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The job title Crime Scene Investigator is one of many that describe individuals who discover, document, and preserve all pieces of evidence at the scene of a crime. This article will give an idea ofhow to become a CSI, as well as an overview of the professional career of a crime scene investigator. It will include everything about how to become a criminal investigator including education requirements and paths to the CSI profession to job duties and crime scene investigator salary information.

A Crime Scene Investigator (CSI) is in charge of extracting every possible piece of evidence from a particular crime scene. More often than not, they are employed by state or federal law enforcement, but civilians with a background in science may also be qualified for this position. These observational experts are also indispensable during trials, due to the importance of their professional testimony in the courtroom.

A CSI is a thorough crime scene examiner that can turn a chaotic crime scene into hard evidence. Their findings will point law enforcement officers in the right direction, and eventually, help solidify the state prosecutors case in court.

The very start of a crime scene investigators work is what differentiates this occupation from other jobs in the field of forensics. Their data collection is not done in a laboratory; it is done primarily out in the field. They must travel to a crime scene to conduct their research. Crime Scene Investigators are basically highly trained forensic scientists on call. That being said, most CSIs work a standard forty-hour work week with standard hours, with only some variation due to specific cases.

To convert a crime scene into practical evidence that law enforcement can use, a crime scene investigator must first preserve the scene, sealing it off to make sure it is not contaminated or tampered with. If the crime scene is contaminated by a civilian or a law enforcement officer, all of the collected evidence could be considered null and void by a judge during the trial.

Then, a crime scene investigator will make precise measurements and take exhaustive photographs of any possible piece of evidence for a detailed diagram of the scene. Scales are always included photographs so that the exact size of every piece of evidence is known, no matter how minuscule or seemingly unimportant. Labels are also included in photographs to easily refer to each piece of evidence. This is all imperative for crime scene recreation and diagram drawing, which may also fall under the responsibilities of a CSI or their close counterpart, the Forensic Technician.

When everything is thoroughly documented, a crime scene investigator is tasked with packaging and preserving all pieces of physical evidence. Investigators must take extraordinary care in all facets of the job, but it may be most important here. Extremely careful collection of evidence with completely sterile equipment is imperative when it comes to the bigger picture. Everything the investigator finds is further analyzed in a forensics lab to provide further information on the role of these objects in the crime and their meaning to the prosecutors case. If these pieces of physical evidence are not packaged and documented correctly, they could be removed from consideration during the trial. If the pieces of evidence themselves are removed from consideration, the forensic analysis of them may be removed, as well.

Every CSI must be able to testify in court about the evidence collected at a crime scene. While on the stand, they have to ensure that the evidence found has not been contaminated or tampered with and they must ensure that the evidence was collected and documented correctly. It is also important for a CSI to be able to convey complicated findings clearly and succinctly in the courtroom so that all participants understand the meaning of each piece of evidence. If they are not able to do this, an important piece of evidence may be misunderstood by the judge or jury.

One of the most important pieces of this occupation is that a CSI must look at a crime scene objectively and analytically, without allowing the disturbing environment distract him or her from collecting helpful evidence. The gore that an investigator will almost definitely come across cannot keep them from thoroughly carrying out their duties.

What does a CSI do? Here are some of the specific job duties that a crime scene investigator will come across frequently in his or her professional career:

Becoming a CSI includes specific work experience and educational requirements are expected of crime scene investigator candidates.

Education

Bachelors Degree, Higher degrees could advance your forensic career

Recommended Fields

Criminal Justice, Computer Science, Forensic Science, or Biology

Preferred Experience

Law Enforcement

Expected Skills

Attention to detail, Critical-thinking, and problem-solving skills, Ability to remain focused despite the environment

It's important to have background knowledge into the foundations of crime scene investigator's responsibilities. Earning a Bachelor of Science in Criminal Justice, Bachelor of Science in Computer Science, or a Bachelor of Science in Biology will prepare you with the knowledge you'll need to succeed as a crime scene investigator. Having a bachelor's of science degree in any of these fields will qualify you to either obtain a job or further your education in this field right after graduation.

