DawgTalkers.net Forums DawgTalk Everything Else... Sicario: Covid-19

Get out the dumbells and clear the squat rack!...

My wife just told me that during the screening processes for the "OK'd on May 1st elective surgeries startup" they are finding a lot of Covid poz's.

Then she told me one of her 62yo female employees died from it.

Sad.

What's a covid poz?

Positive?

Are they finding 'active' covid? Or is it covid antibodies? Probably not the right way to term it - but, are the positives active cases, or cases where 'you had it, but didn't know it'?

We’ve had a big spike here in Erie County PA the last couple of days. Not sure the reason

Active. POZ-itive.

One of our very best friends is a Nurse and she came down with the virus.

Spent 3 weeks at home and is now back to work.

phew.

Where did this Judge get her Medical Education?

Judge Eugene Lucci is a male. No medical background.

Maybe he stayed at a Holiday Inn last night

I'll say the same thing I said in another thread. Is there this much fervor over closed gyms?

The virus has proven to be able to live for over a day on metal surfaces. People continuously share metal surfaces in gyms. If you think everything will get cleaned after every use in a gym, good luck to you. And then you have the really heavy breathing.

Gyms were scheduled to re-open on May 26th anyway. This judge was just looking looking for his 15 minutes in the spotlight.

It should be noted, the judge's ruling also came at the same time republicans in the Ohio House were pushing to pass an amendment to SB1 that would limit Dr. Acton's authority to issue health orders.

J/c

PA high school sports are set to resume upon the Governor’s word. It’s been a political struggle between the PIAA and the governor ... it’ll be interesting to see what transpires now.

https://www.theatlantic.com/health/archi...a-texas/611935/

CDC has been intentionally under reporting numbers.

There are many places I'd not hesitate to go but a gym is not one of them. In the best of times I dont want to lay in the sweat of somebody else.

j/c...

Dust off the bowling ball!...

Judge Eugene Lucci is a male. No medical background. [/quote

Oops.. Anyway, I have no problem with people having opinions on this, but at least, if you are in a position to change what's been made a rule, HE should at least have some medical training....

At my hospital all elective cases are required to have Covid-19 testing. We test for active asymptomatic infection (not antibodies that represent prior infection). We have uncovered multiple positives and those patients are rescheduled for 3-4 weeks later.

The reason? Most surgeries require anesthesia and intubation. Intubation is one of if not the most risky thing that can be done to a Covid + patient in regards to transmission.

Todays' news, The Ohio State Fair is cancelled.

Needless overreach, imo,

They even could have cancelled 85% of the things AT the Fair, and still had the fair, if they wanted to,

Just carte blanche cancel the whole thing, when a large part of a day at the fair is spent walking around outside,

Carte Blanche to cancel the whole thing IMO, is the easy way out.

Especially at a time when having it, even if only 15 out of 100 things there were active,

Having it, would have been a significant boost to morale

Ohioans have the opportunity to show grit, and perserverence, in the face of this virus calamity,
even if they only did 10% of the events,

and instead, the opportunity is taken away by Top Down, CYA, taking the easy way out, imo.

heh.. heh!..

I'm reminded suddenly of a scene from the movie with William Wallace and that guy from Lethal Weapon, on a horse, in front of Scotland, (Braveheart!)

He rides out, he says, "would you at least give me a chance to negotiate, before you tuck tail and run!"

Oh well, I'm sure that last comment will make me out to be the jackdonkey to others opinions.

While the rest of the US "opens up", Alabama is seeing healthcare collapse.


Link
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It does not make you a jackdonkey bro. It just means you disagree with me and some others. that makes you no better or worse than the rest of us. We are all family here bro

Sicario, 2015 film, (Spanish for hitman) is a 2015 action thriller,
Benetio Del Toro, Someone hard to remember, and Emily Blunt,

(R) for Violence, grisly images: ...


(I can't be the only one) I didn't know what Sicaro was, but felt, why not just title it Scarface, I'd instantly know that reference.

