Speaker 1: Welcome to Prognosis. I'm Laura Carlson. It's stay sixty three
Speaker 1: since coronavirus was declared a global pandemic. Our main story,
Speaker 1: COVID nineteen is turning out to have effects well beyond
Speaker 1: the respiratory system. Purple toes and some patients are a
Speaker 1: tip off that the disease is causing serious and potentially
Speaker 1: deadly blood clots, and revealing how much yet there is
Speaker 1: to learn about the disease. But first, here's what happened today.
Speaker 1: The Centers for Disease Control and Prevention wrote a report
Speaker 1: on reopening the country that was more detailed and more
Speaker 1: restrictive than the guidance the White House released last month.
Speaker 1: The advice from the CDC was shelved by Trump administration officials,
Speaker 1: but the Associated Press obtained the sixty three page document.
Speaker 1: It shows that the thinking of the CDC infection control
Speaker 1: experts differs from those in the White House managing the
Speaker 1: pandemic response. The White House is Opening Up America Again
Speaker 1: plan that was released April seventeen included some of the
Speaker 1: CDC's approach, but made clear that the onus for reopening
Speaker 1: decisions was solely on state governors and local officials. By contrast,
Speaker 1: the CDC advocated for a coordinated national response to give
Speaker 1: community leaders step by step instructions to quote help Americans
Speaker 1: re enter civic life, with the idea that there would
Speaker 1: be resurgences of the virus and lots of customization needed.
Speaker 1: The White House said last week that the document was
Speaker 1: a draft and not ready for release. Americans may be
Speaker 1: first in line for a potential COVID nineteen vaccine. French
Speaker 1: pharmaceutical giant Sinophie will likely give priority to the U
Speaker 1: S for doses if it succeeds at delivering a vaccine
Speaker 1: because the US was first to fund its research. That's
Speaker 1: according to the company's chief executive Paul Hudson, who spoke
Speaker 1: to Bloomberg News. Finally, the rapid response coronavirus test from
Speaker 1: Abbot laboratories that's being used at the White House may
Speaker 1: miss as many as half of positive cases, according to
Speaker 1: a report from New York University. The findings have yet
Speaker 1: to be confirmed. An analysis of Abbott's i D now,
Speaker 1: which is in daily use at the White House and
Speaker 1: other prominent locations, missed at least one third of positive
Speaker 1: cases detected with a rival test, and as many as
Speaker 1: forty eight percent when using the currently recommended drying nasal swabs,
Speaker 1: and now our main story. As COVID nineteen continues to escalate,
Speaker 1: doctors around the world are learning that the virus doesn't
Speaker 1: just attack the lungs. The coronavirus can cause kidney failure,
Speaker 1: send the body's immune system into high gear, and lead
Speaker 1: to a range of clodding related disorders. Bloomberg Senior editor
Speaker 1: Jason Gale reports on the ways the coronavirus is affecting
Speaker 1: the body from head to toe. It seems each week
Speaker 1: or two we're learning about a new unexpected dimension of
Speaker 1: the coronavirus. The ways in which it causes illness is
Speaker 1: one of those. As COVID nineteen spreads across millions of
Speaker 1: people worldwide, one surprise finding doctors consistently report is the
Speaker 1: frequency of problems related to blood clots. You may have
Speaker 1: heard of covid toe. It's a term used to describe
Speaker 1: the red and purple skin lesions on the feet of
Speaker 1: coronavirus patients. Some people say they're like chillblains. They're painful
Speaker 1: reaction to cold. Whether people can feel in their fingers
Speaker 1: and toes. Doctors say they're caused by damage to superficial
Speaker 1: veins beneath the skin. The problems relatively benign, but it's
Speaker 1: part of a spectrum of blood circulation disorders occurring with
Speaker 1: COVID nineteen. At the other end of that spectrum are
Speaker 1: blood clots that can cause life threatening strokes and heart failure.
Speaker 1: Besides the toe rashes, these problems can be visible in
Speaker 1: other ways. Doctors working in intensive care units so they
Speaker 1: can see them in arterial catheters and filters used to
Speaker 1: support patients failing kidneys. Just in general, we're seeing clouding
Speaker 1: in a way in this illness that we have not
Speaker 1: seen in the past. This is Professor Mitchell Evy. He's
Speaker 1: Chief of Pulmonary Critical Care and Sleep Medicine at the
Speaker 1: Warren Albert's School of Medicine at Brown University and Providence.
Speaker 1: He's also a director of the Medical Intensive Care Unit
Speaker 1: at Rhode Island Hospital. It's not unusual for infections to
Speaker 1: raise the risk of clotting. Viruses including HIV, DANGHI, and
Speaker 1: the boulder are all known to do it. Fever and
Speaker 1: inflammation brander blood cells more prone to clumping while interfering
Speaker 1: with the body's ability to dissolve clots. It can trigger
Speaker 1: a blood clotting cascade that's thought to begin when the
Speaker 1: lining of blood vessels is disrupted. Mitchell says that procluding
Speaker 1: effect maybe even more pronounced in patients with the coronavirus.
Speaker 1: So when you disrupt that lining of blood vessels, you
Speaker 1: start to liberate factors that begin to make people and
Speaker 1: patience more likely to clot. So we've long understood that
Speaker 1: septs us infection, the body is reacting to infection, creates
Speaker 1: a prothrombotic or a favorable state for leading to clots.