Real-life work experience will provide you with the intricate know-how employers are looking for when hiring for jobs. Obtaining an internship or a job within the crime scene investigator field or similar will add to your educational background in this area and make you a more desirable candidate. Most employers are looking for 6 months - 2 years of experience in the field, and some may even provide you with this experience when you begin. Collecting evidence, then subsequently processing and analyzing the evidence are all key skills you will gain during this time.

Depending on the state, there are different requirements for state licensure as a crime scene investigator. Through the International Association for Identification (IAI), you can complete various certifications to further your career depending on the crime scene investigator specialty you'd like to master. Some certifications include bloodstain pattern analysis, forensic art, latent print, and forensic photography certifications.

Be aware that this is not the only route to take to become a CSI, just the most common. Some become crime scene investigators directly through the police force, without earning their Bachelors degree and only using their experience in the field. Having a bachelor's degree within this field and/or relevant certifications could assist you further down the road if you are looking to advance your field or specialize in a specific area of crime scene investigation.

According to PayScale, a large database on salary information, the most up to date information for the median Crime Scene Investigator salary in 2018 is $43,860 per year.

Lowest Recorded Salary

$29,817 per year

Median Salary

$43,860 per year

Highest Recorded Salary

$73,034 per year

It is important to note that salaries for a crime scene investigator vary greatly based on location and prior experience. In a metropolitan, high-crime area, an experienced and successful CSI may be able to break into a six-figure salary.

Here are the median salaries for similar occupations based on 2017 data from the Bureau of Labor Statistics:

Forensic Technician

$57,850 per year

Biological Technician

$43,800 per year

Police and Detectives

$62,960 per year

In regard to career growth, crime scene investigator is a very interesting occupation. A CSI who is a member of law enforcement can be promoted in the traditional way, through the police ranks (Captain, Lieutenant, etc.). That promotional route results in higher salary, higher rank, and it usually allows the employee to continue working with their original team.

There is also some opportunity for upward mobility when it comes to a CSIs employer. With enough experience and success someone working for local law enforcement, an investigator could pivot into working for a government agency like the FBI. That kind of employment would generally garner a raise in salary.

Another unique thing about career opportunities for a Crime Scene Investigator is that many of them have already completed Police Academy training. This gives them the ability to transfer into different departments within the police force. If a CSI decided their skills would be more helpful somewhere else, they could transfer fairly easily between departments because of their completed Police Academy experience.

Here at Gwynedd Mercy University, we offer a variety of programs that will help kickstart your journey with a crime scene investigator education. Through our three Bachelor of Science Degree programs, you will become highly trained by professors with experience in the CSI field. Find out more about what we offer below!

Source: Bureau of Labor StatisticsSource: Payscale.comSource: CrimeSceneInvestigatorEDU.org

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How to Become a Crime Scene Investigator (CSI): Education ...

CSI: Crime Scene Investigation was a popular television drama series that ran for 15 years on CBS. The show centered on using physical evidence to solve murders.

Parkers Chapel alum Lauren (OPry) McDonald said those shows, while entertaining, arent always realistic. McDonald is a Chief Forensic Chemist of the Arkansas State Crime Laboratory in Little Rock.

These shows have shaped the expectation of the public. Theres always a fingerprint, DNA, or something there. Sometimes prints are there but are not of sufficient value to be usable to identify a person, McDonald said. Even though DNA is present, sometimes an association to a specific person cannot be made, whether it is due to complexity of the sample matrix or lack of a known source of DNA for comparison. We as forensic scientists do not leave the laboratory and question suspects. Our area of expertise is science. We leave the investigations to law enforcement. These television shows depict laboratory analysts getting results within an hour or two of the submission to the laboratory. This is rarely the reality, as forensic testing takes longer than a few hours and each case must undergo peer review to ensure we have followed proper procedures and reached an appropriate conclusion based on the results of testing.

So, while Abby Sciuto on the TV series NCIS might be a quirky, loveable forensic scientist, she's also very much a fictional character.

McDonald, who graduated from Parkers Chapel in 1998, has worked for the crime lab for 15 years. She started as a forensic chemist and progressed to Assistant Chief Forensic Chemist in 2016 and then to Chief Forensic Chemist in 2018.

