COVID-19 may have a deeper, darker side
Doctors are seeing more and more young people infected with COVID-19 who don’t have the commonly associated lung problems. They are having brain strokes and becoming disabled or even worse, dying.
These are people in their 20s, 30s, and 40s. Usually, these types of blood-clot strokes are seen in people well over the age of 60, and generally in people in their mid-70s. Doctors in New York first got suspicious when they realized young people were having strokes at a rate five times higher than normal.
The story in these young stroke victims is a common one. A person has no history of any chronic medical condition. They are taking no medications. They are feeling fine, and then, all of a sudden, they have difficulty talking or moving one side of their body.
The common denominator is that they are young, have the COVID-19 infection, and don’t know it. Thankfully, the overall number of young people that this happens to is relatively low, but it’s still much higher than would be expected.
The fascinating point is that the exact way the virus attacks humans is still not completely understood. Doctors once believed it was a pathogen that primarily targeted the lungs. Scientists are discovering it is much more insidious.
Papers have been published that COVID-19 also attacks red blood cells, and that is what might be responsible for the low oxygen in patients rather than lung damage. The closer scientists look at the virus, the more they are beginning to realize that it can have a devastating impact on every single organ system in the human body.
Doctors are reporting patients with COVID-19 can have damage to their hearts, kidneys, and even skin. In the skin, dermatologists around the country are seeing a strange net-like rash on the legs called reticulated vasculitis.
They also observe red-purple bumps on the toes, another type of vasculitis with probable associated micro-blood clots, called pernio. These peculiar findings of inflammation and clots in the skin, organs and brain are all probably related to what the virus does to human bodies during infection.
It appears that the virus triggers some type of inflammation that acts on blood vessel walls. Typically, blood vessel walls are smooth and resist blood clots. Scientists now think that the virus infects and disrupts blood vessel walls, allowing blood clots to form.
Some stay locally, as seen in patients with “COVID toes.” Others can float around, say from the legs to the lungs (pulmonary embolism), or they can affect any organ where the supplying blood vessel gets blocked.
Doctors see the clots both in arteries (that carry oxygen to organs) and veins (carrying blood cells back to the lungs to pick up more oxygen). That means that everything downstream gets starved of oxygen and gets damaged, or the tissue or organ dies. This sudden interruption of the blood supply is commonly called a stroke or heart attack.
It also affects kidneys (acute kidney failure), heart, lungs, and brain. When a big clot causes a stroke in the brain, it can be devastating. Evidence is suggesting the younger coronavirus patients are suffering these catastrophic, large-vessel blockage strokes to the brain. These strokes are what is seen in young patients with few other symptoms, except they are coronavirus positive.
In New York, paramedics reported that four times as many people were dying at home during the pandemic than before. Many of the people did not have autopsies, but it is suspected that many died from strokes.
The association of young people who are COVID-19 positive and strokes has been seen across the country. Several national medical institutions are currently preparing medical reports concerning the alarming rate of strokes in young people who are COVID-19 positive. Many of these will appear in print this month.
The good news about this strange finding of strokes in young people is that large-vessel strokes to the brain can be treated very effectively if caught early, ideally within six hours but certainly within 12-24 hours. Doctors can remove the clots, and the brain’s blood flow, nourishment and function can be restored.
It is critical for anyone who experiences any one of the following five signs for a stroke to call 911, immediately:
Sudden numbness or weakness in the face, arm or leg (especially on one side of the body)
Sudden confusion or trouble speaking or understanding speech
Sudden vision problems in one or both eyes
Unexpected difficulty walking or dizziness, loss of balance, or problems with coordination
Severe headache with no known cause
Heeding these stroke warning signs will save lives. Doctors are now realizing that the COVID-19 infection is not just one that affects the lungs, but it is a disease that can affect people of all ages and affect every part of the human body.
Charles E. Crutchfield III, MD is a board-certified dermatologist and clinical professor of dermatology at the University of Minnesota Medical School and a Benedict Distinguished Visiting Professor of biology at Carleton College. He also has a private practice, Crutchfield Dermatology in Eagan, MN.
He received his MD and Master’s Degree in molecular biology and
genomics from the Mayo Clinic. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine. Minnesota Medicine recognized Dr. Crutchfield as one of the 100 Most Influential Healthcare Leaders in Minnesota. Dr. Crutchfield specializes in
skin-of-color and has been selected by physicians and nurses as one of the leading dermatologists in Minnesota for the past 18 years.
He is the team dermatologist for the Minnesota Twins, Vikings, Timberwolves, Wild and Lynx. Dr. Crutchfield is an active member of both the American and National Medical Associations and president of the Minnesota Association of Black Physicians. He can be reached at CrutchfieldDermatology.com or by calling 651-209-3600.