I find this sad, lonely, and somewhat like a freakshow fetish. Good Luck America. Let the good times roll.

My Soap General Hospital has no new episodes and won't have any until who knows when. They are no longer filming because of Covid.

Ok, now it's the apocalypse.

How long has that been on the air?


My Mother watched that and the Edge of Night. The Edge of Night is no longer in production.

Day's of our Lives, as well. Being sick as a kid was OK in the mornings. You had shows and gameshows to watch. Come 1PM, TV got pretty pitiful for a kid.

Second paragraph is dead on! School sounded pretty good at that point ofthe day!

I'm hearing that many of the soaps won't be returning. They are going to test daytime reality tv in their time slots during the summer. Big Brother AM might be your future.

j/c...

I can't wait to go bowling, I'll be there! I really want to go back to the movie theater too. Its about time!!!!!!

Make sure your healthcare premiums are paid and up to date.

Hadn't seen this posted yet. Something new? Related?


After 3 Children Die, a Race to Investigate a Baffling Virus Syndrome

At least 161 children in New York have gotten sick, making the state’s caseload one of the largest publicly reported anywhere.

David Vargas, 17, was hospitalized for nearly a week with multisystem inflammatory syndrome. “To be told your heart may be injured is an incredibly frightening thing,” he said.
David Vargas, 17, was hospitalized for nearly a week with multisystem inflammatory syndrome. “To be told your heart may be injured is an incredibly frightening thing,” he said.

Blood will be collected from dozens of children in New York to determine whether they share any genetic variations that might make them susceptible to a mysterious syndrome linked to the coronavirus.

Tissue samples from at least one of the three patients to have died from it — ages 5, 7 and 18 — have been sent to a public health laboratory for intensive testing.

A team of more than 30 disease detectives — epidemiologists, clinicians and statisticians — is poring over thousands of pages of medical records.

Even as doctors and scientists around the world race to develop treatments and vaccines for Covid-19, New York State has become the center of a parallel effort to investigate an unnerving aspect of the outbreak: an illness that is sickening a small but growing number of children.

The ailment has now been reported in at least 161 children in New York, making the state’s caseload one of the largest publicly reported anywhere. Hundreds of other children across the United States and in Europe have also been sickened with the illness, now called multisystem inflammatory syndrome.

The syndrome can be characterized by severe inflammation of the heart, blood vessels, the gastrointestinal tract or other organs, believed to be caused by a reaction to the coronavirus. The inquiries into why it is occurring, and whether a treatment can be found, could have an impact on how the authorities handle the reopening of schools and other activities for children.

Doctors in New York involved in the effort say that not since health officials began investigating the connection between Zika in pregnant women and microcephaly in 2015 and 2016 has there been such an urgent search to understand a mysterious threat to children.

“We’re looking at everything possible — therapies, diagnostics, clinical picture — and we’re trying to pull this all together,” said Dr. Howard A. Zucker, the state health commissioner.

He added: “It does keep you up at night. It’s the worry that is there something we’re going to figure out, in six months from now, and we’re going to say, ‘How did we not think about that possible therapy? How did we not figure out that this would have helped?’”

The rush to understand the syndrome has seemed to strike a chord with Dr. Zucker, who is trained in pediatric cardiology and has reviewed charts of patients with the illness.

He described in an interview the frustrations of doctors trying to treat one of the victims, who at the time was battling against a syndrome that did not have a name. The child was in shock; cardiac function had deteriorated, and with it, breathing.

Tubes were fed down the patient’s throat, and aggressive, life-sustaining measures — mechanical and pharmacological — were deployed, even as a battery of tests were run to try to determine the cause of the illness. The young patient did not survive.

“Everything was done for that child,” Dr. Zucker said. “Everything.”

During a hastily assembled discussion among several pediatricians in New York State that occurred over video conference last week, one doctor spoke of a surge of more than 40 cases at his hospital.

