10 dead as Taliban storm Pakistan airport

Jun 13: Requiring the wearing of masks to prevent the spread of the novel coronavirus in areas at the epicenter of the global pandemic may have prevented tens of thousands of infections, a new study suggests.

Mask-wearing is even more important for preventing the virus' spread and the sometimes deadly COVID-19 illness it causes than social distancing and stay-at-home orders, researchers said, in the study published in PNAS: The Proceedings of the National Academy of Sciences of the USA.

Infection trends shifted dramatically when mask-wearing rules were implemented on April 6 in northern Italy and April 17 in New York City - at the time among the hardest hit areas of the world by the health crisis - the study found.

"This protective measure alone significantly reduced the number of infections, that is, by over 78,000 in Italy from April 6 to May 9 and over 66,000 in New York City from April 17 to May 9," researchers calculated.

When mask-wearing went into effect in New York, the daily new infection rate fell by about 3% per day, researchers said. In the rest of the country, daily new infections continued to increase.

Direct contact precautions - social distancing, quarantine and isolation, and hand sanitizing - were all in place before mask-wearing rules went into effect in Italy and New York City. But they only help minimize virus transmission by direct contact, while face covering helps prevent airborne transmission, the researchers say.

"The unique function of face covering to block atomization and inhalation of virus-bearing aerosols accounts for the significantly reduced infections," they said. That would indicate "that airborne transmission of COVID-19 represents the dominant route for infection."

The U.S. Center for Disease Control and Prevention on Friday urged organizers of large gatherings that involve "shouting, chanting or singing to strongly encourage the use of cloth face coverings to lower the risk of spreading the coronavirus."

Lahore, Jul 10: The Punjab government enforced smart lockdown in seven cities of the province for 15 days with an immediate effect from Thursday night, The News International reported.

The Primary and Secondary Healthcare Department on Thursday issued a notification under the Punjab Infectious Diseases Ordinance 2020, about enforcement of lockdown in Lahore, Multan, Faisalabad, Gujranwala, Sialkot, Gujrat and Rawalpindi, till July 24 midnight.

In Lahore, the lockdown will be enforced in A2 Block Township, EME Society, Main Bazaar Chungi Amr Sadhu, Punjab Government Servants Housing Scheme, Wapda Town, C-Block Jauhar Town and Green City.

The basic necessities of life will remain available in smart lockdown areas. "The purpose of the smart lockdown is to minimise movement of people in hotspots of positive coronavirus cases," said Capt (retd) Muhammad Usman, Secretary, Primary and Secondary Healthcare Department.

The country registered 2,751 new COVID-19 cases during the last 24 hours, taking the tally to 243,599 on Friday. The province-wise breakup includes 85,261 cases in Punjab, 100,900 cases in Sindh, 29,406 in Khyber Pakhtunkhwa, 11,099 in Balochistan, 13,829 in Islamabad, 1,619 in Gilgit-Baltistan and 1,485 in Pakistan-occupied Kashmir.

The death toll due to the virus reached 5,058 with 75 more deaths reported over the last 24 hours, as per data cited by Radio Pakistan.

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."