How many, exactly how many? How many of the 50 thousand plus dead were young, healthy with absolutely no pre existing conditions? Be specific. We need to know if this is an actaul threat to the larger population of young, perfectly healthy people. Was it half of the dead, a third, maybe a quarter, ten percent, five maybe? How many? The actaul number shouldn't be difficult to find since we're tracking every single death as if all of humanity is on the verge of extinction.Health
Young and middle-aged people, barely sick with covid-19, are dying from strokes
Doctors sound alarm about patients in their 30s and 40s left debilitated or dead. Some didn’t even know they were infected.
People walk around Times Square as screens are illuminated as part of the “Light It Blue” initiative to honor health care workers, during the outbreak of the coronavirus disease in New York City on April 23, 2020. (Eduardo Munoz/Reuters)
By
Ariana Eunjung Cha
April 24, 2020 at 6:36 PM EDT
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 needlelike 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, its 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 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.
The analyses suggest coronavirus patients are mostly experiencing the deadliest type of stroke. Known as large vessel occlusions, or LVOs, they can obliterate large parts of the brain responsible for movement, speech and decision-making in one blow because they are in the main blood-supplying arteries.
Many researchers suspect strokes in covid-19 patients may be a direct consequence of blood problems that are producing clots all over some people’s bodies.
Clots that form on vessel walls fly upward. One that started in the calves might migrate to the lungs, causing a blockage called a pulmonary embolism that arrests breathing — a known cause of death in covid-19 patients. Clots in or near the heart might lead to a heart attack, another common cause of death. Anything above that would probably go to the brain, leading to a stroke.
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 “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.
Mocco, 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.
Just a flu bro...literally
- Thread starter Daxtrader
- Start date
How many, exactly how many? How many of the 50 thousand plus dead were young, healthy with absolutely no pre existing conditions? Be specific. We need to know if this is an actaul threat to the larger population of young, perfectly healthy people. Was it half of the dead, a third, maybe a quarter, ten percent, five maybe? How many? The actaul number shouldn't be difficult to find since we're tracking every single death as if all of humanity is on the verge of extinction.
Do you take drama classes?
Captain I have always liked your reasoning and your post are for the most part always spot on. but there is a fundamental flaw in your analysis. This is a novel virus. How do you know what the longterm consequences of this disease are if it didn't exist before? HIV lay dormant in cells for decades before we figured out a way to find where it was hiding. How do you know that this virus does not have an HIV aspect to it if it appears that it comes directly from a laboratory?
many unswered questions for my humble taste.
Point taken, but the very fact that we don't know much about this virus should give us pause before we draw any conclusions and make decisions which have very real and not so easy to undo consequences. In this case I'm simply trying to say that taking what at this point can be construed as statistical anomalies and then posing them as an actaul threat to the broader population of young and healthy people is a stretch. No doubt there is some 75 year old fat bastard with COPD who caught it and survived. I would not then suggest that people of a similar type should go out as if they are not at a greater risk than most. Listen, all I'm trying to do here is take note that we as a nation have made some very big, life changing decisions which most likely will change the direction of our society forever in ways we have yet to fully comprehend, most all of those decisions based on supposition, incomplete data and quite a bit of irrational fear, not to be too dramatic about it.
Time will tell.Point taken, but the very fact that we don't know much about this virus should give us pause before we draw any conclusions and make decisions which have very real and not so easy to undo consequences. In this case I'm simply trying to say that taking what at this point can be construed as statistical anomalies and then posing them as an actaul threat to the broader population of young and healthy people is a stretch. No doubt there is some 75 year old fat bastard with COPD who caught it and survived. I would not then suggest that people of a similar type should go out as if they are not at a greater risk than most. Listen, all I'm trying to do here is take note that we as a nation have made some very big, life changing decisions which most likely will change the direction of our society forever in ways we have yet to fully comprehend, most all of those decisions based on supposition, incomplete data and quite a bit of irrational fear, not to be too dramatic about it.
The issue is that old parachute thinking, it has slowed the rate of descent so we can take it off now.
There is a Trump level tribe who are desperate to take any indication of a higher spread and therefore wider immunity to the bank. These are the guys who don't have or want an understanding of what they don't know.
What is hard to get for the 95.7 percent of earth who are not Americans is the word conservative in the natural sense is now completely detached from the US political meaning.
95.7 percent of the planet are not letting the tail wag the dog. Even Sweden's policy is nothing like Trumpets understand it to be.
It probably has only reached a few percent in most of the country, this means the rest will catch it in an uncontrolled manner.
Oxford have jumped ahead in creating a vaccine, they may have it tested and viable by September. Trump has for some reason decided to pull out of sharing the European projects? Is that so he can tout an American only vaccine in time for the election?
Possibly, above my pay grade. I'm still in the camp of the only real solution is herd immunity. I think is was you, maybe not, that posted the Joe Rogan interview with the infectious disease specialist who said that probably takes nearly 500,000 dead to achieve. High price to pay as he said, but which has longer term consequences? Half a million dead by years end or a economic catastrophe that makes the Great Depression look like a day at summer camp? Which route is truly the most humane approach? Admittedly I don't want that decision on my head, but those that want the power and prestige must get off the proverbial dime or we end up suffering both.
Exactly, but not in the way that you think. The more we learn about this virus, the farther reaching its consequences appear to be. That's not a good thing. The more uncertainty there is, the more margin for error you must have if your objective is survival.
It was not I but I recall a mention of the figure and it is still even with all the paring away science and brains have made largely correct.
Instead of this headlong business insanity the Conservatives who claim to have the light of the Lord and whatnot should be saying hey, money is not what you are here for. As a Christian what is the surefire way (most I think feel) of getting to heaven? You choose to sacrifice yourself, in part or in whole.
Whatever comes is what is meant to and if you die in a ditch but without fear you die well.
What did Trump do? He literally declared that "God will save us", a huxter charlatan. I get that people get addicted to their work but everyone is in the same boat and it will take off on massive parallel again not like recessions before.
Some of course are willing to cause more death and suffering so their country has a lead.
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That's one point of view, I respect that, but it brings up questions. Survival, certainly at the top of the list. Are we talking about the few, or the many? Maybe it's a binary choice, maybe not. Consequences far reaching. Yep, agree again. Consequences of the virus itself, or consequences of action taken to manage the rate of infection? No argument at all that these questions are worthy of debate, and therein lies the problem, there was no debate. No legislation, no point counterpoint, no vote, just Governors and Mayors putting on their Crowns and ruling by decree. Feds guilty too. But, but, there is no time for debate, it's an emergency. And that my friend is exactly the situation which calls for pause. Not the nail dragging endless quagmire of endless political bullshit, but expedient yet thoughtful debate. We did none of that. Never considered a middle ground approach. Went straight to panic, we're all gonna die. Now we flop around in hand wringing mode while Rome burns. Business as usual in the nevet ending political game. These no good bastards can't set that aside no matter what. And they're the solution? They created the problem, again.
Well I don't believe in heaven, post life rewards and punishment, but that's a different debate. I get your point abouy personal sacrifice, fighting and dying fearlessly. Admirable qualities, more rare than the everyone is a hero world we live in, but should be strived for none the less. As usual the people doing the sacrificing are the ones who get little to none of the spoils of victory. Maybe, no absolutely, I take issue being and seeing lions led by lambs. Felt that way since these lying bastards hoodwinked the naive midwestern boy I was all those many years ago. No doubt that taints my view in most everything political. Rambling now. I guess we'll all find out soon enough if the sacrificing of the masses is actually worth it. Good day.