Another doctor spoke of troubling heart ailments in children afflicted with the illness. A third talked about treating a 14-year-old in the Bronx, who was admitted in good condition but then rapidly deteriorated.

“Twenty-four hours later, he was aggressively delirious and had to be restrained and sedated,” that doctor, H. Michael Ushay, recalled.

The illness was so baffling that Dr. Ushay, the medical director of the pediatric critical care division at Children’s Hospital at Montefiore, said he was not sure whether the child’s downturn was caused by the disease or a reaction to the medicine the boy was given at the hospital, which included steroids and ketamine.

The first cases of the new syndrome began to draw doctors’ attention in late April and early May, about a month after the height of the coronavirus outbreak in New York City.

Almost immediately, doctors noticed that in some patients the symptoms bore a striking overlap to a rare childhood illness called Kawasaki disease, which involves inflammation of the blood vessels and whose symptoms can range from redness of the eyes to damaged coronary arteries that can lead to heart attacks and aneurysms.

But with Kawasaki disease, a fraction of children end up in an intensive care unit or requiring life support. Yet a significant number of the patients with the new syndrome do.

The syndrome began to draw doctors’ attention in late April and early May, after the height of the coronavirus outbreak in New York City.
The syndrome began to draw doctors’ attention in late April and early May, after the height of the coronavirus outbreak in New York City.

Dr. Ellen Lee, an epidemiologist at New York City’s Department of Health, was reading through her medical discussion groups in late April, when she came across reports of a mysterious illness affecting children in England that seemed to be linked to the coronavirus. The symptoms included abdominal pain and an inflamed, weakened heart.

She asked her team to call hospitals to inquire if they were seeing anything similar. Some had not. Others had treated children with matching symptoms, but had not understood they were seeing something new. Within a day or two, Dr. Lee’s team had learned of nine cases.

“Those early days, it was just trying to get as much information from the providers, to understand what they were seeing, what was unusual,” Dr. Lee said.

Members of her team contacted the Centers for Disease Control and Prevention. They asked the New York City medical examiner’s office to see if any children had recently died who showed any of the symptoms. They checked with health departments in other major cities. Nobody seemed to know much.

But it would soon become very clear to Dr. Lee, the Health Department and city officials that this new syndrome was rapidly becoming a threat to children in New York.

Across the state, about 70 percent of patients with the syndrome have been cared for in intensive care units, according to Dr. Marcus Friedrich, a senior official at the state’s Department of Health. Some required medicine to raise their blood pressure, Dr. Friedrich said, and 19 percent were put on mechanical ventilators.

A few have required even more drastic intervention, including extracorporeal membrane oxygenation, in which blood is removed from the body and oxygenated by means of a membrane before being pumped back into the patient, doctors said.

Most patients with the new syndrome were previously healthy, without any underlying health problems, doctors said in interviews. And the surge and timing of the cases have led many doctors to conclude the illness is linked to the coronavirus.

Many, though not all, of the children ill with the syndrome tested positive for the coronavirus or for antibodies to it, which indicate a prior exposure. But often, based on interviews with the parents, doctors have concluded that the children had been exposed to the virus several weeks earlier.

“Is it the virus causing this, or the body’s response to the virus after a few weeks?” asked Dr. Edward Conway Jr., the chief of pediatric critical care at Jacobi Medical Center in the Bronx, saying that he suspected the latter.

The Coronavirus Outbreak
Frequently Asked Questions and Advice
Updated May 20, 2020

What are the symptoms of coronavirus?
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

How many people have lost their jobs due to coronavirus in the U.S.?
Over 38 million people have filed for unemployment since March. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.

