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."

Comments

Add new comment

  • Coastaldigest.com reserves the right to delete or block any comments.
  • Coastaldigset.com is not responsible for its readers’ comments.
  • Comments that are abusive, incendiary or irrelevant are strictly prohibited.
  • Please use a genuine email ID and provide your name to avoid reject.
News Network
June 4,2020

London, Jun 4: Meghan, Britain's Duchess of Sussex, has spoken about events following the death of George Floyd saying she was sorry that children had to grow up in a world where racism still existed and that current events in the United States were "devastating".

"I know you know that black lives matter," Meghan said in a video she recorded for students graduating from her old high school in Los Angeles which was aired on Wednesday.

The death of Floyd has become the latest flashpoint for long-simmering rage over police brutality against African Americans and led to nationwide protests, some violent, with curfews imposed in some cities to quell the disorder.

"For the past couple of weeks I've been planning on saying a few words to you for your graduation and as we've all seen over the last week what is happening in our country, and in our state and in our home town of LA is absolutely devastating," said Meghan, whose mother is African American and father is white.

"First thing I want to say to you is that I'm sorry, I'm so sorry that you have to grow up in a world where this is still present," she said in her message to the girls at the Immaculate Heart High School.

The duchess, a former US actress and wife of Queen Elizabeth's grandson Prince Harry, said she wanted to say "the right thing" and was nervous her words would be "picked apart".

"The only wrong thing to say is to say nothing. Because George Floyd's life mattered, and Breonna Taylor's life mattered, and Philando Castile's life mattered and Tamir Rice's life mattered and so did so many other people whose names we know, and whose names we do not know," she said.

Britain's royal family by tradition does not comment on political issues. However, Meghan and Harry stepped down from their official royal roles at the end of March and are now living in Los Angeles with their baby son Archie.

In her message, the 38-year-old reflected on her own memories of the 1992 LA riots.

"Those memories don't go away and I can't imagine that at 17 or 18 years old, which is how old you are now, that you would have to have a different version of that same type of experience," she said.

"That's something you should have an understanding of, but an understanding of as a history lesson not as your reality. So I'm sorry that in a way we have not gotten the world to the place you deserve it to be."

Comments

Add new comment

  • Coastaldigest.com reserves the right to delete or block any comments.
  • Coastaldigset.com is not responsible for its readers’ comments.
  • Comments that are abusive, incendiary or irrelevant are strictly prohibited.
  • Please use a genuine email ID and provide your name to avoid reject.
News Network
February 26,2020

Feb 26: Looking out over the world’s largest cricket stadium, the seats jammed with more than 100,000 people, India’s prime minister heaped praise on his American visitor.

“The leadership of President Trump has served humanity,” Prime Minister Narendra Modi said Monday, highlighting Trump’s fight against terrorism and calling his 36-hour visit to India a watershed in India-U.S. relations.

The crowds cheered. Trump beamed.

“The ties between India and the U.S. are no longer just any other partnership,” Modi said. “It is a far greater and closer relationship.”

India, it seems, loves Donald Trump. It seemed obvious from the thousands who turned out to wave as his motorcade snaked through the city of Ahmedabad, and from the tens of thousands who filled the city’s new stadium. It seemed obvious from the hug that Modi gave Trump after he descended from Air Force One, and from the hundreds of billboards proclaiming Trump’s visit.

But it’s not so simple.

Because while Trump is genuinely popular in India, his clamorous and carefully choreographed welcome was also about Asian geopolitics, China’s growing power and a masterful Indian politician who gave his American visitor exactly what he wanted.

Modi “is doing this not necessarily because he loves Trump,” said Tanvi Madan, the director of the India Project at the Brookings Institution in Washington, D.C. “It’s very much about Trump as the leader of the U.S. and recognizing what it is that Trump himself likes.”

Trump likes crowds — big crowds — and the foot soldiers of India’s political parties have long known how to corral enough people to make any politician look popular. In a city like Ahmedabad, the capital of Modi’s home state of Gujarat and the center of his power base, it wouldn’t take much effort to fill a cavernous sports stadium. It was more surprising that a handful of seats remained empty, and that some in the stands had left even before Trump had finished his speech.

For India, good relations with the U.S. are deeply important: They signal that India is a serious global player, an issue that has long been important to New Delhi, and help cement an alliance that both nations see as a counterweight to China’s rise.

