Mysterious blood clots are COVID-19's latest lethal surprise

News Network
April 28, 2020

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."

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News Network
January 28,2020

Jan 28: China said on Tuesday that 106 people had died from a new coronavirus that is spreading across the country, up from the previous toll of 81.

The number of total confirmed cases in China rose to 4,515 as of Jan. 27, the National Health Commission said in a statement, up from 2,835 reported a day earlier.

The United States warned against travel to China on Monday and Canada issued a more narrow travel warning as the death toll from the spreading coronavirus passed 100, with tens of millions stranded during the biggest holiday of the year and global markets rattled.

Global stocks fell, oil prices hit three-month lows, and China's yuan dipped to its weakest level in 2020 as investors fretted about damage to the world's second-biggest economy from travel bans and the Lunar New Year holiday, which China extended in a bid to keep people at home.

The health commission of China's Hubei province said on Tuesday that 100 people had died from the virus as of Jan. 27, according to an online statement, up from the previous toll of 76, with the number of confirmed cases in the province rose to 2,714.

Other fatalities have been reported elsewhere in China, including the first in Beijing, bringing the deal toll to 106 so far, according to the People's Daily. The state newspaper put the total number of confirmed cases in China at 4,193, though some experts suspect a much higher number.

On Monday, US President Donald Trump offered China whatever help it needed, while the State Department said Americans should "reconsider" visiting all of China due to the virus.

Canada, which has two confirmed cases of the virus and is investigating 19 more potential cases, warned its citizens to avoid travel to China's Hubei province, at the heart of the outbreak.

Authorities in Hubei province are taking increasing flak from the public over their initial response to the virus. Chinese Premier Li Keqiang visited the city of Wuhan, epicentre of the outbreak, to encourage medical workers and promise reinforcements.

Visiting Wuhan in blue protective suit and mask, Li praised medics, said 2,500 more workers would join them in the next two days, and visited the site of a new hospital to be built in days.

The most senior leader to visit Wuhan since the outbreak, Li was shown on state TV leading medical workers in chants of "Wuhan jiayou!" - an exhortation to keep their strength up.

China's ambassador to the United Nations, following a meeting with UN Secretary-General António Guterres on Monday, said "the Chinese government attaches paramount importance to prevention and control of the epidemic, and President Xi Jinping has given important instructions. ...

"China has been working with the international community in the spirit of openness, transparency and scientific coordination," he said.

Guterres said in a statement, "The UN appreciates China's effort, has full confidence in China's ability of controlling the outbreak, and stands ready to provide any support and assistance."

MOUNTING ANGER

On China's heavily censored social media, officials have faced mounting anger over the virus, which is thought to have originated from a market where wildlife was sold illegally.

Some criticised the governor of Hubei province, of which Wuhan is the capital, after he corrected himself twice during a news conference over the number of face masks being produced.

"If he can mess up the data multiple times, no wonder the disease has spread so severely," said one user of the Weibo social media platform.

In rare public self-criticism, Wuhan Mayor Zhou Xianwang said the city's management of the crisis was "not good enough" and indicated he was willing to resign.

The central Chinese city of 11 million people is in virtual lockdown and much of Hubei, home to nearly 60 million people, is under travel curbs.

Elsewhere in China, people from the region faced questioning about their movements. "Hubei people are getting discriminated against," a Wuhan resident complained on Weibo.

Cases linked to people who travelled from Wuhan have been confirmed in a dozen countries, from Japan to the United States, where authorities said they had 110 people under investigation in 26 states. Sri Lanka was the latest to confirm a case.

INVESTORS WORRIED

Investors are worried about the impact. The consensus is that in the short term, economic output will be hit as authorities limit travel and extend the week-long New Year holiday — when millions traditionally travel by rail, road and plane - by three days to limit spread of the virus.

Asian and European shares tumbled, with Japan's Nikkei average sliding 2%, its biggest one-day fall in five months. Demand spiked for safe-haven assets such as the Japanese yen and Treasury notes. European stocks fell more than 2%.

The US S&P 500 closed down nearly 1.6%.

"China is the biggest driver of global growth so this couldn't have started in a worse place," said Alec Young, FTSE Russell's managing director of global markets research.

During the 2002-2003 outbreak of Severe Acute Respiratory Syndrome (SARS), which originated in China and killed nearly 800 people globally, air passenger demand in Asia plunged 45%. The travel industry is more reliant on Chinese travellers now.

Chinese-ruled Hong Kong, which has had eight cases, banned entry to people who had visited Hubei recently.

Some European tour operators cancelled trips to China, while governments around the world worked on repatriating nationals.

Officially known as 2019-nCoV, the newly identified coronavirus can cause pneumonia, but it is still too early to know just how dangerous it is and how easily it spreads.

"What we know about this virus it that transmission occurs through human contact but we are speaking of close contact, i.e. less than a meter," said Jerome Salomon, a senior official with France's health ministry.

"Crossing someone (infected) in the street poses no threat," he said. "The risk is low when you spend a little time near that person and becomes higher when you spend a lot of time near that person."

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News Network
June 18,2020

Amsterdam, Jun 18: A statue of Mahatma Gandhi has been vandalised here in the capital of Netherlands by unknown miscreants with graffiti and spray painting, amid a wave of attacks on controversial figures following the protests around the world after the custodial killing of African-American George Floyd, according to media reports.

The statue of Gandhi on the Churchilllaan in Amsterdam was covered with red paint and the pedestal has 'racist' and an abbreviation for an expletive against the police chalked on it, Metro, the Dutch newspaper, reported.

