Coronavirus may not just be a respiratory disease but could also be a blood vessel disease, doctors have suggested, which could help explain why COVID-19 patients have experienced heart attacks, blood clots, and other ranging symptoms – and may also suggest that the disease is currently being treated the wrong way.
COVID-19, the official name for the disease caused by the new coronavirus, has been commonly described as a respiratory disease – one that primarily affects the lungs, and kills in a similar way to pneumonia.
But as doctors became more familiar with the disease, many noticed that COVID-19 patients suffered damage to a worrying range of vital organs across the body including the heart, brain and kidney.
Now, doctors say that the evidence is growing that coronavirus is also a vascular infection – one that can infect blood vessels – which would explain the range of symptoms it causes.
“All these Covid-associated complications were a mystery. We see blood clotting, we see kidney damage, we see inflammation of the heart, we see stroke, we see encephalitis [swelling of the brain],” said Dr. William Li, speaking to Medium’s Elemental+.
“A whole myriad of seemingly unconnected phenomena that you do not normally see with SARS or H1N1 or, frankly, most infectious diseases,” added Dr. Li, who is the president of the Angiogenesis Foundation, a nonprofit organization that studies how to fight disease through the process of developing new blood vessels.
Dr. Mandeep Mehra, medical director of the Brigham and Women’s Hospital Heart and Vascular Center, told Medium that these symptoms suggest that the virus is probably a “vasculotropic virus, meaning that it affects the [blood vessels].”
“The concept that’s emerging is that this is not a respiratory illness alone, this is a respiratory illness to start with, but it is actually a vascular illness that kills people through its involvement of the vasculature,” Dr. Mehra told Medium.
No harm of RAAS inhibitors in COVID - Potential benefit with ACE Inhibitors and Statins? Do these hypothesis generating findings once again point to the Vascular Disease in COVID-19?— Mandeep R. Mehra, MD (@MRMehraMD) May 1, 2020
Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19 | NEJM https://t.co/hxE701qvd5
Implications: ventilators not enough
If COVID-19 is a vascular infection, it could explain why people with pre-existing conditions including diabetes, high blood pressure, and heart disease are at greater risk from a virus that is supposedly meant to target the lungs and respiratory system.
The re-classification of coronavirus could change the way the scientific community approaches the disease, and may help drive new forms of treatment.
Healthcare workers have focused on providing ventilators to patients to ensure they can breathe while their lungs are infected, leading to respirators becoming a prized commodity at the heart of a global competition.
But understanding the disease as infecting blood cells could help explain why ventilators have often not been enough to ensure patients can breathe – ultimately key to their survival.
Dr. Li recently co-authored a study that found widespread evidence of blood clots in the lungs of COVID-19 patients. These blood vessels are essential to providing the rest of the body with oxygen, and would not be affected by a respirator.
“If you have blood clots within the blood vessels that are required for complete oxygen exchange, even if you’re moving air in and out of the airways, [if] the circulation is blocked, the full benefits of mechanical ventilatory support are somewhat thwarted,” explained Dr. Li to Medium.
Why is Covid-19 so different from other viruses? How can you protect yourself from the virus? What is needed to defeat Covid-19? I dive into all of this on my podcast episode with The Health Hub "Covid-19 - What We Know. What We Need To Know." https://t.co/2lE5xIp1L0 pic.twitter.com/QuHoe3jaGB— William Li (@drwilliamli) May 15, 2020
Implications: statins, ACE blockers could work as treatment
Vascular diseases can also be treated in different ways to respiratory diseases.
A recent study titled “Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19,” authored by a range of doctors including Dr. Mehra and Dr. Desai Sapan, found that statins and ACE inhibitors – treatments for blood vessel diseases – were associated with a better survival rate.
“Most of their benefit in the continuum of cardiovascular illness — be it high blood pressure, be it stroke, be it heart attack, be it arrhythmia, be it heart failure — in any situation the mechanism by which they protect the cardiovascular system starts with their ability to stabilize the endothelial cells,” Dr. Mehra told Medium.
Dr. Mehra's conclusions could influence the wider debate over how best to treat the coronavirus. She recently led a study that found that the anti-malarial drug hydroxychloroquine provided no benefits and may even cause harm to the heart, despite being widely touted by US President Donald Trump.
Instead, he argues that identifying COVID-19 as a blood vessel disease could open up the pathway to a better focus on more effective, alternative treatments.
“The best therapy might actually be a drug that stabilizes the vascular endothelial. We’re building a drastically different concept,” she said.
Data on 8910 patients hospitalized with a diagnosis of #COVID19 were analyzed. Neither the use of angiotensin-converting–enzyme inhibitors nor the use of angiotensin-receptor blockers was associated with an increased risk of in-hospital death.— NEJM (@NEJM) May 1, 2020
Despite Mehra’s optimism, the study she co-authored noted that, “these associations should be considered with extreme caution. Because our study was not a randomized, controlled trial, we cannot exclude the possibility of confounding.”
Scientists have also put forward other explanations to explain COVID-19’s irregular behavior that do not see it as a vascular disease.
The main alternative theory suggests that COVID-19 causes damage to organs and blood clotting indirectly, by provoking the body’s immune system into an over-reaction known as inflammation.
Other respiratory illnesses including pneumonia can provoke similar responses, explaining why doctors were not surprised when they first noticed COVID-19 patients with other symptoms.
Researchers have also tied COVID-19 to a specific inflammatory disease in children.
In April, doctors reported that children in the UK had died from a rare inflammatory syndrome which researchers believe to be linked to COVID-19.
On May 14, the US Centers for Disease Control and Prevention said that the multisystem inflammatory syndrome in children (MIS-C) was associated with coronavirus.
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