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In serious cases, SARS-CoV-2 lands in the lungs and can do deep damage there. But the virus, or the body’s response to it, can injure many other organs. Scientists are just beginning to probe the scope and nature of that harm.
8256734WindpipeBile ductBronchiiImmune cellsCapillaryBlood vesselEndothelial cellACE2SARS-CoV-2SARS-CoV-2ClotMucus12 LiverUp to half of hospitalized patients have enzyme levels that signal a struggling liver. An immune system in overdrive and drugs given to fight the virus may be causing the damage.7 NoseSome patients lose their sense of smell. Scientists speculate that the virus may move up the nose’s nerve endings and damage cells.6 EyesConjunctivitis, inflammation of the membrane that lines the front of the eye and inner eyelid, is more common in the sickest patients.3 KidneysKidney damage is common in severe cases and makes death more likely. The virus may attack the kidneys directly, or kidney failure may be part of whole-body events like plummeting blood pressure.4 IntestinesPatient reports and biopsy data suggest the virus can infect the lower gastrointestinal tract, which is rich in ACE2 receptors. Some 20% or more of patients have diarrhea.1 LungsA cross section shows immune cells crowding an inflamed alveolus, whose walls break down during attack by the virus, diminishing oxygen uptake. Patients cough, fevers rise, and it takes more and more effort to breathe.8 Heart and blood vesselsThe virus (green) enters cells, likely including those lining blood vessels, by binding to ACE2 receptors on the cell surface. Infection can also promote blood clots, heart attacks, and cardiac inflammation.5 BrainSome COVID-19 patients have strokes, seizures, mental confusion, and brain inflammation. Doctors are trying to understand which are directly caused by the virus.
V. ALTOUNIAN/SCIENCE
Some clinicians suspect the driving force in many gravely ill patients’ downhill trajectories is a disastrous overreaction of the immune system known as a “cytokine storm,” which other viral infections are known to trigger. Cytokines are chemical signaling molecules that guide a healthy immune response; but in a cytokine storm, levels of certain cytokines soar far beyond what’s needed, and immune cells start to attack healthy tissues. Blood vessels leak, blood pressure drops, clots form, and catastrophic organ failure can ensue.
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