(Washington Post, April 22, 2020):
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. … “It was in as many as 20, 30 or 40 percent of their patients.” …
… 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 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. …
… 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.” …
… 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. … 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. …
… 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. …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.
