The Coronavirus is officially called SARS-CoV-2, which stands for Severe Acute Respiratory Syndrome Corona Virus 2. This virus causes Covid-19, the disease currently sickening millions and killing hundreds of thousands. Despite the warnings of government officials and health experts, some persons are questioning the severity of this disease. Is it really that bad? Here are some of their concerns:
Concern: “Most of the persons dying are elderly, who would have died of something else, if not from this.”
Response: The total number of persons dying is much higher than this time last year. So that means that most of those dying from the virus would not have died anyway. Some young adults are dying of Covid-19. Some children have usual and sometimes severe symptoms
Concern: “Some of the deaths reported as due to Covid-19 were actually from other causes.”
Response: Yes, there are always some errors in categorization in anything. But overall the deaths from Covid-19 were correctly reported. This is true because it is an unusual disease; it stands out from other causes of death.
Concern: “80% of cases are mild, so for most persons, it is not that bad.”
Response: The 80% figure comes from an early study out of China that categorized patients as mild, severe, or critical; the “mild” category included persons with pneumonia, vomiting or diarrhea, and/or severe muscle pain. More recent studies have used a fourth category: “moderate”. Also, persons who are categorized as mild or moderate could still have lasting bad consequences to their long-term health. The Coronavirus can cause lasting lung damage, in the form of fibrosis; clots in the brain, heart, and deep veins throughout the body; damage to the reproductive system; damage to the central nervous system.
Concern: “The pandemic is being exaggerated in order to disrupt society and give more power to certain persons or organizations.”
Response: This disease really is that bad. See the descriptions of cases and harm caused by the disease. And the disruptions to society, such as violent protests, are perhaps partially caused by fear of the disease (which can cause great suffering and death) and by frustration and anger that not enough is being done to solve this problem. It is not a plot by anyone, but a type of natural disaster that does occur in human history from time to time (e.g. Spanish Flu, Black Plague, and as I write this I’m hoping this pandemic doesn’t measure up to that standard).
How Bad Is It?
The Coronavirus, SARS-CoV-2, is spherical, like a soccer ball, but with hundreds of Spike proteins sticking out of it all around. The “spikes” are actually shaped more like a morel mushroom, or at least a spike with the pointy end down. The Spikes help the virus infect cells. It can only infect cells which have a certain protein on the surface of the cell, embedded in the cell wall. Human cells have many different types of proteins stuck into the cell wall, for various purposes. In this case, the protein is called ACE2.
When a virus Spike docks with an ACE2 receptor, the Spike breaks the receptor and begins merging with the cell. It then drops its RNA into the cell, along with its N-protein (which wraps and protects the viral RNA). Since the virus only infects cells with ACE2 proteins on the surface, which cells have that ACE2? Lungs, heart, kidney, intestines, blood vessels, reproductive organs of men and women, fat tissue, thyroid, esophagus (throat), breast, salivary glands, pancreas [1, 2, 3]. Yes, any and all of those cells can be infected by the Coronavirus. And that is bad. Infection of any organ by SARS-CoV-2 causes harm to that organ.
The Coronavirus versus the Immune System
In summary, the virus’ shell is made of the same stuff as the cell walls of the human cells, so the immune system can’t recognize it as foreign. The viral shell or membrane is coated with hundreds of Spikes, that the immune system should recognize and attack — except that the Spike is coated with sugar chains, called a glycan coat, that flail around and beat back antibodies and such. The Spike stalk is hinged in three places, which allows the Spike “to scan the host cell surface, shielded from antibodies by an extensive glycan coat.” 
The virus infects cells by docking with the ACE2 receptor, and it breaks that receptor, throwing the regulation of the major organs out of balance. Then it drops its RNA into the infected cell, along with an “N-protein” which turns off one of the cell’s defense mechanisms (mRNA silencing system). The N-protein and two of the viral proteases then get to work cutting up and deactivating the human proteins that control the immune system. This makes sure the first line of defense, the innate arm of the immune system, does not react much to the infection. And they cut up other immune system proteins, resulting in a later over-reaction, with hyper-inflammation, called the cytokine storm. See How Covid-19 Attacks your Immune System for details and references.
