Does risk of stroke increase in people with COVID-19 infection?

Fairmont Banff Springs in Alberta, Canada. (Dr. Noorali Bharwani)
Fairmont Banff Springs in Alberta, Canada. (Dr. Noorali Bharwani)

We know COVID-19 affects different people in different ways. Most of the time the infection is mild with fever, cough, tiredness and loss of taste or smell. These individuals recover without hospitalization.

On average it takes five to six days when someone is infected with the virus for symptoms to show, however it can take up to 14 days. The incubation period ranges from 1 to 14 days. The median is 5 to 6 days between exposure and symptom onset.

Some individuals present with serious symptoms. The lungs are the organs most affected by COVID‐19. Symptoms like difficulty breathing, loss of speech, difficulty walking, confusion and chest pain are not uncommon. These individuals need to seek immediate medical attention.

Patients with COVID-19 infection can have neurological problems as well including stoke. This happens because of the change in the thickness of the blood called hypercoagulability. This may predispose an individual to stroke. Hypercoagulability is defined as the tendency to have thrombosis (blood clots) as a result of certain blood defects. Clinical manifestations of hypercoagulability can be devastating and even lethal.

Recently, researchers have found falling rates of new ischemic stroke admissions in hospitals, probably due to social consequences of the pandemic: fear to be infected or not adequately treated in the hospital. This phenomenon is of concern.

In one of the largest studies of its kind to date, published Aug. 14, 2021, in The Lancet (What is the association of COVID-19 with heart attacks and strokes?) researchers found strong evidence that heart attack and stroke risk rises sharply in the weeks following a COVID-19 diagnosis.

In the week after a COVID-19 diagnosis, the risk of a first heart attack increased by three to eight times. The risk of a first stroke caused by a blood clot multiplied by three to six times. In the following weeks, both risks decreased steadily but stayed elevated for at least a month.

Other bacterial and viral infections (such as influenza) are known to temporarily boost rates of heart attacks and strokes. But COVID-19 infections appear to be especially risky, perhaps because they trigger an exaggerated inflammatory response that makes blood clots more likely.

There are two factors responsible and dangerous to the production of strokes. First factor — COVID-19 infection creates inflammation throughout the body. Second factor — it also produces hypercoagulation of the blood that makes the blood to clot easily than normal.

There may be somebody you know who has had a stroke usually without a warning. There are various causes of stroke: 85 per cent are ischemic strokes, which are caused by a blood clot in an artery. Obesity, diabetes, high cholesterol, irregular heart rhythm, smoking, drug abuse and many other risk factors are all linked to an increased likelihood of a stroke. Now we can add COVID-19 to the list.

Outcome of a stoke can vary. Ten per cent of the people recover fully. Thirty per cent of the people recover with minimal of physical and mental deficiency and 60 per cent of the people have major paralysis and end up in a nursing home.

You should seek immediate medical attention if you see somebody exhibits sudden loss of balance and coordination, has trouble seeing out of one or both eyes, face drooping or lop-sided, shows weakness of one arm and speech is slurred then call 9-1-1 right away. Time is of the essence to start tPA therapy.

tPA is short for tissue plasminogen activator and can only be given to patients who are having a stroke caused by a blood clot (ischemic stroke). It can stop a stroke by breaking up the blood clot. It must be given as soon as possible and within 4.5 hours after stroke symptoms start.

You may be familiar with the acronym F.A.S.T. to help you recognize a stroke. F – is the face drooping? A – can the person raise both arms? S – speech slurred? T – time to call 9-1-1.

Take care and be safe. And remember mask, distance and vaccination.

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Oral COVID-19 Treatment

Shoveling snow. (Dr. Noorali Bharwani)
Shoveling snow. (Dr. Noorali Bharwani)

Scientists around the world are working hard to get one step ahead of the various COVID-19 viruses. Is victory in sight?

We have the highly infectious Omicron coronavirus variant causing less severe disease than the Delta strain but it remains a dangerous virus, particularly for those who are unvaccinated. The Omicron variant is the dominant strain in Alberta.

Like other variants, Omicron spreads from the nose and mouth through respiratory droplets at close range and through virus particles that float through the air and can stay suspended for quite a while, especially in places with poor ventilation. That is why use of face masks or coverings has been recommended in public settings to minimise the risk of transmissions.

Then there is Omicron subvariant BA.2. That raises more questions about the evolution of virus behind COVID-19. Alberta recently reported three cases of BA.2 variant. By the time you read this there may be more. Denmark recently reported a surge of BA.2 infections.

Omicron infections make up more than 90 per cent of Canada’s recent cases – and nearly all of those remain BA.1. But BA.2 infections totalled around one per cent of reported cases in early January.

