How Bob Wachters’ COVID fight got dangerous with a hot shower

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Dr. Bob Wachter, chairman of medicine at UCSF and a popular social media figure, revealed Wednesday that his first bout with COVID-19 got significantly worse the moment he stepped into a hot shower.

Dehydrated by illness, the rush of hot water caused Wachter’s blood vessels to dilate, leading to a rapid drop in his blood pressure, which led to him passing out and sustaining a severe head injury.

I woke up to a bloody pool on my bathroom floor, Wachter posted in a lengthy Twitter thread about his experience. There was a dent in the lid of a trash can, probably where my head had hit. I didn’t remember anything. When I managed to get up, it was clear that my face was going to need stitches, and more than a couple.

But can taking a hot shower really have such a dramatic effect on blood pressure?

It turns out that it is, albeit temporarily. When the vaporous water comes in contact with the skin, the blood vessels expand, helping to regulate body temperature. During this process, the blood pressure undergoes a slight drop.

Fainting, or what we call syncope, is very common, said Dr. Gregory Marcus, professor of medicine and associate chief of cardiology for research at UCSF. It means a sudden loss of consciousness. Typically, this occurs when gravity pulls blood away from the brain and there is insufficient blood flow to the brain.

Once the shower is over, the blood vessels return to their normal size, causing a temporary increase in blood pressure.

High blood pressure often manifests without any noticeable symptoms, earning it the nickname the silent killer. The increase in blood pressure resulting from hot showers is usually insignificant for most individuals. However, for those who already suffer from high blood pressure or other health conditions, hot showers can trigger symptoms by raising body temperature, causing blood vessels to widen and heart rate to slow.

When someone is sick, it is natural to crave a hot shower to relieve muscle pain and wash away harmful germs. For people struggling with COVID-19, a hot shower can relieve respiratory symptoms by loosening phlegm and clearing the nasal passages.

On the other hand, for people with low blood pressure, heat can cause blood vessels to dilate, leading to a sudden drop in blood pressure. Consequently, blood may pool in the lower extremities rather than reaching the brain, leading to feelings of lightheadedness, lightheadedness, or even fainting.

An individual may not have enough fluid in the reservoir due to dehydration, and taking a hot shower can cause blood vessels to expand further, Marcus said. If the pipes that deliver blood to the brain are dilated inappropriately, it can reduce blood flow to the brain, which can speed things up.

For those who are sick and dehydrated, hot showers can intensify the potential effects of low blood pressure by reducing the body’s blood volume, which is mostly water.

Experts recommend taking warm rather than hot showers and avoiding prolonged showers. The ideal length of a shower, according to the US Centers for Disease Control and Prevention, should be 5 to 10 minutes. Additionally, it is also helpful to leave a door or window open to increase air circulation.

Standing for long periods can also cause blood to pool in the legs and feet, reducing blood flow to the brain. This can cause symptoms such as nausea, dizziness, lightheadedness, blurred vision, or tunnel vision.

Falls are the leading cause of fatal and nonfatal injuries among older adults, according to the National Council on Aging.

Wachter stressed that his case should serve as a cautionary tale. Collapsing at home from the virus, he suffered a severe head injury, leading to a brain haemorrhage and subsequent hospitalization.

My first case of COVID was pretty dramatic if I hadn’t passed out, it would have been three to four days of a pretty nasty upper respiratory illness, he said in his Twitter feed. But I did, and so my (unusual) case is on my list of reasons why COVID is still worth avoiding if you can.

Contact Aidin Waziri: [email protected]

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