Wednesday, April 29, 2020

UK Virus Alert by John Cleese

https://www.sunraysiadaily.com.au/coronavirus-covid-19/1110524/uk-virus-alert-by-john-cleese

UK Virus Alert by John Cleese

The English are feeling the pinch in relation to recent virus threat and have therefore raised their threat level from "Miffed" to "Peeved." Soon, though, the level may be raised yet again to "Irritated" or even "A Bit Cross." 

The English have not been "A Bit Cross" since the blitz in 1940 when tea supplies nearly ran out. 

The virus has been re-categorized from "Tiresome" to "A Bloody Nuisance." The last time the British issued a "Bloody Nuisance" warning level was in 1588, when threatened by the Spanish Armada. 

The Scots have raised their threat level from "Pissed Off" to "Let's Get the Bastard." They don't have any other levels. This is the reason they have been used on the front line of the British army for the last 300 years. 

The French government announced yesterday that it has raised its alert level from "Run" to "Hide." The only two higher levels in France are "Collaborate" and "Surrender." The rise was precipitated by a recent fire that destroyed France's white flag factory, effectively paralyzing the country's military capability. 

Italy has increased the alert level from "Shout Loudly and Excitedly" to "Elaborate Military Posturing." Two more levels remain: "Ineffective Combat Operations" and "Change Sides." 

The Germans have increased their alert state from "Disdainful Arrogance" to "Dress in Uniform and Sing Marching Songs." They also have two higher levels: "Invade a Neighbour" and "Lose." 

Belgians, on the other hand, are all on holiday as usual; the only threat they are worried about is NATO pulling out of Brussels. 

The Spanish are all excited to see their new submarines ready to deploy. These beautifully designed subs have glass bottoms so the new Spanish navy can get a really good look at the old Spanish navy. 

Australia, meanwhile, has raised its alert level from "No worries" to "She'll be alright, Mate." Two more escalation levels remain: "Crikey! I think we'll need to cancel the barbie this weekend!" and "The barbie is cancelled." So far, no situation has ever warranted use of the final escalation level.

--   Sent from my Linux system.

Fwd: Which state for Retirement?




-------- Forwarded Message --------
Subject: Fwd: Which state for Retirement?
Date: Wed, 29 Apr 2020 17:13:58 -0700
From: David Kramer <mridmk@gmail.com>



Subject: Which state for Retirement?



 
Retirement 
 
You can retire to Arizona where…
 
1.  You are willing to park three blocks away from your house because you found shade. 
2.  You've experienced condensation on your rear-end from the hot water in the toilet bowl.
3.  You can drive for four hours in one direction and never leave town.
4.  You have over 100 recipes for Mexican food.
5.  You know that "dry heat" is comparable to what hits you in the face when you open your oven door at 500 degrees.
6.  The four seasons are: tolerable, hot, really hot, and ARE YOU KIDDING ME??
 
-OR-
 
You can retire to California where… 
 
1.  You make over $450,000 and you still can't afford to buy a house.
2.  The fastest part of your commute is going down your driveway
3.  You know how to eat an artichoke.
4.  When someone asks you how far something is, you tell them how long it will take to get there rather than how many miles away it is. 
5.  The four seasons are:   Fire, Flood, Mud and Drought.
 
-OR-
 
You can retire to New York City where… 
 
1   You say "the city" and expect everyone to know you mean Manhattan. 
2.  You can get into a four-hour argument about how to get from Columbus Circle to Battery Park, but can't find Wisconsin on a map.
3.  You think Central Park is "nature."
4.  You believe that being able to swear at people in their own language makes you multilingual.
5.  You've worn out a car horn.  (IF you have a car.)
6.  You think eye contact is an act of aggression
 
-OR-
 
You can retire to Minnesota where… 
 
1.  You only have three spices:  salt, pepper and ketchup 
2.  Halloween costumes have to fit over parkas.
3.  You have seventeen recipes for casserole.
4.  Sexy lingerie is anything flannel with less than eight buttons.
5.  The four seasons are:   almost winter, winter, still winter, and road repair.
 
-OR-
 
You can retire to The Deep South where. 
 
