This is a well written article.
We Thought It Was Just a Respiratory Virus. We were wrong.
By Ariel Bleicher and Katherine Conrad
https://www.ucsf.edu/magazine/covid-body
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Most likely, though, you won’t feel sick at all. When UCSF researchers tested people for SARS-CoV-2 in San Francisco’s Mission District, 53% of those infected never had any symptoms. “That’s much higher than expected,” says Monica Gandhi, MD, MPH, a UCSF professor of medicine with expertise in HIV. Surveys of outbreaks in nursing homes and prisons show similar or even higher numbers. “If we did a mass testing campaign on 300 million Americans right now, I think the rate of asymptomatic infection would be somewhere between 50% and 80% of cases,” Gandhi says. Millions of people may be spreading the virus without knowing it, she points out, making asymptomatic transmission the Achilles’ heel of efforts to control the pandemic – and highlighting the importance of universal masking.
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It stands to reason that SARS-CoV-2 affects the heart. After all, heart cells are flush with ACE2 receptors, the virus’s vital port of entry. And, indeed, laboratory experiments suggest that the virus can enter and replicate in cultured human heart cells, says Bruce Conklin, MD, a professor of medicine and an expert in heart-disease genetics at UCSF and the Gladstone Institutes.
But Conklin doesn’t think SARS-CoV-2 necessarily kills heart cells outright. Rather, in the process of copying itself, the virus steals pieces of the genetic instructions that tell the heart cells how to do their job. “It’s hauling away and hijacking stuff that’s necessary for the heart to beat,” he says.
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Especially disconcerting, Kattah says, is how long the virus seems to persist in the gut. About 50% of patients with COVID-19 have virus particles in their stools, often for weeks after their nose swabs test negative, he points out. Laboratory studies show that these particles are often still alive and can infect cells in a petri dish. Whether fecal transmission occurs between people, however, is an open question.
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Other specialists are also raising flags. Neurologists worry about reports of COVID-19 patients with headaches, “brain fog,” loss of the sense of smell, dizziness, delirium, and, in rare cases, stroke. Nephrologists worry about kidney stress and failure. Hepatologists worry about liver injuries. Ophthalmologists worry about pink eye. Pediatricians, meanwhile, worry about a peculiar COVID-related inflammatory syndrome that’s showing up in kids and young adults.
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In caring for COVID-19 patients on dialysis machines, she’s been surprised to see blood clots block dialysis tubes more than usual. Clotted tubes are common, she says, “but this is extreme.” That may be because, as growing evidence suggests, SARS-CoV-2 can infect cells in the walls of blood vessels that help regulate blood flow and coagulation, or clotting. If true, this behavior could explain some of the virus’s weirder (and rarer) manifestations, such as heart attacks, strokes, and even “COVID toes.” “Our vasculature is a contiguous system,” says cardiologist Parikh. “Thus injury in one area, such as blood vessels in the lungs, can set off clotting cascades that affect multiple organs.
