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 6,2020

Washington, May 6: The Chinese Army is indulging in aggressive behaviour in the South China Sea and the Chinese Communist Party has ramped up its disinformation campaign to try to shift the blame on coronavirus and burnish its image, US Defense Secretary Mark Esper said on Tuesday.

"While the Chinese Communist Party ramps up its disinformation campaign to try to shift blame and burnish its image, we continue to see aggressive behaviour by the PLA in the South China Sea, from threatening a Philippine Navy ship to sinking a Vietnamese fishing boat and intimidating other nations from engaging in offshore oil and gas development," Esper told reporters at a Pentagon news conference.

Last week, two US Navy ships conducted freedom of navigation operations in the South China Sea to send a clear message to Beijing that America will continue to protect the freedom of navigation and commerce for all nations large and small, he said.

Many countries, Esper said, have turned inward to recover from the pandemic and in the meantime, America's strategic competitors are attempting to exploit this crisis to their benefit at the expense of others.

Responding to a question, he said the Chinese have not been transparent from the beginning on the coronavirus pandemic.

"If they had been more transparent, more open, upfront in terms of giving us access, the reporting, giving us access not to the people on the ground but to the virus they had so we could understand it, we would probably be in a far different place right now. But where we are now is this," Esper said.

China needs to allow the United States in to talk to early patients, Chinese researchers and scientists, and to have access, he added.

Instead, Esper alleged that the Chinese are trying to capitalise on this by promoting their own image that somehow, China is the good guy here.

"Despite everything they did or, more importantly, failed to do, now they want to go out and say well, here's masks. We will give you masks, provide this, or provide that, we will provide you funding. Look at all the good things we are doing," he said.

"Yet, what we know is that they provide masks, they provide supplies. In many cases, it is not good. It does not do what it is supposed to do. It is broken equipment. Also, the strings attached are enormous in many cases. So, they are telling a country you can take these masks, but please, put out publicly how good China is, how great we are doing, et cetera, et cetera," Esper said.

"So there is a number of things they are doing to try and burnish their image. That is just two of them right there," he said.

The Chinese are also doing a lot of strong-arming behind the scenes, Esper said and referred to the war of words between China and Australia. He said he plans to talk to his Australian counterpart later in the day.

"All these activities are going on. It is straight from the Chinese playbook. Once again, it is just a little bit more obvious this time with what they are doing and how they are using a combination of compelling and coercion and everything else to try and shape the narrative and burnish the image of the Chinese Communist Party," Esper said.

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Agencies
March 15,2020

Houston, Mar 15: Researchers, studying the novel coronavirus, have found that the time between cases in a chain of transmission is less than a week, and over 10 per cent of patients are infected by someone who has the virus, but does not show symptoms yet, a finding that may help public health officials contain the pandemic.

The study, published in the journal Emerging Infectious Diseases, estimated what's called the serial interval of the coronavirus by measuring the time it takes for symptoms to appear in two people with the virus -- the person who infects another, and the infected second person.

According to the researchers, including those from the University of Texas at Austin, the average serial interval for the novel coronavirus in China was approximately four days.

They said the speed of an epidemic depends on two things -- how many people each case infects, and how long it takes cases to spread.

The first quantity, the scientists said, is called the reproduction number, and the second is the serial interval.

Due to the short serial interval of the disease caused by the coronavirus -- COVID-19 -- they said, emerging outbreaks will grow quickly, and could be difficult to stop.

“Ebola, with a serial interval of several weeks, is much easier to contain than influenza, with a serial interval of only a few days,” said Lauren Ancel Meyers, study co-author from UT Austin.

Meyers explained that public health responders to Ebola outbreaks have much more time to identify and isolate cases before they infect others.

“The data suggest that this coronavirus may spread like the flu. That means we need to move quickly and aggressively to curb the emerging threat,” Meyers added.

In the study, the scientists examined more than 450 infection case reports from 93 cities in China, and found the strongest evidence yet that people without symptoms must be transmitting the virus -- known as pre-symptomatic transmission.

More than one in ten infections were from people who had the virus but did not yet feel sick, the scientists said.

While researchers across the globe had some uncertainty until now about asymptomatic transmission with the coronavirus, the new evidence could provide guidance to public health officials on how to contain the spread of the disease.

“This provides evidence that extensive control measures including isolation, quarantine, school closures, travel restrictions and cancellation of mass gatherings may be warranted,” Meyers said.

The researchers cautioned that asymptomatic transmission makes containment more difficult.

With hundreds of new cases emerging around the world every day, the scientists said, the data may offer a different picture over time.

