Muslim woman sues US firm for rejecting job due to hijab

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."

Shanghai, Jan 27: The death toll from a coronavirus outbreak in China rose to 81 on Monday, as the government extended the Lunar New Year holiday and more big businesses shut down or told staff to work from home in an effort to curb the spread.

Chinese Premier Li Keqiang visited the central city of Wuhan, the epicenter of the outbreak, as the government sought to signal it was responding seriously to the crisis.

The total number of confirmed cases in China rose about 30% to 2,744, about half of them in Hubei province, whose capital is Wuhan.

As worries grew around the world, Chinese-ruled Hong Kong, which has had eight confirmed cases, banned entry to people who had visited Hubei in the past 14 days. The ban did not cover Hong Kong residents.

The number of deaths from the flu-like virus in Hubei climbed to 76 from 56, health officials said, with five deaths elsewhere in China, including the southern island province of Hainan, which reported its first fatality on Monday.

While a small number of cases have been confirmed in more than 10 countries, linked to people who traveled from Wuhan, no deaths have been reported elsewhere.

Li is the most senior leader to visit Wuhan since the outbreak began. Clad in a blue protective suit and mask, he inspected efforts to contain the epidemic and spoke to patients and medical staff, the government said.

The government is extending the week-long Lunar New Year holiday by three days to February 2, in a bid to slow the spread of the virus. The Lunar New Year is usually a time for millions of people to travel, but many have had to cancel their plans because of travel curbs over the virus.

Incubation

Wuhan is already in virtual lockdown and severe limits on movement are in place in several other Chinese cities.

The city of 11 million clamped down further on Monday, announcing the suspension of visa and passport services until January 30.

Despite the curbs, the mayor of Wuhan said on Sunday that five million people had left the city for holidays and other reasons.

Images from Wuhan showing hospital corridors packed with people seeking treatment have circulated on social media, along with complaints of soaring prices for essentials such as vegetables.

Chinese leaders have urged transparency in the crisis, after public trust was eroded by the cover-up of the spread of Severe Acute Respiratory Syndrome (SARS), a coronavirus that originated in China and killed nearly 800 people globally in 2002 and 2003.

Much is not known about the newly identified coronavirus, including how easily it spreads and just how dangerous it is. It can cause pneumonia, which has been deadly in some cases.

National Health Commission minister Ma Xiaowei said on Sunday the incubation period could range from one to 14 days, and the virus was infectious during incubation, unlike SARS.

That compares with a World Health Organization (WHO) estimate of two to 10 days for the incubation period.

“Understanding the time when infected patients may transmit the virus to others is critical for control efforts,” the WHO said.

The virus is believed to have originated late last year in a Wuhan market illegally selling wildlife. It has spread to other cities, including Beijing and Shanghai, as well as more than 10 countries including France, Japan and the United States.

‘Overwhelmed’

Australia confirmed its fifth case on Monday involving a woman on the last flight out of Wuhan to Sydney before China’s travel ban.

Health minister Greg Hunt told the Australian Broadcasting Corporation (ABC) authorities aimed to get about 100 Australian children and young people out of Wuhan.

One father of two, Nathan Wang, told the ABC his wife was stuck in Wuhan with the children. “We absolutely want the children to come back, because hospitals in Wuhan are overwhelmed,” he said.

Airports around the world have stepped up screening of passengers from China, although some health experts have questioned its effectiveness.

Last week the WHO stopped short of calling the outbreak a global health emergency, but some health experts question whether China can contain the epidemic.

WHO Director-General Tedros Adhanom Ghebreyesus is due to travel to Beijing to meet officials and health experts.

Australia, France, Italy, Japan and the United States have all said they are working to evacuate citizens from Wuhan.

Some of China’s biggest companies have been affected, with hotpot restaurant chain Haidilao International Holding shutting branches nationwide from Sunday until Friday.

Gaming giant Tencent Holdings Ltd advised staff to work from home until February 7, and e-commerce firm Alibaba removed vendors’ offers of overpriced face masks from its online Taobao marketplace as prices surged.