This respiratory disease is typically characterized with the following: fever, cough, malaise, tiredness, dry cough, pneumonia, dyspnea, runny nose, nasal congestion, sore throat, diarrhea, and muscle aches.
Above are depictions of how the Coronavirus affects the lungs, also presenting a normal lung versus an infected lung.
Image Credits: **NOTE: Pictures have been modified using PowerPoint*** Picture on the left from Newsweek, https://www.newsweek.com/ct-scans-coronavirus-lungs-covid-19-sufferers-1491997. Pictures on the right from Business Insider, https://www.businessinsider.com/china-coronavirus-diagnosis-ct-scans-lungs-2020-2#an-analysis-of-nearly-140-coronavirus-scans-suggests-that-patches-of-ground-glass-on-both-lungs-are-a-hallmark-of-the-virus-3.
Image Credit: https://ccphohio.org/covid-19/
Source: Elemental Medium, https://elemental.medium.com/every-covid-19-symptom-we-know-about-right-now-from-head-to-toe-bd1d47584096
However, the impact of COVID-19 on each individual is different given that it heavily depends on the individual's pre-existing health problems and age.
According to the CDC, below are a list of general COVID-19 symptoms patients have had so far (*NOTE: This list is not exhaustive):
Fever or chills
Dry cough
Runny nose
Shortness of breath or difficulty breathing
Fatigue
Muscle or body aches
Headache
New loss of taste or smell
Sore throat
Congestion or runny nose
Nausea or vomiting
Diarrhea
According to the CDC, these are some possible EMERGENCY symptoms for COVID-19 patients (*NOTE: This list is not exhaustive)
Trouble breathing
Persistent pain or pressure in the chest
New confusion
Inability to wake or stay awake
Bluish lips or face
Source for all information in this block: CDC (Center for Disease Control), https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html
Source: Elemental Medium, https://elemental.medium.com/every-covid-19-symptom-we-know-about-right-now-from-head-to-toe-bd1d47584096
The novel Coronavirus causes cells in many key organs and organ systems can get massively inflamed and damaged. Though patients initially appear to be recovering from the virus, major inflammation and damage leads to (1) a sudden body break-down due to an overactive, erratic immune system, and (2) deadly blood clots.
After initial entry, the invading Coronavirus will trigger non-severe body symptoms, eliciting protective immune responses. an individual's health status and HLA haplotype determines their immune system's ability to eliminate the invading virus. If an individual's health status and HLA haplotype is not able to eliminate the virus, immune responses become highly inflammatory and damaging (especially in the lungs) and symptoms become uncontrollable. An article in Nature titled "COVID-19 infection: the perspectives on immune responses," suggests that "at this stage, inhibition of hyaluronan synthase and elimination of hyaluronan can be prescribed. Cytokine activated mesenchymal stem cells can be used to block inflammation and promote tissue reparation. Vitamin B3 can be given to patients starting to have lung CT image abnormalities."
Sources:
Elemental Medium, https://elemental.medium.com/every-covid-19-symptom-we-know-about-right-now-from-head-to-toe-bd1d47584096
Nature. "COVID-19 infection: the perspectives on immune responses," https://www.nature.com/articles/s41418-020-0530-3
Image Credit: Nature, https://www.nature.com/articles/s41418-020-0530-3/figures/1
Image Credit: The New England Journal of Medicine, https://www.nejm.org/doi/full/10.1056/nejm200009073431006
Source for all of above information: Neuroscience News, https://neurosciencenews.com/coronavirus-genetics-immune-system-16199/
SARS-CoV-2 primarily targets the lungs, which have many ACE-2 receptors. The virus can easily enter lung cells and reproduce. An increase in viral load will trigger massive immune responses. Lung cells will get damaged and patients will need hospitalization in severe cases. COVID-19, being a respiratory disease, can cause many lung complications like pneumonia, acute respiratory distress syndrome (ARDS), and sepsis. More on COVID-19 and lung damage here and here.
