‘Risk of spreading’: Chinese city sounds alert for bubonic plague

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."

Houston, Mar 15: Researchers, studying the novel coronavirus, have found that the time between cases in a chain of transmission is less than a week, and over 10 per cent of patients are infected by someone who has the virus, but does not show symptoms yet, a finding that may help public health officials contain the pandemic.

The study, published in the journal Emerging Infectious Diseases, estimated what's called the serial interval of the coronavirus by measuring the time it takes for symptoms to appear in two people with the virus -- the person who infects another, and the infected second person.

According to the researchers, including those from the University of Texas at Austin, the average serial interval for the novel coronavirus in China was approximately four days.

They said the speed of an epidemic depends on two things -- how many people each case infects, and how long it takes cases to spread.

The first quantity, the scientists said, is called the reproduction number, and the second is the serial interval.

Due to the short serial interval of the disease caused by the coronavirus -- COVID-19 -- they said, emerging outbreaks will grow quickly, and could be difficult to stop.

“Ebola, with a serial interval of several weeks, is much easier to contain than influenza, with a serial interval of only a few days,” said Lauren Ancel Meyers, study co-author from UT Austin.

Meyers explained that public health responders to Ebola outbreaks have much more time to identify and isolate cases before they infect others.

“The data suggest that this coronavirus may spread like the flu. That means we need to move quickly and aggressively to curb the emerging threat,” Meyers added.

In the study, the scientists examined more than 450 infection case reports from 93 cities in China, and found the strongest evidence yet that people without symptoms must be transmitting the virus -- known as pre-symptomatic transmission.

More than one in ten infections were from people who had the virus but did not yet feel sick, the scientists said.

While researchers across the globe had some uncertainty until now about asymptomatic transmission with the coronavirus, the new evidence could provide guidance to public health officials on how to contain the spread of the disease.

“This provides evidence that extensive control measures including isolation, quarantine, school closures, travel restrictions and cancellation of mass gatherings may be warranted,” Meyers said.

The researchers cautioned that asymptomatic transmission makes containment more difficult.

With hundreds of new cases emerging around the world every day, the scientists said, the data may offer a different picture over time.

They said infection case reports are based on people's memories of where they went and whom they had contact with, and if health officials move quickly to isolate patients, that may also skew the data.

“Our findings are corroborated by instances of silent transmission and rising case counts in hundreds of cities worldwide. This tells us that COVID-19 outbreaks can be elusive and require extreme measures,” Meyers said.

United Nations, Jun 6: US President Donald Trump’s response to protests against the killing of African-American George Floyd has included language “directly associated with racial segregationists” from America's past, a group of UN human rights experts have said.

There have been widespread protests across the United States as Floyd, 46, was killed by a white police officer in Minneapolis. People from diverse backgrounds have called for justice and have voiced their support to the protests.

In the wake of protests over the killing of Floyd, Trump had tweeted that “when the looting starts, the shooting starts.”

“The response of the President of the United States to the protests at different junctures has included threatening more state violence using language directly associated with racial segregationists from the nation’s past, who worked hard to deny black people fundamental human rights," a statement issued on Friday by over 60 independent experts of the Special Procedures of the United Nations Human Rights Council said.

"We are deeply concerned that the nation is on the brink of a militarised response that reenacts the injustices that have driven people to the streets to protest,” it said.

A report in The New York Times had said that the phrase "When the looting starts, the shooting starts” was used by Miami’s former police chief Walter Headley in 1967. Headley had been “long accused of using racist tactics in his force’s patrols of black neighbourhoods,” the NYT had said.

They said the recent killing of Floyd has shocked many in the world, “but it is the lived reality of black people across the United States. The uprising nationally is a protest against systemic racism that produces state-sponsored racial violence, and licenses impunity for this violence.”

They noted that following the recent spate of killings of African-Americans, many in the United States and abroad are finally acknowledging that “the problem is not a few bad apples” but instead the problem is the very way that economic, political and social life are structured in a country that prides itself in liberal democracy, and with the largest economy in the world.

Separately, 28 UN experts called on the US Government to take decisive action to address systemic racism and racial bias in the country's criminal justice system by launching independent investigations and ensuring accountability in all cases of excessive use of force by police.

“Exactly 99 years after the massacre in Tulsa, involving the killing of people of African descent and the massive loss of life, destruction of property and loss of wealth on ‘Black Wall Street’, African Americans continue to experience racial terror in state-sponsored and privately organised violence,” the experts said.

Strongly condemning the killings of Ahmaud Arbery, Breonna Taylor and George Floyd, the experts called for systemic reform and justice. “Given the track record of impunity for racial violence of this nature in the United States, Black people have good reason to fear for their lives.”

Taylor, a 25-year-old emergency medical technician was shot in her bed when police raided the wrong house; Arbery, 25, was fatally shot while jogging near his home by three white men who chased and cornered him; and Floyd was accused of using counterfeit currency in a store and died in the street while a white officer knelt on his neck and three others participated and observed.

“The origin story of policing in the United States of America starts with slave patrols and social control, where human property of enslavers was ‘protected’ with violence and impunity against people of African descent. In the US, this legacy of racial terror remains evident in modern-day policing,” the experts said.

The experts also raised concern about the police response to demonstrations in several US cities, termed by some the ‘Fed Up-rising’, that have been marked by violence, arbitrary arrest, militarisation and the detention of thousands of protesters. Reporters of colour have been targeted and detained, and some journalists have faced violence and harassment.

“Statements from the US Government inciting and threatening violence against protesters stand in stark contrast to calls for leniency and understanding which the Government had issued in the wake of largely white protests against COVID-19 restrictions on services like barbershops, salons, and spas,” the experts said.