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Published on: Apr 30, 2020
3 minute read
By: Dr Rajan Choudhary

COVID AND CLOTTING: A BRIEF LOOK

At the Mount Sinai hospital, a case series of five patients have been put together, ready to be published in the New England Journal of Medicine. It details patients aged 33, 37, 39, 44, and 49 who all began to experience a sudden onset of symptoms including slurred speech, confusion, drooping on one side of the face, and feeling dead in one arm. At the time of writing one has sadly died, two remain hospitalized and one is in rehab. Only the youngest is able to speak. All of them were found to be COVID positive.

This drastic case series highlights a growing problem of strokes and clotting disorders in COVID patients, one noted by medics across the world. This blog looks at whether this is a common occurrence and what may be causing it.

Before reading this blog it will be helpful to read our previous blog on why and how blood clots.

THE START

In mid-February Tang et al published a paper noting that patients with abnormal clotting parameters were associated with a poorer prognosis. In their study, 11% of their patients died, but out of these patients, 71% had these abnormal parameters, compared to just 0.6% of survivors. The patients who died also demonstrated DIC (disseminated intravascular coagulation), a condition in which clotting is triggered in the patients' blood across the body, not just at the site of injury.

There is one major issue with this study. In most European hospitals patients receive anticoagulant medications on a daily basis. This is because lying in a hospital bed when ill can promote the formation of clots in your legs. Most hospitals in China do not provide this anticoagulation, but even then the incidence of clotting is remarkably high.

After this, the evidence begins piling up. 9th April, Cui et al found 25% of patients with severe COVID had clots in their legs, of which just under half died. Looking at a specific clotting parameter (D-DIMER) was remarkably accurate at predicting high-risk patients.

Italian doctors found in 16 patients in critical care with severe Acute Respiratory Distress Syndrome (a severe inflammatory condition caused by COVID) also had deranged clotting parameters.

French studies had found these sickest patients often had large clots in their lungs, blocking blood flow in the lung and causing severe issues in keeping the patient's blood well oxygenated.

Some studies showed even patients hooked up to artificial lungs (known as ECMO) were not safe from the problems caused by excessive clotting.

WHY?

So why is this occurring? As with everything in medicine, the answer is complicated and usually multifactorial. So we will simplify it.

We must look at the platelets in our blood. These fragmented cells have an important role in triggering the clotting cascade and creating a clot. During an infection white blood cells (important immune cells responsible for finding and destroying invading organisms) release many chemical signals around an infection site. This triggers platelets, the formation of small protein meshes that can literally net the viral particles in the blood.

But it looks like they have an anti-viral role as well. Researchers have found specialist receptors on platelets that recognize viruses in the blood, leading to the release of specialist anti-viral molecules that target and destroy the viruses. This is an interesting finding because it is white blood cells that are known to destroy invading organisms.

So how does it go wrong? In severe infections, there is a very large viral load, and this can cause an excessive response. Too many white blood cells release too many chemical signals, causing too many platelets to activate. The same thing can occur with the virus directly activating too many platelets at once. This results in clots forming in the blood throughout the body, including the lung and the brain. It is another instance of the body falling victim to its own protective mechanism.

A second problem is that as these platelets are activated, they and the clotting proteins in the patient’s blood are “used up”. This is dangerous, because without these platelets and clotting proteins the body is unable to stop any bleeding sites. Profuse bleeding can occur from small injuries, further complicating the treatment of the patient.

So what can be done?

Hospitals have already started looking at giving patients with severe COVID anticoagulation therapy. And it seems in patients with deranged clotting, giving anticoagulation therapy can lower mortality. The International Society on Thrombosis and Haemostasis (Clotting) has recommended that patients with severe COVID receive high dose anticoagulation medication to thin their blood, because these patients are at such high risk of clots. This regime will be used for hospital patients and those in critical care.

And what about for the everyday public? Should we be worried? So far the data suggests this is only happening in people suffering from severe symptoms of COVID. But the incident in New York certainly raises some questions, and it will be interesting to read their report in NEMJ. Should you panic and start taking anti-coagulant medication at home? Definitely not. But what you should do is be educated in the symptoms of common diseases caused by clots. Diseases such as strokes and DVTs.

STROKE

Remember, act F.A.S.T

Facial Droop on one side
Arm or hand on one side feels numb or weak with reduced power (same in one leg)
Slurred speech making it difficult to understand
Time to phone an ambulance

Other symptoms can include sudden loss in balance, sudden loss in vision in one eye, problems swallowing, and more.

DVT

Look out for a swollen, painful calf on one side that is hot to touch.

PULMONARY EMBOLISM

If you have a swollen, painful calf and are also having trouble breathing, with some sharp stabbing pain in your chest, contact the emergency services as soon as possible.

