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
February 22,2020

Feb 22: A 20-year-old Chinese woman from Wuhan, the epicentre of the coronavirus outbreak, travelled 400 miles(675 km) north to Anyang where she infected five relatives, without ever showing signs of infection, Chinese scientists reported on Friday, offering new evidence that the virus can be spread asymptomatically.

The case study, published in the Journal of the American Medical Association, offered clues about how the coronavirus is spreading, and suggested why it may be difficult to stop.

"Scientists have been asking if you can have this infection and not be ill? The answer is apparently, yes," said Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center, who was not involved in the study.

China has reported a total of 75,567 cases of the virus known as COVID-19 to the World Health Organization (WHO) including 2,239 deaths, and the virus has already spread to 26 countries and territories outside of mainland China.

Researchers have reported sporadic accounts of individuals without any symptoms spreading the virus. What's different in this study is that it offers a natural lab experiment of sorts, Schaffner said.

"You had this patient from Wuhan where the virus is, travelling to where the virus wasn't. She remained asymptomatic and infected a bunch of family members and you had a group of physicians who immediately seized on the moment and tested everyone."

According to the report by Dr Meiyun Wang of the People's Hospital of Zhengzhou University and colleagues, the woman travelled from Wuhan to Anyang on Jan. 10 and visited several relatives. When they started getting sick, doctors isolated the woman and tested her for coronavirus. Initially, the young woman tested negative for the virus, but a follow-up test was positive.

All five of her relatives developed COVID-19 pneumonia, but as of Feb. 11, the young woman still had not developed any symptoms, her chest CT remained normal and she had no fever, stomach or respiratory symptoms, such as cough or sore throat.

Scientists in the study said if the findings are replicated, "the prevention of COVID-19 infection could prove challenging."

Key questions now, Schaffner said, are how often does this kind of transmission occur and when during the asymptomatic period does a person test positive for the virus.

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Agencies
May 31,2020

Washington, May 31: US President Donald Trump said Saturday he will delay the G7 summit scheduled to take place in June and invite other countries -- including India and Russia -- to join the meeting.

"I don't feel that as a G7 it properly represents what's going on in the world. It's a very outdated group of countries," Trump told reporters on Air Force One.

He said he would like to invite Russia, South Korea, Australia and India to join an expanded summit in the fall.

It could happen in September, either before or after the UN General Assembly, Trump said, adding that "maybe I'll do it after the election."

Americans head to the polls in early November to choose a new president, with Trump keen for a return to normalcy after the coronavirus pandemic and a healthy economy as voters cast their ballots.

Describing the event as a "G-10 or G-11", Trump said he had "roughly" broached the topic with leaders of the four other countries.

Leaders from the Group of Seven, which the United States heads this year, had been scheduled to meet by videoconference in late June after COVID-19 scuttled plans to gather in-person at Camp David, the US presidential retreat outside Washington.

Trump created suspense last week, however, when he announced that he might hold the huge gathering in-person after all, "primarily at the White House" but also potentially parts of it at Camp David.

German Chancellor Angela Merkel became the first leader to decline the in-person invitation outright.

"Considering the overall pandemic situation, she cannot agree to her personal participation, to a journey to Washington," her spokesman said Saturday.

Her response followed ambivalent to positive reactions to the invitation from Britain, Canada and France.

The 65-year-old chancellor is the oldest G7 leader after Trump, who is 73. Japan's Shinzo Abe, also 65, is several months younger than Merkel. Their age puts them at higher risk from the coronavirus.

The G7 major advanced countries -- Britain, Canada, France, Germany, Italy, Japan and the United States -- hold annual meetings to discuss international economic coordination.

Russia was thrown out of what was the G8 in 2014 after it seized Ukraine's Black Sea peninsula of Crimea, an annexation never recognized by the international community.

The work of the G7 is now more important than ever as countries struggle to repair coronavirus-inflicted damage.

The White House had previously said the huge diplomatic gathering would be a "show of strength" when world economies are gradually reemerging from shutdowns.

The United States is the worst-hit country for COVID-19 infections, recording more than 1.7 million cases and over 103,680 deaths.

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News Network
July 18,2020

Global coronavirus infections passed 14 million on Friday, according to a Reuters tally, marking the first time there has been a surge of 1 million cases in under 100 hours.

The first case was reported in China in early January and it took three months to reach 1 million cases. It has taken just four days to climb to 14 million cases from 13 millionrecorded on July 13.

The United States, with more than 3.6 million confirmed cases, is still seeing huge daily jumps in its first wave of Covid-19 infections. The United States reported a daily global record of more than 77,000 new infections on Thursday, while Sweden has reported 77,281 total cases since the pandemic began.

Despite the surging cases, a cultural divide is growing in the country over wearing masks to slow the spread of the virus, a precaution routinely taken in many other nations.

U.S. President Donald Trump and his followers have resisted a full-throated endorsement of masks and have been calling for a return to normal economic activity and reopening schools despite the surging cases.

COVID-19 Pandemic Tracker: 15 countries with the highest number of coronavirus cases, deaths

Other hard-hit countries have “flattened the curve” and are easing lockdowns put in place to slow the spread of the novel virus while others, such as the cities of Barcelona and Melbourne, are implementing a second round of local shutdowns.

The number of cases globally is around triple that of severe influenza illnesses recorded annually, according to the World Health Organization.

The pandemic has now killed more than 590,000 people in almost seven months, edging towards the upper range of yearly influenza deaths reported worldwide. The first death was reported on Jan. 10 in Wuhan, China before infections and fatalities then surged in Europe and later in the United States.

The Reuters tally, which is based on government reports, shows the disease is accelerating the fastest in the Americas, which account for more than half the world’s infections and half its deaths.
In Brazil, more than 2 million people have tested positive including President Jair Bolsonaro, and more than 76,000 people have died.

India, the only other country with more than 1 millioncases, has been grappling with an average of almost 30,000 new infections each day for the last week.

Those countries were the main drivers behind the World Health Organization on Friday reporting a record one-day increase in global coronavirus cases of 237,743.

In countries with limited testing capacity, case numbers reflect only a proportion of total infections. Experts say official data likely under-represents both infections and deaths.

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