How can I protect myself while flying?
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

Is ‘Covid toe’ a symptom of the disease?
There is an uptick in people reporting symptoms of chilblains, which are painful red or purple lesions that typically appear in the winter on fingers or toes. The lesions are emerging as yet another symptom of infection with the new coronavirus. Chilblains are caused by inflammation in small blood vessels in reaction to cold or damp conditions, but they are usually common in the coldest winter months. Federal health officials do not include toe lesions in the list of coronavirus symptoms, but some dermatologists are pushing for a change, saying so-called Covid toe should be sufficient grounds for testing.

Can I go to the park?
Yes, but make sure you keep six feet of distance between you and people who don’t live in your home. Even if you just hang out in a park, rather than go for a jog or a walk, getting some fresh air, and hopefully sunshine, is a good idea.

How do I take my temperature?
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.

Should I wear a mask?
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

What should I do if I feel sick?
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

How do I get tested?
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.

How can I help?
Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.

The time lag and the signs of inflammation have led many doctors to suspect the new syndrome is caused by “an aggressive, abnormal immune reaction to Covid exposure,” said Dr. George Ofori-Amanfo, chief of pediatric critical care for the Mount Sinai.

For now, doctors have been administering similar treatments as they would to children with Kawasaki disease. Patients often receive a combination of steroids; intravenous immunoglobulin, an antibody-rich serum made from donated blood, pooled together from thousands of people; and intravenous aspirin.

So far, many patients have responded well, four doctors said in interviews.

One Bronx teenager said he realized something was wrong when he was awoke one night with a sharp stinging sensation in the center of his chest. It happened again when he was eating Cheerios and watching YouTube.

“My arms also started to become numb,” the teenager, David Vargas, 17, recalled.

He was hospitalized for nearly a week at Mount Sinai Kravis Children’s Hospital in Manhattan. Testing indicated that he had been infected by the coronavirus, which then had damaged his heart, he said.

“To be told your heart may be injured is an incredibly frightening thing,” said David, who passed the time while hospitalized drawing portraits of doctors and nurses.

“This thing that was happening to me felt very mysterious,” he recalled. “But I realized I wasn’t the only one in the dark. The doctors didn’t really understand my condition and why it was happening.”

He was discharged last weekend with instructions to see a cardiologist for follow-up visits. He was also told to avoid exercise for at least six months — a disappointment to David, who plays outfield and third base for his high school baseball team, and basketball as well.

As more patients with the syndrome emerge, doctors say they have been struck by the variety of ways the new illness seems to manifest.

Recently doctors have begun describing a few cases in which patients had brain inflammation or other symptoms involving the central nervous system — a part of the body that did not seem a focal point of the syndrome initially.

At least one patient has had Guillain-Barré syndrome, which is marked by temporary paralysis, according to Dr. Michael Gewitz, of Maria Fareri Children’s Hospital in Westchester County.

One boy with the new syndrome who died — a 7-year-old — had a severe headache and grew increasingly unresponsive when doctors tried to rouse him, Dr. Gewitz said.

“The child who succumbed had overwhelming brain swelling,” he said.

At Cohen Children’s Medical Center on the border between Queens and Nassau County, which has treated more than 40 patients with the new syndrome — the highest number in the state — one doctor expressed some hope that the number of new patients with the syndrome was beginning to slow in recent days.

“We’re starting to see a flattening” of the number of cases, the doctor, James Schneider, said.

But Dr. Lee, of the city’s Health Department, said it was too soon to know if the number of cases was slowing or still surging.

https://www.nytimes.com/2020/05/22/nyregion/children-coronavirus-syndrome-new-york.html

Unusual Symptoms of Coronavirus: What We Know So Far

While most people are familiar with the hallmark symptoms of COVID-19 by now—cough, fever, muscle aches, headaches and difficulty breathing—a new crop of medical conditions are emerging from the more than 4 million confirmed cases of the disease around the world.

These include skin rashes, diarrhea, kidney abnormalities and potentially life-threatening blood clots. It’s not unusual for viruses to directly infect and affect different tissues and organs in the body, but it is a bit unusual for a primarily respiratory virus like SARS-CoV-2, which is responsible for COVID-19, to have such a wide-ranging reach in the body. “We see a number of other viruses affect so many different organs in the body,” says Dr. Kristin Englund, an infectious disease expert at the Cleveland Clinic. “But do we see influenza, or other respiratory viruses spread to so many different organs? Not usually.”

