A new, and frightening, expression of COVID-19 infection has surfaced. Numerous physicians around the world are reporting a possibly increased risk for blood clots in patients with COVID-19.
Blood clots (what doctors call thrombosis) are particularly worrisome because of the potential consequences. 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.
COVID-19 appears to increase blood clots in both the arteries and the veins. Although all of the studies are small and observational at this point, one study from the Netherlands showed that 31% of subjects with COVID-19 in the ICU developed blood clots despite usual measures to prevent clotting. Another small study from China showed that 25% of the COVID-19 patients developed blood clots in the veins. These are shockingly high numbers.
Physicians are particularly troubled by this possible blood clotting issue for several reasons. One is that the usual treatments (such as blood thinner medications) aren’t working for some patients. Another reason is the report of COVID-19 positive people as young as their 30’s experiencing large strokes that are more typically seen in a much older population.
More information is needed to understand if this is a true correlation between COVID-19 and blood clotting disorder, what the mechanism is, and, most importantly, how to prevent and treat it.
For now, be aware that there’s reason to suspect that COVID-19 could possibly put any of us at risk for stroke.
So, be alert for stroke symptoms – sudden weakness, numbness, trouble speaking, seeing, or the onset of a severe headache without other explanation – even if you wouldn’t ordinarily need to be concerned about stroke risk, and even without other signs of COVID-19 infection.
If you do experience symptoms that may be stroke-related, it is critically important to seek urgent medical attention. Timing is crucial because the best treatments for these types of stroke need to be delivered in the first 3 hours of symptoms to be most effective. As stroke neurologists like to say, “Time is brain.”
And if you suspect a stroke in someone else, act F.A.S.T.:
F—Face: Ask the person to smile. Does one side of the face droop?
A—Arms: Ask the person to raise both arms. Does one arm drift downward?
S—Speech: Ask the person to repeat a simple phrase. Is the speech slurred or strange?
T—Time: If you see any of these signs, call right away.
Understandably, some are reluctant to go to the hospital during the COVID-19 pandemic, but when it comes to a stroke, the consequences of delaying medical treatment could be devastating. Do not delay. Call if anyone has these symptoms.
If you have high blood pressure, it’s a good idea to take extra care to protect yourself during the coronavirus (COVID-19)outbreak. Early research shows that people with the condition may be more likely to:
Get COVID-19
Have worse symptoms
Die from the infection
High Blood Pressure Risks
Data from China and Italy — countries hit early by the virus — show higher risk of COVID-19 infections and complications in people with high blood pressure.
In China, 25% to 50% of people who came to hospitals with coronavirus had high blood pressure or another health condition like cancer, diabetes, or lung disease. In Italy, more than 99% of people who’ve died from the virus had one of these conditions — and 76% of them had high blood pressure.
People with high blood pressure are also slightly more likely to die from coronavirus. Their risk is about 6% higher than the overall population.
What’s the Link?
A weaker immune system is one reason people with high blood pressure and other health problems are at higher risk for coronavirus. Long-term health conditions and aging weaken your immune system so it’s less able to fight off the virus. Nearly two-thirds of people over 60 have high blood pressure.
Another possibility is that the higher risk comes not from high blood pressure itself, but from certain drugs used to treat it — ACE inhibitors and angiotensin receptor blockers (ARBs). This is just a theory, since there’s no research yet on what impact, if any, these medications might have on COVID-19.
The theory is based on the fact that ACE inhibitors and ARBs raise levels of an enzyme called ACE2 in your body. And to infect cells, the COVID-19 virus must attach itself to ACE2.
Until more research comes out, the American College of Cardiology and American Heart Association recommend that you keep taking your high blood pressure medicine as prescribed. If you don’t, it could raise your risk for a heart attack or stroke, putting you in the hospital just as coronavirus cases are coming in.
How Coronavirus Affects People With High Blood Pressure
While pneumonia is the most common complication of the virus, it can also damage the cardiovascular system. That’s why people with high blood pressure, heart disease, and heart failure are at risk.
