Modi meets Chinese prez; discuss countering terrorism, trade

Apr 26: The Chinese city of Wuhan, where the global coronavirus pandemic began, now has no remaining cases in its hospitals, a health official told reporters on Sunday.

"The latest news is that by April 26, the number of new coronavirus patients in Wuhan was at zero, thanks to the joint efforts of Wuhan and medical staff from around the country," National Health Commission spokesman Mi Feng said at a briefing.

The city had reported 46,452 cases, 56% of the national total. It saw 3,869 fatalities, or 84% of China's total.

Feb 17: Chinese authorities on Monday reported a slight upturn in new virus cases and 105 more deaths for a total of 1,770 since the outbreak began two months ago.

The 2,048 new cases followed three days of declines but was up by just 39 cases from the previous day’s figure. Another 10,844 people have recovered from COVID-19, a disease caused by the new coronavirus, and have been discharged from hospitals, according to Monday’s figures.

The update followed the publication late Saturday in China’s official media of a recent speech by President Xi Jinping in which he indicated for the first time that he had led the response to the outbreak from early in the crisis. While the reports were an apparent attempt to demonstrate the Communist Party leadership acted decisively from the start, it also opened Xi up to criticism over why the public was not alerted sooner.

In his speech, Xi said he gave instructions on fighting the virus on Jan. 7 and ordered the shutdown of the most-affected cities that began on Jan. 23.

The disclosure of his speech indicates top leaders knew about the outbreak’s potential severity at least two weeks before such dangers were made known to the public. It was not until late January that officials said the virus can spread between humans and public alarm began to rise.

New cases in other countries are raising growing concerns about containment of the virus.

Taiwan on Sunday reported its first death from COVID-19, the fifth fatality outside of mainland China. Taiwan’s Central News Agency, citing health minister Chen Shih-chung, said the man who died was in his 60s and had not traveled overseas recently and had no known contact with virus patients.

Japanese Prime Minister Shinzo Abe convened an experts meeting to discuss containment measures in his country, where more than a dozen cases have emerged in the past few days without any obvious link to China.

“The situation surrounding this virus is changing by the minute,” Abe said.

Japanese Health Minister Katsunobu Kato said the country is “entering into a phase that is different from before,” requiring new steps to stop the spread of the virus.

Japan now has 413 confirmed cases, including 355 from a quarantined cruise ship, and one death from the virus. Its total is the highest number of cases among about two dozen countries outside of China where the illness has spread.

Hundreds of Americans from the cruise ship took charter flights home, as Japan announced another 70 infections had been confirmed on the Diamond Princess. Canada, Hong Kong and Italy were planning similar flights.

The 300 or so Americans flying on U.S.-government chartered aircraft back to the U.S. will face another 14-day quarantine at Travis Air Force Base in California and Lackland Air Force Base in Texas. The U.S. Embassy said the departure was offered because people on the ship were at a high risk of exposure to the virus. People with symptoms were banned from the flights.

About 255 Canadians and 330 Hong Kong residents are on board the ship or undergoing treatment in Japanese hospitals. There are also 35 Italians, of which 25 are crew members, including the captain.

In China’s Hubei province, where the outbreak began in December, all vehicle traffic will be banned in another containment measure. It expands a vehicle ban in the provincial capital, Wuhan, where public transportation, trains and planes have been halted for weeks.

Exceptions were being made for vehicles involved in epidemic prevention and transporting daily necessities.

Hubei has built new hospitals with thousands of patient beds and China has sent thousands of military medical personnel to staff the new facilities and help the overburdened health care system.

Last Thursday, Hubei changed how it recognized COVID-19 cases, accepting a doctor’s diagnosis rather than waiting for confirmed laboratory test results, in order to treat patients faster. The tally spiked by more than 15,000 cases under the new method.

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."