“It doesn’t start with a cough.” Here are the other suspicious symptoms


Recognize the symptoms of coronavirus in children it may not be simple: if in adults the most common symptoms, as we have known for weeks, are cough, fever and breathing difficulties, in children it is not always the case. In fact, cough can be completely absent in smaller patients, as well as other respiratory disorders: according to a study published in Frontiers in Pediatricsthe most common symptoms would be gastrointestinal disorders and diarrhea associated with fever.

The latter, along with exposure to Sars-CoV-2 positive people, should prompt suspicion of infection, the study recommends. According to the authors, gastrointestinal symptoms also suggest a potential infection through the digestive tract, since the type of ‘target’ receptors of the virus, present in the cells of the lungs, can also be found in the intestine. «Most children are affected only mildly by Covid-19 and the few serious cases often have pre-existing health problems. Diagnosis is easy to escape early on when a child has symptoms other than respiratory symptoms, ”says Wenbin Li of the Department of Pediatrics at Tongji Hospital in Wuhan, China, author of the study.

FIVE CHINESE CHILDREN In the study, Li and his colleagues describe in detail the clinical characteristics of 5 children hospitalized with non-respiratory symptoms, who subsequently received a diagnosis of Covid-19. “Based on our experience, in regions where this virus is epidemic, children suffering from symptoms of the gastrointestinal tract, particularly with fever or a history of exposure to this disease, should be considered as possibly infected.”

“These children came to the emergency room for unrelated problems, for example one had a kidney stone, another had a head injury. Everyone then had pneumonia confirmed by chest CT and the swab turned out to be positive. But their initial symptoms may not have been related to Covid-19: they were mild or relatively ‘hidden before hospitalization. And it is important to emphasize that 4 of the 5 cases had symptoms of the digestive tract as the first manifestation of the disease “.

He hopes that doctors will use this information to quickly diagnose and isolate young patients with similar symptoms, which will encourage early treatment of Covid-19 and hinder the transmission of the virus. The researchers also link gastrointestinal symptoms in children, which have also been reported in adult patients, to a further potential route of infection. “This suggests that Covid-19 could infect patients not only through the respiratory tract in the form of aerosol droplets, but also through the digestive tract by contact or oral-fecal transmission.” However, the researchers admit that theirs is a small study and needs to be confirmed on larger numbers. «We describe five cases of Covid-19 in children showing non-respiratory symptoms before manifestation», now «more studies are needed in more patients

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Last updated: Tuesday 12 May 2020, 10:56

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Coronavirus. Head, toes, lungs, kidneys… the symptoms multiply, know them

From head to toes, including lungs and even the kidneys: every week, the list of symptoms caused by the new coronavirus is growing and few organs seem to be spared from this disease, which varies from mild to severe.

In the space of three months, what had started as an atypical flu has turned into a veritable catalog of syndromes which in their most severe forms can trigger these now famous “Cytokine storms”, a runaway immune response that can lead to death.

It is not uncommon for a virus to cause so many manifestations, but certain symptoms of SARS-CoV-2, such as loss of smell or blood clots, seem very specific to this epidemic.

> Follow our live news from Monday, May 11, on the coronavirus pandemic

Affected children too

Most viruses can damage tissue where it reproduces or cause collateral damage to the immune system that fights infectionsays Jeremy Rossman, virology expert at the British University of Kent.

Doctors suspect Covid-19 may be responsible for the hospitalization of dozens of children in New York, London and Paris with inflammatory conditions multi-systemic rare, suggesting an atypical form of Kawasaki disease or toxic shock syndrome, which attacks the walls of the arteries and can cause organ failure.

Dozens of medical studies have described other potentially lethal consequences of the disease, including stroke and heart damage.

Researchers at Nanjing University of Medicine (China) have reported cases of patients who developed urinary complications and acute kidney damage.

They observed upheavals in the male sex hormones, advising the young men eager to have children to consult when cured.

“Beware of just about everything”

Is this spectrum of symptoms unique? Not necessarily. In a common disease, complications, even rare, will occur frequently, decrypts Babak Javid, specialist in infectious diseases at the Cambridge University Hospital Center.

Over 4 million cases have been reported worldwide, but the true number of infections could reach tens or even hundreds of millions, according to Babak Javid. If one person in a thousand, even in ten thousand, develops complications, that still makes thousands of people.

General practitioners, on the front line, were the first to try to identify patterns in the evolution of the epidemic.

We were told at the start: fever, headache, small cough. We were added: runny nose, itchy throat. Then there were the digestive symptoms: diarrhea, stomach ache, remembers Sylvie Monnoye, family doctor in Paris.

Then pain in the rib cage, loss of taste and smell, skin connections like hives or frostbite on the toes, neurological disorders … We started to think that we should be wary of just about everything, comments Dr. Monnoye.

Chills, fever and cough, the most common symptoms

These testimonies are supported by an internal report from the Center for Disease Prevention and Control (CDC) in the United States, which analyzed the symptoms of 2,591 patients hospitalized between March 1 and May 1.

