, carried out from January 1-28 with a final followup on February 3, 2020, noted that arrhythmia occurred in 23 patients (16.7 percent) and 10 patients suffered acute cardiac injury (7.2 percent).
But there are other ways that COVID-19 can pose a serious danger to the heart, according to an article published in The Harvard Gazette.
The heart muscle can be starved for oxygen when there is a mismatch between oxygen supply and demand, triggered by the action of the virus on the lungs. “Fever and inflammation accelerate heart rate and increase metabolic demands on many organs, including the heart. That stress is compounded if the lungs are infected and incapable of exchanging oxygen and carbon dioxide optimally. This impaired gas exchange can further diminish oxygen supply to the heart muscle,” The Harvard Gazette reports.
But there is also a certain group of people who contract the virus and who then develop “fulminant inflammation” of the heart muscle as a result of the COVID-19 virus directly infecting the heart. “This type of inflammation – viral myocarditis, which can cause congestive heart failure — could lead to heart rhythm disturbances and cardiac muscle damage as well as interfere with the heart’s ability to pump blood optimally,” The Harvard Gazette reports. ““This can be life threatening, and it can happen in people who don’t have any preexisting risk factors.”
COVID-19 Also Attacks the Liver
There are also reports that the virus can attack the liver, according to a report published in the American Journal of Gastroenterology by researchers at Northwell Health and Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York.
The report relates the account of a 59-year-old Long Island woman who arrived at the hospital with symptoms of hepatitis, without fever or respiratory problems.
“Her initial presentation was not typical for COVID-19 and she was evaluated for acute hepatitis,” researchers wrote.
“This workup was negative and 18 hours after admission, she developed respiratory symptoms and was subsequently diagnosed with COVID-19.
“She was treated for COVID-19 with hydroxychloroquine and her symptoms improved as did her liver chemistries.
“As all other causes of acute non-icteric hepatitis were ruled out, it seems highly likely that her acute hepatitis was caused by COVID-19 infection,” the researchers added, clearly linking the living damage to the virus.
Dr. Brennan Spiegel, co-editor in chief of the American Journal of Gastroenterology, said in an interview with The Washington Post that he has seen such reports every day, including one from China reporting on five patients with acute viral hepatitis.
“What we’re learning is, it seems anyway, this virus homes in on more than one organ system.”
Gastrointestinal Damage Also an Outcome
Other researchers have found the virus also appears to cause damage to the colon. Another study published in the American Journal of Gastroenterology documented the case of a 71-year-old woman with “COVID-19 disease which endoscopy confirmed colonic injury and helped exclude other etiologies of disease.”
Although the intestinal symptoms were the initial and primary symptoms in this case, one week later the patient developed the respiratory and other symptoms for which COVID-19 has become known.
“There has been a growing appreciation of the importance of digestive symptoms (nausea, vomiting, anorexia, non-bloody diarrhea, and abdominal pain) in the spectrum of COVID-19 disease,” the researchers wrote. “This case adds to the body of evidence implicating the gastrointestinal tract in the clinical expression and transmission of SARS-CoV-2 infection. On this basis, we believe it is important to institute SARS-CoV-2 precautions in patients who present with either respiratory or digestive symptoms.”
Another rarely-discussed outcome of the virus is the danger of blood clots developing in the legs and other blood vessels. Such clots can break off, travel to the heart or lung and kill a patient by causing a pulmonary embolism or heart attack.
COVID-19 Can Cause Blood Clots Too
A peer-reviewed study of 81 patients hospitalized with COVID-19 in Wuhan that was published April 9 online in the Journal of Thrombosis and Hemostasis described 20 incidents in which blood clots developed in the patients; eight of them died.
“Severe novel coronavirus pneumonia (NCP) patients have abnormal blood coagulation function, but their venous thromboembolism (VTE) prevalence is still rarely mentioned,” the authors wrote.”
In New York City’s Columbia Medical Center, blood thinners are being used with COVID-19 patients “much more than expected,” Assistant Professor Sanjum Sethi, an interventional cardiologist told The Washington Post.
“We’re just seeing so many of these events that we have to investigate further,” he said.