William Li is president of the Angiogenesis Foundation and author of “Eat to Beat Disease.” Andrew von Eschenbach is former commissioner of the U.S. Food and Drug Administration and former director of the National Cancer Institute.
New cases of covid-19 are declining across the country, so it's tempting to wonder whether the worst of the pandemic is behind us.
Not by a long shot. Even as cases decline, it is possible we could soon be grappling with the burden of prolonged or permanent organ damage among the millions of people who have survived covid-19. There’s still a lot we don’t know about the long-term effects of this disease, but they could cripple not just these “survivors" but also our health-care system and our economy, too.
The latest research suggests that this novel coronavirus does widespread damage to blood vessels far beyond the lungs — and is thus far more dangerous than previously thought.
One of us, William Li, recently co-authored a study in the New England Journal of Medicine comparing the lungs of covid-19 patients to those of patients killed by influenza, and to healthy lungs. The coronavirus was found to infect and inflict serious damage to the vascular endothelium — the single layer of cells that line the blood vessels of organs such as our brain, kidneys, heart and lungs. Coronavirus patients also have a much higher likelihood of experiencing clots in these blood vessels.
The vascular component of covid-19 may help explain a number of previously puzzling aspects of the illness, including “long-haulers syndrome," wherein patients struggle with severe symptoms such as brain fog, trouble breathing, fatigue, aches, hair loss and elevated heart rate months after clearing viral infection.
If covid-19′s vascular effects are widespread, the more than 20 million patients who have “recovered” could be living with serious damage to their blood vessels. That could unleash a global surge in vascular diseases, from stroke and atherosclerosis to myocarditis and heart attack.
Consider a recent study published in JAMA Cardiology, which looked at 100 patients who had recently recovered from covid-19. The researchers found some form of heart abnormality in 78 of these cases and detected an inflammation of the heart muscle in 60, despite the lack of a relevant preexisting condition.
This looming pandemic of vascular disease has catastrophic implications for the U.S. health-care system. Before the pandemic, such diseases were responsible for a third of all deaths and a sixth of all health spending. Cardiovascular disease costs the United States more than $500 billion a year. Within 15 years, that tab was expected to exceed $1 trillion. If these conditions proliferate among post-covid-19 people in the prime of their life, the human and economic costs would be staggering.
Now is the time for public health officials, politicians, researchers and medical professionals to address this threat. That begins with an aggressive effort to better understand the virus's effects on our blood vessels and to develop treatments to counteract them.
While we wait for a vaccine, there are no therapies to stop this virus from infecting people. There are no treatments yet for those suffering from long-haulers syndrome. And there's been little to no research into therapies that could address the damage to blood vessels caused by the coronavirus.
This new research effort must transcend the siloed thinking that has historically characterized medicine. Blood vessels interact with every organ in the body. To develop effective treatments, experts must collaborate with others outside their disciplines.
Finally, public health officials need to exhort people to shore up the health of their blood vessels. This includes eating foods that can promote blood vessel health, and regular exercise.
It’s hard to imagine that covid-19 could have an even bigger impact on public health — and the global economy — than it already has. But the vascular consequences of the disease, which we’re only beginning to discover, could make this first wave of the pandemic look mild. The work of preventing this second pandemic can’t begin soon enough.
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