High blood pressure damages arteries and reduces the flow of blood to your heart. That means your heart has to work harder to pump enough blood. Over time, this extra work can weaken your heart to the point where it can’t pump as much oxygen-rich blood to your body.
Coronavirus can also damage the heart directly, which can be especially risky if your heart is already weakened by the effects of high blood pressure. The virus may cause inflammation of the heart muscle called myocarditis, which makes it harder for the heart to pump.
If you also have plaque buildup in your arteries, the virus may make those plaques more likely to break apart and cause a heart attack. Past studies have shown that people with heart disease who get a respiratory illness like the flu or earlier types of coronavirus are at higher risk for a heart attack.
What Should You Do?
Everyone needs to take precautions to prevent coronavirus. People with high blood pressure and other health conditions need to be extra careful.
The CDC offers this advice:
Make sure you have enough medicine on hand to treat high blood pressure and other health conditions.
Stock up on over-the-counter medicines to treat a fever and other symptoms if you get sick.
Stay at home and limit contact with other people as much as you can.
Clean and disinfect all frequently touched surfaces like counter tops and doorknobs.
A coronavirus vaccine isn’t available yet, but the American College of Cardiology recommends that you stay up to date on your other vaccines. The pneumococcal vaccine will prevent you from catching pneumonia on top of coronavirus. Also get a flu vaccine. Its symptoms are easy to confuse with coronavirus, which could make it harder for doctors to diagnose you if you do get sick.
According to a new
study published in the journal Age
and Ageing, there is a link between low blood pressure and early death.
Low blood pressure isn’t
necessarily a cause for concern on its own—but if it’s accompanied by
symptoms such as dizziness, light-headedness, headache, fatigue, and
sometimes blurred vision or nausea, that’s when you should see a doctor.
High blood
pressure is a
major concern when it comes to your heart health, and it can put you at an increased
risk of heart attack and stroke. But contrary to what you may think,
“the lower the better” is not necessarily a mantra to follow, according to
new research published in the journal Age
and Ageing.
In the study, researchers analysed 415,980 electronic
medical records of older adults in England, and they found that people older
than 75 years old with low blood pressure—defined here as below 130/80 millimetres
of mercury (mmHg), although the Mayo Clinic puts it at 90/60 mmHg—had
increased mortality rates compared to those with normal blood pressure. This
was especially pronounced in people classified as “frail.”
The researchers concluded that it wasn’t low blood
pressure that caused the issue, but rather that it acted as an early
warning—those adults who were frail and had low blood pressure likely had
underlying and undiagnosed health issues that would make them susceptible to
early death.
One caveat to the study is that it was done in
less-healthy older people, so for those who are younger and/or fitter, the
results might not apply, according to senior author Jane Masoli,
Ph.D.(c) a
clinical doctoral fellow at the University of Exeter in the U.K.
Masoli also said that this was an observational study,
which means the researchers didn’t prove that low blood pressure caused early
death, only that there was a link.
Even with that said, low blood pressure is a condition to
watch—no matter what your age—to make sure it’s not leading to problematic
effects.
“If you have low blood pressure, that’s not a cause for
concern on its own,” says Natasha Trentacosta, M.D., a sports medicine specialist at the
Cedars-Sinai Kerlan-Jobe Institute in Los Angeles. “But when that blood
pressure is combined with certain symptoms, consider getting checked.”
The most common symptoms are dizziness, light-headedness, headache, fatigue, and sometimes blurred vision
or nausea. There is a condition called
“orthostatic hypotension,” she added, which means you get a head rush when you
change positions suddenly—especially when you go from sitting to standing.
If you do have low blood pressure, consistent exercise
may be able to help in the long-term, but Dr. Trentacosta emphasized that you
may need to employ different strategies to account for your blood pressure in
the short-term. For example, she suggested increasing the intensity level
of exercise gradually, and to slow down if
symptoms like irregular pulse, dizziness, or unusual weakness occur.