As a Chief Forensic Chemist, I manage a team of Forensic Drug Chemists and work closely with the other Chief Forensic Chemist. Drug Chemistrys size necessitates two managers. When fully staffed, we have a total of 30 analysts across three locations. We have satellite laboratories in Hope (Drug Chemistry) and Lowell (Drug Chemistry and Toxicology), said McDonald.

The routine duties of the Chief Forensic Chemist include: case work management, policy and procedure writing and review, instruction to analysts on difficult casework samples, ensuring quality and safety policies are followed, communication with attorneys and law enforcement, education of law enforcement and the public, and working with administration in many ways to grow the agency.

McDonald said she also still works as a forensic chemist when time permits. That role uses multiple testing schemes to analyze evidence submitted to the agency to determine of it contains controlled substances. An official report of the findings is produced and testimony may be called into court.

Whats it like having a job that half of the network television schedule imitates?

Getting to say you work at a crime lab definitely brings the cool factor, but Id say the biggest pro for me is knowing my work is essential in the criminal justice process and contributes to society as a whole, said McDonald. As a manager my favorite part of the job is seeing individual analysts grow in their careers. Forensic scientist jobs are typically stable government jobs with normal Monday-Friday daytime hours, good benefits, and paid time off. Probably everyone in forensics will give you the same con, dont go into this field looking to get rich. You are paid fairly, but most government positions do not have the same leeway for raises and salary increases that private companies do.

See the article here:
Working in a crime lab not the way it looks on television - El Dorado News-Times

He was a school teacher who didnt want to be a cop. He was a cop who never wanted to be sheriff.

But Mike Hawley turned out to be the right person for both jobs. Before retiring last week, he spent 32 years in law enforcement on Whidbey Island, including 10 years as the political head of the Island County Sheriffs Office during a time of personnel crises and transformations in law enforcement.

Mike Hawleys list of accomplishments is near legendary. He put up with politics and bureaucratic mindsets, brought community policing into country neighborhoods, and helped establish the local Juvenile Justice Center, said Jan Smith, who was chief administrative deputy and de facto undersheriff when Hawley was in office.

Then he gave up running for the elected position, went back on the road as a lieutenant and dedicated more of his time to helping his wife MLiss, who passed away last year, with her international career as a quilt and fabric designer, entrepreneur and author.

WHIDBEY ISLAND law enforcement will undoubtedly miss Hawleys knowledge of the web of relationships among the people on the island and his ability to find people.

Mike never lost the curiosity that is essential to top quality investigative work, Island County Prosecutor Greg Banks said. He never stopped asking, What, exactly, went on here? Whether it was a minor criminal trespass case, or a complicated white collar crime, Mike would dig in and get us what we needed as prosecutors.

Over the years, Hawley has also found the time to write police detective novels that were published by Penguin and is working on another in the series.

Hawley grew up in Seattle and taught high school history here. His father-in-law had encouraged him to consider law enforcement, but he wasnt all that interested until he was laid off from the school. He chose to work as a deputy on Whidbey Island.

His years as a patrol deputy informed his calm, respectful manner of law enforcement where deescalation comes naturally.

It was not unusual to work the entire island by yourself, he said. You learn to use communication skills effectively.

HAWLEY WORKED just about every commissioned position in the department, including detective, lieutenant and undersheriff. He was named as jail commander and manager of emergency dispatch, which was an outdated system located in the jail; each agency on the island at the time had its own dispatchers.

Hawley was charged with helping to create a new, coordinated dispatch system for the county and ICOM was the result.

Its still considered state of the art, he said of the facility. The way we set up the board of directors, every agency has an equal say.

But at around that time, the sheriffs office was imploding. A series of sexual harassment lawsuits, counter lawsuits and countless allegations led Sheriff Owen Burt to resign.

Hawley said he and Edd Proft were the only people in administrative positions in the office who were untouched by the scandal. Burt took them into a room and asked if either one of them wanted to be appointed sheriff. They both quickly declined. Burt insisted that one of them had to fill the role, so the two men ended up flipping a quarter.

Hawley lost.

He was appointed Nov. 1, 1996 to complete Burts term and subsequently ran two more times.

