19 ms·

Coronavirus: A third of hospital patients develop dangerous blood clots

87 points by clouddrover 7y ago

umanwizard 7y ago
It's good that doctors and scientists are learning more about the virus, which will help them improve the standard of treatment, so I welcome this discovery. On the other hand, I find that the style of reporting contributes to the irrational panic and fear around COVID-19. Only a tiny fraction of those with COVID-19 are admitted to the hospital, a third of those develop blood clots (assuming the reporting is accurate), and, presumably, in some unknown fraction of those cases, the blood clots cause death or permanent injury. However, people will focus on this "1/3 of people get blood clots!" number, and their intuition about the risk of themselves or people they care about being maimed or killed by COVID-19 will increase irrationally.
- redis_mlc 7y ago
  Even HNers have been falling for that, implying that everybody will have a shorter lifespan.
- talonx 7y ago
  In general, I think journalists have a responsibility to choose their words carefully and avoid sensationalism without downplaying any aspects of the news they are reporting. This is something that is sorely absent from most news reporting. A cursory comparison of headlines and the news content below them, in most newspapers, reveals that if one were to read just the headline, the impression would be something far different from what the actual news is as reported in the article below it.
- flatline 7y ago
  It is currently the leasing cause of death in the US, I feel like there is legitimate reason for concern, if not alarm. No, it’s not going to kill 5% of the population, especially not if hospitals remain at or below capacity. But give it time and people will become less cautious Regardless of government orders, especially months from now when cold and flu season start back up. So things are mostly still “fine”, despite 80k+ deaths, but that is not guaranteed to hold.
  - umanwizard 7y ago
    I never said COVID-19 is not serious, so I’m not sure what this has to do with my comment. I think it’s a cause for concern, yes — and the current reaction is miles beyond what can reasonably be described as “concern”. I think heart disease — the #2 cause of death in the US — is serious too, but I still don’t think sensationalism and panic about it is helpful.
    - ceejayoz 7y ago
      What’s the R0 value for heart disease? They’re entirely different beasts.
      - umanwizard 7y ago
        Heart disease isn’t contagious, so the R_0 is zero. Can you explain what this has to do with my comment?
        danharaj 7y ago
        One risk is self limiting whereas the other is self propagating with unknown long term consequences.
        arcticbull 7y ago
        This is quintessentially the human propensity to fear the new/unknown more than the known. Over your life 3,500,000 people will die in car accidents in the US, 6,000,000 will die of the flu. 7,000,000 will die of opioid overdoses. Each of these has serious, long-term consequences. We shouldn't panic, we should make decisive decisions based on the best information we have, and we should seek to reject fear-driven reactions just because something's new and scary. R_0 really isn't relevant, we're all in all of these together.
        danharaj 7y ago
        As I have mentioned in another thread, when you're dealing with an extreme process with exponential growth and a large absence of information, """"fear"""", also known as respecting your fucking ignorance, is most rational. Even if after the fact it looks like the pandemic didn't have catastrophic long term effects, it was still rational to be extremely cautious. Car accidents don't have the potential to collapse society. A car crash has a chance to cause other crashes but that correlation dies off exponentially fast over relatively small time and distance scales. A pandemic in our modern connected world is basically scale invariant without mitigations. With exponential phenomena, if you wait for evidence of extreme downside it'll already be too late. The absence of evidence is not evidence of absence. You can't wait, you have to act on your ignorance. This is not "panic". Rationality is not just about reasoning about what you know, it's about reasoning about what you don't know as well. In typical, mundane processes you can act on ignorance by collecting evidence. In extreme, self-propagating processes, one needs to apply the rationality of ignorance: extreme value theory and the statistics of extreme distributions.
