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
May 19,2020

May 19: A Chinese laboratory has been developing a drug it believes has the power to bring the coronavirus pandemic to a halt.

The outbreak first emerged in China late last year before spreading across the world, prompting an international race to find treatments and vaccines.

A drug being tested by scientists at China's prestigious Peking University could not only shorten the recovery time for those infected, but even offer short-term immunity from the virus, researchers say.

Sunney Xie, director of the university's Beijing Advanced Innovation Center for Genomics, told AFP that the drug has been successful at the animal testing stage.

"When we injected neutralising antibodies into infected mice, after five days the viral load was reduced by a factor of 2,500," said Xie.

"That means this potential drug has (a) therapeutic effect."

The drug uses neutralising antibodies -- produced by the human immune system to prevent the virus infecting cells -- which Xie's team isolated from the blood of 60 recovered patients.

A study on the team's research, published Sunday in the scientific journal Cell, suggests that using the antibodies provides a potential "cure" for the disease and shortens recovery time.

Xie said his team had been working "day and night" searching for the antibody.

"Our expertise is single-cell genomics rather than immunology or virology. When we realised that the single-cell genomic approach can effectively find the neutralising antibody we were thrilled."

He added that the drug should be ready for use later this year and in time for any potential winter outbreak of the virus, which has infected 4.8 million people around the world and killed more than 315,000.

"Planning for the clinical trial is underway," said Xie, adding it will be carried out in Australia and other countries since cases have dwindled in China, offering fewer human guinea pigs for testing.

"The hope is these neutralised antibodies can become a specialised drug that would stop the pandemic," he said.

China already has five potential coronavirus vaccines at the human trial stage, a health official said last week.

But the World Health Organization has warned that developing a vaccine could take 12 to 18 months.

Scientists have also pointed to the potential benefits of plasma -- a blood fluid -- from recovered individuals who have developed antibodies to the virus enabling the body's defences to attack it.

More than 700 patients have received plasma therapy in China, a process which authorities said showed "very good therapeutic effects".

"However, it (plasma) is limited in supply," Xie said, noting that the 14 neutralising antibodies used in their drug could be put into mass production quickly.

Using antibodies in drug treatments is not a new approach, and it has been successful in treating several other viruses such as HIV, Ebola and Middle East Respiratory Syndrome (MERS).

Xie said his researchers had "an early start" since the outbreak started in China before spreading to other countries.

Ebola drug Remdesivir was considered a hopeful early treatment for COVID-19 -- clinical trials in the US showed it shortened the recovery time in some patients by a third -- but the difference in mortality rate was not significant.

The new drug could even offer short-term protection against the virus.

The study showed that if the neutralising antibody was injected before the mice were infected with the virus, the mice stayed free of infection and no virus was detected.

This may offer temporary protection for medical workers for a few weeks, which Xie said they are hoping to "extend to a few months".

More than 100 vaccines for COVID-19 are in the works globally, but as the process of vaccine development is more demanding, Xie is hoping that the new drug could be a faster and more efficient way to stop the global march of the coronavirus.

"We would be able to stop the pandemic with an effective drug, even without a vaccine," he said.

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News Network
April 21,2020

New York, Apr 21: Oil prices plunged below zero on Monday as demand for energy collapses amid the coronavirus pandemic and traders don't want to get stuck owning crude with nowhere to store it.

Stocks were also slipping on Wall Street in afternoon trading, with the S&P 500 down 0.9%, but the market's most dramatic action was by far in oil, where benchmark U.S. crude for May delivery plummeted to negative $3.70 per barrel, as of 2:15 pm. Eastern time.

Much of the drop into negative territory was chalked up to technical reasons — the May delivery contract is close to expiring so it was seeing less trading volume, which can exacerbate swings. But prices for deliveries even further into the future, which were seeing larger trading volumes, also plunged.

Demand for oil has collapsed so much due to the coronavirus pandemic that facilities for storing crude are nearly full.

Tanks could hit their limits within three weeks, according to Chris Midgley, head of analytics at S&P Global Platts.

Benchmark U.S. crude oil for June delivery, which shows a more ”normal” price, fell 14.8% to $21.32 per barrel, as factories and automobiles around the world remain idled. Big oil producers have announced cutbacks in production in hopes of better balancing supplies with demand, but many analysts say it's not enough.

“Basically, bears are out for blood,” analyst Naeem Aslam of Avatrade said in a report. “The steep fall in the price is because of the lack of sufficient demand and lack of storage place given the fact that the production cut has failed to address the supply glut.”

Halliburton swung between gains and sharp losses, even though it reported stronger results for the first three months of 2020 than analysts expected. The oilfield engineering company said that the pandemic has created so much turmoil in the industry that it “cannot reasonably estimate” how long the hit will last. It expects a further decline in revenue and profitability for the rest of 2020, particularly in North America.

Brent crude, the international standard, was down $1.78 to $26.30 per barrel. .

In the stock market, the mild drops ate into some of the big gains made since late March, driven lately by investors looking ahead to parts of the economy possibly reopening as infections level off in hard-hit areas.

Pessimists have called the rally overdone, pointing to the severe economic pain sweeping the world and continued uncertainty about how long it will last.

The Dow Jones Industrial Average was down 364 points, or 1.5%, to 23,887. The Nasdaq was down 0.1%..

More gains from companies that are winners in the new stay-at-home economy helped limit the market's losses Amazon rose 1.4%, and Netflix jumped 3.8% as people shut in at home buy staples and look to fill their time. Clorox likewise rose toward a new record and was up 1% as households and businesses that remain open look to stay clean.

