COVID-19 Is So Much More Than a Respiratory Disease
Cough. Fever. Shortness of breath. Headaches. Skin rashes. Liver and kidney damage. Gastrointestinal distress. Blood clots. Loss of taste and smell. With all of these ailments observed among coronavirus patients, the real question seems to be: What isn’t a symptom of COVID-19?
“We see a number of other viruses affect so many different organs in the body,” Dr. Kristin Englund, an infectious disease expert at the Cleveland Clinic, told TIME senior health writer Alice Park. “But do we see influenza, or other respiratory viruses, spread to so many different organs? Not usually.”
With the usual caveat that doctors and others are still learning about COVID-19, there are some clues about how it produces such a wide array of symptoms. When SARS-CoV-2 (the virus that causes COVID-19) binds to a cell, it uses a receptor called ACE2. Lung cells have lots of ACE2 receptors, but they’re also found throughout the body—including in the gastrointestinal tract, kidneys, liver and blood vessels. One possibility, Park reports, is that SARS-CoV-2 is invading cells throughout the body, causing issues from head to toe.
But many of these symptoms could also be side effects triggered by the immune system. The body mounts an aggressive inflammatory response while fighting off a virus like SARS-CoV-2. Some very sick patients experience what’s called a “cytokine storm” — as the immune system goes into overdrive, it attacks the body’s own tissues as well as the virus. It’s possible that these aggressive immune responses are leading to damage in many of the body’s organs, Park reports.
“The first symptoms of fever, cough and respiratory problems really were just the first pass. It’s becoming clear that the virus might have more wide-ranging effects on the body,” Park says. “It’s too early to know exactly what that means, but documenting the lesser-known symptoms could be important in helping more people recover.”
Nearly 4.9 million people around the world had been sickened by COVID-19 as of 8 PM eastern time last night, and more than 323,000 people had died.
Here is every country with over 50,000 confirmed cases:
A new cluster of COVID-19 cases in China has experts worried that the virus may have mutated, which could make the pandemic more difficult to control. Compared to earlier coronavirus patients, these newly sick individuals appear to take longer to develop symptoms and clear the virus from their systems.
Meanwhile, many countries are struggling to safely reopen while the coronavirus continues circulating. In Iran, which eased coronavirus restrictions in late April, case numbers are surging in eight provinces. And educators in South Korea, which allowed students back in schools today, sent some students home after they tested positive for the virus.
As Brazil’s coronavirus case count skyrockets, U.S. President Donald Trump is considering a travel ban that would limit Brazilians’ ability to enter the U.S. “I don’t want people coming in here and infecting our people,” Trump said ahead of a cabinet meeting.
Health workers around the world are also concerned for their safety, as fear, skepticism and unrest related to the pandemic lead to violence. The Indian Medical Association, for example, last month called on the country’s government to intervene after a number of attacks on health care workers.
The Situation in the U.S.
The total number of COVID-19 diagnoses in the U.S. rose to more than 1,528,000 as of 8 PM eastern time yesterday, and the death toll neared 92,000.
President Trump yesterday called the U.S.’ 1.5 million cases of COVID-19—the most of any country in the world—a “badge of honor,” arguing that they show the extent of the country’s testing capacity. “It’s a great tribute to the testing and all of the work that a lot of professionals have done,” Trump said. But despite Trump’s repeated boasts about testing in the U.S., many health experts say the country’s daily testing capabilities lag below the level required to get the outbreak under control.
The Centers for Disease Control and Prevention (CDC) published a 60-page document today offering guidelines for safely reopening businesses, schools and more amid the pandemic. The agency’s guidelines closely match a slightly longer draft version that the Associated Press published earlier this month; the AP reported that the original CDC document was shelved by the Trump Administration in favor of less-restrictive guidance.
Trump yesterday defended his decision to take the anti-malarial drug hydroxychloroquine to prevent COVID-19 infection, saying “so far I seem to be OK.” Trump has repeatedly expressed interest in hydroxychloroquine as a potential COVID-19 treatment, despite scientific evidence to the contrary.
The University of Notre Dame yesterday announced that it plans to welcome students back to campus in the fall, with an extensive testing and social-distancing plan to help prevent a virus outbreak. U.S. colleges have come up with a patchwork of responses to the crisis, with a small number committing to online-only classes in the fall and others trying out a mix of online and face-to-face classes. Meanwhile, some high schools are raising eyebrows by pressing forward with traditional, in-person graduation ceremonies this spring.
Houses of worship are also grappling with their coronavirus-era realities. In some churches preparing to reopen, traditions like drinking from a shared cup of wine or accepting a Communion wafer will be tweaked or eliminated to minimize potential viral spread.
The U.S. government has indefinitely extended an order that allows Customs and Border Protection agents to quickly expel migrants stopped along the border. Despite criticism from human-rights advocates, the Trump Administration has defended the policy as necessary for limiting coronavirus spread among people in U.S. custody.
The number of babies born in the U.S. dropped again last year, according to federal data published yesterday. And despite some speculation that COVID-19 lockdowns could lead to a baby boom, experts expect the pandemic to continue driving birth rates down.
All numbers are from the Johns Hopkins University Center for Systems Science and Engineering, and are accurate as of May 19, 8 PM eastern time. To see larger, interactive versions of these maps and charts,click here.
WHAT ELSE YOU SHOULD KNOW
The U.S. Coronavirus Crisis Is a Failure of Democracy
So argues former Obama Administration speechwriter David Litt, who argues that elected officials are ignoring what the American people want when it comes to coronavirus containment. Read more here.
Giving a Face to an ‘Invisible Enemy’
Electron microscopist Elizabeth Fischer has helped the public visualize some of the world’s deadliest pathogens, including Ebola, HIV—and, now, COVID-19. Read more here.
America’s Patchwork Coronavirus Pandemic
As the U.S.’ coronavirus epidemic continues, its patchwork nature—both in terms of where the virus is spreading, and how states are responding—will make it harder to control, writes The Atlantic’s Ed Yong. Read more here.
Check Our Coronavirus FAQ
Using the best information available, we’ve answered some of your most common coronavirus questions. Read the FAQ here.
Let Yourself Have a Bad Day
SELF health editor Patia Braithwaite has a suggestion: Let yourself have a bad day sometimes. “Any emotions you’re feeling right now—positive, negative, or in between—are normal and don’t necessarily need to be ‘fixed,’” she writes. Read more here.
Thanks for reading. We hope you find the Coronavirus Brief newsletter to be a helpful tool to navigate this very complex situation, and welcome feedback at coronavirus.brief@time.com.
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Today’s newsletter was written by Jamie Ducharme and edited by Alex Fitzpatrick.
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