Dr Rajan Choudhary, UK, Chief Product Officer, Second Medic Inc

www.secondmedic.com

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Monthly Health Survey via SecondMedic App: A Smarter Approach to Preventive Healthcare

Healthcare is gradually shifting from reactive treatment to proactive prevention. Traditional health models rely heavily on annual checkups or medical visits only after symptoms become severe. However, many chronic and lifestyle-related conditions develop silently over time. The Monthly Health Survey via the SecondMedic App addresses this gap by enabling continuous health monitoring and early risk identification.

According to the Indian Council of Medical Research (ICMR) and NITI Aayog, early detection and preventive care are critical to reducing the growing burden of non-communicable diseases in India. Digital health tools play a key role in achieving this shift.

What Is the Monthly Health Survey?

The Monthly Health Survey is a structured digital questionnaire delivered through the SecondMedic App. It captures key health indicators such as:

recurring symptoms
lifestyle habits
stress and sleep patterns
nutrition and activity levels
chronic condition markers

By repeating the survey monthly, subtle health trends become visible.

Why Monthly Health Tracking Matters

Annual Checkups Miss Gradual Changes

Many health issues develop slowly. Annual tests may appear normal while symptoms quietly progress between visits.

Monthly surveys:

detect early warning signs
capture symptom patterns
identify lifestyle-related risks

Health Is Dynamic, Not Static

Stress, sleep, diet and activity fluctuate monthly. Regular tracking reflects real-life health variation more accurately than isolated tests.

How the Monthly Health Survey Works

Each month, users answer a guided set of questions related to:

physical symptoms
mental wellbeing
lifestyle behaviours
known medical conditions

The app analyses responses to highlight:

risk trends
symptom persistence
areas needing attention

This structured approach simplifies health awareness.

Key Health Areas Covered

Symptom Monitoring

Persistent fatigue, headaches, breathlessness or digestive issues are tracked across months to identify patterns.

Lifestyle Risk Factors

The survey captures:

sedentary behaviour
sleep quality
stress levels
dietary habits

These factors strongly influence long-term health outcomes.

Chronic Disease Indicators

For individuals with diabetes, hypertension or thyroid conditions, monthly monitoring supports better disease control and early escalation.

Role in Preventive Healthcare

Preventive healthcare focuses on stopping disease before complications arise.

Monthly health surveys support prevention by:

identifying risks early
prompting timely consultations
supporting lifestyle modification
reducing emergency care needs

WHO and NITI Aayog both highlight digital monitoring as a cornerstone of preventive health systems.

Benefits for Individuals

Early Awareness

Users become aware of health changes before symptoms become severe.

Empowered Decision-Making

Access to regular health insights encourages proactive lifestyle choices.

Reduced Anxiety

Structured tracking reduces uncertainty and fear about unexplained symptoms.

Better Doctor Consultations

Survey data provides doctors with a clearer health history, improving consultation quality.

Benefits for Chronic Care Management

For chronic conditions, consistency is key.

Monthly surveys help:

track symptom control
identify early deterioration
support medication adherence
reduce complications

This continuous loop improves long-term outcomes.

Data-Driven Personalised Care

The survey supports personalised care by:

tailoring recommendations
prioritising high-risk users
guiding preventive interventions

This approach moves healthcare from generic advice to individualised guidance.

Privacy and Responsible Use

Health data is sensitive.

The survey framework is designed to:

collect only relevant information
support medical decision-making
maintain confidentiality

Responsible data use builds trust and long-term engagement.

Why Digital Surveys Are Effective in India

India’s healthcare challenges include:

large population
limited access to preventive care
high lifestyle disease burden

Digital surveys overcome barriers by:

being accessible anywhere
requiring minimal time
enabling large-scale preventive monitoring

This scalability makes them highly impactful.

Integration with Broader Health Ecosystems

Monthly health surveys work best when integrated with:

medical consultations
diagnostic services
preventive checkups
digital health records

Integration ensures continuity of care.

Long-Term Impact on Healthcare Outcomes

Over time, regular health tracking leads to:

earlier diagnoses
reduced hospitalisations
better chronic disease control
lower healthcare costs
improved quality of life

Lancet studies show that continuous monitoring significantly improves preventive outcomes.

Who Should Use a Monthly Health Survey?

adults over 30
individuals with chronic conditions
people with high-stress lifestyles
those focusing on preventive health
corporate wellness participants

Proactive monitoring benefits all age groups.

Conclusion

The Monthly Health Survey via the SecondMedic App represents a modern, preventive approach to healthcare. By capturing health trends regularly rather than annually, it empowers individuals to act early, supports doctors with better insights and reduces the burden of advanced disease. In an era where prevention is the most effective medicine, monthly health surveys transform awareness into action and data into healthier lives.

References

Indian Council of Medical Research (ICMR) – Preventive Healthcare and Early Detection Report
NITI Aayog – Digital Health and Preventive Care Strateg
World Health Organization (WHO) – Digital Health Monitoring Guideline
Lancet – Preventive Healthcare and Continuous Monitoring Studies
National Health Authority – Digital Health Mission Indi
Statista – Digital Health App Adoption Trends India

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