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."

Comments

Add new comment

  • Coastaldigest.com reserves the right to delete or block any comments.
  • Coastaldigset.com is not responsible for its readers’ comments.
  • Comments that are abusive, incendiary or irrelevant are strictly prohibited.
  • Please use a genuine email ID and provide your name to avoid reject.
Agencies
June 7,2020

Moscow, Jun 7: OPEC, Russia and allies agreed on Saturday to extend record oil production cuts until the end of July, prolonging a deal that has helped crude prices double in the past two months by withdrawing almost 10% of global supplies from the market.

The group, known as OPEC+, also demanded countries such as Nigeria and Iraq, which exceeded production quotas in May and June, compensate with extra cuts in July to September.

OPEC+ had initially agreed in April that it would cut supply by 9.7 million barrels per day (bpd) during May-June to prop up prices that collapsed due to the coronavirus crisis. Those cuts were due to taper to 7.7 million bpd from July to December.

“Demand is returning as big oil-consuming economies emerge from pandemic lockdown. But we are not out of the woods yet and challenges ahead remain,” Saudi Energy Minister Prince Abdulaziz bin Salman told the video conference of OPEC+ ministers.

Benchmark Brent crude climbed to a three-month high on Friday above $42 a barrel, after diving below $20 in April. Prices still remain a third lower than at the end of 2019.

“Prices can be expected to be strong from Monday, keeping their $40 plus levels,” said Bjornar Tonhaugen from Rystad Energy.

Saudi Arabia, OPEC’s de facto leader, and Russia have to perform a balancing act of pushing up oil prices to meet their budget needs while not driving them much above $50 a barrel to avoid encouraging a resurgence of rival U.S. shale production.

It was not immediately clear whether Saudi Arabia, the United Arab Emirates and Kuwait would extend beyond June their additional, voluntary cuts of 1.18 million bpd, which are not part of the deal.

BULGING INVENTORIES

The April deal was agreed under pressure from U.S. President Donald Trump, who wants to avoid U.S. oil industry bankruptcies.

Trump, who previously threatened to pull U.S. troops out of Saudi Arabia if Riyadh did not act, spoke to the Russian and Saudi leaders before Saturday’s talks, saying he was happy with the price recovery.

While oil prices have partially recovered, they are still well below the costs of most U.S. shale producers. Shutdowns, layoffs and cost cutting continue across the United States.

“I applaud OPEC-plus for reaching an important agreement today which comes at a pivotal time as oil demand continues to recover and economies reopen around the world,” U.S. Energy Secretary Dan Brouillette wrote on Twitter after the extension.

As global lockdowns ease, oil demand is expected to exceed supply sometime in July but OPEC has yet to clear 1 billion barrels of excess oil inventories accumulated since March.

Rystad’s Tonhaugen said Saturday’s decisions would help OPEC reduce inventories at a rate of 3 million to 4 million bpd in July-August. “The quicker stocks fall, the higher prices will get,” he said.

Nigeria’s petroleum ministry said Abuja backed the idea of compensating for its excessive output in May and June.

Iraq, with one of the worst compliance rates in May, agreed to extra cuts although it was not clear how Baghdad would reach agreement with oil majors on curbing Iraqi output.

Iraq produced 520,000 bpd above its quota in May, while overproduction by Nigeria was 120,000 bpd, Angola’s was 130,000 bpd, Kazakhstan’s was 180,000 bpd and Russia’s was 100,000 bpd, OPEC+ data showed.

OPEC+’s joint ministerial monitoring committee, known as the JMMC, will meet monthly until December to review the market, compliance and recommend levels of cuts. JMMC’s next meeting is scheduled for June 18.

OPEC and OPEC+ will hold their next scheduled meetings on Nov. 30-Dec. 1.

Comments

Add new comment

  • Coastaldigest.com reserves the right to delete or block any comments.
  • Coastaldigset.com is not responsible for its readers’ comments.
  • Comments that are abusive, incendiary or irrelevant are strictly prohibited.
  • Please use a genuine email ID and provide your name to avoid reject.
News Network
May 19,2020

May 19: A Chinese laboratory has been developing a drug it believes has the power to bring the coronavirus pandemic to a halt.

The outbreak first emerged in China late last year before spreading across the world, prompting an international race to find treatments and vaccines.

A drug being tested by scientists at China's prestigious Peking University could not only shorten the recovery time for those infected, but even offer short-term immunity from the virus, researchers say.

Sunney Xie, director of the university's Beijing Advanced Innovation Center for Genomics, told AFP that the drug has been successful at the animal testing stage.

