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
June 10,2020

Hong Kong, Jun 10: The Hong Kong police on Wednesday said they had arrested 53 people during demonstrations on Tuesday evening which were called to mark the one-year anniversary of the protest against a bill proposing extraditions to mainland China. That protest grew into a pro-democracy movement and sparked seven months of protests against Beijing's rule.

Hundreds of activists took to the streets in Hong Kong yesterday, at times blocking roads in the heart of the city, before police fired pepper spray to disperse crowds, Al Jazeera reported.

The police informed that 36 males and 17 females were arrested for offenses including unlawful assembly and disorderly conduct.

Protesters had defied a ban on gatherings of more than eight people introduced by the Hong Kong government to prevent the spread of the coronavirus.

"Lawful protests are always respected, but unlawful acts are to be rejected. Please stop breaking the law," police said in a tweet.

More protests are being planned in the coming days, with pro-democracy supporters fearing the proposed national security legislation will stifle freedoms in the city.

While details of the security law or how it will operate have yet to be revealed, authorities in Beijing and Hong Kong have said there is no cause for concern and the legislation will target a minority of "troublemakers".

But critics say the law would destroy the civil liberties Hong Kong residents enjoy under the "one country, two systems" agreement put in place when the United Kingdom handed the territory back to China in 1997. The agreement is set to end in 2047.

Japan had already issued a statement independently expressing serious concern about Beijing's move on May 28, the day China approved the decision and called in the Chinese ambassador to convey its view.

The United States, Britain, Australia, and Canada also condemned the move, with Washington saying it would revoke Hong Kong's special trading status granted under a 1992 law on the condition that the city retains key freedoms and autonomy.

China blames the protests in part on foreign intervention and is rushing to enact the national security law aimed at curbing secessionist and subversive activities in Hong Kong.

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News Network
March 12,2020

Geneva, Mar 12: For the global economy, virus repercussions were profound, with increasing concerns of wealth- and job-wrecking recessions. U.S. stocks wiped out more than all the gains from a huge rally a day earlier as Wall Street continued to reel.

The Dow Jones Industrial Average dropped 1,464 points, bringing it 20% below its record set last month and putting it in what Wall Street calls a “bear market.” The broader S&P 500 is just 1 percentage point away from falling into bear territory and bringing to an end one of the greatest runs in Wall Street’s history.

WHO officials said they thought long and hard about labeling the crisis a pandemic — defined as sustained outbreaks in multiple regions of the world.

The risk of employing the term, Ryan said, is “if people use it as an excuse to give up.” But the benefit is “potentially of galvanizing the world to fight.”

Underscoring the mounting challenge: soaring numbers in the U.S. and Europe’s status as the new epicenter of the pandemic. While Italy exceeds 12,000 cases and the United States has topped 1,300, China reported a record low of just 15 new cases Thursday and three-fourths of its infected patients have recovered.

China’s totals of 80,793 cases and 3,169 deaths are a shrinking portion of the world’s more than 126,000 infections and 4,600 deaths.

“If you want to be blunt, Europe is the new China,” said Robert Redfield, the head of the U.S. Centers for Disease Control and Prevention.

With 12,462 cases and 827 deaths, Italy said all shops and businesses except pharmacies and grocery stores would be closed beginning Thursday and designated billions in financial relief to cushion economic shocks in its latest efforts to adjust to the fast-evolving crisis that silenced the usually bustling heart of the Catholic faith, St. Peter’s Square.

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News Network
April 15,2020

Wuhan, Apr 15: In the six days after top Chinese officials secretly determined they likely were facing a pandemic from a new coronavirus, the city of Wuhan at the epicenter of the disease hosted a mass banquet for tens of thousands of people; millions began traveling through for Lunar New Year celebrations.

President Xi Jinping warned the public on the seventh day, Janaury 20. But by that time, more than 3,000 people had been infected during almost a week of public silence, according to internal documents obtained by The Associated Press and expert estimates based on retrospective infection data.

That delay from Jan 14 to Jan. 20 was neither the first mistake made by Chinese officials at all levels in confronting the outbreak, nor the longest lag, as governments around the world have dragged their feet for weeks and even months in addressing the virus.

But the delay by the first country to face the new coronavirus came at a critical time — the beginning of the outbreak. China's attempt to walk a line between alerting the public and avoiding panic set the stage for a pandemic that has infected almost 2 million people and taken more than 126,000 lives.

A This is tremendous, a said Zuo-Feng Zhang, an epidemiologist at the University of California, Los Angeles. If they took action six days earlier, there would have been much fewer patients and medical facilities would have been sufficient. We might have avoided the collapse of Wuhan's medical system.

Other experts noted that the Chinese government may have waited on warning the public to stave off hysteria, and that it did act quickly in private during that time.

But the six-day delay by China's leaders in Beijing came on top of almost two weeks during which the national Center for Disease Control did not register any cases from local officials, internal bulletins obtained by the AP confirm. Yet during that time, from Jan 5 to Jan 17, hundreds of patients were appearing in hospitals not just in Wuhan but across the country.

It's uncertain whether it was local officials who failed to report cases or national officials who failed to record them. It's also not clear exactly what officials knew at the time in Wuhan, which only opened back up last week with restrictions after its quarantine.

But what is clear, experts say, is that China's rigid controls on information, bureaucratic hurdles and a reluctance to send bad news up the chain of command muffled early warnings. The punishment of eight doctors for rumor-mongering, broadcast on national television on Jan. 2, sent a chill through the city's hospitals.

Doctors in Wuhan were afraid, said Dali Yang, a professor of Chinese politics at the University of Chicago. It was truly intimidation of an entire profession. Without these internal reports, it took the first case outside China, in Thailand on Jan 13, to galvanize leaders in Beijing into recognising the possible pandemic before them. It was only then that they launched a nationwide plan to find cases distributing CDC-sanctioned test kits, easing the criteria for confirming cases and ordering health officials to screen patients, all without telling the public.

The Chinese government has repeatedly denied suppressing information in the early days, saying it immediately reported the outbreak to the World Health Organization.

Allegations of a cover-up or lack of transparency in China are groundless, said foreign ministry spokesman Zhao Lijian at a Thursday press conference.

The documents show that the head of China's National Health Commission, Ma Xiaowei, laid out a grim assessment of the situation on Jan. 14 in a confidential teleconference with provincial health officials.

A memo states that the teleconference was held to convey instructions on the coronavirus from President Xi Jinping, Premier Li Keqiang and Vice Premier Sun Chunlan, but does not specify what those instructions were.

The epidemic situation is still severe and complex, the most severe challenge since SARS in 2003, and is likely to develop into a major public health event, the memo cites Ma as saying.

The National Health Commission is the top medical agency in the country. In a faxed statement, the Commission said it had organised the teleconference because of the case reported in Thailand and the possibility of the virus spreading during New Year travel. It added that China had published information on the outbreak in an open, transparent, responsible and timely manner," in accordance with important instructions repeatedly issued by President Xi.

The documents come from an anonymous source in the medical field who did not want to be named for fear of retribution. The AP confirmed the contents with two other sources in public health familiar with the teleconference. Some of the memo's contents also appeared in a public notice about the teleconference, stripped of key details and published in February.

Under a section titled sober understanding of the situation, the memo said that clustered cases suggest that human-to-human transmission is possible. It singled out the case in Thailand, saying that the situation had changed significantly because of the possible spread of the virus abroad.

With the coming of the Spring Festival, many people will be traveling, and the risk of transmission and spread is high, the memo continued.

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