Speaker 1: There's something about this virus that's exaggerated that to the
Speaker 1: nth degree, and we are seeing an enormous amount of
Speaker 1: clots in these people. Doctors in China noted clotting disorders
Speaker 1: in the first weeks of the pandemic, but the gravity
Speaker 1: of the medical problem has become clearer since thousands of
Speaker 1: cases emerged in Europe and North America. It's making doctors
Speaker 1: think differently about COVID nineteen. According to Professor Edwin van Bak.
Speaker 1: Edwin is Chair of Clinical Radiology at the University of
Speaker 1: Edinburgh's Queen's Medical Research Institute. Everybody has been focusing until
Speaker 1: recently on the ventilation aspects off the disease, because that's
Speaker 1: what flu and long infection and all these things do,
Speaker 1: and people have not really looked at the vascular aspects
Speaker 1: of the disease. We think that is the mechanism where
Speaker 1: so many people are are day. Separate studies from France
Speaker 1: and the Netherlands found that as many as thirty percent
Speaker 1: of severely ill COVID nineteen patients suffered a so called
Speaker 1: pulmonary embolism, a potentially deadly blockage and one of the
Speaker 1: arteries of the lungs. These often occur when a clot
Speaker 1: or thrombosis forms in a deep vein in the leg
Speaker 1: and travels in the blood stream to the lungs. If untreated,
Speaker 1: large arterial lung clots can put an overwhelming strain on
Speaker 1: the heart, causing canniac arrest. Even small clots and the
Speaker 1: lungs can deprive patients of oxygen, but clots may form
Speaker 1: in other parts of the body, potentially damaging vital organs,
Speaker 1: including the heart, kidneys, liver, and bow. In pregnant COVID
Speaker 1: nineteen patients, clots may impair blood supply to the fetus,
Speaker 1: leading to complications associated with miscarriage and low birth weight. Um,
Speaker 1: so there's a lot going on. Were of clopping seems
Speaker 1: to be quite pivotal in the whole process of how
Speaker 1: series held and how what a killer this does. He does.
Speaker 1: In the early nine nineties, Edwin helped develop the so
Speaker 1: called d dime, that blood test that's used around the
Speaker 1: world to monitor clots and patients, including those with COVID nineteen,
Speaker 1: and to dose them with hebron and other anti coagulants.
Speaker 1: Untreated pulmonary embolism is lethal in one in three cases
Speaker 1: and will recur without warning in another third. Edwin says
Speaker 1: in three to seven percent of patients, it will cause
Speaker 1: pulmonary hypertension, another dangerous complication that can cause fatigue and
Speaker 1: shortness of breath. I mean no, of course from from
Speaker 1: bosus of pulmonary embolism. It is sort of a silent
Speaker 1: killer people that we aren't you're aware, and then all
Speaker 1: of a sudden and somebody's days scarred lungs and cludding
Speaker 1: related problems, maybe a lingering legacy of the pandemic. Edwin says.
Speaker 1: Patients who have gotten over the illness but who have
Speaker 1: difficulty breathing, especially on exertion, might mistakenly believe they're experiencing
Speaker 1: a second bow to the infection, when the problem might
Speaker 1: be due to untreated clots coming off blood flow and
Speaker 1: the lungs ominously. If dangerous clots go untreated, they may
Speaker 1: manifest days two weeks after respiratory symptoms have resolved. And
Speaker 1: I don't think a lot of both patients don't know
Speaker 1: when the physicians don't know, you have never looked for it.
Speaker 1: The clothing problem can be dramatic. Cases of stroke have
Speaker 1: been reported in New York and Boston in COVID patients
Speaker 1: younger than fifty. It's a rare complication amplified by the
Speaker 1: sheer numbers of infected patients in these cities. Anthony Fauci,
Speaker 1: the director of the National Institute of Allergy and Infectious Diseases,
Speaker 1: says these findings are puzzling on one hand, but and
Speaker 1: lightning on the other because they can inform better ways
Speaker 1: to treat patients. Now that doctors are using the simple
Speaker 1: d DIM blood test to monitor for clots and using
Speaker 1: blood thinners to prevent the problem, relatively fewer patients are
Speaker 1: experiencing these life threatening complications. Well studies are underway to
Speaker 1: identify drugs to find the virus, researches are figuring out
Speaker 1: strategies to mitigate its deadly effects. That was Bloomberg's Jason Gale,
Speaker 1: and that's our show today. For coverage of the outbreak
Speaker 1: from one bureaus around the world, visit bloomberg dot com
Speaker 1: slash coronavirus and if you like the show, please leave
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Speaker 1: It's the best way to help more listeners find our
Speaker 1: global reporting. The Prognosis Daily edition is hosted by Me
Speaker 1: Laura Carlson. The show is pretty used by Me topher Foreheads,
Speaker 1: Jordan Gaspoure, and Magnus Hendrickson. Today's main story was reported
Speaker 1: by Jason Gale. Original music by Leo Sidrin. Our editors
Speaker 1: are Francesco Levi and Rick Shine. Francesco Levi is Bloomberg's
Speaker 1: head of podcasts. Thanks for listening.