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
May 30,2020

Washington, May 30: President Donald Trump said Friday he would strip several of Hong Kong's special privileges with the United States and bar some Chinese students from US universities in anger over Beijing's bid to exert control in the financial hub.

In a day of concerted action, the United States and Britain also raised alarm at the UN Security Council over a controversial new security law for Hong Kong, angering Beijing which said the issue had no place at the world body.

In a White House appearance that Trump had teased for a day, the US president attacked China over its treatment of the former British colony, saying it was "diminishing the city's longstanding and proud status."

"This is a tragedy for the people of Hong Kong, the people of China and indeed the people of the world," Trump said.

Trump also said he was terminating the US relationship with the World Health Organization, which he has accused of pro-China bias in its management of the coronavirus crisis.

But Trump was light on specifics and notably avoided personal criticism of President Xi Jinping, with whom he has boasted of having a friendship even as the two powers feud over a rising range of issues.

"I am directing my administration to begin the process of eliminating policy that gives Hong Kong different and special treatment," Trump said.

"This will affect the full range of agreements, from our extradition treaty to our export controls on dual-use technologies and more, with few exceptions," he said.

Secretary of State Mike Pompeo on Wednesday informed Congress that the Trump administration would no longer consider Hong Kong to be separate under US law, but it was up to Trump to spell out the consequences.

China this week pressed ahead on a law that would ban subversion and other perceived offenses against its rule in Hong Kong, which was rocked by months of massive pro-democracy protests last year.

US restricts students

In one move that could have long-reaching consequences, Trump issued an order to ban graduate students from US universities who are connected to China's military.

"For years, the government of China has conducted elicit espionage to steal our industrial secrets, of which there are many," Trump said.

Hawkish Republicans have been clamoring to kick out Chinese students enrolled in sensitive fields. The FBI in February said it was investigating 1,000 cases of Chinese economic espionage and technological theft.

But any move to deter students is unwelcome for US universities, which rely increasingly on tuition from foreigners and have already been hit hard by the COVID-19 shutdown.

China has been the top source of foreign students to the United States for the past decade with nearly 370,000 Chinese at US universities, although Trump's order will not directly affect undergraduates.

Critics say Trump has been eager to fan outrage about China to deflect attention from his own handling of the coronavirus pandemic that has killed more than 100,000 people in the United States, the highest number of deaths of any country.

Chuck Schumer, the top Democrat in the Senate, called Trump's announcement "just pathetic."

Eliot Engel, a Democrat who heads the House Foreign Affairs Committee, noted that Trump treaded lightly on Hong Kong during last year's protests as he sought a trade deal with Xi.

"Now, the president wants to shift the blame for his failures onto China, so he's doing the right thing for the wrong reason," Engel said.

Trump's order could also trigger retaliation. China in March expelled US journalists after the Trump administration tightened visa rules for staff at Chinese state media.

Clash at UN

The United States and Britain earlier in the day urged China to reconsider the Hong Kong law during talks at the UN Security Council, where China wields a veto -- making any formal session, let alone action against Beijing, impossible.

The Western allies raised Hong Kong in an informal, closed-door videoconference where China cannot block the agenda.

They said China was violating an international commitment as the 1984 handover agreement with Britain, in which Beijing promised to maintain the financial hub's separate system until at least 2047, was registered with the United Nations.

"The United States is resolute, and calls upon all UN members states to join us in demanding that the PRC immediately reverse course and honor its international legal commitments to this institution and to the Hong Kong people," said US Ambassador Kelly Craft, referring to the People's Republic of China.  

China demanded that the United States and Britain "immediately stop interfering in Hong Kong affairs," saying the law did not fall under the Security Council's mandate.

"Any attempt to use Hong Kong to interfere in China's internal matters is doomed to fail," warned a statement from China's UN mission.

"There was no consensus, no formal discussion in the Security Council, and the US and the UK's move came to nothing," it said.

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News Network
July 4,2020

Maryland, Jul 4: The total number of coronavirus cases worldwide has touched 11 million, according to the latest data by the Johns Hopkins University on Saturday.
More than 523,613 people have died globally due to the infection, according to the data compiled by the university.

