COVID-19: Stroke in Young Adults / New Presentation in Kids / ACS Admissions

By Kelly Young

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

Catch up on some of latest developments on novel coronavirus disease (COVID-19):

Stroke in younger adults: Five patients younger than 50 with COVID-19 presented with severe large-vessel stroke over 2 weeks in one New York City health system. (By comparison, during a normal 2-week period, the system usually treats an average of 0.73 younger patients for stroke.) Two patients delayed calling an ambulance over concerns about the pandemic. The details were published in the New England Journal of Medicine.

Multisystem inflammatory disease in kids: The NHS England and the U.K.'s Paediatric Intensive Care Society are telling clinicians to look out for children presenting with overlapping signs of toxic shock syndrome and atypical Kawasaki Disease with blood work consistent with COVID-19 (i.e., high C-reactive protein, erythrocyte sedimentation rate, and ferritin). NHS has reported a small number of cases. Some tested positive for COVID-19, while others did not. Common features have included abdominal pain, other gastrointestinal symptoms, and cardiac inflammation with elevated troponin and pro-B-type natriuretic peptide levels.

Lower ACS admissions: Admissions for acute coronary syndrome (ACS) across 15 hospitals in northern Italy fell during the COVID-19 outbreak, according to an NEJM report. Specifically, there were, on average, 13.3 ACS admissions per day between Feb. 20 and Mar. 31, compared with 18–19 per day during two earlier control periods. Researchers write: "Recent data suggest a significant increase in mortality during this period that was not fully explained by Covid-19 cases alone. This observation and data from our study raise the question of whether some patients have died from ACS without seeking medical attention during the Covid-19 pandemic."