Coronavirus: Mysterious blood clots are Covid-19's latest lethal surprise

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.

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 told AFP.

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 per cent of 184 patients suffered thrombotic complications, a figure that the researchers called "remarkably high" -- even if extreme consequences like amputation are rare.
- Why is it happening? -

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.
- Microclots -

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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This virus is to be blamed for mysterious illness and paralysis in children

Scientists have found the strongest evidence yet that a virus is to blame for a mysterious illness that can start like the sniffles but quickly paralyse children. The poliolike syndrome, called acute flaccid myelitis or AFM, is very rare. Since the first reports from California in 2012, the US has experienced an increasingly bigger outbreak every other year, from late summer into fall.

Doctors have a chief suspect but proof that it’s the culprit germ has been frustratingly elusive. So researchers tried a new trick: They checked patients’ spinal fluid for signs the immune system had fought an invading virus. Sure enough, kids who got sick harboured antibodies that target enteroviruses, just the viral family specialists believe is to blame.

This is circumstantial evidence that this is what’s going on, but it’s a powerful piece of circumstantial evidence,” said a Dr., who helped lead the research. His team reported the findings Monday in Nature Medicine.

Nailing down a suspect is key to better diagnosis and eventually finding a way to prevent or treat the illness, said study co-author and a neurologist,  whose own son developed AFM at age 4. “If you don’t have a cause, you can’t have a vaccine,” he noted. Wilson developed “a good enough microscope, in a sense, to find things they suspected were there.”

Some 590 cases of the ailment have been confirmed in the US since the Centers for Disease Control and Prevention began counting in 2014. Cases spiked that year and in 2016 and last year, with just a few in the intervening years. So far, there have been 22 this year.

Bove’s son, Luca Waugh, illustrates the pattern: His whole family caught a cold in the summer of 2014 — and a few days later; Luca woke up with weakness in his neck that travelled down his shoulder. Despite fast hospitalisation, within days he had body-wide paralysis and trouble breathing. He recovered gradually, and today still has some paralysis in his neck, shoulder and arm.

Either a germ or the body’s reaction to a germ was damaging nerves in the spinal cords of patients like Luca. The CDC noted that AFM spikes coincided with seasons when certain strains of enteroviruses — named EV-D68 and EV-A71 — were causing widespread respiratory illnesses. The problem: Doctors seldom found those viruses in the patients’ spinal fluid, leaving doubt about the link.

Antibodies programmed to track specific germs only wind up in spinal fluid if they fought infection there — what Wilson’s team set out to find. The researchers customized a Harvard-developed tool to search for evidence of hundreds of viruses simultaneously — including herpes, measles, chickenpox, Zika and a whole list of enteroviruses.  Add some spinal fluid, and any antibodies present would stick to their target, able to be identified.  

In tests of spinal fluid from 42 AFM patients and 58 children with unrelated neurologic illnesses, only enterovirus-targeting antibodies emerged as the potential culprit. Nearly three-fourths of patients harbored them, compared to less than 10 per cent of other children. Further work is underway to narrow down the specific strains.

“Before we develop antivirals or potential vaccines, you really want to prove the viruses are causing disease,” said a infectious disease chief at Children’s Hospital of Pittsburgh, who wasn’t involved with the new study. “It’s pretty compelling” evidence.

Mysteries remain. Enteroviruses are hugely common, and doctors don’t know why only a tiny fraction of those infected develop the ailment, Williams said. And as 2020 approaches, specialists are girding for another possible spike next summer. “There’s a lot of dread,” the researcher said.

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A 40-year-old Californian is 7th Person to Die from a Vaping Illness

A 40-year-old Californian is the seventh person to die of a vaping-related illness as a rash of mysterious lung injuries sweeps the country. 


The Tulare County Health and Human Services Agency said in a statement posted to their Facebook page Monday night that a local person had died of “complications related to the use of e-cigarettes.” 

The unnamed person was the second Californian to die of a vaping-related lung injury; Los Angeles health officials announced the death of an LA resident earlier this month. 

Tulare County, located south of Fresno, said it has seen at least three vaping-related illnesses. It did not specify the severity of those illnesses, what vaping cartridges might have led to those cases, the vaping habits of those sickened, or when people began falling ill. 

Still, at least 380 similar cases have been recorded throughout the country as of Sept. 11, according to the U.S.Centers for Disease Control and Prevention.  And many of those cases have ties to black-market THC cartridges, although the CDC has yet to point to a specific vaping product as the culprit. 

“With sadness, we report that there has been a death of a Tulare County resident suspected to be related to severe pulmonary injury associated with vaping,”  Tulare County’s public health officer, wrote in a statement. “The Tulare County Public Health Branch would like to warn all residents that any use of e-cigarettes poses a possible risk to the health of the lungs and can potentially cause severe lung injury that may even lead to death.”

Monday’s announced death followed California Gov. Gavin Newsom’s executive order to push legislators to stop kids from vaping with a new $20 million ad campaign. E-cigarettes are popular with younger people, and were once advertised as a healthier alternative to traditional cigarettes. The recent vaping deaths are actually scaring some people back into smoking tobacco cigarettes. 

Apart from the California deaths, Kansas, Indiana, Illinois, Oregon and Minnesota have also reported fatalities linked to vaping. The CDC activated its Emergency Operations Center in light of the deaths, according to report.The agency is recommending people avoid vaping until they know more, and is warning people to watch out for coughing, nausea and fatigue.

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