The woman was dying. Workers at New Yorks Mt. Sinai Hospital were about to call her husband and break the news that there was nothing left to try. Then Dr. Hooman Poor took a gamble.
With high-stress, high-stakes decisions, doctors around the world are frantically trying to figure out how COVID-19 is killing their patients so they can attempt new ways to fight back. One growing theory: In the sickest of the sick, little blood clots clog the lungs.
Poor couldnt prove it. The tests required would further endanger his staff, who were already at risk of exposure to the novel coronavirus, which causes COVID-19. But the lung specialist saw clues that were screaming blood clots. So Poor pulled out a drug best known for treating strokes, and he held his breath.
I said, What do we actually have to lose? Poor said. Thats when I decided to give not just a blood thinner but a blood-clot buster.
Exactly whats going on with blood clots in at least some COVID-19 patients is a mystery.
Newsletter
Get our free Coronavirus Today newsletter
Sign up for the latest news, best stories and what they mean for you, plus answers to your questions.
You may occasionally receive promotional content from the Los Angeles Times.
Chinese doctors were first to sound the alarm. In March, Chinese heart specialists advised the American College of Cardiology to watch for clots and said certain blood tests showing a rise in clot risk might signal which patients were in greatest danger. Other reports suggested the clots can show up all over the body. But were they a cause of deterioration or an effect?
Already, many hospitals are attempting preventive doses of blood thinners to keep clots from forming. Theres huge debate over what kind to try, what dose is safe the drugs can cause dangerous bleeding and how soon to start.
In New York, Poor was going a step further with a drug called tissue plasminogen activator, or tPA, which doesnt prevent clots it breaks them up.
Its an example of how, with no vaccine or approved treatment for COVID-19, many overwhelmed doctors are following trails of clues to figure out what to try next.
Poors 55-year-old patient wasnt getting enough oxygen even after doctors rolled her onto her stomach for an extreme ventilation technique called prone positioning. She was in shock. Other organs were failing fast.
Twenty minutes after the injection of tPA, her oxygen levels rose. Poor was elated. But not for long.
She gets better, but then she starts to get worse, he said. Most likely were breaking up the clot, but she is immediately forming the clot again.
So he tried something novel, putting the woman on a low-dose drip of tPA for about 24 hours, together with a blood thinner, in hopes of chipping away at existing clots while blocking new ones.
To Poors dismay, the experimental treatment bought the woman only a few more days of life. A sudden, different complication killed her on Friday.
But last weekend, Poors team tested the new clot-fighting approach in four other severely ill patients. One didnt survive, dying of cardiac arrest from a massive blood clot in his heart.
The rest saw improvement in oxygen levels and shock. As of Friday, three remained on ventilators but were doing better, especially one who had been treated soon after her lungs failed. In a new report, Poor called for urgent study of whether abnormal clotting drives at least some patients deterioration, even as his own hospital updated treatment advice for its sickest cases.
Others are onto the same lead. Specialists at the University of Colorado and Harvard recently published a similar tPA research call and cited three additional cases in which it was tried, as hospitals in Colorado and Massachusetts prepare for a study.
Were taking care of extremely ill patients that are dying in front of us, and we cant get any diagnostic testing, yet still have to make treatment decisions, said Dr. Steven Pugliese, a pulmonologist at the University of Pennsylvania.
Pugliese called Poors tPA report very intriguing and concluded: What these doctors did in these very ill patients who were dying was a judgment call, and it was the right thing to do.
But with the bleeding risk, the strategy has to be studied in carefully chosen patients, Pugliese said, especially with no good way to tell in advance who really has these tiny clots.
Poor first noticed oddities as his ICU filled with patients who just werent responding to care the way doctors expected. They were on breathing machines after developing acute respiratory distress syndrome, or ARDS. Its an inflammatory form of lung failure that, when caused by other infections, stiffens lungs.
At least early on, Poor didnt see that.
It was like Groundhog Day with each patient, he said, referring to the movie in which the same events repeat day after day. They had severe abnormalities in oxygen and carbon dioxide levels, but, shockingly, their lungs were not stiff.
He recalled Italian doctors who spotted the same thing and wrote in an American Thoracic Society journal that COVID-19 was causing atypical ARDS.
Back in Poors hospital, when ventilated patients had improved enough to allow them to wake up a bit, alarms would sound as their blood oxygen levels immediately plummeted.