- kaoD 7y ago
  > Only a tiny fraction of those with COVID-19 are admitted to the hospital What is your definition of tiny? My country is running an antibody study. Preliminary results are around 1-2% fatality rate. I wouldn't call that tiny, and the hospital admission rate is obviously higher.
  - irq11 7y ago
    The infection fatality rate for this virus is somewhere between 0.5% and 1%, heavily skewed to the oldest members of the population. This is most reflective of the chance that an infected person will actually die, if you don’t take age into account. For younger people, the risk of death is quite low. In NYC, for example, IFR from ages 0-17 is 0, and for 18-44 is 0.019%. The hospitalization rates for those two age brackets are 0.02% and 0.2%, respectively. https://www1.nyc.gov/site/doh/covid/covid-19-data.page https://www1.nyc.gov/site/doh/covid/covid-19-data.page
    - kaoD 7y ago
      > The infection fatality rate for this virus is somewhere between 0.5% and 1% Source? Your link only has CFR (and >10%). In my country's (CFR ~15%) antibody study (reminder: preliminary data) the IFR is ~1.5%. Both pretty close to initial estimates. > heavily skewed to the oldest members of the population And? Either way: the huge influx of patients completely collapsed the healthcare system, which made it harder to treat everyone else.
      - taeric 7y ago
        I don't think the argument is to not care about the older group. But it is possible more than just deaths are skewed to them. Is also possible age is just a proxy to what the real risk factor is. (My money is still on exposure to lung weakening environments.) That said, I think the natural next step for this argument is targeted testing at younger populations to see what their IFR is. With stronger (read: expensive) measures to isolate long term care facilities. Occupants, care givers, cooks, cleaners, all. (If the immunity antibody story plays out, work on ways to get antibody positive people in those positions.) And I will again point out. I'm a random internet poster. No, nobody should do something just because I think it makes sense. :)
- stickfigure 7y ago
  "More than half of patients with fatal coronavirus infections die!"
- Alex3917 7y ago
  There are people who are dying from blood clots without getting admitted to the hospital, and people who are getting released from the hospital and then dying from blood clots later. And we don’t know how many months or years after exposure you remain at risk.
  - jansan 7y ago
    This. And many (maybe most) of those deaths could be prevented with the right prophylactic treatment.
    - lbeltrame 7y ago
      To be honest a study was posted here on HN (I can't find the link at the moment) where retrospectively (lots of confounding factors etc., but 2000-ish people studied) the mortality was about halved when anticoagulants were used. At the same time the risk of hemorraging events was the same as the non-anticoagulant group.
Spooky23 7y ago
Many hospitals are pretty awful about patient care in normal times. I’m sure many of these clot situations are neglect due to understaffing.
trikonasana 7y ago
Misleading title and misleading article. Better title would be "One of the major complications facing hospitalized coronavirus patients is blood clots". There is one line that quotes a doctor stating, "He believes the number of critically ill coronavirus patients developing blood clots could be significantly higher than the published data in Europe of up to 30%." No mention of the percentage of cases that require hospitalizations in the first place, let alone any non-anecdotal evidence to back his claim. I wish we would stop sharing articles that are not backed by any scent of a scientific study or peer review. It leads to fear, like others have pointed out.
- jansan 7y ago
  There is non-anectodal evidence. In Hamburg/Germany they conducted more than 190 autopsies and found a surprising number of thrombosis. About 30% of the patients who dies with COVID-19 may have actually died from lung embolism.
  - lbeltrame 7y ago
    In Italy most hospitals are treating hospitalized patients with heparin exactly for this reason. The government forbade autopsies, but some doctors did them anyway and came back with the same result as Hamburg (note: some virologists called those findings "baloney" in public when they were shared, shortly before the Hamburg study came out).
