WEBVTT - The Scary Implications of 'Covid Toe'

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<v Speaker 1>Welcome to Prognosis. I'm Laura Carlson. It's stay sixty three

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<v Speaker 1>since coronavirus was declared a global pandemic. Our main story,

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<v Speaker 1>COVID nineteen is turning out to have effects well beyond

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<v Speaker 1>the respiratory system. Purple toes and some patients are a

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<v Speaker 1>tip off that the disease is causing serious and potentially

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<v Speaker 1>deadly blood clots, and revealing how much yet there is

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<v Speaker 1>to learn about the disease. But first, here's what happened today.

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<v Speaker 1>The Centers for Disease Control and Prevention wrote a report

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<v Speaker 1>on reopening the country that was more detailed and more

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<v Speaker 1>restrictive than the guidance the White House released last month.

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<v Speaker 1>The advice from the CDC was shelved by Trump administration officials,

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<v Speaker 1>but the Associated Press obtained the sixty three page document.

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<v Speaker 1>It shows that the thinking of the CDC infection control

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<v Speaker 1>experts differs from those in the White House managing the

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<v Speaker 1>pandemic response. The White House is Opening Up America Again

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<v Speaker 1>plan that was released April seventeen included some of the

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<v Speaker 1>CDC's approach, but made clear that the onus for reopening

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<v Speaker 1>decisions was solely on state governors and local officials. By contrast,

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<v Speaker 1>the CDC advocated for a coordinated national response to give

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<v Speaker 1>community leaders step by step instructions to quote help Americans

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<v Speaker 1>re enter civic life, with the idea that there would

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<v Speaker 1>be resurgences of the virus and lots of customization needed.

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<v Speaker 1>The White House said last week that the document was

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<v Speaker 1>a draft and not ready for release. Americans may be

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<v Speaker 1>first in line for a potential COVID nineteen vaccine. French

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<v Speaker 1>pharmaceutical giant Sinophie will likely give priority to the U

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<v Speaker 1>S for doses if it succeeds at delivering a vaccine

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<v Speaker 1>because the US was first to fund its research. That's

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<v Speaker 1>according to the company's chief executive Paul Hudson, who spoke

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<v Speaker 1>to Bloomberg News. Finally, the rapid response coronavirus test from

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<v Speaker 1>Abbot laboratories that's being used at the White House may

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<v Speaker 1>miss as many as half of positive cases, according to

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<v Speaker 1>a report from New York University. The findings have yet

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<v Speaker 1>to be confirmed. An analysis of Abbott's i D now,

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<v Speaker 1>which is in daily use at the White House and

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<v Speaker 1>other prominent locations, missed at least one third of positive

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<v Speaker 1>cases detected with a rival test, and as many as

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<v Speaker 1>forty eight percent when using the currently recommended drying nasal swabs,

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<v Speaker 1>and now our main story. As COVID nineteen continues to escalate,

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<v Speaker 1>doctors around the world are learning that the virus doesn't

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<v Speaker 1>just attack the lungs. The coronavirus can cause kidney failure,

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<v Speaker 1>send the body's immune system into high gear, and lead

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<v Speaker 1>to a range of clodding related disorders. Bloomberg Senior editor

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<v Speaker 1>Jason Gale reports on the ways the coronavirus is affecting

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<v Speaker 1>the body from head to toe. It seems each week

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<v Speaker 1>or two we're learning about a new unexpected dimension of

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<v Speaker 1>the coronavirus. The ways in which it causes illness is

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<v Speaker 1>one of those. As COVID nineteen spreads across millions of

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<v Speaker 1>people worldwide, one surprise finding doctors consistently report is the

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<v Speaker 1>frequency of problems related to blood clots. You may have

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<v Speaker 1>heard of covid toe. It's a term used to describe

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<v Speaker 1>the red and purple skin lesions on the feet of

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<v Speaker 1>coronavirus patients. Some people say they're like chillblains. They're painful

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<v Speaker 1>reaction to cold. Whether people can feel in their fingers

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<v Speaker 1>and toes. Doctors say they're caused by damage to superficial

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<v Speaker 1>veins beneath the skin. The problems relatively benign, but it's

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<v Speaker 1>part of a spectrum of blood circulation disorders occurring with

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<v Speaker 1>COVID nineteen. At the other end of that spectrum are

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<v Speaker 1>blood clots that can cause life threatening strokes and heart failure.

