Teenager dies after suspected ice bucket challenge goes horribly wrong

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."

Wuhan, Apr 15: In the six days after top Chinese officials secretly determined they likely were facing a pandemic from a new coronavirus, the city of Wuhan at the epicenter of the disease hosted a mass banquet for tens of thousands of people; millions began traveling through for Lunar New Year celebrations.

President Xi Jinping warned the public on the seventh day, Janaury 20. But by that time, more than 3,000 people had been infected during almost a week of public silence, according to internal documents obtained by The Associated Press and expert estimates based on retrospective infection data.

That delay from Jan 14 to Jan. 20 was neither the first mistake made by Chinese officials at all levels in confronting the outbreak, nor the longest lag, as governments around the world have dragged their feet for weeks and even months in addressing the virus.

But the delay by the first country to face the new coronavirus came at a critical time — the beginning of the outbreak. China's attempt to walk a line between alerting the public and avoiding panic set the stage for a pandemic that has infected almost 2 million people and taken more than 126,000 lives.

A This is tremendous, a said Zuo-Feng Zhang, an epidemiologist at the University of California, Los Angeles. If they took action six days earlier, there would have been much fewer patients and medical facilities would have been sufficient. We might have avoided the collapse of Wuhan's medical system.

Other experts noted that the Chinese government may have waited on warning the public to stave off hysteria, and that it did act quickly in private during that time.

But the six-day delay by China's leaders in Beijing came on top of almost two weeks during which the national Center for Disease Control did not register any cases from local officials, internal bulletins obtained by the AP confirm. Yet during that time, from Jan 5 to Jan 17, hundreds of patients were appearing in hospitals not just in Wuhan but across the country.

It's uncertain whether it was local officials who failed to report cases or national officials who failed to record them. It's also not clear exactly what officials knew at the time in Wuhan, which only opened back up last week with restrictions after its quarantine.

But what is clear, experts say, is that China's rigid controls on information, bureaucratic hurdles and a reluctance to send bad news up the chain of command muffled early warnings. The punishment of eight doctors for rumor-mongering, broadcast on national television on Jan. 2, sent a chill through the city's hospitals.

Doctors in Wuhan were afraid, said Dali Yang, a professor of Chinese politics at the University of Chicago. It was truly intimidation of an entire profession. Without these internal reports, it took the first case outside China, in Thailand on Jan 13, to galvanize leaders in Beijing into recognising the possible pandemic before them. It was only then that they launched a nationwide plan to find cases distributing CDC-sanctioned test kits, easing the criteria for confirming cases and ordering health officials to screen patients, all without telling the public.

The Chinese government has repeatedly denied suppressing information in the early days, saying it immediately reported the outbreak to the World Health Organization.

Allegations of a cover-up or lack of transparency in China are groundless, said foreign ministry spokesman Zhao Lijian at a Thursday press conference.

The documents show that the head of China's National Health Commission, Ma Xiaowei, laid out a grim assessment of the situation on Jan. 14 in a confidential teleconference with provincial health officials.

A memo states that the teleconference was held to convey instructions on the coronavirus from President Xi Jinping, Premier Li Keqiang and Vice Premier Sun Chunlan, but does not specify what those instructions were.

The epidemic situation is still severe and complex, the most severe challenge since SARS in 2003, and is likely to develop into a major public health event, the memo cites Ma as saying.

The National Health Commission is the top medical agency in the country. In a faxed statement, the Commission said it had organised the teleconference because of the case reported in Thailand and the possibility of the virus spreading during New Year travel. It added that China had published information on the outbreak in an open, transparent, responsible and timely manner," in accordance with important instructions repeatedly issued by President Xi.

The documents come from an anonymous source in the medical field who did not want to be named for fear of retribution. The AP confirmed the contents with two other sources in public health familiar with the teleconference. Some of the memo's contents also appeared in a public notice about the teleconference, stripped of key details and published in February.

Under a section titled sober understanding of the situation, the memo said that clustered cases suggest that human-to-human transmission is possible. It singled out the case in Thailand, saying that the situation had changed significantly because of the possible spread of the virus abroad.

With the coming of the Spring Festival, many people will be traveling, and the risk of transmission and spread is high, the memo continued.

