Is COVID-19 actually a disease of the blood vessels? New research could help explain odd symptoms from strokes to purple toes – The Flamborough Review

When people first started to get sick, the focus was on those organs, he said. But that started to shift as health workers saw first thousands and now millions of patients with COVID-19, including many whose symptoms didnt fit the typical profile of a respiratory disease.

Patients were showing up with blood clots, strokes, brain swelling and, on the more mild end of the spectrum, toe pain.

The authors approached their study like a crime scene investigation, trying to figure out why all these strange symptoms were happening, Li said.

And looking at these tissues, what we found was that the respiratory virus had not only infected the lung, but the virus had also made a beeline for the cells lining blood vessels, he said.

When those endothelial cells are damaged by the virus, it makes the blood more likely to clot, he said.

The studys authors saw from close-up pictures that the virus had moved from the air sacs of the lungs, infecting directly into the blood vessel cells.

The cells were being destroyed from the inside out, unlike when someone has high cholesterol and theyre damaged from the outside. There was emergency blood vessel growth as they divided to get more blood flow, which can lead to clots. The immune system trying to clear the virus can also cause inflammation and clotting.

So this is sort of three strikes that we saw in our study to help explain this clotting, Li said.

The damage was found in vast areas of the lungs at the same time, he added, and not just a few pockets.

Thats not something that we normally see with respiratory virus, and it seems to be unique to COVID-19.

His study also looked at the lungs of people who had died from H1N1, and found they had nine times fewer blood clots in the lungs.

An April paper in The Lancet also showed damage to endothelial cells in several areas of the body including the lungs, heart, kidneys, liver and intestines of COVID-19 patients.

Isaac Bogoch, an infectious diseases specialist at the University of Toronto and University Health Network, said he hasnt seen any COVID toes yet but has seen some vascular symptoms such as blood clots, in patients at Toronto General. Its not uncommon for diseases to have an inflammatory component, he said.

Cat-scratch disease, a bacterial infection caused by cats who turn on their owners, is one example.

But its important to remember that most people dont get a blood clot, he said, adding that within hospitals doctors are still seeing blood clots in some individuals but certainly not most individuals.

Lis research might help explain, though, why older people and those with conditions like diabetes or heart disease tend to have worse outcomes. Their blood vessels are already more vulnerable.

And it does open some new doors of thinking about treatments, Li said.

Blood thinners could be one example. There are also ongoing clinical trials looking at dilating the blood vessels with nitric oxide, and stem cell treatments to regenerate the cells. Its also important to remember that maintaining a nutritious diet can help keep blood vessels healthy, he added.

A New England Journal of Medicine paper from early May looked at outcomes of 8,910 patients across Asia, North America and Europe. It found that the use of either ACE inhibitors (medications that dilate blood vessels) or statins (drugs that help lower cholesterol) was associated with better survival. But the study could not prove a cause-and-effect relationship as it was not a randomized, controlled trial.

Researchers still dont know why COVID-19 is so much worse for some seemingly healthy people than for others, at what point the blood vessel damage starts to occur, and why blood vessels are affected in some parts of the body but not others.

The unknowns of this disease still far outnumber the knowns, so it will take time to construct the full picture of how the SARS- COV2 virus actually causes COVID-19, Li said. But blood clotting could help explain COVID toes, as well as more serious symptoms like strokes.

Multisystem inflammatory syndrome, which has been diagnosed in a small number of kids and teens who test positive for COVID-19 or antibodies that suggest they had it, may also be connected to blood vessel damage, he added.

Luckily, Jake didnt experience any severe issues, but he did have an on-and-off fever. Hes the only one in his family who had the COVID toes. His dad, Jeff, said he had the heavy, heavy chest and didnt feel like he had a full set of lungs but was lucky it didnt get more serious. His younger sister Ella had a low-grade fever for several days, but his mom and two other siblings didnt notice anything out of the ordinary.

They were told by doctors, who diagnosed Jakes toes through virtual visits, to assume they all had it, said Jeff. And their family shows the wide range of effects the disease can have on different people.

Weve got four kids, so we have a larger sample size, he said with a laugh. Weve shared air amongst us and 50 per cent had issues and 50 per cent didnt.

The Reymer family was initially told not to go for testing and just to keep self-isolating. By the time Jake and his father did get tested weeks later, when it opened up to people with more unusual symptoms, they were both negative, possibly because the virus had already cleared from their systems. The province is now urging anyone with even one mild symptom, including loss of taste and smell, and COVID toes, to get a test, as well as asymptomatic people who work in front-line jobs or think they may have been exposed.

Jake is now back to playing basketball and walking around the neighbourhood. Hes feeling good and his toes seem to be improving. But theyre still purple.

They havent shown any real signs of resolving, he said.

Im 100 per cent, its just my toes still arent normal.

May Warren is a Toronto-based breaking news reporter for the Star. Follow her on Twitter: @maywarren11

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Is COVID-19 actually a disease of the blood vessels? New research could help explain odd symptoms from strokes to purple toes - The Flamborough Review