Science Vs - Coronavirus: Weirdest Virus Ever?

Episode Date: June 12, 2020

The coronavirus seems to cause symptoms all over our body, from nose to toes. So how can one virus do so many strange things? To find out, we talk to gastroenterologist Dr. Anthony DeBenedet, virologist and immunologist Professor Ann Sheehy, otorhinolaryngologist Professor Thomas Hummel, and dermatologist Professor Amy Paller.  Here’s a link to our transcript: https://bit.ly/2zqehBZ  This episode was produced by Rose Rimler and Meryl Horn with help from Wendy Zukerman, Sinduja Srinivasan, Michelle Dang and Mathilde Urfalino. We’re edited by Blythe Terrell with help from Caitlin Kenney. Fact checking by Lexi Krupp. Mix and sound design by Peter Leonard. Music written by Peter Leonard, Marcus Bagala, Emma Munger, and Bobby Lord. A huge thanks to all the researchers we got in touch with for this episode, including Dr. Ahmad Sedaghat, Professor Richard Doty, Dr. Elnara Negri, Dr. Evgeniy Podolskiy, Prof. Yvonne Maldonado, Prof. Steven Mentzer, Dr. John Paget, Dr. Connor Bamford, and Dr Gaetano Santulli. And special thanks to Kendra Pierre-Louis, the Zukerman family, and Joseph Lavelle Wilson. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Hi, I'm Wendy Zuckerman, and you're listening to Science Versus from Gimlet. When we first started hearing about the new coronavirus, we were told to be on the lookout for a few specific symptoms. Coughing, fever, shortness of breath. But as the virus has crept around the world, strange stories started appearing about people getting these really weird symptoms. Like this doctor told us about a patient showing up to an ER in Michigan back in March.

With the chief complaint of bloody diarrhea, so blood in her stool, without getting, you know, too gross for listeners. This is my wheelhouse, though. This is Dr. Anthony DeBenedet. He's a gastroenterologist in Michigan. So Anthony's patient was a woman in her 70s who had just gotten back from a vacation to Egypt.

She'd done a cruise down the Nile. And when Anthony heard about her tummy troubles, his mind didn't go to the new coronavirus. She had no fever and no respiratory symptoms at all. So she didn't immediately raise any major red flags. We thought that it was what's commonly referred to as traveler's diarrhea. So to find out what bugs she had, he sent off what's called a biofire stool test. It's the coolest of the stool tests. Which essentially tests for every known GI infection.

And that had come back negative. Meanwhile, Anthony found out that someone on her tour group tested positive for the coronavirus. And so he thought, This could be it. He did the classic coronavirus nose test. But at the time, Anthony was thinking, even if she did have coronavirus up her nose, could that really explain her diarrhea? He wanted to know if the virus was in her poo, because that would suggest that it had wormed its way through her gut. The only problem? Poo tests weren't really a thing in Anthony's hospital. So then at that point,

we decided to do something a little sneaky. And we decided to actually take a nasopharyngeal SARS-CoV-2 kit and actually swab the patient's stool sample. And producer Rose Rimlett talked to Anthony about it. So that was kind of like an off-label use. Totally. Totally off-label. And we sent it to the lab and they processed it as if it was a nasal sample, but it wasn't. We all knew it wasn't. Why did you have to be so sneaky? Well, we had to be sneaky because you're supposed to use the swab, you know, for people's noses.

Labs follow rules. Anthony's gamble paid off. And sure enough, the result was positive. Yeah. And back in March, this idea that this virus could be found in the poo could cause issues to your gut. For Anthony, it was kind of a breakthrough. It surprised us because up until that point, and everyone was just, you know, that this was a respiratory disease in early March. That's how we were all thinking. We didn't realize, I think, that SARS

CoV-2 infection can do really whatever it wants. All around the world, doctors have been having similar breakthroughs to Anthony's. They're seeing patients with symptoms that have nothing to do with fever or shortness of breath. Things like blood clots and COVID toes and people losing their sense of smell. Oh my gosh. There's never previously been a virus infection linked to these reddish-purple toes before. Well, what is this all about?

But these patients were just showing up simply with sudden loss of their sense of smell. Oh yeah, that's crazy. Even as a virologist, this is a little bit, yeah, it is very weird. So today on the show, could one virus really be responsible for all of these things? When it comes to this coronavirus, it feels like it's... Something a little sneaky. But then there's science. Science versus

what the hell is this virus? It's coming up just after the break. Y'all afraid of ghosts? We'll be right back. Here's the best part. It's topped with a sauce made from ghost peppers and oncho chilies. If that doesn't send a chill of anticipation down your spine, nothing will. Get your ghost pepper sandwich today at Popeye's before it ghosts you for another year. Bumble knows it's hard to start conversations. Hey. No, too basic.