The virus breaks these ACE2 receptors, irreparably, when it infects a cell. This causes a sudden decrease in the amount of ACE2 in your body, but the amount of ACE1 (actually just called “ACE”) remains the same. This imbalance causes havoc with regulation of blood pressure and blood vessels. Ordinarily, you have enough of both types of “ACE” to keep kidneys, lungs, heart, and blood vessels in balance. Wrecking most of your ACE2 throws this ACE system (technically the Renin-Angiotensin System) into a tail spin. One effect is the blood vessels in the lungs expand, and let fluid seep into the lungs, making it increasingly difficult to breath. This is why many Covid-19 patients need to be put on mechanical ventilation. They have to breath very deliberately, deep and fast, just to get barely enough oxygen, and they just can’t keep that up without mechanical assistance and extra oxygen. It’s like drowning from the inside.
After a patient recovers from Covid-19, they can have so much damage to their lungs that a type of lung scar tissue, fibrosis develops, making it permanently hard to breathe. The similar virus SARS-CoV-1, which causes “SARS”, patients had so much fibrosis in their lungs even a year or more later, that some of them were dying of this cause . Those who don’t die have a decreased quality of life. It’s not fun to have constant difficult breathing.
Damage to the heart has been found in many Covid-19 patients, “occurring in 20% to 30% of hospitalized patients and contributing to 40% of deaths” . This damage is caused in part because the Coronavirus infects heart muscle cells by means of their ACE2 on the surface of heart cells, thus destroying many cells of the heart. Usually, a heart attack is caused by a clogged artery, cutting off blood flow and therefore oxygen to the heart muscle. Here, the virus attacks the heart cells directly by infecting them. After forcing the heart cells to make many copies of the virus, the virus then destroys the cells.
A recent study found that liver damage “is more frequently occurring in severe COVID-19 cases compared with patients with mild disease. The underlying mechanism of hepatotoxicity in patients with COVID-19 could be due to systemic inflammation, drug-induced liver injury, or pre-existing chronic liver diseases.”  It is not clear what is causing the liver damage. It might be the disease itself, or the medications used to treat the disease.
Massive Blood Clotting
Thrombosis occurs when a blood clot inside the blood vessels gets stuck in an artery or vein, blocking the blood vessel. Covid-19 can cause massive blood clotting. The SARS-CoV-2 virus infects the cells that line the blood vessels; damaging the lining causes clotting. Blood clots can add to the damage of the lungs and heart. They can also cause damage to the brain. Some of the blood clots lodge in the deep veins of the body. About half the time, blood clots mainly affect the lungs; but they can also affect the brain (causing a stroke), heart, or the arms/legs .
A physician [Roger Seheult, MedCram] who specializes in lungs (pulmonologist) described dealing with a blood clot in the brain of one of his patients. They used contrast so they could see the clogged blood vessel in the brain. They used a long catheter device to reach the vein in the brain. Then they watched on the monitor in real time as they cleared the clot — and another clot immediately formed. Clearing that clot led to another one forming right away again. They had never seen that before in any patient. Scary.
An ICU physician [Mike Hansen] had a patient with Covid whose kidneys shutdown. They put the patient on dialysis — but the machine kept clogging from the massive amount of blood clots! [video link here]
This CNN news report discusses a case series  of autopsies showing extensive clotting in almost every organ of the body. The autopsies also found blood clots in the capillaries of the lungs.
One theory  is that the virus can attach to the outside of Red Blood Cells (RBCs) and also attach to platelets. So when clotting occurs, the virus becomes part of the clot; it helps to bind the RBCs and platelets and fibrin altogether. It can also infect the platelets. This study — Platelet Gene Expression and Function in COVID-19 Patients — states that SARS-CoV-2 infects platelets, even though they don’t have ACE2, and causes the platelets to go into a state of hyperactivity, which is part of the reason for massive clotting in some patients.
