Will have to take military way if India doesn't listen, warns China

Beijing/Wuhan, Apr 17: China's coronavirus death toll mounted to 4,632 on Friday as the country revised figures in its epicentre Wuhan with 1,290 additional fatalities amid international criticism of under-reporting of COVID-19 data.

The Wuhan municipal headquarters on Friday revised the number of confirmed COVID-19 cases and deaths due to the disease, state-run Xinhua news agency reported.

As of April 16, the total number of confirmed coronavirus cases in Wuhan was increased by 325 to 50,333 and the number of fatalities up by 1,290 to 3,869.

The revised figure raised China's overall COVID-19 death toll to 4,632. The total number of cases also increased to 82,692.

The Wuhan municipal headquarters in a notification said the revisions were made in accordance with related laws and regulations as well as the principle of being responsible for history, the people and the deceased.

The revision of figures came amid sharp criticism of China by the US and other nations for its alleged under-reporting of the coronavirus cases and cover-up of the origin of the viral strain, which emerged in Wuhan in December last, reportedly from the local Hunan sea food market.

Explaining the reason for the figure revision, the Wuhan municipality said it was done to ensure that the information on the city's COVID-19 epidemic is open and transparent, and that the data are accurate.

Listing the reasons for the data discrepancies, it said the surging number of patients at the early stage of the epidemic overwhelmed medical resources and the admission capacity of medical institutions. Some patients died at home without having been treated in hospitals.

Besides, during the height of their treating efforts, hospitals were operating beyond their capacities and medical staff were preoccupied with saving and treating patients, resulting in belated, missed and mistaken reporting.

Also, due to a rapid increase of designated hospitals for treating COVID-19 patients -- including those administered by ministries, Hubei Province, Wuhan city and its districts, those affiliated to companies, as well as private hospitals and makeshift hospitals -- a few medical institutions were not linked to the epidemic information network and failed to report their data in time.

The registered information of some of the deceased patients was incomplete, and there were repetitions and mistakes in the reporting, the Wuhan authorities noted.

Citing an official of the Wuhan municipal headquarters, Xinhua reported that a group for epidemic-related big data and epidemiological investigations was established in late March.

The group used information from online systems and collected full information from all epidemic-related locations to ensure that facts about every case are accurate and every figure is objective and correct.

"What lie behind the epidemic data are the lives and health of the general public, as well as the credibility of the government," the official was quoted by the report.

The timely revision of the figures, among other things, shows respect for every single life, the official said.

Meanwhile, the revised cases were not included in the overall national figures released by China's National Commission (NHC) in its daily report on Friday as it reports previous day's cases.

As per NHC data, as of Thursday the overall confirmed cases of coronavirus was 82,367, including 3,342 deaths.

As many as 1,081 patients are being treated and 77,944 people discharged after recovery, it said.

NHC said it received reports of 26 new confirmed COVID-19 cases from the mainland on Thursday, of which 15 were imported.

The other 11 new cases were domestically transmitted, it said, noting that five cases were reported in Guangdong Province, three in Heilongjiang Province, two in Shandong Province and one in Liaoning Province.

No death was reported on Thursday on the mainland.

As of Thursday, China has a total of 1,549 imported cases, NHC said, adding that 879 were undergoing treatment with 45 in severe condition. Besides, there were 66 new asymptomatic cases, taking the tally to 1,038.

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.

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."