She also recommends building in more time for stretching before and after exercise to
help blood pressure regulate more effectively. But most of all, she emphasizes
the importance of staying hydrated.
“Dehydration can affect someone with low
blood pressure more,” says Dr. Trentacosta. “Definitely drink more water
before, during, and after exercise. And if you’re feeling lightheaded, dial
down the intensity.”
Plus, 3 ways to protect yourself without freaking out
With coronavirus (COVID-19) dominating the
news cycle, you’re starting to throw around words like “quarantine” with an
uneasy casualness. But what do these words really mean for your life?
“Quarantine doesn’t have to be a
scary thing,” explains infectious disease specialist Steven Gordon, MD. “And it’s an effective
way to protect the public.”
Dr. Gordon explains the ins and
outs of quarantine and other common terms connected with disease outbreaks.
What does quarantine mean?
Governments use quarantines to stop the spread of
contagious diseases. Quarantines are for people or groups who don’t have
symptoms but were exposed to the sickness. A quarantine keeps them away from
others so they don’t unknowingly infect anyone.
Quarantines may be used during:
Outbreaks: When there’s a sudden rise in
the number of cases of a disease.
Epidemics: Similar to outbreaks, but
generally considered larger and more widespread.
Pandemics: Larger than epidemics,
generally global in nature and affect more people.
What’s the difference between isolation and quarantine?
While isolation serves the same
purpose as quarantine, it’s reserved for those who are already sick. It
keeps infected people away from healthy people to prevent the
sickness from spreading.
Can you be legally quarantined?
According to the U.S. Constitution,
yes. The federal government can use isolation and quarantine to
protect people from contagious diseases. States also have the authority to
institute isolations or quarantines. Breaking a quarantine has consequences
that range from a fine to imprisonment.
But government-mandated quarantines
are rare. You have to go all the way back to the infamous Spanish flu pandemic
of 1918-1919 for the last enforced, large-scale isolation and quarantine,
according to the U.S. Centers for Disease Control and Prevention (CDC).
In response to suspected or
confirmed coronavirus exposure, some have been asked to self-quarantine. And
while it’s highly recommended that you do, these quarantines are currently
voluntary.
“For anyone who has close contact
with someone infected with the coronavirus, it is important that you listen to
instructions from your health department,” Dr. Gordon says.
What exactly is “close contact?”
It’s defined as being within approximately 6 feet (2 meters) of someone with
COVID-19 for a prolonged period of time. That includes if you are living with,
visiting or sharing a healthcare waiting area or room with someone with
COVID-19. Or if you have been coughed on by someone with the disease.
Health departments identify close
contacts through what’s called contact tracing, Dr. Gordon explains. “They will
notify you if they think you have been exposed to a known case and provide you
with instructions for next steps,” he says. Unsure if you qualify as having
been in close contact? Reach out to your local health department.
What happens when you are quarantined?
While not all quarantines are the
same, look to the CDC for how best to do your part. Currently, the CDC
recommends:
Make it a staycation: Avoid leaving the
house unless absolutely necessary (read: visiting your healthcare
provider, though see the next bullet for how to do that). That means no
work, school or church and saying no to your cousin’s bat mitzvah.
Call ahead: While your local or state
health department will most likely keep tabs on your health, you may need
to see your doctor, too. “First, try a virtual visit. Or at least, call ahead
first, so that the medical facility can take steps to prevent others from
getting infected,” says Dr. Gordon.
Worried about Fido? At this time, the CDC
says there’s no evidence that companion
animals, including pets, can spread COVID-19. But it may still be
good to still use caution. If you’ve been exposed to COVID-19, avoid
“petting, snuggling, being kissed or licked and sharing food [during a
coronavirus quarantine],” recommends the CDC.