Then, too, because the virus is attacking the cells that line the blood vessels, the opposite problem can occur, bleeding instead of clotting. These so-called hemorrhagic events can occur in the brain, liver, deep in the muscles, or in the gastro-intestinal system . In the brain, whether it is a clot or a hemorrhage, a stroke can occur as a result.
Attack on Hemoglobin
Liu, W., & Li, H. (2020). “COVID-19: attacks the 1-beta chain of hemoglobin and captures the porphyrin to inhibit human heme metabolism.” Preprint revised on, 10(04).
“These three domains were highly overlapping so that ORF3a could dissociate the iron of heme to form porphyrin. Heme linked sites of E protein may be relevant to the high infectivity, and the role of heme linked sites of N protein may link to the virus replication.”
“The study results showed orf1ab, ORF3a, and ORF10 proteins could coordinately attack 1-beta chain of hemoglobin.”
The Covid-19 virus evades the immune system, in various ways, so that it takes a while before your system can recognize that a viral infection is occurring and fight back. In the meantime, the virus is multiplying, without restraint. When the immune system finally recognizes that an infection is underway, it suddenly sees a vast amount of virus — and it over-reacts. It pours out a large amount of all its “troops” called cytokines. Cytokines include numerous different types of small proteins which cause inflammation and fight infection. But in excess, they wreck your body, especially your lungs. This is the cytokine storm. It kills many Covid-19 patients.
Covid-19 Attacks the Brain
A large percentage of severe Covid-19 cases develop delirium during the worst days of the disease.
“Delirium is a sudden, fluctuating, and usually reversible disturbance of mental function. It is characterized by an inability to pay attention, disorientation, an inability to think clearly, and fluctuations in the level of alertness (consciousness).” [Merck Manual]
In one study, “Delirium occurred in 73.6% (106/144) and delirium or coma occurred in 76.4% (110/144)” of ICU patients with Covid-19 . The delirium lasted about 5 days, cases with delirium and coma lasted about 7 days.
Yes, delirium and coma can result from Covid-19, and it is not rare. And there are other neurological problems caused by SARS-CoV-2, including a case of acute vision loss , Guillain-Barre Syndrome (sudden onset of progressive weakening of the muscles) , auditory hallucinations, and brain/spine demyelinating lesions (loss of insulating fat on the neurons) .
Covid-19 can cause strokes. This is caused either by thrombosis, clots that clog arteries in the brain, or by hemorrhaging, by bleeding in the brain.
Why does this happen? SARS-CoV-2 can infect neurons in the brain and the rest of the nervous system . “Reports indicate that 30-60% of patients with COVID-19 suffer from CNS symptoms” .
“Between 25 and 40% of the SARS-CoV-2 patients present neurological symptoms, these can go from mild symptoms including olfactory and gustatory disorders, dizziness, headache, confusion, to a more severe cerebrovascular disease, encephalitis, seizures or the Guillain-Barré syndrome (Asadi-Pooya and Simani, 2020; Mao et al., 2020).” 
theguardian in the UK: Warning of serious brain disorders in people with mild coronavirus symptoms – “UK neurologists publish details of mildly affected or recovering Covid-19 patients with serious or potentially fatal brain conditions”
Winter Is Coming
Several studies have now concluded that Covid-19 is a seasonal disease, one which will be worse in winter than in summer. See the explanation in this article. If so, then the case rate and fatality rate will climb in October, and again in November, and again in December. And then things will remain bad until late spring, 2021.
Vaccines to the Rescue
Or maybe not. As the article on the immune system explains, this virus is good at evading and even outright attacking our immune system. This suggests that the first vaccine might have a low effectiveness. They might protect 25 to 33% of the population from infection, and then, for those who are vaccinated but also become sick with Covid-19, it may lessen the severity of the disease. But after spending almost every day for 4 months reading the research on this disease, I find it hard to believe that the first vaccine will work better than that. This virus is just better than almost any other in fighting the immune system.
