T cell shortage linked to severe COVID-19 in elderly; antiseptic spray may limit virus spread

By Nancy Lapid

(Reuters) – The following is a roundup of some of the latest scientific studies on the novel coronavirus and efforts to find treatments and vaccines for COVID-19, the illness caused by the virus.

Shortage of ‘naive’ T cells raises COVID-19 risk in elderly

A lower supply of a certain type of immune cell in older people that is critical to fighting foreign invaders may help explain their vulnerability to severe COVID-19, scientists say. When germs enter the body, the initial “innate” immune response generates inflammation not specifically targeted at the bacteria or virus.

Within days, the more precise “adaptive” immune response starts generating antibodies against the invader along with T cells that either assist in antibody production or seek out and attack infected cells.

In a small study published on Wednesday in Cell, COVID-19 patients with milder disease had better adaptive immune responses, and in particular, stronger T-cell responses to the coronavirus.

People over age 65 were much more likely to have poor T cell responses, and a poorly coordinated immune response in general, coauthor Shane Crotty of the La Jolla Institute for Immunology said in a news release.

As we age, our supply of “naive” T cells shrinks, he explained. Put another way, we have fewer “inexperienced” T cells available to be activated to respond to a new invader. “Ageing and scarcity of naive T cells may be linked risk factors for failure to generate a coordinated adaptive immune response, resulting in increased susceptibility to severe COVID-19,” the researchers said.

Antiseptic nasal spray may help limit coronavirus spread

An antiseptic nasal spray containing povidone-iodine may help curb transmission of the new coronavirus, preliminary research suggests.

In test tube experiments, a team of ear, nose and throat doctors found that a povidone-iodine nasal spray inactivated the virus in as little as 15 seconds. The nasal spray they tested is typically used to disinfect the inside of the nose before surgery. Formulations designed for use on skin are not safe in the nose, the researchers note.

They reported on Thursday in JAMA Otolaryngology – Head and Neck Surgery that they now have their patients use the spray before intranasal procedures, to reduce the risk of virus transmission through the air via droplets and aerosol spread.

They also suggest instructing patients to perform nasal decontamination before coming to appointments, to “further decrease intranasal viral load and … prevent spread in waiting areas and other common areas.” They caution, however, that routine use of povidone-iodine would not be safe for some people, including pregnant women and patients with thyroid conditions. Larger clinical trials have not yet proved that viral transmission is curbed by intranasal povidone-iodine solutions, but “these studies are already underway,” the researchers said.

Not all COVID-19 antibody tests are equal

Some COVID-19 antibody tests are much more reliable than others. But even with the best ones, reliability varies among patient subgroups, a new study suggests. Some tests look for IgM or IgA antibodies, the first antibodies produced by the immune system in response to an invader, which do not remain long in the body.

Other tests – the most common kind – look for IgG antibodies, which generally develop within seven to 10 days after symptoms begin and remain in the blood for some time after the patient recovers.

In a study posted on medRxiv on Wednesday in advance of peer review, researchers analyzed data from 11,809 individuals whose COVID-19 had been diagnosed with highly rated tests to see how well the various antibody assays would “recall” that the patient had been infected.

The most commonly used assays, which look for IgG, had a 91.2% recall rate. But the IgA and IgM assays had estimated recall rates of 20.6% and 27.3%, respectively, coauthor Natalie Sheils of UnitedHealth Group told Reuters. “Recall varies significantly across sub-populations and according to timing of the tests, with performance becoming relatively stable after day 14,” she said. “The tests performed better for men versus women, for non-whites versus whites and for individuals above age 45.” More research is needed to understand why these variations occur, Sheils added.

(Reporting by Nancy Lapid; Editing by Bill Berkrot)

COVID-19 often goes undiagnosed in hospital workers; virus may impair heart functions

By Nancy Lapid

(Reuters) – The following is a roundup of some of the latest scientific studies on the novel coronavirus and efforts to find treatments and vaccines for COVID-19, the illness caused by the virus.

