1/ #Frontline https://abs.twimg.com/hashflags... draggable="false" alt=""> clinicians across the world are observing a #hypercoagulable state in patients with #COVID19. Could the severe and varied effects of the disease on multiple organ systems possibly be due to thrombus/micro-thrombus and associated sequela? @ASH_hematology @EricTopol https://twitter.com/NEJM/status/1248011487500795910">https://twitter.com/NEJM/stat...
2/ Could a mechanism of #microvascular injury during the infection be through inappropriate effects of excess free angiotensin-II protein floating around because the ACE-2 that would normally be soaking it up is occupied by #SARSCOV2 particles? @EricTopol @ASH_hematology
4/ I was also thinking about the patient populations effected:

Men —> more ACE2

Post menopausal women —> more ACE2

Pregnant women —> higher risk for clot —> ACE2 expression increases in normal pregnancy 2nd trimester

Diabetes, HTN, Smoking —> preexisting vascular damage
5/ So are the people that are more susceptible to #SARSCOV2 those with more ACE2 receptors at baseline? @ASH_hematology @EricTopol #medtwitter #nursetwitter
6/ The most striking reports have been interviews with clinicians on the front lines:

Neurology Today (Italy interview):
"There is a dramatic increase in the number of vascular events, ischemic strokes, and thrombosis..." https://journals.lww.com/neurotodayonline/blog/breakingnews/pages/post.aspx?PostID=920">https://journals.lww.com/neurotoda...
7/ Another interview with an Italian anesthesiologist:
“We are performing daily echo on our patients in the ICU. We are seeing a number of patients with echo signs of pulmonary embolism (dilated right ventricle, tricuspid regurgitation). These patients are typically in the ICU...
9/ Additional studies have also recently come out, including:

Abnormal Coagulation Parameters Are Associated With Poor Prognosis in Patients With Novel Coronavirus Pneumonia (China) https://pubmed.ncbi.nlm.nih.gov/32073213/ ">https://pubmed.ncbi.nlm.nih.gov/32073213/...
12/ @ASH_hematology recommends: "All hospitalized patients with #COVIDー19 should receive pharmacologic thromboprophylaxis with LMWH or fondaparinux (suggested over unfractionated heparin to reduce contact) unless patient has increased bleeding risk."

https://www.hematology.org/covid-19/covid-19-and-vte-anticoagulation">https://www.hematology.org/covid-19/...
13/
13/ @farid__jalali proposed a theory that has been widely circulated on @Facebook.

http://farid.jalali.one/covid19emailpdf.pdf?fbclid=IwAR0rirn05ULVLeaiGvAgDDJeObPDNbIjZsgz0OVY3nYFJfIVXzcVGpB3ZkY">https://farid.jalali.one/covid19em...
14/ Another theory by @VectorSting
"Physiology of COVID19 pneumonitis has the gist of shunt way out of proportion to lung injury. This suggests specific dysregulation of the pulmonary vascular compartment. Here is a hypothesis to explain why this might be the case..."
15/ Lastly, I am a Women’s Health NP. I fully acknowledge that I am not an infectious disease specialist, epidemiologist, immunologist, cardiologist, geneticist, or physician.

I just keep asking questions.

Have to do something with my COVID-induced insomnia #WhenImUpAtNight
16/ Forgot to include one interesting study from Italy!

ACE2 and TMPRSS2 variants and expression as candidates to sex and country differences in COVID-19 severity in Italy

https://www.medrxiv.org/content/10.1101/2020.03.30.20047878v1.full.pdf">https://www.medrxiv.org/content/1...
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