Mysterious blood clots are COVID-19's latest lethal surprise

News Network
April 28, 2020

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."

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News Network
February 9,2020

Nakhon Ratchasima, Feb 9: The Thai soldier who killed at least 20 people and holed up in a mall overnight was shot dead Sunday morning by commandos, ending a near-17-hour ordeal which left dozens wounded and stunned the country.

It was unclear how many people remained trapped inside the Terminal 21 mall in Nakhon Ratchasima -- also known as Korat -- where the gunman held out through the night, armed with assault weapons stolen from his barracks.

Volleys of gunfire rang out as the siege ran into dawn, hours after Thai security services stormed the ground floor and freed scores of stunned, terrified shoppers from a bloody rampage that the gunman -- a junior army officer identified as Sergeant-Major Jakrapanth Thomma -- had relayed via Facebook posts.

"He was shot dead thirty minutes ago" (0200 GMT), chief of the Crime Suppression Division Jirabhob Bhuridej told AFP.

Commandos from elite Thai police units killed the gunman, a police spokesman added, after an operation involving hundreds of security personnel.

"The official death toll is 20 and wounded 42... nine are in surgery," Narinrat Pitchayakamin, a Korat doctor told reporters, revising down an initial death toll of 21.

But it was unclear if there were more victims inside the multi-level complex which was packed with Saturday shoppers when the gunman stormed in.

A fleet of ambulances left the front of the complex and forensic police poured into the grim crime scene, shortly before the gunman's death was confirmed.

The night was peppered with heavy exchanges of gunfire and sporadic evacuations.

A police officer who took part in a raid to flush out the gunman died, according to deputy prime minister Anutin Charnvirakul. "He had been hit and unfortunately, he couldn't make it," said Anutin.

Shocked evacuees recounted how an ordinary Saturday shopping day at the busy mall descended into horror as the gunman entered.

"It was like a dream... I'm grateful I survived," Sottiyanee Unchalee, 48, told AFP, explaining she hid in the toilet of a gym inside the mall as she heard the gunfire.

"I'm so sorry for those who died... (and) the people still trapped inside."

Stolen weapons

Jakrapanth relayed his shooting spree through Facebook posts which charted the attack from the army barracks in the city to the mall, where an unknown number of shoppers remained trapped.

A volunteer rescue worker recounted a bloody scene of horror after his team carried four corpses to the hospital.

"I've never seen anything like this," Peerapong Chatadee told AFP.

"I just feel so sad. He is a soldier, he should not have fired at unarmed people."

The bloodshed began Saturday afternoon when Jakrapanth shot three people -- among them at least one soldier -- at a senior officer's house and then at the nearby army barracks, before driving an army vehicle to the town centre.

There the gunman used weapons stolen from the military arsenal to unleash carnage in the town centre.

He "used a machine gun and shot innocent victims resulting in many injured and dead", said police spokesman Krissana Pattanacharoen.

Throughout the day, Jakrapanth posted images of himself and wrote several posts on his Facebook page as the attack unfolded.

In one Facebook video -- since deleted -- the assailant, wearing an army helmet, filmed from an open-top jeep, saying, "I'm tired... I can't pull my finger anymore" as he made a trigger symbol with his hand.

There were also photos of a man in a ski mask holding up a pistol.

A Facebook spokesperson said: "We have removed the gunman's accounts from our services and will work around the clock to remove any violating content related to this attack as soon as we become aware of it."

The city is home to one of the largest barracks in Thailand, a country where the military is enmeshed in politics and society.

The nation also has one of the highest rates of gun ownership in the world, and several shootings at courthouses last year renewed concern about gun violence.

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News Network
May 6,2020

Washington, May 6: The Chinese Army is indulging in aggressive behaviour in the South China Sea and the Chinese Communist Party has ramped up its disinformation campaign to try to shift the blame on coronavirus and burnish its image, US Defense Secretary Mark Esper said on Tuesday.

"While the Chinese Communist Party ramps up its disinformation campaign to try to shift blame and burnish its image, we continue to see aggressive behaviour by the PLA in the South China Sea, from threatening a Philippine Navy ship to sinking a Vietnamese fishing boat and intimidating other nations from engaging in offshore oil and gas development," Esper told reporters at a Pentagon news conference.