Three-quarters of the patients had chills, fever and / or cough, and almost as much difficulty breathing, the most common symptoms of the new coronavirus.

Almost a third complained of body aches, ditto for diarrhea; a quarter of the nausea or vomiting. Some 18% had headaches, 10 to 15% had lung or abdominal problems, runny nose, sore throat.

However, until the end of April, the CDC had only listed three symptoms: cough, fever and difficulty breathing. Her website has since been updated, but only added a few: chills, body aches, headaches, loss of smell. French health authorities did the same in early May.

Blood clots, kidney failure

Loss of smell (anosmia) and taste (ageusia) was only detected in 3.5% of patients in the CDC cohort, but experts believe these symptoms are more common in less severe cases .

Anosmia and ageusia rarely occur with other viruses. Much like the development of blood clots, which studies have linked to heart problems, hepatic thrombosis, pulmonary embolism and brain damage in Covid-19 patients.

When a Covid-19 patient is very ill, they may have problems with blood clots, which seem to be much more common than with other viruses., according to Babak Javid, who concludes: Compared to the flu, you’re more likely to get very sick and die.

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Uncover a surprising new method for transmission of the Coronavirus infection

1:00 AM

Sunday 03 May 2020

Agencies

A study published by the European portal Eurekalert revealed that the Coruna virus is capable of infecting and multiplying intestinal cells, which indicates the possibility of infection spreading not only by airborne drops.

Dutch scientists from the Habrecht Institute, the Erasmus University Medical Center in Rotterdam, and Maastricht University have examined the effects of coronavirus on cell culture models in the human intestine and the response of these cells. When the coronavirus was added to the genome of these cells, it quickly became infected and the number of infected cells increased suddenly, according to “Russia Today”.

According to experts, many patients suffer from other symptoms of COVID-19 such as nausea and diarrhea, as well as detection of viral particles in the stool, and the data obtained from this study indicate that the virus can spread through something called “transmission”. Oral stool virus “, meaning that the virus in the stool of an infected person can be transmitted to a healthy person by this stool.

On March 11, the World Health Organization announced that an outbreak of the Corona virus, a new epidemic, is a global pandemic. According to the latest data from the World Health Organization, the global death toll of those infected with Corona Virus has exceeded the ceiling of 3.3 million cases, while the death toll is close to a quarter of a million people.

The United States remains first in the number of deaths and patients, and there is a large disaster system in place.

Also read: After the “Health” warning … this is what a lot of alcohol does

And in the list of countries most vulnerable to outbreaks of the coronavirus come, respectively: Spain, Italy, France, Germany, Britain, while Russia ranks seventh in the number of infected people, before Iran, China and Turkey.

Today, Saturday, the Russian health authorities announced that 57 new deaths and 9,623 cases of the new Corona virus “Covid-19” had been recorded in the past 24 hours.

The operation room for fighting the Corona outbreak in Russia confirmed in its daily report that the total number of coronavirus infections in the country has become 123054 cases, while 1222 people have died so far.

Also read: We are stronger than SK

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According to the study, this is how the infection gets into the body

How does Corona get into the body? The most likely first line of infection for the virus is now clear, according to a new study. However, according to the investigation, there are indications of a further path.

According to a study, special cells in the nose are the most likely entry points for the new coronavirus. Several teams of researchers had cells out lung, Nose, eye, intestine, heart, kidney and liver are examined, as reported by the Max Delbrück Center for Molecular Medicine (MDC) in Berlin on Thursday.

They wanted to find out which cells contain the two most important entry proteins, ACE2 and TMPRSS2, which do virus for the infection uses. “We then showed that of all cells, the mucus-producing goblet cells and cilia in the nose have the highest concentrations of these two proteins,” explained lead author Waradon Sungnak of the Wellcome Sanger Institute. “This makes these cells the most likely primary route of infection for the virus.”

Indications of a further route of infection

The Max Delbrück Center also reported that the two most important entry proteins are also found in the corneal cells of the eye and in the intestinal mucosa. This indicates a further possible route of infection via the eye or the tear glands. The MDC writes rather cautiously that there is also potential for transmission via feces and ingestion by mouth. The research teams have published their results in the journal “Nature Medicine”.

Various institutes were involved in the study, including the Wellcome Sanger Institute, the University Hospital Groningen and the University of Cote d’Azur, as well as the Human Cell Atlas Lung Biological Network.

According to the MDC message, up to 20 percent of corona patients suffer damage to the heart muscle up to heart failure. There are also docking points for that Corona virus been found. However, it is still unclear whether the virus itself causes damage to the heart or whether it is secondary effects.

Important NOTE: The information is by no means a substitute for professional advice or treatment by trained and recognized doctors. The contents of t-online.de cannot and must not be used to independently diagnose or start treatments.

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Symptoms, transmission, course, treatment & protection

The pathogen of a new lung disease has kept the world in suspense for months. The virus also spreads in Europe and Germany. Researchers explain how contagious the new corona virus is – and how dangerous.

