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
March 16,2020

Manila, Mar 16: The Philippines has detected an outbreak of avian flu in a northern province after tests showed presence of the highly infectious H5N6 subtype of the influenza A virus in a quail farm, the country's farm minister said on Monday.

Agriculture Secretary William Dar said the bird flu virus, the same strain that hit some local poultry farms in 2017, was detected in Jaen municipality in Nueva Ecija province, where about 1,500 quails had died on one farm alone.

A total of 12,000 quails have been destroyed and buried to prevent further infections, Dar said, citing field reports.

"We are on top of the situation," he said. "Surveillance around the 1-km and 7-km radius will be carried out immediately to ensure that the disease has not progressed around the said perimeter."

Animal quarantine checkpoints have also been set up to restrict the movement of all live domestic birds to and from the quarantine area, he said.

"We would like to emphasise that this is a single case affecting one quail farm only," Dar said.

Dr. Arlene Vytiaco, technical spokeswoman for avian flu at the agriculture department, said that while there is a possibility of transmission to humans through excretion and secretion, "the chances are very slim".

"There is also zero mortality rate," she said.

Dar said his department and the local government were jointly conducting an investigation and contact-tracing to determine the source of infection.

To ensure steady domestic supply of poultry, he said the transport of day-old chicks, hatching eggs and chicken meat will be allowed provided the source farms have tested negative for bird flu.

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News Network
March 13,2020

Mar 13: Canadian Prime Minister Justin Trudeau and his wife announced they were self-isolating Thursday as she undergoes tests for the new coronavirus after returning from a speaking engagement with "mild flu-like symptoms."

Sophie Gregoire-Trudeau's symptoms have subsided since she recently got back from Britain, but as a precaution the prime minister "will spend the day in briefings, phone calls and virtual meetings from home," according to a statement.

Trudeau also cancelled a meeting Thursday and Friday with Canada's provincial and territorial leaders in Ottawa, but still planned to speak with them and world leaders by phone about measures being taken to curb the spread of the virus in Canada.

Gregoire-Trudeau's symptoms had included "a low fever late last night." She immediately sought medical advice and testing.

Trudeau has exhibited no symptoms, and was advised by doctors "to continue daily activities while self-monitoring."

"However, out of an abundance of caution, the prime minister is opting to self-isolate and work from home until receiving Sophie's results," said his office.

Since the novel coronavirus first emerged in late December 2019, 127,070 cases have been recorded in 115 countries and territories, killing 4,687 people, according to an AFP tally compiled at 1200 GMT on Thursday based on official sources.

Canada has so far reported more than 100 cases in six provinces, and one death.

Also Thursday, the Canada's Juno music awards cancelled its upcoming gala show, planned for Sunday evening in Saskatoon, Saskatchewan.

"We are devastated to cancel this national celebration of music, but at this time of global uncertainty, the health, safety and well-being of all Canadians must stand at the forefront of any decisions that impact our communities," organisers said in a statement.

And in Quebec province, Premier Francois Legault unveiled a series of measures to prevent the spread of the coronavirus, including placing all travellers returning from overseas under quarantine for two weeks.

Quebec also banned indoor gatherings of more than 250 people.

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Agencies
March 14,2020

Nairobi, Mar 14: Kenya and Ethiopia on Friday announced their first confirmed cases of coronavirus, as East Africa, which has so far been unscathed by the global pandemic, scaled up emergency measures to contain its spread.

In Kenya, a 27-year-old Kenyan woman tested positive for the virus on Thursday in Nairobi, a week after returning from the United States via London.

She was in a stable condition and recovering, Health Minister Mutahi Kagwe told reporters.

"We wish to assure all Kenyans that the government will use all the resources available to fight coronavirus," he said, as the government rolled out a raft of new containment measures.

The government had traced all the contacts of the patient since she arrived back in Kenya on March 5, he said.

"At the moment, there is absolutely no need for panic and worry," he said.

Kenya, with a population of 50 million people, saw a spree of panic buying among the middle-class in Nairobi supermarkets, in the wake of the announcement.

Meanwhile Ethiopia, Africa's second most populous nation with over 100 million people, said a 48-year-old Japanese man who had arrived in the country on March 4 from Burkina Faso was confirmed to have contracted the virus.

"He is undergoing medical follow-up and is in a stable condition. Those who have been in contact with this person are being traced and quarantined," the health ministry said in a statement.

Burkina Faso only confirmed its first case on Tuesday -- a couple returning from France -- and the Japanese patient had been in that country since February 24.

Ethiopian Health Minister Lia Tadesse said three other patients were in isolation.

Ethiopia becomes the 15 country in Africa with a confirmed case of the virus that has swept the globe, infecting more than 130,000 people and killing nearly 5,000 since it first emerged in China.

But to date the continent has been spared the worst of the pandemic.

Only five people have succumbed to coronavirus so far -- all in north Africa -- with the sub-Saharan region recording no deaths and very low numbers of confirmed cases.

But countries in East Africa -- which until the positive case in Kenya, had only recorded negative test results -- have been taking precautions.

Some flights have been restricted, with Kenya Airways suspending its route to Rome, and charter flights from Italy to the Kenyan coast on hold.

It has also suspended international conferences, a top earner in Nairobi, a hub for such events in the region, and non-essential travel abroad for politicians.

The government announced more expansive restrictions on Friday, including a temporary ban on major public gatherings, prison visits and activities between schools.

Other countries in the region have been rolling out their own measures.

In Rwanda, which shares a border with the Democratic Republic of Congo, which has confirmed cases, washing basins with soap and sanitiser have been placed on streets for commuters to use before boarding buses.

Authorities in Kigali, the capital, have also banned concerts, rallies and trade fairs -- although like in Kenya and Uganda, church services have been proceeding and bars, restaurants and entertainment precincts remain open.

Neighbouring Burundi, meanwhile, has quarantined 34 people in a hotel in Bujumbura as a precaution.

Uganda has ordered that visitors from a number of affected countries self quarantine for 14 days, or consider simply not visiting at all.

South Sudan's health ministry said meanwhile that it was "temporarily suspending direct flights between South Sudan and all affected countries".

Kagwe, the Kenyan health minister, also addressed a rumour circulating on social media that people with black skin cannot contract the virus.

"I would like to disabuse that notion. The lady (confirmed with coronavirus in Kenya) is an African, like you and I," he said.

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