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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 Field Day with Patients & Staff: Building Stronger Connections for Better Health

Healthcare outcomes are shaped not only by medical treatments but also by trust, communication and community engagement. As healthcare systems in India move toward preventive and patient-centric models, initiatives that foster meaningful interaction between patients and healthcare professionals are gaining importance. One such initiative is the Monthly Field Day with Patients & Staff.

A field day creates a shared space where patients and healthcare teams interact beyond clinical settings. These interactions humanise healthcare, improve understanding and encourage long-term wellness practices.

Why Community Engagement Matters in Healthcare

Modern healthcare recognises that health is influenced by behaviour, awareness and social support. According to the World Health Organization (WHO) and NITI Aayog, community-based health engagement improves preventive care adoption and patient outcomes.

Field days help bridge the gap between healthcare providers and patients by:

encouraging open dialogue
reducing fear and hesitation
promoting shared responsibility for health

What Is a Monthly Field Day with Patients & Staff?

A Monthly Field Day with Patients & Staff is a structured wellness initiative organised outside the routine clinical environment. It focuses on interaction, education and preventive health activities.

Typical elements include:

basic health screenings
lifestyle education sessions
fitness or relaxation activities
informal conversations with healthcare staff
family and caregiver participation

The aim is to create a supportive and approachable healthcare experience.

Why Monthly Frequency Matters

Consistency is key in behaviour change and preventive health.

Monthly field days:

reinforce health messages regularly
build familiarity and trust
allow continuous follow-up
keep wellness top of mind

According to public health studies, repeated engagement significantly improves health literacy and adherence.

Benefits for Patients

1. Improved Health Awareness

Patients gain better understanding of:

chronic disease management
preventive screenings
nutrition and lifestyle habits

Education in informal settings improves retention.

2. Increased Comfort with Healthcare Teams

Regular interaction reduces anxiety and hesitation around seeking medical care.

Patients are more likely to:

ask questions
follow medical advice
attend follow-ups

3. Early Risk Identification

Field days often include basic screenings that help detect:

high blood pressure
elevated blood sugar
obesity risk

Early identification enables timely intervention.

4. Enhanced Emotional Wellbeing

Social interaction and community activities reduce feelings of isolation, especially among elderly or chronically ill patients.

Benefits for Healthcare Staff

1. Better Understanding of Patient Needs

Direct interaction outside clinical settings helps staff understand patient challenges more holistically.

2. Improved Communication Skills

Informal engagement strengthens empathy and communication effectiveness.

3. Reduced Burnout

Positive patient interaction and community appreciation contribute to staff morale and job satisfaction.

WHO recognises staff wellbeing as a critical factor in healthcare quality.

Role of Field Days in Preventive Healthcare

Preventive healthcare focuses on reducing disease burden before complications arise. Field days support prevention by:

promoting routine screenings
encouraging healthy lifestyle habits
addressing myths and misconceptions
reinforcing long-term care plans

NITI Aayog identifies community engagement as a cornerstone of preventive healthcare strategies.

Activities Commonly Included in Field Days

Health Screening Stations

Blood pressure, blood sugar, BMI and basic assessments.

Wellness Education

Short talks on nutrition, exercise, sleep and stress.

Interactive Sessions

Q&A discussions with doctors, nurses and health educators.

Physical Activities

Group walks, yoga sessions or light exercises.

Family Engagement

Including caregivers improves adherence and support systems.

Impact on Chronic Disease Management

For patients with chronic conditions such as diabetes or hypertension, regular engagement:

improves medication adherence
reinforces lifestyle modification
reduces emergency visits

Lancet studies highlight that community-based interventions improve chronic disease outcomes.

Building Trust Through Transparency

Field days foster trust by:

making healthcare providers approachable
encouraging open dialogue
demonstrating commitment to patient wellbeing

Trust improves treatment adherence and satisfaction.

Role of Data and Feedback

Feedback collected during field days helps healthcare organisations:

identify common concerns
refine wellness programs
personalise future interventions

Data-driven engagement enhances program effectiveness.

Long-Term Impact on Healthcare Outcomes

Organisations that invest in regular patient-staff engagement observe:

higher patient satisfaction
improved preventive screening rates
reduced disease complications
stronger community relationships

According to WHO, patient-centred care models improve health outcomes and system efficiency.

Why Field Days Are Especially Relevant in India

India’s diverse population faces challenges such as:

limited health literacy
delayed care-seeking
chronic disease burden

Community-based initiatives like field days address these challenges through education and trust-building.

Conclusion

A Monthly Field Day with Patients & Staff is more than a community event—it is a strategic preventive healthcare initiative. By fostering open communication, promoting health awareness and strengthening relationships, field days improve patient engagement and staff wellbeing alike. In a healthcare landscape increasingly focused on prevention and community trust, regular field days play a vital role in building healthier, more connected communities.

References

ICMR – Community Health and Preventive Care Reports
National Family Health Survey (NFHS-5) – Health Awareness and Engagement Dat
NITI Aayog – Community-Based Preventive Healthcare Strategies
WHO – Patient-Centred Care and Community Health Guidelines
Lancet – Community Engagement and Health Outcome Studies
Statista – Healthcare Engagement and Preventive Care Trends India
EY-FICCI – Healthcare Workforce and Patient Engagement Reports

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