HAWLEY FOCUSED on upgrading and modernizing the office to keep up with a world in which law enforcement was becoming computerized and digitized, crime scene investigation was being revolutionized by DNA testing and other techniques, and rules were changing about sex offenses and domestic violence. He was part of the process of building a new Law and Justice building and the Juvenile Justice Center. He started the precincts.

Mike has made tremendous contributions to the modernization and professionalism of the Island County Sheriffs Office, current Sheriff Rick Felici said. He has also supported and encouraged me personally throughout my career. I will miss his counsel.

Hawley found ways to put more deputies on the roads instead of administrators in offices. As Smith said, he ran a lean department.

Hawley said he also focused on bridging the gap between the community and police.

We held at least 500 community meetings during my time in office, he said. At least one each week.

AFTER 10 years as sheriff, his wifes business, MLisss Quilting World, was skyrocketing. She had spent so much time supporting his career, Hawley felt it was only fair for him to reciprocate. Plus, the business proved to be very profitable and involved travel around the world.

I got to tag along and carry her luggage, he joked.

But in fact, Hawley learned to design fabric and is continuing the business. MLiss Design fabric is still selling in Hobby Lobby.

Tragically, MLiss was diagnosed with a rare heart disease. Hawley was her caregiver for five years.

It was the most difficult thing I will ever have to do, he said, and the most gratifying.

Hawley said he was thankful for the support he received from his friends in the department and the county.

He said he loved going to work nearly every day, but it is a job that comes with violence and tragedy. Over the years, Hawley was involved with more than 20 murder cases.

Some stick with you, he said. Some I am still processing.

ONE OF the most difficult and tragic cases was the murder of Marjie Monnett, a well-known housing advocate, and her daughter Holly Swartz in an act of domestic violence in 2002. Swartzs boyfriend killed them both with a shotgun in a quiet Freeland neighborhood, injured two other people, shot 20 to 30 rounds into neighbors houses and then killed himself.

Hawley was sheriff at the time but lived nearby and was the second officer at the scene at around 2 a.m.

I had no idea what had happened, he said. There were three blown-apart bodies right in front of me. He didnt leave the scene for the next 42 hours as law enforcement, crime scene investigators and media from across the region came and went.

HAWLEY WAS known for his ability to find people. He said he earned his 20 minutes of world fame when he rather nonchalantly caught the Cascade Mall shooter in Oak Harbor in 2016.

Hawley explained that his son Alex, a detective in King County, called him after hearing the news about the shooting and asked his father if he thought the shooter could be from Whidbey. He said he doubted it. Not long afterward, Hawley learned the shooter was Arcan Cetin and realized that he knew him from a previous gun-related call. He called his son back to tell him.

Then Hawley got a call that the shooters car was found parked in Oak Harbor. Hawley and the other deputies drove to the area. As Hawley was driving down Oak Harbor Road, he saw Cetin and locked eyes with him. He took him into custody without a problem.

No big deal, he said.

Hawley called his son back.

Guess what? he said. I got him.

Cetin committed suicide in Snohomish County jail before trial.

Not so long after that, Hawley was at the Sunnyside Cemetery in Oak Harbor, where his family members own a series of plots. He looked at his own and realized that Cetin is buried next to it.

That literally freaked me out, he said. I have an appointment for a spot right next to him.

But before that day, Hawley will be enjoying retirement. He said he plans to continue running the fabric business, writing more crime fiction and doing a lot of traveling, especially now that his daughter Adrienne and her wife have moved to Ireland.

He will be missed, Animal Control Officer Carol Barnes said. Whether or not you have a badge, everyone likes Mike Hawley.

Link:
Ex-sheriff is cruising into retirement after 32 years - South Whidbey Record

BRICK, NJ A Brick Township woman who has been charged with the murder of her wife has been extradited to New Jersey to face the charges against her, authorities said Tuesday.

Mayra Gavilanez-Alectus, 48, of Brick, has been returned to Ocean County from Houston, Texas, where she was apprehended May 20 by FBI officers, the U.S. Marshals Service and the Houston Police Department, Ocean County Prosecutor Bradley D. Billhimer and Brick Township Police Chief James Riccio announced.

