12 killed as lorry ploughs into Berlin Xmas market

Washington, Apr 28: After nearly three weeks in an intensive care unit in Los Angeles, doctors treating 41-year-old Broadway actor Nick Cordero for COVID-19 were forced to amputate his right leg.

The flow of blood had been impeded by a blood clot: yet another dangerous complication of the disease that has been bubbling up in frontline reports from China, Europe and the United States.

To be sure, so-called "thrombotic events" occur for a variety of reasons among intensive care patients, but the rates among COVID-19 patients are far higher than would be otherwise expected.

"I have had 40-year-olds in my ICU who have clots in their fingers that look like they'll lose the finger, but there's no other reason to lose the finger than the virus," Shari Brosnahan, a critical care doctor at NYU Langone said.

One of these patients is suffering from a lack of blood flow to both feet and both hands, and she predicts an amputation may be necessary, or the blood vessels may get so damaged that an extremity could drop off by itself.

Blood clots aren't just dangerous for our limbs, but can make their way to the lungs, heart or brain, where they may cause lethal pulmonary embolisms, heart attacks, and strokes.

A recent paper from the Netherlands in the journal Thrombosis Research found that 31 percent of 184 patients suffered thrombotic complications, a figure that the researchers called "remarkably high" -- even if extreme consequences like amputation are rare.

Behnood Bikdeli, a doctor at New York-Presbyterian Hospital, assembled an international consortium of experts to study the issue. Their findings were published in the Journal of The American College of Cardiology.

The experts found the risks were so great that COVID-19 patients "may need to receive blood thinners, preventively, prophylactically," even before imaging tests are ordered, said Bikdeli.

What exactly is causing it? The reasons aren't fully understood, but he offered several possible explanations.

People with severe forms of COVID-19 often have underlying medical conditions like heart or lung disease -- which are themselves linked to higher rates of clotting.

Next, being in intensive care makes a person likelier to develop a clot because they are staying still for so long. That's why for example people are encouraged to stretch and move around on long haul flights.

It's also now clear the COVID-19 illness is associated with an abnormal immune reaction called "cytokine storm" -- and some research has indicated this too is linked to higher rates of clotting.

There could also be something about the virus itself that is causing coagulation, which has some precedent in other viral illnesses.

A paper in the journal The Lancet last week showed that the virus can infect the inner cell layer of organs and of blood vessels, called the endothelium. This, in theory, could interfere with the clotting process.

According to Brosnahan, while thinners like Heparin are effective in some patients, they don't work for all patients because the clots are at times too small.

"There are too many microclots," she said. "We're not sure exactly where they are."

Autopsies have in fact shown some people's lungs filled with hundreds of microclots.

The arrival of a new mystery however helps solve a slightly older one.

Cecilia Mirant-Borde, an intensive care doctor at a military veterans hospital in Manhattan, told AFP that lungs filled with microclots helped explain why ventilators work poorly for patients with low blood oxygen.

Earlier in the pandemic doctors were treating these patients according to protocols developed for acute respiratory distress syndrome, sometimes known as "wet lung."

But in some cases, "it's not because the lungs are occupied with water" -- rather, it's that the microclotting is blocking circulation and blood is leaving the lungs with less oxygen than it should.

It has just been a little under five months since the virus emerged in Wuhan, China, and researchers are learning more about its impact every day.

"While we react surprised, we shouldn't be as surprised as we were. Viruses tend to do weird things," said Brosnahan.

While the dizzying array of complications may seem daunting, "it's possible there'll be one or a couple of unifying mechanisms that describe how this damage happens," she said.

"It's possible it's all the same thing, and that there'll be the same solution."

Beijing, Jun 16: The coronavirus situation in China's capital is "extremely severe", a city official warned Tuesday, as 27 new infections were reported from Beijing where a new cluster has sparked a huge trace-and-test programme.

The COVID-19 resurgence -- believed to have started at the sprawling Xinfadi wholesale food market in the capital -- has sparked alarm as China had largely brought its outbreak under control through mass testing and lockdowns imposed earlier in the year.

The new cases took the number of confirmed infections in Beijing over the past five days to 106, as authorities locked down almost 30 communities in the city and tested tens of thousands of people.

"The epidemic situation in the capital is extremely severe," Beijing city spokesman Xu Hejian warned at a press conference.

The World Health Organization had already expressed concern about the cluster, pointing to Beijing's size and connectivity.

Officials in the capital have said they will test stall owners and managers at all of the city's food markets, restaurants and government canteens.

Beijing's coronavirus testing capacity has been expanded to 90,000 a day, according to China's official news agency Xinhua.

On Tuesday, the capital's transport commission banned taxi- and ride-hailing services from driving out of the city, Xinhua reported, in another move to try and contain the new outbreak.

All indoor sports and entertainment venues in Beijing were ordered to shut on Monday, and some other cities across China warned they would quarantine those arriving from the capital.

The National Health Commission also reported four new domestic infections in Hebei province, which surrounds Beijing, and a case reported in southwestern Sichuan province was linked to the Beijing cluster.

Authorities were also racing to track people from Beijing who had travelled to other parts of China, and those who visited the capital have been encouraged to get tested.