COVID-19 often undiagnosed in front line hospital workers

A high proportion of COVID-19 infections among U.S. healthcare personnel appear to go undetected, according to a report on Monday in the Morbidity and Mortality Weekly Report of the U.S. Centers for Disease Control and Prevention. Between April and June, among more than 3,000 front line workers in 12 states, roughly 1 in 20 had antibody evidence of a previous COVID-19 infection, but 69% of those infections had never been diagnosed. Among those with antibodies to the novel coronavirus, about one-third did not recall having symptoms in the preceding months, nearly half did not suspect that they had been infected, and some two-thirds had never had a positive COVID-19 test. Infections among front line healthcare personnel may be going undetected, the study authors say, because some infections may be only minimally symptomatic or asymptomatic and also because personnel with symptoms may not always have access to testing. COVID-19 antibodies were less common among workers who reported using a face covering for all patient encounters and more common among those who reported a shortage of personal protective equipment. The researchers call for more frequent testing of healthcare personnel and universal use of face coverings in hospitals.

Virus may impair heart’s beating, contracting

Following recent reports that the new coronavirus can invade heart muscle cells comes the discovery that infected cells show impairments in function. In test tube experiments, researchers infected “myocytes,” or heart muscle cells, with the new coronavirus and found that before the infected cells die, they progressively lose their “electrophysiological and contractile properties.” This means they have trouble transmitting the electrical impulses that regulate heartbeats and shortening or lengthening their fibers so the heart can expand and contract to pump blood. In a paper posted online Sunday on bioRxiv ahead of peer review, the researchers note that their test tube experiments likely do not exactly replicate what happens with cells in the body, and more research is needed to confirm their findings. Still, they say, their results suggest that cardiac symptoms in COVID-19 patients are likely a direct effect of the virus and warn that “long-term cardiac complications might be possible … in patients who recover from this illness.”

Eye symptoms common in children with COVID-19

Children with COVID-19 often have non-serious eye symptoms like itching, discharge, or pink eye, a study from China suggests. Among 216 children hospitalized with COVID-19 in Wuhan, the epicenter of the outbreak there, 23% had these kinds of eye issues, doctors found. Eye problems were more common in children with other symptoms such as cough or fever. In all cases, the eye problems were mild and eventually went away either without treatment or with “minimal” eye drops, researchers reported in JAMA Ophthalmology. It is reassuring that most of the children had other symptoms first, said Dr. Douglas Fredrick, chief of pediatric ophthalmology at the Mount Sinai Health system in New York City, who was not involved in the study. If conjunctivitis, or pink eye, were always among the first symptoms, “we’d be more worried that children could spread this by pink eye from one child to another,” he told Reuters. Still, he said, the study doesn’t completely rule out that type of transmission.

Cell phone activity may predict COVID-19 spread

Cell phone use patterns suggest that when people stay home, coronavirus infection rates go down, researchers say. For a study published on Monday in JAMA Internal Medicine, they analyzed publicly available de-identified cell phone activity and location data collected between January and May from 2,740 counties across the United States. After mid-February, when the coronavirus outbreak began, cell phone activity declined significantly in workplaces, stores and restaurants, and mass transit stations and increased in homes – with the greatest initial changes seen in areas with higher rates of COVID-19. Two weeks after cell phone activity shifted away from workplaces and retail locations, the counties with the most pronounced changes had the lowest rates of new COVID-19 cases. “Perhaps reassuringly,” the researchers said, cell phone activity at grocery stores and in areas classified as parks was not strongly associated with rates of growth in COVID-19 cases. They speculate that publicly available cell phone location data might help health offices better predict COVID-19 growth rates and inform decision about where to implement shutdowns and re-openings.

(Reporting by Nancy Lapid and Linda Carroll; Editing by Bill Berkrot)

Hiroshima marks 75 years since atomic bombing in scaled-back ceremony

By Elaine Lies

TOKYO (Reuters) – Bells tolled in Hiroshima on Thursday for the 75th anniversary of the world’s first atomic bombing, with ceremonies downsized due to the coronavirus and the city’s mayor urging nations to reject selfish nationalism and unite to fight all threats.