The reports of these non-respiratory effects started to build as doctors began treating more and more patients, and much of current scientific understanding of them is still in the early stages, and not confirmed with rigorous studies. But recognizing they exist could help health care professions spot them sooner, and possibly minimize their effects on patients’ health. Here’s a rundown of what the science says, so far, about these lesser-known effects of the disease.

Skin rashes and “COVID toes”

It’s not unusual to see skin rashes in someone with a viral infection, says Dr. Kanade Shinkai, professor of dermatology at University of California, San Francisco, and editor in chief of JAMA Dermatology—think chicken pox, or herpes. There can be two reasons for this: either the invading virus is directly targeting the skin, as is the case with chicken pox in which the virus sequesters in the telltale pustules on the skin, or the lesions are a byproduct of an aggressive immune system fighting mightily against an intruding microbe, like the rash that can form during Epstein Barr Virus or West Nile infections.

“What’s unclear about COVID-19 is whether the rashes associated with infection are specific to the virus, meaning there is actual virus in the skin, or if they are a manifestation of the immune system reacting to the virus that is elsewhere in the body,” Shinkai says.

So far, doctors have reported a range of skin-related conditions that might be connected to COVID-19, including head-to-toe red rashes, hive-like eruptions, blister-like bubbles and even lacy, purply rashes spreading across larger patches of skin. Recently, the lesions that have captured the most attention are red, tender bumps that appear around the toes and heels—dubbed “COVID toes.”

Shinkai says there aren’t enough data yet to determine whether any of these skin symptoms are related at all to COVID-19. Recently, more and more reports of skin rashes are coming to doctors’ attention (often through telehealth consultations), but given the limited amount of testing available in the U.S. to date, not all of these reports have been followed up with COVID-19 testing.

In an effort to address that, dermatologists around the world are starting to create registries of information on confirmed COVID-19 patients and their skin conditions. To begin to see if there is a link between the two, Shinkai says, doctors need to perform head-to-toe exams of every positive COVID-19 patient—“literally looking in between the toes”—to confirm any relevant skin findings. The next priority is looking at the medical histories of patients with rashes, including medications they might be taking that could contribute to their skin reactions. Finally, wherever possible, if the patients agree, doctors should be taking biopsies of skin lesions to test for the presence of SARS-CoV-2.

All of that could be useful in managing patients in coming months and even years, since the skin lesions might be an early sign of infection that doctors could use to guide decisions to advise people to isolate themselves and potentially lower their risk of spreading infection to others. The rashes may also help identify people who might be at higher risk of COVID-19 complications—the lacy purple rashes, for example, are also common among people who tend to develop blood clots, which can obstruct blood flow to the brain and other important organs. “These studies are needed to really help us understand if anything about the skin findings helps us predict who will become ill, and who might experience severe illness,” says Shinkai. “These are critical questions that might allow us to triage people better when they are coming in with infection or even consider different ways to support them through their infection.”

Gut and Intestines

When gut experts learned about how the SARS-CoV-2 virus latches on to the body’s cells to launch infection, they realized COVID-19 symptoms wouldn’t be limited to the lungs.

In order to bind to a cell, the virus uses a receptor called ACE2 which is found on lung cells, but also abundant in intestinal cells. “We were all thinking the same thing,” says Dr. Brennan Spiegel, director of health services research at Cedars-Sinai Medical Center and professor of medicine and public health there and at University of California, Los Angeles. “We knew ACE2 is expressed so heavily in the gastrointestinal (GI) tract and we know the virus is in the saliva. So this thing could be getting into the GI system because it’s in saliva, and we swallow saliva.”

