475: Italy reports highest one-day toll of any nation since corona crisis began

New Delhi, Jul 24: India reported the highest single-day spike of 49,310 coronavirus cases on Friday, according to the Union Ministry of Health and Family Welfare.

The total COVID-19 positive cases stand at 12,87,945 including 4,40,135 active cases, 8,17,209 cured/discharged/migrated.
With 740 deaths in the last 24 hours, the cumulative toll reached 30,601.

Maharashtra has reported 3,47,502 coronavirus cases, the highest among states and Union Territories in the country. A total of 1,92,964 cases have been reported from Tamil Nadu till now, while Delhi has recorded 1,27,364 coronavirus cases.

According to the Indian Council of Medical Research (ICMR), 3,52,801 samples were tested for coronavirus on Thursday and overall 1,54,28,170 samples have been tested so far. 

UN, May 26: Countries could see a "second peak" of coronavirus cases during the first wave of the pandemic if lockdown restrictions were lifted too soon, the World Health Organization (WHO) has warned.

Mike Ryan, the WHO's head of emergencies, told a briefing on Monday that the world was "right in the middle of the first wave", the BBC reported.

He said because the disease was "still on the way up", countries need to be aware that "the disease can jump up at any time".

"We cannot make assumptions that just because the disease is on the way down now that it's going to keep going down," Ryan said.

There would be a number of months to prepare for a second peak, he added.

The stark warning comes as countries around the world start to gradually ease lockdown restrictions, allowing shops to reopen and larger groups of people to gather.

Experts have said that without a vaccine to give people immunity, infections could increase again when social-distancing measures are relaxed.

Ryan said countries where cases are declining should be using this time to develop effective trace-and-test regimes to "ensure that we continue on a downwards trajectory and we don't have an immediate second peak".

Also on Monday, Tedros Adhanom Ghebreyesus, WHO Director-General, said that a clinical trial of hydroxychloroquine (HCQ) on COVID-19 patients has come to "a temporary pause", while the safety data of the the anti-malaria drug was being reviewed.

According to the WHO chief, The Lancet medical journal on May 22 had published an observational study on HCQ and chloroquine and its effects on COVID-19 patients that have been hospitalized, reports Xinhua news agency.

The authors of the study reported that among patients receiving the drug, when used alone or with a macrolide, they estimated a higher mortality rate.

"The Executive Group of the Solidarity Trial, representing 10 of the participating countries, met on Saturday (May 23) and has agreed to review a comprehensive analysis and critical appraisal of all evidence available globally," Tedros said in a virtual press conference.

The developments come as the total number of global COVID-19 cases has increased to 5,508,904, with 346,508 deaths, according to the Johns Hopkins University.

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."