Wednesday, May 13, 2020


Wednesday: Kwei Quartey MD

With a little wordplay on "Murder Is Everywhere," I digress somewhat this week from murder to COVID-19. Poignantly, the virus that causes this illness, SARS-CoV-2, really is a killer. It introduced itself as a respiratory affliction, but lo and behold, it does a lot more damage than that. Doctors and researchers are beginning to look at it as a vascular and inflammatory disease. The respiratory system is only the conduit, like an intruder creeping in through your bedroom window and then proceeding to all the other rooms to cause mayhem. That's why we say COVID-19 is a "nose-to-toes" disease.

One indication of this is that people with respiratory disorders as the only comorbidity, e.g. asthma, chronic obstructive pulmonary disease, are not as high-risk for COVID-19 as are patients with high blood pressure, obesity, and diabetes. These last three conditions often coexist, but each is also an independent causative factor in cardiovascular disease, which the SARS-CoV-2 appears to exploit. 

Even in relatively young people who don't have such underlying issues, COVID-19 has induced strokes via abnormal clotting mechanisms that clog up the brain's arteries. In the brain arteriogram shown below, Fig 1 shows a blood clot (arrow) on the right side with blockage of the blood supply; in Fig 2, blood flow resumes after removal (or dissolution) of the clot.

Occluded artery in brain circulation (arrow)

Restoration of blood supply after clot dissolution (Image: Samunella/Shutterstock)

At the other end of the body, we have "COVID toes," which are red or purplish spots on the toes due to vascular clots and/or inflammatory changes in the skin.

Covid Toes (Image: Chris Curry/Shutterstock)

And all along the path from head to toes, COVID-19 can leave destruction in its wake in the heart, lungs (of course), kidneys, and liver.

Coming to our attention over the past few weeks is a pediatric manifestation possibly connected with COVID-19: a Kawasaki Disease/Syndrome-like illness that's been branded Pediatric Inflammatory Multisystem (or Multi-organ) Syndrome, or PIMS. It seems odd that in some cases the PIMS has occurred quite some time after the acute infection in the child has passed. The syndrome involves a fever, dramatic rash, swollen lymph nodes, abdominal pain, peeling of the hands and feet, "strawberry tongue," and conjunctivitis ("pink eye.") 

Child with Kawasaki Syndrome (Image: Chu KyungMin/Shutterstock) 

What is largely missing in our discourse on the COVID-19 pandemic is much mention of how it affects and has affected the continent of Africa, so I will tackle this in my next blog.


  1. It's all very depressing. Would you point us to a vaccine in your next post also?

  2. An unvarnished factual description of the sort we're getting far too few of these days, Kwei. Thank you.

  3. It seems that the more we learn about COVID-19, we more we realise how much there is still to know.

  4. I am sitting in my clinic reading this as I get to grips with the sanitization, the masking, the guarding, the gloving and the spraying with a view to opening the front door for an emergency. I am stealing the phrase 'a nose to toes disease.' for my signage!

  5. So scary, Kwei. So important to know. It's great that we have a doctor in the house.