After he had spent nearly three weeks in an intensive care unit being treated for Covid-19, Broadway and TV actor Nick Cordero’s doctors were forced to amputate his right leg.
The 41-year-old’s blood flow had been impeded by a clot: yet another dangerous complication of the disease that has been bubbling up in frontline reports from China, Europe and the United States.
He remains in Los Angeles hospital hooked up to a breathing machine.
To be sure, so-called “thrombotic events” occur for a variety of reasons among intensive care patients, but the rates among Covid-19 patients are far higher than would be otherwise expected.
“I have had 40-year-olds in my ICU who have clots in their fingers that look like they’ll lose the finger, but there’s no other reason to lose the finger than the virus,” Shari Brosnahan, a critical care doctor at NYU Langone said.
One of these patients is suffering from a lack of blood flow to both feet and both hands, and she predicted an amputation may be necessary, or the blood vessels may get so damaged that an extremity could drop off by itself.
Blood clots aren’t just dangerous for our limbs, but can make their way to the lungs, heart or brain, where they may cause lethal pulmonary embolisms, heart attacks, and strokes.
A recent paper from the Netherlands in the journal Thrombosis Research found that 31 per cent of 184 patients suffered thrombotic complications, a figure that the researchers called “remarkably high” – even if extreme consequences like amputation were rare.
Behnood Bikdeli, a doctor at New York-Presbyterian Hospital, assembled an international consortium of experts to study the issue. Their findings were published in the Journal of The American College of Cardiology.
The experts found the risks were so great that Covid-19 patients “may need to receive blood thinners, preventively, prophylactically,” even before imaging tests are ordered, said Bikdeli.
What exactly is causing it? The reasons aren’t fully understood, but he offered several possible explanations.
People with severe forms of Covid-19 often have underlying medical conditions like heart or lung disease – which are themselves linked to higher rates of clotting.
Next, being in intensive care makes a person likelier to develop a clot because they are staying still for so long. That’s why for example people are encouraged to stretch and move around on long-haul flights.
Italian and British medical experts meanwhile are investigating a possible link between the pandemic and clusters of severe inflammatory disease among infants who are arriving in hospital with high fevers and swollen arteries.
Doctors in northern Italy, one of the world’s hardest-hit areas during the pandemic, have reported extraordinarily large numbers of children under age nine with severe cases of what appears to be Kawasaki disease, more common in parts of Asia.
In Britain, doctors have made similar observations, prompting Health Secretary Matt Hancock to tell a coronavirus news briefing on Monday that he was “very worried” and that medical authorities were looking at the issue closely.
In the United States, a leading paediatric society says it has yet to see something similar.
Kawasaki disease, whose cause is unknown, often afflicts children aged under five and is associated with fever, skin rashes, swelling of glands, and in severe cases, inflammation of arteries of the heart. There is some evidence that individuals can inherit a predisposition to the disease, but the pattern is not clear.
A hospital in the northern Italian town of Bergamo has seen more than 20 cases of severe vascular inflammation in the past month, six times as many as it would expect to see in a year, said paediatric heart specialist Matteo Ciuffreda.
He has called on his colleagues to document every such case to determine if there is a correlation between Kawasaki disease and Covid-19. He aims to publish the results of the Italian research in a scientific journal.
Kawasaki disease was anecdotally linked 16 years ago to another known coronavirus, though it was never proven. The research was carried out after another, related coronavirus known as NL63 was found in a baby showing symptoms of Kawasaki disease in 2004.
Ian Jones, professor of virology at the University of Reading in Britain, said the NL63 virus uses the same receptor as the new coronavirus to infect humans, but he also stressed it was too early to draw conclusions.
“We just have to wait and see if this becomes a common observation,” he said.