US, UK, Canada issue 'travel advisory', ask citizens to 'exercise caution'

Madrid, Jul 25: Spain is witnessing a new surge in virus" coronavirus infections with nearly a thousand cases daily, a month after lifting the pandemic lockdown.

The country is reinstating both voluntary guidelines and mandatory restrictions that it had lifted on June 21, The Washington Post reported.

Spain on Wednesday reported over 224 outbreaks and 2,622 virus" coronavirus cases. According to a report in Washington Post, the new surge is attributed primarily to seasonal farmworkers, people attending family get-togethers and nightclub partyers.

On Thursday, the health ministry reported an additional 971 cases.

"The majority are related to fruit collection and also to the spaces where measures to avoid contact are relaxed," Spain Health Minister Salvador Illa told parliament. "We have to call on citizens to not lose respect for the virus not to be afraid of it, but not to lose respect for it either."

The government of Spain lifted all restrictions put in place to combat virus" coronavirus on June 21 and declared 'a new normal'. 

The virus" coronavirus pandemic till then had killed 24,000 people and infected more than 2,70,166.

Countries around the world are witnessing the second surge of virus" coronavirus. The resurgence could threaten the economic bounce Spain was hoping to get from vacationers eager for summer fun.

The surge in cases has been greatest in the northeastern region of Catalonia with more than 7,953 new confirmed cases since July 10.

Spain's National Epidemiological Survey has predicted that the rate of increase more than doubled in the past three weeks.

Meanwhile, the Catalan government reverted to pre-June 21 confinement rules in Barcelona and a dozen other municipalities in the metropolitan area, as well as in Figueras, Vilafant, La Noguera and Lleida.

Authorities have ordered bars and restaurants to limit indoor occupancy to 50 per cent, reduced sports to fewer than 10 people, closed night clubs and gyms and blocked some cultural activities.

The epidemiologist in charge of the region's biggest hospital warned in an interview last week with the Spanish daily El Pais that the situation in the agricultural hub of Lleida, located about 100 miles west of Barcelona, "had clearly gotten out of hand."

"Nobody foresaw that there would be a number of people coming from abroad to pick fruit in unfavourable conditions and that they might be infected," said epidemiologist Magda Campins of Vall d'Hebron in Barcelona. "And when the infections began to be detected, it was hard to keep tabs on the cases and their contacts because some of them, although they should have been in isolation, got away because they needed to earn money."

Catalonia's Department of Labour, Social Affairs and Family is using a hotel in Lleida to quarantine fruit workers who test positive for COVID-19 but are unable to isolate at home.

In the capital of Madrid, which was the epicentre during the pandemic's first wave in the spring, authorities reported 710 new cases in the past week. The use of face masks is widespread, but the region has shied away from making them mandatory in public.

Madrid's regional health secretary, Enrique Ruiz Escudero, defended that position while citing an uptick in infections in the under-40 age group. He told young people not to let down their guard.

"We can't take even one step backwards. Young people have to be aware of the responsibility they have," Ruiz Escudero said in a news conference Thursday. "I ask them to use the face mask and to maintain a safe distance."

London, May 3: The British government had a contingency plan for prime minister Boris Johnson’s death as his condition deteriorated while he battled COVID-19 last month in intensive care, Johnson said in an interview with The Sun newspaper.

Johnson returned to work on Monday, a month after testing positive for COVID-19. Johnson, 55, spent 10 days in isolation in Downing Street from late March, but was then was taken to London’s St Thomas’ Hospital where he received oxygen treatment and spent three nights in intensive care.

“They had a strategy to deal with a ‘death of Stalin’-type scenario,” Johnson, 55, was quoted as saying by The Sun. “It was a tough old moment, I won’t deny it.”

After Johnson was discharged, St Thomas’ said it was glad to have cared for the prime minister, but the hospital has given no details about the gravity of his illness beyond stating that he was treated in intensive care.

Johnson and his fiancée, Carrie Symonds, on Saturday announced the name of their newly born son as Wilfred Lawrie Nicholas, partly as a tribute to two of the intensive care doctors who they said had saved Johnson’s life.

“The doctors had all sorts of arrangements for what to do if things went badly wrong,” Johnson said of his COVID-19 battle. “The bloody indicators kept going in the wrong direction.”

He said doctors discussed invasive ventilation.

“The bad moment came when it was 50-50 whether they were going to have to put a tube down my windpipe,” he said. “That was when it got a bit . . . they were starting to think about how to handle it presentationally.”

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."