CONTINUE: PUBLIC SERVICE ANNOUNCEMENT CONCERNING COVID-19 FROM THE FORECLOSURE SOLUTIONS GROUP & Danny Hammond
URGENT FOR EVERYONE. NOT JUST FOLLOWERS OF THIS BLOG
The Following are original stories from the Washington Post. I came across this story two days ago and the later one is from today. There is nothing I have to write today that matters compared to this news on the Coronavirus Pandemic. I am 68 years old and had a year of high dose chemotherapy in my past. I thought I was in the most susceptible group.
But, it turns out many people may have not been counted in the Pandemic cases and deaths counts. This is so urgent that I am sending it out from my blog without permission from the Washington Post. But, I was shaken by it.
This changes the way that they (and I) are thinking about all age groups including under 40 and this horrific new side of COVID-19.
There are more photos, video interviews, and links to other current Covid-19 events and facts in the original website article. I urge you to search for these stories and watch for more on the following.
Danny Hammond
Health
A Mysterious Blood-Clotting Complication Is Killing Coronavirus Patients
Once thought a relatively straightforward respiratory virus, COVID-19 is proving to be much more frightening. Young and middle-aged people, barely sick with COVID-19 (Coronavirus), are dying from strokes.
Doctors sound the alarm about patients in their 30s and 40s left debilitated or dead. Some didn’t even know that they were infected.
By Ariana Eunjung Cha April 22, 2020 at 3:39 p.m. CDT
Craig Coopersmith was up early that morning as usual and typed his daily inquiry into his phone. “Good morning, Team Covid,” he wrote, asking for updates from the ICU team leaders working across 10 hospitals in the Emory University health system in Atlanta.
One doctor replied that one of his patients had a strange blood problem. Despite being put on anticoagulants, the patient was still developing clots. A second said she’d seen something similar. And a third. Soon, every person on the text chat had reported the same thing. “That’s when we knew we had a huge problem,” said Coopersmith, a critical-care surgeon.
As he checked with his counterparts at other medical centers, he became increasingly alarmed: “It was in as many as 20, 30 or 40 percent of their patients.”
One month ago when the country went into lockdown to prepare for the first wave of coronavirus cases, many doctors felt confident they knew what they were dealing with. Based on early reports, COVID-19 appeared to be a standard variety respiratory virus, albeit a contagious and lethal one with no vaccine and no treatment.
They’ve since seen how COVID-19 attacks not only the lungs but also the kidneys, heart, intestines, liver, and brain. Increasingly, doctors also are reporting bizarre, unsettling cases that don’t seem to follow any of the textbooks they’ve trained on. They describe patients with startlingly low oxygen levels — so low that they would normally be unconscious or near death — talking and swiping on their phones. Asymptomatic pregnant women suddenly in cardiac arrest. Patients who by all conventional measures seem to have mild disease deteriorating within minutes and dying at home.
With no clear patterns in terms of age or chronic conditions, some scientists hypothesize that at least some of these abnormalities may be explained by severe changes in patients’ blood.
The concern is so acute some doctor groups have raised the controversial possibility of giving preventive blood thinners to everyone with COVID-19 — even those well enough to endure their illness at home. Blood clots, in which the red liquid turns gel-like, appear to be the opposite of what occurs in Ebola, Dengue, Lassa, and other hemorrhagic fevers that lead to uncontrolled bleeding. But they actually are part of the same phenomenon — and can have similarly devastating consequences.
Autopsies have shown some people’s lungs fill with hundreds of microclots. Errant blood clots of a larger size can break off and travel to the brain or heart, causing a stroke or heart attack. On Saturday, Broadway actor Nick Cordero, 41, had his right leg amputated after being infected with the novel coronavirus and suffering from clots that blocked blood from getting to his toes.
Lewis Kaplan, a University of Pennsylvania physician and head of the Society of Critical Care Medicine, said every year doctors treat people with clotting complications, from those with cancer to victims of severe trauma, “and they don’t clot like this.” “The problem we are having is that while we understand that there is a clot, we don’t yet understand why there is a clot,” Kaplan said. “We don’t know. And therefore, we are scared.”
‘It crept up on us’
The first sign something was going haywire was in legs, which were turning blue and swelling. Even patients on blood thinners in the ICU were developing clots — which is not unusual in one or two patients in one unit but is for so many at the same time.
