COVID-19 ICU Patients Have High Risk of Clots, Research Shows | Health News

By Alan Mozes
HealthDay Reporter

(HealthDay)

TUESDAY, Oct. 6, 2020 (HealthDay News) — Hospitalized COVID-19 patients face an increased risk of developing dangerous blood clots, a new review indicates.

The odds of a clot are highest for the most critically ill patients. Analysis of 66 studies found that 23% of COVID-19 patients in an intensive care unit (ICU) developed a blood clot in the leg, known as a deep vein thrombosis (DVT).

Overall prevalence of a DVT was 14% among ICU and non-ICU COVID-19 patients, and 8% among those with mild-to-moderate disease risk who were not admitted to the ICU.

The “numbers are surprisingly high when compared with other hospitalized patients,” said study author Dr. Cihan Ay.

Of great concern are blood clots in the legs that can break away and travel to the lungs. This is a life-threatening condition known as pulmonary embolism (PE).

Nearly 4% of patients not admitted to the ICU developed a pulmonary embolism. And “we found a very high PE risk of 14% in patients treated at an intensive care unit,” said Ay, an associate professor in hematology and hemostaseology at the Medical University of Vienna in Austria.

According to the American Heart Association, DVT and PE are each a form of venous thromboembolism, or VTE, as both refer to a blood clot that originates in a vein.

VTE is estimated to affect between 300,000 and 600,000 Americans every year, the AHA notes. It is most frequently triggered by surgery, cancer, hospitalization or long-term immobilization.

To examine VTE risk related to COVID-19, Ay and his colleagues analyzed the findings of 66 studies, involving roughly 28,000 COVID-19 patients.

On average, the COVID-19 patients were about 63 years old, and six in 10 were men. About one-fifth had been admitted to an ICU.

None of the studies looked at clotting risk among COVID-19 patients who had not received hospital treatment. So the findings do not speak to DVT or PE risk among such patients, said Ay, although “it seems that the risk of clots is low in patients with a mild clinical course of COVID-19.”

Early in the pandemic, it became clear that blood clot risk seemed elevated in patients with COVID-19 compared to other diseases. To prevent clotting, “physicians worldwide intensified dosing of blood thinners for COVID-19 patients,” Ay said.

This created another potential problem, however, since blood thinners increase the risk of bleeding.

The study authors hope their review will offer clinicians more insight into clotting risk profiles, offering guidance as to which patients truly need preventive clot treatment, Ay said.

As to why COVID-19 might drive up clotting risk in the first place, Ay said experts can only speculate based on available data.

“First, the clinical course in such patients is often severe, which by itself increases the thrombosis [clotting] risk,” he said. “Second, researchers found that COVID-19 interacts with the blood clotting system and the blood vessels, which might explain the increased risk in those patients.”

Dr. Gregg Fonarow is director of the

The Latest: India records 75,800 new cases, recovery high

A heath worker attends a patient in an intensive care unit designated for people infected with COVID-19 at a hospital in Buenos Aires, Argentina, Friday, Oct. 2, 2020.

A heath worker attends a patient in an intensive care unit designated for people infected with COVID-19 at a hospital in Buenos Aires, Argentina, Friday, Oct. 2, 2020.

AP

NEW DELHI — India has registered 75,829 confirmed coronaviruses cases in the past 24 hours, a day after crossing 100,000 fatalities.

The Health Ministry raised India’s confirmed total to more than 6.5 million on Sunday and said at least 101,782 people have died of COVID-19.

India is still registering the highest number of daily cases globally but with the recovery rate at more than 83%, the number of those cured has surpassed 5.5 million, the Health Ministry said.

India also has the low fatality rate of 1.56%, which is nearly half of the global one.

The Health Ministry credited the increased testing in the country to a sustained low death rate. India has conducted nearly 79 million tests so far, according to official data.

India is preparing to reopen cinemas and entertainment parks with limited capacity beginning Oct. 15, in an effort to revive the economy. Health experts warn the move has the potential for the virus to spread during the upcoming religious festival and winter season.

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HERE’S WHAT YOU NEED TO KNOW ABOUT THE VIRUS OUTBREAK:

— Doctor: Trump improving, but not ‘out of the woods’ yet

— Analysis: Trump faces credibility crisis over health scare

— Pence ordered borders closed after CDC experts refused

— South Africa and India have asked the World Trade Organization to waive some provisions in the international agreements that regulate intellectual property rights to speed up efforts to prevent, treat and contain the COVID-19 pandemic.