Though thousands usually pack the Peace Park in the center of the Japanese city to pray, sing and offer paper cranes as a symbol of peace, entrance was sharply limited and only survivors and their families could attend the memorial ceremony.

The city said the significance of the anniversary of the bombing that killed 140,000 people before the end of 1945 had prompted its decision to hold the ceremony despite the spread of the virus, but taking strict precautions.

“On August 6, 1945, a single atomic bomb destroyed our city. Rumor at the time had it that ‘Nothing will grow here for 75 years,'” said mayor Kazumi Matsui.

“And yet, Hiroshima recovered, becoming a symbol of peace.”

At 8:15 a.m. on Aug 6, 1945, U.S. B-29 warplane Enola Gay dropped a bomb nicknamed “Little Boy” and obliterated the city with an estimated population of 350,000, where thousands more died later from injuries and radiation-related illnesses.

On Thursday, as cicadas shrilled in the heavy summer heat and the Peace Bell sounded, the crowd stood to observe a moment of silence at the exact time the bomb exploded.

“When the 1918 flu pandemic attacked a century ago, it took tens of millions of lives and terrorized the world because nations fighting World War I were unable to meet the threat together,” Matsui added.

“A subsequent upsurge in nationalism led to World War Two and the atomic bombings. We must never allow this painful past to repeat itself. Civil society must reject self-centered nationalism and unite against all threats.”

Prime Minister Shinzo Abe attended as usual, but the number of foreign visitors was down. Overall attendance was scaled back to less than a tenth of the usual figure, with chairs spaced far apart and most people wearing masks.

Matsui urged Japan to ratify a 2017 United Nations pact banning nuclear arms, but Abe avoided any direct reference, saying Japan would “work as a bridge between nations” to abolish nuclear weapons.

Keiko Ogura, who was eight when the bomb blast knocked her off her feet, has dedicated her life to working for peace.

“The nuclear danger is spreading around the world, and under that mushroom cloud, no one can escape,” she told a recent news conference.

The anniversary was a top trending topic on Japanese Twitter as most users offered prayers for world peace, although one drew a parallel with this week’s huge blast that killed at least 135 in Beirut, the Lebanese capital.

“I really hadn’t been able to imagine it before, but looking at the damage from the Beirut explosion and imagining something several times more powerful, I was struck with a huge sense of fear,” wrote the commenter, identified as “Sato-san.”

The bombing of Hiroshima was followed by the bombing of Nagasaki on Aug. 9, instantly killing more than 75,000 people. Japan surrendered six days later, ending World War Two.

(Reporting by Elaine Lies; Additional reporting by Linda Sieg; Editing by Michael Perry and Clarence Fernandez)

WHO says COVID-19 pandemic is ‘one big wave’, not seasonal

By Emma Farge

GENEVA (Reuters) – A World Health Organization official on Tuesday described the COVID-19 pandemic as “one big wave” and warned against complacency in the northern hemisphere summer since the infection does not share influenza’s tendency to follow seasons.

WHO officials have been at pains to avoid describing a resurgence of COVID-19 cases like those in Hong Kong as “waves” as this suggests the virus is behaving in ways beyond human control, when in fact concerted action can slow its spread.

Margaret Harris repeated that message in a virtual briefing in Geneva. “We are in the first wave. It’s going to be one big wave. It’s going to go up and down a bit. The best thing is to flatten it and turn it into just something lapping at your feet,” she said.

Pointing to high case numbers at the height of the U.S. summer, she urged vigilance in applying measures and warned against mass gatherings.

“People are still thinking about seasons. What we all need to get our heads around is this is a new virus and…this one is behaving differently,” she said.

“Summer is a problem. This virus likes all weather.”

However, she expressed concern about COVID-19 cases coinciding with normal seasonal influenza cases during the southern hemisphere’s winter, and said the Geneva-based body was monitoring this closely.

So far, she said, laboratory samples are not showing high numbers of flu cases, suggesting a later-than-normal start to the season.

“If you have an increase in a respiratory illness when you already have a very high burden of respiratory illness, that puts even more pressure on the health system,” she said, urging people to be vaccinated against flu.

