1 00:00:06,400 --> 00:00:11,760 Speaker 1: Welcome to Prognosis. I'm Laura Carlson. It's stay sixty three 2 00:00:11,960 --> 00:00:16,720 Speaker 1: since coronavirus was declared a global pandemic. Our main story, 3 00:00:17,880 --> 00:00:21,360 Speaker 1: COVID nineteen is turning out to have effects well beyond 4 00:00:21,360 --> 00:00:25,960 Speaker 1: the respiratory system. Purple toes and some patients are a 5 00:00:26,079 --> 00:00:29,800 Speaker 1: tip off that the disease is causing serious and potentially 6 00:00:29,800 --> 00:00:34,040 Speaker 1: deadly blood clots, and revealing how much yet there is 7 00:00:34,080 --> 00:00:41,440 Speaker 1: to learn about the disease. But first, here's what happened today. 8 00:00:49,479 --> 00:00:52,800 Speaker 1: The Centers for Disease Control and Prevention wrote a report 9 00:00:52,960 --> 00:00:56,440 Speaker 1: on reopening the country that was more detailed and more 10 00:00:56,480 --> 00:00:59,959 Speaker 1: restrictive than the guidance the White House released last month. 11 00:01:01,480 --> 00:01:06,040 Speaker 1: The advice from the CDC was shelved by Trump administration officials, 12 00:01:06,400 --> 00:01:10,759 Speaker 1: but the Associated Press obtained the sixty three page document. 13 00:01:12,040 --> 00:01:15,400 Speaker 1: It shows that the thinking of the CDC infection control 14 00:01:15,480 --> 00:01:19,200 Speaker 1: experts differs from those in the White House managing the 15 00:01:19,240 --> 00:01:24,240 Speaker 1: pandemic response. The White House is Opening Up America Again 16 00:01:24,280 --> 00:01:28,360 Speaker 1: plan that was released April seventeen included some of the 17 00:01:28,360 --> 00:01:33,039 Speaker 1: CDC's approach, but made clear that the onus for reopening 18 00:01:33,040 --> 00:01:39,080 Speaker 1: decisions was solely on state governors and local officials. By contrast, 19 00:01:39,319 --> 00:01:43,600 Speaker 1: the CDC advocated for a coordinated national response to give 20 00:01:43,680 --> 00:01:49,000 Speaker 1: community leaders step by step instructions to quote help Americans 21 00:01:49,200 --> 00:01:53,280 Speaker 1: re enter civic life, with the idea that there would 22 00:01:53,280 --> 00:01:57,080 Speaker 1: be resurgences of the virus and lots of customization needed. 23 00:01:58,240 --> 00:02:01,160 Speaker 1: The White House said last week that the document was 24 00:02:01,200 --> 00:02:05,440 Speaker 1: a draft and not ready for release. Americans may be 25 00:02:05,560 --> 00:02:09,680 Speaker 1: first in line for a potential COVID nineteen vaccine. French 26 00:02:09,720 --> 00:02:13,440 Speaker 1: pharmaceutical giant Sinophie will likely give priority to the U 27 00:02:13,639 --> 00:02:16,720 Speaker 1: S for doses if it succeeds at delivering a vaccine 28 00:02:17,320 --> 00:02:21,320 Speaker 1: because the US was first to fund its research. That's 29 00:02:21,320 --> 00:02:25,440 Speaker 1: according to the company's chief executive Paul Hudson, who spoke 30 00:02:25,480 --> 00:02:30,920 Speaker 1: to Bloomberg News. Finally, the rapid response coronavirus test from 31 00:02:30,960 --> 00:02:34,240 Speaker 1: Abbot laboratories that's being used at the White House may 32 00:02:34,360 --> 00:02:38,160 Speaker 1: miss as many as half of positive cases, according to 33 00:02:38,200 --> 00:02:42,760 Speaker 1: a report from New York University. The findings have yet 34 00:02:42,760 --> 00:02:47,160 Speaker 1: to be confirmed. An analysis of Abbott's i D now, 35 00:02:47,520 --> 00:02:49,600 Speaker 1: which is in daily use at the White House and 36 00:02:49,720 --> 00:02:53,840 Speaker 1: other prominent locations, missed at least one third of positive 37 00:02:53,840 --> 00:02:57,400 Speaker 1: cases detected with a rival test, and as many as 38 00:02:57,600 --> 00:03:02,480 Speaker 1: forty eight percent when using the currently recommended drying nasal swabs, 39 00:03:08,480 --> 00:03:15,639 Speaker 1: and now our main story. As COVID nineteen continues to escalate, 40 00:03:16,120 --> 