Next came the clogging of the dialysis machines, which filter impurities in blood when kidneys are failing and jammed several times a day. “There was a universal understanding that this was different,” Coopersmith said. Then came the autopsies. When they opened up some deceased patients’ lungs, they expected to find evidence of pneumonia and damage to the tiny air sacs that exchange oxygen and carbon dioxide between the lungs and the bloodstream.
Instead, they found tiny clots all over. Zoom meetings were convened in some of the largest medical centers nationwide. Tufts. Yale-New Haven. The University of Pennsylvania. Brigham and Women’s. Columbia-Presbyterian. Theories were shared. Treatments debated. Although there was no consensus on the biology of why this was happening and what could be done about it, many came to believe the clots might be responsible for a significant share of U.S. deaths from COVID-19 — possibly explaining why so many people are dying at home.
In hindsight, there were hints blood problems had been an issue in China and Italy as well, but it was more of a footnote in studies and on information-sharing calls that had focused on the disease’s destruction of the lungs. “It crept up on us. We weren’t hearing a tremendous amount about this internationally,” said Greg Piazza, a cardiovascular specialist at Brigham and Women’s who has begun a study of bleeding complications of COVID-19.
Helen W. Boucher, an infectious-disease specialist at Tufts Medical Center, said there’s no reason to think anything is different about the virus in the United States. More likely, she said, the problem was more obvious to American doctors because of the unique demographics of U.S. patients, including large percentages with heart disease and obesity that make them more vulnerable to the ravages of blood clots.
She also noted small but important differences in the monitoring and treatment of patients in ICUs in this country that would make clots easier to detect. “Part of this is by virtue of the fact that we have such incredible intensive care facilities,” she said. A leading cause of death The body’s cardiovascular system often is described as a network of one-way streets that connect the heart to other organs.
Blood is the transport system, responsible for moving nutrients to the cells and waste away from them. A common cold or a cut on the finger can lead to changes that help repair the damage, but when the body undergoes a more significant trauma, the blood can overreact, leading to an imbalance that can cause excessive clots or bleeding — and sometimes both. Scientists call this “hemostatic derangement.”
In math, a derangement is a permutation in which no element is in its original position. Harlan Krumholz, a cardiac specialist at the Yale-New Haven Hospital Center, said no one knows whether blood complications are a result of a direct assault on blood vessels or a hyperactive inflammatory response to the virus by the patient’s immune system.
“One of the theories is that once the body is so engaged in a fight against an invader, the body starts consuming the clotting factors, which can result in either blood clots or bleeding. In Ebola, the balance was more toward bleeding. In COVID-19, it’s more blood clots,” he said.
A study published in JAMA on Wednesday found that a large number of COVID-19 patients admitted to New York State’s largest health system came in with blood test readings that indicated clotting problems. And a Dutch study published April 10 in the journal Thrombosis Research provided more evidence the issue is widespread, finding 38 percent of 184 COVID-19 patients in an intensive care unit had blood that clotted abnormally.
The researchers called it “a conservative estimation” because many of the patients were still hospitalized and at risk of further complications. Early data from China on a sample of 183 patients showed more than 70 percent of patients who died of COVID-19 had small clots develop throughout their bloodstream.
Although acute respiratory distress syndrome still appears to be the leading cause of death in COVID-19 patients, blood complications are not far behind, said Behnood Bikdeli, a fourth-year fellow at Columbia University Irving Medical Center, who helped anchor a paper about the blood clots in the Journal of The American College of Cardiology. “My guess is it’s one of the top three causes of demise and deterioration in COVID-19 patients,” he said.
That recognition is prompting many hospitals to change the way they think about the disease and manage it. When the novel coronavirus first hit, the Centers for Disease Control and Prevention and others put people with asthma at the top of their lists of those who might be the most vulnerable. But European researchers writing in the journal Lancet noted it was “striking” how underrepresented asthma patients had been.
Earlier this month, when New York state released data about the top chronic health problems of those who died of COVID-19, asthma was not among them. Instead, they were almost all cardiovascular conditions. Some medical centers have begun giving all hospitalized COVID-19 patients small doses of blood thinners as preventive measures, and many are adjusting doses upward for the most seriously ill.
The challenge is the more you give, the greater the danger of upsetting the balance in the other direction, and having the patient bleed to death. Another big mystery the doctors hope the blood issue will shed light on is why some maternity patients are collapsing during or after giving birth.