(Reporting by Emma Farge; Editing by Michael Shields, William Maclean)

New travel curbs imposed as world tackles second COVID-19 wave

By Stephen Coates and Peter Graff

SYDNEY/LONDON (Reuters) – Nations in Asia imposed new restrictions on Monday and an abrupt British quarantine on travelers from Spain threw Europe’s summer reopening into disarray, as the world confronted the prospect of a second wave of COVID-19 infections.

In the United States, where infection rates have been climbing since mid-June, President Donald Trump’s national security adviser Robert O’Brien became the most senior White House official to test positive.

Surges were reported in a number of countries previously singled out as places where the virus was under control.

Australia recorded a record daily rise. Vietnam locked down the city of Danang, forcing tens of thousands of visitors to evacuate. Mainland China confirmed the most new locally transmitted cases since early March. Papua New Guinea shut its borders.

Hong Kong banned gatherings of more than two people, closed down restaurant dining and introduced mandatory face masks in public places, including outdoors.

Just weeks after European countries trumpeted the reopening of tourism, a surge in infections in Spain prompted Britain to order all travelers from there to quarantine for two weeks, torpedoing the travel plans of hundreds of thousands of people.

The World Health Organization said travel restrictions could not be the answer for the long term, and countries had to do more to halt the spread inside their borders by adopting proven strategies such as social distancing and the wearing of masks.

“It is going to be almost impossible for individual countries to keep their borders shut for the foreseeable future. Economies have to open up, people have to work, trade has to resume,” WHO emergencies program director Mike Ryan said.

“What is clear is pressure on the virus pushes the numbers down. Release that pressure and cases creep back up.”

NOT LIKE BEFORE

Officials in some of the European and Asian countries where the virus is again spreading say new outbreaks will not be as bad as the original waves that hit earlier this year, and can be contained with local measures rather than nationwide shutdowns.

But countries that have suffered extreme economic hardship from months of lockdowns are also determined not to let the virus get out of control again, even if that means reversing the path to reopening.

Europe has yet to lift bans on travelers from many countries, including the United States where the White House said national security adviser O’Brien presented no risk of infection for Trump or Vice President Mike Pence.

Britain’s announcement of the return of quarantine for Spain was likely to torpedo the revival of airlines and tourism businesses across the continent, which had thought they had survived their biggest crisis in living memory.

Britain accounts for more than 20% of foreign visitors to Spain, where tourism represents 12% of the economy.

Europe’s biggest airline, Ryanair, cut its annual passenger target by a quarter on Monday and warned a second wave of COVID-19 infections could lower that further.

A British junior health minister said more European countries could end up on the “red list” if infections surge.

“If we see the rates going up, we would have to take action because we cannot take the risk of coronavirus being spread again across the UK,” Helen Whately told Sky News when asked if Germany or France might be next after Spain.

In China, which managed to squelch local transmission through firm lockdowns after the virus first emerged in the central city of Wuhan late last year, a new surge has been driven by infections in the far western region of Xinjiang.

In the northeast, Liaoning province reported a fifth straight day of new infections and Jilin province reported two new cases, its first since late May.

Australian authorities who have imposed a six-week lockdown in parts of the southeastern state of Victoria said it could last longer after the country’s highest daily increase in infections.

“The tragedy of COVID-19 is that we know, with the number of new infections that we have seen today, that there will be many further deaths in the days ahead,” Australian Deputy Chief Medical Officer Michael Kidd told reporters.

In Japan, the government said it would urge business leaders to ramp up anti-virus measures such as staggered shifts, and aimed to see rates of telecommuting return to levels achieved during an earlier state of emergency.

“At one point, commuter numbers were down by 70 to 80%, but now it’s only about 30%,” Economy Minister Yasutoshi Nishimura said late on Sunday. “We really don’t want to backtrack on this, so we have to explore new ways of working and keep telecommuting high.”

Vietnam is evacuating 80,000 people, mostly local tourists, from Danang after three residents tested positive at the weekend. Until Saturday, the country had reported no community infections since April.

