Why we keep missing signs of COVID-19 infections
A friend asked me whether her daughter’s headache could be due to the new coronavirus. She became worried after reading that the virus might be causing neurological problems like headaches — as well as seizures, strokes, confusion, delirium, paralysis and impairment of taste or smell. “Every day,” she said, “it seems like the coronavirus is doing something new and horrible to people.”
Her anxiety is understandable. It has been stressful enough during the pandemic to worry about contracting coronavirus and developing a potentially fatal pneumonia. The added prospect of a prolonged hospitalization, with doctors and nurses unequipped with protective gear and lacking ventilators, just amped up the adrenaline.
Subsequently, we’ve been hearing reports about infected patients who developed serious medical conditions beyond the lungs: neurological problems, kidney failure, heart diseases, skeletal muscle injury, intestinal and liver disease, skin rashes and “Covid toes.” Some patients developed clots inside their major blood vessels, cutting off blood supply to organs.
What’s going on? How can we make sense of the ever-expanding clinical picture of COVID-19, the disease caused by coronavirus, that seems to be developing? Is the virus becoming more powerful and brazen? When can we rest assured that a potentially lethal virus isn’t lurking behind every new symptom we experience, from head to toe?
While we may be able to reliably identify the coronavirus under a microscope, we’ve not been as skilled at identifying the virus within infected human beings. Our failure to spot the virus in humans — because they have no symptoms, or we’ve limited our search to those with coughs and fevers — has led to inadvertent exposures and further transmission.
Fortunately, much can be done to improve our ability to spot coronavirus and, in the process, alleviate public anxiety about its menacing, lurking presence. But we must drop our blinders.
First, we need to stop restricting our view of coronavirus infection to the lungs, and instead envision it as a systemic illness. While coursing through the body, the virus can infect other organs. We also know it can kick up a cytokine storm — a strong but harmful immune response that can attack multiple organs. And it can irritate the lining of blood vessels, causing clots to form that obstruct blood flow to different organs.
Next, we need to rethink our testing strategies for detecting coronavirus. Our initial strategy — testing only people with respiratory symptoms who had recently traveled to China or had been in contact with someone who might be infected — left us blind to the coronavirus that was spreading in the general population, as well as any patients with non-respiratory COVID-19 manifestations.
And because we tested only sick people, we couldn’t spot the virus in healthy people who were carrying it around. Even now, our inadequate testing leaves us uncertain about the true prevalence of coronavirus in most communities. That, in turn, makes it hard to know whether an illness like stroke is mere coincidence or statistically more likely to be caused by coronavirus.
Finally, we need to drop the blinder that keeps us from seeing how everyone is being harmed by coronavirus. Our new sighting of COVID-19 in babies and children is an artifact of not having looked earlier. We minimized infection in young adults, refusing to see the actual burden on them. We were slow to look carefully at whether the virus was disproportionately affecting impoverished communities and people of color.
Pandemic beginnings are always chaotic affairs, steeped in scientific unknowns, swirling with public anxiety, stumbling over rumors and political roadblocks. And though you can’t expect absolute clarity about the scope and manifestations of the current one now, it’s realistic to expect the better clarity that could — and should — be had if we begin to test broadly for the virus and drop our preconceived notions about it.