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
February 13,2020

Feb 13: Two Indian crew on board a cruise ship off the Japanese coast have tested positive for the novel coronavirus, the Indian Embassy in Japan said on Wednesday as authorities confirmed that 174 people have been infected with the deadly disease.

The cruise ship Diamond Princess with 3,711 people on board arrived at the Japanese coast early last week and was quarantined after a passenger who de-boarded last month in Hong Kong was found to be the carrier of the novel virus on the ship.

A total of 138 Indians, including passengers and crew, were on board the ship.

“Due to the suspicion of novel coronavirus (nCoV) infection, the ship has been quarantined by the Japanese authorities till February 19, 2020,” the embassy said in a statement.

“Altogether 174 people have been tested positive for nCoV, including two Indian crew members,” it said.

All the infected people have been taken to hospitals for adequate treatment, including further quarantine, in accordance with the Japanese health protocol, it said.

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Agencies
March 31,2020

Months after the outbreak of COVID-19 in Wuhan city of central China, families of those deceased, who contracted the contagious infection, stood in long queues at funeral homes demanding to receive the cremated ashes of their loved ones.

Now this has spurred questions about the actual tally of COVID-19 related casualties in Wuhan, in a renewed pressure on the Chinese government that is already struggling to control its containment narrative of the pandemic spread.

Chinese media outlet Caixin showed how trucks carrying 2,500 urns with the ashes of the deceased COVID-19 cases were being shipped in a funeral home last week. Another picture published revealed how 3,500 urns were stacked within these funeral homes. It is therefore unclear how many urns have been filled in.

According to media reports, workers at several funeral parlors declined to provide any details as to how many urns were waiting to be collected, saying they either did not know or were not authorised to share the number.

Some families said they had been forced to wait for several hours to pick up the ashes. The photos circulated as mass deaths from the virus spiked in cities across the west, including Milan, Madrid and New York, where hospitals were erecting tents to handle the overflow as global infections soar past 500,000, with 24,000 dead.

According to Chinese government figures, 2,535 people in Wuhan have died of the virus. The announcement that a lockdown in place since January would be lifted came after the country said its tally of new cases had hit zero and stepped up diplomatic outreach to other countries hard hit by the virus, sending some of them medical supplies.

But some in China have been skeptical of the accuracy of the official tally, particularly given Wuhan's overwhelmed medical system, authorities' attempts to cover up the outbreak in its initial stages, and multiple revisions to the way official cases are counted.

Residents on social media have demanded disciplinary action against top Wuhan officials.

Many people who died had Covid-19 symptoms, but weren't tested and excluded from the official case tally, Caixin said. There were also patients who died of other diseases due to a lack of proper treatment when hospitals were overwhelmed dealing with those who had the coronavirus.

There were 56,007 cremations in Wuhan in the fourth quarter of 2019, according to data from the city's civil affairs agency. The number of cremations was 1,583 higher than those in the fourth quarter of 2018 and 2,231 higher than the fourth quarter of 2017.

Two locals in Wuhan who have lost family members to the virus said online that they were informed they had to be accompanied by their employers or officials from neighborhood committees when picking up the urns, likely as a measure against public gatherings.

COVID-19 is affecting 199 countries and territories around the world. Over 664,000 coronavirus cases have been registered globally out of which 30,890 have succumbed to the infection.

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News Network
July 3,2020

Jul 3: China under President Xi Jinping has stepped up its "aggressive" foreign policy toward India and "resisted" efforts to clarify the Line of Actual Control that prevented a lasting peace from being realised, according to a report released by a US Congress appointed commission.

The armies of India and China have been locked in a bitter standoff at multiple locations in eastern Ladakh for the last seven weeks, and the tension escalated after 20 Indian soldiers were killed in a violent clash in the Galwan Valley on June 15.

“Under General Secretary of the Chinese Communist Party (CCP) Xi Jinping, Beijing has stepped up its aggressive foreign policy toward New Delhi. Since 2013, China has engaged in five major altercations with India along the Line of Actual Control (LAC),” said a brief issued by US-China Economic and Security Review Commission.

"Beijing and New Delhi have signed a series of agreements and committed to confidence-building measures to stabilise their border, but China has resisted efforts to clarify the LAC, preventing a lasting peace from being realised,” said the report and was prepared at the request of the Commission to support its deliberations.

Authored by Will Green, a Policy Analyst on the Security and Foreign Affairs Team at the Commission, the report says that the Chinese government is particularly fearful of India’s growing relationship with the United States and its allies and partners.

“The latest border clash is part of a broader pattern in which Beijing seeks to warn New Delhi against aligning with Washington,” it said.

After Xi assumed power in 2012, there was a significant increase in clashes, despite the fact that he met Prime Minister Narendra Modi several times and Beijing and New Delhi have agreed to a series of confidence-building mechanisms designed to mitigate tensions.

Prior to 2013, the last major border clash was in 1987. The 1950s and 1960s were a particularly tense period, culminating in 1962 with a war that left thousands of soldiers dead on both sides, according to the records of China's People's Liberation Army, the report said.

“The 2020 skirmish is in line with Beijing’s increasingly assertive foreign policy. The clash came as Beijing was aggressively pressing its other expansive sovereignty claims in the Indo-Pacific region, such as over Taiwan and in the South and East China seas,” it said.

China is engaged in hotly contested territorial disputes in both the South China Sea and the East China Sea. Beijing has built up and militarised many of the islands and reefs it controls in the region. Both areas are stated to be rich in minerals, oil and other natural resources and are vital to global trade.

China claims almost all of the South China Sea. Vietnam, the Philippines, Malaysia, Brunei and Taiwan have counter claims over the area.

Several weeks before the clash in the Galwan Valley, Chinese Defence Minister Wei Fenghe called on Beijing to “use fighting to promote stability” as the country’s external security environment worsened, a potential indication of China’s intent to proactively initiate military tensions with its neighbours to project an image of strength, the report said.

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