Apr 29: US President Donald Trump doubled down on China for failing to tame the coronavirus at its very origin, saying it has led to 184 countries "going through hell", as several American lawmakers demanded steps to reduce dependence on Beijing for manufacturing and minerals.

Trump has been publicly blaming China for the global spread of the "invisible enemy" and launched an investigation against it. He has also indicated that the US may be looking at "a lot more money" in damages from China than the USD 140 billion being sought by Germany from Beijing for the pandemic.

Leaders of the US, the UK and Germany believe that the deaths and the destruction of the global economy could have been avoided, had China shared the information about the virus in its early phases.

"It's in 184 countries, as you hear me say often. It's hard to believe. It's inconceivable," Trump told reporters at White House Tuesday. "It should have been stopped at the source, which was China. It should have been stopped very much at the source, but it wasn't. And now we have 184 countries going through hell.”

The virus, which originated in China's Wuhan city in mid-November, has killed more than two lakh people and infected over three million globally. The largest number of them are in the US: nearly 59,000 deaths and over one million infections.

The massive outbreak in the US has put Trump under increasing pressure from American lawmakers to decrease US dependence on Beijing and they have also sought compensation from China.

Senator Ted Cruz and his colleagues have urged Defence Secretary Mark Esper and Interior Secretary David Bernhardt to support the development of a fully domestic supply chain of rare earths and other minerals that are critical for manufacturing defence technologies and supporting national security.

“It is clear that our dependence on China for vital rare earths threatens our US manufacturing and defence-industrial base. As the October 2018 Defence Industrial Base Report states: ‘China represents a significant and growing risk to the supply of materials deemed strategic and critical to US national security.' [...] Ensuring a US supply of domestically sourced rare earths will reduce our vulnerability to supply disruptions that poses a grave risk to our military readiness," the Senators wrote.

The US is 100 percent import-dependent for rare earths as well as 13 other metals and minerals on the US Government Critical Minerals List and more than 75 percent import reliant for an additional 10 minerals.

Congressman Brian Mast on Tuesday introduced a legislation to hold China accountable for its "coronavirus deception". The resolution would empower the US to withhold payments on debts owed to China equal to the costs incurred by the US in response to COVID-19.

“China's total lack of transparency and mishandling of the coronavirus outbreak has cost tens of thousands of lives, millions of jobs and left untold economic destruction. Congress must hold China accountable for their cover-up and force them to pay back the taxpayer dollars that have been spent as a result,” Mast said.

Cruz, member of the Senate Foreign Relations Committee, announced his intention to introduce a legislation to cut off Hollywood studios from assistance they receive from the Department of Defence if those studios censor their films for screening in China.

This legislation is part of Sen. Cruz's comprehensive push to combat China's growing influence over what Americans see and hear, which includes legislation targeting information warfare from the Chinese Communist Party across higher education, sports, films, radio broadcasts, and more.

Indian-American Congressman Ami Bera and Congressman Ted S. Yoho, both members of the House Foreign Affairs Committee, will lead a bipartisan virtual Special Order to highlight the importance of US global leadership during the COVID-19 pandemic.

“If we abdicate our place as a leader in global health, there is another country eager to take the reins. China has not been subtle in asserting itself on global health issues, and often not for the benefit of other nations. China's recent coronavirus debacle should be evidence enough that their communist regime cannot be trusted to lead with accountability, transparency, or pragmatism, traits that are essential when fighting widespread disease,” Yoho said.

“As for how China would fare as a global health leader, look no further than the disastrous initial response by the WHO to coronavirus, one that was clearly influenced by Beijing. Information was slow-walked, warnings from nations like Taiwan were ignored at crucial turning points, and cooperation with outside health experts was spurned until it was too late. And it has resulted in the largest public health disaster the world has seen in over a century,” he said.

In an interview to Fox News, Senator Marco Rubio alleged that if China had acted when those warnings were being made, instead of silencing the people that were talking about it, they could have limited the spread.

“So there was no doubt that that was a deliberate decision made on their part. The one way to hold them accountable is to do what we should be doing anyway. That is moving the means of production to become less and less dependent upon them. What you're going to see after this pandemic is that more and more countries are going to prioritize their healthcare manufacturing capabilities and other industries,” he said.