1.  You can rent a movie and buy bait in the same store. 
2  "Y'all" is singular and "all y'all" is plural
3.  "He needed killin " is a valid defense.
4.  Everyone has two first names:  Billy Bob, Jimmy Bob, Joe Bob, Betty Jean, Mary Beth, etc.
5.  Everything is either:  "in yonder,"  "over yonder"  or "out yonder. "
6. You can say anything about anyone, as long as you say "Bless his heart" at the end!
 
-OR-
 
You can move to Colorado where… 
 
1.  You carry your $3,000 mountain bike atop your $500 car. 
2.  You tell your husband to pick up Granola on his way home, so he stops at the day care center.
3.  A pass does not involve a football or dating.
4.  The top of your head is bald, but you still have a pony tail .
 
-OR-
 
You can retire to Nebraska or Kansas where…   
 
1.  You've never met any celebrities, but the mayor knows your name. 
2.  Your idea of a traffic jam is three cars waiting to pass a tractor.
3.  You have had to switch from "heat" to "A/C" on the same day.
4.  You end every sentence with a preposition;  "Where's my coat at?"
 
-OR-
 
FINALLY you can retire to Florida where… 
 
1.  You eat dinner at 3:15 in the afternoon. 
2.  All purchases include a coupon of some kind - even houses and cars.
3.  Everyone can recommend an excellent cardiologist, dermatologist, proctologist, podiatrist, or orthopedist.
4.  Road construction never ends anywhere in the state.
5.  Cars in front of you often appear to be driven by headless people.
 
 

 

Tuesday, April 28, 2020

Videos from some anti-lockdown protests.

Watch "Anti-Lockdown Protest Organizer Tests Positive For COVID-19, Demonstrations Continue |
NowThis" on YouTube
https://youtu.be/vf6NIf32PwU

I haven't verified the claims presented in these videos, such as when and whether the protest
leaders in the videos were diagnosed with COVID-19, but I am prepared to state without equivocation
that these are Trump supporters.

Glenn

--
Sent from my Linux system.

Fwd: Zoom Suit


I never wore a suit to work, but if you must, here's the COVID-19 version.

order yours today!

For you guys!


From my friend from England
 

Monday, April 27, 2020

Plagued.

Video from Bill Kristol on behalf of the Republicans for the Rule of Law: This is our president.

https://twitter.com/i/status/1254185205818109952

--
Sent from my Linux system.

Friday, April 24, 2020

Older than Dirt

Okay, as with my previous email along these lines, if you're half my age or younger, feel free to
hit the delete key without reading this.