Sources for all of above information:
Elemental Medium, https://elemental.medium.com/every-covid-19-symptom-we-know-about-right-now-from-head-to-toe-bd1d47584096
John's Hopkins Medicine, https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/what-coronavirus-does-to-the-lungs
Image Credit: *NOTE: Image has been modified with PowerPoint* LEFT image = https://ardsglobal.org/5th-international-ards-conference-berlin-germany/ and RIGHT image = https://radiopaedia.org/cases/normal-chest-x-ray
As mentioned above, SARS-CoV-2 primarily targets the lungs, and in severe cases leading to various respiratory complications. The virus initially invades alveolar epithelial cells lining the lungs, triggering immune responses, which can sometimes become erratic when the body is not easily able to attack the pathogen. An erratic/haywire immune system will stimulate a cytokine storm by triggering the rapid release of cytokines - inflammatory proteins secreted by immune system cells that are involved in proper immunoregulation and cell signaling. Cytokine storms will lead to systemic inflammatory responses throughout the lung tissue, increased fluidity, and cell death. An overload of white blood cells will begin to attack healthy cells due to the hyperactive immune system. In severe cases, lung tissue inflammation can cause acute respiratory distress syndrome (ARDS), septic shock, metabolic acidosis, coagulation dysfunction, and multiple organ dysfunction syndromes throughout the body. Hyperinflammation in different tissues throughout the body (not necessarily in the respiratory system) will cause leaky blood vessels (proteins and fluid begin to leak out of blood vessels), low blood pressure, and lack of blood oxygen. Many other things not specified here can happen as a result of a cytokine storm - each person's immune system will impact their body differently.
Source for all of above information:
Elemental Medium, https://elemental.medium.com/every-covid-19-symptom-we-know-about-right-now-from-head-to-toe-bd1d47584096
Frontiers in Public Health, https://www.frontiersin.org/articles/10.3389/fpubh.2020.00189/full
Image Credit: The Wall Street Journal, https://www.wsj.com/articles/haywire-immune-response-eyed-in-coronavirus-deaths-treatment-11586430001
Purple specks above are cytokines
Image Credit:
Howard Hughes Medical Institute (hhmi), https://www.hhmi.org/news/preventing-cytokine-storm-may-ease-severe-covid-19-symptoms
Original image from scientificanimations.com / Wikimedia Commons
Image Credit: New Scientist, https://www.newscientist.com/term/cytokine-storm/
Some COVID-19 patients will develop silent hypoxia, a condition where patient oxygen saturation levels (blood oxygen levels) will fall way below normal but the patient will not demonstrate any respiratory distress or if at all, they will demonstrate mild respiratory issues like slight shortness of breath or tiredness. Scientists have termed this condition 'silent hypoxia' because though pulmonary gas exchange is inefficient, severely low oxygen levels do not immediately manifest themselves in the patient. The patient, however, often comes to the hospital with atypical Coronavirus symptoms like high fever, cough, cold, fatigue, and muscle aches.
According to the article titled "COVID-19 patients with respiratory failure: what can we learn from aviation medicine?" in the Elsevier Public Health Emergency Collection, Carbon Dioxide (CO2) diffuses through tissues 20 times faster than oxygen (O2) in patients with silent hypoxia, which most likely accounts for their disproportional pulmonary gas exchange. Carbon Dioxide levels in COVID-19 patients have been reported to range from 1.4-2.0 kPa according to the same study. Normal blood-oxygen levels are around 97%. COVID-19 patients with silent hypoxia reach levels below 90%, which is worrisome.
Silent hypoxia is often connected to aviation medicine because decompression to thin air at high altitudes causes silent hypoxia. In COVID-19 patients, sudden respiratory failure will occur due to the accumulation of fluid or pus in the alveoli of the lungs. A lack of oxygen could lead to severe organ damage throughout the body. It will especially affect the brain, leading to confusion and mental disruptions.