A paper published in the American Journal of Obstetrics & Gynecology MFM in late March detailed how two women with no prior symptoms of COVID-19 ended up in intensive care. The first was a 38-year-old patient of New York-Presbyterian/Columbia University Irving Medical Center in Manhattan who spiked a fever of 101.3 while undergoing a C-section delivery and began bleeding profusely. The second woman, 33, also underwent a C-section but the next day developed a cough that progressed to respiratory distress. Her heart beat irregularly and her blood pressure jumped to as high as 200/90. Several physician-researchers said the relationship between COVID-19, clotting, and pregnant women is “an area of interest.”
Women in childbirth can experience clotting and bleeding complications because of the involvement of the blood-rich placenta, but it’s possible COVID-19 may be triggering additional cases by making some women’s bodies “lose balance.” “There’s lots of speculation,” Krumholz said.
“That’s one of the frustrating things about this virus. We’re in a lot of darkness still.”
Ariana Eunjung Cha Ariana Eunjung Cha is a national reporter. She has previously served as The Post's bureau chief in Shanghai and San Francisco, and as a correspondent in Baghdad. Follow chief in Shanghai and San Francisco, and as a correspondent in Baghdad.
RELATED STORY BY MS CHA BELOW Posted by the Washington Post 04/25/2020
By Ariana Eunjung Cha April 24, 2020 at 5:36 p.m. CDT
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Thomas Oxley wasn’t even on call the day he received the page to come to Mount Sinai Beth Israel Hospital in Manhattan. There weren’t enough doctors to treat all the emergency stroke patients, and he was needed in the operating room. The patient’s chart appeared unremarkable at first glance. He took no medications and had no history of chronic conditions. He had been feeling fine, hanging out at home during the lockdown like the rest of the country, when suddenly, he had trouble talking and moving the right side of his body.
Imaging showed a large blockage on the left side of his head. Oxley gasped when he got to the patient’s age and COVID-19 status: 44, positive. The man was among several recent stroke patients in their 30s to 40s who were all infected with the coronavirus. The median age for that type of severe stroke is 74.
As Oxley, an interventional neurologist, began the procedure to remove the clot, he observed something he had never seen before. On the monitors, the brain typically shows up as a tangle of black squiggles — “like a can of spaghetti,” he said — that provide a map of blood vessels.
A clot shows up as a blank spot. As he used a needle-like device to pull out the clot, he saw new clots forming in real-time around it. “This is crazy,” he remembers telling his boss.
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"Stroke surge "
Reports of strokes in the young and middle-aged — not just at Mount Sinai, but also in many other hospitals in communities hit hard by the novel coronavirus — are the latest twist in our evolving understanding of its connected disease, COVID-19. Even as the virus has infected nearly 2.8 million people worldwide and killed about 195,000 as of Friday, it's biological mechanisms continue to elude top scientific minds.
Once thought to be a pathogen that primarily attacks the lungs, it has turned out to be a much more formidable foe — impacting nearly every major organ system in the body. Until recently, there was little hard data on strokes and COVID-19. There was one report out of Wuhan, China, that showed that some hospitalized patients had experienced strokes, with many being seriously ill and elderly.
But the linkage was considered more of “a clinical hunch by a lot of really smart people,” said Sherry H-Y Chou, a University of Pittsburgh Medical Center neurologist, and critical care doctor.
Now for the first time, three large U.S. medical centers are preparing to publish data on the stroke phenomenon. The numbers are small, only a few dozen per location, but they provide new insights into what the virus does to our bodies. Coronavirus destroys lungs.
But doctors are finding its damage in kidneys, hearts, and elsewhere. A stroke, which is a sudden interruption of the blood supply, is a complex problem with numerous causes and presentations. It can be caused by heart problems, clogged arteries due to cholesterol, even substance abuse. Mini-strokes often don’t cause permanent damage and can resolve on their own within 24 hours. But bigger ones can be catastrophic.
Robert Stevens, a critical care doctor at Johns Hopkins Hospital in Baltimore, called strokes “one of the most dramatic manifestations” of the blood-clotting issues. “We’ve also taken care of patients in their 30s with stroke and COVID, and this was extremely surprising,” he said.
Many doctors expressed worry that as the New York City Fire Department was picking up four times as many people who died at home as normal during the peak of infection that some of the dead had suffered sudden strokes. The truth may never be known because few autopsies were conducted. Chou said one question is whether the clotting is because of a direct attack on the blood vessels, or a “friendly-fire problem” caused by the patient’s immune response.
