Covid death toll climbs to 1,90,000 worldwide, two thirds of fatalities from Europe

Washington, Apr 12: The US has overtaken Italy as the country with the highest number of deaths due to COVID-19 pandemic with the fatalities crossing 20,000, according to Johns Hopkins University data, as the novel coronavirus continues to wreak havoc across the globe.

The deadly coronavirus, that originated in China in December last year, has so far killed more than one lakh people across the globe. The United States on Saturday became the country with the highest number of deaths at 20,597, surpassing Italy's 19,468 fatalities.

More than 5.3 lakh Americans have tested positive for coronavirus, which is about the same for the next four countries put together: Spain (163,027), Italy (152,271), Germany (125,452) and France (93,790). In terms of fatalities, the US and Italy are followed by Spain (16,606), France (13832) and United Kingdom (9,875), the varsity data showed.

New York City, the financial capital of the world, has emerged as the epicenter of coronavirus in the world. A city of 8.3 million, which is one of the most densely populated cities in the US, by Saturday night had as many as 8,627 deaths and more than 180,000 people had tested positive for COVID-19.

President Donald Trump has declared a national emergency and all the 50 States have been notified with major disaster declaration. More than 95 per cent of the country's 330 million population are under stay-at-home order. Trump has deployed more than 50,000 personnel from the armed forces in fight against COVID-19.

After an initial two-week social mitigation measures, that includes social distancing, the measures have been extended till April 30. Initially, members of the White House Task Force on Coronavirus had projected between one and two lakhs deaths. Now, they have dropped the projection to 60,000 deaths, mainly due to the successful implementation of these measures.

"The people of our country have gone through a lot. But we did it the right way. And we look like we'll be coming in on the very, very low side, really below the lowest, the lowest side of the curve of death," Trump told Fox News on Saturday night.

Trump asserted that situation was improving in places like New York, where there is a drop in new patients. Responding to a question, he said he wanted the country to open up as soon as possible.

However, he has not taken a decision so far, even as some media reports said that he the President was looking for early May.

"I think it's going to be the toughest decision that I've ever made. I really, hopefully that I ever will have to make. But it's certainly the toughest decision that I've ever made. I hope that I'm going to make the right decision," Trump said, adding that he will be making a decision reasonably soon.

"We're setting up a council now of some of the most distinguished leaders in virtually every field including politics and business and medical. We'll be making that decision fairly soon," Trump said.

Meanwhile, The New York Times reported that its investigations have revealed that the president was warned about a potential pandemic but that internal divisions, lack of planning and his faith in his own instincts led to a halting response.

According to The Washington Post, coronavirus is killing about one in 10 hospitalised middle-aged patients and four in 10 older than 85 in the United States. It is particularly lethal to men even when taking into account common chronic diseases that exacerbate risk.

Globally, the novel coronavirus has killed 108,862 people and infected over 1.7 million people globally. The US has the highest number of infections at 529,887, according to Johns Hopkins University data.

Houston, Mar 15: Researchers, studying the novel coronavirus, have found that the time between cases in a chain of transmission is less than a week, and over 10 per cent of patients are infected by someone who has the virus, but does not show symptoms yet, a finding that may help public health officials contain the pandemic.

The study, published in the journal Emerging Infectious Diseases, estimated what's called the serial interval of the coronavirus by measuring the time it takes for symptoms to appear in two people with the virus -- the person who infects another, and the infected second person.

According to the researchers, including those from the University of Texas at Austin, the average serial interval for the novel coronavirus in China was approximately four days.

They said the speed of an epidemic depends on two things -- how many people each case infects, and how long it takes cases to spread.

The first quantity, the scientists said, is called the reproduction number, and the second is the serial interval.

Due to the short serial interval of the disease caused by the coronavirus -- COVID-19 -- they said, emerging outbreaks will grow quickly, and could be difficult to stop.

“Ebola, with a serial interval of several weeks, is much easier to contain than influenza, with a serial interval of only a few days,” said Lauren Ancel Meyers, study co-author from UT Austin.

Meyers explained that public health responders to Ebola outbreaks have much more time to identify and isolate cases before they infect others.

“The data suggest that this coronavirus may spread like the flu. That means we need to move quickly and aggressively to curb the emerging threat,” Meyers added.

In the study, the scientists examined more than 450 infection case reports from 93 cities in China, and found the strongest evidence yet that people without symptoms must be transmitting the virus -- known as pre-symptomatic transmission.

More than one in ten infections were from people who had the virus but did not yet feel sick, the scientists said.

While researchers across the globe had some uncertainty until now about asymptomatic transmission with the coronavirus, the new evidence could provide guidance to public health officials on how to contain the spread of the disease.

“This provides evidence that extensive control measures including isolation, quarantine, school closures, travel restrictions and cancellation of mass gatherings may be warranted,” Meyers said.

The researchers cautioned that asymptomatic transmission makes containment more difficult.

With hundreds of new cases emerging around the world every day, the scientists said, the data may offer a different picture over time.

They said infection case reports are based on people's memories of where they went and whom they had contact with, and if health officials move quickly to isolate patients, that may also skew the data.

“Our findings are corroborated by instances of silent transmission and rising case counts in hundreds of cities worldwide. This tells us that COVID-19 outbreaks can be elusive and require extreme measures,” Meyers 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."