Glenn

>
>
> This one is a bit long, so start it when you have a few minutes to invest, but it will bring back
> many great memories...  At least is did for me...
>
>
>
> From one "Older than Dirt"
>
> 'Someone asked the other day, 'What was your favorite fast food when you were growing up?'
>
> 'We didn't have fast food when I was growing up, I informed him.
>
> 'All the food was slow.'
> 'C'mon, seriously Where did you eat?'
> 'It was a place called 'at
> Home,'' I explained. !
>
> 'Mom cooked every day and when Dad got home from work, we sat down together at the dining room
> table, and if I didn't like what she put on my plate I was allowed to sit there until I did like it.'
>
>
> By this time, the kid was laughing so hard I was afraid he was going to suffer serious internal
> damage, so I didn't tell him the part about how I had to have permission to leave the table.
>
>
> But here are some other things I would have told him about my childhood if I figured his system
> could have handled it :
>
>
> Some parents NEVER owned their own house, never wore Levis , never set foot on a golf course,
> never traveled out of the country or had a credit card.
>
>
>
> In their later years they had something called a revolving charge card. The card was good only at
>  Sears Roebuck. Or maybe it was Sears & Roebuck.  Either way, there is no Roebuck anymore. Maybe
> he died.
>
>
> My parents never drove me to soccer practice. This was mostly because we never had heard of soccer.
>
>
> I had a bicycle that weighed probably 50 pounds, and only had one speed, (slow).  We didn't have a
> television in our house until I was 11.
>
>
> It was, of course, black and white, and the station went off the air at midnight, after playing
> the national anthem and a poem about God; it came back on the air at about 6 a.m. And there was
> usually a locally produced news and farm show on, featuring local people.
>
>
> I was 19 before I tasted my first pizza, it was called 'pizza pie.' When I bit into it, I burned
> the roof of my mouth and the cheese slid off, swung down, plastered itself against my chin and
> burned that, too. It's still the best pizza I ever had.
>
>
> I never had a telephone in my room. The only phone in the house was in the living room and it was
> on a party line. Before you could dial, you had to listen and make sure some people you didn't
> know weren't already using the line.
>
>
> Pizzas were not delivered to our home.
>
> But milk was.
>
>
> All newspapers were delivered by boys and all boys delivered newspapers -- my brother delivered a
> newspaper, six days a week. It cost 7 cents a paper, of which he got to keep 2 cents.  He had to
> get up at 6 AM every morning.
>
>
> On Saturday, he had to collect the 42 cents from his customers. His favorite customers were the
> ones who gave him 50 cents and told him to keep the change. His least favorite customers were the
> ones who seemed to never be home on collection day.
>
>
> Movie stars kissed with their mouths shut. At least, they did in the movies. There were no movie
> ratings because all movies were responsibly produced for everyone to enjoy viewing, without
> profanity or violence or most anything offensive.
>
>
> If you grew up in a generation before there was fast food, you may want to share some of these
> memories with your children or grandchildren
>
>
> Just don't blame me if they bust a gut laughing.
>
>
> Growing up isn't what it used to be, is it?
>
>
> MEMORIES from a friend :
> My Dad is cleaning out my grandmother's house (she died in December) and he brought me an old
> Royal Crown Cola bottle. In the bottle top was a stopper with a bunch of holes in it. I knew
> immediately what it was, but my daughter had no idea. She thought they had tried to make it a salt
> shaker or something. I knew it as the bottle that sat on the end of the ironing board to
> 'sprinkle' clothes with because we didn't have steam irons. Man, I am old.
>
>
> How many do you remember?
> Head lights dimmer switches on the floor.
> Ignition switches on the dashboard.
> Heaters mounted on the inside of the fire wall.
> Real ice boxes.
> Pant leg clips for bicycles without chain guards.
> Soldering irons you heat on a gas burner.
> Using hand signals for cars without turn signals.
>
>
> Older Than Dirt Quiz :
> Count all the ones that you remember not the ones you were told about. Ratings at the bottom.
>
> 1. Blackjack chewing gum
> 2. Wax Coke-shaped bottles with colored sugar water
> 3. Candy cigarettes
> 4. Soda pop machines that dispensed glass bottles
> 5. Coffee shops or diners with table side jukeboxes
> 6. Home milk delivery in glass bottles with cardboard stoppers
> 7. Party lines on the telephone
> 8 Newsreels before the movie
> 9. P.F. Flyers
> 10. Butch wax  (that was our hair product)
> 11. TV test patterns that came on at night after the last show and were there until TV shows
> started again in the morning. (there were only 3 channels... [if you were fortunate )
> 12. Peashooters
> 13. Howdy Doody
> 14. 45 RPM records
> 15. S&H green stamps
> 16. Hi-fi's
> 17. Metal ice trays with lever
> 18. Mimeograph paper
> 19. Blue flashbulb
> 20. Packards
> 21. Roller-skate keys
> 22. Cork popguns
> 23. Drive-ins
> 24. Studebakers
> 25. Wash tub wringers
>
> If you remembered 0-5 = You're still young
> If you remembered 6-10 = You are getting older
>
> If you remembered 11-15 = Don't tell your age,
> If you remembered 16-25 = You' re older than dirt!
>
> I might be older than dirt but those memories are some of the best parts of my life.
>
> Don't forget to pass this along!!
> Especially to all your really good  O L D  FRIENDS
>
>
>

At least the air is cleaner, for now.






 


Thursday, April 23, 2020

Fwd: Re: A couple of tunes for our times, from the Left Coast.

Here's a little bit of good news from someone on my list. Lest we forget, the Earl Warren court was the result of an Eisenhower appointment. Eisenhower reportedly said that the Warren appointment was "The biggest damn fool mistake I ever made." It strikes me that Eisenhower was no fool, so I tend to doubt that report, but if true, it points up just how far from their appointers the justices can stray. There's always hope.