“In your body’s attempt to fight off the virus, does the immune response end up hurting your brain?” she asked. Chou is hoping to answer such questions through a review of strokes and other neurological complications in thousands of COVID-19 patients treated at 68 medical centers in 17 countries. Thomas Jefferson University Hospitals, which operates 14 medical centers in Philadelphia, and NYU Langone Health in New York City, found that 12 of their patients treated for large blood blockages in their brains during a three-week period had the virus. Forty percent were under 50, and they had few or no risk factors.
Their paper is under review by a medical journal, said Pascal Jabbour, a neurosurgeon at Thomas Jefferson. Jabbour and his co-author Eytan Raz, an assistant professor of neuroradiology at NYU Langone, said that strokes in COVID-19 patients challenge conventional thinking. “We are used to thinking of 60 as a young patient when it comes to large vessel occlusions,” Raz said of the deadliest strokes. “We have never seen so many in their 50s, 40s, and late 30s.”
Raz wondered whether they are seeing more young patients because they are more resistant than the elderly to the respiratory distress caused by COVID-19: “So they survive the lung side, and in time develop other issues.”
A mysterious blood-clotting complication is killing coronavirus patients. Jabbour said many cases he has treated have unusual characteristics. Brain clots usually appear in the arteries, which carry blood away from the heart. But in COVID-19 patients, he is also seeing them in the veins, which carry blood in the opposite direction and are trickier to treat. Some patients are also developing more than one large clot in their heads, which is highly unusual.
“We’ll be treating a blood vessel and it will go fine, but then the patient will have a major stroke” because of a clot in another part of the brain, he said.
"The 33-Year-Old"
At Mount Sinai, the largest medical system in New York City, physician-researcher J Mocco said the number of patients coming in with large blood blockages in their brains doubled during the three weeks of the COVID-19 surge to more than 32, even as the number of other emergencies fell. More than half of were COVID-19 positive.
It isn’t just the number of patients that was unusual. The first wave of the pandemic has hit the elderly and those with heart disease, diabetes, obesity, or other preexisting conditions disproportionately. The COVID-19 patients treated for stroke at Mount Sinai were younger and mostly without risk factors. On average, the COVID-19 stroke patients were 15 years younger than stroke patients without the virus.
“These are people among the least likely statistically to have a stroke,” Mocco said. who has spent his career studying strokes and how to treat them, said he was “completely shocked” by the analysis. He noted the link between COVID-19 and stroke “is one of the clearest and most profound correlations I’ve come across.”
“This is much too powerful of a signal to be chance or happenstance,” he said. In a letter to be published in the New England Journal of Medicine next week, the Mount Sinai team details five case studies of young patients who had strokes at home from March 23 to April 7. They make for difficult reading: The victims’ ages are 33, 37, 39, 44, and 49, and they were all home when they began to experience sudden symptoms, including slurred speech, confusion, drooping on one side of the face and a dead feeling in one arm.
One died, two are still hospitalized, one was released to rehabilitation, and one was released home to the care of his brother. Only one of the five, a 33-year-old woman, is able to speak. Oxley, the interventional neurologist, said one striking aspect of the cases is how long many waited before seeking emergency care. The 33-year-old woman was previously healthy but had a cough and headache for about a week.
Over the course of 28 hours, she noticed her speech was slurred and that she was going numb and weak on her left side but, the researchers wrote, “delayed seeking emergency care due to fear of the COVID-19 outbreak.” It turned out she was already infected. By the time she arrived at the hospital, a CT scan showed she had two clots in her brain and patchy “ground glass” in her lungs — the opacity in CT scans that is a hallmark of COVID-19 infection.
She was given two different types of therapy to try to break up the clots and by Day 10, she was well enough to be discharged. Oxley said the most important thing for people to understand is that large strokes are very treatable. Doctors are often able to reopen blocked blood vessels through techniques such as pulling out clots or inserting stents. But it has to be done quickly, ideally within six hours, but no longer than 24 hours:
“The message we are trying to get out is if you have symptoms of stroke, you need to call the ambulance urgently. ” As for the 44-year-old man Oxley was treating, doctors were able to remove the large clot that day in late March, but the patient is still struggling. As of this week, a little over a month after he arrived in the emergency room, he is still hospitalized.
Look up the original Washington Post Story to get photos, video interviews and links to other Covid-19 current events