Dr. Mary Fowkes was instrumental in highlighting the findings that COVID-19 has many systemic effects, including abnormal hypercoagulation with occurrence of large pulmonary emboli and microemboli in many organs, including lungs, heart, liver and brain. You commented that this phenomenon is heightened in patents with recurring illness. Is it also commonly contributing to morbidity and mortality in those patients with a first exposure who progress to severe symptoms needing intensive care?

This is true of some patients and not others, but it is a common feature. It is largely missed because there are so few autopsies done these days to truly look at a tissue and cellular level when you have something that is presumed, in the first place, to be a respiratory virus and the member of a pre-existing family about which much is known and has been studied. Dr. Fowkes was a real pioneer and was instrumental in drawing attention to this more unique aspect that COVID-19 has a heavier predominance of these complications than other respiratory viruses, like the original SARS. Whether or not it is a key determinant of survival will be quite variable, but it will cause damage that increases vulnerability and will compound the consequences of other illnesses involving these target organs, including a reinfection with the COVID-19 virus. The patient will simply be more vulnerable and more likely to have a worse round of illness, assuming that any immunity gained by the first go-round was modest or has waned sufficiently to make the person vulnerable to reinfection.