Glenn


If you're looking for good news, in 2 recent Supreme Court cases, they
ruled 6-3 in favor of requiring unanimous verdicts in criminal cases and
that groundwater was protected by the Clean Air and Water Act.
Gorsuch wrote the majority opinion in the verdict case, and Kavanaugh
voted with the majority in both cases.
I really don't like the way Mitch McTurtle gamed the system, but at least
Gorsuch and Kavanaugh don't look like rubber stamps for the Republican/Trump
agenda



A couple of tunes for our times, from the Left Coast.

Here's one from the Raging Grannies of Mendocino

And here's another, by Roy Zimmerman and The ReZisters, featuring Sandy Riccardi. Made in collaboration with the Raging Grannies of Mendocino.

https://www.youtube.com/watch?v=ExHd1ZGYCm8




Tuesday, April 21, 2020

Winning the WH Can't Buy You Class




https://pbs.twimg.com/media/EWLAj_FWkAAT72j?format=jpg&name=mediumhttps://pbs.twimg.com/media/EWLAj_FWkAAT72j?format=jpg&name=medium
https://pbs.twimg.com/media/EWLAj_FWkAAT72j?format=jpg&name=mediumhttps://pbs.twimg.com/media/EWLAj_FWkAAT72j?format=jpg&name=medium    --   Sent from my Linux system.

Fwd: How Does Covid-19 Kill?


  • https://www.sciencemag.org/news/2020/04/how-does-coronavirus-kill-clinicians-trace-ferocious-rampage-through-body-brain-toes?utm_source=Nature+Briefing&utm_campaign=4525e04069-briefing-dy-20200421&utm_medium=email&utm_term=0_c9dfd39373-4525e04069-43551805


  • The coronavirus wreaked extensive damage (yellow) on the lungs of a 59-year-old man who died at George Washington University Hospital, as seen in a 3D model based on computerized tomography scans.

    George Washington Hospital and Surgical Theater

    How does coronavirus kill? Clinicians trace a ferocious rampage through the body, from brain to toes

    Science's COVID-19 reporting is supported by the Pulitzer Center.

    On rounds in a 20-bed intensive care unit one recent day, physician Joshua Denson assessed two patients with seizures, many with respiratory failure and others whose kidneys were on a dangerous downhill slide. Days earlier, his rounds had been interrupted as his team tried, and failed, to resuscitate a young woman whose heart had stopped. All shared one thing, says Denson, a pulmonary and critical care physician at the Tulane University School of Medicine. "They are all COVID positive."

    As the number of confirmed cases of COVID-19 surges past 2.2 million globally and deaths surpass 150,000, clinicians and pathologists are struggling to understand the damage wrought by the coronavirus as it tears through the body. They are realizing that although the lungs are ground zero, its reach can extend to many organs including the heart and blood vessels, kidneys, gut, and brain.

    "[The disease] can attack almost anything in the body with devastating consequences," says cardiologist Harlan Krumholz of Yale University and Yale-New Haven Hospital, who is leading multiple efforts to gather clinical data on COVID-19. "Its ferocity is breathtaking and humbling."

    Understanding the rampage could help the doctors on the front lines treat the fraction of infected people who become desperately and sometimes mysteriously ill. Does a dangerous, newly observed tendency to blood clotting transform some mild cases into life-threatening emergencies? Is an overzealous immune response behind the worst cases, suggesting treatment with immune-suppressing drugs could help? What explains the startlingly low blood oxygen that some physicians are reporting in patients who nonetheless are not gasping for breath? "Taking a systems approach may be beneficial as we start thinking about therapies," says Nilam Mangalmurti, a pulmonary intensivist at the Hospital of the University of Pennsylvania (HUP).

    Related story

    What follows is a snapshot of the fast-evolving understanding of how the virus attacks cells around the body, especially in the roughly 5% of patients who become critically ill. Despite the more than 1000 papers now spilling into journals and onto preprint servers every week, a clear picture is elusive, as the virus acts like no pathogen humanity has ever seen. Without larger, prospective controlled studies that are only now being launched, scientists must pull information from small studies and case reports, often published at warp speed and not yet peer reviewed. "We need to keep a very open mind as this phenomenon goes forward," says Nancy Reau, a liver transplant physician who has been treating COVID-19 patients at Rush University Medical Center. "We are still learning."

