I don't know how you are supposed to self treat this if you get it but not bad enough to go to a hospital. I'm hoping my 325 aspirin is enough. Or may be I just demand a Lovenox shot. Not sure if walk in clinics would have anticoagulation therapies immediately available.
Autopsies indicate blood clots are lethal in COVID-19
In mid-March, pathologist Sigurd Lax
pulled on a water-repellant surgery coat, a surgical cap, special
booties to cover his shoes, a respiratory mask, and two pairs of gloves,
then walked into an operating room at Hospital Graz II in Austria.
There before him lay a patient who died of COVID-19 only 48 hours
earlier.
“COVID-19 is a new disease, and we
really want to know what’s underlying it,” Lax says. There’s only one
method to determine what causes illness and death. “It’s doing an
autopsy.”
Methodically, Lax sliced into the
patient, taking care not to spray any bodily fluids into the air. He’d
waited two days to perform the autopsy to reduce the risk of
transmitting SARS-CoV-2, the coronavirus that causes COVID-19. With
little known about the illness at the time, he and his colleagues wanted
to take extra precautions to avoid getting sick. Waiting 48 hours after
death to perform the autopsy, however, didn’t rid the body of
SARS-CoV-2 RNA.
“We
don’t know if the virus is still infectious,” Lax says, but finding its
genetic material lingering in the patient’s tissues prompted him to be
even more cautious. This autopsy was the first of 11 he and his
colleagues have performed on patients who died from COVID-19. In May,
the pathologists’ published a paper in the Annals of Internal Medicine reporting what they’d found.
Lax, a professor of pathology at the Johannes Kepler University Linz, spoke with The Scientist about the results and what they reveal about possible therapeutics for COVID-19.
The Scientist: As you started performing these autopsies, what was most striking in terms of damage done to the body?
Sigurd Lax:Both
lungs were symmetrically damaged, with damage to the alveoli, the tiny
air sacs of the lungs. The pleurae, the double-lined membranes,
surrounding the lungs showed very little inflammatory changes, a little
fluid. Most cases had a strongly dilated heart, but the abdomen was not
really involved. That was what we saw at first view.
TS:
In your paper, you write that patients had blood clots in their small
to mid-sized pulmonary arteries. What’s the significance of this
finding?
SL:
We saw an occlusion of multiple pulmonary arteries, usually in the
periphery. There were some clots in the larger branches, but we think
seeing more of them in the periphery means the clots are thrombotic
rather than embolic. [Editor’s note: thrombotic
clots develop in a blood vessel where there is damage, in this case in
the lungs, while embolic clots form elsewhere, in a blood vessel in the
leg, for example, and travel through body and become lodged in blood
vessels of the lung.] And this concurs also with findings in
pediatric cases, where you have occlusion of arteries in the fingers,
for example, or necrosis in back, so in the skin on their back. So it’s
not the pulmonary embolism which is the major cause of severe illness
but the inflammation of the blood vessels and a change in the clotting
system of the blood. And this causes occlusion of the pulmonary
arteries, which increases the pressure of pulmonary circulation and then
leads to an insufficiency of the heart to pump blood through the body
properly.
TS: Does the virus cause the blood clots to form or is it the immune response to the virus that causes them?
SL:So
far that’s not clear. I think one can speculate that either one or the
other or both may be the reason, but I think it might be more the immune
response, that inflammatory mechanisms lead to the thrombosis.
TS:
When doing the autopsies, did you focus mainly on the lungs or were
there other body regions that you also examined, such as the brain?
SL:In
the first cases we only looked at the brain in one case, but we’ve done
more autopsies since the paper came out and from those, the central
nervous system doesn’t seem to be really specifically affected, at least
grossly. I don’t have so far any microscopic data, but the analysis is
ongoing.
TS:There have been reports that infection with SARS-CoV-2 could cause diabetes by leading to damage of insulin-producing cells. Was there any indication of that in the autopsies?
SL:Not
really. I think there’s a coincidence with diabetes. I think that has
to do with the vascular changes caused by diabetes. . . . These patients
due to their diabetes have atherosclerosis, then they have heart
disease, and this aggravates the course of these COVID-19–associated
pulmonary changes because, you know, when you have a strong heart, you
will be able to overcome the infection, but if you have some associated
disease, particularly heart diseases, you will undergo cardiac failure.
TS: What do your results say, right now, about treating COVID-19 patients with a severe form of the disease?
SL:Right
after being admitted to the hospital, ten out of our eleven patients
received an anticoagulant at a prophylactic level to prevent clotting in
the blood.(You talked about doing 11 autopsies, so even with immediate anticoagulation those 10 still died? What is the solution then?) We did not find thrombosis in the deep arteries of the
pelvis and the deep blood vessels of the pelvis and upper legs, but the
treatment was not enough to prevent thrombosis in the pulmonary
arteries.
TS:Given
the autopsy data and all of the information researchers are gathering
on COVID-19, what are the biggest questions that have yet to be
answered?
SL:What
we really don’t know at the moment is how the virus goes through the
body, what are the sequence of changes caused by the virus. That’s not
completely solved.
Editor’s note: This interview has been edited for brevity.
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