Hijab-wearing White House staffer quits Trump administration in 8 days

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."

May 14: The UN’s children agency has warned that an additional 6,000 children could die daily from preventable causes over the next six months as the COVID-19 pandemic weakens the health systems and disrupts routine services, the first time that the number of children dying before their fifth birthday could increase worldwide in decades.

As the coronavirus outbreak enters its fifth month, the UN Children’s Fund (UNICEF) requested USD 1.6 billion to support its humanitarian response for children impacted by the pandemic.

The health crisis is “quickly becoming a child rights crisis. And without urgent action, a further 6,000 under-fives could die each day,” it said.

With a dramatic increase in the costs of supplies, shipment and care, the agency appeal is up from a USD 651.6 million request made in late March – reflecting the devastating socioeconomic consequences of the disease and families’ rising needs.

"Schools are closed, parents are out of work and families are under strain," UNICEF Executive Director Henrietta Fore said on Tuesday.

 “As we reimagine what a post-COVID world would look like, these funds will help us respond to the crisis, recover from its aftermath, and protect children from its knock-on effects.”

The estimate of the 6,000 additional deaths from preventable causes over the next six months is based on an analysis by researchers from the Johns Hopkins Bloomberg School of Public Health, published on Wednesday in the Lancet Global Health Journal.

UNICEF said it was based on the worst of three scenarios analysing 118 low and middle-income countries, estimating that an additional 1.2 million deaths could occur in just the next six months, due to reductions in routine health coverage, and an increase in so-called child wasting.

Around 56,700 more maternal deaths could also occur in just six months, in addition to the 144,000 likely deaths across the same group of countries. The worst case scenario, of children dying before their fifth birthdays, would represent an increase "for the first time in decades,” Fore said.

"We must not let mothers and children become collateral damage in the fight against the virus. And we must not let decades of progress on reducing preventable child and maternal deaths, be lost,” she said.

Access to essential services, like routine immunisation, has already been compromised for hundreds of millions of children and threatens a significant increase in child mortality.

According to a UNICEF analysis, some 77 per cent of children under the age of 18 worldwide are living in one of 132 countries with COVID-19 movement restrictions.

The UN agency also spotlighted that the mental health and psychosocial impact of restricted movement, school closures and subsequent isolation are likely to intensify already high levels of stress, especially for vulnerable youth.

At the same time, they maintained that children living under restricted movement and socio-economic decline are in greater jeopardy of violence and neglect. Girls and women are at increased risk of sexual and gender-based violence.

The UNICEF pointed out that in many cases, refugee, migrant and internally displaced children are experiencing reduced access to protection and services while being increasingly exposed to xenophobia and discrimination.

“We have seen what the pandemic is doing to countries with developed health systems and we are concerned about what it would do to countries with weaker systems and fewer available resources,” Fore said.

In countries suffering from humanitarian crises, UNICEF is working to prevent transmission and mitigate the collateral impacts on children, women and vulnerable populations – with a special focus on access to health, nutrition, water and sanitation, education and protection.

To date, the UN agency said it has received USD 215 million to support its pandemic response, and additional funding will help build upon already-achieved results.

Within its response, UNICEF has reached more than 1.67 billion people with COVID-19 prevention messaging around hand washing and cough and sneeze hygiene; over 12 million with critical water, sanitation and hygiene supplies; and nearly 80 million children with distance or home-based learning.

The UN agency has also shipped to 52 countries, more than 6.6 million gloves, 1.3 million surgical masks, 428,000 N95 respirators and 34,500 COVID-19 diagnostic tests, among other items.