"When we injected neutralising antibodies into infected mice, after five days the viral load was reduced by a factor of 2,500," said Xie.

"That means this potential drug has (a) therapeutic effect."

The drug uses neutralising antibodies -- produced by the human immune system to prevent the virus infecting cells -- which Xie's team isolated from the blood of 60 recovered patients.

A study on the team's research, published Sunday in the scientific journal Cell, suggests that using the antibodies provides a potential "cure" for the disease and shortens recovery time.

Xie said his team had been working "day and night" searching for the antibody.

"Our expertise is single-cell genomics rather than immunology or virology. When we realised that the single-cell genomic approach can effectively find the neutralising antibody we were thrilled."

He added that the drug should be ready for use later this year and in time for any potential winter outbreak of the virus, which has infected 4.8 million people around the world and killed more than 315,000.

"Planning for the clinical trial is underway," said Xie, adding it will be carried out in Australia and other countries since cases have dwindled in China, offering fewer human guinea pigs for testing.

"The hope is these neutralised antibodies can become a specialised drug that would stop the pandemic," he said.

China already has five potential coronavirus vaccines at the human trial stage, a health official said last week.

But the World Health Organization has warned that developing a vaccine could take 12 to 18 months.

Scientists have also pointed to the potential benefits of plasma -- a blood fluid -- from recovered individuals who have developed antibodies to the virus enabling the body's defences to attack it.

More than 700 patients have received plasma therapy in China, a process which authorities said showed "very good therapeutic effects".

"However, it (plasma) is limited in supply," Xie said, noting that the 14 neutralising antibodies used in their drug could be put into mass production quickly.

Using antibodies in drug treatments is not a new approach, and it has been successful in treating several other viruses such as HIV, Ebola and Middle East Respiratory Syndrome (MERS).

Xie said his researchers had "an early start" since the outbreak started in China before spreading to other countries.

Ebola drug Remdesivir was considered a hopeful early treatment for COVID-19 -- clinical trials in the US showed it shortened the recovery time in some patients by a third -- but the difference in mortality rate was not significant.

The new drug could even offer short-term protection against the virus.

The study showed that if the neutralising antibody was injected before the mice were infected with the virus, the mice stayed free of infection and no virus was detected.

This may offer temporary protection for medical workers for a few weeks, which Xie said they are hoping to "extend to a few months".

More than 100 vaccines for COVID-19 are in the works globally, but as the process of vaccine development is more demanding, Xie is hoping that the new drug could be a faster and more efficient way to stop the global march of the coronavirus.

"We would be able to stop the pandemic with an effective drug, even without a vaccine," he said.

Comments

Add new comment

  • Coastaldigest.com reserves the right to delete or block any comments.
  • Coastaldigset.com is not responsible for its readers’ comments.
  • Comments that are abusive, incendiary or irrelevant are strictly prohibited.
  • Please use a genuine email ID and provide your name to avoid reject.
News Network
February 2,2020

Feb 2: The Philippines on Sunday reported the first death from a new virus outside of China, where authorities delayed the opening of schools in the worst-hit province and tightened quarantine measures in a city that allow only one family member to venture out to buy supplies.

The Philippine Department of Health said a 44-year-old Chinese man from Wuhan was admitted on Jan. 25 after experiencing a fever, cough, and sore throat. He developed severe pneumonia, and in his last few days, “the patient was stable and showed signs of improvement, however, the condition of the patient deteriorated within his last 24 hours resulting in his demise.”

The man’s 38-year-old female companion, also from Wuhan, also tested positive for the virus and remains in hospital isolation in Manila.

President Rodrigo Duterte approved a temporary ban on all travelers, except Filipinos, from China and its autonomous regions. The U.S., Japan, Singapore and Australia have imposed similar restrictions despite criticism from China and an assessment from the World Health Organization that they were unnecessarily hurting trade and travel.

The death toll in China climbed by 45 to 304 and the number of cases by 2,590 to 14,380, according to the National Health Commission, well above the number of those infected in in the 2002-03 outbreak of SARS, or severe acute respiratory syndrome, which broke out in southern China and spread worldwide.

Meanwhile, six officials in the city of Huanggang, neighboring the epicenter of Wuhan in Hubei province, have been fired over “poor performance” in handling the outbreak, the official Xinhua News Agency reported.

It cited the mayor as saying the city’s “capabilities to treat the patients remained inadequate and there is a severe shortage in medical supplies such as protective suits and medical masks.”

After Huanggang, the trading center of Wenzhou in coastal Zhejiang province also confined people to homes, allowing only one family member to venture out every other day to buy necessary supplies.