00:03:19,240 Speaker 1: doctors around the world are learning that the virus doesn't 41 00:03:19,280 --> 00:03:23,680 Speaker 1: just attack the lungs. The coronavirus can cause kidney failure, 42 00:03:24,360 --> 00:03:27,760 Speaker 1: send the body's immune system into high gear, and lead 43 00:03:27,800 --> 00:03:33,040 Speaker 1: to a range of clodding related disorders. Bloomberg Senior editor 44 00:03:33,160 --> 00:03:36,680 Speaker 1: Jason Gale reports on the ways the coronavirus is affecting 45 00:03:36,680 --> 00:03:42,760 Speaker 1: the body from head to toe. It seems each week 46 00:03:42,880 --> 00:03:45,960 Speaker 1: or two we're learning about a new unexpected dimension of 47 00:03:46,000 --> 00:03:49,920 Speaker 1: the coronavirus. The ways in which it causes illness is 48 00:03:49,960 --> 00:03:53,760 Speaker 1: one of those. As COVID nineteen spreads across millions of 49 00:03:53,840 --> 00:03:59,160 Speaker 1: people worldwide, one surprise finding doctors consistently report is the 50 00:03:59,280 --> 00:04:03,320 Speaker 1: frequency of problems related to blood clots. You may have 51 00:04:03,360 --> 00:04:06,360 Speaker 1: heard of covid toe. It's a term used to describe 52 00:04:06,360 --> 00:04:08,720 Speaker 1: the red and purple skin lesions on the feet of 53 00:04:08,840 --> 00:04:13,240 Speaker 1: coronavirus patients. Some people say they're like chillblains. They're painful 54 00:04:13,280 --> 00:04:15,640 Speaker 1: reaction to cold. Whether people can feel in their fingers 55 00:04:15,640 --> 00:04:19,880 Speaker 1: and toes. Doctors say they're caused by damage to superficial 56 00:04:19,960 --> 00:04:23,960 Speaker 1: veins beneath the skin. The problems relatively benign, but it's 57 00:04:24,040 --> 00:04:27,400 Speaker 1: part of a spectrum of blood circulation disorders occurring with 58 00:04:27,480 --> 00:04:31,000 Speaker 1: COVID nineteen. At the other end of that spectrum are 59 00:04:31,040 --> 00:04:34,400 Speaker 1: blood clots that can cause life threatening strokes and heart failure. 60 00:04:34,960 --> 00:04:38,320 Speaker 1: Besides the toe rashes, these problems can be visible in 61 00:04:38,360 --> 00:04:41,920 Speaker 1: other ways. Doctors working in intensive care units so they 62 00:04:41,960 --> 00:04:45,400 Speaker 1: can see them in arterial catheters and filters used to 63 00:04:45,440 --> 00:04:50,200 Speaker 1: support patients failing kidneys. Just in general, we're seeing clouding 64 00:04:51,040 --> 00:04:53,039 Speaker 1: in a way in this illness that we have not 65 00:04:53,200 --> 00:05:00,960 Speaker 1: seen in the past. This is Professor Mitchell Evy. He's 66 00:05:01,000 --> 00:05:03,880 Speaker 1: Chief of Pulmonary Critical Care and Sleep Medicine at the 67 00:05:03,880 --> 00:05:07,440 Speaker 1: Warren Albert's School of Medicine at Brown University and Providence. 68 00:05:07,920 --> 00:05:10,720 Speaker 1: He's also a director of the Medical Intensive Care Unit 69 00:05:10,920 --> 00:05:14,640 Speaker 1: at Rhode Island Hospital. It's not unusual for infections to 70 00:05:14,720 --> 00:05:18,839 Speaker 1: raise the risk of clotting. Viruses including HIV, DANGHI, and 71 00:05:18,839 --> 00:05:21,760 Speaker 1: the boulder are all known to do it. Fever and 72 00:05:21,880 --> 00:05:26,280 Speaker 1: inflammation brander blood cells more prone to clumping while interfering 73 00:05:26,279 --> 00:05:29,560 Speaker 1: with the body's ability to dissolve clots. It can trigger 74 00:05:29,600 --> 00:05:32,920 Speaker 1: a blood clotting cascade that's thought to begin when the 75 00:05:33,000 --> 00:05:37,200 Speaker 1: lining of blood vessels is disrupted. Mitchell says that procluding 76 00:05:37,240 --> 00:05:40,960 Speaker 1: effect maybe even more pronounced in patients with the coronavirus. 