The number of infections caused by the novel Corona virus rises steadily. New deaths are known every day. In Germany, too, there have been deaths from Covid-19 since March 9. Many people are concerned. How dangerous is that virus? You can see an animation of how the pathogen acts in the human body in our video above or here.

Infected and deaths in Germany

In Germany, cases of the corona virus have now been detected in all federal states. One An overview of the number of infected people and deaths can be found here.

What is known about the corona virus?

Since February 11, the pathogen originally named 2019-nCoV has had a new name: SARS-CoV-2 belongs to the large family of corona viruses – so named because they are surrounded by jagged structures that resemble a crown. Harmless types often only trigger mild cold infections. The new Corona virus on the other hand can lead to pneumonia and severe breathing difficulties. The lung disease that can trigger the corona virus has been given the name Covid-19 (Corona Virus Disease 2019).

Many doctors compared it, especially at the beginning of the outbreak, with the SARS pathogen, which developed a disease in 2002/2003 epidemic caused. SARS stands for “Severe Acute Respiratory Syndrome”. The new name of the corona virus indicates the close relationship between the two viruses. According to the World Health Organization (WHO) SARS affected 8,096 people worldwide, 774 of them died. At that time, 349 deaths from mainland China were reported, as well as 299 others from China’s Hong Kong Special Administrative Region.

Symptoms of the coronavirus

According to current knowledge, the virus usually triggers the following symptoms:

Even more severe symptoms like one lung infection can occur. Other symptoms can chills, nausea, a headache and Shortness of breath his. Also typical flu symptoms like sniff or Sore throat can belong, according to the Robert Koch Institute. According to the Federal Ministry of Health, some of those affected also suffer diarrhea.

Researchers at the Institute of Virology at the University of Bonn also recently found that the majority of Covid-19 patients from the Heinsberg district of North Rhine-Westphalia, particularly affected by SARS-CoV-2, had another symptom: 70 percent of them had temporary for two up to three days lost their sense of smell and taste – but without suffering from a runny or stuffy nose at the same time.

Professor Hendrik Streeck, head of the Institute of Virology at the University of Bonn, and his team had analyzed the data from more than 100 Covid-19 patients from Heinsberg. It was noticed that the majority of patients reported a loss of smell and taste over several days, said Streeck recently in the “Frankfurter Allgemeine Zeitung”.

However, the scientists cannot yet explain the phenomenon. In addition, many patients complain of being able to smell and taste bad or not at all, even with a flu infection or influenza. It is also the first expert observation of this symptom.

The incubation period – the period between infection and the onset of symptoms – should be two to 14 days according to current knowledge. However, some studies show that somewhat longer periods are also possible. There is currently no special therapy for treating the infection, only the symptoms can be alleviated with medication.

How is the corona virus transmitted?

Like all corona viruses, the new pathogen was probably first transmitted from animals to humans. Mammals in particular carry germs that can spread to humans. Bats and fruit bats are among the sources of the new corona viruses. Farm animals have also transmitted corona viruses to humans in the past.

The new virus can also transmitted directly from person to person will. This is possible even before an infected person experiences symptoms such as fever or to cough has developed.

So far, scientists assume that SARS-CoV-2 is primarily about Droplet infection and probably also Smear infection is passed on. The virus multiplies in the throat. While an infected person speaks or coughs, he gives droplet of itself, said virologist Christian Drosten of the Berlin Charité at the end of February. “They fly maybe 1.5 meters and fall relatively quickly to the ground. It is the inhalation of such a cloud that infects you in most cases.”

The new types of corona viruses were also found in stool samples from some of those affected. According to the Federal Center for Health Education, it has not yet been finally clarified whether the virus can also be spread via the stool. The German Society for Infectious Diseases assumes that you have to be in contact at a distance of less than one meter in order to become infected.

As the Ärzteblatt reports, Günter Kampf from the Institute for Hygiene and Environmental Medicine at the University Medical Center Greifswald, together with Eike Steinmann from the Ruhr University Bochum, has compiled 22 studies on coronaviruses and their inactivation. This means that corona viruses can remain on inanimate surfaces such as metal, glass or plastic for up to nine days – if they are not removed. Experts such as the Berlin-based virologist Christian Drosten note, however, that in practice the virus is probably much shorter infectious when humans contact it through such surfaces.

In addition to the path of droplet and smear infection, initial studies indicate a possible further transmission path.

For the first time in mid-March, researchers were able to demonstrate in a study published in The New England Journal of Medicine (NEJM) that the coronavirus can survive as suspended particles in the air for three hours. To do this, they sprayed the virus with a kind of atomizer in the air in a laboratory experiment. The authors concluded from this that “transmission of the SARS-CoV-2 virus via aerosol”, that is to say via the air, is entirely possible. This means that viruses can remain in the air as suspended particles for a longer period of time. In theory, these could also be inhaled.