She was charged May 18 with the murder of her wife, Rebecca Gavilanez-Alectus, 32, who was found dead May 16 in an upstairs bedroom of their Creek Road home, authorities said. She had been beaten to death with a wine chiller, the prosecutor's office said. Read more: Brick Woman Sought In Killing Of Her Wife: Prosecutor

"The defendant was processed this afternoon at the Brick Township Police Department and is currently lodged in the Ocean County Jail," Billhimer said. She had traveled to Houston from New York City by bus, he said when Mayra Gavilanez-Alectus was arrested.

The warrant for Mayra Gavilanez-Alectus's arrest was issued after an investigation by the Ocean County Prosecutor's Office Major Crime Unit, Brick Township Police Department Detective Bureau, and Ocean County Sheriff's Office Crime Scene Investigation Unit determined that she was responsible for the death of Rebecca Gavilanez-Alectus.

Investigators found Rebecca Gavilanez-Alectus had injuries consistent with a cylinder, and found she had been killed with a cylindrical container used for chilling wine, the prosecutor's office said. Further investigation ultimately determined Mayra Gavilanez-Alectus caused Rebecca Gavilanez-Alectus's death.

In addition to the murder charge, Mayra Gavilanez-Alectus is charged with unlawful possession of a weapon and possession of a weapon for an unlawful purpose, the proscutor's office said.

Have a news tip? Email karen.wall@patch.com Follow Brick Patch on Facebook.

Link:
Brick Woman Extradited To Face Murder Charge In Wifes Death - Brick, NJ Patch

Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

This transcript has been edited for clarity.

Andrew N. Wilner, MD: Welcome to Medscape. I'm Dr Andrew Wilner, and today I have the pleasure of speaking with Dr William Li, president and medical director of the Angiogenesis Foundation. Welcome, Dr Li.

William W. Li, MD: Thank you, Dr Wilner. It's a pleasure to be here.

Wilner: Thanks for joining us. I saw that you are one of the coauthors of a paper this month in the New England Journal of Medicine that has to do with angiogenesis and COVID-19. This is a pretty hot topic. Because you're one of the authors, you know more about it than anybody else. I'm glad to have you here to speak with us. So tell us about the paper. What did you find?

Li: When the COVID-19 pandemic hit, I, like many scientists, immediately started to pivot from whatever we were doing at the time to trying to tackle this enigma which, in 200,000 years of human history, humans have never encountered.

There's been so much confusion and some misinformation. I think that this is where medical science really steps in to take command and control, because while we don't know everything about SARS-CoV-2 and COVID-19, every layer of the onion we peel back gives us an additional piton on a rock wall to understanding this disease.

In modern medicine, that's what we really try to do. Before we can develop effective treatments, we really need to understand the pathophysiology.

As a vascular biologist, I teamed up with my colleagues who study pathology and angiogenesis, the microcirculation, to ask what is actually happening in the lungs of these people who are infected with COVID-19. We felt that to get at the answer, we'd start at the end to understand that beginning.

We were able to obtain autopsy tissue from people who died of COVID-19 and compare their lungs with those from people who had died almost 20 years ago from the SARS-CoV-1 pandemic.

We also looked at H1N1 and at normal lungs donated by people who were providing tissue for lung transplants. We started to do a deep dive to look at what was actually happening. What we found and reported in the New England Journal Medicine was really interesting because this respiratory virus, which we breathe in, does get down to our pulmonary tree. It does cause respiratory infections, so we saw intense inflammation and the acute respiratory distress syndrome pathologic signs.

We also found something surprising, which is that this respiratory virus makes a beeline for the vascular, or endothelial, cells, where gas exchange takes place. As the vascular cells and endothelium are infected, it damages them.

We actually saw the damaged cell membranes using transmission electron microscopy. This was directly associated with the microthrombi, which we've now recognized to be a hallmark of COVID-19not in every patient, but in many patients that winds up becoming a significant problem.

As we dove deeper, we realized that this respiratory virus actually causes a vascular disease as well as a pulmonary disease. We then dove deeper to really ask what is happening at the gene-expression level. How do the blood vessels respond to it, which actually is a form of new blood vessel growth, a kind of an emergency response or panic response to microthrombi.