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<v Speaker 1>Besides the toe rashes, these problems can be visible in

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<v Speaker 1>other ways. Doctors working in intensive care units so they

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<v Speaker 1>can see them in arterial catheters and filters used to

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<v Speaker 1>support patients failing kidneys. Just in general, we're seeing clouding

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<v Speaker 1>in a way in this illness that we have not

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<v Speaker 1>seen in the past. This is Professor Mitchell Evy. He's

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<v Speaker 1>Chief of Pulmonary Critical Care and Sleep Medicine at the

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<v Speaker 1>Warren Albert's School of Medicine at Brown University and Providence.

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<v Speaker 1>He's also a director of the Medical Intensive Care Unit

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<v Speaker 1>at Rhode Island Hospital. It's not unusual for infections to

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<v Speaker 1>raise the risk of clotting. Viruses including HIV, DANGHI, and

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<v Speaker 1>the boulder are all known to do it. Fever and

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<v Speaker 1>inflammation brander blood cells more prone to clumping while interfering

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<v Speaker 1>with the body's ability to dissolve clots. It can trigger

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<v Speaker 1>a blood clotting cascade that's thought to begin when the

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<v Speaker 1>lining of blood vessels is disrupted. Mitchell says that procluding

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<v Speaker 1>effect maybe even more pronounced in patients with the coronavirus.

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<v Speaker 1>So when you disrupt that lining of blood vessels, you

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<v Speaker 1>start to liberate factors that begin to make people and

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<v Speaker 1>patience more likely to clot. So we've long understood that

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<v Speaker 1>septs us infection, the body is reacting to infection, creates

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<v Speaker 1>a prothrombotic or a favorable state for leading to clots.

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<v Speaker 1>There's something about this virus that's exaggerated that to the

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<v Speaker 1>nth degree, and we are seeing an enormous amount of

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<v Speaker 1>clots in these people. Doctors in China noted clotting disorders

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<v Speaker 1>in the first weeks of the pandemic, but the gravity

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<v Speaker 1>of the medical problem has become clearer since thousands of

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<v Speaker 1>cases emerged in Europe and North America. It's making doctors

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<v Speaker 1>think differently about COVID nineteen. According to Professor Edwin van Bak.

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<v Speaker 1>Edwin is Chair of Clinical Radiology at the University of

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<v Speaker 1>Edinburgh's Queen's Medical Research Institute. Everybody has been focusing until

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<v Speaker 1>recently on the ventilation aspects off the disease, because that's

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<v Speaker 1>what flu and long infection and all these things do,

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<v Speaker 1>and people have not really looked at the vascular aspects

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<v Speaker 1>of the disease. We think that is the mechanism where

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<v Speaker 1>so many people are are day. Separate studies from France

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<v Speaker 1>and the Netherlands found that as many as thirty percent

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<v Speaker 1>of severely ill COVID nineteen patients suffered a so called

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<v Speaker 1>pulmonary embolism, a potentially deadly blockage and one of the

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<v Speaker 1>arteries of the lungs. These often occur when a clot

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<v Speaker 1>or thrombosis forms in a deep vein in the leg

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<v Speaker 1>and travels in the blood stream to the lungs. If untreated,

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<v Speaker 1>large arterial lung clots can put an overwhelming strain on

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<v Speaker 1>the heart, causing canniac arrest. Even small clots and the

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<v Speaker 1>lungs can deprive patients of oxygen, but clots may form

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<v Speaker 1>in other parts of the body, potentially damaging vital organs,

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<v Speaker 1>including the heart, kidneys, liver, and bow. In pregnant COVID

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<v Speaker 1>nineteen patients, clots may impair blood supply to the fetus,

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<v Speaker 1>leading to complications associated with miscarriage and low birth weight. Um,

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<v Speaker 1>so there's a lot going on. Were of clopping seems

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<v Speaker 1>to be quite pivotal in the whole process of how

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<v Speaker 1>series held and how what a killer this does. He does.