Last week, two US Navy ships conducted freedom of navigation operations in the South China Sea to send a clear message to Beijing that America will continue to protect the freedom of navigation and commerce for all nations large and small, he said.

Many countries, Esper said, have turned inward to recover from the pandemic and in the meantime, America's strategic competitors are attempting to exploit this crisis to their benefit at the expense of others.

Responding to a question, he said the Chinese have not been transparent from the beginning on the coronavirus pandemic.

"If they had been more transparent, more open, upfront in terms of giving us access, the reporting, giving us access not to the people on the ground but to the virus they had so we could understand it, we would probably be in a far different place right now. But where we are now is this," Esper said.

China needs to allow the United States in to talk to early patients, Chinese researchers and scientists, and to have access, he added.

Instead, Esper alleged that the Chinese are trying to capitalise on this by promoting their own image that somehow, China is the good guy here.

"Despite everything they did or, more importantly, failed to do, now they want to go out and say well, here's masks. We will give you masks, provide this, or provide that, we will provide you funding. Look at all the good things we are doing," he said.

"Yet, what we know is that they provide masks, they provide supplies. In many cases, it is not good. It does not do what it is supposed to do. It is broken equipment. Also, the strings attached are enormous in many cases. So, they are telling a country you can take these masks, but please, put out publicly how good China is, how great we are doing, et cetera, et cetera," Esper said.

"So there is a number of things they are doing to try and burnish their image. That is just two of them right there," he said.

The Chinese are also doing a lot of strong-arming behind the scenes, Esper said and referred to the war of words between China and Australia. He said he plans to talk to his Australian counterpart later in the day.

"All these activities are going on. It is straight from the Chinese playbook. Once again, it is just a little bit more obvious this time with what they are doing and how they are using a combination of compelling and coercion and everything else to try and shape the narrative and burnish the image of the Chinese Communist Party," Esper said.

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Agencies
March 8,2020

Panic gripped big tech firms like Facebook and Twitter which decided to close their offices from Seattle to London as more employees tested positive for the new coronavirus.

Facebook shut its three London offices till Monday after an employee was diagnosed with COVID-19.

The social networking giant told nearly 3,000 employees in London to work from home after an employee, who is based in Singapore but visited the London offices between February 24-26, was diagnosed with the new coronavirus, Sky News reported on Friday.

"An employee based in our Singapore office who has been diagnosed with COVID-19 visited our London offices on February 24-26.

"We are therefore closing our London offices until Monday for deep cleaning and employees are working from home until then," the company said in a statement.

There have been 163 cases of coronavirus so far in the UK.

Earlier, Facebook recommended all its Bay Area employees in the US to work from home. The latest precautions come after San Francisco announced its first two coronavirus cases on Thursday.

Facebook has also shut its Seattle office until Monday after one of its contractors was confirmed to be infected with the virus. The infected contractor last visited the Facebook office on February 21. King County health officials said all Facebook sites should work from home until March 31.

Twitter shut its Seattle office for a 'deep clean' after an employee developed COVID-19 like symptoms though final result was still awaited.

"A Seattle-based employee has been advised by doctor about likely COVID-19, though still awaiting the final testing," Twitter said in a tweet on Friday.

"While the employee has not been at a Twitter office for several weeks and hasn't been in contact w/others, we're closing our Seattle office to deep clean," the company added.

According to The Seattle Times, at least 14 people have died due to COVID-19 in Washington State till date.

Amazon, Microsoft, Google and Facebook have advised their employees in Washington State to work from home.

Apple has reportedly suggested its employees at California campuses to work from home as an "extra precaution" while new coronavirus cases spread on the west coast in the US, especially Seattle area.

Apple's flagship developers' conference WWDC 2020 in June is also at the risk of getting cancelled as the Santa Clara public health department has warned against large public gatherings. The event draws nearly 5,000 developers from across the world.

The US death toll from the new coronavirus has climbed to 14, according to Johns Hopkins' tracker, with 329 cases reported across the country.

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