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| Coronavirus May Pose a New Risk to Younger Patients: Strokes | Coronavirus May Pose a New Risk to Younger Patients: Strokes |
| (7 days later) | |
| Ravi Sharma was doubled over on his bed when his father found him. He’d had a bad cough for a week and had self-quarantined in his bedroom. As an emergency medical technician, he knew he was probably infected with the coronavirus. | Ravi Sharma was doubled over on his bed when his father found him. He’d had a bad cough for a week and had self-quarantined in his bedroom. As an emergency medical technician, he knew he was probably infected with the coronavirus. |
| Now, Mr. Sharma, 27, could not move the right side of his body, and could only grunt in his father’s direction. His sister, Bina Yamin, on the phone from her home in Fort Wayne, Ind., could hear the sounds. | Now, Mr. Sharma, 27, could not move the right side of his body, and could only grunt in his father’s direction. His sister, Bina Yamin, on the phone from her home in Fort Wayne, Ind., could hear the sounds. |
| “Call 911,” she told her father. “I think Ravi’s having a stroke.” She was right. | “Call 911,” she told her father. “I think Ravi’s having a stroke.” She was right. |
| Over the next few hours, doctors at a Queens hospital worked frantically to break up a blood clot blocking an artery to Mr. Sharma’s brain. But the doctors were puzzled. | Over the next few hours, doctors at a Queens hospital worked frantically to break up a blood clot blocking an artery to Mr. Sharma’s brain. But the doctors were puzzled. |
| Mr. Sharma was far too young for a stroke. He worked out every day and didn’t have diabetes, high blood pressure or the kinds of medical conditions that can set the stage for strokes in young adults, which are rare. | Mr. Sharma was far too young for a stroke. He worked out every day and didn’t have diabetes, high blood pressure or the kinds of medical conditions that can set the stage for strokes in young adults, which are rare. |
| Neurologists in New York City, Detroit, New Jersey and other parts of the country have reported a flurry of such cases. Many are now convinced that unexplained strokes represent yet another insidious manifestation of Covid-19, the illness caused by the new coronavirus. | Neurologists in New York City, Detroit, New Jersey and other parts of the country have reported a flurry of such cases. Many are now convinced that unexplained strokes represent yet another insidious manifestation of Covid-19, the illness caused by the new coronavirus. |
| The cases add to evidence that the coronavirus attacks not just the lungs, but also the kidneys, brain, heart and liver. In rare cases, it seems to trigger a life-threatening inflammatory syndrome in children. | The cases add to evidence that the coronavirus attacks not just the lungs, but also the kidneys, brain, heart and liver. In rare cases, it seems to trigger a life-threatening inflammatory syndrome in children. |
| “We’re seeing a startling number of young people who had a minor cough, or no recollection of viral symptoms at all, and they’re self-isolating at home like they’re supposed to — and they have a sudden stroke,” said Dr. Adam Dmytriw, a University of Toronto radiologist who is a co-author of a paper describing patients who suffered strokes related to Covid-19. The paper has not yet been peer reviewed. | “We’re seeing a startling number of young people who had a minor cough, or no recollection of viral symptoms at all, and they’re self-isolating at home like they’re supposed to — and they have a sudden stroke,” said Dr. Adam Dmytriw, a University of Toronto radiologist who is a co-author of a paper describing patients who suffered strokes related to Covid-19. The paper has not yet been peer reviewed. |
| Though many of those patients had diabetes and hypertension, none had heart risks known to increase the odds of a stroke. Many were under age 65. For some, stroke was the first symptom of coronavirus infection, and they postponed going to the emergency room, fearing exposure. | Though many of those patients had diabetes and hypertension, none had heart risks known to increase the odds of a stroke. Many were under age 65. For some, stroke was the first symptom of coronavirus infection, and they postponed going to the emergency room, fearing exposure. |
| Of 10 patients described in Dr. Dmytriw’s paper, two died because the coronavirus attacked their lungs, and two men — a 46-year-old and a 55-year-old — were killed by strokes. | Of 10 patients described in Dr. Dmytriw’s paper, two died because the coronavirus attacked their lungs, and two men — a 46-year-old and a 55-year-old — were killed by strokes. |
