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 18,2020

Melbourne, Mar 18: Australian Prime Minister Scott Morrison on Wednesday warned its citizens not to travel abroad and banned "non-essential" gatherings of 100 people or more as the government declared the deadly coronavirus, that has infected over 450 people in the country, a "human biosecurity emergency".

Prime Minister Morrison on Wednesday said Australians should abandon all overseas travel because of the coronavirus epidemic. There have been 40 new cases since Tuesday.

Of the 454 confirmed cases in Australia, 43 have recovered and 5 have died from the COVID-19, according to the official figures.

Morrison declared a national "human biosecurity emergency" and ordered a halt to "non-essential" indoor gatherings of more than 100 people, on top of an existing ban on outdoor events of more than 500.

He said, "We haven't seen this sort of thing in Australia since the end of the First World War. This is a once-in-a-100-year-type event," Morrison said.

"Life is changing in Australia, as it is changing all around the world. Life is going to continue to change. The travel advice to every Australian is do not travel abroad. Do not go overseas."

However, schools across the country were still to remain open.

Morrison said Australia should prepare for "at least six months" of disruption as health authorities attempt to get on top of the coronavirus.

"For those of you thinking about going overseas for the school holidays, don’t. Don't go overseas," he said.

Morrison said there would be no short-term, quick fix to deal with the COVID-19 crisis in Australia, and warned that "tens of thousands of jobs" could be lost.

Responding to the panic buying, the prime minister urged the public to "Stop hoarding."

"I can't be more blunt about it. Stop it. It is not sensible, it is not helpful and it has been one of the most disappointing things I have seen in Australian behaviour in response to this crisis," he said.

On Wednesday, the New South Wales recorded a massive jump in new 59 cases as travellers returned from overseas. The cases jumped from 210 to 269 in the past 24 hours, according to the media reports here.

Queensland's total number of confirmed cases stood at 94.

State Premier Annastacia Palaszczuk said it is now "a different world" from just last week.

For Victoria, the Premier Daniel Andrew said the government could also ban gatherings of fewer than 100 people, noting he could not rule out further changes.

Chief Health Officer Brett Sutton said the spike in cases has been due to people who have travelled overseas.

Sutton said that the transmission in Victoria was not because of community transition like Italy.

Sutton has continued to urge people to wash their hands, socially distance and stay home if they are unwell.

"These are critical measures to be applied regardless of the 100 and 500 threshold,” he said.

In Western Australia, Health Minister Roger Cook said four new coronavirus cases have been confirmed overnight, taking the State's total to 35.

McGowan also condemned panic buyers in supermarkets as "jerks, drongos and bloody idiots."

He said there was "plenty of food to go round" and no need for people to buy in excessive quantities.

The outbreak, which first emerged in China's Wuhan city last year, has marched across the globe, infecting 198,006 people and killing 7,948, according to a tracker maintained by the Johns Hopkins University.

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Agencies
May 23,2020

Washington, May 23: President Donald Trump has labeled churches and other houses of worship as “essential" and called on governors nationwide to let them reopen this weekend even though some areas remain under coronavirus lockdown.

The president threatened Friday to “override” governors who defy him, but it was unclear what authority he has to do so.

“Governors need to do the right thing and allow these very important essential places of faith to open right now — for this weekend," Trump said at a hastily arranged press conference at the White House. Asked what authority Trump might have to supersede governors, White House press secretary Kayleigh McEnany said she wouldn't answer a theoretical question.

Trump has been pushing for the country to reopen as he tries to reverse an economic free fall playing out months before he faces reelection. White evangelical Christians have been among the president's most loyal supporters, and the White House has been careful to attend to their concerns throughout the crisis.

Following Trump's announcement, the Centers for Disease Control and Prevention released new guidelines for communities of faith on how to safely reopen, including recommendations to limit the size of gatherings and consider holding services outdoors or in large, well-ventilated areas.

Public health agencies have generally advised people to avoid gatherings of more than 10 people and encouraged Americans to remain 6 feet (1.8 meters) away from others when possible. Some parts of the country remain under some version of remain-at-home orders.

In-person religious services have been vectors for transmission of the virus. A person who attended a Mother's Day service at a church in Northern California that defied the governor's closure orders later tested positive, exposing more than 180 churchgoers. And a choir practice at a church in Washington state was labeled by the CDC as an early “superspreading" event.

But Trump on Friday stressed the importance of churches in many communities and said he was “identifying houses of worship — churches, synagogues and mosques — as essential places that provide essential services.”

“Some governors have deemed liquor stores and abortion clinics as essential” but not churches, he said. “It's not right. So I'm correcting this injustice and calling houses of worship essential." “These are places that hold our society together and keep our people united,” he added.

Dr. Deborah Birx, coordinator of the White House coronavirus task force, said faith leaders should be in touch with local health departments and can take steps to mitigate risks, including making sure those who are at high risk of severe complications remain protected.

“There's a way for us to work together to have social distancing and safety for people so we decrease the amount of exposure that anyone would have to an asymptomatic," she said.

A person familiar with the White House's thinking who spoke on condition of anonymity to discuss internal deliberations said Trump had called the news conference, which had not been on his public schedule, because he wanted to be the face of church reopenings, knowing how well it would play with his political base.

Churches around the country have filed legal challenges opposing virus closures.