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Download Bumble and try it for yourself. It's season three of The Joy of Why, and I still have a lot of questions. Like, what is this thing we call time? Why does altruism exist? And where is Jan 11? I'm here, astrophysicist and co-host, ready for anything. That's right, I'm bringing in the A-team. So brace yourselves. Get ready to learn. I'm Jana Levin. I'm Steve Strogatz. And this is Quantum Magazine's podcast, The Joy of Why. New episodes drop every other Thursday, starting February 1st. Welcome back. So weird symptoms seem to be showing up all over the place with this coronavirus.

And we wanted to know why. How can one virus wreak all this havoc? So to find out what could be going on here, we called up this virologist. Yes, I am Professor Anne Sheehy. Anne is a professor of virology and immunology at the College of the Holy Cross in Massachusetts. And so to find out what this virus is doing once it gets into our body, we're going to hop onto the magic school bus. By the way, I'm a big fan of magic school bus myself. Perfect. So let's shrink down and become a little coronavirus. Whoa! Let's say someone's taken a sniff and you've been pulled up into their nose.

Hmm. It's dark in here. And we have a mission. We need to get inside cells. But they're locked. So to open some of these cells, we've got a special tool. It's these little spikes all over our body. And you can think of them like a key. If I'm little coronavirus, what I'm doing is I'm kind of reaching around with my key in my hand,

but it's actually not going to fit well enough into just any protein. As a little coronavirus, we can only get into cells which have the right lock. It's a protein. And its name? It's going to have to be ACE2. ACE2. This protein is stuck all over the surface of some cells. And we've talked about it before on the show, because very early on, scientists figured out that this coronavirus, it uses ACE2 to crack into cells. And so, once we bust in, we cause a lot of trouble. Once a cell gets infected, it's done. All right, let's leave the magic school bus. So once the virus is inside a cell, it can start replicating and it triggers this process which can kill cells. So this all

means that if a cell has an ACE2 receptor, then chances are this virus can infect it. And one of the places that you can find ACE2 is up your nose. There's a particular spot way up there where there are cells with tons of the ACE2 receptor. And one idea out there is that this can explain one of these weird symptoms that we've been hearing about, people losing their sense of smell. And if you get a lot of cell death, then you would lose your sense of smell temporarily. It makes sense, right?

And this idea that people could lose their sense of smell after being infected with the coronavirus, it really started making headlines back in March when doctors were seeing it in some of their patients. But they didn't know how common it was. And one of the tools that helped them work this out was invented by Thomas Hummel, a professor who runs the Smell and Taste Clinic at the Technical University of Dresden in Germany. He spoke with our producer, Meryl Horn. What's your favorite smell?

My favorite smell? That's a good question. Lily of the Valley. And I love them. But I adore every smell. For Thomas's test, he uses real high-tech equipment. Actually, we have pens. Pens? Oh, like a Sharpie. Yeah, like a felt pen. So we open the cup and then you present the odor and then you cap it again. The pens are called sniffing sticks.

And to get the smell into the pen, researchers actually take this thing that's basically a tampon and soak it in a liquid with a distinctive scent. They then put those soaked tampons inside the pan. It's very elegant because like a pan, it doesn't leak. You know, the odor is sort of sealed there. And here's what Thomas will do with those pans once he's ready to test someone. He'll pull one out with a distinctive smell.

Let's use pineapple. And then it's all people say, I know this. And then you give them a list where it says, this is grass, fish, bread, pineapple. So it's all people say, oh, I know this. And then you give them a list where it says, this is grass, fish, bread, pineapple. So it's very easy. And most people can do this then. And if they can't, then you know they're in trouble.

Yeah. If someone's sense of smell is impaired, they can't figure out whether they're, say, smelling pineapple or fish. When researchers in Germany used this test on coronavirus patients in their hospital, they found that a lot of them had trouble acing it. 80% had some sort of problem with their smell. And this is backed up by similar studies.

And the CDC, it knows this. They now list temporary loss of smell as one of the most common symptoms of the coronavirus. So that's what's going on with smell. But this protein, ACE2, it can explain a lot of other symptoms too. And that's because ACE2, it's not just found in cells in the nose. It's actually found all over our body. Yeah. Here's Professor Anne Sheehy again. So the ACE2 receptor, it's in lung, it's in heart, kidney, cells of the blood vessels, it's liver, it's in the GI tract. The GI tract.