| Doctors at Mount Sinai Health System in New York have also seen an unusual number of young stroke patients, saying they treated five such patients with Covid-19 during a recent two-week period. The medical center typically sees only one stroke patient under the age of 50 every three weeks, Dr. Johanna Fifi, a neurologist, and her colleagues noted in a letter in The New England Journal of Medicine. | Doctors at Mount Sinai Health System in New York have also seen an unusual number of young stroke patients, saying they treated five such patients with Covid-19 during a recent two-week period. The medical center typically sees only one stroke patient under the age of 50 every three weeks, Dr. Johanna Fifi, a neurologist, and her colleagues noted in a letter in The New England Journal of Medicine. |
| Four of the five patients were relatively healthy; two patients in their 30s had no known risk factors for stroke. “We came to the conclusion it had to be related to Covid-19,” Dr. Fifi said in an interview. | Four of the five patients were relatively healthy; two patients in their 30s had no known risk factors for stroke. “We came to the conclusion it had to be related to Covid-19,” Dr. Fifi said in an interview. |
| Though strokes seem to affect a very small number of Covid-19 patients, they appear to be related to a broader phenomenon that has emerged in critically ill patients: excessive blood clotting. | Though strokes seem to affect a very small number of Covid-19 patients, they appear to be related to a broader phenomenon that has emerged in critically ill patients: excessive blood clotting. |
| Patients with severe Covid-19 may develop clots in the legs and lungs that can be life-threatening, doctors said. Their blood can be so thick and viscous that it blocks intravenous lines and catheters. Tiny clots in other organs, like the kidneys and liver, have been found in autopsies of coronavirus patients. | Patients with severe Covid-19 may develop clots in the legs and lungs that can be life-threatening, doctors said. Their blood can be so thick and viscous that it blocks intravenous lines and catheters. Tiny clots in other organs, like the kidneys and liver, have been found in autopsies of coronavirus patients. |
| Dr. Michael Yaffe, an intensive care physician at Beth Israel Deaconess Medical Center in Boston, called clotting a “hallmark” of the disease, although “not in everyone.” | Dr. Michael Yaffe, an intensive care physician at Beth Israel Deaconess Medical Center in Boston, called clotting a “hallmark” of the disease, although “not in everyone.” |
| German scientists reported last week that autopsies of 12 Covid-19 patients turned up a type of blood clot called deep vein thrombosis in seven of them. The cause of death in four patients was another type of blood clot in the lungs, called a pulmonary embolism. | German scientists reported last week that autopsies of 12 Covid-19 patients turned up a type of blood clot called deep vein thrombosis in seven of them. The cause of death in four patients was another type of blood clot in the lungs, called a pulmonary embolism. |
| Clotting is a risk in all critically ill patients if they are immobile for long periods. But patients with the coronavirus have elevated levels of clotting proteins in the blood, and the condition seems to be less responsive to blood-thinning drugs, said Dr. Adam Cuker, an associate professor of medicine at the University of Pennsylvania. | Clotting is a risk in all critically ill patients if they are immobile for long periods. But patients with the coronavirus have elevated levels of clotting proteins in the blood, and the condition seems to be less responsive to blood-thinning drugs, said Dr. Adam Cuker, an associate professor of medicine at the University of Pennsylvania. |
| Some evidence suggests that the coronavirus may directly infect the endothelial cells that line the inside of blood vessels, causing injury and swelling that draws proteins that promote clotting, Dr. Cuker said. | Some evidence suggests that the coronavirus may directly infect the endothelial cells that line the inside of blood vessels, causing injury and swelling that draws proteins that promote clotting, Dr. Cuker said. |
| People who have been exposed to the coronavirus, or are managing the infection at home, should call their doctors if they notice chest pain and shortness of breath, which may signal a blood clot in the lung, or leg pain, swelling, redness and discoloration that may indicate a clot. | People who have been exposed to the coronavirus, or are managing the infection at home, should call their doctors if they notice chest pain and shortness of breath, which may signal a blood clot in the lung, or leg pain, swelling, redness and discoloration that may indicate a clot. |
| Until he arrived at Jamaica Hospital on April 1, Mr. Sharma had never been tested for infection with the coronavirus. But he knew he was at risk. He had spent weeks making back-to-back ambulance runs, ferrying sick, elderly patients from nursing homes to hospitals in Brooklyn and Queens in February and March. | Until he arrived at Jamaica Hospital on April 1, Mr. Sharma had never been tested for infection with the coronavirus. But he knew he was at risk. He had spent weeks making back-to-back ambulance runs, ferrying sick, elderly patients from nursing homes to hospitals in Brooklyn and Queens in February and March. |