We speculated that if this is happening in the lung, could it be happening in other organs of the body as well?yielding some explanation for some of these other vexing clinical signs that we've seen in COVID-19.

Wilner: That was a great explanation. First of all, I read the paper just before we started this interview, and it is a fantastic paper. It is clear. I love the images. It brought back memories of when I was on my pathology rotation in medical school, and I could actually understand it! I read all these papers and they have an image and there's different blue and red and greenI never know what they are, but these images were very clear.

I've spent a lot of time recently trying to understand the neurologic complications [of COVID-19]. A big question has been, is this virus neurotrophic? In fact, there's an article that I wrote a couple of weeks ago that's on Medscape that reviews all of this.

My conclusion was that it doesn't seem to be, but one of the thorny points was, how come so many patients are having strokes? At first we said it's because they're old, sick, they're in the ICU, and they're going to have strokes. But then there have been reports of young, otherwise healthy patients having strokes.

It looks like you may have the explanation: that there is a hypercoagulable state because of damage to the blood vessels that causes not only lung but also vascular disease in the brain and causes strokes. What do you think?

Li: Well, our paper focused on the lung as a starting point, but I think it opens the door to future investigations, which we're actually in the middle of right now ourselves. We are looking at brain. Within a few weeks, we should have the first detailed comparison of whether or not the endothelium is similarly infected and injured in the people who actually died of stroke.

We actually are interested in comparing COVID-19 stroke with other forms of strokeischemic stroke, or classic strokesto look for those differences. Stay tuned for that.

I think that the other issue is that if this is a vascular disease that could be extrapolated from the lungs throughout the body, is this also happening within the myocardium? We are actually getting capillary endothelialitis within the heart muscle, within brain tissue, and maybe even within peripheral nerve as well.

An interesting finding is COVID toe, which has actually been the presenting sign in people who don't have a cough or fever, and they go to their podiatrist or vascular surgeon with this beefy red toe and a lot of pain. It turns out that later on they test positive for the SARS-CoV-2 virus.

Are we looking at a systemic vasculitic type of syndrome that can affect everything from the toe to the brain? If we are, how do we understand, number one, how the virus transmits from the lung to those distal organs? Are they circulating and disseminating as an infection or are they actually finding another way to crawl cell to cell and Tarzan-ing their way into our organs?

Once they get to those organs, how do they cause damage? Why don't they cause damage in every patient? How much is actually due to coagulopathy versus other potential effects? Don't forget, the coagulopathy is on the inward-facing side of endothelial cells to the blood. Endothelial cells have two sides, including the abluminal side, or the side that actually faces the tissue.

When I started to look at some of the neurologic manifestations of COVID-19, I noticed that there were some patients who presented with bilateral encephalitis. I started to wonder how that works, because that's not a classic ischemic stroke.

You would be a much better judge of this than I would, but as an internist, I started thinking, how many things go to both sides of the brain? And why would that actually happen? Are there telltale clinical symptoms or signs that might allow us to actually do early detection, early diagnosis of people who might be more vulnerable or might go on to develop more serious neurologic symptoms?

Wilner: Let's jump to the ICU, where we have patients with COVID. Should they be anticoagulated?

Li: A really important paper came out in the Journal of the American College of Cardiology just a couple of weeks before our paper, looking at patients who had been hospitalized and discharged or expired, and looking at their coagulation or anticoagulation status.

It was pretty clear from that studyDr Valentin Fuster, a colleague of mine, was one of the coauthors of that paperthat those patients who were anticoagulated actually had a better outcome or higher rate of discharge from the hospital. Now, that's not necessarily a cause and effect, but it's a pretty compelling association if you take a look at the fact that these microthromboses could be happening not only in the lung but everywhere in the body.

I think an even bigger question would be, if you test positive and you're not hospitalized, should you be discharged from the emergency room home with anticoagulation? Would that be something we should be doing? Should you be on low-molecular-weight heparin? Should you be on aspirin? How should you be monitored post discharge home?