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<v Speaker 1>In the early nine nineties, Edwin helped develop the so

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<v Speaker 1>called d dime, that blood test that's used around the

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<v Speaker 1>world to monitor clots and patients, including those with COVID nineteen,

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<v Speaker 1>and to dose them with hebron and other anti coagulants.

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<v Speaker 1>Untreated pulmonary embolism is lethal in one in three cases

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<v Speaker 1>and will recur without warning in another third. Edwin says

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<v Speaker 1>in three to seven percent of patients, it will cause

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<v Speaker 1>pulmonary hypertension, another dangerous complication that can cause fatigue and

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<v Speaker 1>shortness of breath. I mean no, of course from from

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<v Speaker 1>bosus of pulmonary embolism. It is sort of a silent

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<v Speaker 1>killer people that we aren't you're aware, and then all

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<v Speaker 1>of a sudden and somebody's days scarred lungs and cludding

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<v Speaker 1>related problems, maybe a lingering legacy of the pandemic. Edwin says.

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<v Speaker 1>Patients who have gotten over the illness but who have

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<v Speaker 1>difficulty breathing, especially on exertion, might mistakenly believe they're experiencing

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<v Speaker 1>a second bow to the infection, when the problem might

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<v Speaker 1>be due to untreated clots coming off blood flow and

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<v Speaker 1>the lungs ominously. If dangerous clots go untreated, they may

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<v Speaker 1>manifest days two weeks after respiratory symptoms have resolved. And

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<v Speaker 1>I don't think a lot of both patients don't know

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<v Speaker 1>when the physicians don't know, you have never looked for it.

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<v Speaker 1>The clothing problem can be dramatic. Cases of stroke have

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<v Speaker 1>been reported in New York and Boston in COVID patients

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<v Speaker 1>younger than fifty. It's a rare complication amplified by the

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<v Speaker 1>sheer numbers of infected patients in these cities. Anthony Fauci,

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<v Speaker 1>the director of the National Institute of Allergy and Infectious Diseases,

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<v Speaker 1>says these findings are puzzling on one hand, but and

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<v Speaker 1>lightning on the other because they can inform better ways

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<v Speaker 1>to treat patients. Now that doctors are using the simple

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<v Speaker 1>d DIM blood test to monitor for clots and using

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<v Speaker 1>blood thinners to prevent the problem, relatively fewer patients are

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<v Speaker 1>experiencing these life threatening complications. Well studies are underway to

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<v Speaker 1>identify drugs to find the virus, researches are figuring out

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<v Speaker 1>strategies to mitigate its deadly effects. That was Bloomberg's Jason Gale,

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<v Speaker 1>and that's our show today. For coverage of the outbreak

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<v Speaker 1>from one bureaus around the world, visit bloomberg dot com

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<v Speaker 1>slash coronavirus and if you like the show, please leave

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<v Speaker 1>us a review and a rating on Apple Podcasts or Spotify.

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<v Speaker 1>It's the best way to help more listeners find our

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<v Speaker 1>global reporting. The Prognosis Daily edition is hosted by Me

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<v Speaker 1>Laura Carlson. The show is pretty used by Me topher Foreheads,

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<v Speaker 1>Jordan Gaspoure, and Magnus Hendrickson. Today's main story was reported

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<v Speaker 1>by Jason Gale. Original music by Leo Sidrin. Our editors

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<v Speaker 1>are Francesco Levi and Rick Shine. Francesco Levi is Bloomberg's

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<v Speaker 1>head of podcasts. Thanks for listening.