77 00:05:43,279 --> 00:05:46,960 Speaker 1: So when you disrupt that lining of blood vessels, you 78 00:05:47,000 --> 00:05:52,599 Speaker 1: start to liberate factors that begin to make people and 79 00:05:52,760 --> 00:05:58,919 Speaker 1: patience more likely to clot. So we've long understood that 80 00:05:59,200 --> 00:06:04,040 Speaker 1: septs us infection, the body is reacting to infection, creates 81 00:06:04,080 --> 00:06:09,560 Speaker 1: a prothrombotic or a favorable state for leading to clots. 82 00:06:09,680 --> 00:06:14,080 Speaker 1: There's something about this virus that's exaggerated that to the 83 00:06:14,160 --> 00:06:17,640 Speaker 1: nth degree, and we are seeing an enormous amount of 84 00:06:18,120 --> 00:06:21,880 Speaker 1: clots in these people. Doctors in China noted clotting disorders 85 00:06:22,040 --> 00:06:24,800 Speaker 1: in the first weeks of the pandemic, but the gravity 86 00:06:24,800 --> 00:06:28,240 Speaker 1: of the medical problem has become clearer since thousands of 87 00:06:28,320 --> 00:06:32,760 Speaker 1: cases emerged in Europe and North America. It's making doctors 88 00:06:32,920 --> 00:06:37,839 Speaker 1: think differently about COVID nineteen. According to Professor Edwin van Bak. 89 00:06:38,120 --> 00:06:40,920 Speaker 1: Edwin is Chair of Clinical Radiology at the University of 90 00:06:40,960 --> 00:06:45,279 Speaker 1: Edinburgh's Queen's Medical Research Institute. Everybody has been focusing until 91 00:06:45,320 --> 00:06:48,880 Speaker 1: recently on the ventilation aspects off the disease, because that's 92 00:06:48,920 --> 00:06:51,800 Speaker 1: what flu and long infection and all these things do, 93 00:06:53,000 --> 00:06:55,400 Speaker 1: and people have not really looked at the vascular aspects 94 00:06:55,440 --> 00:06:59,159 Speaker 1: of the disease. We think that is the mechanism where 95 00:06:59,160 --> 00:07:06,760 Speaker 1: so many people are are day. Separate studies from France 96 00:07:06,760 --> 00:07:09,880 Speaker 1: and the Netherlands found that as many as thirty percent 97 00:07:09,960 --> 00:07:13,800 Speaker 1: of severely ill COVID nineteen patients suffered a so called 98 00:07:13,880 --> 00:07:18,080 Speaker 1: pulmonary embolism, a potentially deadly blockage and one of the 99 00:07:18,160 --> 00:07:21,400 Speaker 1: arteries of the lungs. These often occur when a clot 100 00:07:21,560 --> 00:07:24,360 Speaker 1: or thrombosis forms in a deep vein in the leg 101 00:07:24,720 --> 00:07:28,160 Speaker 1: and travels in the blood stream to the lungs. If untreated, 102 00:07:28,560 --> 00:07:31,880 Speaker 1: large arterial lung clots can put an overwhelming strain on 103 00:07:31,920 --> 00:07:35,680 Speaker 1: the heart, causing canniac arrest. Even small clots and the 104 00:07:35,720 --> 00:07:39,559 Speaker 1: lungs can deprive patients of oxygen, but clots may form 105 00:07:39,600 --> 00:07:43,120 Speaker 1: in other parts of the body, potentially damaging vital organs, 106 00:07:43,200 --> 00:07:47,560 Speaker 1: including the heart, kidneys, liver, and bow. In pregnant COVID 107 00:07:47,640 --> 00:07:51,560 Speaker 1: nineteen patients, clots may impair blood supply to the fetus, 108 00:07:51,640 --> 00:07:56,560 Speaker 1: leading to complications associated with miscarriage and low birth weight. Um, 109 00:07:56,640 --> 00:08:00,840 Speaker 1: so there's a lot going on. Were of clopping seems 110 00:08:00,840 --> 00:08:04,000 Speaker 1: to be quite pivotal in the whole process of how 111 00:08:04,160 --> 00:08:07,120 Speaker 1: series held and how what a killer this does. He does. 112 00:08:07,760 --> 00:08:10,840 Speaker 1: In the early nine nineties, Edwin helped develop the so 113 00:08:11,000 --> 00:08:14,400 Speaker 1: called d dime, that blood test that's used around the 114 00:08:14,440 --> 00:08:18,080 Speaker 1: world to monitor clots and patients, including those with COVID nineteen, 115 00:08:18,560 --> 00:08:21,640 Speaker 1: and to dose them with hebron and other anti coagulants. 