| By mid-March, Mr. Sharma had developed a dry cough. He went to an urgent care clinic, where he was told that it was out of tests, but that he should stay home because he was probably infected. | By mid-March, Mr. Sharma had developed a dry cough. He went to an urgent care clinic, where he was told that it was out of tests, but that he should stay home because he was probably infected. |
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| At the hospital, emergency room doctors took aggressive steps to restore the blood supply to the left side of his brain. They also diagnosed acute respiratory distress syndrome, finding that Mr. Sharma’s infected lungs were filling with fluid and his blood oxygen levels were low. A test revealed infection with the coronavirus, and he was placed on a ventilator. | At the hospital, emergency room doctors took aggressive steps to restore the blood supply to the left side of his brain. They also diagnosed acute respiratory distress syndrome, finding that Mr. Sharma’s infected lungs were filling with fluid and his blood oxygen levels were low. A test revealed infection with the coronavirus, and he was placed on a ventilator. |
| The doctors were kind but honest with the family, Ms. Yamin said: “They told us that it was 50-50. They didn’t know if he would live or die.” | The doctors were kind but honest with the family, Ms. Yamin said: “They told us that it was 50-50. They didn’t know if he would live or die.” |
| Over the next few days, while Mr. Sharma remained sedated, Ms. Yamin spoke frequently with the doctors and nurses at the hospital, taking meticulous notes that she shared with relatives and with The New York Times. | Over the next few days, while Mr. Sharma remained sedated, Ms. Yamin spoke frequently with the doctors and nurses at the hospital, taking meticulous notes that she shared with relatives and with The New York Times. |
| Mr. Sharma’s body was flooded with blood thinners to prevent additional clots from forming. His fever spiked as high as 104 degrees Fahrenheit some days, raising his heart rate and further incapacitating his lungs. | Mr. Sharma’s body was flooded with blood thinners to prevent additional clots from forming. His fever spiked as high as 104 degrees Fahrenheit some days, raising his heart rate and further incapacitating his lungs. |
| Then, on April 8, Mr. Sharma started having seizures. He was sedated more deeply and put on additional medications. Doctors cranked up the ventilator. | Then, on April 8, Mr. Sharma started having seizures. He was sedated more deeply and put on additional medications. Doctors cranked up the ventilator. |
| By mid-April he had been intubated for two weeks, a period considered a critical make-or-break point for Covid-19 patients, and Ms. Yamin was concerned. No one knew the toll of the stroke itself, or whether Mr. Sharma would be able to walk or talk when he woke up. | By mid-April he had been intubated for two weeks, a period considered a critical make-or-break point for Covid-19 patients, and Ms. Yamin was concerned. No one knew the toll of the stroke itself, or whether Mr. Sharma would be able to walk or talk when he woke up. |
| The left side of the brain controls movement on the right side of the body, as well as speech and language, reading and writing, organizational ability, reasoning and analysis. | The left side of the brain controls movement on the right side of the body, as well as speech and language, reading and writing, organizational ability, reasoning and analysis. |
| Updated June 30, 2020 | |
| Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. | |
| Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles. | Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles. |
| A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. | A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. |
| The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. | The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. |
| The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. | The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. |
| So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. | So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. |
| Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. | Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. |
| A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. | A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. |
| The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. | The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. |
| If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) | If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) |
| If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. | If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. |
| “I began to lose faith,” Ms. Yamin recalled in an interview. | “I began to lose faith,” Ms. Yamin recalled in an interview. |
