All systemic effects of COVID-19

All systemic effects of COVID-19

All systemic effects of Covid-19

After only a few days of care for critically sick Covid 19 patients at the beginning of the outbreak in New York City, Dr. Aakriti Gupa that this was much more than a respiratory disease.

"From the beginning of the front ..."

"I was at the forefront from the start. I observed that the blood of the patient was often over, they had a high blood sugar, even if they had no diabetes and many had an impairment of their hearts and kidneys," says Guppa, one of the first Columbia cardiologists who were used for the Covid intensive care units at the Irving Medical Center at Columbia University.

At the beginning of March there were not many clinical guidelines on the non-respiratory effects of COVID-19, hence Guppa decided to connect the results of studies that just appeared in the literature to connect with the results of the doctors.

GUPTA organized together with the senior author Donald Landry, MD, PhD, Chair of Medicine at the Vagelos College of Physicians and Surgeons of Columbia University, senior co-authors, and Gupta together with two other colleagues, Mahesh Madhavan, MD, a cardiologist at Cuimc and Dr. Kartik Sehgal, a scholarship holder for hematology / oncology at Beth Israel Deaconess Medical Center / Harvard Medical School, mobilized, among other things, clinicians in Columbia, Harvard, Yale and Mount Sinai Hospital to check the latest findings. 19 Effect on organ systems outside the lungs and offer clinical instructions for doctors.

Your overview-the first comprehensive overview of the effects of Covid-19 on all affected organs outside the lungs-was published in Nature Medicine today.

"Doctors have to imagine Covid-19 as a multi-system disease," says Guppa. "There is a lot of news about the clotting, but it is also important to understand that a significant part of these patients suffer from kidney, heart and brain damage and doctors have to treat these diseases together with the respiratory disease."

blood clot, inflammation and immune system at overdrive

"In the first weeks of pandemic there were many thrombotic complications, more than we had expected due to the experience with other viral diseases," says Sehgal, "and they can have profound consequences for the patient."

Scientists believe that these coagulation complications are due to the virus attack on cells that line the blood vessels. When the virus attacks blood vessel cells, the inflammation increases and blood begins to form large and small clot. These blood clots can spread all over the body and destroy the organs and maintain a vicious circle of platelets.

In order to combat the clotting and its harmful effects, clinicists in Columbia, of whom many co-authors of this review are, carry out a randomized clinical study to examine the optimal dose and the optimal time of anticoagulation medication in critically ill patients with covid-19

The unadorned inflammation can also overestimulate the immune system, and although doctors initially shy away from the use of steroids for global oppression of the immune system, a recently carried out clinical study showed that at least one steroid, dexamethasone, which reduced deaths in ventilated patients by a third. Randomized clinical studies are underway to examine certain components of the thrombboinflammation and immune system such as interleukin-6 signal transmission.

"Scientists around the world work at the game to understand how this virus specifically abuses the normally protective biological mechanisms. We hope that this will contribute to the development of more effective, precise and safe treatments for COVID-19 in the near future," says Sehgal.

directly into the heart

clot can cause heart attacks, but the virus attacks the heart in another way, says one author.

"The mechanism of heart damage is currently unclear because the virus in autopal cases has not often been isolated from the heart tissue," says Guppa.

The heart muscle can be damaged by systemic inflammation and the associated cytokin release, a flood of immune cells that usually enlightens infected cells, but can get out of control in severe covid 19 cases.

Despite the extent of heart damage, the doctors were unable to use the diagnostic and therapeutic strategies, including heart biopsies and cardiac catheter examinations, which they would normally apply in the early stages of pandemic, since personnel and patients have to be protected from the transfer of viruses. This has changed because the disease prevalence in New York City has dropped.

kidney failure

Another surprising finding was the high proportion of COVID 19 patients in the intensive care unit with acute kidney damage.

The ACE2 receptor used by the virus to penetrate the cells is in high concentrations in the kidney and could probably be responsible for kidney damage. Studies in China reported kidney complications, but in New York City, doctors saw kidney failure in the intensive care unit.

"About 5 to 10% of patients needed dialysis. This is a very high number," says Guppa.

Currently there is no data on long -term kidney damage, but a significant part of the patients will probably still need permanent dialysis.

"Future studies after patients in whom complications of Covid-19 have occurred during the hospital stay will be of crucial importance," Madhavan notes.

neurological effects

neurological symptoms such as headache, dizziness, fatigue and loss of smell can occur in about a third of the patients.

In addition, strokes occur by blood clots in up to 6% of severe cases and delirium in 8 to 9% of cases.

"Covid 19 patients can be intubated for two to three weeks. A quarter needs ventilation devices for 30 or more days," says Guppa.

"These are very long intubations, and the patients need a lot of sedation. The" delirium in the intensive care unit "was a known disease before Covid, and the hallucinations may be less an impact of the virus than an effect of the extended sedation. “

"This virus is unusual and it is difficult to take a step back and not be impressed by how many manifestations it has on the human body," says Madhavan.

"Despite the training as a sub -specialist, our task is to keep an eye on all organ systems if we take care of the patients. We hope that our reviews, observations and recommendations can help other clinics if the cases are currently increasing."