4 lakh staff will go without pay, 3.8 lakh ‘on leave’ as US shutdown begins

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."

Washington, Mar 28: A US-based lab has unveiled a portable test that can tell if someone has COVID-19 in as little as five minutes, it said in a statement Friday.

Abbot Laboratories said the US Food and Drug Administration (FDA) had given it emergency authorization to begin making the test available to healthcare providers as early as next week.

The test, which is the size of a small toaster and uses molecular technology, also shows negative results within 13 minutes, the company said in a press statement.

"The COVID-19 pandemic will be fought on multiple fronts, and a portable molecular test that offers results in minutes adds to the broad range of diagnostic solutions needed to combat this virus," said Abbot president and chief operating officer Robert Ford.

The test's small size means it can be deployed outside the "traditional four walls of a hospital in outbreak hotspots," Ford said, and Abbott is working with the FDA to send it to virus epicenters.

The test has not been cleared or approved by the FDA, and has only been authorized for emergency use by approved labs and healthcare providers, the company said.

Beijing, Mar 29: In a rare display of public anger in China, dozens of people in central Hubei province, the epicentre of the coronavirus outbreak till recently, attacked official vehicles after they were stopped from crossing a bridge and travel to neighbouring Jiangxi after the lifting of the lockdown.
Hubei province with over 56 million people was kept under lockdown from January 23 as part of aggressive measures to bring down COVID-19 cases which rapidly spread in the area.

Videos on Chinese social media on Friday showed unprecedented scenes of police from Hubei and Jiangxi clashing on the bridge connecting the two provinces over barricades erected from stopping Hubei people from moving out over fears of coronavirus spreading.

Policemen from both sides argued over how to verify if people were allowed to enter Jiangxi, according to local media reports.

It was a major relief for millions of people in Hubei province, when the Chinese government which kept it under lockdown lifted the restrictions on travel.

The government will permit people from the province to travel if they hold a green health code, meaning no contact with any infected or suspected COVID-19 cases.

But people of Hubei to their shock on Friday found roadblocks on the 1st Yangtze River Bridge that separates Huangmei county in Hubei erected by Huangmei county of Jiangxi province.

In local media reports, witnesses were quoted as saying that Huangmei police in Jiujiang erected roadblocks on the bridge to stop people from Hubei from crossing it, a move they alleged stigmatised them.

Video footage shared online showed rows of police armed with riot shields holding back the crowds, while members of the public could be seen damaging and even overturning police vehicles.

In a clip published by the Huanggang city government, which administers Huangmei, the county's Communist Party chief Ma Yanzhou could be heard speaking to the people through a loud hailer, warning them that by gathering in a large group they were increasing their chances of contracting the virus, Hong Kong-based South China Morning Post reported.

While it is unclear exactly how the clash started, police from the two sides published separate official statements online, which were quickly deleted, it said.

The incident underlines the problems China faces as it seeks a return to normalcy after months of lockdown, the Post said.

After the incident, the governments of Huangmei and Jiujiang on Friday issued a joint statement saying they had agreed to remove the barriers set up to restrict travel during the lockdown, and also to recognise each other's health screening codes to make it easier for people in good health to get to where they needed to be, the Post report said.

An article by the ruling Communist Party of China (CPC) mouthpiece, People''s Daily acknowledged the problems in getting the country back on its feet.

"In the past few days, all walks of life have called for governments to accept workers from Hubei," it said.

"However, it is undeniable that some places, intentionally or not, have set up obstacles for Hubei migrant workers to return to their posts and hold prejudices against them."