116 00:08:22,360 --> 00:08:26,200 Speaker 1: Untreated pulmonary embolism is lethal in one in three cases 117 00:08:26,640 --> 00:08:30,040 Speaker 1: and will recur without warning in another third. Edwin says 118 00:08:30,680 --> 00:08:33,199 Speaker 1: in three to seven percent of patients, it will cause 119 00:08:33,240 --> 00:08:38,000 Speaker 1: pulmonary hypertension, another dangerous complication that can cause fatigue and 120 00:08:38,040 --> 00:08:40,920 Speaker 1: shortness of breath. I mean no, of course from from 121 00:08:40,920 --> 00:08:43,920 Speaker 1: bosus of pulmonary embolism. It is sort of a silent 122 00:08:44,040 --> 00:08:46,600 Speaker 1: killer people that we aren't you're aware, and then all 123 00:08:46,640 --> 00:08:50,720 Speaker 1: of a sudden and somebody's days scarred lungs and cludding 124 00:08:50,720 --> 00:08:55,480 Speaker 1: related problems, maybe a lingering legacy of the pandemic. Edwin says. 125 00:08:55,679 --> 00:08:58,160 Speaker 1: Patients who have gotten over the illness but who have 126 00:08:58,400 --> 00:09:04,319 Speaker 1: difficulty breathing, especially on exertion, might mistakenly believe they're experiencing 127 00:09:04,320 --> 00:09:07,800 Speaker 1: a second bow to the infection, when the problem might 128 00:09:07,840 --> 00:09:10,199 Speaker 1: be due to untreated clots coming off blood flow and 129 00:09:10,240 --> 00:09:14,760 Speaker 1: the lungs ominously. If dangerous clots go untreated, they may 130 00:09:14,840 --> 00:09:19,600 Speaker 1: manifest days two weeks after respiratory symptoms have resolved. And 131 00:09:19,679 --> 00:09:21,440 Speaker 1: I don't think a lot of both patients don't know 132 00:09:21,520 --> 00:09:24,320 Speaker 1: when the physicians don't know, you have never looked for it. 133 00:09:24,679 --> 00:09:28,840 Speaker 1: The clothing problem can be dramatic. Cases of stroke have 134 00:09:29,000 --> 00:09:32,360 Speaker 1: been reported in New York and Boston in COVID patients 135 00:09:32,480 --> 00:09:37,040 Speaker 1: younger than fifty. It's a rare complication amplified by the 136 00:09:37,120 --> 00:09:41,440 Speaker 1: sheer numbers of infected patients in these cities. Anthony Fauci, 137 00:09:41,559 --> 00:09:44,880 Speaker 1: the director of the National Institute of Allergy and Infectious Diseases, 138 00:09:45,360 --> 00:09:49,079 Speaker 1: says these findings are puzzling on one hand, but and 139 00:09:49,280 --> 00:09:52,400 Speaker 1: lightning on the other because they can inform better ways 140 00:09:52,440 --> 00:09:56,000 Speaker 1: to treat patients. Now that doctors are using the simple 141 00:09:56,120 --> 00:09:59,200 Speaker 1: d DIM blood test to monitor for clots and using 142 00:09:59,240 --> 00:10:03,600 Speaker 1: blood thinners to prevent the problem, relatively fewer patients are 143 00:10:03,720 --> 00:10:09,120 Speaker 1: experiencing these life threatening complications. Well studies are underway to 144 00:10:09,200 --> 00:10:13,839 Speaker 1: identify drugs to find the virus, researches are figuring out 145 00:10:13,960 --> 00:10:33,480 Speaker 1: strategies to mitigate its deadly effects. That was Bloomberg's Jason Gale, 146 00:10:34,240 --> 00:10:37,199 Speaker 1: and that's our show today. For coverage of the outbreak 147 00:10:37,200 --> 00:10:41,640 Speaker 1: from one bureaus around the world, visit bloomberg dot com 148 00:10:41,640 --> 00:10:46,160 Speaker 1: slash coronavirus and if you like the show, please leave 149 00:10:46,240 --> 00:10:49,640 Speaker 1: us a review and a rating on Apple Podcasts or Spotify. 150 00:10:50,400 --> 00:10:52,959 Speaker 1: It's the best way to help more listeners find our 151 00:10:53,000 --> 00:10:57,320 Speaker 1: global reporting. The Prognosis Daily edition is hosted by Me 152 00:10:57,920 --> 00:11:01,760 Speaker 1: Laura Carlson. The show is pretty used by Me topher Foreheads, 153 00:11:02,040 --> 00:11:07,280 Speaker 1: Jordan Gaspoure, and Magnus Hendrickson. Today's main story was reported 154 00:11:07,280 --> 00:11:12,360 Speaker 1: by Jason Gale. Original music by Leo Sidrin. Our editors 155 00:11:12,400 --> 00:11:17,480 Speaker 1: are Francesco Levi and Rick Shine. Francesco Levi is Bloomberg's 156 00:11:17,480 --> 00:11:19,959 Speaker 1: head of podcasts. Thanks for listening.