Scientists have coined in the term 'COVID Pneumonia' to describe the silent hypoxia condition. According to an article in the Center for Infectious Disease Research and Policy, approximately 12 patients who died from COVID-19 in Hamburg, Germany, had water-filled lungs weighing more than four pounds, when the average lung weight is under two pounds.
Sources for all of above information:
Elemental Medium, https://elemental.medium.com/every-covid-19-symptom-we-know-about-right-now-from-head-to-toe-bd1d47584096
Center for Infectious Disease Research and Policy, https://www.cidrap.umn.edu/news-perspective/2020/05/autopsies-covid-19-patients-reveal-clotting-concerns
LiveScience, https://www.livescience.com/silent-hypoxia-killing-covid-19-coronavirus-patients.html
NCBI PMC, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7165289/
According to emergency department physician Richard Levitan, there is a possible way to prevent severe complications caused by silent hypoxia by using a PULSE OXIMETER. Click on the picture below to learn more.
"Silent Hypoxia Typically Not the First Symptom of COVID-19, Other Early Symptoms Should Be Monitored" from the American Lung Association
"'Silent hypoxia' may be killing COVID-19 patients. But there's hope" from LiveScience
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COVID-19 has been shown to infect blood and damage blood vessels, further leading to both venous and arterial thromboembolism (venous - blood clots in a vein and arterial - blood clots in an artery) and microvascular injury. According to this study in Thrombosis Research, 31% of COVID-19 patients with Covid pneumonia out of a total of 184 studied in ICU had blood clots, most likely due to excessive inflammation, hypoxia, immobilisation, and diffuse intravascular coagulation (rephrase these 3 things in own words). Blood clots, which are clumps of cells and proteins that intend to stop excessive bleeding in the body, can become very severe and as a result will prevent sufficient blood flow to the brain, causing a stroke. According to a prospective cohort study in the Annals of Internal Medicine, 7 out of the first 12 patients (58%) who died of COVID-19 in Hamburg, Germany had undiagnosed deep venous thrombosis. The prospective cohort study suggests that COVID-19 induced coagulation methods could be used to impair blood clotting. Another review in Nature states that blood thinners do not reliably preventing clotting in COVID-19 patients.
Doctors are seeing very high amounts of D-dimer protein fragments in the blood of those with COVID-19-associated blood clotting. They are finding the presence of major clots and smaller clots that can damage the heart, lungs, kidneys, and other organs. Pneumonia is not the only thing damaging tiny air sacs in the lungs. Rather, it is severe blood clotting.
However, the COVID-19 jel-like blood clots are unlike the clotting that other hemorrhagic fevers like Ebola, Dengue, and Lassa induce yet they are equally dangerous, sharing the same phenomenon.
Sources for all of above information:
Elemental Medium, https://elemental.medium.com/every-covid-19-symptom-we-know-about-right-now-from-head-to-toe-bd1d47584096
Center for Infectious Disease Research and Policy, https://www.cidrap.umn.edu/news-perspective/2020/05/autopsies-covid-19-patients-reveal-clotting-concerns
Annals of Internal Medicine. "Autopsy Findings and Venous Thromboembolism in Patients With COVID-19," https://www.acpjournals.org/doi/10.7326/M20-2003
Nature. "Coronavirus blood-clot mystery intensifies," https://www.nature.com/articles/d41586-020-01403-8
Thrombosis Research. "Incidence of thrombotic complications in critically ill ICU patients with COVID-19," https://www.thrombosisresearch.com/article/S0049-3848(20)30120-1/fulltext
Image Credit: Cleveland Clinic, https://health.clevelandclinic.org/should-you-be-worried-about-blood-clots-with-covid-19/
A. Diffuse alveolar damage with hyaline membranes (case 4) (hematoxylin–eosin [H&E] stain; original magnification,×50). B. Hyaline membranes (case 4) (cytokeratin AE1/AE3 stain, original magnification×50). C. Squamous metaplasia in the lung (case 5) (H&E stain; original magnification,×100). D. Pulmonary embolism (case 1) (H&E stain; original magnification,×100).
