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
June 2,2020

London/Milan, Jun 2: World Health Organization experts and a range of other scientists said on Monday there was no evidence to support an assertion by a high profile Italian doctor that the coronavirus causing the COVID-19 pandemic has been losing potency.

Professor Alberto Zangrillo, head of intensive care at Italy's San Raffaele Hospital in Lombardy, which bore the brunt of Italy's COVID-19 epidemic, on Sunday told state television that the new coronavirus "clinically no longer exists".

But WHO epidemiologist Maria Van Kerkhove, as well as several other experts on viruses and infectious diseases, said Zangrillo's comments were not supported by scientific evidence.

There is no data to show the new coronavirus is changing significantly, either in its form of transmission or in the severity of the disease it causes, they said.

"In terms of transmissibility, that has not changed, in terms of severity, that has not changed," Van Kerkhove told reporters.

It is not unusual for viruses to mutate and adapt as they spread, and the debate on Monday highlights how scientists are monitoring and tracking the new virus. The COVID-19 pandemic has so far killed more than 370,000 people and infected more than 6 million.

Martin Hibberd, a professor of emerging infectious disease at the London School of Hygiene & Tropical Medicine, said major studies looking at genetic changes in the SARS-CoV-2 virus that causes COVID-19 did not support the idea that it was becoming less potent, or weakening in any way.

"With data from more than 35,000 whole virus genomes, there is currently no evidence that there is any significant difference relating to severity," he said in an emailed comment.

Zangrillo, well known in Italy as the personal doctor of former Prime Minister Silvio Berlusconi, said his comments were backed up by a study conducted by a fellow scientist, Massimo Clementi, which Zangrillo said would be published next week.

Zangrillo told Reuters: "We have never said that the virus has changed, we said that the interaction between the virus and the host has definitely changed."

He said this could be due either to different characteristics of the virus, which he said they had not yet identified, or different characteristics in those infected.

The study by Clementi, who is director of the microbiology and virology laboratory of San Raffaele, compared virus samples from COVID-19 patients at the Milan-based hospital in March with samples from patients with the disease in May.

"The result was unambiguous: an extremely significant difference between the viral load of patients admitted in March compared to" those admitted last month, Zangrillo said.

Oscar MacLean, an expert at the University of Glasgow's Centre for Virus Research, said suggestions that the virus was weakening were "not supported by anything in the scientific literature and also seem fairly implausible on genetic grounds."

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Agencies
January 11,2020

New York, Jan 11: The United Nations Security Council (UNSC) on Friday renewed a six-year-long cross-border humanitarian aid deliveries mechanism into Syria.

According to Sputnik, the Security Council voted in favour of a resolution on Friday that allows cross border deliveries to be conducted via Turkey, preserving two checkpoints and excluding the Al-Yarubiyah border crossing with Iraq and the Al-Ramtha crossing with Jordan, until July 10, 2020.

Russia proposed to amend the adopted resolution by replacing a part of the draft which stipulates that humanitarian assistance into Syria should be delivered based on the principles of humanity, neutrality, impartiality and independence by the phrase that such aid should be provided "in accordance with the guiding principles of humanitarian emergency assistance, as contained in UNGA resolution 46/182."

The agreement was reached after Belgium and Germany decided to amend the original version of their joint resolution, which proposed keeping three points for cross-border deliveries into the Arab republic.

In December last year, the United Nations had said that over 235,000 people fled the Idlib region in the last two weeks after Russia and Syria launched airstrikes in a bid to take over the last major opposition bastion.

Russia backed Syria government launched a fresh assault to capture the province.

Syrian Bashar al-Assad regime, backed by Iran, has reportedly promised to take back the rebel-controlled area and broke a ceasefire that was announced in August.

They have since December 19 seized dozens of towns and villages from armed fighters amid clashes that have killed hundreds on both sides.

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News Network
May 21,2020

Canberra, May 21: Australian Prime Minister Scott Morrison and his Indian counterpart, Narendra Modi, are looking forward to deepening the countries' strategic relationship, with both sides expected to sign a range of pacts from defence to trade in strategic sectors amid heightened tensions with China over Beijing's response to coronavirus pandemic.

During a virtual summit, scheduled to take place on June 4, both leaders are expected to ramp up efforts to diversify Australia's export markets and find trusted suppliers of vital products and components, a local newspaper, The Australian reported on Tuesday.

The new agreements will focus on reliable supply chains in key strategic sectors, including medical goods, technology and critical minerals, amid heightened tensions with China over Beijing's response to coronavirus pandemic.

The leaders will seal a new defence agreement allowing reciprocal access to bases and co-operation on military technology projects, while a new education partnership will be on the table to help overcome Australian university reliance on Chinese students.

The talks in terms of strategic convergence, now have greater significance as COVID-19 exacerbates the strategic contest between the US and China, and forces like-minded countries to seek out reliable partners.

Australian farmers could also benefit, with talks underway on expanding agricultural exports to India, including barley, as China throws up new trade barriers, media reports stated.

The virtual summit follows the cancellation of Morrison's planned state visit to India in January due to the bushfires.

Morrison said last year, ahead of his planned visit, that India was "a natural partner for Australia", referring to the countries' "shared values" -- a point of differentiation with China.

Former Department of Foreign Affairs and Trade secretary Peter Varghese, who wrote a landmark report on the bilateral relationship in 2018, was quoted by the newspaper as saying that India would be even more important to Australia in the post-COVID world. "If one of the lessons from COVID is that countries need to spread their risk, then finding new markets or building up existing markets is a crucial part of that," he added.

Varghese noted that India, a member of the Quadrilateral Security Dialogue along with Australia, Japan and the US, was a vital strategic partner to Australia in helping "constrain China's ambitions to be the predominant power".

"That shared objective between Australia and India of not wanting to see the region dominated by China is a key component of building up our geopolitical relationship," he told The Australian.

The summit also follows recent talks between Australian Foreign Minister Marise Payne and Indian counterpart Subrahmanyam Jaishankar on the pandemic response and Australia's call for an independent inquiry, which was overwhelmingly backed at the World Health Assembly on Tuesday.

Australia wants to support India to develop a domestic critical minerals processing industry, which would provide Western nations with an alternative to sourcing the materials from China.

Meanwhile, India has strong expertise as a manufacturer of drugs and medical equipment, while Australia is a centre of biomedical research, opening the possibility for closer co-operation in the key sector, the media reported further.

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