Have your own stuff: Don’t swap
unwashed “dishes, drinking glasses, cups, eating utensils, towels or
bedding with other people or pets in your home,” says the CDC.
Wash, rinse, repeat: “Hygiene is an
integral part of this, even at home. Handwashing should be your first
line of defence when under quarantine,” relates Dr. Gordon. “And don’t
forget to cough or sneeze into your elbows or a tissue that you then throw
away.”
Other protective measures:
Quarantine isn’t the only way to
protect yourself during an epidemic. Dr. Gordon also recommends:
Social distancing: Social distancing
involves avoiding large gatherings. If you have to be around people, keep
6 feet (2 meters) between you when possible. “Social distancing is pretty
much like using common sense,” Dr. Gordon says. “We don’t realize how
interconnected we are until we’re asked to avoid people.” But he notes
that terms like “mass gatherings” or “congregate settings” are vague.
They’re used to describe things like shopping centers, movie theaters or
stadiums. But how many people together is too many? “That’s a moving
target,” he says. There’s no official definition, though the CDC
recently advised that all U.S. events of
10+ people should be cancelled or held virtually.
Staying calm: “While fear is normal,
educating yourself is a great way to counterbalance your anxiety,” says
Dr. Gordon. “Stay informed from reliable sources — but not too intensely.
Hyper-fixating on the news can be just as detrimental.”
Cooperating with the authorities: Following
quarantines and other public health mandates help slow — and stop — the
spread of contagious diseases.
Being cooped up inside may seem
unbearable. But the time WILL pass, and your forced staycation may save lives.
1/31/2020 UPDATE: The newest strain of coronavirus, called 2019-nCoV, surfaced in Wuhan, China, at the end of 2019. The Centers for Disease Control and Prevention (CDC) has confirmed six cases to date in the United States, but has only detected one instance of person-to-person spread in this country. Therefore, 2019-nCoV is not considered to be spreading among communities in the U.S. at this time. CDC monitoring is ongoing.
Coronavirus is a common family of viruses named for its appearance of having a crown (corona in Latin means “crown”). The crown is composed of a protein, called the spike protein, that sticks out from the virus’s surface.1
There are different types of coronaviruses, and while the majority typically cause mild cold symptoms (e.g., runny nose or sore throat), more dangerous types, like the coronaviruses that cause Middle East respiratory syndrome (MERS) or Severe Acute Respiratory Syndrome (SARS), may cause more severe disease, including pneumonia, and even death.
It is impossible to tell the difference between coronavirus infections and other illnesses based on symptoms alone. While doctors need to take a careful history and perform a physical exam, laboratory tests are needed to accurately diagnose coronavirus infections.
At this time, there are no medicines a person can take to prevent or treat the virus itself. Treatment for coronavirus infections is supportive, which means that the patient is supported while the infection runs its course and the body’s immune system clears the infection.
Types and Transmission:
Coronaviruses belong to the family Coronaviridae, and there are seven types that can infect humans.2
Types:
Four common types of human coronaviruses cause symptoms of the common cold.
These four coronaviruses—229E, NL63, OC43, HKU1—are often referred to as community-acquired coronaviruses because they are common and infect people all over the world.3
The other three coronaviruses are more worrisome because they have been linked to severe complications, like pneumonia and death.
These three coronaviruses include:
2019 novel coronavirus (2019-nCoV)
Severe acute respiratory syndrome coronavirus (SARS-CoV)
Middle East respiratory syndrome (MERS-CoV)
Transmission:
In the United States, the coronavirus most commonly infects people in the fall and winter.4
Ways in which the virus can spread from person to person include the following forms of contact:
Droplets (after someone who has the virus coughs or sneezes)
Touch (e.g., shaking hands with an infected person or touching an object that contains the virus and then touching your mouth, eyes, or nose prior to washing your hands)
Feces (fecal-oral spread from infected patients; rare)
Symptoms:
The four community-acquired coronaviruses usually cause “cold” symptoms in the upper respiratory tract, such as:5
Runny nose
Cough
Sore throat
Fever
Headache
Malaise
Sometimes, the coronavirus can affect your respiratory system and complications, like pneumonia or bronchitis, may develop.