— Madrid has started its first day under a partial lockdown with police controlling travel in and out of the Spanish capital. The Madrid region has become Europe’s most critical hot spot in the second wave of the coronavirus.

— Pope Francis has traveled to the tomb of his nature-loving namesake to sign an encyclical laying out his vision of a post-COVID world built on solidarity, fraternity and care for the environment.

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Follow AP’s pandemic coverage at http://apnews.com/VirusOutbreak and https://apnews.com/UnderstandingtheOutbreak

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HERE’S WHAT ELSE IS HAPPENING:

MELBOURNE, Australia — The premier of Australia’s Victoria state has called on citizens to “stay the course” after large groups flooded beaches and parks at the weekend in defiance of strict lockdown regulations.

Victoria, emerging from a major winter spike in coronavirus cases, relaxed lockdown regulations last weekend but still allowed only five people from up to two households to congregate outside.

Many ignored those regulations on Saturday and crowded parks and beaches, causing Premier Daniel Andrews to remind Victorians not to be selfish and maintain social distancing. Victoria reported only 12 new coronavirus cases and one death Sunday, well down on the peaks of winter.

“We are so, so close,” Andrews said. “Let’s not any of us do anything that might undermine the very positive numbers. Once we get them low, we can keep them low and we

Trump positive for COVID-19, is in high risk groups for severe case

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President Donald Trump said Tuesday it’s “a shame” that the U.S. reached the grim milestone of 200,000 deaths due to COVID-19. But he said had his administration not taken the actions it did, that number would’ve been “substantially more.” (Sept. 22)

AP Domestic

President Trump has tested positive for the coronavirus, as have more than 7 million other Americans. Here’s what we know about the usual course of the disease.

So far the President’s doctor has said only Trump is “well.” No information is available as to whether he is experiencing symptoms.

About 40% of people who are exposed to COVID-19 don’t have any symptoms at all. It’s too early to know if the President will be among them as symptoms typically appear two to 14 days after exposure, according to the Centers for Disease.

Trump was presumably exposed by his aide, Hope Hicks. It was announced that she had tested positive for COVID-19 and was symptomatic on Thursday. She appears to have been diagnosed on Wednesday evening when she flew with the President to Minnesota. 

There is increasing data that people infected with COVID-19 who show symptoms have higher viral loads than those without symptoms. That could mean that Hicks exposed the President to higher levels of the SARS-CoV-2 virus than she would have if she had an asymptomatic case of the disease.

In addition, the President rarely wears a mask in public appearances. “That may put him at higher risk of being exposed to a higher viral inoculum,” said Dr. Monica Gandhi, a professor of medicine and infectious disease expert at the University of California. 

“However, the interplay between host and pathogen is complex and so we will have to wait and observe this carefully,” she said. 

If Trump was first exposed to the virus on Wednesday, it is still very early for him to begin exhibiting symptoms. Most people who are symptomatic begin to feel sick within 11 and a half days, according to the CDC. In rare cases it can take even longer. 

For the 60% of people infected who do develop symptoms, they can experience fever, cough, shortness of breath, fatigue, body aches, headache, loss of taste or smell, sore throat, runny nose, nausea or vomiting and diarrhea.

Because of his age and obesity, Trump is in two very high-risk groups for developing severe COVID-19 disease, hospitalization and death.

At 74, the president is five times more likely to be hospitalized and 90 times more likely to die of COVID-19 than someone between the ages of 18 and 29, according to the CDC.   

Trump is 6-foot-3 and at his last reported medical checkup weighed 243 pounds, giving him a body mass index of 30.4. That’s just over the line into obesity.

Adults with obesity have triple the risk of hospitalization due to a COVID-19 infection, according to the CDC. This is in part because obesity is linked to impaired immune function and decreased lung capacity and reserve. 

Trump took “portions” of his physical exam

SD reaches record high coronavirus death toll

South Dakota recorded a record high COVID-19 death toll Thursday with 13 fatalities and 747 new positive virus cases.

According to state epidemiologist Josh Clayton, cities and rural zones are reporting significant clusters of the virus in recent days, the Associated Press reported.

