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Why Congressman Letlow died from COVID- a thread.
1/ Before we start it’s important to understand that what we know about Mr. Let low is filtered through the media, which is not renouned for its accuracy with covid and covid related complications; or medical reporting in general
1/ Before we start it’s important to understand that what we know about Mr. Let low is filtered through the media, which is not renouned for its accuracy with covid and covid related complications; or medical reporting in general
/2 Covid in and of itself, tends to be most dangerous to three categories of people. People over 65, par with immunological diseases or suppression and those with severe chronic disease, like renal or heart failure.
/3 That’s not to say it’s not dangerous in younger, healthier people like the congressman- just that it’s LESS dangerous. There are a myriad of complications that can cause lasting damage to several systems.
/4 Now, Con. Let is reported to have died of an ‘Unrecoverable heart attack’. Medically imprecise wording but the meaning is clear: he experienced a cardiac arrest event from which the team was unable to resuscitate him with standard advanced cardiac life support methods.
/5 One of the little reported on complications of the SARS COV2 19 virus is a hypercoaguable state. In layman’s terms, it means your blood clots faster and thicker due to changes in the cell mediated clotting process.
You can read more about it here. https://hms.harvard.edu/news/covid-19-blood-clots
You can read more about it here. https://hms.harvard.edu/news/covid-19-blood-clots
/6 In my experience, these patients experienced clot related complications at a much higher rate- deep vein clots, pulmonary embolisms and myocardial infarctions. We attempted to mitigate this by administering high dose heparin, a drug we routinely use for clot prevention.
/7. We saw some efficacy with high dose heparin- 7500 units BID as opposed to the 5000 TID. We also occasionally put high risk patients on heparin infusions. When imitated these would *usually* prevent clot related mortality.
/8 However, it didn’t stop *all* clot events, just reduced them. To give an example, I’m going to tell you about why I witnessed. (Yes, anecdotal evidence is the lowest form, but it’s part of the story).
/9 When I would place central lines- that’s IV lines about 15 cm long that go into the internal jugular or subclavian veins so we can give high dose medications and fluids. To place them, you access the vessel with a needle, put a wire in, then slide the catch over the wire.
10/ Usually, you know you’re in the vein by seeing a big gush of blood in the syringe, and seeing the needle in the vein on bedside vascular sonography. I’d then remove the syringe and thread the wire through- except quite a few times, I couldn’t thread it.
11/ When you can’t thread it, it usually means the needle isn’t in the right place. Procedure says remove wire , reposition and try again; which I did. As I pulled the wire out, I was seeing blood clots on it, which was strange. Blood doesn’t usually clot in seconds.
/12 Removing the wire and picking up the syringe I’d laid down, I pushed the blood out onto a waste gauze like I have hundreds of times before-except it didn’t squirt. It oozed and splattered. To my surprise, the blood in the syringe, which had been there for only maybe
/13 fifteen seconds- *had already clotted solid*. Not knowing what the hell was going on, I aborted the procedure and went to get my attending, who promptly got on the phone to call colleagues in other hot spots.
/14. It turns out that people were seeing these coagulation issues everywhere. It was causing a ton of extra mortality as you can see by some of the studies. Scientists promptly went to work and finding out what was going on based on our (the clinicians) observations.
/15 Now, back to the congressman.
While he had little or no underlying disease, if he didn’t get the high dose anticoagulants in time (or sometimes even if he DID) there’s a chance clots form where we can’t get to them fast enough- with the right main coronary artery being one.
While he had little or no underlying disease, if he didn’t get the high dose anticoagulants in time (or sometimes even if he DID) there’s a chance clots form where we can’t get to them fast enough- with the right main coronary artery being one.
/16 It’s bad, crap luck that he had the clot form there; but it’s a known complication of this disease. Contrary to tropes, it’s NOT harmless to those outside of the high risk categories- just LESS dangerous.
/17 It’s also worth noting that Congressman Let died FROM COVID- because it caused the AMI that killed him. This bug kills several ways, and he died from one of them- hyper coagulation leading to organ failure.
/18. I hope this clarifies it. Let me know if you have questions or need me to clarify anything.
