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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Agencies
February 23,2020

Wuhan, Feb 23: Ninety-seven more people died in China due to coronavirus, taking the death toll to 2,442, officials said on Sunday, as a team of WHO experts visited the worst-affected Wuhan city in Hubei province.

By the end of Saturday, a total of 2,442 people had died of the disease and 76,936 confirmed cases of novel coronavirus infection had been reported in 31 provincial-level regions, China's National Health Commission (NHC) said in its daily update on Sunday.

Ninety-six deaths were reported from Hubei province and one from Guangdong province on Saturday besides 648 new confirmed cases of coronavirus infections, it said.

Hubei province, where the virus first emerged in December last, reported 630 new confirmed cases, taking the total confirmed cases in the hard-hit province to 64,084, state-run Xinhua news agency reported.

The NHC also said China's daily number of newly cured and discharged novel coronavirus patients has surpassed that of new confirmed infections for the fifth consecutive day, indicating that cases of infections are coming down.

Saturday saw 2,230 people walk out of hospital after recovery, much higher than the number of the same day's new confirmed infections, which was 648, Xinhua reported.

A total of 22,888 patients infected with the novel coronavirus had been discharged from hospital after recovery by the end of Saturday, NHC said.

Meanwhile, a team of public health experts from the World Health Organisation (WHO) visited Wuhan on Saturday to conduct a detailed probe about the virus which reportedly originated from a seafood market in the city in December last year.

The NHC said WHO experts along with their Chinese counterparts who formed a joint investigation team have held talks with the local health authority in Wuhan and visited relevant healthcare institutions.

The UN team comprises specialists from the United States, Germany, Japan, Nigeria, Russia, Singapore and South Korea, Hong-Kong based South China Morning Post reported.

The 12-member team, which arrived in China on Monday, was initially designated to visit only Beijing, Guangdong and Sichuan provinces, while the worst-affected Hubei province and its capital Wuhan were missing from the list.

However, the team was finally given permission to visit Wuhan by the Chinese government.

Besides controlling the spread of the virus, a major task for the WHO team along with their Chinese counterparts was to come up with standard medicine to cure the disease.

The NHC said on Saturday that the team had met top Chinese respiratory disease expert Zhong Nanshan in Guangdong, and visited the centre for disease control and prevention in Guangdong and the city of Shenzhen, and Sichuan.

The specialists also discussed quarantine measures, the wild animal trade and community prevention measures with their Chinese counterparts, it said.

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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.

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News Network
June 15,2020

Stockholm, Jun 15: Nuclear powers continue to modernise their arsenals, researchers said Monday, warning that tensions were rising and the outlook for arms control was "bleak".

"The loss of key channels of communication between Russia and the USA... could potentially lead to a new nuclear arms race," said Shannon Kile, director of the nuclear arms control programme at the Stockholm International Peace Research Institute (SIPRI) and co-author of the report.

Russia and the US account for more than 90 percent of the world's nuclear weapons.

Kile was referring to the future of the New START treaty between the US and Russia, which is set to expire in February 2021.

It is the final nuclear deal still in force between the two superpowers, aimed at maintaining their nuclear arsenals below Cold War levels.

"Discussions to extend New START or to negotiate a new treaty made no progress in 2019," the SIPRI researchers noted.

At the same time, nuclear powers continue to modernise their weapons while China and India are increasing the size of their arsenals.

"China is in the middle of a significant modernisation of its nuclear arsenal. It is developing a so-called nuclear triad for the first time, made up of new land- and sea-based missiles and nuclear-capable aircraft," SIPRI said.

The country has repeatedly rejected Washington's insistence that it join any future nuclear arms reduction talks.

The number of nuclear warheads declined in the past year.

At the start of 2020, the United States, Russia, Britain, China, India, Pakistan, Israel and North Korea together had 13,400 nuclear arms, according to SIPRI's estimates, 465 fewer than at the start of 2019.

The decline was attributed mainly to the United States and Russia.

While the future of the New START treaty remains uncertain, Washington and Moscow have continued to respect their obligations under the accord.

"In 2019, the forces of both countries remained below the limits specified by the treaty," the report said. But both nations "have extensive and expensive programmes underway to replace and modernise their nuclear warheads, missile and aircraft delivery systems, and nuclear weapon production facilities," it added.

"Both countries have also given new or expanded roles to nuclear weapons in their military plans and doctrines, which marks a significant reversal of the post-Cold War trend towards the gradual marginalisation of nuclear weapons."

The Treaty on the Non-Proliferation of Nuclear Weapons (NPT), a cornerstone of the global nuclear non-proliferation regime, celebrates its 50th anniversary this year.

The number of nuclear arms worldwide has declined since hitting a peak of almost 70,000 in the mid-1980s.

The five original nuclear powers -- Washington, Beijing, Moscow, Paris and London -- in March reiterated their commitment to the treaty.

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