According to alderman Rutger Groot Wassink, the municipality will file a declaration for daubing.

"Obviously, we are opposed to any form of vandalism and daubing of these things is completely unacceptable," the city official was quoted as saying by the AD.nl.

"It is logical that we will file a declaration, the image will be cleaned," Wassink said.

It is not yet known who is behind the daubing. An employee of the Kunstwacht, who provides maintenance and repairs, says that the cleaning work can take hours.

A 75-year-old man saw the daubs on Wednesday and called the municipality. “I have lived here for forty years and I have never experienced this. I have been watching the statue for years," the man said.

Since the death of 46-year-old Floyd on May 25 in Minneapolis, US, and subsequent worldwide Black Lives Matter protests, there has been much debate about street names and statues of people with a colonial past. All over the world, statues of controversial historical figures are brought down or defaced.

Recently, images and buildings have been defaced in various places that refer to the colonial past of the Netherlands, including the Tropenmuseum in Amsterdam and the statue of Piet Hein in Rotterdam. These are anti-racist expressions that follow the death of Floyd through a white police officer, Metro reported.

Gandhi was known as a champion of human rights and non-violence. But in his twenties, which he spent in South Africa, he still called black people “troublesome, very dirty and they live like beasts” and found that the white people were the “dominant race”. Later he renounced those ideas, the report added.

The statue was unveiled on the Churchillaan on October 2, 1990 in honour of Gandhi's 121st birthday.

The design was made by the sculptor Karel Gomes, who died in 2016. At the time, the plan for the statue came from the Hindu organisation Triveda.

Gandhi is depicted walking, featuring robes around the body, slippers on the feet, a book in one hand and a stick in the other.

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News Network
June 20,2020

Sao Paulo, June 20: Brazil’s government confirmed on Friday that the country has risen above 1 million confirmed coronavirus cases, second only to the United States.

The country’s health ministry said that the total now stood at 10,32,913, up more than 50,000 from Thursday. The ministry said the sharp increase was due to corrections of previous days’ underreported numbers.

Brazilian President Jair Bolsonaro still downplays the risks of the virus after nearly 50,000 deaths from COVID-19 in three months, saying the impact of social isolation measures on the economy could be worse than the disease itself.

Specialists believe the actual number of cases in Brazil could be up to seven times higher than the official statistic. Johns Hopkins University says Brazil is performing an average of 14 tests per 1,00,000 people each day, and health experts say that number is up to 20 times less than needed to track the virus.

Official data show a downward trend of the virus in Brazil’s north, including the hard-hit region of the Amazon, a plateau in cases and deaths in the countries’ biggest cities near the Atlantic coast, but a rising curve in the south.

In the Brazilian countryside, which is much less prepared to handle a crisis, the pandemic is clearly growing. Many smaller cities have weaker health care systems and basic sanitation that’s insufficient to prevent contagion.

“There is a lot of regional inequality in our public health system and a shortage of professionals in the interior,” said Miguel Lago, executive director of Brazil’s Institute for Health Policy Studies, which advises public health officials.

That creates many health care deserts, with people going long distances to get attention. When they leave the hospital, the virus can go with them.

The cattle-producing state of Mato Grosso was barely touched by the virus when it hit the nation’s biggest cities in March. Sitting far from the coast, between the Bolivian border and Brazil’s capital of Brasilia, its 33 lakh residents led a mostly normal life until May. But now its people live under lockdown and meat producers have dozens of infected workers.

In Tangará da Serra, a city of 1,03,000 people in Mato Grosso, the mayor decided Friday to forbid the sale of alcoholic drinks for two weeks as an incentive for people to stay home.

Fᢩo Junqueira said the measure was needed after a spike in COVID-19 cases that filled 80% of the city’s 54 intensive care beds. The city has had nearly 300 cases of the disease, plus three fatalities.

In Rondonópolis, only 300 miles away from Tangará da Serra and home to a thriving economy, health authorities closed the local meatpacking industry after 92 cases were confirmed there. The city of 1,44,000 inhabitants counted 21 deaths from the virus and more than 600 cases. The mayor has also decided to limit sales of alcoholic beverages.

Even regions once considered examples of successful efforts against the virus are now struggling.

Porto Alegre, home to about 14 lakh people, had success in slowing the virus’ spread over the last three months. But now its mayor is considering increasing social isolation measures after ICU occupancy in the city jumped to 80% this month.

We were already making projections for schools to come back, Mayor Nelson Marchezan Jr. told The Associated Press. Now the trend is to impose more restrictions. Outside Sao Paulo city, five regions of the state’s countryside will have to close shops starting Monday due to a rise in coronavirus cases. Governor João Doria announced the decision Friday.

Dr. Mike Ryan, the World Health Organization’s executive director, said at a news conference that Brazil needs to increase its efforts to stop the spread of infections.

“The epidemic is still quite severe in Brazil. I believe health workers are working extremely hard and under pressure to be able to deal with the number of cases that they see on a daily basis,” Dr. Ryan said.

“Certainly the rise is not as exponential as it was previously, so there are some signs that the situation is stabilising. But we’ve seen this before in other epidemics in other countries.”

Margareth Dalcolmo, a clinical researcher and professor of respiratory medicine at the state-funded Oswaldo Cruz Foundation in Rio de Janeiro, believes the reopening in major cities and the virus traveling by road into Brazil’s heartland will keep the pressure on the country’s health system.

“The risk in the interior now is very big,” she said. “Our health system just can’t solve the most serious cases of COVID in many places of the countryside.”

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