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