North Korean state media reported on the weekend that the border town of Kaesong was in lockdown after a person who defected to South Korea three years ago returned this month with symptoms of COVID-19. If confirmed, it would be the first case officially acknowledged by Pyongyang.

Papua New Guinea halted entry for travellers from Monday, except those arriving by air, as it tightens curbs against infections that have more than doubled over the past week.

(Reporting by Reuters bureaus; Writing by Stephen Coates and Peter Graff; Editing by Nick Macfie)

U.S. to pay Pfizer, BioNTech $1.95 bln for millions of COVID-19 vaccine doses

By Ankur Banerjee and Michael Erman

(Reuters) – The U.S. government will pay $1.95 billion to buy 100 million doses of Pfizer Inc and German biotech firm BioNTech SE’s COVID-19 vaccine candidate if they are able to successfully develop one, the companies said on Wednesday.

Pfizer said they will not receive any money from the government unless the vaccine is deemed to be safe and effective and is successfully manufactured.

The agreement allows the U.S. government to acquire an additional 500 million doses, the Department of Health and Human Services (HHS) and the Department of Defense said.

HHS said the vaccine will be made available to Americans at no cost, although their health insurance may be charged.

In clinical trials, Pfizer and BioNTech have been testing vaccines that require two injections. That means a supply of 100 million doses would likely vaccinate 50 million Americans.

The Trump administration has agreed to spend billions of dollars for the development and procurement of potential vaccines. The administration launched Operation Warp Speed — a joint HHS and Department of Defense program — to accelerate the development of coronavirus vaccines, treatments and diagnostics.

More than 150 coronavirus vaccines using a variety of technologies are in development globally, with some two dozen already in human trials. Governments have signed deals with drugmakers to secure the supply of various vaccine candidates.

Pfizer and BioNTech’s vaccine candidate is among those that are set to be tested in a large trial. The vaccine has shown promise in early-stage small studies in humans.

Pfizer will deliver the doses if the product receives emergency use authorization or licensing from the U.S. Food and Drug Administration, after demonstrating safety and efficacy in a large Phase 3 clinical trial.

The companies said they expect to be ready to seek some form of regulatory approval as early as October if the ongoing studies are successful.

Pfizer and BioNTech currently expect to manufacture up to 100 million doses globally by the end of 2020, and potentially more than 1.3 billion doses by the end of 2021, subject to final dose selection from their clinical trial.

(Reporting by Ankur Banerjee in Bengaluru; Editing by Shounak Dasgupta)

Global coronavirus cases exceed 15 million: Reuters tally

By Jane Wardell and Gayle Issa

SYDNEY/LONDON (Reuters) – Global coronavirus infections surged past 15 million on Wednesday, according to a Reuters tally, with the pandemic gathering pace even as countries remain divided in their response to the crisis.

In the United States, which has the highest number of cases in the world with 3.91 million infections, President Donald Trump warned: “It will probably, unfortunately, get worse before it gets better.”

The top five countries with the most cases is rounded out by Brazil, India, Russia and South Africa. But, the Reuters tally shows the disease is accelerating the fastest in the Americas, which account for more than half the world’s infections and half its deaths.

Globally, the rate of new infections shows no sign of slowing, according to the Reuters tally, based on official reports.

After the first COVID-19 case was reported in Wuhan, China, in early January, it took about 15 weeks to reach 2 million cases. By contrast, it took just eight days to climb above 15 million from the 13 million reached on July 13.

Health experts stress that official data almost certainly under-reports both infections and deaths, particularly in countries with limited testing capacity.

The official number of coronavirus cases at 15,009,213 is at least triple the number of severe influenza illnesses recorded annually, according to World Health Organization data, while the death toll of more than 616,000 in seven months is close to the upper range of yearly influenza deaths.

RELAX OR TIGHTEN

With the first wave of the virus still to peak in several countries and a resurgence of case numbers in others, some countries are reintroducing strict social distancing measures while others relax restrictions.