    The infection begins

    When an infected person expels virus-laden droplets and someone else inhales them, the novel coronavirus, called SARS-CoV-2, enters the nose and throat. It finds a welcome home in the lining of the nose, according to a preprint from scientists at the Wellcome Sanger Institute and elsewhere. They found that cells there are rich in a cell-surface receptor called angiotensin-converting enzyme 2 (ACE2). Throughout the body, the presence of ACE2, which normally helps regulate blood pressure, marks tissues vulnerable to infection, because the virus requires that receptor to enter a cell. Once inside, the virus hijacks the cell's machinery, making myriad copies of itself and invading new cells.

    As the virus multiplies, an infected person may shed copious amounts of it, especially during the first week or so. Symptoms may be absent at this point. Or the virus' new victim may develop a fever, dry cough, sore throat, loss of smell and taste, or head and body aches.

    If the immune system doesn't beat back SARS-CoV-2 during this initial phase, the virus then marches down the windpipe to attack the lungs, where it can turn deadly. The thinner, distant branches of the lung's respiratory tree end in tiny air sacs called alveoli, each lined by a single layer of cells that are also rich in ACE2 receptors.

    Normally, oxygen crosses the alveoli into the capillaries, tiny blood vessels that lie beside the air sacs; the oxygen is then carried to the rest of the body. But as the immune system wars with the invader, the battle itself disrupts this healthy oxygen transfer. Front-line white blood cells release inflammatory molecules called chemokines, which in turn summon more immune cells that target and kill virus-infected cells, leaving a stew of fluid and dead cells—pus—behind. This is the underlying pathology of pneumonia, with its corresponding symptoms: coughing; fever; and rapid, shallow respiration (see graphic). Some COVID-19 patients recover, sometimes with no more support than oxygen breathed in through nasal prongs.

    But others deteriorate, often quite suddenly, developing a condition called acute respiratory distress syndrome (ARDS). Oxygen levels in their blood plummet and they struggle ever harder to breathe. On x-rays and computed tomography scans, their lungs are riddled with white opacities where black space—air—should be. Commonly, these patients end up on ventilators. Many die. Autopsies show their alveoli became stuffed with fluid, white blood cells, mucus, and the detritus of destroyed lung cells.

    An invader's impact

    In serious cases, SARS-CoV-2 lands in the lungs and can do deep damage there. But the virus, or the body's response to it, can injure many other organs. Scientists are just beginning to probe the scope and nature of that harm.



        8 2 5 6 7 3 4 Windpipe Bile duct Bronchii Immune cells Capillary Blood vessel Endothelial cell ACE2 SARS-CoV-2 SARS-CoV-2 Clot Mucus 1 2 LiverUp to half of hospitalized patients have enzyme levels that signal a struggling liver. An immune system in overdrive and drugs given to fight the virus may be causing the damage. 7 NoseSome patients lose their sense of smell. Scientists speculate that the virus may move up the nose's nerve endings and damage cells. 6 EyesConjunctivitis, inflammation of the membrane that lines the front of the eye and inner eyelid, is more common in the sickest patients. 3 KidneysKidney damage is common in severe cases and makes death more likely. The virus may attack the kidneys directly, or kidney failure may be part of whole-body events like plummeting blood pressure. 4 IntestinesPatient reports and biopsy data suggest the virus can infect the lower gastrointestinal tract, which is rich in angiotesin-converting enzyme 2 (ACE2) receptors. Some 20% or more of patients have diarrhea. 1 LungsA cross section shows immune cells crowding anin­amed alveolus, or air sac, whose walls break down during attack by the virus, diminishing oxygen uptake. Patients cough, fevers rise, and breathing becomes labored. 8 Heart and blood vesselsThe virus (teal) enters cells, likely including those lining blood vessels, by binding to ACE2 receptors on the cell surface.Infection can also promote blood clots, heart attacks, and cardiac in­ammation. 5 BrainSome COVID-19 patients havestrokes, seizures, confusion, and brain in­ammation. Doctors are trying to understand which are directly caused by the virus.
    V. ALTOUNIAN/SCIENCE

    Some clinicians suspect the driving force in many gravely ill patients' downhill trajectories is a disastrous overreaction of the immune system known as a "cytokine storm," which other viral infections are known to trigger. Cytokines are chemical signaling molecules that guide a healthy immune response; but in a cytokine storm, levels of certain cytokines soar far beyond what's needed, and immune cells start to attack healthy tissues. Blood vessels leak, blood pressure drops, clots form, and catastrophic organ failure can ensue.