| Then, on April 15, there was some movement on the left side of Ravi’s body, the side not affected by the stroke. His fever ebbed. The staff lowered the ventilator setting, and he tolerated it. | Then, on April 15, there was some movement on the left side of Ravi’s body, the side not affected by the stroke. His fever ebbed. The staff lowered the ventilator setting, and he tolerated it. |
| “Looks like he’s slowly beating this,” Ms. Yamin wrote in a note to the family. “We just need to be patient.” | “Looks like he’s slowly beating this,” Ms. Yamin wrote in a note to the family. “We just need to be patient.” |
| By April 18, Ravi was breathing more on his own. His fever had disappeared, and his blood pressure and heart rate had stabilized. The next day, he woke up, was taken off the ventilator and started breathing on his own. | By April 18, Ravi was breathing more on his own. His fever had disappeared, and his blood pressure and heart rate had stabilized. The next day, he woke up, was taken off the ventilator and started breathing on his own. |
| He still could not speak and didn’t know what had happened to him, but a nurse held up his phone so the family could see him on FaceTime. “We couldn’t stop crying,” Ms. Yamin said. “We just said: ‘Oh my gosh, Ravi, we love you. These are happy tears.’” | He still could not speak and didn’t know what had happened to him, but a nurse held up his phone so the family could see him on FaceTime. “We couldn’t stop crying,” Ms. Yamin said. “We just said: ‘Oh my gosh, Ravi, we love you. These are happy tears.’” |
| Mr. Sharma whispered into the phone for the first time the next day, his throat still sore and hoarse from the ventilator tube. | Mr. Sharma whispered into the phone for the first time the next day, his throat still sore and hoarse from the ventilator tube. |
| Progress continued in baby steps. He ate some applesauce one day, a whole container the next. He started walking using a walker for support. | Progress continued in baby steps. He ate some applesauce one day, a whole container the next. He started walking using a walker for support. |
| After a few weeks of inpatient physical therapy at Nassau University Medical Center, he graduated from a walker to a cane. He walked up stairs, sat in a chair and practiced getting up from the bed on his own. | After a few weeks of inpatient physical therapy at Nassau University Medical Center, he graduated from a walker to a cane. He walked up stairs, sat in a chair and practiced getting up from the bed on his own. |
| A full recovery from a stroke can take months or even years, and Mr. Sharma is also recovering from the lingering effects of Covid-19, which has left him fatigued, and 50 pounds lighter than before his illness, he said in a video interview with The Times. | A full recovery from a stroke can take months or even years, and Mr. Sharma is also recovering from the lingering effects of Covid-19, which has left him fatigued, and 50 pounds lighter than before his illness, he said in a video interview with The Times. |
| But he has made great strides in a short time, and those closest to him say he is still the old Ravi: a social butterfly. | But he has made great strides in a short time, and those closest to him say he is still the old Ravi: a social butterfly. |
| Mr. Sharma boasted that he is everyone’s “favorite patient” at the rehab facility and that he is recovering quickly because staff members have been sneaking him chocolate milk and sweets. | Mr. Sharma boasted that he is everyone’s “favorite patient” at the rehab facility and that he is recovering quickly because staff members have been sneaking him chocolate milk and sweets. |
| “I got the doctors to order me ice cream as part of my diet,” he said. | “I got the doctors to order me ice cream as part of my diet,” he said. |
| He wants to go home, see his family in person, continue to build strength and start building a future with his girlfriend, Leana Soman. They both cried when they were able to video chat for the first time. | He wants to go home, see his family in person, continue to build strength and start building a future with his girlfriend, Leana Soman. They both cried when they were able to video chat for the first time. |
| “He couldn’t speak, his throat was so bad, so I was lip reading,” Ms. Soman recalled. “He said, ‘I love you,’ and I said, ‘I got that — I love you too.’” | “He couldn’t speak, his throat was so bad, so I was lip reading,” Ms. Soman recalled. “He said, ‘I love you,’ and I said, ‘I got that — I love you too.’” |
| Too many people are still cavalier about the coronavirus, Mr. Sharma said, and young people think they are immune. The disease “was like being hit by a bus,” Mr. Sharma said. | Too many people are still cavalier about the coronavirus, Mr. Sharma said, and young people think they are immune. The disease “was like being hit by a bus,” Mr. Sharma said. |
| “I’m 27, and if this could happen to me, it could happen to anyone,” he said. “This is real and it’s scary. I want people to go out there and be cautious.” | “I’m 27, and if this could happen to me, it could happen to anyone,” he said. “This is real and it’s scary. I want people to go out there and be cautious.” |