Los Angeles becomes first US city to offer free COVID-19 testing for all

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."

Washington DC, Jul 7: With US President Donald Trump promoting re-opening the economy, the country has now four epicentres of coronavirus instead of one -- Los Angeles, cities in Texas, cities in Florida and Arizona. This has led to the governors fearing that their hospitals could be overrun with patients.

"We are right back where we were at the peak of the epidemic during the New York outbreak...The difference now is that we really had one epicentre of spread when New York was going through its hardship. Now, we really have four major epicentres of spread -- Los Angeles, cities in Texas, cities in Florida and Arizona. Florida looks to be in the worst shape," Scott Gottlieb, former Food and Drug Administration commissioner was quoted by The Washington Post as saying in an interview.

As per the latest data, Florida, New York and California have crossed the 200,000 mark of coronavirus cases.

After Texas continued to break its own record of registering the highest number of coronavirus cases, Austin Mayor Steve Adler (D) was quoted as saying in an interview, "If we do not change this trajectory, then I am within two weeks of having our hospitals overrun."

He further said that intensive care units in the city will start overflowing within 10 days.

Echoing similar sentiments, Judge Lina Hidalgo, the top elected official in Harris County, said, "As long as we're doing as little as possible and hoping for the best, we are always going to be chasing this thing. We are always going to be behind and the virus will always outrun us...And so what we need right now is to do what works, which is a stay-home order."

She was stripped of authority to issue stay-at-home orders after Governor Greg Abbott decided to move forward with the reopening plan.

"It is clear that the (coronavirus) growth is exponential at this point...We have been breaking record after record after record... the last couple of weeks," Miami Mayor Francis Suarez was quoted as saying in an interview.

"The city of Miami was the last city in the entire state of Florida to open. I was criticized for waiting so long. But there is no doubt that the fact that when we reopened, people started socialising as if... the virus didn't exist."

He further said that if the numbers do not begin to fall "more drastic measures" will be taken in the coming week.

As per the latest update by the Johns Hopkins University, a total of 2,938,625 people in the US have tested coronavirus positive and 130,306 deaths have been reported so far.

Jun 24: The coronavirus tally in Pakistan reached 188,926 with the detection of 3,892 new cases in the last 24 hours, the health ministry said on Wednesday.

Sixty more people died due to the viral infection, taking the death toll to 3,755.

As many as 3,337 patients are in critical condition across the country, the ministry said.

With the detection of 3,892 new cases in the last 24 hours, the coronavirus tally in the country now stands at 188,926, it said.

Sindh reported the maximum number of 72,656 cases, followed by 69,536 in Punjab, 23,388 in Khyber-Pakhtunkhwa, 11,483 in Islamabad, 9,634 in Balochistan, 1,337 in Gilgit-Baltistan and 892 in Pakistan-occupied Kashmir (Pok).

Health authorities have so far conducted 1,150,141 coronavirus tests, including 23,380 in the last 24 hours.

A total of 77,754 patients have recovered so far from the disease.