As more people have developed COVID-19, it’s become clear that not all of those infected display the classic respiratory symptoms that doctors focused on early in the pandemic; many people only experience diarrhea, nausea and vomiting. An influential New England Journal of Medicine paper describing COVID-19 symptoms, published in February, said that only 3.8% of patients had diarrhea. “A lot of doctors took that to mean that if someone had diarrhea, then they probably don’t have COVID-19,” says Spiegel, who is also co-editor-in-chief of the American Journal of Gastroenterology. “That has been proven wrong, or inconsistent. But that set the stage for our understanding that well, maybe [COVID-19] isn’t really a GI issue at all.”

In a paper published in Nature Medicine on May 13, researchers in Hong Kong reported that SARS-CoV-2 can infect both bat and human intestinal cells in the lab. The scientists created organoids, or clusters of intestinal cells meant to roughly mimic the intestine, and then exposed them to the virus in a lab dish. SARS-CoV-2 could churn out additional copies of itself in both the bat and human organoid environments.

Not only does it seem like COVID-19 can impact the GI system, evidence suggests that when it does, it can have an especially damaging effect on patients. In a study published in the American Journal of Gastroenterology, Spiegel worked with colleagues in Wuhan, China, where the virus first emerged in humans, and found that people with intestinal complaints tend to be diagnosed later, and also tend to endure longer infections. Most likely, that’s because the GI system is a “massive immune organ,” he says. “Once you are infected, it takes a long time to clear the virus out. We found that on average people have diarrhea for five days, with a range from one to 14 days.”

Appreciating that COVID-19 can affect the gut as well as the respiratory system is critical, especially when it comes to controlling spread of infection. Studies have shown that this virus can be shed in the feces, which means that shared bathrooms can be a source of infection. Spiegel advises people who are diagnosed with COVID-19 and still at home to use separate bathrooms from the rest of their house- or apartment-mates if possible, and if not, then separate rolls of toilet paper. He also suggests that everyone in these situations close the toilet lid before flushing to prevent aerosolizing any virus in the waste water, as well as completely cleaning the seat and washing hands after every visit. “And if it’s me and I’m living with someone who is positive, I am wearing a mask for sure in the bathroom,” he says.

In most cases, the harsh acids in the stomach would normally kill microbes that enter the gut via saliva. Spiegel and his team have hypothesized that heartburn medications, which are meant to neutralize the highly acidic environment of the stomach to protect its lining, may be creating fertile ground for SARS-CoV-2 to travel freely into the gut system. They’re currently conducting a study to determine if those who use these drugs might be a higher risk of developing gut-related COVID-19 symptoms.

Kidney

The gut isn’t the only open target for the virus; kidney cells also carry the ACE2 receptor. In some studies, doctors have reported finding SARS-CoV-2 in the urine of infected people, although extensive studies of kidney tissues so far aren’t conclusive. “Some studies have found virus in the urine, and some studies did not. Some autopsies have found virus in the kidney, and some did not,” says Dr. Kenar Jhaveri, associate chief of nephrology at Northwell Health, a large, non-profit health care provider in the New York area. It’s also not clear yet what finding virus actually means when it comes to infection. “Just because there is virus sitting there in a certain organ doesn’t mean it’s pathologic. We don’t know if there is cause and effect,” he says

As more patients started to come to the hospital with COVID-19 in early 2020, Jhaveri and his colleagues began seeing a spike in cases of acute kidney injury among COVID-19 patients, and launched a study to better understand what, if any, relationship the virus had to the kidneys. “While we were in the trenches, we were all of a sudden getting almost triple the amount of consultations than we normally get at this time of year,” he says. “That was unusual and we wanted to quantify it.”

He studied the electronic health records of more than 5,000 people hospitalized for COVID-19 in the Northwell Health system (which has hospitals throughout New York), and reported the findings in the journal Kidney International. He found that 36.6% of admitted COVID-19 patients developed acute kidney injury, and of those 1,830 patients, 14% required dialysis to compensate for their failing kidney function. (These were all patients who had not had kidney transplants or did not have pre-existing end stage kidney disease.) Kidney injury correlated with worsening respiratory symptoms; nearly 90% of those needing ventilators developed kidney problems compared to around 22% of those who did not need mechanical ventilation.

