In the early days of the coronavirus pandemic, most hospitals, even those known for their research capabilities, were only able to focus on saving lives. After months of cases, pathologists have been able to turn their attention to what can be learned from COVID-19 patients who lost their lives to the disease.
Researchers have published the first large batch of findings from COVID-19 patient autopsies. According to a recent article in the Washington Post, they provide critical information that’s contributing to our growing understanding of the virus and its affect on the human body.
It comes as no surprise to most who treat COVID-19 patients that the lungs are a primary organ damaged by the disease. One of the first investigations in April 2020 from Richard Vander Heide at LSU Health found hundreds of thousands of microclots in the lungs of patients, a startling revelation. Corroborated by other pathologists, this early learning influenced some physicians to treat COVID-19 patients with blood thinners.
When early reports on coronavirus from China indicted myocarditis in 20% to 30% of hospitalized patients, learning more about how the virus impacts the heart became a primary research goal. Several autopsy studies, including one conducted by Mary Fowkes and her team at Mouth Sinai Health, found that there was little evidence to suggest patients had myocarditis. Instead, they found megakaryocytes (which produce platelets to help control clotting) in the heart of patients. This is a highly unusual finding because megakaryocytes are typically only found in lungs and bone marrow. Fowkes reached out to Jeffrey Berger, a cardiac specialist at NYU running an NIH-funded lab on platelets, who believes the autopsies suggest anti-platelet medications may be effective in treating COVID-19. Based on this information, Berger a major clinical trial on blood thinners to include anti-platelet drugs.
Given the neurological symptoms and impairments that patients are reporting worldwide, Isaac Solomon, a neuropathologist at Brigham and Women’s Hospital in Boston, recently published a study in the New England Journal of Medicine on the effect of COVID-19 on the brain. After autopsies of 18 patients, he found very little virus in the brain. This may mean good news for drug development. because treatment can be easier when a virus is less pervasive.
Instead, Solomon found several small blood clots in different areas of the brain, which is a striking finding. Perhaps even important was that Solomon found significant brain damage from oxygen deprivation in both patients with long-term ICU stays and those who passed suddenly from COVID-19. This underscores the importance of putting patients on supplemental oxygen quickly to prevent long-term brain damage. One key area of future study is whether those who recover from the virus will sustain any lasting neurological effects.
A study published in the Lancet journal EClinicalMedicine by Amy Rapkiewicz at NYU Langone Health found megakaryocytes not only in the heart but in almost every organ she and her researchers looked at. Abnormal clotting in the heart, liver and kidneys suggests that this may be the cause of death in patients with multiple organ failure.
While some research confirms what the medical community has suspected, much of it sheds new light on how COVID-19 impacts the human body. While it’s too soon to know how this research will impact treatment, the findings are already leading to future studies, raising a wide variety of questions that researchers are rushing to find answers to.
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