How does coronavirus kill? Clinicians trace a ferocious rampage through the body, from brain to toes
Science’s COVID-19 reporting is supported by the Pulitzer Center. On rounds in a 20-bed intensive care unit (ICU) one recent day, physician Joshua Denson assessed two patients with seizures, many with respiratory failure and others whose kidneys were on a dangerous downhill slide. Days earlier, his rounds had been interrupted as his team tried, and failed, to resuscitate a young woman whose heart had stopped. All shared one thing, says Denson, a pulmonary and critical care physician at the Tulane University School of Medicine. “They are all COVID positive.”
As the number of confirmed cases of COVID-19 surges past 2.2 million globally and deaths surpass 150,000, clinicians and pathologists are struggling to understand the damage wrought by the coronavirus as it tears through the body. They are realizing that although the lungs are ground zero, its reach can extend to many organs including the heart and blood vessels, kidneys, gut, and brain.
“[The disease] can attack almost anything in the body with devastating consequences,” says cardiologist Harlan Krumholz of Yale University and Yale-New Haven Hospital, who is leading multiple efforts to gather clinical data on COVID-19. “Its ferocity is breathtaking and humbling.”
Understanding the rampage could help the doctors on the front lines treat the fraction of infected people who become desperately and sometimes mysteriously ill. Does a dangerous, newly observed tendency to blood clotting transform some mild cases into life-threatening emergencies? Is an overzealous immune response behind the worst cases, suggesting treatment with immune-suppressing drugs could help? What explains the startlingly low blood oxygen that some physicians are reporting in patients who nonetheless are not gasping for breath? “Taking a systems approach may be beneficial as we start thinking about therapies,” says Nilam Mangalmurti, a pulmonary intensivist at the Hospital of the University of Pennsylvania (HUP).
The rest of the article: 10.1126/science.abc3208
For survivors of severe COVID-19, beating the virus is just the beginning
By Kelly Servick
The next few months will be full of grim updates about the spread of the new coronavirus, but they will also be full of homecomings. Patients hospitalized with severe COVID-19, some having spent weeks breathing with the help of a mechanical ventilator, will set about resuming their lives. Many will likely deal with lingering effects of the virus—and of the emergency treatments that allowed them to survive it.
“The issue we’re all going to be faced with the most in the coming months is how we’re going to help these people recover,” says Lauren Ferrante, a pulmonary and critical care physician at the Yale School of Medicine. Hospital practices that keep patients as lucid and mobile as possible, even in the throes of their illness, could improve their long-term odds. But many intensive care unit doctors say the pandemic’s strain on hospitals and the infectious nature of the virus are making it hard to stick to some of those practices.
While COVID-19 is sending even young, previously healthy people to the intensive care unit (ICU), older adults are at greatest risk of both severe disease and long-term impairment, says Sharon Inouye, a geriatrician at Harvard Medical School’s Hebrew SeniorLife health care system. “It’s taken us a long, long time to [develop] some best practices for geriatric care in the hospital and ICU, and I just see all of that being eroded during this crisis.”
