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
April 26,2020

Seoul, Apr 26: A train presumed to belong to North Korean's Kim Jong-un has been spotted at a station in the state's eastern coastal town of Wonsan amid speculation about the leader's health, a US monitor said on Sunday, citing commercial satellite imagery on the region, Yonhap news agency reported.

According to 38 North-- a website devoted to analysis about North Korea, the imagery showed a train "probably belonging to Kim Jong Un parked at the Leadership Railway Station servicing his Wonsan compound since at least April 21."

"The approximately 250-metre long train, although partially covered by the station's roof, can be seen at a railway station reserved for use by the Kim family. It was not present on April 15 but was present on both April 21 and 23," it said.

"The train's presence does not prove the whereabouts of the North Korean leader or indicate anything about his health, but it does lend weight to reports that Kim is staying at an elite area on the country's eastern coast," it added.

The report came as rumours about his health have spread as Kim apparently skipped an important annual visit to the Kumsusan Palace of the Sun on the occasion of the April 15 birthday of late state founder and his grandfather, Kim Il-sung.

CNN intensified the speculation by reporting earlier last week that the United States is looking into intelligence that Kim is "in grave danger" after surgery.

Seoul officials have disputed recent media reports about Kim, saying there have been no unusual signs from the North. Some said that Kim is presumed to be staying in Wonsan for unspecified reasons.

Washington has also dismissed the reports, with US President Donald Trump calling such reports "incorrect" in a press briefing late last week.

On Saturday, other media reports stated that China has dispatched a team of medical doctors and officials to North Korea "to advise on" Kim, citing multiple unnamed people familiar with the situation.

North Korea's state media, however, has not made any mention of Kim's public activity for two weeks since he was last seen in April 11 presiding over a major party meeting, though it has reported on his handling of routine state affairs, such as sending diplomatic letters.
But not all speculation has proven to be false.

When he was absent from public for about a month in 2014, speculation arose about his health and a political crisis in the secretive state. He later reemerged with a cane and a limp reportedly after having a cyst removed from his ankle.

The 36-year-old leader is known to have various health problems apparently caused by obesity and heavy smoking. He took office as leader of the communist state after his father, Kim Jong-il, died of a heart attack in late 2011.

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News Network
February 22,2020

Feb 22: A 20-year-old Chinese woman from Wuhan, the epicentre of the coronavirus outbreak, travelled 400 miles(675 km) north to Anyang where she infected five relatives, without ever showing signs of infection, Chinese scientists reported on Friday, offering new evidence that the virus can be spread asymptomatically.

The case study, published in the Journal of the American Medical Association, offered clues about how the coronavirus is spreading, and suggested why it may be difficult to stop.

"Scientists have been asking if you can have this infection and not be ill? The answer is apparently, yes," said Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center, who was not involved in the study.

China has reported a total of 75,567 cases of the virus known as COVID-19 to the World Health Organization (WHO) including 2,239 deaths, and the virus has already spread to 26 countries and territories outside of mainland China.

Researchers have reported sporadic accounts of individuals without any symptoms spreading the virus. What's different in this study is that it offers a natural lab experiment of sorts, Schaffner said.

"You had this patient from Wuhan where the virus is, travelling to where the virus wasn't. She remained asymptomatic and infected a bunch of family members and you had a group of physicians who immediately seized on the moment and tested everyone."

According to the report by Dr Meiyun Wang of the People's Hospital of Zhengzhou University and colleagues, the woman travelled from Wuhan to Anyang on Jan. 10 and visited several relatives. When they started getting sick, doctors isolated the woman and tested her for coronavirus. Initially, the young woman tested negative for the virus, but a follow-up test was positive.

All five of her relatives developed COVID-19 pneumonia, but as of Feb. 11, the young woman still had not developed any symptoms, her chest CT remained normal and she had no fever, stomach or respiratory symptoms, such as cough or sore throat.

Scientists in the study said if the findings are replicated, "the prevention of COVID-19 infection could prove challenging."

Key questions now, Schaffner said, are how often does this kind of transmission occur and when during the asymptomatic period does a person test positive for the virus.

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News Network
March 19,2020

Rome, Mar 19: Italy on Wednesday reported 475 new deaths from the novel coronavirus, the highest one-day official toll of any nation since the first case was detected in China late last year.

The total number of deaths in Italy has reached 2,978, more than half of all the cases recorded outside China, while the number of infections stood at 35,713.

The previous record high of 368 deaths was also recorded in Italy, on Sunday. The nation of 60 million has now recorded 34.2 percent of all the deaths officially attributed to COVID-19 across the world.

With the death rate still climbing despite the Mediterranean country entering a second week under an effective lockdown, officials urged Italians to have faith and to stay strong.

"They main thing is, do not give up," Italian National Institute of Health chief Silvio Brusaferro said in a nationally televised press conference.

"It will take a few days before we see the benefits" of containment measures, said Brusaferro. "We must maintain these measures to see their effect, and above all to protect the most vulnerable."

Imposed nationally on March 12, the shutdown of most Italian businesses and a ban on public gatherings are due to expire on March 25.

But school closures and other measures, such as a ban fan attendance at sporting events, are due to run on until April 3.

A top government minister hinted Wednesday that the school closure would be extended well into next month, if not longer.

The rates within Italy itself remained stable, with two-thirds of the deaths -- 1,959 in all -- reported in the northern Lombardy region around Milan, the Italian financial and fashion capital.

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