The prevalence of these effects is too great to attribute them solely to the cytokine storm, a powerful immune-system response that attacks the body, causing severe damage, doctors and researchers said.
Almost half the people hospitalized because of covid-19 have blood or protein in their urine, indicating early damage to their kidneys, said Alan Kliger, a Yale University School of Medicine nephrologist who co-chairs a task force assisting dialysis patients who have covid-19.
Even more alarming, he added, is early data that shows 14to 30percent of intensive-care patients in New York and Wuhan, China birthplace of the pandemic have lost kidney function and require dialysis, or its in-hospital cousin, continuous renal replacement therapy. New York intensive care units are treating so much kidney failure, he said, they need more personnel who can perform dialysis and have issued an urgent call for volunteers from other parts of the country. They also are running dangerously short of the sterile fluids used to deliver that therapy, he said.
Thats a huge number of people who have this problem. Thats new to me, Kliger said. I think its very possible that the virus attaches to the kidney cells and attacks them.
But in medicine, logical inferences often do not prove true when research is conducted. Everyone interviewed for this story stressed that with the pandemic still raging, they are speculating with much less data than is normally needed to reach solid clinical conclusions.
Many other possible causes for organ and tissue damage must be investigated, they said, including respiratory distress, the medications patients received, high fever, the stress of hospitalization in an ICU and the now well-described impact of cytokine storms.
It does raise the very clear suspicion that at least a part of the acute kidney injury that were seeing is resulting from direct viral involvement of the kidney, which is distinct from what was seen in the SARS outbreak in 2002, said Paul M. Palevsky, a University of Pittsburgh School of Medicine nephrologist and president-elect of the National Kidney Foundation.
One New York hospital recently had 51 ICU patients who needed 24-hour kidney treatment but had just 39 machines to do it, he said. The hospital had to ration the care, keeping each patient on the therapy less than 24 hours a day, he said.
The virus also may be damaging the heart. Clinicians in China and New York have reported myocarditis, an inflammation of the heart muscle, and, more dangerous, irregular heart rhythms that can lead to cardiac arrest in covid-19 patients.
They seem to be doing really well as far as respiratory status goes, and then suddenly they develop a cardiac issue that seems out of proportion to their respiratory issues, said Mitchell Elkind, a Columbia University neurologist and president-elect of the American Heart Association. This seems to be out of proportion to their lung disease, which makes people wonder about that direct effect.
One review of severely ill patients in China found that about 40percent suffered arrhythmias and 20percent had some form of cardiac injury, Elkind said. There is some concern that some of it may be due to direct influence of the virus, he said.
The new virus enters the cells of people who are infected by latching onto the ACE2 receptor on cell surfaces. It unquestionably attacks the cells in the respiratory tract, but there is increasing suspicion that it is using the same doorway to enter other cells. The gastrointestinal tract, for instance, contains 100 times more of these receptors than other parts of the body, and its surface area is enormous.
If you unfurl it, its like a tennis court of surface area this tremendous area for the virus to invade and replicate itself, said Brennan Spiegel, co-editor in chief of the American Journal of Gastroenterology.
In a subset of covid-19 cases, researchers have found, the immune system battling the infection goes into hyperdrive. The uncontrolled response leads to the release of a flood of substances called cytokines that, in excess, can result in damage to multiple organs. In some severely ill covid-19 patients, doctors have found high levels of a pro-inflammatory cytokine called interleukin-6, known by the medical shorthand IL-6.
The unfettered response, also called cytokine release syndrome, has long been recognized in other patients, including those with autoimmune diseases such as rheumatoid arthritis or in cancer patients undergoing certain immunotherapies.
For covid-19 patients, cytokine storms are a major reason that some require intensive care and ventilation, said Jeffrey S. Weber, deputy director of the Perlmutter Cancer Center at NYU Langone Medical Center.