Given the data so far, Jhaveri says it’s possible that the SARS-CoV-2 virus could be affecting the kidneys in one or both of two ways—first by directly infecting kidney cells, using the ACE2 receptor, and/or by triggering an aggressive inflammatory response in the body. “The cytokine storm [of the immune system] affects the blood vessels—they start leaking fluid, and blood flow is decreased to different organs,” he says. “There are tubules in the kidney that are part of the excretion component of the kidneys and they do not like when there is less blood flow. When that happens, they develop ischemic damage. They aren’t able to maintain oxygenation and they kidney gets injured.”

Other early studies of hospitalized COVID-19 patients show similar percentages of people with kidney complications—around 30% to 40%. What’s more concerning, says Dr. C. John Sperati, associate professor of medicine in the division of nephrology at Johns Hopkins University School of Medicine, is the possibility that in some people with COVID-19, the virus may be causing structural damage to the kidneys well before they experience any symptoms. “Give it time, and seven or 10 days after symptoms start developing, 30% of them may develop decreased kidney function,” says Sperati. But among hospitalized patients, for example, doctors are finding microscopic amounts of blood, as well as hints of proteins, in the urine, both of which are signs of cellular injury to the kidneys even if the patients don’t complain of any symptoms.

That means that, among people infected with the virus who aren’t hospitalized, there may be a significant percentage who are at risk of kidney injury but may not be treated until the damage is severe enough to need dialysis. The problem there is that if you aren’t diagnosed with COVID-19 until you get to that extreme point, you are much more likely to have a severe or even deadly outcome; among COVID-19 patients who develop acute kidney injury, says Sperati, the mortality rate is significantly higher among those who need dialysis.

Testing for blood and protein in the urine could indicate which people might be at higher risk of developing kidney-related problems with their COVID-19 infection, and that could steer doctors away from certain medications that could further burden the kidneys.

Longer term, Sperati is concerned about the possible medical legacy COVID-19 might have on the kidneys. Protein and blood in the urine signal cellular injury, which, combined with COVID-19 could put people at higher risk of compromised kidney function later in life, even if they don’t immediately experience kidney problems related to their COVID-19 infection.

Liver

The liver, too, is full of cells that harbor the ACE2 receptor, and lab studies using cells in petri dishes show that SARS-CoV-2 can enter and infect these cells using the receptor. Further, over half of people hospitalized for COVID-19 seem to have elevated or lower-than-normal levels of liver enzymes, which could signal that the virus has invaded the organ. Combined, those two facts make it reasonable to question whether the virus can infect and injure the liver. Fortunately, however, current data suggest that COVID-19 infection doesn’t lead to dramatic liver failure, says Dr. Raymond Chung, director of hepatology and the liver center at Massachusetts General Hospital.

That could mean that the virus’ effect on the liver is less due to direct infection and more likely caused by the heightened inflammatory response that affects a number of different organs as the disease progresses. “We see liver tests worsen when the patients get sicker and other organs, like the lungs and heart, are affected,” says Chung. “In many ways it may be a barometer for what’s going on systemically. The liver may be responding to the stress of the [immune reaction].”

Blood Clots and Stroke

One of the more urgent risks arising from the growing database of COVID-19 cases has to do with blood clots, including those that can lead to stroke. Even before COVID-19, doctors had been studying how certain viruses (like influenza) and bacteria can contribute to higher risk of stroke. However, some experts believe SARS-CoV-2 could be uniquely damaging to the circulatory system. “It remains possible that there is a specific aspect to this virus that leads to a particular increase in the risk of blood clotting,” says Dr. Michael Elkind, professor of neurology and epidemiology at Columbia University and president-elect of the American Heart Association.

