We’re starting to understand more and more that COVID-19 can be a multi-organ disease with effects that extend beyond the respiratory system, some of which may persist into the longer term.

US doctors have compiled a review to outline what is understood so far. The review demonstrates that SARS-CoV-2 (the virus that causes COVID-19) can affect nearly every organ in the body, including the brain and nervous system, cardiovascular, digestive, liver, kidney and hormonal systems. As one of the lead authors of the review says, ‘Physicians need to think of COVID-19 as a multisystem disease.’

Organisations in the UK and globally are building an ever-increasing suite of clinical guidelines on the multi-system management of COVID-19, both in the acute infective and longer-term recovery periods.

Where did the story come from?

Medical News Today reported on the review, which was published in the peer-reviewed journal Nature Medicine. The review was authored by doctors working in New York City and other hospitals in the North East of the US.

What is the basis for the claim?

The review authors explain that SARS-CoV-2 enters the body cells via its spike protein, which binds to angiotensin converting enzyme 2 (ACE 2) receptors on the cell surface.  The virus primarily infects cells of the respiratory tract, where there are high levels (expression) of ACE2 receptors. Cell samples have also shown that the virus can enter tissues in the digestive, urinary, cardiovascular and nervous system, where there is expression of the ACE2 receptor. It is expected that any effects beyond the lungs result from the virus causing direct damage to the cells, inflammation and disruption of normal processes. It is not known how SARS-CoV-2 may travel from the lungs to elsewhere in the body, but it is thought possibly via the bloodstream.

The authors summarised the various multi-organ effects of COVID-19, beyond the lungs:

  • Brain and nervous system e.g. brain disorders (encephalopathy), muscle weakness and paralysis, and symptoms such as headaches and loss of smell.
  • Blood clots (thromboembolic), e.g. deep vein thrombosis (DVT), pulmonary embolism and strokes (may also be included in the above neurological category).
  • Heart e.g. heart attack and heart rhythm problems.
  • Digestive system e.g. diarrhoea, vomiting and loss of appetite.
  • Kidney damage e.g. blood or protein in the urine.
  • Liver damage e.g. raised liver enzymes.
  • Hormonal e.g. raised blood sugar.
  • Skin e.g. rashes.

As examples, studies have indicated that, of patients hospitalised with COVID, up to 40% have had signs of neurological involvement, 40% have had signs of kidney damage, 20-30% have had blood clots and 20-30% have had signs of heart muscle damage.

The authors have suggested recommendations on the assessment and management of these various multi-organ effects. For example, routinely assessing blood clotting in all patients hospitalised with COVID and giving drug treatment to prevent clots in most cases. Or routinely analysing urine samples, addressing fluid balance and starting renal (kidney) replacement therapy where indicated.

Doctors will need to continue to gather information and build on existing protocols and guidance around the management of these non-respiratory effects of COVID-19.

What do trusted sources say?

The National Institute for Health and Care Excellence (NICE) has produced guidelines on managing the various complications of COVID-19, including acute kidney injury and heart damage.

Many other national and international organisations have produced guidance on assessing and managing the various clinical manifestations of COVID-19, such as WHO guidance on clinical management.

Analysis by EIU Healthcare, supported by Reckitt Benckiser


  1. Gupta A, Madhavan MV, et al. Extrapulmonary manifestations of COVID-19. Nature Medicine. 2020 Jul 10:1-6. https://www.nature.com/articles/s41591-020-0968-3

Reading list

  1. NICE. Coronavirus (COVID-19). (Accessed 22 July 2020)
  2. WHO. Clinical management of COVID-19. Interim guidance, published 27 May 20