In Tokyo the Nikkei 225 fell 1.1% after Japan reported that its exports fell nearly 12% in March from a year earlier as the pandemic hammered demand in its two biggest markets, the U.S. and China.

The Hang Seng index in Hong Kong lost 0.2%, and South Korea's Kospi fell 0.8%.

European markets were modestly higher The German DAX was up 0.5%, the French CAC 40 was up 0.7% and the FTSE 100 in London gained 0.7%.

In a sign of continued caution in the market, Treasury yields remained extremely low. The yield on the 10-year Treasury slipped to 0.64% from 0.65% late Friday. It started the year near 1.90%. Bond yields drop when their prices rise, and investors tend to buy Treasurys when they're worried about the economy.

Stocks have been on a generally upward swing recently, and the S&P 500 just closed out its first back-to-back weekly gain since the market began selling off in February. Promises of massive aid for the economy and markets by the Federal Reserve and U.S. government ignited the rally, which sent the S&P 500 up as much as 28.5% since a low on March 23.

More recently, countries around the world have tentatively eased up on business-shutdown restrictions put in place to slow the spread of the virus.

But health experts warn the pandemic is far from over and new flareups could ignite if governments rush to allow ”normal” life to return prematurely.

The S&P 500 remains about 15% below its record high in February as millions more U.S. workers file for unemployment every week amid the shutdowns.

Many analysts also warn that a significant part of the recent recovery in stocks is due to the expectation among some investors that the economy will rebound sharply once economic quarantines are lifted. They're essentially predicting that a line chart of the economy will ultimately resemble the letter “V,” with a wild ride down but then a quick pivot to a vigorous recovery.

That may be to optimistic. “We caution that a U-shaped recovery is also quite likely,” where the economy bottoms out and stays at that low level for a while before recovering, strategists at Barclays warned in a recent report.

Without strong testing programs for COVID-19, businesses likely won't feel comfortable bringing back their full workforces for a while.

”With risk assets now overbought, the chance for a correction has increased,” Morgan Stanley strategists wrote in a report.

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News Network
May 8,2020

May 8: Thousands of migrants have been stranded “all over the world” where they face a heightened risk of COVID-19 infection, the head of the UN migration agency International Organization for Migration (IOM) has said.

IOM Director-General António Vitorino said that more onerous health-related travel restrictions might discriminate disproportionately against migrant workers in future.

“Health is the new wealth,” Vitorino said, citing proposals by some countries to introduce the so-called immunity passports and use mobile phone apps designed to prevent the spread of the new coronavirus.

“In lots of countries in the world, we already have a system of screening checks to identify the health of migrants, above all malaria, tuberculosis… HIV-AIDS, and now I believe that there will be increased demands in health controls for regular migrants,” he said on Thursday.

Travel restrictions to try to limit the spread of the pandemic has left people on the move more vulnerable than ever and unable to work to support themselves, Vitorino told journalists via videoconference.

“There are thousands of stranded migrants all over the world.

 “In South-East Asia, in East Africa, in Latin America, because of the closing of the borders and with the travel restrictions, lots of migrants who were on the move; some of them wanted to return precisely because of the pandemic,” he said.

They are blocked, some in large groups, some in small, in the border areas, in very difficult conditions without access to minimal care, especially health screening, Vitorino said.

“We have been asking the governments to allow the humanitarian workers and the health workers to have access to (them),” he said.

Turning to Venezuelan migrants, who are believed to number around five million amidst a worsening economic crisis in the country, the IOM chief said “thousands… have lost their jobs in countries like Ecuador and Colombia and are returning back to Venezuela in large crowds without any health screening and being quarantined when they go back”.

In a statement, the IOM highlighted the plight of migrants left stranded in the desert in west, central and eastern Africa, either after having been deported without the due process, or abandoned by the smugglers.

The IOM’s immediate priorities for migrants include ensuring that they have access to healthcare and other basic social welfare assistance in their host country.

Among the UN agency’s other immediate concerns is preventing the spread of new coronavirus infection in more than 1,100 camps that it manages across the world.

They include the Cox’s Bazar complex in Bangladesh, home to around one million mainly ethnic Rohingya from Myanmar, the majority having fled persecution.

So far, no cases of infection have been reported there, the IOM chief said, adding that preventative measures have been communicated to the hundreds of thousands of camp residents, while medical capacity has been boosted.

Beyond the immediate health threat of COVID-19 infection, migrants also face growing stigmatization from which they need protection, Vitorino said.

Allowing hate speech and xenophobic narratives to thrive unchallenged also threatens to undermine the public health response to COVID-19, he said, before noting that migrant workers make up a significant percentage of the health sector in many developed countries including the UK, the US and Switzerland.

Populist narratives targeting migrants as carriers of disease could also destabilise national security through social upheaval and countries’ post-COVID economic recovery by removing critical workers in agriculture and service industries, he said.

Remittances have already seen a 30 per cent drop during the pandemic, Vitorino said, citing the World Bank data, meaning that some USD 20 billion has not been sent home to families in countries where up to 15 per cent of their gross domestic product comes from pay packets earned abroad.

Vitorino, in a plea, urged to give the health of migrants as much attention as that of the host populations in all countries.

“It is quite clear that health is the new wealth and that health concerns will be introduced in the mobility systems - not just for migration - but as a whole; where travelling for business or professional reasons, health will be the new gamechanger in town.

“If the current pandemic leads to a two or even three-tier mobility system, then we will have to try to solve the problem – the problem of the pandemic - but at the same time we have created a new problem of deepening the inequalities,” he said.

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