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Inflammation Is Emerging As A New Coronavirus Symptom

Some experts say COVID-19-related rashes, heart attacks and strokes are all related.

For months now, we’ve been hearing about the same symptoms of the novel coronavirus: high fever, chest pain, trouble breathing.

But new symptoms presenting themselves in patients all over the world are highlighting how little we know about the virus, according to a Canadian doctor.

Inflammation-related symptoms

Doctors in the U.K. have reported a surprising amount of inflammation occurring in children who have contracted COVID-19, describing a sometimes fatal illness that appears to be a form of toxic shock syndrome.

Dr. Dina Kulik, a pediatrician with a practice in Toronto, said she hasn’t seen this personally in any of her patients. But she’s been reading about how these symptoms show up in people of all ages who contracted coronavirus, whether or not they showed symptoms.

“We’re finding out that many people with COVID are having an inflammatory-type response,” she told HuffPost Canada. It’s thought to have to do with one of the layers of our blood vessels, called the endothelium. Inflammation of the endothelium, or endotheliitis, can cause blood clots.

“That can cause many symptoms,” Kulik said. “Anything that would present in an inflammatory way. Some people are presenting with strokes, some people are presenting with heart attacks, some people are presenting with weird rashes, typically on the extremities on the feet.”

While “COVID toes” have so far mostly been reported in kids, this kind of inflammation has been seen in people of all ages who contracted COVID-19, Kulik explained.

Patients in their 30s and 40s with the virus have been dying of strokes, which usually affect people much older. Strokes occur when blood is prevented from getting to the brain, which can happen when clots get lodged in blood vessels.

COVID-19 may be primarily a blood vessel disease

That this kind of inflammation is only starting to be understood now proves just how little we know about COVID-19, Kulik said.

Other doctors agree. Hooman Poor, a pulmonologist and critical care specialist at Mount Sinai Hospital in New York City, noticed high levels of a protein in patients that he believed indicated that they were trying to fight off blood clots. He started giving patients a drug that breaks clots, typically used to treat people with strokes. His patients all stabilized after receiving the drug, although most died a few weeks later.

“It did bring to light the possibility that blood clots are playing a bigger role in this disorder than we previously appreciated,” he told WebMD.

And a research letter in The Lancet found that three people who died of COVID-19 all had the virus within endothelial cells all over their body.

“It did bring to light the possibility that blood clots are playing a bigger role in this disorder than we previously appreciated.”

One of the study’s authors told WebMD that he believes that damage to the blood vessels is the primary role of COVID-19, and that all the complications it causes — including what it does to the lungs and respiratory tract — are a byproduct of that blood vessel damage.

“This is actually a disease of the endothelium,” Mandeep Mehra told the outlet.

‘It certainly behaves differently than a typical pneumonia’

None of that information has been confirmed yet, because the virus is just too new. But Kulik said one thing we do know for sure is that the coronavirus is quite different from the lung diseases we do know about.

“It certainly behaves differently than a typical pneumonia would,” she said.

Pneumonia can cause low oxygen levels, as the coronavirus can. But with pneumonia, or influenza, or even SARS, people with low oxygen levels have trouble breathing in a specific way, Kulik said. “They’re breathing really quickly, they’re breathing in and out in a difficult way, gasping,” she explained.

“But patients with COVID that have low oxygen levels don’t seem to be behaving that way. They’re behaving more akin to something like altitude sickness, where they might have low oxygen levels, but they have fewer respiratory symptoms and more symptoms like dizziness or headache or decreased level of consciousness.”

We don’t yet know why that is, which is part of why we don’t yet know how to treat it, she said.

“Maybe this is systemic inflammation rather than local pneumonia that’s causing the difficulty with breathing,” she suggested. “So we really have to be thinking of COVID as a very unique, novel virus.”

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