    - jansan 7y ago
      The German official institution for disease prevention (RKI) also discouraged from making autopsies. The Hamburg pathologists did not give a shit, said that it is their job to find out what happened and carried on. I am so happy that there are still many people out there who can think for themselves.
      - ComputerGuru 7y ago
        Why are autopsies being forbidden/discouraged? Is it to minimize biohazards and contamination?
jansan 7y ago
The Universitätsklinikum Hamburg-Eppendorf has conducted autopsies in more than 190 people who died from corona, although German officials recommended not to do any autopsies. Their findings are similar. In the first 12 cases they found thrombosis in 7 cases[1] They recommend prophylactic treatment with Heparin, even in ambulantory care. https://www.ncbi.nlm.nih.gov/pubmed/32374815 https://www.ncbi.nlm.nih.gov/pubmed/32374815
censorsheep 7y ago
I am definitely an anti-lockdown person. I wanted to see the numbers for myself so I used data from the CDC's site and the WHO's site. Please check my math and reasoning https://math.stackexchange.com/questions/3668979/is-this-an-okay-way-to-calculate-covid-19-death-rates https://math.stackexchange.com/questions/3668979/is-this-an-... My calculations for the Coronavirus death rate: <5 0% 5-14 0% 15-24 0% 25-34 .04% 35-44 .12% 45-54 .37% 55-64 .9% 65-74 2.1% 75-84 5.5% 85+ 16.9% Based on this data I think the lockdown is an absurdly heavy handed approach. Subjective opinion increases -> It's about older voters. In Eric Weinstein's words "they are hoarding well-being on every front" to the point that they will gladly screw over the younger generations. We need to end this nonsense ASAP.
- speedgoose 7y ago
  It's easy to criticize now that we have some good data. In my humble opinion, lockdowns were decided in Europe because governments started to plan for the worse since China's data was definitely not trustable anymore.
- redis_mlc 7y ago
  I agree. If politicians want to do testing and tracing for nursing home and hospital staff, fine. Otherwise, end the lockdown.
- thro1 7y ago
  Sorry, what's your age ? edit: OK I got one downvote instead of an answer. Wasn't the question gentle enough? The death rate for my age is .37%, it seems that the death rate for your age may be not important at all -correct ?
  - censorsheep 7y ago
    It wasn't me that downvoted you. I don't do that, even when I can. I can't on HN btw. I'm in the 35-44 range. A lot of people are making arguments without keeping things in perspective. First, people die. That is a fact of life. Our attempt to smooth out nature will be smyted in time. It will snap back. We are spending too much money. We are creating a fear-driven easily controlled society. We are encouraging censorship. All of this stuff is very bad. Do you agree with that?
sheinsheish 7y ago
Have a look at this video and the previous from the series. He indicates which episodes are related. https://www.youtube.com/watch?v=JOlVkES_kC8 https://www.youtube.com/watch?v=JOlVkES_kC8
dustinmoris 7y ago
Sitting on long haul flights also SIGNIFICANTLY increases the risk of blood clots, just like thousand other things in life. That’s why it’s important to not be a fat McDonalds eating potato and be active in life and look after your health so when a virus makes you ill you’re not gonna crumble and die. No news here, just normal life, everything has consequences, unfit people die earlier, that’s how nature works in general. EDIT: Just to clarify, not saying that any death is less tragic, just that this is really not news worthy. It’s pretty well understood that blood clots can happen when people are ill and even when they are not ill, and the fatter one is the higher the chance of this happening. Journalists really scrape for any BS to write about recently.
acd 7y ago
I think nitric oxide gas and L-arginine may help prevent blood clots. https://www.hopkinsmedicine.org/Press_releases/2003/10_17_03.html https://www.hopkinsmedicine.org/Press_releases/2003/10_17_03...
DoreenMichele 7y ago
I'm glad to see information on the blood aspects of the condition getting some press. That's another way that blood oxygen levels can be suppressed and blood issues suppressing oxygen levels would help explain the terrible figures associated with ventilator treatments, where people are dying at shockingly high rates and ventilators aren't doing what they normally do for patients put on them for other conditions.

