What complications can COVID-19 cause?
Anika H. Ahmed, MD
Although COVID-19 is a new disease appearing first in China in the winter of 2019, the pattern seen so far in patients across the globe is that the symptoms and complications depend mainly on the immune system of each individual. There is a wide range of symptoms that anyone infected with Coronavirus can exhibit, starting from dry cough and fever to breathlessness that may evolve into a full-blown acute respiratory distress syndrome. COVID-19 can give rise to serious complications because the SARS-CoV-2, RNA Coronavirus can attach to human cells in many parts of the body and easily penetrate several major organs of the body, mainly the lungs, heart, blood vessels and kidney. For the most part the symptoms are of the kind that can be managed at home with supportive care under the watchful eye of health workers. However, more serious complications are also seen, mostly in the elderly above the age of 65 years and those with chronic underlying medical conditions like Diabetes, heart disease and lung disease. Cytokine Release Syndrome, a condition seen in severe cases of COVID-19, is a Cytokine storm triggered by the immune system. A cytokine storm is an inflammatory reaction of the immune system each time it comes across an infection, such as SARS-CoV-2 in the case of COVID-19. The immune system floods the bloodstream with inflammatory proteins called Cytokines, which in turn attack the heart, lungs, and the kidneys. The attack can damage tissues and give rise to the following complications:
- Acute Respiratory Distress Syndrome (ARDS) – Seen clinically as difficulty in breathing, this is breathlessness to the extent of being unable to complete a sentence. Low oxygen saturation less than 90% (as shown by an oximeter) could lead to respiratory failure requiring intubation and artificial ventilation.
- Pneumonia – Breathlessness and severe cough could be due to filling of the pockets of lungs with inflammatory cells. The underlying pneumonia may be seen with X-rays and scans as light grey patchy markings on the lungs, or ground glass appearance, that may not heal due to damage to the lung tissue.
- Organ failure – Some cases of COVID-19 have died due to complications of heart and kidney failure. It is still not clear whether SARS-CoV-2 was the main cause, or the superimposed stress and cytokine inflammatory response, resulting in damage to the heart, kidney, and liver, that caused failure of these vital organs. Much research still needs to be done to have a clear answer. Some scientists believe that the Coronavirus itself can attach to tissues of heart, lungs, kidney, and liver, resulting in their failures and complications.
- Septic shock – Uncontrolled infection throughout the body can result in the spread of infection resulting in sepsis throughout the body with septic shock. The drop in blood pressure can be life-threatening and needs to be actively managed in the hospital.
- Disseminated Intravascular Coagulation – In some patients COVID-19 presents as a bleeding disorder. The normal blood-clotting mechanisms do not work properly, resulting in bruising, clotting disorders and fatal clots that can clog vessels, lungs and heart, resulting in the failure of vital organs. More severe Coronavirus infection may lead to overt disseminated intravascular coagulation, causing high mortality. It usually arises due to systemic inflammatory response to the virus with tissue damaged due to the infection. In such cases raised levels of D-dimers that are products of Fibrin (indicator of clot formation), low platelets and low fibrinogen are all complications that require intensive care in a hospital.
Most of the complications do require hospitalization. In order to avoid the fatal complications above, registration on a telehealth platform is strongly encouraged in order to have quick and easy access to a health professional for immediate care and timely management of potentially fatal complications arising from COVID-19.