When your cytokines are systemically out of control, bad stuff happens, he said. It can be a complete disaster. It isnt clear why cytokine storms occur in some patients and not others, though genetic factors may play a role, some doctors say.
To treat cytokine storms, some doctors are using anti-IL-6 drugs such as tocilizumab, which is approved for cancer patients who develop cytokine storms as a result of immunotherapy.
Another odd, and now well-known, symptom of covid-19 is loss of smell and taste. Claire Hopkins, president of the British Rhinological Society, said studies of patients in Italy and elsewhere have shown that some lose their sense of smell before they show signs of being sick.
The coronavirus can actually attack and invade olfactory nerve endings, Hopkins said. When these aroma-detecting fibers are disrupted, they cant send odors to the brain.
Anosmia the medical term for the inability to smell was not initially recognized as a symptom of covid-19, Hopkins said. Doctors were so overwhelmed by patients with severe respiratory problems, she said, that they didnt ask the question.
But subsequent data from a symptom-tracking app has shown that 60percent of people later diagnosed with covid-19 reported losing their senses of smell and taste. About a quarter of participants experienced anosmia before developing other symptoms, suggesting it can be an early warning sign of infection.
Intriguingly, Hopkins said, people who lose their sense of smell dont seem to develop the same severe respiratory problems that have made covid-19 so deadly. But a very small number of patients have experienced confusion, low blood oxygen levels and even lost consciousness a sign that the virus may have traveled along their olfactory nerve endings straight to the central nervous system.
Why you get this different expression in different people, nobody knows, she said.
There are also reports that covid-19 can turn peoples eyes red, causing pinkeye, or conjunctivitis, in some patients. One study of 38 hospitalized patients in Hubei province, China, found that a third had pinkeye.
But like many of the non-respiratory effects of the virus, this symptom may be relatively uncommon and may develop only in people already severely ill. The fact that the virus has been found in the mucus membrane that covers the eye in a small number of patients, however, does suggest that the eye could be an entryway for the virus and is one reason that face shields and goggles are being used to protect health-care workers.
The virus also is having a clear impact on the gastrointestinal tract, causing diarrhea, vomiting and other symptoms. One study found that half of covid-19 patients have gastrointestinal symptoms, and specialists have coined a Twitter hashtag, #NotJustCough, to raise awareness of them.
Studies suggest that patients with digestive symptoms will also develop a cough, but one may occur days before the other.
The question is, is it kind of behaving like a hybrid of different viruses? Spiegel said. What were learning is, it seems anyway, that this virus homes in on more than one organ system.
Reports also indicate that the virus can attack the liver. A 59-year-old woman in Long Island came to the hospital with dark urine, which was ultimately found to be caused by acute hepatitis. After she developed a cough, physicians attributed the liver damage to a covid-19 infection.
Spiegel said he has seen more such reports every day, including one from China on five patients with acute viral hepatitis.
A particular danger of the virus appears to be its tendency to produce blood clots in the veins of the legs and other vessels, which can break off, travel to the lung and cause death by a condition known as pulmonary embolism.
Across New York City, blood thinners are being used with covid-19 patients much more than expected, said Sanjum Sethi, an interventional radiologist and assistant professor of medicine at Columbia Universitys Irving Medical Center.
Were just seeing so many of these events that we have to investigate further, he said.