87 points by clouddrover 7y ago

It's good that doctors and scientists are learning more about the virus, which will help them improve the standard of treatment, so I welcome this discovery. On the other hand, I find that the style of reporting contributes to the irrational panic and fear around COVID-19. Only a tiny fraction of those with COVID-19 are admitted to the hospital, a third of those develop blood clots (assuming the reporting is accurate), and, presumably, in some unknown fraction of those cases, the blood clots cause death or permanent injury. However, people will focus on this "1/3 of people get blood clots!" number, and their intuition about the risk of themselves or people they care about being maimed or killed by COVID-19 will increase irrationally.

redis_mlc 7y ago
Even HNers have been falling for that, implying that everybody will have a shorter lifespan.
talonx 7y ago
In general, I think journalists have a responsibility to choose their words carefully and avoid sensationalism without downplaying any aspects of the news they are reporting. This is something that is sorely absent from most news reporting. A cursory comparison of headlines and the news content below them, in most newspapers, reveals that if one were to read just the headline, the impression would be something far different from what the actual news is as reported in the article below it.
flatline 7y ago
It is currently the leasing cause of death in the US, I feel like there is legitimate reason for concern, if not alarm. No, it’s not going to kill 5% of the population, especially not if hospitals remain at or below capacity. But give it time and people will become less cautious Regardless of government orders, especially months from now when cold and flu season start back up. So things are mostly still “fine”, despite 80k+ deaths, but that is not guaranteed to hold.
- umanwizard 7y ago
  I never said COVID-19 is not serious, so I’m not sure what this has to do with my comment. I think it’s a cause for concern, yes — and the current reaction is miles beyond what can reasonably be described as “concern”. I think heart disease — the #2 cause of death in the US — is serious too, but I still don’t think sensationalism and panic about it is helpful.
  - ceejayoz 7y ago
    What’s the R0 value for heart disease? They’re entirely different beasts.
    - umanwizard 7y ago
      Heart disease isn’t contagious, so the R_0 is zero. Can you explain what this has to do with my comment?
      - danharaj 7y ago
        One risk is self limiting whereas the other is self propagating with unknown long term consequences.
        arcticbull 7y ago
        This is quintessentially the human propensity to fear the new/unknown more than the known. Over your life 3,500,000 people will die in car accidents in the US, 6,000,000 will die of the flu. 7,000,000 will die of opioid overdoses. Each of these has serious, long-term consequences. We shouldn't panic, we should make decisive decisions based on the best information we have, and we should seek to reject fear-driven reactions just because something's new and scary. R_0 really isn't relevant, we're all in all of these together.
        danharaj 7y ago
        As I have mentioned in another thread, when you're dealing with an extreme process with exponential growth and a large absence of information, """"fear"""", also known as respecting your fucking ignorance, is most rational. Even if after the fact it looks like the pandemic didn't have catastrophic long term effects, it was still rational to be extremely cautious. Car accidents don't have the potential to collapse society. A car crash has a chance to cause other crashes but that correlation dies off exponentially fast over relatively small time and distance scales. A pandemic in our modern connected world is basically scale invariant without mitigations. With exponential phenomena, if you wait for evidence of extreme downside it'll already be too late. The absence of evidence is not evidence of absence. You can't wait, you have to act on your ignorance. This is not "panic". Rationality is not just about reasoning about what you know, it's about reasoning about what you don't know as well. In typical, mundane processes you can act on ignorance by collecting evidence. In extreme, self-propagating processes, one needs to apply the rationality of ignorance: extreme value theory and the statistics of extreme distributions.
kaoD 7y ago
> Only a tiny fraction of those with COVID-19 are admitted to the hospital What is your definition of tiny? My country is running an antibody study. Preliminary results are around 1-2% fatality rate. I wouldn't call that tiny, and the hospital admission rate is obviously higher.
- irq11 7y ago
  The infection fatality rate for this virus is somewhere between 0.5% and 1%, heavily skewed to the oldest members of the population. This is most reflective of the chance that an infected person will actually die, if you don’t take age into account. For younger people, the risk of death is quite low. In NYC, for example, IFR from ages 0-17 is 0, and for 18-44 is 0.019%. The hospitalization rates for those two age brackets are 0.02% and 0.2%, respectively. https://www1.nyc.gov/site/doh/covid/covid-19-data.page https://www1.nyc.gov/site/doh/covid/covid-19-data.page
  - kaoD 7y ago
    > The infection fatality rate for this virus is somewhere between 0.5% and 1% Source? Your link only has CFR (and >10%). In my country's (CFR ~15%) antibody study (reminder: preliminary data) the IFR is ~1.5%. Both pretty close to initial estimates. > heavily skewed to the oldest members of the population And? Either way: the huge influx of patients completely collapsed the healthcare system, which made it harder to treat everyone else.
    - taeric 7y ago
      I don't think the argument is to not care about the older group. But it is possible more than just deaths are skewed to them. Is also possible age is just a proxy to what the real risk factor is. (My money is still on exposure to lung weakening environments.) That said, I think the natural next step for this argument is targeted testing at younger populations to see what their IFR is. With stronger (read: expensive) measures to isolate long term care facilities. Occupants, care givers, cooks, cleaners, all. (If the immunity antibody story plays out, work on ways to get antibody positive people in those positions.) And I will again point out. I'm a random internet poster. No, nobody should do something just because I think it makes sense. :)
stickfigure 7y ago
"More than half of patients with fatal coronavirus infections die!"
Alex3917 7y ago
There are people who are dying from blood clots without getting admitted to the hospital, and people who are getting released from the hospital and then dying from blood clots later. And we don’t know how many months or years after exposure you remain at risk.
- jansan 7y ago
  This. And many (maybe most) of those deaths could be prevented with the right prophylactic treatment.
  - lbeltrame 7y ago
    To be honest a study was posted here on HN (I can't find the link at the moment) where retrospectively (lots of confounding factors etc., but 2000-ish people studied) the mortality was about halved when anticoagulants were used. At the same time the risk of hemorraging events was the same as the non-anticoagulant group.

Spooky23 7y ago

Many hospitals are pretty awful about patient care in normal times. I’m sure many of these clot situations are neglect due to understaffing.

trikonasana 7y ago

Misleading title and misleading article. Better title would be "One of the major complications facing hospitalized coronavirus patients is blood clots". There is one line that quotes a doctor stating, "He believes the number of critically ill coronavirus patients developing blood clots could be significantly higher than the published data in Europe of up to 30%." No mention of the percentage of cases that require hospitalizations in the first place, let alone any non-anecdotal evidence to back his claim. I wish we would stop sharing articles that are not backed by any scent of a scientific study or peer review. It leads to fear, like others have pointed out.