He noted that 245 of the infections reported were backlogged from previous days after a reporting error.

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One large outbreak stemmed from a women’s prison in Pierre, with testing showing positive results for 29 women in one housing unit.

The prison recorded a total of 197 prisoners and staff have tested positive while 110 have recovered.

According to Johns Hopkins University, as of Tuesday, the state’s seven-day average testing positivity rate was 26 percent — the highest in the country.

The record numbers of new cases come as Gov. Kristi NoemKristi Lynn NoemSouth Dakota governor spars with PETA over viral ‘social distancing’ hunting video South Dakota AG issues statement on fatal crash, says ‘I discovered the body’ Authorities confirm South Dakota attorney general involved in fatal crash MORE (R) tweeted late last month, “South Dakota’s #COVID19 spread peaked the latest of just about any state.”

Other states in the Midwest are also reporting record COVID-19 numbers, including Minnesota, Wisconsin and Kansas.

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Suicide rate among active duty troops jumps to six-year high

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As the number of veterans committing suicide has climbed to an alarming rate, a civilian-run treatment center has now become a model for treating PTSD and other causes of military suicides. (July 29)

WASHINGTON – The suicide rate among active-duty troops increased in 2019, according to a Pentagon report released Thursday, and Army officials worry that stress caused by the COVID-19 pandemic may push figures higher in 2020.

Last year, the rate of suicide among active-duty troops was 25.9 per 100,000 troops, according to the Pentagon’s annual report on suicide. The rate was 24.9 per 100,000 people in 2018, and 21.9 per 100,000 troops in 2017. The rate has showed a steady increase from 2014, when the rate was 18.5 per 100,000 service members. The suicide rates in the National Guard and reserve components of the military remained stable last year, according to the report. 

In all, 498 troops died by suicide in 2019.

Among all Americans, the suicide rate has increased 35% over the past 20 years, according to the National Institute of Mental Health. The suicide rate among all Americans was 14.2 per 100,000 in 2018, but the Pentagon’s report states that after controlling for differences in age, suicide rates among troops are roughly equivalent or lower than the U.S. population.

U.S. Army Secretary Ryan McCarthy, seen here in 2018 announcing that Austin would be the new headquarters for the Army Futures Command, visited Fort Hood on Thursday and announced an independent investigation to determine the root causes of recent violence and sexual misconduct there. (Photo: CHIP SOMODEVILLA/GETTY IMAGES)

Chief Warrant Officer Cliff Bauman:Suicide never entered his mind. Then 9/11 happened.

Young enlisted troops are the primary concern. They account for 43% of the military population but 61% of deaths by suicide. Personally owned firearms, not military weapons, were the primary cause of death.

“None of us has solved this issue,” said Karin Orvis, director of the Defense Suicide Prevention Office. “There is no quick fix.”

OPINION:We can solve military suicides – with your help, Pentagon and VA say

The Army, in a joint statement Thursday by Army Secretary Ryan McCarthy and Gen. James McConville on the suicide report, noted that COVID-19 has prompted the service to bolster mental health services for soldiers this year. 

The active-duty Army has seen a 30% increase in 2020 in deaths by suicide, from 88 deaths by suicide in 2019 to 114 this year, the Associated Press has reported. 

“In the face of additional stress of a pandemic, we are working to improve access to behavioral health care while enhancing our resilience training and stigma reduction efforts,” according to their statement.

Orvis would not speculate on the effect of COVID-19 on suicide deaths in the military, saying the data continues to change.

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Cliff Bauman shares the story of how his PTSD from 9/11 led him to attempt suicide, and why he’s so glad he survived.

USA TODAY

Suicide Lifeline: If you or someone you know may be struggling

High demand for flu shots? Experts hope to avoid ‘twindemic’

October is prime time for flu vaccinations, and the U.S. and Europe are gearing up for what experts hope is high demand as countries seek to avoid a “twindemic” with COVID-19.

“Take flu out of the equation this fall,” said Dr. Daniel Jernigan of the U.S. Centers for Disease Control and Prevention.

A record number of flu vaccine doses are on the way, between 194 million and 198 million for the U.S. alone — seemingly plenty considering last year just under half of adults got vaccinated and there usually are leftovers.

Still, there’s no way to know how many will seek shots this year and some people occasionally are finding drugstores or clinics temporarily out of stock.



