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.
News Network
February 17,2020

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.

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 13,2020

Islamabad, May 13 : The number of confirmed COVID-19 cases in Pakistan rose to 34,370 on Wednesday after new infections were confirmed in the country.

As per province-wise breakup of the total tally cited by Radio Pakistan, so far 13,225 cases have been registered in Punjab, 12,610 in Sindh, 5,021 in Khyber Pakhtunkhwa, 2,158 in Balochistan, 759 in Islamabad, 475 in Gilgit Baltistan and 88 in Pakistan-occupied Kashmir.

As many as 2,255 cases positive were confirmed, while 31 deaths reported during the last 24 hours.

At least 737 patients have died so far while 8,812 stand recovered, the media reported further.

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 25,2020

Karachi, May 25: The pilot of the Pakistan International Airlines (PIA)'s crashed plane ignored three warnings from the air traffic controllers about the aircraft's altitude and speed before the landing, saying he was satisfied and would handle the situation, according to a report on Monday.

The national flag carrier's PK-8303 tragedy on Friday, in which 97 people were killed and two miraculously survived, is one of the most catastrophic aviation disasters in the country's history.

The Airbus A-320 from Lahore to Karachi was 15 nautical miles from the Jinnah International Airport, flying at an altitude of 10,000 feet above the ground instead of 7,000 when the Air Traffic Control (ATC) issued its first warning to lower the plane's altitude, Geo News quoted an ATC report as saying.

Instead of lowering the altitude, the pilot responded by saying that he was satisfied. When only 10 nautical miles were left till the airport, the plane was at an altitude of 7,000 feet instead of 3,000 feet, it said.

The ATC issued a second warning to the pilot to lower the plane's altitude. However, the pilot responded again by stating that he was satisfied and would handle the situation, saying he was ready for landing, the report said.

The report said that the plane had enough fuel to fly for two hours and 34 minutes, while its total flying time was recorded at one hour and 33 minutes.

Pakistani investigators are trying to find out if the crash is attributable to a pilot error or a technical glitch.

According to a report prepared by the country's Civil Aviation Authority (CAA), the plane's engines had scraped the runway thrice on the pilot's first attempt to land, causing friction and sparks recorded by the experts.

When the aircraft scraped the ground on the first failed attempt at landing, the engine's oil tank and fuel pump may have been damaged and started to leak, preventing the pilot from achieving the required thrust and speed to raise the aircraft to safety, the report said.

The pilot made a decision "on his own" to undertake a "go-around" after he failed to land the first time. It was only during the go-around that the ATC was informed that landing gear was not deploying, it said.

"The pilot was directed by the air traffic controller to take the aircraft to 3,000 feet, but he managed only 1,800. When the cockpit was reminded to go for the 3,000 feet level, the first officer said 'we are trying'," the report said.

Experts said that the failure to achieve the directed height indicates that the engines were not responding. The aircraft, thereafter, tilted and crashed suddenly.

The flight crashed at the Jinnah Garden area near Model Colony in Malir on Friday afternoon, minutes before its landing in Karachi's Jinnah International Airport. Eleven people on the ground were injured.

The probe team, headed by Air Commodore Muhammad Usman Ghani, President of the Aircraft Accident and Investigation Board, is expected to submit a full report in about three months.

According to the PIA's engineering and maintenance department, the last check of the plane was done on March 21 this year and it had flown from Muscat to Lahore a day before the crash.

In the wake of the COVID-19 pandemic, the Pakistan government had allowed the limited domestic flight operations from five major airports - Islamabad, Karachi, Lahore, Peshawar and Quetta - from May 16.

After the plane tragedy, the PIA has called off its domestic operation.

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.