Stung by low approval ratings for his handling of the epidemic and downplaying the risks during the early stages, Trump made a significant shift in rhetoric on Tuesday, encouraging Americans to wear a face mask.

While the epidemic worsened in the United States, Trump’s focus ahead of a presidential election in November has been on reopening the economy, and governors in the hard-hit states of Texas, Florida and Georgia continue to push back hard against calls for stricter restrictions.

In Brazil, more than 2.15 million people have tested positive including President Jair Bolsonaro, and more than 81,000 people have died. While Bolsonaro has played down the outbreak, its scale has made Brazil a prime testing ground for potential vaccines.

India, the only other country with more than 1 million cases, reported almost 40,000 new cases on Wednesday. Having been keen to reopen its economy, India is now facing the twin challenge of combating the pandemic and massive flooding in the country’s northeast.

Two ministers in South Africa’s cabinet were admitted to hospital with COVID-19, as Africa’s most-industrialized country counted a total 372,628 confirmed cases and 5,173 deaths.

Other countries are reintroducing restrictions in response to fresh outbreaks.

In Spain, the number of people allowed on Barcelona’s beaches was limited after crowds flocked to the seaside over the weekend despite advice to stay home.

In Australia, residents of Melbourne, the country’s second biggest city, were ordered to wear masks in public from Wednesday after the country reported a record 501 new cases.

Officials in Canada were closely watching a spike in cases as the economy reopens, attributing the rise in part to large numbers of young people gathering in bars.

China, meanwhile, announced that passengers on inbound flights must provide negative COVID-19 test results before boarding, as authorities seek to reduce the risk of imported cases amid increased international travel.

(Reporting By Jane Wardell and Gayle Issa; Editing by Simon Cameron-Moore)

3M, MIT partner to make rapid COVID-19 antigen test

By Carl O’Donnell

(Reuters) – U.S. industrial conglomerate 3M Co has partnered with the Massachusetts Institute of Technology to develop a rapid antigen test for COVID-19, the company said on Tuesday.

The test would produce results within minutes and could be administered on a low-cost, paper-based device, similar to a home pregnancy test, that could be delivered at the point of care.

“We are seeking to improve the speed, accessibility and affordability of testing for the virus, a major step in helping to prevent its spread,” said John Banovetz, the chief technology officer at 3M.

The research effort is being aided by a grant from the National Institutes of Health, which is running a project called Rapid Acceleration of Diagnostics (RADx) that funds the development of new testing technologies in academia and business.

The program aims to have the new tests available for use by late summer or early fall.

Antigen tests scan for proteins that can be found on or inside a virus. They can detect the virus very quickly and can potentially be produced at a lower cost than other tests.

3M says it could scale manufacturing to millions of tests per day once it is developed.

(Reporting by Carl O’Donnell; Editing by Leslie Adler)

Coronavirus crisis may get ‘worse and worse and worse’, warns WHO

GENEVA (Reuters) – The raging coronavirus pandemic has the potential to get far worse if all nations do not adhere to basic healthcare precautions, the World Health Organization (WHO) warned on Monday.

“Let me be blunt, too many countries are headed in the wrong direction, the virus remains public enemy number one,” Director General Tedros Adhanom Ghebreyesus told a virtual briefing from WHO headquarters in Geneva.

“If basics are not followed, the only way this pandemic is going to go, it is going to get worse and worse and worse. But it does not have to be this way.”

Infections rose above 13 million across the world on Monday, according to a Reuters tally, climbing by one million in just five days in a pandemic that has killed more than half a million people.

(Reporting by Stephanie Nebehay, Michael Shields and Silke Koltrowitz; Editing by Andrew Cawthorne)

Alarmed as COVID patients’ blood thickened, New York doctors try new treatments

By Jonathan Allen

NEW YORK (Reuters) – As the novel coronavirus spread through New York City in late March, doctors at Mount Sinai Hospital noticed something strange happening to patients’ blood.

Signs of blood thickening and clotting were being detected in different organs by doctors from different specialties. This would turn out to be one of the alarming ways the virus ravages the body, as doctors there and elsewhere were starting to realize.