Studies have shown that your gut is full of cells with ACE2, which might explain what was going on with Anthony's patient who had symptoms like diarrhea. Because if the virus gets into your gut, it kills cells there. Those cells would slough off that would turn up as blood, right? So bloody diarrhea as it washed through the system. ACE2 can also explain some of the stuff we've been hearing around blood. Coronavirus patients can get strokes and blood clots. And ACE2, it's found in our blood vessels. And so scientists think that the virus might be attacking our veins and arteries, kicking off this crappy cascade where a bunch of proteins and cells clog up our blood vessels. Now you have red blood cells that cannot traffic through, right?

So they're blocked. And so then they start to clump together. Right. They're like little bits of lint that start to clump together, right? They're like little bits of lint that start to collect with one another and aggregate and cause many clots. So ACE2, it's giving this virus a foothold into lots of different parts of the body, which goes a long way to explaining some of the weird symptoms we've been seeing. But the thing is, even though you can find ACE2 all through the body,

it's not like the coronavirus is ravaging every organ in every infected person. And that could be because for the virus to infect cells, say in your gut, it actually has to get there. And while it's pretty easy for a little coronavirus to get hoofed up someone's nose, it's harder to find its way into the intestine, which could be why diarrhea isn't turning up all the time. One review paper found it happened in roughly 10% of cases. So that's the ACE theory. Can this ACE theory explain all the symptoms that people have? No. No, I don't think ACE is the end of the story.

What is the end of the story? What else could be going on here? Well, that's coming up just after the break. Welcome back. We just learned that some of our cells are sitting ducks for this virus because they have these ACE2 proteins stuck all over them. It's a big part of why the coronavirus can cause trouble all around our body. But it's not the whole story here. There's something else going on. It turns out that in some cases,

this virus can whip our immune system into a frenzy and really mess us up. Our immune system is really trying to get rid of this virus that's being so destructive and fighting too hard. That's Amy Paller, a professor at Northwestern University, just outside Chicago. And Amy told us that when our immune system is trying to kill this virus,

it sends out a bunch of proteins. These are like chemical messengers that can cause inflammation. We see massive inflammation in a wide variety of organs, causing damage in the process. This inflammatory response, it can start attacking our lungs, leading to respiratory failure. And this process is also thought to cause that rare inflammatory condition that's showing up in some kids with coronavirus.

This is where their immune system starts going after vital organs, like kidneys and hearts. So, our immune system overshooting, it can do some serious damage. And that's what we think is going on here. But it turns out that there's a weird and less serious thing coming from coronavirus that might be linked to inflammation. And that's COVID toes. What do we know about COVID toes? Well, what we know about COVID toes is that there are a lot of around. That's our producer Rose talking to Amy. And yeah, one way that our immune system may be

freaking out in response to the coronavirus comes down to 10 little piggies. Or actually... We found that the average number of toes involved was 8.4. Is the.4 the pinky toe? No, that's an average. Those 8.4 toes can look red or discoloured, kind of blotchy. They also might feel itchy or painful. Amy reckons it's this nasty inflammation causing it. But a big question is...

Now, why the toes? Well, the fingers and toes have the smallest blood vessels. So if they're inflamed, we may see redness and swelling of toes very readily. Recently, doctors in Belgium took a closer look at what's going on here. They had a patient with COVID toes and took a biopsy of one of his toes. Yeah, they took a little slice from one of his little piggies. It was the third one, the one that had roast beef.

And when they looked at that toe slice under the microscope, ta-da, they could see a lot of inflammation. Now, one thing we have to tell you is that scientists actually haven't definitively linked these weird toes to the coronavirus, mostly because a lot of people who have them aren't getting tested. But researchers like Amy are pretty sure there's a link here. It's just so hard to believe this doesn't have something to do with the pandemic that's going on. It would just be too weird if this was all popping up now and had nothing.

Too weird, right. And we all believe it's related. Doctors have published papers describing these toes in Germany, northern Italy, France and Spain. And Amy, she's seen hundreds of them. It's a lot of toes. I started making pictures out of them to make a collage, and I ran out of space.

You know what you can do with that collage? That would be a great Zoom background. You're right. I should do that. Even though Amy has seen a lot of patients with these toes, she says that we still don't know why this stuff happens, like why some people get COVID toes and other people get completely different symptoms.

