COVID-19 is far more than just a respiratory disease, according to a new review.

“[It’s] important to understand that a substantial proportion of [COVID-19] patients suffer kidney, heart, and brain damage, and physicians need to treat those conditions along with the respiratory disease,” said the study’s lead author Aakriti Gupta, M.D., a Columbia University cardiologist. “Physicians need to think of COVID-19 as a multisystem disease.”

Gupta and doctors from Columbia, Harvard and Yale Universities, as well as Mount Sinai Hospital, performed what they say is the “first extensive review” of COVID-19’s effects on human organs. Findings included the following (summarized):  

Blood clots and inflammation: COVID-19 can cause numerous blood clots. These clots travel all over the body, wreaking havoc on organs, and perpetuating more clotting. Some of the review’s authors are studying whether anticoagulants can help.

Heart damage: Blood clots can affect the heart in COVID-19. But the heart may also be damaged by systemic inflammation and cytokine release, a normal flood of immune cells that spirals out of control in severe COVID-19 cases, say the reviewers. Other studies have found that COVID-19 can worsen existing heart conditions, while causing new ones.

Kidney failure: An enzyme receptor used by the virus to enter cells (angiotensin-converting enzyme 2) is found in high concentrations in the kidneys. The reviewers suspect that ACE2 is responsible for the kidney damage seen in many patients. In fact, studies in China have found that up to 50% of patients in intensive care units had renal failure.

Neurological symptoms: About a third of patients with COVID-19 experience headache, dizziness, fatigue, and/or loss of smell. Strokes occur in about 6% of severe cases, and in up to 9% of those patients are diagnosed with delirium — likely from prolonged intubation.

The review was published Monday in Nature Medicine.