(COPIED AND PASTED FROM STUDY CITED BELOW)
Image Credit: Annals of Internal Medicine, https://www.acpjournals.org/doi/10.7326/M20-2003
The multisystem inflammatory syndrome in some COVID-19 diagnosed children (MIS-C) was observed first by clinicians in the United Kingdom (UK) on April 26th, 2020. Previously healthy children with this syndrome present symptoms of an unrelated Kawasaki disease - an acute febrile illness that causes inflammation in the walls of some blood vessels and is one of the leading causes of pediatric heart disease. Children affected with the multisystem inflammatory syndrome can present persistent fever, swelling of the hands and feet, irritation and redness of the whites of the eyes, swollen lymph glands in the neck, irritation and inflammation of the mouth, lips, and throat, hypotension, multiorgan (e.g., cardiac, gastrointestinal, renal, hematologic, dermatologic and neurologic) involvement, elevated inflammatory markers, rash, cracked lips, and bloodshot eyes. However, every child does not have evident respiratory symptoms. It is still unknown whether this syndrome occurs in adults.
There was a severe outbreak of the Kawasaki-like disease in the Bergamo Italian province in _____ as observed by an observational cohort study in the Lancet.
Sources for all of above information:
Elemental Medium, https://elemental.medium.com/every-covid-19-symptom-we-know-about-right-now-from-head-to-toe-bd1d47584096
CDC (Center for Disease Control and Prevention), https://emergency.cdc.gov/han/2020/han00432.asp
CDC (Center for Disease Control and Prevention), https://www.cdc.gov/kawasaki/index.html
Lancet. "An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study," https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31103-X/fulltext
Image Credit: WebMD, https://www.webmd.com/lung/news/20200515/trending-clinical-topic-kawasaki-disease-and-covid-19
The loss of smell is called anosmia, and occurs with congested nose and nasal passages or disrupted olfactory nerves in the nasal cavity. COVID-19 causes anosmia. It is still not clear as to why COVID-19 triggers anosmia, but it is known that the ACE2 receptor exists in the olfactory epithelium - an epithelial tissue inside the nasal cavity involved in smell. Anosmia can be permanent in some patients, unlike the mucus that clogs the nose after a cold or flu.
Sources for all of above information:
Elemental Medium, https://elemental.medium.com/every-covid-19-symptom-we-know-about-right-now-from-head-to-toe-bd1d47584096
Yale School of Medicine, https://medicine.yale.edu/news-article/23640/
Image Credit: Medium, https://medium.com/@shinjieyong/smell-loss-a-neuroprotective-mechanism-against-covid-19-e3da791e9ae3
In addition to fevers and headaches, COVID-19 causes brain swelling and confusion. According to a study by the Radiology Society of North America, it is specifically associated with Acute Hemorrhagic Necrotizing Encephalopathy (ANE), a rare encephalopathy associated with other viral infections like influenza that causes altered mental status and seizures. COVID-19-associated Acute Hemorrhagic Necrotizing Encephalopathy is also associated with major structural changes in the brain as described by the same study. An MRI brain scan of one patient with COVID-19-associated Acute Hemorrhagic Necrotizing Encephalopathy demonstrated hemorrhagic rim enhancing lesions within the bilateral thalami, medial temporal lobes, and subinsular regions. Patients with severe COVID-19 cases, are very likely to have intracranial cytokine storms and thus a cytokine storm syndrome (over-reactive immune system). Both children and adults are vulnerable to ANE.
Another study in the JAMA Neurology Network states that out of 214 COVID-19 patients, 36.4% of patients had neurological symptoms. These patients had central nervous system manifestations like dizziness, headache, impaired consciousness, acute cerebrovascular disease, ataxia, and seizures, peripheral nervous system manifestations like taste impairment, smell impairment, vision impairment, and nerve pain, and muscle injury. More details in the article.
