| Daily Briefing

It's not just lungs: Covid-19 may damage the heart, brain, and kidneys

It's widely known that the new coronavirus attacks patients' lungs, but clinicians and researchers around the world are reporting that the virus is damaging other organs, as well—a discovery that could have implications for the way doctors treat Covid-19, the disease caused by the virus, and for how patients recover.

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Cardiac injuries reported in almost half of critically ill Covid-19 patients

In addition to the widely reported lung injuries associated with Covid-19, clinicians around the world are reporting that the disease also could be causing cardiac injuries in patients that sometimes lead to cardiac arrest.

According to the Washington Post, health care workers in China and New York have reported seeing myocarditis, an inflammation of the heart muscle, as well as irregular heart rhythms in Covid-19 patients—even in patients with no pre-existing heart conditions.

At first, the patients "seem to be doing really well as far as respiratory status goes," said Mitchell Elkind, a neurologist at Columbia University and president-elect of the American Heart Association (AHA). But the patients "suddenly … develop a cardiac issue that seems out of proportion to their respiratory issues," Elkind said.

Elkind noted that one review found about 40% of seriously ill Covid-19 patients in China experienced arrhythmias and 20% experienced other cardiac injuries. "There is some concern that some of it may be due to direct influence of the virus," Elkind said.

A separate study of 416 hospitalized Covid-19 patients in China found that 19% showed signs of heart damage, and those patients were more likely to die. According to the study, 51% of patients with heart damage died, compared with 4.5% of patients who showed no signs of cardiac injury.

Doctors are trying to determine whether the damage to patients' heart muscles is caused by the new coronavirus, itself, or if the damage occurs as a result of other symptoms of Covid-19, such as pneumonia and inflammation, Kaiser Health News (KHN) reports.

"It's extremely important to answer [that] question," said Ulrich Jorde, head of heart failure, cardiac transplantation, and mechanical circulatory support for Montefiore Health System. "This may save many lives in the end."

Nervous system damage in Covid-19 patients leads to seizures, hallucinations

Doctors also are reporting a growing number of Covid-19 patients with symptoms of neurological damage, including brain inflammation, seizures, and hallucinations, the Wall Street Journal reports.

A group of Chinese doctors in a study published last week in JAMA Neurology found that more than one-third of 214 hospitalized Covid-19 patients in Wuhan had neurologic symptoms, the most common of which were dizziness, headaches, impaired consciousness, loss of taste and smell, and skeletal-muscle injuries. More serious but less commonly reported symptoms included seizures and stroke, according to the study.

The findings have prompted doctors to begin performing simple neurological exams on Covid-19 patients, the Journal reports.

Further, while health experts originally were telling patients to avoid seeking care at hospitals unless they had common Covid-19 symptoms such as a fever, cough, or trouble breathing, neurologists are hoping the new data will add neurological symptoms—such as confusion, numbness, or trouble speaking—to that list. "This article should open up everyone's eyes that this disorder affects the brain as well." said S. Andrew Josephson, chair of neurology at the University of California-San Francisco.

Kidney damage increasingly common in Covid-19 patients

Kidney damage also is becoming a commonly reported issue among Covid-19 patients.

Alan Kliger, a nephrologist at the Yale School of Medicine, said early data showed 14% to 30% of ICU Covid-19 patients in New York and Wuhan, China, lost kidney function and later required dialysis. Similarly, a study published last week in the journal Kidney International found that nine of 26 people who died of Covid-19 in Wuhan had acute kidney injuries, and seven had units of the new coronavirus in their kidneys.

The findings suggest it's "very possible that the virus attaches to the kidney cells and attacks them," Kliger said.

Blood clots found in majority of patients who died of Covid-19, Chinese study shows

The new coronavirus also appears to produce blood clots that can travel from patients' veins to their lungs, causing a pulmonary embolism, and other organs.

According to STAT News, Chinese researchers in one report said they found small blood clots in about 70% of the patients who died of Covid-19 and were included in the study. In comparison, the researchers found similar blood clots in fewer than one in 100 patients who survived the disease. In a separate peer-reviewed study of 81 patients in Wuhan that was published last week in the Journal of Thrombosis and Hemostasis, researchers wrote that 20 patients experienced pulmonary embolism and eight died from the condition.

Based on what they've seen so far, doctors said the blood clots in Covid-19 patients are smaller but cause more damage than blood clots typically seen in patients with other conditions, STAT News reports.

Sanjum Sethi, an interventional cardiologist and assistant professor of medicine at Columbia University's Irving Medical Center, said doctors have been using blood thinners to treat the clots in Covid-19 patients, hoping that relieving the clots will allow the patients' immune systems to focus on fighting off the coronavirus.

While Clyde Yancy, chief of cardiology at Northwestern University Feinberg School of Medicine, said it's too early to "declare anything definitively," he added, "[W]e know from the best available data that about one-third of patients who have Covid-19 infections do in fact have evidence of thrombotic disease."

Doctors said it is still unclear why the clots develop in Covid-19 patients, according to STAT News.

Reports have implications for treatment, recovery

While doctors' reports of different types of organ damage in Covid-19 patients are increasing, clinicians and researchers have yet to determine whether the new coronavirus is directly attacking those organs, or whether the injuries are caused by the patients' immune responses to the infection. Doctors said researchers also should investigate whether the organ damage and failure is being caused by medication, respiratory distress, fevers, the stress of hospitalization, and so-called "cytokine storms."

Regardless of the cause, the organ damage is threatening patients' lives. "It's not necessarily the virus killing people, it's the organ failure that happens as a result of the viral infection," said Christopher Barrett, a senior surgical resident at Beth Israel Deaconess Medical Center.

But results indicating that the virus is directly attacking patients' organs could impact the way doctors treat and evaluate Covid-19 patients, especially in the early stages of infection, KHN reports.

"This is a real-time learning experience," Yancy said (Bernstein et al., Washington Post, 4/15; Hawryluk, Kaiser Health News, 4/6; Hernandez, Wall Street Journal, 4/14; Cooney, STAT News, 4/16; Owermohle/Eisenberg, Politico, 4/15).






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