However, there are doubts about the transferability of the experiment. Scientists pointed out that there is little in common with reality: if a sick person coughs or sneezes, “compared to an aerosol, the droplets fall to the ground fairly quickly” because they are heavier than the suspended particles from a spray, said Paul Hunter of the British University of East Anglia. In addition, the corona virus dries out quickly in the air.

Christian Drosten, chief virologist at the Charité in Berlin, explains in the NDR podcast that such a drop is so small “that it dries very quickly, the virus is then no longer in a liquid and is then destroyed”. However, he generally believes it is possible for air movements in the room to transport aerosols that could ultimately be inhaled by a person.

The Robert Koch Institute writes on its website that airborne transmissions are not yet known. Further studies on this must follow.

Read here whether people who have recovered from Covid-19 are immune.

A case from Wuhan also suggested a few weeks ago that the virus can also be transmitted from the mother to the newborn. Such an infection was found in an infant 30 hours after birth, the head of the newborn section of the children’s hospital reported Wuhan, Zeng Lingkong, according to the news agency China News service. The following studies have so far found no evidence that the virus can pass from mother to unborn child.

Coronavirus under the microscope: Many questions about the enigmatic lung disease from China have still not been answered. (Source: dpa / Center for Disease Control / epa)Coronavirus under the microscope: Many questions about the enigmatic lung disease from China have still not been answered. (Source: Center for Disease Control / epa / dpa)

Where does the virus come from?

The Corona virus probably has its origins in a fish market in Wuhan, a city with eleven million inhabitants in the east Chinese province of Hubei.

“The source is believed to have been animals sold in this market,” said Arnaud Fontanet, head of the epidemiology of emerging diseases department at the Pasteur Institute in Paris. The market was closed and disinfected at the beginning of the year.

Are the dangers comparable to SARS?

The new pathogen is currently considered to be contagious but less dangerous than the SARS pathogen. The death rate, for example, shows whether the pathogen is more or less dangerous: While the death rate for the SARS virus was around ten percent, it is only an estimated one to two percent for the corona virus. It is assumed that the rate is even lower because cases with a mild course are not recorded at all. In Italy, however, the death rate is currently significantly higher.

If the corona virus mutates like SARS at the time, the death rate could change worldwide. Some scientists assume that the situation will improve with the onset of warmer weather, which “is not conducive to the spread of contagious respiratory diseases”. However, other experts, such as infectiologist Stefan Moritz from Halle University Hospital and virologist Christian Drosten, question this.

Contagion and course of the disease during the SARS pandemic 2002/2003

Is the flu or Covid-19 more dangerous?

The corona virus, it seems so far, is easier to transmit than the flu virus. The infection rate of the new SARS-CoV-2 coronavirus is, according to the data available to date, higher than that of influenza, as the influenza virus. Both viruses are transmitted by droplet infection. This means that when you speak, sneeze, cough or shake hands, it can pass from one person to another.

According to the RKI, the flu’s incubation period – the period between infection and the onset of symptoms – averages one to two days. In the case of an infection with the new corona virus, a very variable incubation time has been assumed so far. After being infected, the period of time until symptoms appear can last two days to two weeks. This in turn facilitates the virus transmission from healthy-looking, but already infected people to other people.

Corona virus: Is there a vaccine?

There is currently no vaccine. When a vaccination could be available is currently not foreseeable. However, according to the Robert Koch Institute, those who get vaccinated against the flu help to relieve the burden on the healthcare system. Older people can also get pneumococcal vaccinations.

Scientists around the world are already working on the development of an active ingredient. In the United States, a volunteer was first tested with a possible vaccine. This marks the start of the first phase of clinical tests for the vaccine in the US metropolis of Seattle. 45 healthy volunteers between 18 and 55 should take the test.

In order to support international measures to contain the virus, the Chinese authorities published the gene sequence of the pathogen early. As a result, a test for identifying infections with the novel corona virus was quickly developed.

How can you protect yourself against the corona virus?

The Federal Ministry of Health advises to adhere to the following measures:

If you are already ill, wearing a nose and throat protector can be useful to reduce the risk of infecting other people with droplets that occur when you cough or sneeze. On However, according to many experts, mouth and nose protection, as used in surgery, does not protect against infection by other infected. According to the Robert Koch Institute, wearing a mask can even create a false sense of security.

If you are concerned that you have already contracted an infection, for example, you should contact your responsible health department. After an individual survey, necessary measures are then taken. RKI President Lothar Wieler also warns that it is important to call the doctor’s office before visiting a doctor. “Even people with very few symptoms can infect others.”

The following areas are classified as risk areas by the Robert Koch Institute and should therefore be avoided: (as of 02/04/2020)

  • Italy
  • Iran
  • Egypt
  • United Kingdom
  • France
  • Austria
  • Spain
  • USA
  • Netherlands
  • Switzerland
  • In China: Hubei Province (including Wuhan City)
  • In South Korea: Gyeongsangbuk-do Province (North Gyeongsang)

Since March 31, 2020, the RKI has no longer identified any particularly affected areas in Germany, since there are outbreaks in all districts with large numbers of cases.

