The heart is both an easy target and a terrible one for a virus. Unlike the brain, it collects blood from all over the body and is easy to reach. infecting the heart could cause death to the host without triggering symptoms that would allow a virus to easily spread. The University of North Carolina at Chapel Hill’s Efran Rivera-Serrano says that viruses that affect the heart do not exist.
One Toronto-based study found its genetic material in seven of 20 autopsied hearts. Myocarditis was also present in these hearts. By contrast, autopsied hearts with traces of the new coronaviruses typically don’t. It’s not clear whether the virus was doing anything or not.
The heart can be affected by viruses. In the Western world, they are the most common cause of myocarditis. There are at least 20 known viruses that can cause this condition.
Paul Checchia is a cardiologist at Texas Children’s Hospital. The whole body reacts when a pathogen enters. It’s no different with SARS-CoV-2. The response of the immune system to the coronaviruses can be slow and severe. The immune overreactions are similar to those caused by other respiratory viruses. This stronger crossfire could cause the heart to fail.
Aviruses don’t need to be in the heart to wreak havoc. It can cause indirect damage by attacking the lungs and starving the heart of oxygen, or by triggering an inflammatory immune response that affects the entire body. Viruses that primarily affect the gut or respiratory system can cause myocarditis in this way, when they travel through the bloodstream and inflame the heart. Coxsackie B is the most widely studied cause of viral myocarditis, but is primarily a gut virus that spreads through fecal contamination, but it does much of its damage through the immune system.
The study was thorough and detailed. It spawned a wave of articles and papers about the possibility that COVID-19 could cause long-term harm to the hearts of people who aren’t sick, and possibly influenced decisions about whether college athletes should be allowed to play. These discussions sparked a lot of criticism. The study was criticized for several errors, including missing data, incorrect reports, and the wrong statistical tests. The main conclusions of the paper still stand, despite the fact that the team corrected it.
How often does that happen? The risk of heart injuries seemed to be related to the severity of the illness in the early months of the Pandemic. The picture was complicated in July by a team of people. The researchers found that 78 percent of people who had recovered from COVID-19 still had a heart abnormality two months later on their magnetic resonance images. About 60 percent of them still had signs of myocarditis.
Sometimes viral myocarditis isn’t a problem. It is possible that you have had the condition at some point in your life. Some people recover but have scarring that weakens their heart and increases their risk of problems years down the line. In a third group, the inflammation rapidly worsens, leading to faulty heartbeats, heart failure, or even death.
Tiffany Chen of Penn Medicine was not involved in the study but she thinks the data is good. Mild cases of COVID-19 had a lot of abnormality. It is frightening. She says that the implications of these findings are not yet understood.
It is hard to know what to make of the study without that information. Some patients have myocarditis, but what does that mean? The numbers compare to other respiratory viruses. Some patients with myocarditis may have long-term problems. Is the virus doing something strange or is it just being studied more intensely than other viral infections? It is difficult to say for now.
It is hard to give accurate percentages, but the latter two outcomes are rare. Doctors only see cases of myocarditis when they fall into the third group, and severe symptoms warrant diagnostic tests. Martha Gulati, the cardiology chief at the University of Arizona, says that they don’t know how many people with the flu have inflammation or long-term outcomes. In two small pilot studies, Checchia found signs of heart damage in 40 and 55 percent of children who were hospitalized with a respiratory disease. He says that they seemed fine on discharge. We couldn’t get funding to look at them for a long time.
There hasn’t been an obvious influx of patients being admitted to the hospital with unexplained myocarditis, despite the huge numbers who have had COVID-19. I don’t think it’s convincing that there is a lot of myocarditis in people who are feeling well. The worry is that COVID-19 is doing everything it can at scale. The impact on the heart was lost in the historical bin of the scientific literature when the original outbreak of the disease was over in three months. At least 31 million people have been affected by the disease and 960,000 have died. Its effects are thousands of times more obvious than the previous one. Even if it isn’t worse than any other viral illness, a small risk of long-term problems would still translate to a lot of failing hearts.
It can be frightening for people who are sick. Kontorovich, who is part of a team that provides care for long-haulers, said that long-haulers are responding to the media’s interpretation of the studies and are rightfully freaked out. She sees the myocarditis issue and the long-hauler phenomenon as separate issues.
Long-term studies are important according to him and others. Chen says that they are still early. We have to follow these patients for months or years down the road because I don’t think there’s a defined time point when we’d expect to see heart failure.
College athletes are also facing decisions. In the past two months, a basketball player and a football player have died from heart attacks. They had previously contracted COVID-19.
Some long-haulers have been diagnosed with a group of disorders that disrupt bodily functions, including heartbeats and blood pressure, which can suddenly crash. Long-haulers usually experience chronic symptoms of myocarditis, but people who have lingered heart problems after viral myocarditis usually don’t, and they have measurable changes to their hearts that long-haulers don’t. Kontorovich said there may be a connection, but it hasn’t been proven.
If athletes are diagnosed with clinical myocarditis, they are taken out of play for at least three months to give the heart a chance to recover. The question now is what to do about the people who have no symptoms but can be seen on a medical scanner. The risk of heart failure is low, but the outcome is catastrophic, says the sports cardiologist. The guidance from the American College of Cardiology states that athletes who test positive for COVID-19 should rest for at least two weeks.
A research team at the Ohio State University scanned the hearts of 26 college athletes who tested positive for COVID-19 and had mild or absent symptoms. Some of them had signs of myocarditis. The Ohio study didn’t examine a control group of athletes who didn’t have COVID-19, and even healthy athletes experience changes in their heart as they train, including features that are similar to what you might see with infections or scarring
It makes sense to stop players from spreading the myocarditis to one another, especially when so many colleges are facing large outbreaks. There are a lot of reasons to not play football. There is plenty of evidence to take COVID-19 seriously.
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