Visit link:
- The Health Department website was attacked in the middle of the coronavirus pandemic - Vox.com [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- Defining Coronavirus Symptoms: From Mild To Moderate To Severe : Goats and Soda - NPR [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- What Are the Symptoms of a Coronavirus Infection? - The New York Times [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- Hotels Were Rolling Out Tools to Help Calm Travelers. Then Coronavirus Hit. - The New York Times [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- The Coronavirus, by the Numbers - The New York Times [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- Opinion: Early Coronavirus Testing Failures Will Cost Lives - NPR [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- Coronavirus Cases Surge in U.S. and Europe - The New York Times [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- Two Emergency Room Doctors Are in Critical Condition With Coronavirus - The New York Times [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- Coronavirus: Over 1000 Cases Now In U.S., And 'It's Going To Get Worse,' Fauci Says - NPR [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- China Spins Tale That the U.S. Army Started the Coronavirus Epidemic - The New York Times [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- Everything to Know About the Coronavirus in the United States - The Cut [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- Coronavirus closed this school. The kids have special needs: 'You can't Netflix them all day.' - USA TODAY [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- How Long Can The Coronavirus Live On Surfaces? : Shots - Health News - NPR [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- Coronavirus Cost to Businesses and Workers: It Has All Gone to Hell - The New York Times [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- In the U.S., More Than 300 Coronavirus Cases Are Confirmed - The New York Times [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- How Jair Bolsonaro's Son, Eduardo, Confirmed His Father's Positive Coronavirus Test to Fox News, Then Lied About It - The Intercept [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- De Blasio Resisted on Coronavirus. Then Aides Said Theyd Quit. - The New York Times [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- Trump Is Tested for Coronavirus, and Experts Ask: What Took So Long? - The New York Times [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- Live Coronavirus Updates and Coverage - The New York Times [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- Coronavirus Threatens Americans With Underlying Conditions - The New York Times [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- Coronavirus Capitalism and How to Beat It - The Intercept [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- An essential reading guide to understand the coronavirus - Vox.com [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- N.Y.C.s Economy Could be Ravaged by Coronavirus Outbreak - The New York Times [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- 'A ticking time bomb': Scientists worry about coronavirus spread in Africa - Science Magazine [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- How coronavirus is affecting the restaurant business, in one chart - Vox.com [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- Coronavirus Map: How To Track Coronavirus Spread Across The Globe - Forbes [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- Coronavirus Testing Website Goes Live and Quickly Hits Capacity - The New York Times [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- Map: How Many Cases Of Coronavirus Are There In Each US State? : Shots - Health News - NPR [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- Live Coronavirus Updates and Coverage Globally - The New York Times [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- This Is How the Coronavirus Will Destroy the Economy - The New York Times [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Every Star and Public Figure Diagnosed with COVID-19: A Running List - The Daily Beast [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Coronavirus: What you need to know - Fox News [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Travel updates: which countries have coronavirus restrictions and FCO warnings in place? - The Guardian [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Staff angered as Charter prohibits working from home despite spread of coronavirus - TechCrunch [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- If coronavirus scares you, read this to take control over your health anxiety - The Guardian [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- San Francisco and Bay Area will shelter in place to slow coronavirus spread - The Verge [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Coronavirus spreading fastest in UK in London - The Guardian [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Businesses Face a New Coronavirus Threat: Shrinking Access to Credit - The New York Times [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Welcome to Marriage During the Coronavirus - The New York Times [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Sweeping restrictions take effect in coronavirus response as health officials warn US is at a tipping point - CNN [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- How Long Will the Coronavirus Outbreak and Shutdown Last? - The