Written by Healogics Chief Medical Officer, Dr. William Ennis.
We continue to monitor the current information about COVID and there appears to be two new developments that should be of interest to our Healogics community.
The first is the concept of “thrombo-inflammation” and how it might develop in COVID patients leading to clots, strokes and heart attacks. In a recent publication, 30 tests on 24 intubated COVID patients in Italy, demonstrated abnormal clotting patterns. https://www.ncbi.nlm.nih.gov/pubmed/32302438
These findings argued for COVID-19 resulting in a hypercoagulopathic state rather than DIC, which was previously postulated. A second paper (https://www.ncbi.nlm.nih.gov/pubmed/32302448) reported similar findings and noted reductions in fibrinogen levels with thromboprophylaxis. These investigators also demonstrated a correlation between increased IL-6 levels and fibrinogen levels. These findings might help to explain the recent findings of pulmonary emboli and strokes in COVID patients and may provide another therapeutic option. The process of thrombo-inflammation was reviewed by Jackson and colleagues. (https://doi.org/10.1182/blood-2018-11-882993)
From a wound care standpoint, thrombi impacting the microcirculation could play a role in poor wound healing? As more patients recover from COVID infections we will monitor healing rates and outcomes to look for correlations.
It is also possible that this thrombo-inflammation might be the cause of the recently described finding known as “COVID toes”. Several dermatology practices are reported blisters and purple discoloration on the toes of younger patients that spontaneously resolve over time. The patients are reporting pain and burning at the site of discoloration. Rashes are also being described in these patients. Remember to always remove the socks and shoes from both feet on all of our wound care patients and to file this new syndrome in your diagnostic tool bag. (https://time.com/5827912/coronavirus-skin-rashes)
As of 4/28/20 there are 1,026,634 cases in the US with 58,906 deaths. The worldwide case load is now 3,083,467 with 213,824 deaths.
Famotidine is the latest drug to start investigative trials, more to come. (https://www.msn.com/en-us/health/health-news/famotidine-new-york-hospitals-studying-heartburn-drug-as-covid-19-treatment/ar-BB13fflX)