[guest post by Dana]
Yet another awful find about COVID-19 and sick patients:
As the novel coronavirus spread through New York City in late March, doctors at Mount Sinai Hospital noticed something strange happening to patients’ blood.
Signs of blood thickening and clotting were being detected in different organs by doctors from different specialties. This would turn out to be one of the alarming ways the virus ravages the body, as doctors there and elsewhere were starting to realize.
At Mount Sinai, nephrologists noticed kidney dialysis catheters getting plugged with clots. Pulmonologists monitoring COVID-19 patients on mechanical ventilators could see portions of lungs were oddly bloodless. Neurosurgeons confronted a surge in their usual caseload of strokes due to blood clots, the age of victims skewing younger, with at least half testing positive for the virus.
“It’s very striking how much this disease causes clots to form,” Dr. J Mocco, a Mount Sinai neurosurgeon, said in an interview, describing how some doctors think COVID-19, the illness caused by the coronavirus, is more than a lung disease. In some cases, Mocco said, a stroke was a young patient’s first symptom of COVID-19.
Doctors were compelled to develop new treatment protocols:
As colleagues from various specialties pooled their observations, they developed a new treatment protocol. Patients now receive high doses of a blood-thinning drug even before any evidence of clotting appears.
“Maybe, just maybe, if you prevent the clotting, you can make the disease less severe,” said Dr. David Reich, the hospital president. The new protocol will not be used on certain high-risk patients because blood thinners can lead to bleeding in the brain and other organs.
In the three weeks beginning mid-March, Mocco saw 32 stroke patients with large blood blockages in the brain, double the usual number for that period.
Five were unusually young, under age 49, with no obvious risk factors for strokes, “which is crazy,” he said. “Very, very atypical.” The youngest was only 31.
At least half of the 32 patients would test positive for COVID-19, Mocco said.
Meanwhile, Dr. Hooman Poor, a Mount Sinai lung specialist, found himself working a late shift with 14 patients on ventilators. The ventilator readings were not what he expected.
The lungs did not seem stiff, as is common in pneumonia. Instead, it seemed blood was not circulating freely through the lungs to be aerated with each breath.
Poor ran into a kidney doctor that night, who remarked that dialysis catheters were often getting blocked with clots.
“And I said, ‘It’s funny that you mentioned that because I feel like all these patients have blood clots in their lungs,’” Poor recalled.
Doctors throughout the country started noticing the emergence of blood clots in their COVID patients as well. And although blood clots present a common danger for patients immobile for long periods of time, the onset of blood clots in COVID patients appears more rapidly:
Clotting can develop in anyone who gets very sick and spends long periods of time immobile on a ventilator, but doctors say the problem seemed to show up sooner in COVID-19 patients as a more direct consequence of the virus.
Under the new protocols, patients at Mt. Sinai are being given higher doses of the blood thinner, heparin even before clots have been detected.
Just days ago, Broadway actor Nick Cordero, who had been battling coronavirus for three weeks, had to have his leg amputated due to blood clotting:
Cordero, who has been in the hospital since March 31, was being treated with blood thinners to help relieve clotting in his leg, but doctors had to stop the medication because it was causing internal bleeding… On Saturday, the decision was made to amputate, Kloots said, according to the AP.
Losing his leg is just the latest serious complication Cordero has faced after being hospitalized with what was initially thought to be pneumonia, but later turned out to be covid-19, the respiratory illness caused by the novel coronavirus, according to his wife.
On April 12, for example, Cordero “lost consciousness, he lost his pulse and they had to resuscitate him” after a lung infection set off a chain reaction that affected his blood pressure and heart, Kloots said in a now-deleted Instagram story, Variety reported.
The hard reality is this:
Blood clotting has emerged as a phenomenon in covid-19 patients suffering from particularly serious infections, with physicians unsure of what type of treatment is most effective, according to STAT News. While blood clots aren’t unusual in those who are immobile for long periods of time, like people on ventilators, “they seem to be smaller and cause far more severe damage” in patients diagnosed with covid-19, STAT News reported.
As Science Magazine reports, the prevalence of clots may be yet another indication that the novel virus can wreak havoc on the human body far beyond the lungs, which are considered “ground zero.”
The disease “can attack almost anything in the body with devastating consequences,” cardiologist Harlan Krumholz of Yale University and Yale New Haven Hospital told the magazine. “Its ferocity is breathtaking and humbling.”