The Federal Foreign Office has also issued a worldwide travel warning and the Federal Government has issued one Return campaign started for vacationers.

What is a pandemic?

“Pandemics are global epidemics that spread from person to person across large regions and usually affect many people,” says Dr. Stefan Moritz, Head of Clinical Infectious Diseases at the University Hospital Halle.

Despite increasing numbers of cases in several countries, the World Health Organization (WHO) was initially optimistic. The spread of the virus could still be “slowed down considerably”. On March 11, however, the institution had to officially declare a pandemic.

The Robert Koch Institute (RKI) in Berlin assessed the risk of coronavirus on a global level earlier than the WHO as a “very dynamically developing and serious situation.” In Germany, too, further cases, chains of infection and outbreaks must be expected. According to the Robert Koch Institute, the virus was expected to spread worldwide.

Where can I find current information?

The Robert Koch Institute and the Federal Center for Health Education have set up corresponding websites. From the World Health Organization WHO there are other tips in English – including information about common myths and incorrect information about the virus. The Barmer health insurance has set up a free hotline for telephone questions (0800/84 84 111). It is available around the clock.

You can also find the latest information at t-online.de. Current case numbers for Germany Is there … here. All important new research findings, advice on hygiene measures and everyday life in times of the corona virus are collected on this page. The latest news about the virus in Germany and worldwide as well as political decisions you can read here.

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What we know and what we don’t know about the Covid-19

DECRYPTION – Symptoms, contagiousness, immunity, mortality, mutations… The new coronavirus which appeared in China last December is gradually being revealed.

Coronaviruses owe their name to their appearance in a crown, linked to the “spicules” present on the surface of their envelope, protuberances visible under a microscope.
Coronaviruses owe their name to their appearance in a crown, linked to the “spicules” present on the surface of their envelope, protuberances visible under a microscope. Centers for Disease Control and Prevention / AP

More than two million cases diagnosed worldwide, at least 130,000 dead. Unknown just over three months ago, the new coronavirus has turned our world upside down … and still contains many gray areas.

Varied symptoms

The incubation period lasts from one to fourteen days, most often around five days. Symptoms appear gradually: headache, muscle pain, fatigue. Fever and dry cough then come with, at the height of the disease, possible chest pain and difficulty in breathing. In some patients, these symptoms are accompanied by a runny nose or sore throat. Other clinical signs have been described as sudden loss of taste and smell, diarrhea, or frostbite on the tips of the feet and hands. Typically, symptoms last for about two weeks. Some people have none.

Brutal aggravations

After seven to nine days, the case of certain patients

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Detect and Treat Stroke | NDR.de – Guide

As of April 14, 2020, 2:28 p.m.

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If the wall of a carotid artery tears when you cough, for example, a stroke can result.

Around 200,000 people suffer a stroke in Germany every year. Due to a cerebral hemorrhage or a sudden reduced blood supply to the brain, the nerve cells receive too little oxygen and die. Many people are afraid of getting infected with the corona virus in the hospital and often complain too long before they call 911. This can have serious consequences, particularly in the case of a stroke. Even in corona times, the following applies: under no circumstances wait and dial 112 immediately – because every minute counts. After a stroke, up to two million nerve cells per minute die.










Stroke: interpret and act correctly

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Strokes can be triggered by relatively harmless circumstances, such as infections or surgery. Important: Call the emergency doctor immediately if you are suspected – even in the corona pandemic.

Typical symptoms and signs of a stroke

With a stroke, these symptoms can appear:

  • sudden feeling of weakness, paralysis or numbness on one side of the body
  • Visual disturbances such as half-sided loss of vision, double vision, blurred vision or loss of vision in one eye
  • Disorders of speech or speech understanding
  • sudden dizziness with gait insecurity
  • severe headache, nausea and vomiting

Possible triggers for stroke: cough, infection, or surgery

A stroke can be triggered by various circumstances, for example respiratory infections or a recent operation. Even a violent cough or a tantrum can cause a stroke due to increased blood pressure in the carotid artery. Even if the causal relationships have not yet been clarified, it is now clear that infections can trigger strokes. Infections also seem to be a trigger in younger people. And especially in patients who do not have the classic risk factors, infections are often found as trigger factors for strokes.

Obesity and diabetes are risk factors

Until now, medical professionals have thought that the inflammation levels in the blood, which are often increased in the case of a stroke, were more likely to be a consequence of the stroke. But now there is much to suggest that the stroke follows the inflammation. Elderly people who are already at high risk of stroke are particularly at risk, for example from overweight, diabetes and deposits in the vessels. Doctors therefore urgently recommend prevention, including through the annual one Flu shot.

