A group of researchers reveals in their study that the coronavirus might not be a respiratory virus. Instead, it might be causing a toll on endothelial cells, affecting blood vessels. Many unexpected symptoms of COVID-19 started to arise in April, including blood clotting, strokes, and painful red or purple toes. 

Scientists later discovered that new symptoms related to cardiovascular complications. Months after the pandemic started, experts began to see sense behind the mysterious symptoms. 

In the study, the authors determined that the SARS-CoV-2 affected endothelial cells in the lungs, heart, liver, kidneys, and intestines in infected patients. Furthermore, endothelial cells line the inside of blood vessels and give off a protein responsible for numerous processes such as blood clotting and immune response. 

The findings of the paper were published on April 20, 2020, in the scientific journal The Lancet.

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COVID-19 Affects the Blood Vessels

According to Mandeep Mehra, MD, the Medical Director of the Brigham and Women's Hospital Heart and Vascular Center, COVID-19 appears to start as a respiratory disease. It then, later on, ends up affecting the body's vasculature system, which ultimately causes death in most severely-ill patients.

William Li, M.D., the Angiogenesis Foundation president, adds that the new symptoms seemingly unrelated to the respiratory system, such as kidney damage, stroke, encephalitis, and inflammation of the heart, seemed to be a mystery at first. He explained that the symptoms were not normally seen in most infectious diseases, like SARS or H1N1. 

The endothelial cell layer is in part responsible for the regulation of blood clots, according to Sanjum Sethi, MD, MPH, an interventional cardiologist at Columbia University Irving Medical Center. Furthermore, it inhibits clot formation in a variety of ways. If the process is disrupted, blood clots would most likely be the result, he adds. 

Additionally, a new paper published last week in the New England Journal of Medicine uncovered extensive evidence of blood clots and infection in the endothelial cells in the lungs of people who died from COVID-19. 

Moreover, researchers believe that infection of the blood vessels could be how the virus makes its way through the body and infects other organs. This behavior of the virus is something not commonly seen in respiratory infections, experts say.

Antiviral Therapy Might not be the Best to Fight Coronavirus

If the theory of the coronavirus being a vasculotropic virus proves to be true, scientists say that antiviral therapy might not be of much help to fight it. Instead, they suggest that ACE inhibitor drugs might just do the trick. 

In another New England Journal of Medicine study, researchers looked at nearly 9,000 people with COVID-19 and presented that the use of statins and ACE inhibitors were linked to higher rates of survival. Statins are drugs that significantly reduce the risk of heart attacks by lowering cholesterol or preventing plaque formation in the blood vessels. 

Mehra says that both statins and ACE inhibitors are significantly protective of vascular diseases since they stabilize endothelial cells. He adds that they are building a completely different approach in treating COVID-19, as it might be better to go for a drug that preserves the vascular endothelial cells, rather than focus on antiviral therapy.

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