The AIIMS experts were discussing the various extra-pulmonary complications that could be caused by COVID-19 during the weekly ‘National Clinical Grand Rounds’.
Coronavirus impact: Coronavirus-induced COVID-19 is capable of affecting almost all of the organs besides the lungs, AIIMS experts have said. According to a report by news agency PTI, the initial symptoms of COVID-19 might be completely unrelated to chest complaints. The experts also emphasised that the current method of deciding the severity of cases based on just the respiratory symptoms should be revisited and expanded to include the involvement of other organs as well.
The AIIMS experts were discussing the various extra-pulmonary complications that could be caused by COVID-19 during the weekly ‘National Clinical Grand Rounds’, which is held in collaboration with the NITI Aayog. The panel of experts included AIIMS Director Dr Randeep Guleria, Neurology head of department Dr MV Padma Srivastava, Cardiology professor Dr Ambuj Roy and department of Medicine associate professor Dr Neeraj Nischal.
During the session, Dr Guleria said that a lot has now been learnt about COVID-19, since the world is eight months into the pandemic, and these insights lead to frequent changes in the strategies adopted to deal with the infection. He added that it was initially thought of as a viral pneumonia, but it has now been found that the infection has manifestations that go beyond the lungs, the report stated.
He further stated that the virus enters into a cell using ACE2 receptors. These are present abundantly in the lungs as well as upper airways, but they are also present in several other organs, which means that these organs are also impacted. He said they had seen a lot of patients who came with features that were extrapulmonary manifestations. He stated that while pulmonary manifestations were dominant in most of the COVID-19 cases, there were still a significant number of patients who presented extrapulmonary manifestations, which might or might not have been alongside pulmonary issues.
He added that clinicians should “have a high index of suspicion” in present times regarding when to suspect, treat as well as isolate such patients so that they can be provided with good quality care.
Experts, during the discussion, highlighted several cases where patients, based on respiratory symptoms, were labelled as being asymptomatic or having a mild case of COVID-19, even as they had extrapulmonary manifestations as severe and life-threatening as heart blocks and stroke.
Dr Nischal said, according to the report, that COVID-19 has now become a multi-systemic disease. However, he added, it is still to be decided whether these extrapulmonary manifestations are, in fact, a result of the novel coronavirus (SARS-CoV-2) or whether it was just present in the patients’ bodies in these cases without actually having any role in these manifestations.
He then called for a revisit into the method to classify cases into mild, moderate and severe. He also emphasised that the patients with other organ involvement should be treated based on the existing guidelines for the management of that particular complication itself. He also gave the example of a 35-year-old man who came with a case of headache and vomiting, but was diagnosed as having a life-threatening cortical vein thrombosis. He also tested positive for COVID-19, and as per the current classification system, he was asymptomatic.
Dr Padma stated that various neurological manifestations have been linked to COVID-19, and in some cases, the brain has also been involved. She said that it might lead to clotting, and consequently a stroke, or it could result in an infection, leading to encephalitis. Or it might just have some other complication that might not be related to lungs at all, the report stated.
The report stated that Dr Roy presented a case where a patient came with a very low pulse rate. The patient was found positive for COVID-19, and needed an initial support to improve the heart rate. Dr Roy said that usually in such cases, a pacemaker is installed in the patient, but cashing on the experience which has been documented, they realised that it could just be due to COVID-19, and therefore forewent the pacemaker. The patient’s heart rate gradually improved with the help of supportive treatment. Dr Roy said that sometimes COVID-19 can affect the electric pulse system in humans, which causes heart beats. This improves with time, and therefore these patients do not need a pacemaker, Dr Roy stated.
However, there is a need for more evidence to make sure whether these are a result of COVID-19 itself, since the disease is new and only limited information and experience is available as of now, Dr Roy stressed.