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COVID Crisis Post 40: So. Crazy. Complex.


I have come to accept pretty much anything and everything is possible with COVID-19. And I want to continue to share what I read and learn about it, even though it can be nerve-wracking.


A man in China is still in quarantine because he still has not had two consecutive negative COVID-19 tests even after 10 WEEKS.


This. Is. In. Sane.


His situation has led him to even have suicidal ideations. I do not blame him. Scientists do not understand why the man, who is asymptomatic, continues to test positive since he should have cleared the virus by now, nor do they know if he could still be infectious. So as a result, until he has those two consecutive negative test 24 hours apart, he will not be released.


He very well could be an exception, but there are other instances of patients testing positive for COVID-19 after a negative test. Could this be due to reactivation of the virus, reinfection, false negative swab, etc? We still do not know.


An outbreak of 9 COVID-19 infections at a restaurant in China points to spread of the virus in the direction of airflow caused by the air conditioning units.


Great - just something else we need to worry about and consider if we ever reopen restaurants.


A very small study coming out of India, and one that has been heavily criticized, claims testicles could serve as a reservoir for COVID-19 due to presence of ACE2 receptors and be contributing to the increased likelihood of death amongst men versus women. This has NOT been proven to be the case.


But what I CAN confirm is that COVID-19 sucks balls. Fact.


Besides all the well-known signs and symptoms of disease already well-described, such as involvement of the lungs, heart, liver, kidneys, blood and blood vessels, brain, GI tract, and olfactory system, there are even more unbelievable possible signs and symptoms being unfurled.


COVID toes. I am not making this up. There has been a spike of patients presenting with toes that look like they are frost-bitten: red/purple, swollen, sometimes itchy, usually painful. It is found disproportionately in children and young adults, many of whom are asymptomatic, as well as the most severely ill COVID-19 patients.


It could be related to localized inflammation of the blood vessels or small blood clots forming in the toes, where clot formation in various organ systems has been a hallmark of this disease. No proven connection yet, but the spike in cases seems too coincidental.


The clot issue presents small and large. And this is where things get really scary.


Mount Sinai neurosurgeons treated 5 patients between March 23-April 7 - aged 33, 37, 39, 44, and 49 years of age - with no prior medical history who presented with sudden, severe stroke due to clot formation in the large arteries of the brain. Mount Sinai usually only averages 3 large vessel strokes every TWO MONTHS.


These are the worst types of strokes and can lead to severe disability and even death. And these must be treated immediately because we are taught two important concepts in regards to stroke in medical school - PLEASE REMEMBER THEM:


Act FAST: Facial drooping, Arm weakness, Speech difficulties, Time to call emergency services

because

TIME IS BRAIN.


All 5 patients tested positive for COVID-19, even though all had only mild or no symptoms at all of the virus. Two delayed calling an ambulance likely out of fear due to the outbreak. And the fate of those 5 patients?


One died, two are still hospitalized, one is undergoing rehabilitation, and the 33 year old was released home... and is the only one who is able to speak.


Those ages are shocking. The average age for this type of severe stroke is above 70. 60 is considered YOUNG.


But hospitals across the country, including my own, have seen a spike in young patients presenting with large vessel stroke who are COVID-19+; in fact, the average age of large vessel stroke in COVID-19+ patients is 15 years YOUNGER than what is typical. In addition, clots are also forming on the venous side of the brain circulation - could we soon see cases of cerebral venous sinus thrombosis in these patients?


And in one of the scariest things I have read yet about this disease, one of the neuro-interventional radiologists who worked to remove the clot from the brain of the 44 year old stated he saw new clots forming in real time.


Okay, I am going to stop now. This may be the most complex disease process humankind has ever faced. That is not an exaggeration.


Though the most important thing I think should be taken away from today's post is this:

PLEASE, go to the hospital if you think something significant may be befalling you. Do not wait. Do not be scared. We want to help you. We have not forgotten about you.


Because your life could depend on it. Please.


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