Though the virus is believed to have emerged from the Chinese city of Wuhan, the United States is the worst-hit country from COVID-19, which was declared as a pandemic by the WHO on March 11.

At least 129,275 people have died in the US from the coronavirus, according to Johns Hopkins University's latest tally.
There are at least 2,786,178 cases of the disease in the country. The US has the highest number of cases in the world.

The second worst-hit country is Brazil, which has reported 1,496,858 lakh cases. The country's death toll stands at 61,884.

The countries around the world including the US, India, Denmark, and Italy have started the process of lifting the lockdown by easing restrictions despite the number of cases continues to rise.

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News Network
May 8,2020

Washington, May 8: Four top Republican senators have urged US President Donald Trump to suspend all-new guest worker visas for 60 days and some of its categories, including the H-1B visa, for at least the next year or until unemployment figures return to normal levels in the country.

The unemployment figures in the US have reached an all-time high due to the coronavirus pandemic. The letter has been signed by Senators Ted Cruz, Tom Cotton, Chuck Grassley and Josh Hawley.

"As you know, more than 33 million Americans have filed for unemployment coverage just since mid-March, and approximately one-fifth of the American workforce is currently out of work. This is a stunning difference compared with the historically-low nationwide unemployment rate of just 3.5 per cent in February this year," they said in their letter to the president on Thursday.

The letter, dated May 7, specifically calls for suspension of all non-immigrant guest worker visas for the next 60 days, followed by a continued suspension of certain categories of new non-immigrant guest worker visas for a year or until the national unemployment figures return to normal levels.

"To protect unemployed Americans in the early stages of economic recovery, we urge you to suspend all non-immigrant guest worker visas for the next 60 days," the senators said.

Exceptions to this suspension should be rare, limited to time-sensitive industries such as agriculture and issued only on a case-by-case basis, when the employers can demonstrate that they have been unable to find Americans to take the jobs, the senators wrote.

After 60 days, the senators urged Trump to continue to suspend new non-immigrant guest workers for a year or until the national unemployment figures return to normal levels, whichever comes first.

"That suspension should, at a minimum, include H-2B visas (non-agricultural seasonal workers), H-1B visas (specialty occupation workers) and the Optional Practical Training (OPT) program (extension of foreign student visas after graduation). We also urge you to suspend the EB-5 immigrant visa program, effective immediately," the lawmakers wrote.

The H-1B work visa for foreign technology professionals is highly popular among Indians and a large number of Indians also opt for the EB-5 investors visa.

The senators argued that there is no reason why unemployed Americans and recent college graduates should have to compete in such a limited job market against an influx of additional H-1B workers, most of whom work in business, technology or STEM fields.

"Temporarily suspending the issuance of new H-1B visas would also protect the hundreds of thousands of H-1B workers and their families already working in the United States -- workers who could otherwise be subject to deportation if they are laid off for more than 60 days," they said.

"Of course, appropriate exceptions could also be crafted to the H-1B program suspension to allow for doctors, nurses and other healthcare professionals who wish to come to the United States to assist in combating the coronavirus pandemic," the senators wrote.

Additionally, the United States ought to suspend its Optional Practical Training (OPT) programme, which allows foreign students in the country to extend their stay after graduation for one to three years to get "experience in the field" by taking jobs here, they wrote.

In 2019, more than 223,000 former foreign students had their OPT applications approved or extended. While the merits of such a programme are subject to debate, there is certainly no reason to allow foreign students to stay for three additional years just to take jobs that would otherwise go to unemployed Americans as the country's economy recovers, the lawmakers said.

The senators also urged Trump to remove the EB-5 visa from the exemptions in his Presidential Proclamation issued on April 22, at least until real reforms are adopted.

The EB-5 programme has long been plagued by scandal and fraud, and criticised as effectively functioning as a pay-for-citizenship scheme in many cases. There is no reason that the programme should receive preferential treatment as opposed to other green card programmes for employment-based immigrants, the lawmakers said.

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