Registered nurse Raquel Hernandez reaches in to swab a passenger for a COVID-19 test at a mobile testing site at the Murray County Expo Center in Sulphur, Okla., Tuesday, April 14, 2020, in Sulphur, Okla. The testing was performed by staff from District Eight of the Oklahoma State Department of Health. AP Photo/Sue Ogrocki)
Oklahoma is nearing one thousand deaths from COVID-19 complications. Like everywhere else, the people dying here have a high rate of what are called comorbidities, or underlying health conditions. They make it harder for the body to fight the virus, and they make death from it more likely.
In Oklahoma, seventy-six percent of people who died had a comorbidity. Taking a closer look, more than half of the people who died had a heart or circulatory condition.
State Epidemiologist Jared Taylor says there are likely many reasons for that. First, heart conditions are common among Oklahoma’s elderly. According to the United Health Foundation’s annual report, more than 15 percent of Oklahomans over 65 have heart disease.
“That it’s just something that’s very common in the oldest population who are at greatest risk,” he said. “I don’t believe it is simply a correlation issue at all. It is actually a cardiovascular attacking disease.”
To understand how the disease attacks the cardiovascular system, you have to know a little about how viruses work. Viruses make us sick by getting into our bodies, invading our cells, and then replicating, causing damage along the way. Our cells have doorways that let things inside them. Different viruses look for specific doorways into our cells. The doorway that the virus causing COVID-19 looks for is related to the circulatory system, as well as a few other parts of the body, like the lungs and intestines. Taylor said it makes sense then that the virus would cause damage to those organs.
“The virus doesn’t only affect the cardiovascular system, obviously,” Taylor said. “But because it uses a doorway that is integral and critical to the cardiovascular system functionality, it disrupts the cardiovascular system.”
Dr. Jabraan Pasha practices internal medicine, and serves as the president of the board of directors for the Tulsa American Heart Association. He says when the virus first appeared in the spring, the symptoms related to the respiratory system were in the forefront. But as the medical community continues studying this novel virus, its impact on the heart is becoming more clear. .
“We can see that that does indeed appear to be the case, that individuals who have cardiovascular disease are dying at rates not seen with most other conditions,” Pasha said. “And so now I think it’s fair to say that this virus isn’t just a respiratory virus, it’s also a vascular virus.”
Autopsy reports highlight heart damage in people who died of COVID-19, even in those who hadn’t had heart-related comorbidities. Heart damage is starting to be seen in survivors as well.
“They’ve also seen in studies where they took individuals who had cleared the infection, per se, at least recovered and did a cardiac MRI, which is a special MRI. They could see inflammation in the heart that was most likely from COVID.”
COVID-19 damage research like this MRI study is being conducted across the world, including here in Oklahoma. Dr. Judith James is an immunologist and medical doctor at the Oklahoma Medical Research Foundation.
She says there are studies, such as the one Dr. Pasha mentioned, looking at inflammation and other kinds of damage to the heart. But that isn’t the only way the circulatory system is affected. She and her colleague Joan Merrill have been researching how COVID-19 can cause blood clots, and who is likely to develop them. That’s especially important in Oklahoma.
“One of the things that’s clearly become evident is that some people have an increased risk of having clotting disorders or blood clots thrombosis,” she said. “And that right now we can’t predict who those people are. So there are Oklahoma investigators and people around the world who are working on trying to understand. Can we when you first come in with a new COVID infection, can we identify the people who are at higher risk for clot?”
It might sound strange that our understanding of the disease has changed so much in just a few months. Taylor, the state epidemiologist, and James at OMRF says that’s to be expected because the virus is new. Here’s Taylor.
“We have diseases we’ve been studying for decades that we don’t fully understand at the molecular and cellular systems level,” he said.