At Mount Sinai, nephrologists noticed kidney dialysis catheters getting plugged with clots. Pulmonologists monitoring COVID-19 patients on mechanical ventilators could see portions of lungs were oddly bloodless. Neurosurgeons confronted a surge in their usual caseload of strokes due to blood clots, the age of victims skewing younger, with at least half testing positive for the virus.

“It’s very striking how much this disease causes clots to form,” Dr. J Mocco, a Mount Sinai neurosurgeon, said in an interview, describing how some doctors think COVID-19, the illness caused by the coronavirus, is more than a lung disease. In some cases, Mocco said, a stroke was a young patient’s first symptom of COVID-19.

As colleagues from various specialties pooled their observations, they developed a new treatment protocol. Patients now receive high doses of a blood-thinning drug even before any evidence of clotting appears.

“Maybe, just maybe, if you prevent the clotting, you can make the disease less severe,” said Dr. David Reich, the hospital president. The new protocol will not be used on certain high-risk patients because blood thinners can lead to bleeding in the brain and other organs.

“FUNNY YOU MENTIONED THAT”

In the three weeks beginning mid-March, Mocco saw 32 stroke patients with large blood blockages in the brain, double the usual number for that period.

Five were unusually young, under age 49, with no obvious risk factors for strokes, “which is crazy,” he said. “Very, very atypical.” The youngest was only 31.

At least half of the 32 patients would test positive for COVID-19, Mocco said.

Meanwhile, Dr. Hooman Poor, a Mount Sinai lung specialist, found himself working a late shift with 14 patients on ventilators. The ventilator readings were not what he expected.

The lungs did not seem stiff, as is common in pneumonia. Instead, it seemed blood was not circulating freely through the lungs to be aerated with each breath.

Poor ran into a kidney doctor that night, who remarked that dialysis catheters were often getting blocked with clots.

“And I said, ‘It’s funny that you mentioned that because I feel like all these patients have blood clots in their lungs,'” Poor recalled.

Reich, the hospital president, told Poor about the surge in strokes seen by Mocco and said the two doctors should team up, setting off days of discussions and meetings with the hospital’s department heads.

At 2:46 a.m. on Easter Sunday, Poor sent Mocco his first draft of what would become the new treatment protocol.

DOCTORS SHARE FINDINGS

As their wards began to overflow with COVID-19 patients, the Mount Sinai doctors read papers describing similar findings from doctors in China’s Hubei province and other hard-hit areas, and discussed them with their peers in phone calls and webinars.

Mocco called neurosurgeons he knows elsewhere in the country. At Philadelphia’s Thomas Jefferson University Hospital, Dr. Pascal Jabbour had begun to see a similar surge in strokes among people with COVID-19. The way his patients’ blood congealed reminded him of congenital conditions such as lupus, or certain cancers.

“I’ve never seen any other viruses causing that,” Jabbour said.

In Boston, the Beth Israel Deaconess Medical Center began a clinical trial earlier this month to see if tPA, an anti-clotting drug, could help severely sick COVID-19 patients.

Clotting can develop in anyone who gets very sick and spends long periods of time immobile on a ventilator, but doctors say the problem seemed to show up sooner in COVID-19 patients as a more direct consequence of the virus.

At Mount Sinai, patients in intensive care often receive the blood-thinning agent heparin in weaker prophylactic doses. Under the new protocol, higher doses of heparin normally used to dissolve clots will be given to patients before any clots are detected.

The treatment joins a growing toolbox at the hospital, where some patients are receiving the antibody-rich plasma of recovered COVID-19 patients or experimental antiviral drugs.

The American Society of Hematology, which has also noted the clotting, says in its guidance to physicians that the benefits of the blood-thinning therapy for COVID-19 patients not already showing signs of clotting are “currently unknown.”

“I certainly wouldn’t expect harps to play and angels to sing and people to just rip out their intravenous lines and waltz out of the hospital,” said Reich. “It’s likely going to be something where it just moderates the extent of the disease.”

(Reporting by Jonathan Allen in New York; Editing by Nancy Lapid, Ross Colvin and Aurora Ellis)