    Some studies have shown elevated levels of these inflammation-inducing cytokines in the blood of hospitalized COVID-19 patients. "The real morbidity and mortality of this disease is probably driven by this out of proportion inflammatory response to the virus," says Jamie Garfield, a pulmonologist who cares for COVID-19 patients at Temple University Hospital.

    But others aren't convinced. "There seems to have been a quick move to associate COVID-19 with these hyperinflammatory states. I haven't really seen convincing data that that is the case," says Joseph Levitt, a pulmonary critical care physician at the Stanford University School of Medicine.

    He's also worried that efforts to dampen a cytokine response could backfire. Several drugs targeting specific cytokines are in clinical trials in COVID-19 patients. But Levitt fears those drugs may suppress the immune response that the body needs to fight off the virus. "There's a real risk that we allow more viral replication," Levitt says.

    Meanwhile, other scientists are zeroing in on an entirely different organ system that they say is driving some patients' rapid deterioration: the heart and blood vessels.

    Striking the heart

    In Brescia, Italy, a 53-year-old woman walked into the emergency room of her local hospital with all the classic symptoms of a heart attack, including telltale signs in her electrocardiogram and high levels of a blood marker suggesting damaged cardiac muscles. Further tests showed cardiac swelling and scarring, and a left ventricle—normally the powerhouse chamber of the heart—so weak that it could only pump one-third its normal amount of blood. But when doctors injected dye in the coronary arteries, looking for the blockage that signifies a heart attack, they found none. Another test revealed why: The woman had COVID-19.

    How the virus attacks the heart and blood vessels is a mystery, but dozens of preprints and papers attest that such damage is common. A 25 March paper in JAMA Cardiology documented heart damage in nearly 20% of patients out of 416 hospitalized for COVID-19 in Wuhan, China. In another Wuhan study, 44% of 36 patients admitted to the ICU had arrhythmias.

    The disruption seems to extend to the blood itself. Among 184 COVID-19 patients in a Dutch ICU, 38% had blood that clotted abnormally, and almost one-third already had clots, according to a 10 April paper in Thrombosis Research. Blood clots can break apart and land in the lungs, blocking vital arteries—a condition known as pulmonary embolism, which has reportedly killed COVID-19 patients. Clots from arteries can also lodge in the brain, causing stroke. Many patients have "dramatically" high levels of D-dimer, a byproduct of blood clots, says Behnood Bikdeli, a cardiovascular medicine fellow at Columbia University Medical Center.

    "The more we look, the more likely it becomes that blood clots are a major player in the disease severity and mortality from COVID-19," Bikdeli says.

    Infection may also lead to blood vessel constriction. Reports are emerging of ischemia in the fingers and toes—a reduction in blood flow that can lead to swollen, painful digits and tissue death.

    The more we look, the more likely it becomes that blood clots are a major player in the disease severity and mortality from COVID-19.

    Behnood Bikdeli, Columbia University Irving Medical Center

    In the lungs, blood vessel constriction might help explain anecdotal reports of a perplexing phenomenon seen in pneumonia caused by COVID-19: Some patients have extremely low blood-oxygen levels and yet are not gasping for breath. It's possible that at some stages of disease, the virus alters the delicate balance of hormones that help regulate blood pressure and constricts blood vessels going to the lungs. So oxygen uptake is impeded by constricted blood vessels, rather than by clogged alveoli. "One theory is that the virus affects the vascular biology and that's why we see these really low oxygen levels," Levitt says.

    If COVID-19 targets blood vessels, that could also help explain why patients with pre-existing damage to those vessels, for example from diabetes and high blood pressure, face higher risk of serious disease. Recent Centers for Disease Control and Prevention (CDC) data on hospitalized patients in 14 U.S. states found that about one-third had chronic lung disease—but nearly as many had diabetes, and fully half had pre-existing high blood pressure.

    Mangalmurti says she has been "shocked by the fact that we don't have a huge number of asthmatics" or patients with other respiratory diseases in HUP's ICU. "It's very striking to us that risk factors seem to be vascular: diabetes, obesity, age, hypertension."

