New coronavirus losing potency, top Italian doctor says

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."

The total number of global COVID-19 cases was nearing 9 million, while the deaths have increased to over 467,000, according to the Johns Hopkins University.

By Monday morning, the total number of cases stood at 8,927,195, while the fatalities increased to 467,636, the University's Center for Systems Science and Engineering (CSSE) revealed in its latest update.

With 2,279,306 cases and 119,967 deaths, the US continues with the world's highest number of COVID-19 infections and fatalities, according to the CSSE.

Brazil comes in the second place with 1,083,341 infections and 50,591 deaths.

In terms of cases, Russia ranks third (583,879), and was followed by India (410,461), the UK (305,803), Peru (251,338), Spain (246,272), Chile (242,355), Italy (238,499), Iran (204,952), France (197,008), Germany (191,272), Turkey (187,685), Mexico (180,545), Pakistan (176,617), Saudi Arabia (157,612), Bangladesh (112,306) and Canada (103,078), the CSSE figures showed.

The other countries with over 10,000 deaths are the UK (42,717), Italy (34,634), France (29,643), Spain (28,323), Mexico (21,825) and India (13,254).

Jun 11: The total death toll in the US from the novel coronavirus pandemic could hit the grim figure of 200,000 by September and expecting a dramatic decrease in COVID-19 cases in the country will be a "wishful thinking , an eminent Indian-American professor has warned.

Ashish Jha, the head of Harvard's Global Health Institute, told CNN on Wednesday that he is not trying to scare people to stay at home rather urged everyone to wear masks, adhere to the social distancing rules and called for ramping up testing and tracing infrastructure.

Anybody who's expecting a dramatic decrease in cases is almost surely engaging in wishful thinking. And if it (COVID numbers) stays just flat for the next three months, we're going to hit 200,000 deaths sometime in September and that is just awful, Jha said.

Jha said the 200,000 death toll is not just a guess . Currently 800-1000 people are dying daily in America from the virus and all data suggest that the situation is going to get worse.

We're gonna have increases, but even if we assume that it's going to be flat all summer, that nothing is going to get worse... even if we pick that low number of 800 a day, that is 25,000 (deaths) a month in three and a half months. We're going to add another 88,000 people and we will hit 200,000 sometime in September, Jha said.

The United States is by far the hardest-hit country in the global pandemic, in terms of both confirmed infections and deaths.

According to data by the Johns Hopkins University, the number of coronavirus cases in the US currently is nearly two million and about 112,900 people have died in the country, the most in the world.

When asked about an improvement in states like New York, which had been the epicenter of the COVID19 pandemic in the US, Jha said while coronavirus cases are declining in New York, New Jersey, Connecticut and Massachusetts, the numbers are increasing in states such as Arizona, Florida, Texas, North and South Carolina while the country as a whole is pretty flat.

He said, people should take measures as that will help suppress the virus and ensure people could get back outside safely but he voiced concern that this was not the situation in reality.

We're not doing that and so we're going to unfortunately have another 25,000 deaths a month until September, and then it'll keep going. It's not going to magically disappear. We've got a turn around. This is not the future I want, he said.

Jha said he had expected the situation to improve in the summer months but on the contrary the numbers have continued to rise even in the warm weather.

Summer was supposed to be our better months - warmer weather, people outside, a little less transmission. This is not the time (summer) I was expecting a lot more cases. We're seeing a lot more cases, especially in states like Arizona where the numbers look really scary, he said.

Jha added that he was hopeful that maybe the summer months would give us more of a break. I think I may have been too optimistic on that.