We should not forget Alpha, Beta, Gamma and Delta variants. They are still around. We should continue to practice what reduces our risk of getting seriously ill with COVID-19 infection. Vaccination does not provide hundred per cent protection but it can reduce the risk of getting seriously ill. Vast majority of the patients with COVID-19 infection in the ICU are not vaccinated.

Here is the good news.

The new oral COVID-19 antiviral treatment is now available in Canada. This is Pfizer’s antiviral Paxlovid, which can be given to COVID-19 patients who are at high-risk of severe illness from the virus. A doctor has to prescribe the pills.

Paxlovid combines a new drug developed by Pfizer, Nirmatrelvir, with an existing antiretroviral drug named Ritonavir, a low-dose HIV drug that helps Nirmatrelvir remain active in the body longer.

The treatment comprises three pills – two of Nirmatrelvir and one of Ritonavir – taken at home twice a day for five days. That is 30 pills over five days. A person should start taking Paxlovid no more than five days after symptoms start. Hopefully, this will take pressure off the health-care system.

Health Canada has authorized the use of these drugs in high-risk adults (18 and older) with mild or moderate confirmed cases of COVID-19 patients. People who are immunocompromised, 80 years of age and over, or who may not have access to health care because of geographical or socioeconomic concerns are first in line – regardless of vaccination status.

Health Canada has warned the product should not be used while a patient is on any of a long list of other drugs, including common medications used to treat erectile dysfunction, high cholesterol and seasonal allergies, among others.

Here are few things to remember:

  • The treatment must be started within five days of the onset of symptoms.
  • It is designed to help the body fight off infection and shorten the period of illness.
  • It has been found highly effective – Paxlovid reduced the risk of hospitalization or death by 89 per cent compared to a placebo.
  • The treatment is likely to work against the Omicron variant.
  • Receiving the treatment does not exempt people from isolation requirements, and is not an alternative to vaccination.
  • These antiviral drugs are not a replacement for vaccines, which remain the best way to keep people out of hospital. Statistics show unvaccinated people are 19 times more likely to be hospitalized with COVID-19 than fully vaccinated people.

Coronaviruses die very quickly when exposed to the UV light in sunlight. The viruses survive longest when the temperature is at room temperature or lower, and when the relative humidity is low (<50 per cent).

We know most transmissions occur indoor. We should continue with preventive measures – physical distancing, quarantining, ventilation of indoor spaces, covering coughs and sneezes, hand washing, and keeping unwashed hands away from the face.

Take care and be safe.

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Is coronasomnia wrecking your sleep?

Columbia Icefields (Dr. Noorali Bharwani)
Columbia Icefields (Dr. Noorali Bharwani)

Some sleep experts have coined a word “coronasomnia” to describe sleep problems related to stress caused by the COVID-19 pandemic. Coronasomnia is real and widespread. More people than ever are fighting a serious loss of sleep. It is affecting all age groups.

Sleep researchers are normally focused on primary sleep disorders such as sleep apnea, narcolepsy, or periodic limb movement disorder. But stresses of daily life can affect even healthy sleep.

Over the years scientists have known that psychological stress can have strong effect on normal sleep pattern. But it is not easy to define stress.

Stress can encompass all kinds of stimuli of varying amounts and duration. It can be physical stress or psychological stress or social stress. It can be acute or chronic, and high intensity versus low intensity stress. It is possible that different types of stressors may bring with them different impacts on sleep.

Sleep problems and ADHD (attention deficit hyperactivity disorder) are tightly interwoven. Plus, comorbid psychiatric disorders like anxiety and depression can cause or aggravate sleep problems. ADHD medications can cause insomnia. ADHD symptoms and the first-line interventions to treat those symptoms both elevate an individual’s risk for poor sleep.

Ask yourself what has produced unprecedented changes in your life to keep you awake at night. For many people, COVID-19 has generated significant stress, anxiety, depression and worries about health, social isolation, employment, finances as well as the challenge of combining work and family obligations and uncertainty about the future.

Are you putting on weight? Poor sleep can lead to weight gain, which causes problems like reflux that keep you awake. Lack of sleep can lead to depression, high blood pressure to higher risks for heart attack or stroke. Stress can make us more vulnerable to COVID-19, and knowing that creates more worries and more insomnia and more binge eating.

Whatever may be the cause of your sleep problem there are things you can do to help you get a good night’s sleep. Here are some examples.