It might be mixed up in things like your genes, the way your immune system reacts, or pre-existing conditions you have. Just the meat and potatoes that makes you, you. Remember that our responses to infection are very individual. There's got to be something about these selected individuals that's different. They produce a little bit of a different stew, they can have the COVID toast. So we think there's two big ways that the coronavirus is working its wizardry. The first is when it directly attacks cells in our body, cracking them open via ACE2. The second,

when our immune system goes haywire trying to get rid of this virus. And often these two suspects are working together hand in hand. And a combo of these two things could actually be leading to a lot of the symptoms we talked about on this show, including losing your sense of smell, getting diarrhea and blood clots. So it's looking like this virus really can cause all these weird symptoms. And that made us wonder, how weird is this for one virus to do all that stuff? It's a nasty virus, isn't it? But it's actually not unusual. She said in the wild world of viruses, this coronavirus, it's not so strange. Like take influenza. We mostly think about it like a lung infection.

But actually, it can make your brain swell and your kidneys fail. Another one, the mumps. For most people, it causes their salivary glands to swell. But for some people, it can make their balls swell too. I'm not even kidding. Yes, I'm talking about the testicles. In fact, Anne Sheehy says the reason this coronavirus might seem so unusual is that it's new and we're giving it a lot of attention, more than we do for most other viruses.

I think the weird stuff poking up now is, I think, is somewhat unusual. But I think it's because everybody's looking. You can think about this virus as the Kylie Jenner of viruses. People are watching it super closely, so they're seeing every little thing it's doing. And Anne's like, if we gave West Nile virus, or say, Angelica Houston, this much attention, we'd notice some weird stuff they were doing too. So, this virus is new, and from all the headlines, it might feel like it's the weirdest virus we've ever seen. But from what we're learning, it's not.

Yeah, so I don't think there's anything crazy unique. I don't think this is an Andromeda strain or anything nuts. It's a virus. It's just a virus. It's just a virus. And now, time for a little NCBC. Today, narwhals. They're known as unicorns of the Arctic. You know, they're the animals with that very long tusk that sticks straight out of their heads. And the funny thing is, other than that massive tusk, scientists don't know much about these creatures. Narwhals are really difficult to study. They hang out in places that are hard for many researchers to get to, like glacial fjords off the coast of Greenland. And they're also

really shy. If narwhals see a giant research boat, they tend to swim away. So last summer, researchers from Hokkaido University in Japan teamed up with some Inuit hunters in Greenland. We knew the lowdown on how to get close to narwhals. They hopped on some boats and got as close as possible, 25 metres or 80 feet away from the narwhals. Then they shut down the engines and lowered microphones into the water to see what sounds they'd pick up. And they did this a bunch of times, managing to record over 17 hours of narwhal sounds, which is really rare. And here's what they heard. These are the actual recordings of the narwhals.

Scientists think this is a social call. Like maybe the narwhals are saying, how's it going, to each other. And researchers also heard this sound. Hear how the noise gets faster and louder, kind of like someone weed whacking next door. Well, scientists realised that narwhals made this noise when they were getting closer and closer to food.

So they think it helps them catch their prey. Which means to all the Arctic fishies out there listening to this podcast, if you hear a suspicious weed whacker sound, swim away. That's Science Versus. Hello? Hey, Meryl. How many citations in this week's episode? Let me scroll down.

There are 107 citations. Oh, we cracked 100. We did it. I think this might be the most of the whole season. Yeah. I guess, you know, science is growing. That's the lesson here. And if people want to see these citations, where should they go?

They can click on our show notes and then follow the links to the transcripts. Thanks, Meryl. Yep. Bye, Wendy. This episode was produced by Rose Rimler and Meryl Horne with help from me, Wendy Zuckerman, Sindhuja Srinivasan, Michelle Dang and Mathilde Erfolino. We're edited by Blythe Terrell with help from Caitlin Kenny. Fact-checking by Lexi Krupp.

Mix and sound design by Peter Leonard. Music written by Peter Leonard, Marcus Begala, Emma Munger and Bobby Lord. A huge thanks to all the researchers we got in touch with for this episode, including Dr. Ahmad Sedegat, Professor Richard Dottie, Dr. Elnara Negri, Dr. Yevgeny Podolsky, Professor Yvonne Maldonado, Professor Stephen Mensah, Dr. John Padgett, Dr. Connor Bamford, and Dr. Gaetano Santulli. A special thanks to Kendra Pierre-Lewis, the Zuckerman family,

and Joseph LaBelle Wilson. I'm Wendy Zuckerman. I'll back to you next time.