MBA BY THE BAY: See how an MBA could change your life with SFGATE’s interactive directory of Bay Area programs.


Be patient: Flu vaccine ships gradually, in batches, and the CDC and manufacturers say more is in transit.

“This year I think everyone is wanting to get their vaccine and maybe wanting it earlier than usual,” Jernigan told The Associated Press. “If you’re not able to get your vaccination now, don’t get frustrated” but keep trying.

Pharmaceutical giant Sanofi Pasteur, which is supplying nearly 250 million doses worldwide including 80 million for the U.S., says it has shipments staggered into November.

Vaccine maker Seqirus is exploring if it could squeeze out “a limited number of additional doses” to meet high demand, said spokeswoman Polina Miklush.

Brewing flu vaccine is time-consuming. Once production ends for the year, countries can’t simply order more — making for a stressful balancing act as they guess how many people will roll up their sleeves.

Germany usually buys 18 million to 19 million doses, and this year ordered more. As German Health Minister Jens Spahn put it: “If we manage, together, to get the flu vaccination rate so high that all 26 million doses are actually used, then I’d be a very happy health minister.”

Spain purchased extra doses in hopes of vaccinating far more older adults and pregnant women than usual, along with key workers in health facilities and nursing homes.

In contrast, Poland, which last year had 100,000 doses go unused, didn’t anticipate this fall’s high demand and is seeking more.

The good news: The same precautions that help stop spread of the coronavirus — wearing masks, avoiding crowds, washing your hands and keeping your distance — can help block influenza, too.

Winter just ended in the Southern Hemisphere and countries like South Africa, Australia, Argentina and Chile diagnosed hardly any flu thanks to COVID-19 restrictions combined with a big push for influenza vaccinations.

With the coronavirus still circulating and cold weather coming just as more schools and businesses reopen, there’s no guarantee that countries in the Northern Hemisphere will be as lucky with flu.

“How much flu, we don’t know — but there will be flu,” predicted Dr. William Schaffner of Vanderbilt University and the National Foundation for Infectious Diseases.

A flu vaccine only protects against

Boston Coronavirus Cases Surge, City Added To 23 ‘High Risk’ Zones

KEY POINTS

  • Boston and 10 other Massachusetts cities have been listed as coronavirus red zones
  • State health officials reported more than 8 cases per 100,000 residents over the past 14 days
  • 23 municipalities in Massachusetts are considered “high risk” for COVID-19 infection

Boston and 10 other Massachusetts cities have been listed as red zones or “high risk” areas as of Wednesday night as a sudden spike in the number of cases bring the state’s total to 128,753.

According to Boston News, health officials from the Department of Public Health reported more than eight cases per 100,000 residents over the past two weeks. They also confirmed 32 new COVID-19 casualties, which brings Massachusetts’ death toll up to 9,242. 

In all, 23 municipalities in the state are considered “high risk” for coronavirus infection. The new communities joining Boston on the list are Attleboro, Avon, Dracut, Haverhill, Lowell, Lynnfield, Methuen, Middleton, North Andover, and Springfield. 

Health officials also moved three communities—Saugus, Tyngsborough, and Wrentham—to moderate risk as their infection rates continue to experience a drop. 

Before the release of the report, Boston Mayor Marty Walsh said the city was not moving into the second step of its three-phase reopening plan due to the surge of coronavirus cases. 

“We expect to be in the red zone very soon, and it is likely to happen this evening. That means we’ve been seeing more than eight new cases per day per 100,000 people population,” Walsh said Wednesday.

During a press conference, Walsh noted that half of the new cases reported in the city involved people aged 29 and younger. He also said the city would maintain its coronavirus restrictions to curb the virus’s spread, WBUR reported.

Food courts may continue to operate, and movie theaters may go to a 50% capacity and limit their audience to 250 people. Gatherings will be limited to 25 people for indoor events and 50 for outdoor affairs. 

According to WCVB, public school students in Boston will begin returning to classrooms Thursday, depending on their grade level and academic needs. The highest-need students will be the first to transition using a hybrid model. 

Pre-schoolers and kindergartners would be required to report to school in the second week of October, while first- and third-graders would follow the week of Oct. 22.

Under the hybrid model, students are to learn in-person for two days a week and switch back to remote-learning the other three days of school. Families are given the option to keep their children remote. 