“For both countries, their biggest rival is China,” said John Echeverri-Gent, a professor at the University of Virginia whose research often focuses on India. “China is rapidly expanding its presence in the Indian Ocean, which India has long considered its backyard and its exclusive realm for security concerns.”

“It’s very clearly a major concern for both India and the United States,” he said.

Trump isn’t the first U.S. president that Modi has courted. In 2015, then-President Barack Obama was the first American chief guest at India’s Republic Day parade, a powerful symbolic gesture. Obama also got a Modi hug, and the media in both countries were soon writing about the two leaders’ “bromance.”

Trump is popular in India, even if some of that is simply because he’s the U.S. president. A 2019 Pew Research Center poll showed that 56% of Indians had confidence in Trump’s abilities in world affairs, one of only a handful of countries where he has that level of approval. But Obama was also popular: Before he left office, he had 58% approval in world affairs among Indians.

The Pew poll also indicated that Trump’s support was higher among supporters of Modi’s Hindu nationalist party.

That’s not surprising. Both men have fired up their nationalist bases with anti-Muslim rhetoric and government policies, from Trump’s travel bans to Modi’s crackdown in Kashmir, India’s only Muslim-majority state.

And Trump’s Indian support is far from universal. Protests against his trip roiled cities from New Delhi to Hyderabad to the far northeastern city of Gauhati, although those demonstrations were mostly overshadowed by protests over a new Indian citizenship law that Modi backs.

Modi, who is widely popular in India, has faced weeks of protests over the law, which provides fast track naturalization for some foreign-born religious minorities — but not Muslims. While Trump talked about ties with India on Tuesday, Hindus and Muslims fought in violent clashes that left at least 10 people dead over two days.

In some ways, Modi and Trump are powerful echoes of each other.

They have overlapping political styles. Both are populists who see themselves as brash, rule-breaking outsiders who disdain their countries’ traditional elites. Both are seen by their critics as having authoritarian leanings. Both surround themselves with officials who rarely question their decisions.

But are they friends?

Trump says yes. “Really, we feel very strongly about each other,” he said at a New Delhi press briefing.

But many observers aren’t so sure.

“The question is how much of this is real chemistry, as opposed to what I’d call planned chemistry” orchestrated for diplomatic reasons, said Madan. “It’s so hard to know if you’re not in the room.”

Certainly, Modi understands America’s importance to India. While the two countries continue to bicker about trade issues, the prime minister organized a welcome that impressed even India’s news media, which have watched countless choreographed mass political rallies.

“There is no other country for whose leader India would hold such an event, and for which an Indian prime minister would lavish such rhetoric,” the Hindustan Times said in an editorial.

“The spectacle and the sound were worth a thousand agreements.”

Comments

Add new comment

  • Coastaldigest.com reserves the right to delete or block any comments.
  • Coastaldigset.com is not responsible for its readers’ comments.
  • Comments that are abusive, incendiary or irrelevant are strictly prohibited.
  • Please use a genuine email ID and provide your name to avoid reject.
News Network
June 30,2020

Six months since the new coronavirus outbreak, the pandemic is still far from over, the World Health Organization said Monday, warning that "the worst is yet to come".

Reaching the half-year milestone just as the death toll surpassed 500,000 and the number of confirmed infections topped 10 million, the WHO said it was a moment to recommit to the fight to save lives.

"Six months ago, none of us could have imagined how our world -- and our lives -- would be thrown into turmoil by this new virus," WHO chief Tedros Adhanom Ghebreyesus told a virtual briefing.

"We all want this to be over. We all want to get on with our lives. But the hard reality is this is not even close to being over.

"Although many countries have made some progress, globally the pandemic is actually speeding up.

"We're all in this together, and we're all in this for the long haul.

"We will need even greater stores of resilience, patience, humility and generosity in the months ahead.

"We have already lost so much -- but we cannot lose hope."

Tedros also said that the pandemic had brought out the best and worst humanity, citing acts of kindness and solidarity, but also misinformation and the politicisation of the virus.

In an atmosphere of global political division and fractures on a national level, "the worst is yet to come. I'm sorry to say that," he said.

"With this kind of environment and condition, we fear the worst."

Comments

Add new comment

  • Coastaldigest.com reserves the right to delete or block any comments.
  • Coastaldigset.com is not responsible for its readers’ comments.
  • Comments that are abusive, incendiary or irrelevant are strictly prohibited.
  • Please use a genuine email ID and provide your name to avoid reject.