With the outbreak showing little sign of abating, authorities in Hubei and elsewhere have extended the Lunar New Year holiday, due to end this week, well into February. The annual travel crunch of millions of people returning from their hometowns to the cities is thought to pose a major threat of secondary infection at a time when authorities are encouraging people to avoid public gatherings.

All Hubei schools will postpone the opening of the new semester until further notice and students from elsewhere who visited over the holiday will also be excused from classes.

Far away on China’s southeast coast, the manufacturing hub of Wenzhou put off the opening of government offices until Feb. 9, private businesses until Feb. 17 and schools until March 1.

With nearly 10 million people, Wenzhou has reported 241 confirmed cases of the virus, one of the highest levels outside Hubei. Similar measures have been announced in the provinces and cities of Heilongjiang, Shandong, Guizhou, Hebei and Hunan, while the major cities of Shanghai and Beijing were on indefinite leave pending developments.

Despite imposing drastic travel restrictions at home, China has chafed at those imposed by foreign governments, criticizing Washington’s order barring entry to most non-citizens who visited China in the past two weeks. Apart from dinging China’s international reputation, such steps could worsen a domestic economy already growing at its lowest rate in decades.

The crisis is the latest to confront Chinese leader Xi Jinping, who has been beset by months of anti-government protests in the semi-autonomous Chinese city of Hong Kong, the reelection of Taiwan’s pro-independence president and criticism over human rights violations in the traditionally Muslim northwestern territory of Xinjiang. Economically, Xi faces lagging demand and dramatically slower growth at home while the tariff war with the U.S. remains largely unresolved.

Among a growing number of airlines suspending flights to mainland China was Qatar Airways. The Doha-based carrier said on its website that its flights would stop Monday. It blamed “significant operational challenges caused by entry restrictions imposed by a number of countries” for the suspension of flights.

Oman also halted flights to China, as did Saudi Arabia’s flagship national carrier, Saudia.

Saudi Arabia’s state-run TV reported that 10 Saudi students were evacuated from Wuhan on a special flight. It said the students would be screened upon arrival, but did not say whether they would be quarantined for 14 days.

This weekend, South Korea and India flew hundreds of their citizens out of Wuhan. They went into a two-week quarantine.

On Sunday, South Korea reported three more cases for a total of 15. They include an evacuee, a Chinese relative of a man who tested positive and a man who returned from Wuhan. India reported a second case, also in southern Kerala state.

South Korea also barred foreigners who have stayed or traveled to Hubei province within the last 14 days from entering the country.

Indonesia flew back 241 nationals from Wuhan on Sunday and quarantined them on the remote Natuna Islands for two weeks. Several hundred residents protested the move, with one saying, “This is not because we do not have a sense of solidarity with fellow nationals. But because we fear they could infect us with the deadly virus from China.”

A Turkish military transport plane carrying 42 people arrived in Ankara from Wutan Saturday night. The 32 Turkish, six Azerbaijani, three Georgian nationals and an Albanian will remain under observation for 14 days, together with 20 personnel who participated in the evacuation, Health Minister Fahrettin Koca said.

Vietnam counted its seventh case, a Vietnamese-American man who had a two-hour layover in Wuhan on his way from the U.S. to Ho Chi Minh City.

The virus’ rapid spread in two months prompted the WHO on Thursday to declare it a global emergency.

That declaration “flipped the switch” from a cautious attitude to recommending governments prepare for the possibility the virus might spread, said the WHO representative in Beijing, Gauden Galea. Most cases reported so far have been people who visited China or their family members.

WHO said it was especially concerned that some cases abroad involved human-to-human transmission.

“Countries need to get ready for possible importation in order to identify cases as early as possible and in order to be ready for a domestic outbreak control, if that happens,” Galea told The Associated Press.

Both the new virus and SARS are from the coronavirus family, which also includes those that cause the common cold.

The death rate in China is falling, but the number of confirmed cases will keep growing because thousands of specimens from suspected cases have yet to be tested, Galea said.

“The case fatality ratio is settling out at a much lower level than we were reporting three, now four, weeks ago,” he said.

Although scientists expect to see limited transmission of the virus between people with family or other close contact, they are concerned about cases of infection spreading to people who might have less exposure.

Comments

Add new comment

  • Coastaldigest.com reserves the right to delete or block any comments.
  • Coastaldigset.com is not responsible for its readers’ comments.
  • Comments that are abusive, incendiary or irrelevant are strictly prohibited.
  • Please use a genuine email ID and provide your name to avoid reject.