As the Covid-19 pandemic continues taking hundreds of thousands of lives across the world, respiratory therapists aren’t the only medical professionals who are in shortage. More and more hospitals across the country are finding out that young and middle-aged people are dying of strokes in great numbers due to Covid-19 despite lack of symptoms.
Interventional neurologist Thomas Oxley from the Mount Sinai Beth Israel Hospital in Manhattan is one of the many doctors who’ve discovered there’s a rapid rise in the number of stroke cases during the coronavirus pandemic. Strokes weren’t a rare health problem for Americans even before the pandemic but the recent rise of strokes in younger and middle-aged people seems to be directly related to the Covid-19 virus.
“This is crazy,” Oxley remembers telling his boss right after operating on a 44-year-old Covid-19 patient who had a blood clot that needed removing. As Oxley was removing the blood clot, he saw multiple other blood clots forming around it in real-time – something neither he nor most of his colleagues had seen in their professional life.
What these strokes reveal about our understanding of the virus
These strange strokes in younger Covid-19 patients are still not the most dangerous aspect of the disease but they’re showing us that we still don’t understand how the virus operates.
There were some scarce reports from Wuhan, China about Covid-19 patients who had died of strokes but up until recently, these weren’t given much thought. That’s because many of the patients were older or in already critical conditions and the strokes were seen mostly as a coincidence.
As time passed, that link is now considered “a clinical hunch by a lot of really smart people,” said Sherry H-Y Chou, a neurologist and critical care doctor at the University of Pittsburgh Medical Center. Three separate U.S. medical centers are currently preparing to release data on this stroke phenomenon.
It should also be pointed out that there are different types of strokes – some called “mini-strokes” who usually don’t cause much permanent damage and others who are much more catastrophic. Unfortunately, from the recorded cases that we have right now, the strokes in Covid-19 patients – symptomatic and asymptomatic alike – tend to be of the deadliest type.
These strokes are referred to as LVOs or “Large vessel occlusions”. They form in main blood-supplying arteries and are capable of obliterating large sections of the brain, especially in its decision-making, speech, and movement parts.
So far, the connection medical professionals are drawing lies in the blood clots which have been shown to be a very common problem in Covid-19 patients. Such blood clots are also the cause of increased pulmonary embolism deaths which is what happens when a blood clot migrates to the patient’s lungs instead of their brain. Clots near the heart can cause heart attacks.
Critical care doctor Robert Stevens from the John Hopkins Hospital in Baltimore and who’s insight we’ve already shared, called strokes “one of the most dramatic manifestations” of blood clots. He also added that “We’ve also taken care of patients in their 30s with stroke and covid, and this was extremely surprising.”
Why are these complications so hard to figure out?
One of the key factors that prevents medical professionals from adequately addressing and processing all the data they have is not only that they are overworked but that the whole system isn’t functioning properly. This is very clearly highlighted by news such as that about the New York Fire Department picking up four times as many people who’ve died at home from sudden strokes.
That’s a statistic that should be meticulously analyzed but because autopsies were not conducted due to the system being overwhelmed, we can’t know what’s the official cause of those strokes. All we can do is speculate that because the 4x increase happened in the heat of the pandemic, the two must be related.
This uncertainty also leads to a lot of questions regarding how exactly the virus is causing these additional problems. According to Chou, one of the main questions is whether the clotting is due to a direct attack on the patient’s blood vessels by the virus or an overreaction of their immune system.
“In your body’s attempt to fight off the virus, does the immune response end up hurting your brain?” Chou said. She hopes that with thousands of Covid-19 patients treated for neurological complications in 68 medical centers in 17 countries right now, the answer will be discovered quickly.
14 medical centers of Thomas Jefferson University Hospitals, as well as NYU Langone Health In NYC, have already discovered that 40% of their Covid-19 patients with blood blockage problem were under 50 years of age and in no risk groups. Their joint paper is currently under review by a medical journal.
Are there any particular Covid-19 symptoms that might indicate a risk of stroke?
The next bit of bad news is that all those unexpected Covid-19 strokes didn’t just happen in younger and “low-risk” patients but in people with only mild or no symptoms at all.
Pascal Jabbour, a neurosurgeon at Thomas Jefferson and Eytan Raz, an assistant professor of neuroradiology at NYU Langone have said that these strokes “challenge conventional thinking.”
“We are used to thinking of 60 as a young patient when it comes to large vessel occlusions,” Raz commented on the most severe stroke cases. “We have never seen so many in their 50s, 40s, and late 30s.”
One hypothesis Raz shared was that maybe younger people suffer from these strokes because they are more resistant to the respiratory problems than the elderly. “So they survive the lung side, and in time develop other issues,” Raz wondered.
Jabbour also shared Oxley’s discovery of newer blood clots forming rapidly as the surgeons were treating previous ones.
“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,” Jabbour said.
What’s the average age of the stroke victims?
The average age of the Covid-19 stroke victims is ~15 years younger than not only the average age of Covid-19 victims but that of non-Covid-19 stroke victims as well. That, together with the fact that they are mostly asymptomatic, makes the situation all the more puzzling.
“These are people among the least likely statistically to have a stroke,” said J. Mocco, director of Mount Sinai’s Cerebrovascular Center.
Mocco also noted that while he is “completely shocked” he is also 100% convinced in the relation between Covid-19 and the sudden strokes. “[It] is one of the clearest and most profound correlations I’ve come across,” he said. “This is much too powerful of a signal to be chance or happenstance.”
The Mount Sinai team has sent a letter to be published in the New England Journal of Medicine soon in which they detail the conditions of five patients, aged 33, 37, 39, 44, and 49.
According to Oxley, they all reached critical conditions because they “delayed seeking emergency care due to fear of the covid-19 outbreak.” The dark irony is that they had Covid-19 without knowing it.
For Oxley, the most important people thing need to understand about these strokes is that even the large ones are perfectly treatable if they are caught early.