The residents would yell at me, So and so is desaturating! Poor recalled. Classically in ARDS, we think thats because the lung is collapsing. But it wasnt.
Poor often treats patients for pulmonary embolism, a large clot in the lungs that can quickly kill. The COVID-19 patients didnt look quite like that. Nor were their hearts struggling to pump blood into the lungs.
Then, as he was doing laundry at 2 a.m., Poor remembered a rare disease in which some lung blood vessels abnormally dilate even as others are clogged. If that explains the COVID-19 contradictions, he thought, a clot-buster might help.
I did a case series of five. This does not prove anything, he cautioned. Perhaps it brings light to possibilities where further research can delve into what exactly is going on.
Neergaard writes for the Associated Press.
Link:
Doctor treating COVID-19 patients gambles on clot-busting drug - Los Angeles Times
- Coronavirus Scam Alert: Watch Out For These Risky COVID-19 Websites And Emails - Forbes [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- COVID19: Broome County Executive expected to sign executive orders on virus - WBNG-TV [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- Houston-based company ready to test COVID-19 'vaccine candidate,' but doesn't have the funds - KHOU.com [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- COVID19 Mesa County Public Health [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- Coronavirus Disease 2019 (COVID-19) | SCDHEC [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- Coronavirus disease 2019 - Wikipedia [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- Hackers are jumping on the COVID-19 pandemic to spread malware - TechCrunch [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- COVID-19 can last a few days on surfaces, according to new experiment findings - ABC News [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- The Guardian view on the UKs Covid-19 response: confused and hesitant - The Guardian [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- The COVID-19 Coronavirus Pandemic Highlights The Importance Of Scientific Expertise - Forbes [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- WHO Expert: Aggressive Action Against Coronavirus Cuts Down On Spread : Goats and Soda - NPR [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- 2 new cases of COVID-19 at Chicago schools - WGN TV Chicago [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- Will Gargling with Salt Water or Vinegar 'Eliminate' the COVID-19 Coronavirus? - Snopes.com [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- Worried about dying from COVID-19? You might be a millennial | TheHill - The Hill [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- Startups developing tech to combat COVID-19 urged to apply for fast-track EU funding - TechCrunch [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- Why do dozens of diseases wax and wane with the seasonsand will COVID-19? - Science Magazine [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- WHO, UN Foundation and partners launch first-of-its-kind COVID-19 Solidarity Response Fund - World Health Organization [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- Covid-19: PM to address nation tonight - New Straits Times [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- COVID-19: Where every sport lies after mass disruption - RTE.ie [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- COVID-19: Facts, myths and hypotheses | TheHill - The Hill [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- Hong Kong Has Largely Survived COVID-19. Can New York and The US Do It Too? - BuzzFeed News [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- UPDATE: Case of COVID-19 confirmed in Wilson County - WITN [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- Is This Train Car Carrying 'COVID-19'? - Snopes.com [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- Coronavirus pandemic: facts, updates and what to do about COVID-19 - The Verge [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- DHS: 34 people test positive for COVID-19 in Wisconsin - WBAY [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- COVID-19 by the numbers; plus key resources to help you stay informed - Berkeleyside [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- The Covid-19 puzzles that scientists are still trying to answer - The Guardian [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- What's the COVID-19 end game? - The San Diego Union-Tribune [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- The Covid-19 coronavirus is not the flu. Its worse. - Vox.com [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- Phones Could Track the Spread of Covid-19. Is It a Good Idea? - WIRED [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- NIH Reports First Known Employee with COVID-19 Infection - National Institutes of Health [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- Newborn tests positive for COVID-19 in London - Livescience.com [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- Covid-19: Malaysia's pandemic action plan activated for the coronavirus - The Star Online [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- How Bad Will The COVID-19 Coronavirus Epidemic Get In The U.S.? Health Experts Weigh In - Forbes [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- Can People Who Recover from COVID-19 Become Reinfected? - Snopes.com [Last Updated On: March 16th, 2020] [Originally Added On: March 16th, 2020]