Suffering and Death
Covid-19 is a disease that can be mild in some persons. It can also be very severe, causing much pain, making the person feel as if they cannot breath, can causing fear and anxiety. The disease can cause lasting damage to the human body. And then there is the death rate, which is currently at about 5%, comparing deaths to reported cases. Recently, the world surpassed 10 million reported cases and half a million deaths at about the same time (late June). That is 10 million persons who suffered a great deal, and half a million who died.
How bad is it? Millions have suffered, and millions more will suffer. Over half a million have died, and it is likely millions will die before it is all over. If it is all over. It’s possible that the virus may evolve, so that we need a new vaccine every year, as with the flu. It’s possible that an effective vaccine will not be found.
Please do not underestimate the threat posed by Covid-19.
Ronald L. Conte Jr.
Note: the author of this article is not a doctor, nurse, or healthcare provider.
1. Bastolla, Ugo. “The differential expression of the ACE2 receptor across ages and gender explains the differential lethality of SARS-Cov-2 and suggests possible therapy.” arXiv preprint arXiv:2004.07224 (2020).
2. Barros, Romulo O., et al. “Interaction of drugs candidates with various SARS-CoV-2 receptors: an in silico study to combat COVID-19.” (2020).
3. Basu, Anamika, Anasua Sarkar, and Ujjwal Maulik. “Computational approach for the design of potential spike protein binding natural compounds in SARS-CoV2.” (2020).
4. Hui, David S., et al. “The 1-year impact of severe acute respiratory syndrome on pulmonary function, exercise capacity, and quality of life in a cohort of survivors.” Chest 128.4 (2005): 2247-2261.
5. Akhmerov, Akbarshakh, and Eduardo Marbán. “COVID-19 and the heart.” Circulation research 126.10 (2020): 1443-1455.
6. Fraissé, Megan, et al. “Thrombotic and hemorrhagic events in critically ill COVID-19 patients: a French monocenter retrospective study.” Critical Care 24.1 (2020): 1-4.
7. Merkler, Alexander E., et al. “Risk of Ischemic Stroke in Patients with Covid-19 versus Patients with Influenza.” medRxiv (2020).
8. Turoňová, Beata, et al. “In situ structural analysis of SARS-CoV-2 spike reveals flexibility mediated by three hinges.” bioRxiv (2020).
9. Song, Eric, et al. “Neuroinvasive potential of SARS-CoV-2 revealed in a human brain organoid model.” bioRxiv (2020).
10. Selvaraj, Vijairam, et al. “ACUTE VISION LOSS IN A PATIENT WITH COVID-19.” medRxiv (2020).
11. Toscano, Gianpaolo, et al. “Guillain–Barré syndrome associated with SARS-CoV-2.” New England Journal of Medicine (2020).
12. Zanin, Luca, et al. “SARS-CoV-2 can induce brain and spine demyelinating lesions.” Acta Neurochirurgica (2020): 1-4.
13. Song, Eric, et al. “Neuroinvasive potential of SARS-CoV-2 revealed in a human brain organoid model.” bioRxiv (2020).
14. Khan, Sikandar H., et al. “Delirium Incidence, Duration and Severity in Critically Ill Patients with COVID-19.” medRxiv (2020).
15. Murta, Veronica, Alejandro Villarreal, and Alberto Javier Ramos. “SARS-CoV-2 Impact on the Central Nervous System: Are Astrocytes and Microglia Main Players or Merely Bystanders?.” (2020).
16. Scheim, David. “Antimalarials for COVID-19 Treatment: Rapid Reversal of Oxygen Status Decline with the Nobel Prize-Honored Macrocyclic Lactone Ivermectin.” Available at SSRN 3617911 (2020).
17. Farshidpour, Maham, et al. “A brief review of liver injury in patients with Corona Virus Disease-19 during the pandemic.” Indian Journal of Gastroenterology (2020): 1-4.
18. Rapkiewicz, Amy V., et al. “Megakaryocytes and platelet-fibrin thrombi characterize multi-organ thrombosis at autopsy in COVID-19: A case series.” EClinicalMedicine (2020): 100434.