These complications are more common in babies and the elderly, as well as people with a suppressed immune system or an underlying heart or lung disease.
MERS-CoV and SARS-CoV:
These serious types of coronaviruses jumped from animals to humans, and are potentially life-threatening.2
According to the Centers for Disease Control and Prevention (CDC), MERS-CoV usually causes fever, cough, and trouble breathing, which often then leads to pneumonia. Thirty to 40 percent of people with MERS coronavirus have died.5
SARS-CoV causes a similar illness of fever, chills, body aches, and respiratory infection which can be fatal.
There are still cases of MERS, mostly in the Arabian peninsula. There have been no cases of SARS in the world since 2004.
2019 Novel Coronavirus (2019-nCoV):
At the end of 2019, a new coronavirus, called 2019-nCoV, surfaced in Wuhan, China. Similar to MERS and SARS, this coronavirus likely jumped from an animal (probably a bat, although scientists are not completely certain) to a human, perhaps via some other species. 6
It appears that the 2019-nCoV infection is causing a severe respiratory (lung) illness similar to SARS. Common initial symptoms of the infection include fever, cough, fatigue, and muscle aches.7 Available data suggests while the disease can be severe and even fatal, it may not have as high a mortality rate as MERS or SARS. The medical community is still trying to get accurate data early in this outbreak.
Diagnosis:
The diagnosis of a routine coronavirus infection (cold symptoms) involves a medical history, including travel history, and a physical examination. Most often, the patient will be diagnosed with a cold, and sent home.
If your symptoms are severe, your healthcare team may order tests to specifically check for the virus. This is done by taking a sample of your blood and/or a swab from your nose or throat.
With the new concern for 2019-nCoV infections, symptomatic patients and their doctors have to be careful to obtain a travel history to China or other infected regions, or a history of contacts with other people who may have been exposed. Laboratory testing for 2019-nCoV is currently being coordinated with public health offices and the CDC.
Treatment:
There is no vaccine or specific medicine to treat coronavirus. Instead, the treatment for mild coronavirus infections is supportive, which means doing things to ease your symptoms.8
Using a cool-mist humidifier to help soothe your cough
Rest
Drinking fluids
Important Note:
Do not give your child or teenager aspirin or aspirin-containing products due to their risk of Reye syndrome, a potentially fatal condition.
SARS, MERS, and illnesses caused by 2019-nCoV also require supportive care, of a different type: hospitalization, oxygen, fluids, and other life-saving treatment may be necessary to support the patient while the immune system responds to, and clears, the infection.
Antiviral medicines shown to suppress or destroy coronaviruses are currently commercially available.
Prevention:
You can reduce your risk of contracting human coronavirus by doing what you would do to protect yourself from getting the flu or common cold:8
Scrub your hands with soap and water for at least 20 seconds (try singing the Happy Birthday song twice for proper timing)
Avoid touching your eyes, nose, and mouth
Avoid being around people who are sick
If you are sick, you can protect others by staying home from work or school.
If you do cough or sneeze, be sure to cover your mouth and nose with a tissue, and then wash your hands after discarding the tissue. Alternatively, if you do not have a tissue available, sneeze or cough into the crook of your elbow.
A Word From Verywell:
Coronavirus is a common virus that infects people at least once over the course of their lifetime. The good news is that in most cases, it causes a mild, run-of-the-mill “cold.”
If your symptoms are severe or persistent, or if you have an underlying medical condition, be sure to see your doctor.
The 2019-nCoV coronavirus is concerning because of the potential for spreading globally, and because it can cause severe symptoms. As more information is gathered on this infection, we hope to remain a resource for you so you can get the information you need. If you are worried that you may have been exposed to this newly-described virus, it is a good idea to get medical care promptly.
