The un­usu­al oc­cur­rence of strokes among youths bat­tling COVID-19 is yet an­oth­er rea­son to pre­vent the virus' spread - be­cause lo­cal au­thor­i­ties haven’t yet in­sti­tut­ed treat­ment for these strokes.

Plus, in some bad COVID cas­es, air es­capes the lung in­to the skin, giv­ing the pa­tient an in­flat­ed “Miche­lin Man” look. And if you have to go on a ven­ti­la­tor dur­ing treat­ment, it’s a last re­sort and there’s a high chance of death.

Con­sul­tant/car­dio­tho­racic sur­geon at the Er­ic Williams Med­ical Sci­ences Com­plex in Mt Hope, Dr Mark West, shared the in­for­ma­tion at yes­ter­day’s Min­istry of Health Min­istry me­dia up­date.

On Mon­day in Par­lia­ment, Health Min­is­ter Ter­rence Deyals­ingh spoke of the lat­est dis­cov­ery that youths with COVID were suf­fer­ing blood clots and “peo­ple are dy­ing” in re­sponse to UNC MP Fuad Khan’s call to re­open food busi­ness­es. Deyals­ingh said the blood clot de­vel­op­ment had thrown a “span­ner in­to the works” and Gov­ern­ment would take de­ci­sions on­ly on sci­en­tif­ic da­ta.

Yes­ter­day, West said COVID-19 is a killer af­fect­ing res­pi­ra­to­ry and “just about every oth­er sys­tem”, in­clud­ing thick­en­ing blood. He said while strokes oc­cur in old­er peo­ple for dif­fer­ent rea­sons, COVID pa­tients of all ages are show­ing blood clots and strokes - and that’s un­usu­al in youths.

“The virus is act­ing in some way to cre­ate high vis­cous blood flow to the brain,” West said, adding if pa­tients were lucky they sur­vived.

West said T&T hasn’t yet in­sti­tut­ed pre­ven­ta­tive treat­ment against blood clots but not­ed it's not yet wide­spread.

He said pa­tients are usu­al­ly giv­en drugs and some­times steroids to re­duce in­flam­ma­tion, “but pre­ven­tive treat­ment of strokes isn’t among the treat­ment”.

He said it may be that T&T doesn’t have ran­domised tri­als to show ben­e­fits of such treat­ment but work’s done on a case-by-case ba­sis - cau­tious­ly.

“T&T’s been very lucky and done very well but there’s risk of re­duc­ing vig­i­lance and we may see a rise in cas­es. We must main­tain vig­i­lance,” West added.

Deyals­ingh said Gov­ern­ment’s us­ing a care­ful path with the new de­vel­op­ment re­gard­ing strokes in youths.

“I hope what Dr West said re­in­forces in the pub­lic mind that what Trinidad and To­ba­go’s do­ing is cor­rect. Stay home, wear masks.’’

West al­so re­mind­ed the pub­lic of how se­ri­ous the virus is, the need to pre­vent it and what some pa­tients en­dure.

Speak­ing about a COVID case which was man­aged at Cou­va Hos­pi­tal, West said the pa­tient was an el­der­ly, male non-smok­er, dis­play­ing a mu­cus-rich cough, short­ness of breath and fa­tigue. He had no trav­el his­to­ry but was in con­tact with a COVID pa­tient who was on the cruise ship where pas­sen­gers fell ill. The man al­so had hy­per­ten­sion, di­a­betes and chron­ic kid­ney dis­ease. He went to the Ari­ma hos­pi­tal, was trans­ferred to Mt Hope, then Cou­va when short­ness of breath wors­ened.

He was put in the High De­pen­den­cy Unit and med­ical equip­ment was in­sert­ed in­to his chest to as­sist oxy­gen in­take. West showed slides of lung col­lapse where air es­caped in­to the chest cav­i­ty and couldn’t ex­it the body. An­oth­er slide showed fur­ther com­pli­ca­tions, with air leak­ing out­side the man’s chest in­to his skin. This blows up the ap­pear­ance, cre­at­ing a “Miche­lin Man” look, West added.

West said tubes were in­sert­ed in the man’s chest to drain the air.

“His oxy­gen set­tled down and dis­tress de­creased - he im­proved. He was go­ing the wrong way and was go­ing to end up on a ven­ti­la­tor. But he re­cov­ered, was even­tu­al­ly re­moved from HDU in­to a gen­er­al ward and lat­er walked. Af­ter two neg­a­tive tests, he was dis­charged.”

But West added not all cas­es go well. He showed more slides with se­vere COVID ef­fects on a pa­tient’s lungs and pneu­mo­nia. This caus­es se­vere res­pi­ra­to­ry prob­lems - re­quir­ing ven­ti­la­tor sup­port - and over­whelm­ing in­flam­ma­to­ry re­sponse, of­ten caus­ing death.

“We may have been head­ing to this with the first pa­tient but I’m de­light­ed to say we didn’t. We were lucky,” he said.

Very sick pa­tients re­quire ven­ti­la­tors to keep oxy­gen in their sys­tem and could prob­a­bly die with­out it. “Ven­ti­la­tion may be nec­es­sary but it’s a last re­sort,” he said.

In the process, a tube is passed through a pa­tient’s air­way and at­tached to a ven­ti­la­tor, mov­ing air in­to the lungs. In some in­stances, those whose lungs are al­ready dam­aged don’t sur­vive.