    Scientists are struggling to understand exactly what causes the cardiovascular damage. The virus may directly attack the lining of the heart and blood vessels, which, like the nose and alveoli, are rich in ACE2 receptors. Or perhaps lack of oxygen, due to the chaos in the lungs, damages blood vessels. Or a cytokine storm could ravage the heart as it does other organs.

    "We're still at the beginning," Krumholz says. "We really don't understand who is vulnerable, why some people are affected so severely, why it comes on so rapidly … and why it is so hard [for some] to recover."

    Multiple battlefields

    The worldwide fears of ventilator shortages for failing lungs have received plenty of attention. Not so a scramble for another type of equipment: dialysis machines. "If these folks are not dying of lung failure, they're dying of renal failure," says neurologist Jennifer Frontera of New York University's Langone Medical Center, which has treated thousands of COVID-19 patients. Her hospital is developing a dialysis protocol with different machines to support additional patients. The need for dialysis may be because the kidneys, abundantly endowed with ACE2 receptors, present another viral target.

    According to one preprint, 27% of 85 hospitalized patients in Wuhan had kidney failure. Another reported that 59% of nearly 200 hospitalized COVID-19 patients in China's Hubei and Sichuan provinces had protein in their urine, and 44% had blood; both suggest kidney damage. Those with acute kidney injury (AKI), were more than five times as likely to die as COVID-19 patients without it, the same Chinese preprint reported.

    Medical staff work to help a COVID-19 patient in an intensive care unit in Italy.

    Antonio Masiello/Getty Images

    "The lung is the primary battle zone. But a fraction of the virus possibly attacks the kidney. And as on the real battlefield, if two places are being attacked at the same time, each place gets worse," says Hongbo Jia, a neuroscientist at the Chinese Academy of Sciences's Suzhou Institute of Biomedical Engineering and Technology and a co-author of that study.

    Viral particles were identified in electron micrographs of kidneys from autopsies in one study, suggesting a direct viral attack. But kidney injury may also be collateral damage. Ventilators boost the risk of kidney damage, as do antiviral compounds including remdesivir, which is being deployed experimentally in COVID-19 patients. Cytokine storms also can dramatically reduce blood flow to the kidney, causing often-fatal damage. And pre-existing diseases like diabetes can increase the chances of kidney injury. "There is a whole bucket of people who already have some chronic kidney disease who are at higher risk for acute kidney injury," says Suzanne Watnick, chief medical officer at Northwest Kidney Centers.

    Buffeting the brain

    Another striking set of symptoms in COVID-19 patients centers on the brain and central nervous system. Frontera says neurologists are needed to assess 5% to 10% of coronavirus patients at her hospital. But she says that "is probably a gross underestimate" of the number whose brains are struggling, especially because many are sedated and on ventilators.

    Frontera has seen patients with the brain inflammation encephalitis, with seizures, and with a "sympathetic storm," a hyperreaction of the sympathetic nervous system that causes seizurelike symptoms and is most common after a traumatic brain injury. Some people with COVID-19 briefly lose consciousness. Others have strokes. Many report losing their sense of smell. And Frontera and others wonder whether in some cases, infection depresses the brain stem reflex that senses oxygen starvation. This is another explanation for anecdotal observations that some patients aren't gasping for air, despite dangerously low blood oxygen levels.

    ACE2 receptors are present in the neural cortex and brain stem, says Robert Stevens, an intensive care physician at Johns Hopkins Medicine. But it's not known under what circumstances the virus penetrates the brain and interacts with these receptors. That said, the coronavirus behind the 2003 severe acute respiratory syndrome (SARS) epidemic—a close cousin of today's culprit—could infiltrate neurons and sometimes caused encephalitis. On 3 April, a case study in the International Journal of Infectious Diseases, from a team in Japan, reported traces of new coronavirus in the cerebrospinal fluid of a COVID-19 patient who developed meningitis and encephalitis, suggesting it, too, can penetrate the central nervous system.

    A 58-year-old woman with COVID-19 developed encephalitis, resulting in tissue damage in the brain (arrows).

    N. Poyiadji et al.Radiology, (2020) doi.org/10.1148/radiol.2020201187

    But other factors could be damaging the brain. For example, a cytokine storm could cause brain swelling, and the blood's exaggerated tendency to clot could trigger strokes. The challenge now is to shift from conjecture to confidence, at a time when staff are focused on saving lives, and even neurologic assessments like inducing the gag reflex or transporting patients for brain scans risk spreading the virus.

