Tag Archives: body

Chauvin trial witness backtracks on whether body cam captured George Floyd saying he ‘ate too many drugs’

The lead Minnesota state investigator on the George Floyd case changed his testimony at the trial of Derek Chauvin on Wednesday, telling the court that he now believed Floyd said, “I ain’t do no drugs,” not “I ate too many drugs,” during his May 2020 arrest.

Senior Special Agent James Reyerson of Minnesota’s Bureau of Criminal Apprehension initially agreed with Floyd’s defence attorney that it sounded like Floyd said the latter in police body-camera video played in Hennepin County District Court in Minneapolis Wednesday.

But after listening to a longer version of the recording, Reyerson said, he believed Floyd was, in fact, saying: “I ain’t do no drugs.”

Floyd, a 46-year-old Black man, died on May 25, 2020, after Chauvin, who is white, pressed a knee on the back of Floyd’s neck and his back for around nine minutes as two other officers held him down. Video of the arrest captured by a bystander prompted widespread outrage, setting off protests across the U.S. and around the world.

Chauvin, 45, is facing trial on charges of second-degree unintentional murder; third-degree murder; and second-degree manslaughter. Wednesday marked the eighth day of the trial.

Drug use a key question in trial

The issue of Floyd’s drug use is significant to Chauvin’s defence. The prosecution says Chauvin pressing his knee into Floyd’s neck caused his death. But the defence argues Chauvin did what his training taught him and that it was a combination of Floyd’s underlying medical conditions, drug use and adrenaline flowing through his system that ultimately killed him.

Floyd had been detained outside a convenience store after being suspected of paying with a counterfeit bill. All four officers were later fired. 

Chauvin’s lawyer, Eric Nelson, had earlier in the day introduced this evidence during his cross-examination of prosecution witness Jody Stiger, a Los Angeles Police Department sergeant and use-of-force expert.

Nelson played a snippet of video from the body-worn camera of J. Alexander Kueng, one of four officers involved in the arrest and later fired, and asked Stiger if he could hear Floyd say, “I ate too many drug” as he was handcuffed and prone on the pavement, pinned by the officers.

Stiger replied that he could not make out those words in the footage.

Later, Nelson attempted to get confirmation of the comment while cross-examining Reyerson. Nelson played the clip again, and asked whether it sounded like Floyd said, “I ate too many drugs.”

“Yes, it did,” Reyerson said.

After a short break, Reyerson was questioned by prosecutor Matthew Frank and told the court that during the break, he was able to watch a longer version of the clip that included discussion by officers about Floyd’s potential drug use.

“Having heard it in context, were you able to tell what Mr. Floyd was saying there?” Frank asked Reyerson after the clip was played again in court.

“Yes, I believe Mr. Floyd is saying, ‘I ain’t doing no drugs,'” Reyerson said.

Chauvin had responsibility to re-evaluate use of force: expert witness

Earlier in the day, court heard from Stiger, appearing as a paid prosecution witness providing expert testimony on use of force, say that Chauvin had a responsibility to re-evaluate pressing his knee into Floyd’s neck during their encounter as the health of the 46-year old Black man was clearly “deteriorating.”

Jody Stiger, a Los Angeles Police Department sergeant, serving as a paid prosecution witness providing expert testimony on use of force, appeared for his second day of testimony Wednesday, the eighth day of trial. (COURT TV/The Associated Press)

Stiger had testified the day before that the pressure being exerted on Floyd was excessive and could cause positional asphyxia and lead to death. On Wednesday he reaffirmed that the force Chauvin used on Floyd was “not objectively reasonable.”

Prosecutor Steve Schleicher asked Stiger whether Chauvin had an obligation to take into account the distress Floyd was displaying when considering whether to continue the type of force he was applying.

“Absolutely. As the time went on … his health was deteriorating,” Stiger said. “His breath was getting lower. His tone of voice was getting lower. His movements were starting to cease.

“So at that point, as on officer on scene, you have a responsibility to realize, ‘OK, something is not right. Something has changed drastically from what was occurring earlier.’ So therefore, you have responsibility to take some type of action.”

During cross-examination, Chauvin’s lawyer asked a question he has posed to other witnesses — whether there are times when a suspect can fake the need for medical attention. Stiger agreed there were.