These factors can trigger a stroke

Triggering factors, so-called triggers, for a stroke are, for example:

  • recent past Operations or Injuries
  • Sports with short-term high loads and blood pressure peaks, for example climbing or weight lifting
  • Tantrums with a three to four times higher risk in the first two hours afterwards
  • Enjoyment of alcohol with a double risk in the first hour

Precautions to be taken when there is an increased risk of stroke

People with an increased risk of stroke should pay particular attention to this:

  • Lower blood pressure through medication and other measures such as endurance sports, regular blood donation and a conscious diet
  • Treating an irregular heartbeat (atrial fibrillation)
  • annual flu shot
  • Pneumococcal vaccination every five years
  • stop anticoagulant late in surgery and then take it again early
  • stop smoking
  • Normalize body weight, for example through interval fasting

Hemorrhagic or ischemic stroke

A distinction is made between hemorrhagic cerebral infarctions, the symptoms of which are caused by cerebral hemorrhage, and ischemic, i.e. strokes, which are caused by a sudden reduced blood flow to the brain. Ischemias are the most common form with about 80 percent of all strokes. Almost one in four dies of the consequences within the first year. The survivors often have to struggle with stressful disabilities such as paralysis, speech and vision disorders.

Causes of blocked vessels in the brain

Vascular blockage in the brain can have various causes:

  • arteriosclerosisLime and fat deposits on the vessel walls initially lead to a narrowing of blood vessels. Local inflammatory reactions occur there. This can result in tears in the vessel wall and the formation of blood clots. These can partially or even completely close the vessels. From the neck vessels such clots can be washed up into the brain (embolism).
  • Atrial fibrillation causes at least 30,000 strokes each year. Overall, the cause of the stroke remains unknown in every fifth case. But experts now believe that atrial fibrillation has often led to a stroke in these cases too. This emerges from studies in which the heart rhythm of patients after a stroke of unknown cause was monitored over the long term.

Stroke due to tears in the carotid artery

In a so-called spontaneous vertebral dissection, doctors find an ultrasound tear (dissection) in the wall of one of the carotid arteries. The so-called vertebral artery runs between the vertebral bodies and is exposed to high mechanical loads there. If the vessels are attacked, a jerky movement of the head may be sufficient, for example a look at the shoulder when driving a car, a serve when playing tennis or a shock when riding a bicycle, so that there is bleeding into the arterial wall of the artery.

The bruise in the vessel wall narrows the vein, the blood flow is restricted and a blood clot can form behind the constriction. If the clot dissolves, it can be washed into the brain and close a vessel there, thus triggering a stroke.

Typical warning signs of a dissection include unilateral headache, dizziness, visual disturbances, and ringing in the ears. The tricky thing is that ultrasound examinations are more likely to be seen as a thickening of the artery and not as the constriction that they actually represent. If a narrowing dissection is found, the patient must be treated quickly with blood-thinning medication so that no blood clot forms. The therapy continues until the tear in the wall of the vessel has healed and the bruise has disappeared.

Atrial fibrillation: increased risk of stroke

Atrial fibrillation is one of the most common forms of irregular heartbeat. Around 1.8 million people are affected in Germany. Disordered cardiac muscle activity creates the risk of blood clots forming in the atria. If these become detached, they can enter the blood vessels supplying the brain, close them and thus lead to a stroke.

Some people have atrial fibrillation (paroxysmal atrial fibrillation), others have it permanently. Typical complaints are rapid heartbeat and stumbling, which can be accompanied by shortness of breath or a restriction of stress. For the majority of those affected, however, atrial fibrillation remains unnoticed.

The risk of suffering a stroke is greatest if the atrial fibrillation goes unnoticed and therefore remains untreated. In this case, 15 out of 100 people affected have a stroke within one year.

Monitoring via ECG and event recorder

According to the current guidelines, a long-term ECG is performed after every stroke, the cause of which cannot be clarified immediately (“cryptogenic”), in order to detect occasional atrial fibrillation as a trigger. For long-term monitoring, those affected can be implanted with a so-called event recorder that records the heart rhythm over months. With this examination, atrial fibrillation could be detected in six times more patients than with the conventional ECG. Have also proven to be helpful in identifying previously unrecognized atrial fibrillation Smartwatches with an ECG function proven.

Anticoagulants reduce the risk of stroke

If atrial fibrillation is reliably identified as the cause of the stroke, the risk of a new stroke can be reduced with drugs that inhibit blood clotting. Because anticoagulants can themselves cause bleeding in the brain, atrial fibrillation must be guaranteed before starting therapy.