Madrid has seen a surge in coronavirus cases in Spain's second wave Madrid has seen a surge in coronavirus cases in Spain’s second wave Photo: AFP / OSCAR DEL POZO

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English COVID-19 prevalence high but growth slowing

LONDON (Reuters) – The prevalence of COVID-19 infections in England is much higher than it was at the end of August but there are signs that growth in infection rate is slowing, a study by Imperial College said on Thursday.

The findings come after Prime Minister Boris Johnson pleaded with Britons to obey the rules imposed to tackle a rapidly accelerating second wave of the coronavirus, with more than 7,000 new cases of COVID-19 reported in each of the last two days.

The Imperial study showed 1 in 200 people were infected, but also that the reproduction R rate dropped from 1.7 to 1.1, meaning that on average, 10 infected people will go on to infect another 11 people rather than 17 people.

The fall in the R number therefore implies the epidemic’s growth might be decelerating.

“While our latest findings show some early evidence that the growth of new cases may have slowed, suggesting efforts to control the infection are working, the prevalence of infection is the highest that we have recorded to date,” Imperial’s Professor Paul Elliott said.

The study, the largest of its kind in Britain, tested 84,610 volunteers between Sept. 18 and 26.

Of those, 363 tested positive, which is 55 people per 10,000 – and an increase on the 13 per 10,000 people found to be infected in the previous study between Aug. 24 and Sept. 7.

The latest study implied 411,000 people had the coronavirus, with prevalence increasing in all age groups.

Half of the volunteers did not have symptoms at the time of testing or the week before, but not all of those people remained asymptomatic throughout, the study said.

(Reporting by Alistair Smout; editing by Stephen Addison)

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High TMB Predicts Response to Pembrolizumab

Tissue tumor mutation burden (tTMB) has been under study for some time as a biomarker that could predict which patients are most likely to respond to immunotherapy.

In June, it was approved by the US Food and Drug Administration as a biomarker for pembrolizumab (Keytruda) use in patients with advanced cancers who have progressed on prior therapy.

Now the data supporting that approval have been published in Lancet Oncology.

They come from analysis of outcomes from 790 patients who participated in the phase 2 KEYNOTE-158 study of treatment with pembrolizumab in 10 tumor-type-specific groups.

The results show better responses in patients who had a high tissue TMB (≥10 mutations per megabase), which was found in 102 (13%) of the 790 participants.

The majority of these patients (87%) did not have high tTBM.

Of the 102 patients with high tTMB, 29% achieved an objective response to pembrolizumab compared with 6% in the non-tTMB-high group. In addition, the median duration of response was not reached in the tTMB-high group vs 33.1 months in the non-tTMB-high group.

An expert not involved with the study was enthusiastic about the results.

“This gives clinicians treating patients with any metastatic solid tumor the possibility of offering immunotherapy with pembrolizumab to those whose tumors have a TMB greater than 10 mutations per megabase,” said Matthew R. Zibelman, MD, assistant professor, Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.

“The real win here is not for clinicians but for the patients who may get access to this drug with an opportunity for a meaningful response, ” he said.

TMB is essentially a measurement of the number of somatic mutations within a tumor and defined as the total number of somatic mutations per coding area of a tumor genome, he explained.

“Currently, its use as a predictive marker to choose treatment remains investigational in most clinical settings,” Zibelman told Medscape Medical News. “This testing is becoming standard in most commercially available next-generation sequencing platforms offered, and has been looked at as a potential biomarker in several tumors, including non-small cell lung cancer and melanoma,” he added.

Zibelman suggested that the results should now be implemented into clinical practice. “Testing should be offered to all patients with metastatic solid tumors, particularly those without prior approvals for immunotherapy agents specific to their indication,” he said.

“Clear Advantage”

“The higher the TMB, the greater the number of neoantigens expressed by the tumor, enhancing the probability of cancer cells being recognized by the immune system. This simple but captivating rationale likely underlies the clear advantage from pembrolizumab treatment found for patients with tTMB-high tumors, in terms of objective response and duration of response,” writes Melissa Bersanelli, MD, Medical Oncology Unit, University Hospital of Parma, Italy, in an accompanying editorial.

The authors showed the usefulness of tTMB status even in tumors that are well known to be poorly immunogenic, such as small cell lung cancer, she noted.

However, in this setting of rare tumors where there are few viable options and limited