COVID-19 stroke fears

In mid-April, it was brain function. Last week, there were concerns that COVID-19 may trigger diabetes in otherwise healthy people.

Now, University of Sydney infectious diseases expert Professor Robert Booy suspects the virus could cause “real damage” to the heart and lungs that could last for months or even years.

And doctors have confirmed the possibility of an increased risk of blood clotting in patients with COVID-19. That means an increased likelihood of strokes. Some doctors are reporting severe strokes afflicting even otherwise young, fit patients who contract the virus.

Cardiologist R. Todd Hurst explains why blood clots are so worrisome.

“Blood clots in the veins can travel to the lungs (which is called pulmonary embolus), a potentially life-threatening problem. Blood clots in the arterial system are even more alarming because these can lead to heart attacks, strokes and amputations.”

Thomas Oxley, a neurosurgeon at Mount Sinai in New York, and colleagues published a letter in The New England Journal of Medicine detailing their observations of five cases of stroke in patients younger than 50.

Oxley says “It’s the biggest story emerging” about COVID-19.

“I’m a haematologist, and this is unprecedented,” Dr Jeffrey Laurence, of Weill Cornell Medical College, told vox.com. “This is not like a disease we’ve seen before.”

He says the incidence of patients with low oxygen levels but flexible lungs points to the possibility of “micro-vessel clots (in the lungs) shutting off the ability of people to bring oxygen into their blood”.

A study in the Netherlands, which followed 184 severe COVID-19 patients, found that a “remarkably high” 31 per cent had blood-clotting issues.

In February, Chinese researchers published a paper that found evidence of clotting in 71 per cent of 183 people hospitalised with COVID-19 pneumonia in Wuhan, China. Only one per cent of survivors had clotting.

Dr Laurence says one of the biggest issues with COVID-19 is the “insidious feedback loop of inflammation” it causes.

This contributes to the long-term damage to survivors, which concerns Prof. Booy. “We’re very worried about the people who have an immune response that is exaggerated and does it best to kill the virus, but it also damages our own physiology,” Prof. Booy told The Age.

“What that does is damage our own measures to protect ourselves, so the lungs are eventually scarred and reduced in capacity. That combination of the virus and our immune response to it could mean that we have damage that goes on for months and years and that’s a real worry.

“We are learning huge amounts right now. But the simple outcome is that you are damaged. It can affect your heart, your lungs and possibly your cardiovascular system, which is the blood vessel that supplies your key organs and that’s not just your lungs, but also your heart and your brain.”

Lung damage leaves survivors of COVID-19 vulnerable to later lung failure, especially if they have underlying health conditions such as heart disease or diabetes.

“The scarring and the damage could go on not just for months, but years, meaning that people who have survived are at increased risk of dying from further lung insults,” he said.

Allen Cheng, professor of epidemiology and preventive medicine at Melbourne’s The Alfred hospital is also concerned by the potential for damage to the heart muscle.

“It is also known that infections like influenza can trigger heart attacks and other diseases,” he said. “Whether this occurs with COVID-19 is not yet known.”

Professors Booy and Cheng stressed the need for more detailed, longer-term examination of COVID-19 before conclusions could be reached.

Are you becoming more concerned about the effects of the coronavirus with each passing week and with further research?

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Written by Will Brodie

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