Just when you thought it was safe to get on an airplane, subway car, train, or bus, a new strain of Covid-19 emerges. Our former Dear Leader assured us that this pesky virus would “just go away” in a few months or succumb to ‘light treatments’ or ‘intravenous bleach.’ Skeptical physicians and scientists who dared disagree with this optimistic nonsense were belittled and threatened. President John Adams drafted and passed the Alien and Sedition Acts to shut up his critics. More recent Leaders have relied on the Internet and Broadcast News outlets to silence their critics. Just as the Alien and Sedition Acts failed to improve the State of the Union, the efforts to trivialize the impact of Covid-19 failed to improve the health of the nation. Fortunately, scientists in our country and elsewhere ignored the abuse heaped upon them and developed vaccines and antiviral medications that dramatically reduced the death rate from Covid.
Like many contagious viral diseases, Covid took a heavy toll on the elderly and the immunocompromised. Many, if not most, of the deaths from the virus occurred because of damage to the lungs. What was atypical with Covid-19 was an inordinate vulnerability of middle-aged men and women to stroke. A stroke is an irreversible injury to the brain, or occasionally the spinal cord, related to the nervous system’s vascular supply. With Covid-19 the most common cause for a stroke was the formation of blood clots that interfered with blood flow to parts of the brain.
Stroke risk with Covid infection is increased in all age-groups, whether they be bedridden, elderly men and women, or children on chemotherapy for cancer or leukemia. What was not expected was that a low-risk group, the middle-aged American, would show an increased risk of stroke, unassociated with high blood pressure, chronically elevated blood cholesterol levels, or valvular heart disease, when infected with Covid-19.
For more than ten years, Americans had a decreasing number of deaths from stroke in the ‘middle-age’ group of citizens 45 to 64 years old. This steady decline in stroke deaths was attributed to cigarette smoking cessation, drugs to reduce high blood pressure, drugs and devices to suppress abnormal heart rhythms, etc. Physicians believed this trend would continue as new treatments to reduce stroke risk were developed.
Unfortunately and unexpectedly, the death rate from stroke for middle-aged Americans stopped declining in 2012. In fact, the death rate started to increase over the next eight years and abruptly rose by 12 percent when the Covid pandemic took hold. During the pandemic, deaths from strokes were more likely in men than in women and more likely in people identified as “Black” than in those identified as “White.” Stroke deaths in Covid sufferers were higher in the Southern U.S. than in the Northern U.S., but this probably had more to do with access to healthcare than to any environmental factors. Early and aggressive stroke treatment reduces death and permanent disability.
As the number of Covid cases has decreased, the number of stroke deaths in middle-aged Covid patients has similarly decreased. The virus apparently increases the risk of developing blood clots in people infected with the virus. One might expect that administering an agent that interferes with clot formation early in the course of a Covid infection would reduce stroke risk and stroke death, but studies of clinical outcomes with a variety of anticlotting agents have not demonstrated clear benefits.
The Covid-19 pandemic produced a spike in American death rates by directly damaging organs and also more indirectly by disrupting the normal functioning of society. Homicides increased during the pandemic, perhaps as a consequence of financial stress, social isolation, or an as yet unidentified trigger. When the brains of people who committed these murders are ultimately examined in detail, we may find that there is a ‘Covid derangement disorder’ independent of brain damage from Covid-induced strokes.
Covid-19 infections obviously account for some of the stroke-related deaths observed over the past few years, but other factors must be responsible for the increase in stroke deaths between 2012 and 2019. Confounding the investigation of what is adding to our risk of dying from a stroke is the delay that may occur between exposure to an aggravating agent and the development of a blood clot. Most Americans [thanks to infomercials] are aware of lung cancer developing years or decades after exposure to an irritant, such as cigarette smoke or asbestos. A gene defect may produce excessive clot formation or vulnerability to clot formation in an adult, even though the defect was present from birth. Alternatively, a dietary agent, such as an artificial sweetener, may increase the risk of clot formation within minutes or hours of ingestion.
Artificial sweeteners have effects on elements involved in blood clotting, called platelets, that raise safety concerns. Erythritol is one such agent commonly used in diet drinks that greatly increases the risk of blood clot formation when consumed in relatively large amounts. Perhaps the national inactivity associated with the Covid pandemic in combination with an increased consumption of diet drinks to limit weight gain accounts for some of the stroke deaths occurring during the pandemic.
During the Covid-19 pandemic, infection with that virus was the fourth leading cause of death in America. As of 2023, it had dropped to the tenth leading cause of mortality. Heart disease, cancer, and unintentional injuries, such as accidental overdoses, were the top causes of death during the pandemic and continue to be the leading causes of death amongst Americans. The sharp drop in Covid-related deaths in 2023 and 2024 is most likely a consequence of widespread vaccine use. Unfortunately, we still are burdened with politicians and celebrities who urge us to avoid vaccines and other medical interventions. When the next lethal virus rises up in our country, as it certainly will, we can only hope that the toll exacted by Covid-19 will not be forgotten or ignored.
Dr. Lechtenberg is an Easton resident who graduated from Tufts University and Tufts Medical School in Massachusetts and subsequently trained at The Mount Sinai Hospital and Columbia-Presbyterian Medical Center in Manhattan. He worked as a neurologist at several New York Hospitals, including Kings County and The Long Island College Hospital, while maintaining a private practice, teaching at SUNY Downstate Medical School, and publishing 15 books on a variety of medical topics. He worke
