China revises corona figures in Wuhan; death toll jumps to 4,632

Tehran, Feb 28: The coronavirus epidemic in Iran has cost 26 lives, the health ministry announced Thursday, with a vice president becoming the latest top official to be infected as the spread appeared to accelerate.

Health ministry spokesman Kianoush Jahanpour told a news conference that the tally of infections had risen to 245 with 106 more cases confirmed -- the highest number for a single day since Iran announced its first infections on February 19.

The Islamic republic has the highest death toll from the virus outside China, where COVID-19 first emerged.

Among the latest coronavirus sufferers is one of Iran's seven vice presidents, Massoumeh Ebtekar, who oversees women's affairs.

Ebtekar, a former spokeswoman for students who took 52 Americans hostage at the US embassy in Tehran in 1979, is being treated at home and members of her team have been tested, state news agency IRNA reported.

Mojtaba Zolnour, head of parliament's national security and foreign affairs committee, also contracted the virus, appearing in a video posted by Fars news agency saying he was in self-quarantine.

The cleric is a deputy for the Shiite holy city of Qom in central Iran where the country's first cases were detected.

According to media reports, among the deceased in Qom on Thursday was theologian Hadi Khroroshahi, who in 1981 was named Iran's first ambassador to the Vatican.

The announcement by Zolnour comes two days after another top official, deputy health minister Iraj Harirchi, head of the government's coronavirus task force, said he too had contracted the virus.

On Wednesday, Iranian authorities announced domestic travel restrictions for people with confirmed or suspected infections.

They also placed curbs on access to major Shiite pilgrimage sites, including the Imam Reza shrine in second city Mashhad and the Fatima Masumeh shrine in Qom.

Visitors to the shrines will be allowed to visit on condition they are provided "with hand-washing liquids, proper (health) information, masks", Health Minister Saeed Namaki said.

They must "not gather together in groups but just pray and leave", he said.

In a rare move, authorities announced the cancellation of the main Friday weekly prayers in Tehran, Qom and Mashhad as well as in the capitals of 22 of Iran's 31 provinces and other infected areas.

"All of these decisions are temporary and if the situation changes, we might intensify or ease them," Namaki said.

London, May 3: The British government had a contingency plan for prime minister Boris Johnson’s death as his condition deteriorated while he battled COVID-19 last month in intensive care, Johnson said in an interview with The Sun newspaper.

Johnson returned to work on Monday, a month after testing positive for COVID-19. Johnson, 55, spent 10 days in isolation in Downing Street from late March, but was then was taken to London’s St Thomas’ Hospital where he received oxygen treatment and spent three nights in intensive care.

“They had a strategy to deal with a ‘death of Stalin’-type scenario,” Johnson, 55, was quoted as saying by The Sun. “It was a tough old moment, I won’t deny it.”

After Johnson was discharged, St Thomas’ said it was glad to have cared for the prime minister, but the hospital has given no details about the gravity of his illness beyond stating that he was treated in intensive care.

Johnson and his fiancée, Carrie Symonds, on Saturday announced the name of their newly born son as Wilfred Lawrie Nicholas, partly as a tribute to two of the intensive care doctors who they said had saved Johnson’s life.

“The doctors had all sorts of arrangements for what to do if things went badly wrong,” Johnson said of his COVID-19 battle. “The bloody indicators kept going in the wrong direction.”

He said doctors discussed invasive ventilation.

“The bad moment came when it was 50-50 whether they were going to have to put a tube down my windpipe,” he said. “That was when it got a bit . . . they were starting to think about how to handle it presentationally.”

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."