Are there other ways that we should be doing follow-up on these patients other than the classic "You're not sick enough with an infectious disease to be hospitalized; lets send you home"? Maybe in some of the people who go home and then drop a few weeks later, there is a propagating coagulopathy that really could have been managed from the time of sending them home from the emergency room.

Wilner: Maybe after a positive COVID test, you need a D-dimer test or some other assessment of coagulation to see if you're high-risk in at least a moment in time.

Now, let's just turn this upside down a little bit. One of the things you've told us is that this virus causes the blood vessels to react and actually increases angiogenesis. Could that ever be a good thing?

Li: Right. Don't forget, this is an autopsy study. This is not a real-time study. Think of it as a crime scene investigation; we're collecting the clues and trying to put together the pieces of what's happening.

One of the things that we did see that was surprising is that the blood vessels that had thrombi actually underwent a reactive form of angiogenesis, new blood vessel growth. That type of reactive angiogenesis was different from the regular sprouting that you would see in the heart, in wounds that are healing, and granulation tissue. Even following a typical ischemic stroke, you wind up getting some sprouting angiogenesis around these focal points of ischemia.

Here, what we saw is a different form of angiogenesis called intussusception. Now, this is not the pediatric intussusception where you think about the intestines. This is a form where a single blood vessel divides into two blood vessels by actually dropping drywall in and splitting into two.

Think about what this means. Why is it a reactive form? When you actually have all these microthrombi occurring everywhere, you don't have time for the 2 or 3 days it takes to sprout. You need immediate splitting in an effort to deliver better blood flow.

Now think about yourself as a car driving in a one-lane tunnel. Your car is an erythrocyte, and you're driving in a one-lane tunnel and the blood vessel is trying to react, and it drops drywall in from the ceiling to the floor. Where is the car going to go? You suddenly have turbulent blood flow in this emergency reactive form of angiogenesis, which probably contributes to the thrombotic setting in the context of endothelial damage.

The third strike for coagulopathy is really this intense inflammatory response. We saw tons of T cells wrapped around these thrombotic, reactive, angiogenic small blood vessels, and that makes total sense. The T cells are trying to clear the virus from the endothelial cells, but our normal circulation is in the way.

These were three smoking guns that we saw that might help us understand the microthrombosis, leading us to ask what is happening in other organs. That's really where we are todaytaking this crime scene investigation into the heart, into the brain, into the toes, into the kidneys, and into other organ systems so we can really try to put together a more systemic view of the role of endothelialitis and angiogenesis in COVID-19.

Wilner: Dr Li, this has been a fantastic illumination of what is happening inside the human body with COVID-19. I think it's also a message to all of those who think it's okay to give up social distancing. I think it's a reinforcement to say, hey, you don't want to get COVID-19 now. Why don't you keep social distancing, wear that mask, keep 6 feet away, and don't get the disease.

In 6 months or a year, we may understand this disease well enough that we will have a therapy. You don't want to be sick in the ICU orworsenext weekend when we're both on call, right? I think this is really great.

Li: One concluding point that I will tell you that this raises a specter upon is that after the virus is cleared from the body, after one has recovered from the SARS-CoV-2 virus, we don't know yet what the long-term damage is that may occur and may persist in the vascular endothelium. If it turns out that there was widespread systemic damage to endothelial cells, then that could persist much longer than the actual infectious component of the virus.

I think that one of the red flags that got sent up as we looked at this is to ask the question in long-term survivors of COVID-19, of which there will be many because this virus doesn't kill most people. It kills some, but many people actually recover. What might be the long-term manifestations of this novel coronavirus? I think time will tell, but this is where medical research is just beginning to chip away at the enigma of COVID-19.

Wilner: Where can people find more information about the Angiogenesis Foundation?

Li: You can find out about the Angiogenesis Foundation on our website at http://www.angio.org or you can find me pretty easily on the Internet at drwilliamli.com.

I've also written a book called Eat to Beat Disease. There's quite a lot of interest in this because I'm also interested in the impact of healthy lifestyles and diet on endothelial health.

Wilner: That's great. Thank you very much for joining us on Medscape, Dr Li. I look forward to your next set of discoveries.

Li: Thank you, Dr Wilner.

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Understanding the Puzzling Pathology of COVID-19 - Medscape