Further information

05:29

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Strokes can be triggered by relatively harmless circumstances, such as infections or surgery. If there is an increased risk, you should avoid the so-called trigger factors.
Video (05:29 min)

04:55

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Strokes can be triggered by relatively harmless circumstances, such as infections or surgery. Neurologist Dr. explains who is particularly at risk Frederick Palm.
Video (04:55 min)

If there are signs of a stroke, you should immediately call an emergency doctor, because it counts every minute. An overview of which specialists can help in which area.
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Many sufferers feel left alone after a stroke. The family is overwhelmed, doctors have long waiting times. Support groups can help.
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Experts on the subject

Dr. Gabriele Bender
Medical Director and Senior Physician of Neurology
RehaCentrum Hamburg
Martinistrasse 66, 220246 Hamburg
www.rehahamburg.de

Prof. Dr. Christian Gerloff
Chief physician clinic and polyclinic for neurology
Director Head and Neuro Center
University Medical Center Hamburg-Eppendorf
Martinistrasse 52, 20246 Hamburg
www.uke.de

Further information
German Stroke Aid Foundation
Schulstrasse 22, 33311 Gütersloh
Service and advice center
(05241) 977 90
www.schlaganfall-hilfe.de

Competence network stroke
Charité Campus Mitte
Charitéplatz 1, 10117 Berlin
www.kompetenznetz-schlaganfall.de

German Stroke Society (DSG)
Reinhardtstrasse 27c, 10117 Berlin
(030) 531 437-931
www.dsg-info.de

Stroke risk test
Test by the German Stroke Aid Foundation for people who are 40 years or older
www.schlaganfall-test.de

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04/14/2020 | 8:15 p.m.

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“Vaccine stoppers against the infection already exist”

There are many unanswered questions about the corona virus. Scientists worldwide are researching new tests, drugs and vaccines against SARS-CoV-2. An expert explains which approaches are available and how reliable the tests are.

The rheumatologist and immunologist Prof. Dr. Andreas Radbruch is currently a sought-after man. After already in Podcast “Soundtrack Knowledge” was a guest, speaks in an interview with t-online.de about vaccine development, possible immunity in those who have recovered and the advantages and disadvantages of the individual test procedures.

t-online.de: Prof. Radbruch, when do you expect a vaccine against SARS-CoV-2?

Prof. Radbruch: There are already vaccines against the new corona virus. The first are already in the first clinical test phases – at least 50 different products are rolling towards us. So the problem is not the vaccine itself, but its testing. You have to make sure that – unlike the virus – it doesn’t make you sick and still immunizes everyone. With SARS-CoV-2, we don’t even know how long the immune protection lasts. However, the right vaccine should protect us from it for a long time and this must be thoroughly clinically tested. Vaccine development used to take several years, today we can count on the fact that within one year we actually have substances that are approved and work.

Prof. Dr. Andreas Radbruch is Scientific Director at the German Rheumatism Research Center and President of the European Federation of Immunological Societies. (Source: Gero Breloer)Prof. Dr. Andreas Radbruch is Scientific Director at the German Rheumatism Research Center and President of the European Federation of Immunological Societies. (Source: Gero Breloer)

There is currently a controversial discussion among scientists about loosening contact blocks. For example, the virologist Alexander Kekulé said in the daily news on April 4: “We cannot shutdown until we have a vaccine.” How do you assess the current situation?

Here the question arises, what exactly is a shutdown. I think the term “shutdown” is a whole range of different measures. Which measures are needed to bring the infection rate primarily from the exponential rate to a linear rate and which measures can be loosened or even removed from this point of view – this is a difficult question. I think that politicians and scientists will have to hold a lot of talks in order to slowly return to a somewhat more normal state.

In this context, herd immunity is often talked about. Do you see the time for it, or do we need a better supply of protective material to the health system?

Mr Kekulé said that it was necessary to gradually build up herd immunity – I think that is a bold assertion. It is not entirely clear to me how one can gradually build up such herd immunity with scientific advice. There will be more and more people infected and recovered by themselves – as long as the infection rate is not brought to zero or a vaccine is available. When easing the measures, two aspects should not be forgotten: first, that the health system must function by protecting employees as well as possible, and second, that especially the risk groups – i.e. the elderly and those with previous illnesses – are protected.

Is our healthcare system ready for the peak of the corona crisis?

Our health system is very well positioned to deal with the situation – apart from the fact that a lot of protective material is no longer manufactured in Germany for price reasons and there are bottlenecks. But that has now been recognized and will change direction there.

I think it would be a bit cynical to expose people at risk to possible infections – consciously or unconsciously. No matter how well the health system is set up, after all, patients also die with us.

How do you assess the chances of successful treatment with existing medications that have not yet been developed specifically for the coronavirus?

The SARS-CoV-2 coronavirus is not fundamentally different from many other viruses – including other coronaviruses. There are a number of medications that disrupt the way other viruses live so that the infection is contained. So it is very sensible to test these drugs now to see if they also work against SARS-CoV-2. However, to my knowledge, there are currently no well-controlled studies on this. What medication with Covid-19 time really has to work.

Smaller studies have found evidence that Covid-19 patients treated with the malaria drug hydroxychloroquine recover more quickly from the typical symptoms. How do you rate the chances of this product, but also the risks – for example from side effects – in connection with Covid-19?