They said infection case reports are based on people's memories of where they went and whom they had contact with, and if health officials move quickly to isolate patients, that may also skew the data.

“Our findings are corroborated by instances of silent transmission and rising case counts in hundreds of cities worldwide. This tells us that COVID-19 outbreaks can be elusive and require extreme measures,” Meyers said.

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Agencies
March 24,2020

Beijing, Mar 24:  China reported 78 new confirmed cases, including 74 imported infections, while the death toll from the novel coronavirus increased to 3,277 after seven more fatalities were confirmed from the COVID-19, health officials said on Tuesday.

The overall confirmed cases on the Chinese mainland have reached 81,171 by the end of Monday. This included 3,277 people who died of the disease, 4,735 patients who were still being treated and 73,159 patients discharged after recovery, the National Health Commission (NHC) said on Tuesday.

The NHC said, 78 new confirmed COVID-19 cases were reported on the Chinese mainland on Monday, of which 74 were imported from abroad taking the number of overseas cases to 427.

Also on Monday, seven deaths and 35 new suspected cases were reported on the mainland with all the deaths in Hubei Province.

The total COVID-19 cases in Beijing climbed to 522 with eight deaths prompting local governments of Beijing as well as Shanghai to announce that all overseas arrivals will be subjected to nucleic acid tests to ensure proper detection.

Of the 74 newly imported cases, 31 were reported in Beijing, 14 in Guangdong, nine in Shanghai, five in Fujian, four in Tianjin, three in Jiangsu, two in Zhejiang and Sichuan respectively, and one in Shanxi, Liaoning, Shandong and Chongqing respectively, the NHC said.

Beijing is already diverting all international flights to different cities where the passengers will be quarantined for 14 days before arriving in the city.

The NHC said 132 people were still suspected of being infected with the virus.

Coronavirus epicentre Wuhan has reported one confirmed case after a gap of five days prompting officials to begin to ease restrictions.

Wuhan also reported seven new deaths, bringing the total number of deaths in the city and Hubei province for which Wuhan is the capital to 3,160.

The province also saw 444 patients discharged from hospital after recovery on Monday. Among the 4,200 patients being treated in hospital, 1,203 were still in severe condition and another 336 in critical condition, the local health commission said.

By the end of Monday, 356 confirmed cases, including four deaths have been reported in Hong Kong, which has restricted the entry of foreigners into the city. Also a total of 25 confirmed cases were reported in Macao and 195 in Taiwan including two deaths, state-run Xinhua news agency reporrted.

After days of decline in coronavirus cases, China on Monday said that COVID-19 has effectively been "stemmed" in the country and it started easing severe restrictions imposed on Wuhan's 11 million people who were under lockdown since January 23.

The authorities began relaxing restrictions in Wuhan as it reported no new case for the fifth consecutive day on Monday.

Significantly, the Central Leading Group (CLP), headed by Premier Li Keqiang which is coordinating efforts to contain the virus since January 23, said the virus has been curtailed in the country as well as in Wuhan.

"The meeting noted that the spread of the virus nationwide, particularly in the epicentre of Wuhan, has been effectively stemmed," an official statement said on Monday.

The meeting, however, warned that the risks for sporadic infections and localised outbreaks have not gone away. With the pandemic rampaging across the world, the situation remains complex and challenging.

"Wuhan city and Hubei province should stay focused on medical treatment and community-level containment as the two key priorities. They should continue to treat the severe cases, promptly admit new cases, and advance epidemiological investigations," the meeting said.

In Wuhan, officials said people are allowed to go back to work while restrictions on the public transport are gradually being eased.

The Hubei province and its capital Wuhan with over 56 million people were under lockdown since January 23. The vicious virus broke out in city, reportedly at a live animal market in December last year and became virulent inflicting thousands of people in the city and province catching the government off guard.

As the country saw a surge in imported infections, the Chinese government announced that all international flights scheduled to arrive in Beijing will be redirected to airports in 12 other Chinese cities from Monday.

International passengers flying to Beijing will instead land at airports in 12 cities including Shanghai, Tianjin, Nanjing and Shenyang as their first points of entry, the Civil Aviation Administration of China (CAAC) said in a statement.

On Monday, China said international travellers should "think twice" about choosing Beijing for flight transfer in view of the restrictions.

Starting from Monday, all international flights scheduled to arrive in Beijing will be redirected to airports in 12 other Chinese cities, Liu Haitao, an official with China's National Immigration Administration said.

Passengers would go through entry procedures and quarantine measures at the designated cities' airports before they continue their flights to Beijing, Liu said, urging travellers to reserve enough time for their next flights to make sure that they do not miss their outbound flights.

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