Obligated to believe

But when asked by the prosecutor whether an officer can “opt not to believe” the detained individual, Stiger said an officer is still obligated to believe them. 

“That’s part of our duty,” he said. 

Stiger also testified that Chauvin knelt on Floyd’s neck or neck area from the time officers put Floyd on the ground until paramedics arrived.

“That particular force did not change during the entire restraint period?” Schleicher asked as he showed the jury a composite image of five photos taken from various bystander and body-cam videos of the arrest.

Chauvin, a former Minneapolis police officer, faces two murder charges — second-degree unintentional murder and third-degree murder — in Floyd’s death. (COURT TV/The Associated Press)

“Correct,” Stiger replied.

But Nelson was able to get Stiger to agree with a number of statements. Stiger agreed with Nelson, for example, that an officer’s actions must be viewed from the point of view of a reasonable officer on the scene, not in hindsight.

He also agreed that a not-risky situation can suddenly escalate and that a person in handcuffs can still pose a threat to an officer.

Stiger also agreed that when Chauvin arrived at the scene and saw officers struggling to get him in the back seat of the squad car, it would have been within police policy guidelines for Chauvin to have stunned Floyd with a Taser. 

And he agreed with Nelson that sometimes the use of force “looks really bad” but is still lawful.

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Indonesia officials say rescuers have found body parts, debris from plane crash

Indonesian rescuers pulled body parts, pieces of clothing and scraps of metal from the Java Sea early Sunday morning, a day after a Boeing 737-500 with 62 people onboard crashed shortly after takeoff from Jakarta, officials said.

Officials were hopeful they were homing in on the wreckage of Sriwijaya Air Flight 182 after sonar equipment detected a signal from the aircraft.

Transportation Minister Budi Karya Sumadi told reporters that authorities have launched massive search efforts after identifying “the possible location of the crash site.”

“These pieces were found by the SAR team between Lancang Island and Laki Island,” National Search and Rescue Agency Bagus Puruhito said in a statement.

Indonesian military chief Air Chief Marshal Hadi Tjahjanto said teams on the Rigel navy ship equipped with a remote-operated vehicle had detected a signal from the aircraft, which fit the coordinates from the last contact made by the pilots before the plane went missing.

Search and rescue teams conduct operations at sea where the Sriwijaya Air Boeing 737-500 is suspected to have crashed on Sunday. (Adek Berry/AFP via Getty Images)

“We have immediately deployed our divers from navy’s elite unit to determine the finding to evacuate the victims,” Tjahjanto said.

More than 12 hours since the Boeing plane operated by the Indonesian airline lost contact, little is known about what caused the crash.

Fishermen in the area around Thousand Islands, a chain of islands north of Jakarta’s coast, reported hearing an explosion around 2:30 p.m. local time Saturday.

“We heard something explode, we thought it was a bomb or a tsunami since after that we saw the big splash from the water,” fisherman Solihin, who goes by one name, told The Associated Press by phone.

“It was raining heavily and the weather was so bad. So it is difficult to see around clearly. But we can see the splash and a big wave after the sounds. We were very shocked and directly saw the plane debris and the fuel around our boat.”

Sumadi said Flight SJ182 was delayed for an hour before it took off at 2:36 p.m. local time. It disappeared from radar four minutes later, after the pilot contacted air traffic control to ascend to an altitude of 8,839 metres, he said.

There were 62 people on board, including seven children and three babies.

Relatives of passengers on board missing Sriwijaya Air flight 182 wait for news at the Supadio airport in Pontianak on Indonesia’s Borneo island on Saturday. (Louis Anderson/AFP via Getty Images)

Authorities established two crisis centres, one at airport and one at port. Families gathered to wait for news of loved ones.

On social media, people began circulating the flight manifest with photos and videos of those who were listed as passengers. One video shows a woman with her children waving goodbye while walking through the airport.

Plane was ‘airworthy’

Sriwijaya Air President Director Jefferson Irwin Jauwena said the plane, which is 26 years old and previously used by airlines in the United States, was airworthy. He told reporters Saturday that the plane had previously flown to Pontianak and Pangkal Pinang city on the same day.

