One month ago, as 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. But they’ve since become increasingly convinced covid-19 attacks not only the lungs, but also the kidneys, heart, intestines, liver and brain.
Many doctors also are reporting bizarre, unsettling cases that don’t seem to follow 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.”
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 focused on the disease’s effects on 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.
https://www.washingtonpost.com/health/2020/04/22/coronavirus-blood-clots/