    Last month, Sherry Chou, a neurologist at the University of Pittsburgh Medical Center, began to organize a worldwide consortium that now includes 50 centers to draw neurological data from care patients already receive. The early goals are simple: Identify the prevalence of neurologic complications in hospitalized patients and document how they fare. Longer term, Chou and her colleagues hope to gather scans, lab tests, and other data to better understand the virus' impact on the nervous system, including the brain.

    Chou speculates about a possible invasion route: through the nose, then upward and through the olfactory bulb—explaining reports of a loss of smell—which connects to the brain. "It's a nice sounding theory," she says. "We really have to go and prove that."

    Most neurological symptoms "are reported from colleague to colleague by word of mouth," Chou adds. "I don't think anybody, and certainly not me, can say we're experts."

    Reaching the gut

    In early March, a 71-year-old Michigan woman returned from a Nile River cruise with bloody diarrhea, vomiting, and abdominal pain. Initially doctors suspected she had a common stomach bug, such as Salmonella. But after she developed a cough, doctors took a nasal swab and found her positive for the novel coronavirus. A stool sample positive for viral RNA, as well as signs of colon injury seen in an endoscopy, pointed to a gastrointestinal (GI) infection with the coronavirus, according to a paper posted online in The American Journal of Gastroenterology (AJG).

    Her case adds to a growing body of evidence suggesting the new coronavirus, like its cousin SARS, can infect the lining of the lower digestive tract, where the crucial ACE2 receptors are abundant. Viral RNA has been found in as many as 53% of sampled patients' stool samples. And in a paper in press at Gastroenterology, a Chinese team reported finding the virus' protein shell in gastric, duodenal, and rectal cells in biopsies from a COVID-19 patient. "I think it probably does replicate in the gastrointestinal tract," says Mary Estes, a virologist at Baylor College of Medicine.

    Recent reports suggest up to half of patients, averaging about 20% across studies, experience diarrhea, says Brennan Spiegel of Cedars-Sinai Medical Center in Los Angeles, co–editor-in-chief of AJG. GI symptoms aren't on CDC's list of COVID-19 symptoms, which could cause some COVID-19 cases to go undetected, Spiegel and others say. "If you mainly have fever and diarrhea, you won't be tested for COVID," says Douglas Corley of Kaiser Permanente, Northern California, co-editor of Gastroenterology.

    The presence of virus in the GI tract raises the unsettling possibility that it could be passed on through feces. But it's not yet clear whether stool contains intact, infectious virus, or only RNA and proteins. To date, "We have no evidence" that fecal transmission is important, says coronavirus expert Stanley Perlman of the University of Iowa. CDC says that based on experiences with SARS and with the virus that causes Middle East respiratory syndrome, another dangerous cousin of the new coronavirus, the risk from fecal transmission is probably low.

    The intestines are not the end of the disease's march through the body. For example, up to one-third of hospitalized patients develop conjunctivitis—pink, watery eyes—although it's not clear that the virus directly invades the eye. Other reports suggest liver damage: More than half of COVID-19 patients hospitalized in two Chinese centers had elevated levels of enzymes indicating injury to the liver or bile ducts. But several experts told Science that direct viral invasion isn't likely the culprit. They say other events in a failing body, like drugs or an immune system in overdrive, are more likely driving the liver damage.

    This map of the devastation that COVID-19 can inflict on the body is still just a sketch. It will take years of painstaking research to sharpen the picture of its reach, and the cascade of cardiovascular and immune effects it might set in motion. As science races ahead, from probing tissues under microscopes to testing drugs on patients, the hope is for treatments more wily than the virus that has stopped the world in its tracks.

    *Correction, 20 April, 12:25 p.m.: This story has been updated to correct the description of a sympathetic storm. It has also been updated to more accurately describe the geographic locations of the patients found to have protein and blood in their urine.

    Posted in:

    doi:10.1126/science.abc3208

    Jocelyn Kaiser

    Jocelyn is a staff writer for Science magazine.

    Catherine Matacic

    Catherine Matacic

    Catherine Matacic is an associate online editor, specializing in linguistics and the social sciences.


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