Hydroxy-chloroquine works as follows: It interferes with the breakdown of the blood pigment hemoglobin and causes the malaria– Pathogens die because they need the blood pigment. However, it has been found to have a side effect: it interferes with the multiplication of cells and their ability to absorb particles. This medication is therefore particularly tricky. It is not only used for malaria, it also has an effect on rheumatic diseases. The agent is currently being tested for Covid 19 disease. So far, however, no well-founded data are available. The studies that are sometimes cited are not meaningful enough. It is not yet scientifically possible to say that it works. Unfortunately.

Is there any knowledge about how the use of immunosuppressive drugs, for example for the treatment of rheumatism, affects an infection with SARS-CoV-2?

Studies are underway to determine whether rheumatism medication suppresses certain aspects of the immune system in Covid-19. That is, whether this means responding to that Corona virus inhibit. It is still completely unclear. But one thing can already be said from a rheumatological point of view: stopping medication by the patients themselves is nonsensical. Because if the rheumatism returns and there is a corona infection, the treatment becomes much more difficult. The rheumatism patients would have to take very strong immunosuppressants, which would be bad for their state of health – and nobody wants that. Patients are therefore advised not to interrupt their therapies and to stop taking the medication themselves. If you have any questions about this, you should speak to your rheumatologist.

What protective measures do you recommend for rheumatics and patients with other autoimmune diseases with regard to SARS-CoV-2?

Autoimmune diseases such as rheumatism, multiple sclerosis or chronic intestinal inflammation affects a lot of people. About five to ten percent of the population suffer from it. They are also among the diseases that many only develop at an advanced age. Due to their suppressed immune system, these patients belong to the risk groups of a Covid 19 disease. The general protective measures that apply to both healthy and high-risk patients should be followed. This includes limited contact and strict adherence to hygiene rules – i.e. washing hands and keeping a distance from other people.

What do you expect from the therapeutic approach of passive immunization with antibodies from the blood of recovered people?

Passive immunization – that is, protection by antibodies from animals or other people – is a very old principle. It works very well, but only for a certain time. Because antibodies are proteins that disappear from the blood of the vaccinated within weeks. For this time, however, they offer astonishingly good passive protection. Passive immunization is very useful for people who are at high risk. Ultimately, this is a 1-to-1 situation, you have to give relatively many antibodies so that the person is also protected. You cannot protect many other people with the serum of a donor.

Today we are in a situation where we can develop the next generation of passive immunization: by synthetically producing therapeutic antibodies. That would be passive immunization 2.0. The genetic information for such antibodies is obtained from the blood of those who have recovered. In some diseases, this is already happening and antibodies are being produced in large quantities using technology. Therapeutic antibodies have been used in rheumatology for more than 20 years.

Passive immunization has a certain advantage over virus vaccines: the antibodies used always consist of human proteins. The approval procedures are therefore not as complex as with active vaccines that contain virus components.

How do you rate the different test procedures on SARS-CoV-2? In your opinion, does a rapid test produce a reliable result?

When testing, you always have to consider what you want to test. The normal diagnostic test that was developed at the Charité in Berlin is based on multiplying the genetic material of the virus in a so-called polymerase chain reaction so that it can ultimately be seen. The test therefore detects the virus. This takes a certain amount of time and you need a special laboratory for it. But it is a very reliable test that can detect even the slightest trace of the virus.

Covid-19 test: A blood test could also find antibodies. (Source: imago images / Future Image)Covid-19 test: A blood test could also find antibodies. (Source: Future Image / imago images)

The antibody test, on the other hand, shows how humans react to the virus. You have to be careful that the antibodies are specific and actually originate from the infection. The advantage here is that you can also demonstrate some protection with the antibodies. The disadvantage is that the antibodies only appear in a late phase of the infection – after about a week or two.

The various rapid tests can detect both the virus and antibodies. There are rapid tests that work like a pregnancy test. The problem with these rapid tests is that very few have been tested for their reliability so far. That is, how often they are wrong and deliver false positive and false negative results. So far, there does not seem to be a quick test for private use. They should be able to be carried out in every doctor’s office, but not by private individuals. The path to a rapid test – which can be used like a pregnancy test – is therefore still a long one.

When is the earliest possible estimate of how long immunity will persist among those who have recovered?

In principle, an immune reaction is very violent in the first few weeks. Antibodies are formed that are still detectable in the blood for half a year to a maximum of one year. Unless an immunological memory is formed. This presupposes that different types of lymphocytes work together – T and B lymphocytes – and then there are so-called memory cells that sit in different organs such as the lungs or bone marrow for years. When the virus returns, the antibodies and these cells can react immediately.

After a year at the earliest, you will find out how many of those who have recovered actually have longer-lasting immunity. This can last a lifetime – such as measles. Those who developed measles as a child or were vaccinated against the pathogen are still immune to it thirty years later. Whether this is the case with SARS-CoV-2 can be estimated at the earliest in a year. That is exactly the challenge for the development of vaccines. As far as possible, we need a vaccine that only has to be administered once and then already produces immunity that lasts for a long time and does not have to be repeated every year.

Thank you for the interview, Prof. Radbruch!

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