  1. Try cognitive behavioral therapy for insomnia. A sleep therapist can help you replace thoughts and behaviors that hurt your sleep with new behaviors and thinking that will help you sleep well.
  2. Have an exercise schedule during the day that will help you relax. Include yoga and meditation in your schedule. Have a physical trainer show you the right technique and encourage you to keep you going.
  3. Do not watch TV in the bedroom. Do not bring your laptop to bed. Life will go on without these distractions.
  4. Find time to spend outdoors in the sun. It helps to keep our circadian rhythms in pattern so we produce melatonin at night, not during the day.
  5. Don’t go to bed hungry. Don’t eat late in the night. You want your body to shut down all metabolic activity and digest your food before going to bed. Avoid nicotine, caffeine and alcohol in the evenings.
  6. Daytime naps can be good if they are limited to 30-minutes or less. Longer naps will keep you awake at night.
  7. If your partner is a snorer then he or she has to get some expert advice. This can be investigated and managed.
  8. Taking sleeping pills can be useful for short term use but it has risks involved for long term use. Different types of sleep medications affect the brain and the body in different ways. All sleep medications have side effects – most commonly causing people to feel drowsy, dizzy, mentally less sharp, or unsteady the next day. More rarely, people taking sleep medications have reported sleepwalking, hallucinations, memory lapses, and odd behavior, such as eating or driving while asleep. With most medications, long-term use can be habit-forming and stopping the drugs can lead to a rebound effect, where insomnia actually gets worse. Do not take sleeping pills without medical advice. Researchers have estimated people taking sleeping pills were as likely to be in a car crash as those driving with a blood alcohol level over the legal limit.

There is nothing new in this advice. It is not rocket science. What we need is discipline and perseverance. The end result can be a satisfactory night with good sleep. So, I wish you a good night’s sleep tonight and every night. Take care and be safe.

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Year three of the pandemic – what to expect in 2022.

Hawaii Ocean (Dr. Noorali Bharwani)
Hawaii Ocean (Dr. Noorali Bharwani)

In 2022, it will be year three of the COVID-19 pandemic. As we continue to fight Delta variant, we are now facing Omicron virus. None of the experts expected the pandemic to last this long. Many countries are enduring multiple major waves of infections. This is unusual.

COVID-19 is not going to end soon because it is so transmissible, and it continues to vary. Now we have to deal with the Omicron variant of the coronavirus. It is spreading rapidly. The Omicron variant is now in 70 countries.

By the time you read this it may have spread in other countries. Is it dangerous? Early indications suggested it may be less dangerous than Delta, which continues to drive the pandemic. But this information will change as we gather more information. Recently, Britain recorded world’s first publicly confirmed death due to Omicron.

President Joe Biden’s chief medical adviser, Dr. Anthony Fauci, told CNN’s State of the Union that scientists need more information before drawing conclusions about Omicron’s severity.

Reports from South Africa, where the Omicron virus emerged and is becoming the dominant strain in that country, suggest that hospitalization rates have not increased alarmingly.

So far Delta remains the dominant variant, making up more than 99 per cent of cases and driving a surge of hospitalizations. This may not be true anymore. In London, England the Omicron variant now accounts for 40 per cent of infections.

“So, I think the idea that this is somehow a milder version of the virus – I think that’s something we need to set on one side – and just recognize the sheer pace at which it accelerates through the population,” says Boris Johnson, British Prime Minister. Johnson said people should rush to get booster vaccines to protect “our freedoms and our way of life.”

What does the World Health Organization (WHO) say?

The WHO’s main message is – do not underestimate Omicron.

On December 14, 2021, UN News reported the following:

The Omicron variant is “probably” now present in most of the world’s countries and it would be a mistake to dismiss the COVID-19 strain as “mild”, said the head of the UN health agency (WHO).

Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, told reporters from WHO headquarters in Geneva that the variant was now present in 77 countries.

“Omicron is spreading at a rate we have not seen with any previous variant. We’re concerned that people are dismissing Omicron as mild”, he said. “Surely, we have learned by now that we underestimate this virus at our peril.”

“Even if Omicron does cause less severe disease, the sheer number of cases could once again overwhelm unprepared health systems. I need to be very clear: vaccines alone will not get any country out of this crisis. Countries can – and must – prevent the spread of Omicron with measures that work today.”

It is worth remembering Omicron is dangerous because it spreads and infects people very effectively than other variants. It is always better to prevent it than to have to worry about treating it.

Will pre-pandemic life ever return?


We have to be extremely careful. We can transmit COVID-19 before we start showing symptoms or without ever developing symptoms. Evidence indicates that vaccines are effective at preventing serious outcomes due to COVID-19, such as severe illness, hospitalization and death.

Vaccination does not change your risk of exposure to the virus. Vaccination is the best prevention against post COVID-19 condition. So, get vaccinated, wear a mask, clean your hands and keep a safe distance.

Have a wonderful holiday season, Merry Christmas and a Happy New Year. And do not underestimate Omicron.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!