As with lung, kidney, liver and intestinal cells, blood-vessel cells also carry the ACE2 receptor, which means the virus could be directly infecting the cells that line the vessels and, therefore, contributing to clot formations. “We have autopsy studies looking at the effect of COVID-19 throughout the body, and we see evidence of small blood clots in different organs throughout the body,” says Elkind. “That supports the idea that COVID-19 causes a tendency for the blood to clot. Usually, when we see blood clots, we may see them in one location such as the leg, or lung. But in these cases we are seeing them throughout many organs in the body, suggesting that this is a systemic process going on.”

Armed with that knowledge, doctors are currently debating whether all patients admitted to the hospital with COVID-19 should be given blood thinners to reduce the risk of clotting. “It’s a controversial issue right now. We’re talking here about higher doses of blood thinner to prevent arterial as well as venous blood clots,” Elkind says. Some early studies suggest that COVID-19 patients treated with blood thinners while hospitalized experienced fewer complications and left the hospitals sooner than those who were not. That doesn’t establish that blood thinners are responsible for the improvement, but indicates they may be worth exploring in more rigorous studies.

Such studies are underway, both in animals and in the lab, as well as with available autopsy tissue from infected patients. Some researchers are also beginning to collect biopsies from COVID-19 patients while they are hospitalized, although these are challenging given restrictions on performing any procedures on COVID-19 patients during which the virus could spread to health care workers or others in the hospital. At Columbia University, scientists are building a biobank of tissue, including from the heart, that have been taken from COVID-19 patients and could begin to reveal how SARS-CoV-2 is affecting various organs, and what consequences that has for health outcomes.

Smell and Taste

Another group of intriguing reports from people affected by COVID-19 has to do with their loss of smell and taste. Most of us are familiar with the way congestion from a cold or allergies can impact these senses; doctors are now investigating whether losing smell and/or taste could be a sign of a SARS-CoV-2 infection.

On March 26, the American Academy of Otolaryngology-Head and Neck Surgery launched a survey on its website to collect more information about the prevalence of these symptoms from doctors and patients. The Academy is the professional organization for ear, nose and throat specialists but the survey was open to any health care provider or patient. As of publication, about 900 people have responded to 16 questions about smell and taste effects; about a quarter reported losing those senses themselves (in the case of patients) or seeing patients lose those senses (in the case of providers). More studies will be needed to understand if these losses of sense are permanent, says Dr. James Denneny, executive vice president for the Academy and clinical professor at the University of Missouri. So far, researchers are finding that SARS-CoV-2 particles are heavily concentrated in the area where the nose, throat and mouth meet. The damage may be caused by the inflammatory reaction that causes tissues to swell and compress and compromise the nerves, or because of more direct viral infection—only more detailed autopsy studies can provide information to clarify that question. “I expect that as the pandemic winds down, there will be opportunities to look at pathologic specimens that may give us more clarity in looking at nerve endings,” says Denneny.

The success of those studies will also depend, to some extent, on the data that have been and are currently being collected from patients—including blood and tissue samples that could provide valuable genetic information, among other things, about how the virus affected their various body systems. Early on in the pandemic, doctors didn’t know to look for wide-ranging symptoms, and even if they did, there hasn’t been a useful repository for depositing and sharing that data in a way that would help doctors to pick out trends and study patterns. “From the study standpoint, we at this point in time should be gathering a lot of data, such as radiological data [from X-rays and CT scans], and doing a lot of blood tests on patients,” says Englund. “We need to reach across different hospital systems so we are able to get a much more nationwide database—that would be wonderful to look at more symptoms. Widespread testing will also help us to understand those patients who had different symptoms that we didn’t recognize as being related to COVID-19. We’re just at the beginning of understanding this disease.”

https://time.com/5837591/unusual-symptoms-of-coronavirus/

This doesn't even mention the strange rash thing it's doing to kids.