New York Times [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- 201920 coronavirus pandemic - Wikipedia [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Coronavirus - World Health Organization [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- What Is Coronavirus? | HowStuffWorks [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Coronavirus | CISA [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Is there a cure for the new coronavirus? - Livescience.com [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Shelter in Place: Some Residents in Bay Area Ordered to Stay Home - The New York Times [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Tracking the Impact of the Coronavirus on the U.S. - The New York Times [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- 8 Things Parents Should Know About The Coronavirus: Life Kit - NPR [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Spain, on Lockdown, Weighs Liberties Against Containing Coronavirus - The New York Times [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- New Yorks Nightlife Shuttered to Curb Coronavirus - The New York Times [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- How best to fight the economic impact of the coronavirus pandemic - The Guardian [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Heres whos most at risk from the novel coronavirus - The Verge [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Closing Down the Schools Over Coronavirus - The New York Times [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- The U.S. Economy Cant Withstand the Coronavirus by Itself - The New York Times [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- U.S. Lags in Coronavirus Testing After Slow Response to Outbreak - The New York Times [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- U.K. Steps Up Coronavirus Prevention, But Its Hospitals Have Already Been Strained - NPR [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Coronavirus panic is clearing out grocery stores; heres how workers are handling it - Vox.com [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Tracking the Coronavirus: How Crowded Asian Cities Tackled an Epidemic - The New York Times [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Coronavirus Treatment: Hundreds of Scientists Scramble to Find One - The New York Times [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Coronavirus cases have dropped sharply in South Korea. What's the secret to its success? - Science Magazine [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Facebook was marking legitimate news articles about the coronavirus as spam due to a software bug - The Verge [Last Updated On: March 18th, 2020] [Originally Added On: March 18th, 2020]
- The Single Most Important Lesson From the 1918 Influenza - The New York Times [Last Updated On: March 18th, 2020] [Originally Added On: March 18th, 2020]
- How to Protect Older People From the Coronavirus - The New York Times [Last Updated On: March 18th, 2020] [Originally Added On: March 18th, 2020]
- Coronavirus Is Killing Iranians. So Are Trump's Brutal Sanctions. - The Intercept [Last Updated On: March 18th, 2020] [Originally Added On: March 18th, 2020]
- Is there a cure for coronavirus? Why Covid-19 is so hard to treat - Vox.com [Last Updated On: March 18th, 2020] [Originally Added On: March 18th, 2020]
- Coronavirus: The math behind why we need social distancing, starting right now - Vox.com [Last Updated On: March 18th, 2020] [Originally Added On: March 18th, 2020]
- Europeans Erect Borders Against Coronavirus, but the Enemy Is Already Within - The New York Times [Last Updated On: March 18th, 2020] [Originally Added On: March 18th, 2020]
- Some of the last people on earth to hear about the coronavirus pandemic are going to be told on live TV - CNN [Last Updated On: March 18th, 2020] [Originally Added On: March 18th, 2020]
- Why the US is still struggling to test for the coronavirus - The Verge [Last Updated On: March 18th, 2020] [Originally Added On: March 18th, 2020]
- The Coronavirus Is Here to Stay, So What Happens Next? - The New York Times [Last Updated On: March 18th, 2020] [Originally Added On: March 18th, 2020]
- Coronavirus in the U.S. - The New York Times [Last Updated On: March 18th, 2020] [Originally Added On: March 18th, 2020]
- Watch the Footprint of Coronavirus Spread Across Countries - The New York Times [Last Updated On: March 18th, 2020] [Originally Added On: March 18th, 2020]
- Coronavirus Briefing: What Happened Today - The New York Times [Last Updated On: March 18th, 2020] [Originally Added On: March 18th, 2020]
- Why the Covid-19 coronavirus is worse than the flu, in one chart - Vox.com [Last Updated On: March 21st, 2020] [Originally Added On: March 21st, 2020]
- Fact-Checking 5 Trump Administration Claims On The Coronavirus Pandemic - NPR [Last Updated On: March 21st, 2020] [Originally Added On: March 21st, 2020]
- Trump has scoreboard obsession. It hasnt worked with coronavirus - POLITICO [Last Updated On: March 21st, 2020] [Originally Added On: March 21st, 2020]
- Here's What Is In The 'Families First' Coronavirus Aid Package Trump Approved - NPR [Last Updated On: March 21st, 2020] [Originally Added On: March 21st, 2020]
- Young Adults Come to Grips With Coronavirus Health Risks - The New York Times [Last Updated On: March 21st, 2020] [Originally Added On: March 21st, 2020]
- Which Country Has Flattened the Curve for the Coronavirus? - The New York Times [Last Updated On: March 21st, 2020] [Originally Added On: March 21st, 2020]