Beijing spokesman Xu said: "High-risk people who have left Beijing must inform local authorities immediately."

Market inspections

Authorities shut down another market on Tuesday -- Tiantaohonglian in the central Xicheng district -- after one employee there was diagnosed with COVID-19, state broadcaster CCTV reported.

Seven residential estates surrounding that market were also locked down.

In total, Beijing officials said Tuesday they have disinfected 276 agricultural markets, closed 11 markets, and disinfected more than 33,000 food and beverage businesses in a bid to stamp out the new cluster.

Officials had warned Sunday that since May 30, 200,000 people had visited the Xinfadi market -- the original site of the new outbreak.

More than 8,000 workers from Xinfadi have been tested and sent to centralised quarantine facilities.

Until this recent outbreak, most of China's cases in recent months were nationals returning home as the pandemic spread to other countries.

China's Center for Disease Control and Prevention said Monday that the virus strain found in the Beijing outbreak was a "major epidemic strain in the European countries".

While the virus was detected on chopping boards used to handle imported salmon at Xinfadi, "it does not clearly or definitely indicate it's from imported seafood", Wu Zunyou, the body's chief epidemiologist, said in an interview with state broadcaster CCTV.

"Ever since new cases suddenly emerged in Beijing, we have tried to figure out the reasons for the outbreak since there were no COVID-19 cases found over the past two months," Wu Zunyou said.

"We came up with several possibilities, and the most likely one is that the carrier of the novel coronavirus comes from outside China or other parts of China and brought it here."

On Tuesday, another eight imported cases were reported.

Rome, Mar 11: Italy has recorded its deadliest day of the coronavirus crisis despite locking down the entire country, as New York deployed the National Guard to contain a disease that has sown worldwide panic.

The hardest-hit country in Europe said its death toll from the COVID-19 virus had risen Tuesday by a third to 631, with the surging epidemic taking its toll on global sporting, cultural and political events.

While authorities in China, where the outbreak began, have declared it "basically curbed", cases are multiplying around the world, sparking panic buying in shops, and wild swings on financial markets.

China remains the hardest-hit overall with more than 80,000 cases and over 3,000 deaths, out of a global total of 117,339 cases and 4,251 deaths across 107 countries and territories, according to an AFP tally.

The virus is infecting all walks of life, including politics, with US Democratic presidential hopefuls Bernie Sanders and Joe Biden both cancelling campaign rallies and British health minister Nadine Dorries saying she had tested positive.

And amid criticism of the US authorities' response, New York deployed the National Guard for the first time during the crisis to help contain the spread of the disease from an infection-hit suburb.

There have been 173 confirmed cases in New York state, including 108 in Westchester County, home to New Rochelle where the majority of infections have been detected.

"It is a dramatic action, but it is the largest cluster in the country. This is literally a matter of life and death," said state governor Andrew Cuomo.

"People are scared, it's an unusual situation to be in," Miles Goldberg, who runs a New Rochelle bar, told AFP.

"It makes people nervous to be around others, it makes people nervous to get inside into businesses and such," he said.

In an unprecedented move, Italian Prime Minister Giuseppe Conte has told the 60 million residents of his country they should travel only for the most urgent work or health reasons.

And while squares in Milan and Rome were emptied of their usual bustle and traffic, some residents appeared uncertain if they were even allowed to leave their homes for everyday tasks like shopping.

The virus has battered tourism around the world, as people scrap travel plans, and a restaurant owner in Florence in northern Italy said that the impact on business had been catastrophic.

"We hope that we will see the end of it, because from around 140 covers a day, this afternoon, we've gone down to 20-25," Agostino Ferrara told AFP.

Pope Francis also seemed to muddy the waters, holding a mass in which he urged priests to go out and visit the sick -- something Conte has specifically discouraged.

Sporting events continued to fall victim to the virus as authorities urge people to avoid large gatherings.

Arsenal's game at Manchester City was postponed after players from the London club were put into quarantine, making it the first Premier League fixture to be called off because of the virus.

The virus has sparked doubts about the Olympics due to open in Tokyo on July 24 and the traditional flame lighting ceremony in Greece is set to be held without spectators.

In the United States, organisers rescheduled the two-week Coachella music festival for October.

The virus and the response to the crisis has prompted pandemonium on global markets with volatility not seen since the world financial crisis in 2008.

After suffering its worst session in more than 11 years at the beginning of the week, the Dow Jones Index in New York bounced back significantly, rising five percent on Tuesday.

Politicians around the world have scrambled to put together emergency packages to ease the significant financial hardships the virus is expected to cause for households and businesses.

US President Donald Trump, who is relying on a strong economy to boost his re-election hopes, promised to announce "major" economic measures on Tuesday.

The biggest item on his wish list is a cut in payroll taxes. But even allies in Congress and reportedly some aides in the White House are sceptical, questioning the cost.

Italy prepared Tuesday to let families skip mortgage and some tax payments while Japan unveiled a second emergency package to tackle economic woes stemming from the outbreak, including $15 billion in loan programmes to support small businesses.

Analysts warned of further volatility ahead however.

"It's like winding up a rubber band. The more you wind it, when you let go, the more it pops," said LBBW's Karl Haeling.

"A lot of the uncertainty goes to the root of the virus itself."