- THE LATEST: 41 test positive for COVID-19 in the state - WFSB [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Twelve new cases of COVID-19 announced in Illinois; bringing total to 105 - KWQC-TV6 [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Eagle County outlines shift for COVID-19 testing, Vail Health shifts operations - Vail Daily News [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- 7th positive COVID-19 case announced in Hawaii, all cases related to travel - KHON2 [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Canada tightens borders over coronavirus will it curb COVID-19s spread? - Global News [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- As health care workers prepare for COVID-19, medical students pitch in on the homefront - Minnesota Public Radio News [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Coronavirus First positive case of COVID-19 confirmed in Geauga County Kaylyn Hlavaty 7:58 AM - News 5 Cleveland [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- 2nd presumptive case of COVID 19 reported in Bell County - KWTX [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- New confirmed cases of COVID-19 in Wisconsin - WKOW [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Hawaii National Guard ready to step in against spread of COVID-19 - KHON2 [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Alberta orders all classes cancelled, daycares closed as COVID-19 cases rise to 56 in the province - Global News [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Has Italy Stopped Treating the Elderly in the COVID-19 Pandemic? - Snopes.com [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Coronavirus testing: Information on COVID-19 tests according to state health departments - NBCNews.com [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Working from home because of COVID-19? Here are 10 ways to spend your time - Science Magazine [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Two positive COVID-19 cases announced in Fairbanks, bringing Alaska's confirmed total to 3 - Anchorage Daily News [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- 8 more positive cases of COVID-19 brings Michigan total to 33 - FOX 2 Detroit [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- COVID-19: Who Is Infectious? - Forbes [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- The Guardian view on the latest Covid-19 steps: a recipe for isolation - The Guardian [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Government publishes updated COVID-19 industry guidance - GOV.UK [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- NIH clinical trial of investigational vaccine for COVID-19 begins - National Institutes of Health [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Expanding Colorado's COVID-19 Testing Capacity Proves Frustrating to Polis, Doctors And The Public - Colorado Public Radio [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Microsoft Bing launches interactive COVID-19 map to provide pandemic news - The Verge [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Coronavirus tips: How to slow the spread of COVID-19 with hand-washing, social distance - USA TODAY [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- See Which Countries are Flattening their COVID-19 Curve - Visual Capitalist [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- With launch of COVID-19 data hub, the White House issues a call to action for AI researchers - TechCrunch [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- COVID-19 - Cabinet for Health and Family Services [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Coronavirus Disease 2019 (COVID-19) | AustinTexas.gov [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- First COVID-19 case in Waterbury is confirmed - Waterbury Republican American [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Covid-19 reveals the alarming truth that many children cant wash their hands at school - The Guardian [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Statement on COVID-19 Panel Discussion Notes That Were Attributed to UCSF - UCSF News Services [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Covid-19 coronavirus testing in the US has been absurdly sluggish. That puts us at risk. - Vox.com [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Regal is closing all theaters until further notice over COVID-19 fears - TechCrunch [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Amazon limiting shipments to certain types of products due to COVID-19 pandemic - TechCrunch [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Coralville company to produce millions of kits to test for COVID-19 - KCRG [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Number of COVID-19 cases in Erie County rises to 11, new case confirmed in Wyoming County - WIVB.com - News 4 [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Coronavirus tips and symptoms: What everyone should know about getting the new coronavirus - Vox.com [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Tech giants are getting creative to manage the COVID-19 crisis - The Verge [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- COVID-19: Mental health in the age of coronavirus - UN News [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- White House provides an update on COVID-19 testing in the U.S., says theres been a dramatic ramp - TechCrunch [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Covid-19: How long does the coronavirus last on surfaces? - BBC News [Last Updated On: March 17th, 2020] [Originally Added On: March 17th, 2020]
- Hospital in Boston will be converted into Covid-19 treatment center - STAT [Last Updated On: March 18th, 2020] [Originally Added On: March 18th, 2020]
- 78 cases of COVID-19 confirmed in Tennessee - NewsChannel5.com [Last Updated On: March 18th, 2020] [Originally Added On: March 18th, 2020]
- COVID 19: Tennessee confirmed cases reaches 52, Dept of Health releases age ranges of those infected - Clarksville Now [Last Updated On: March 18th, 2020] [Originally Added On: March 18th, 2020]
- Housing associations under pressure to offer Covid-19 rent holidays - The Guardian [Last Updated On: March 18th, 2020] [Originally Added On: March 18th, 2020]
- Sacramento woman dead from COVID-19 attended church with others who have virus - KCRA Sacramento [Last Updated On: March 18th, 2020] [Originally Added On: March 18th, 2020]