Sri Lanka lifts state of emergency as communal tensions subside

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."

Berlin, Mar 28: The number of confirmed coronavirus infections worldwide topped 600,000 on Saturday as new cases stacked up quickly in Europe and the United States and officials dug in for a long fight against the pandemic.

The latest landmark came only two days after the world passed half a million infections, according to a tally by John Hopkins University, showing that much work remains to be done to slow the spread of the virus. It showed more than 602,000 cases and a total of over 27,000 deaths.

While the U.S. now leads the world in reported infections — with more than 104,000 cases — five countries exceed its roughly 1,700 deaths: Italy, Spain, China, Iran and France.

“We cannot completely prevent infections at this stage, but we can and must in the immediate future achieve fewer new infections per day, a slower spread,” German Chancellor Angela Merkel, who is in quarantine at home after her doctor tested positive for the virus, told her compatriots in an audio message. “That will decide whether our health system can stand up to the virus.”

The virus already has put health systems in Italy, Spain and France under extreme strain. Lockdowns of varying severity have been introduced across Europe. Merkel's chief of staff, Helge Braun, said that Germany — where authorities closed nonessential shops and banned gatherings of more than two in public — won't relax its restrictions before April 20.

As the epicenter has shifted westward, the situation has calmed in China, where some restrictions on people's lives have now been lifted. Six subway lines restored limited service in Wuhan, where the virus first emerged in December, after the city had its official coronavirus risk evaluation downgraded from high to medium on Friday. Five districts of the city of 11 million people had other restrictions on travel loosened after their risk factor was downgraded to low.

For most people, the coronavirus causes mild or moderate symptoms, such as fever and cough that clear up in two to three weeks. But for others, especially older adults and people with existing health problems, the virus can cause more severe illness, including pneumonia, and lead to death.

More than 130,000 people have recovered, according to Johns Hopkins' tally.

In one way or another, the effects of the COVID-19 outbreak have been felt by the powerful and the poor alike.

On Friday, British Prime Minister Boris Johnson became the first leader of a major country to test positive for the virus. He said he would continue to work from self-quarantine.

Countries are still scrambling bring home some citizens stranded abroad by border closures and a near-shutdown of flights. On Saturday, 174 foreign tourists and four Nepali nationals on the foothills of Mount Everest were flown out days after being stranded on the only airstrip serving the world's highest mountain.

In neighboring India, authorities sent a fleet of buses to the outskirts of the capital to meet an exodus of migrant workers desperately trying to reach their home villages during the world's largest lockdown.

Thousands of people, mostly young male day laborers but also families, had fled their New Delhi homes after Prime Minister Narendra Modi announced a 21-day lockdown that began on Wednesday and effectively put millions of Indians who live off daily earnings out of work.

In a possibly hopeful sign, the U.S. Food and Drug Administration cleared a new rapid test from Abbott Laboratories, which the company says can detect the coronavirus in about 5 minutes. Medical device maker Abbott announced the emergency clearance of its cartridge-based test Friday night, saying the test delivers a negative result in 13 minutes when the virus is not detected.

While New York remained the worst-hit city in the U.S., Americans braced for worsening conditions elsewhere, with worrisome infection numbers being reported in New Orleans, Chicago and Detroit.

New Orleans’ sprawling Ernest N. Morial Convention Center, along the Mississippi River, was being converted into a massive hospital as officials prepared for thousands more patients than they could accommodate.

In New York, where there are more than 44,000 cases statewide, the number of people hospitalized with COVID-19 passed 6,000 on Friday, double what it had been three days earlier.

Gov. Andrew Cuomo called for 4,000 more temporary beds across New York City, where the Jacob K. Javits Convention Center has already been converted into a hospital.

The struggle to defeat the virus will take “weeks and weeks and weeks,” Cuomo told members of the National Guard working at the Javits Center.

President Donald Trump invoked the Defense Production Act on Friday, ordering General Motors to begin manufacturing ventilators. Trump had previously rejected Cuomo's pleas for tens of thousands more of the machines and the governor's calls to implement the Korean War-era production law.

Trump signed a $2.2 trillion stimulus package, after the House approved the sweeping measure by voice vote. Lawmakers in both parties lined up behind the law to send checks to millions of Americans, boost unemployment benefits, help businesses and toss a life preserver to an overwhelmed health care system.

Dr. John Brooks of the U.S. Centers for Disease Control and Prevention warned Americans remained “in the acceleration phase” of the pandemic and that all corners of the country were at risk.

"There is no geographic part of the United States that is spared from this," he said.