In Minnesota, after Democratic Gov. Tim Walz this week declined to lift restrictions on churches, Roman Catholic and some Lutheran leaders said they would defy his ban and resume worship services. They called the restrictions unconstitutional and unfair since restaurants, malls and bars were allowed limited reopening.

Some hailed the president's move, including Kelly Shackelford, president of the conservative First Liberty Institute.

“The discrimination that has been occurring against churches and houses of worship has been shocking," he said in a statement. "Americans are going to malls and restaurants. They need to be able to go to their houses of worship.” But Rabbi Jack Moline, president of Interfaith Alliance, said it was “completely irresponsible” for Trump to call for a mass reopening of houses of worship.

“Faith is essential and community is necessary; however, neither requires endangering the people who seek to participate in them,” he said.

“The virus does not discriminate between types of gatherings, and neither should the president." Rhode Island Gov. Gina Raimondo, a Democrat, made clear that churches and other houses of worship will not resume in-person services in her state until at least next weekend and said she was skeptical Trump had the authority to impose such a requirement.

“It's reckless to force them to reopen this weekend. They're not ready,” she said. “We've got a good plan. I'm going to stick with it.” New Hampshire Gov. Chris Sununu, a Republican, said he would review the federal guidance, while maintaining a decision rests with him.

"Obviously we'd love to get to the point where we can get those open, but we'll look at the guidance documents and try to make some decisions rather quickly, depending on what it might say,” he said. “It's the governor's decision, of course.”

The CDC more than a month ago sent the Trump administration documents the agency had drafted outlining specific steps various kinds of organizations, including houses of worship, could follow as they worked to reopen safely.

But the White House dragged its feet, concerned that the recommendations were too specific and could give the impression the administration was interfering in church operations.

The guidance posted Friday contains most of the same advice as the draft guidance. It calls for the use of face coverings and recommends keeping worshippers 6 feet from one another and cutting down on singing, which can spread aerosolized drops that carry the virus.

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Agencies
June 24,2020

Seoul, Jun 24: North Korea on Wednesday said leader Kim Jong Un suspended a planned military retaliation against South Korea, possibly slowing the pressure campaign it has waged against its rival amid stalled nuclear negotiations with the Trump administration.

Last week, the North had declared relations with the South as fully ruptured, destroyed an inter-Korean liaison office in its territory and threatened unspecified military action to censure Seoul for a lack of progress in bilateral cooperation and for activists floating anti-Pyongyang leaflets across the border.

Analysts say North Korea, after weeks deliberately raising tensions, may be pulling away just enough to make room for South Korean concessions.

Pyongyang's official Korean Central News Agency said Kim presided by video conference over a meeting Tuesday of the ruling Workers' Party's Central Military Commission, which decided to postpone plans for military action against the South brought up by the North's military leaders.

KCNA didn't specify why the decision was made. It said other discussions included bolstering the country's "war deterrent".

Yoh Sang-key, spokesman of South Korea's Unification Ministry, said Seoul was "closely reviewing" the North's report but didn't further elaborate.

Yoh also said it was the first report in state media of Kim holding a video conferencing meeting, but he didn't provide a specific answer when asked whether that would have something to do with the coronavirus.

The North says there hasn't been a single COVID-19 case on its territory, but the claim is questioned by outside experts.

Kim Dong-yub, an analyst from Seoul's Institute for Far Eastern Studies, said it's likely that the North is waiting for further action from the South to salvage ties from what it sees as a position of strength, rather than softening its stance on its rival.

"What's clear is that the North said (the military action) was postponed, not cancelled," said Kim, a former South Korean military official who participated in inter-Korean military negotiations.

Other experts say the North would be seeking something major from the South, possibly a commitment to resume operations at a shuttered joint factory park in Kaesong, which was where the liaison office was located, or restart South Korean tours to the North's Diamond Mountain resort.

Those steps are prohibited by the international sanctions against the North over its nuclear weapons programme.

The public face of the North's recent bashing of the South has been Kim Yo Jong, the powerful sister of leader Kim Jong Un, who has been confirmed as his top official on inter-Korean affairs.

Issuing harsh statements through state media, she had said the North's demolishing of the liaison office would be just the first in a series of retaliatory action against the enemy South and that she would leave it to the North's military to come up with the next steps.

The General Staff of the North's military has said it would send troops to the mothballed inter-Korean cooperation sites in Kaesong and Diamond Mountain and restart military drills in frontline areas.

Such steps would nullify a set of deals the Koreas reached during a flurry of diplomacy in 2018 that prohibited them from taking hostile action against each other.

Also condemning the South over North Korean refugees floating anti-Pyongyang leaflets across the border, the North said Monday it printed 12 million of its own propaganda leaflets to be dropped over the South in what would be its largest ever anti-Seoul leafleting campaign.

It wasn't immediately clear whether Kim's decision to hold back military action would affect the country's plans for leafleting. The North's military had said it would open border areas on land and sea and provide protection for civilians involved in the leafleting campaigns.

The North has a history of dialling up pressure against the South when it fails to get what it wants from the United States. The North's recent steps came after months of frustration over Seoul's unwillingness to defy US-led sanctions and restart the inter-Korean economic projects that would breathe life into its broken economy.

Nuclear negotiations between Pyongyang and Washington largely stalled after Kim's second summit with President Donald Trump last year in Vietnam, where the Americans rejected North Korea's demands for major sanctions relief in exchange for a partial surrender of its nuclear capabilities.

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