Is COVID-19 a vascular disease, not a respiratory one? What does it imply for your treatment?

A study from the University of San Diego in California claims to have proof that COVID-19 is not a respiratory disease but a vascular one. This could explain the presence of thrombi in the blood – perhaps also those that occurred after inoculating certain vaccines – and other symptoms such as “COVID feet” that did not seem to have a place in a classic respiratory disease.

The study published in the scientific journal “Circulation Research” accurately shows the mechanism by which the virus damages the cells of the vascular system.

It was already known that among the various symptoms of COVID-19, in addition to the well-known respiratory problems, there are thrombi and other cardiovascular complications that can affect other parts of the body. The novelty is that the team that also includes scientists from the Salk Institute for Biological Studies in La Jolla, California, has demonstrated the way in which the virus attacks the vascular system.

The virus’s protein S, the “spike” that forms its “crown,” attacks the ACE2 receptor, damaging the mitochondria, which generate the “energy” for cells, causing damage to the endothelium, which lines blood vessels. This is something that has already been observed in other investigations. What was not known is the exact mechanism and role of protein S, the “spike” of the virus.

This protein is replicated with different methods in all vaccines on the market.

The study, creating a pseudovirus that only has protein S but not the rest of the virus, demonstrated in the laboratory that this protein, the famous coronavirus, is sufficient by itself to cause the disease. And that its main action is on the vascular system.

Conditions in the respiratory system are a consequence of inflammation of the vascular tissues of the lung.

“A lot of people think it’s a respiratory disease, but it’s actually a vascular disease,” says research assistant professor Uri Manor, a co-author of the study. “That could explain why some people have strokes and why others have problems elsewhere in the body. What they have in common is that they all have a vascular background.”

An effect only in severe cases?

For Professor Rafael Máñez Mendiluce, who has been treating COVID-19 patients for a year as head of intensive care at the Bellvitge University Hospital, it is not a surprise, in view of the clinical pictures presented by those who come to his service.

A year ago he already explained to us that the greatest risk of COVID-19 was the inflammatory condition that patients presented. Remember also that thrombi are phenomena that occur in other viruses.

In addition, Máñez Mendiluce also wonders if vascular problems do not occur only in the most serious patients, once the infection has already “conquered” the respiratory tract, spreading through the blood. “In general, in mild patients, the infection is limited only to the upper airways.” He also wonders if vascular problems are not related to the inflammatory response of the patient’s immune system, as is the case with other diseases.

He estimates that it could be only one of the factors involved in this disease.

For Máñez Mendiluce, with 30 years of experience in intensive care, this discovery does not drastically change the possibilities of treating the most serious cases. Remember that antithrombotic drug treatments have not been shown to be particularly effective and that for now it is recommended to focus on inflammation caused by the immune response.

It is an old problem in intensive care. “We continue to have no treatment for thrombosis caused by the inflammatory response generated by the infection,” he explains.

The discussion in the scientific community remains open, he adds. These problems are recurrent in intensive care units.

However, for Máñez Mendiluce, this study does not question the existing vaccines, although it would be necessary to better understand why the Astrazeneca and Johnson & Johnson vaccines have caused some rare cases of blood clots.

The discovery has caused quite a stir. Some wonder if the strategy so far has not been wrong. And if it is not dangerous for vaccines to inoculate precisely replicas of the protein S that seems to be capable of causing the disease.

However, Manor himself said on his Twitter account that, contrary to what the anti-vaccines say, the study only shows that COVID-19 is a very insidious disease. Explain that the amount of protein S in vaccines is too small to be problematic.

He also comments that the messenger RNA vaccine is much safer than suffering from the disease. “Everyone should get it, I did and everyone in my family did too! Our article just shows that this disease really sucks.”

Now researchers at the Salk Institute hope to better understand the mechanism by which protein S-damaged ACE2 receptors cause mitochondria to deform and damage, which then cause problems in vascular tissue.

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