jansan 7y ago
There is non-anectodal evidence. In Hamburg/Germany they conducted more than 190 autopsies and found a surprising number of thrombosis. About 30% of the patients who dies with COVID-19 may have actually died from lung embolism.
- lbeltrame 7y ago
  In Italy most hospitals are treating hospitalized patients with heparin exactly for this reason. The government forbade autopsies, but some doctors did them anyway and came back with the same result as Hamburg (note: some virologists called those findings "baloney" in public when they were shared, shortly before the Hamburg study came out).
  - jansan 7y ago
    The German official institution for disease prevention (RKI) also discouraged from making autopsies. The Hamburg pathologists did not give a shit, said that it is their job to find out what happened and carried on. I am so happy that there are still many people out there who can think for themselves.
    - ComputerGuru 7y ago
      Why are autopsies being forbidden/discouraged? Is it to minimize biohazards and contamination?

jansan 7y ago

The Universitätsklinikum Hamburg-Eppendorf has conducted autopsies in more than 190 people who died from corona, although German officials recommended not to do any autopsies. Their findings are similar. In the first 12 cases they found thrombosis in 7 cases[1] They recommend prophylactic treatment with Heparin, even in ambulantory care. https://www.ncbi.nlm.nih.gov/pubmed/32374815 https://www.ncbi.nlm.nih.gov/pubmed/32374815

censorsheep 7y ago

I am definitely an anti-lockdown person. I wanted to see the numbers for myself so I used data from the CDC's site and the WHO's site. Please check my math and reasoning https://math.stackexchange.com/questions/3668979/is-this-an-okay-way-to-calculate-covid-19-death-rates https://math.stackexchange.com/questions/3668979/is-this-an-... My calculations for the Coronavirus death rate: <5 0% 5-14 0% 15-24 0% 25-34 .04% 35-44 .12% 45-54 .37% 55-64 .9% 65-74 2.1% 75-84 5.5% 85+ 16.9% Based on this data I think the lockdown is an absurdly heavy handed approach. Subjective opinion increases -> It's about older voters. In Eric Weinstein's words "they are hoarding well-being on every front" to the point that they will gladly screw over the younger generations. We need to end this nonsense ASAP.

speedgoose 7y ago
It's easy to criticize now that we have some good data. In my humble opinion, lockdowns were decided in Europe because governments started to plan for the worse since China's data was definitely not trustable anymore.
redis_mlc 7y ago
I agree. If politicians want to do testing and tracing for nursing home and hospital staff, fine. Otherwise, end the lockdown.
thro1 7y ago
Sorry, what's your age ? edit: OK I got one downvote instead of an answer. Wasn't the question gentle enough? The death rate for my age is .37%, it seems that the death rate for your age may be not important at all -correct ?
- censorsheep 7y ago
  It wasn't me that downvoted you. I don't do that, even when I can. I can't on HN btw. I'm in the 35-44 range. A lot of people are making arguments without keeping things in perspective. First, people die. That is a fact of life. Our attempt to smooth out nature will be smyted in time. It will snap back. We are spending too much money. We are creating a fear-driven easily controlled society. We are encouraging censorship. All of this stuff is very bad. Do you agree with that?

sheinsheish 7y ago

Have a look at this video and the previous from the series. He indicates which episodes are related. https://www.youtube.com/watch?v=JOlVkES_kC8 https://www.youtube.com/watch?v=JOlVkES_kC8

dustinmoris 7y ago

Sitting on long haul flights also SIGNIFICANTLY increases the risk of blood clots, just like thousand other things in life. That’s why it’s important to not be a fat McDonalds eating potato and be active in life and look after your health so when a virus makes you ill you’re not gonna crumble and die. No news here, just normal life, everything has consequences, unfit people die earlier, that’s how nature works in general. EDIT: Just to clarify, not saying that any death is less tragic, just that this is really not news worthy. It’s pretty well understood that blood clots can happen when people are ill and even when they are not ill, and the fatter one is the higher the chance of this happening. Journalists really scrape for any BS to write about recently.

acd 7y ago

I think nitric oxide gas and L-arginine may help prevent blood clots. https://www.hopkinsmedicine.org/Press_releases/2003/10_17_03.html https://www.hopkinsmedicine.org/Press_releases/2003/10_17_03...

DoreenMichele 7y ago

I'm glad to see information on the blood aspects of the condition getting some press. That's another way that blood oxygen levels can be suppressed and blood issues suppressing oxygen levels would help explain the terrible figures associated with ventilator treatments, where people are dying at shockingly high rates and ventilators aren't doing what they normally do for patients put on them for other conditions.