Sources for all of above information:
Elemental Medium, https://elemental.medium.com/every-covid-19-symptom-we-know-about-right-now-from-head-to-toe-bd1d47584096
Radiology Society of North America, https://pubs.rsna.org/doi/10.1148/radiol.2020201187
JAMA Neurology Network, https://jamanetwork.com/journals/jamaneurology/fullarticle/2764549
A, Image from noncontrast head CT demonstrates symmetric hypoattenuation within the bilateral medial thalami (arrows). B, Axial CT venogram demonstrates patency of the cerebral venous vasculature, including the internal cerebral veins (arrows). C, Coronal reformat of aCT angiogram demonstrates normal appearance of the basilar artery and proximal posterior cerebral arteries.
(CAPTION ABOVE COPIED AND PASTED)
Image and Caption Credit: Radiology Society of North America, https://pubs.rsna.org/doi/10.1148/radiol.2020201187
MRI images demonstrate T2 FLAIR hyperintensity within the bilateral medial temporal lobes and thalami (A, B, E, F) with evidence of hemorrhage indicated by hypointense signal intensity on susceptibility-weighted images (C, G) and rim enhancement on postcontrast images (D, H).
(CAPTION ABOVE COPIED AND PASTED)
Image and Caption Credit: Radiology Society of North America, https://pubs.rsna.org/doi/10.1148/radiol.2020201187
MRI images demonstrate T2 FLAIR hyperintensity within the bilateral medial temporal lobes and thalami (A, B, E, F) with evidence of hemorrhage indicated by hypointense signal intensity on susceptibility-weighted images (C, G) and rim enhancement on postcontrast images (D, H).
(CAPTION ABOVE COPIED AND PASTED)
Image and Caption Credit: Radiology Society of North America, https://pubs.rsna.org/doi/10.1148/radiol.2020201187
A, Image from noncontrast head CT demonstrates symmetric hypoattenuation within the bilateral medial thalami (arrows). B, Axial CT venogram demonstrates patency of the cerebral venous vasculature, including the internal cerebral veins (arrows). C, Coronal reformat of aCT angiogram demonstrates normal appearance of the basilar artery and proximal posterior cerebral arteries.
(CAPTION ABOVE COPIED AND PASTED)
Image and Caption Credit: Radiology Society of North America, https://pubs.rsna.org/doi/10.1148/radiol.2020201187
Ischemia of the fingers and toes is caused by a reduction of blood flow to the fingers and toes. Red or purplish lesions begin appearing on fingers and toes due to the lack of blood flow. This painful condition can lead to tissue death. "Covid toes" are appearing more in younger individuals, who sometimes do not exhibit any other symptoms. This study published in the Lancet hypothesizes that the COVID-19-associated ischemia is due to endothelial cell infection by SARS-CoV-2 and thus inflammation and dysfunction. In fact, the ACE-2 receptor is widely expressed on endothelial cells. SARS-CoV-2 can infect engineered human blood vessel organoids in vitro. Their findings demonstrated the presence of many viral elements in endothelial cells and accumulation of inflammatory cells, suggesting that SARS-CoV-2 induces endothelitis in several organs.
Doctors state that COVID-19-associated ischemia resembles Raynaud's disease - a disorder that causes the blood vessels, typically in the fingers and toes, to narrow, further inhibiting blood flow to the affected areas.
Sources for all of above information:
Elemental Medium, https://elemental.medium.com/every-covid-19-symptom-we-know-about-right-now-from-head-to-toe-bd1d47584096
Lancet. "Endothelial cell infection and endotheliitis in COVID-19," https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)30937-5.pdf
PodiatryToday. "Could COVID Toes Be An Emerging Acro-Ischemia Symptom Of The COVID-19 Virus?" https://www.podiatrytoday.com/blogged/could-covid-toes-be-emerging-acro-ischemia-symptom-covid-19-virus
Image Credit: Harvard Health Publishing, https://www.health.harvard.edu/a_to_z/raynauds-phenomenon-a-to-z