“Maintenance report said everything went well and airworthy,” Jauwena told a news conference. He said the plane was delayed due to bad weather, not because of any damage.

Indonesia, the world’s largest archipelago nation, with more than 260 million people, has been plagued by transportation accidents on land, sea and air because of overcrowding on ferries, aging infrastructure and poorly enforced safety standards.

Indonesian soldiers stand near a crisis centre set up at Soekarno-Hatta International Airport in Tangerang, Indonesia, on Saturday. (Tatan Syuflana/The Associated Press)

In October 2018, a Boeing 737 MAX 8 jet operated by Lion Air plunged into the Java Sea just minutes after taking off from Jakarta, killing all 189 people on board. The plane involved in Saturday’s incident did not have the automated flight-control system that played a role in the Lion Air crash and another crash of a 737 MAX 8 jet in Ethiopia five months later, leading to the grounding of the MAX 8 for 20 months.

The Lion Air crash was Indonesia’s worst airline disaster since 1997, when 234 people were killed on a Garuda airlines flight near Medan on Sumatra island. In December 2014, an AirAsia flight from the Indonesian city of Surabaya to Singapore plunged into the sea, killing 162 people.

Sriwijaya Air has only has several minor incidents in the past, though a farmer was killed in 2008 when landing plane went off runway due to a hydraulic issue.

The United States banned Indonesian carriers from operating in the country in 2007, but reversed the decision in 2016, citing improvements in compliance with international aviation standards. The European Union has previously had similar bans, lifting them in June 2018.

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Rescuers recover body after Norway landslide, continue search for 9 others

Rescuers found one body on Friday, two days after a landslide in southern Norway swept away at least nine buildings, police said, with nine people still missing.

Another 10 people were injured after Wednesday’s landslide in the residential area in the Gjerdrum municipality, about 30 kilometres northeast of the capital, Oslo.

“One person has been found. Unfortunately this person is confirmed dead,” the head of the police operation at the site, Roy Alkvist, told reporters, declining to give any details about the person.

Emergency workers are continuing their search in what Bjoern Nuland, head of the health team at the site, said was still a rescue operation. A search-and-rescue team from neighbouring Sweden was assisting.

Some 1,000 people have so far been relocated from Gjerdrum, including 46 people from an area two kilometres away from the landslide, after cracks were observed in the ground.

Emergency services work during a rescue operation in Ask on Friday. (Terje Bendiksby/NTB/Reuters)

The landslide and the rescue effort have gripped the Nordic nation of 5.4 million.

King Harald, 83, said at the start of his traditional New Year’s Eve speech on Thursday that the “tragic event leaves a deep impression on us all.”

“I feel with you who go in the New Year with grief and uncertainty,” he said.

“With you who have lost your homes, and who are right now despairing and do not see the way forward.”

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World’s top intensive care body advises against use of remdesivir for sickest COVID-19 patients

The antiviral drug remdesivir should not be used as a routine treatment for COVID-19 patients in critical care wards, the head of one of the world’s top bodies representing intensive care doctors said, in a blow to the drug developed by U.S. firm Gilead.

Remdesivir, also known as Veklury, and the steroid dexamethasone are the only drugs authorized to treat COVID-19 patients across the world.

But the largest study on remdesivir’s efficacy, run by the World Health Organization (WHO), showed on Oct. 15 that it had little or no impact, contradicting previous trials.

In light of the new interim data from the WHO’s Solidarity trial, “remdesivir is now classified as a drug you should not use routinely in COVID-19 patients,” the president of the European Society of Intensive Care Medicine (ESICM), Jozef Kesecioglu, said in an interview with Reuters.

Gilead contests findings

Kesecioglu said the recommendation would be discussed in a scientific paper on COVID-19 therapies that ESICM is preparing with the Society of Critical Care Medicine, another intensive care body, expected to be published by January.

The first version of the paper, released in March, said there was not enough information to recommend the use of remdesivir and other antivirals in critically ill COVID-19 patients.

Gilead, which has questioned the WHO’s findings, said in an emailed statement: “We are confident that doctors on the front lines recognize the clinical benefit of Veklury based on robust evidence from multiple randomized, controlled studies.”

ESICM represents thousands of anesthesiologists, respiratory physicians, nurses and other critical care professionals in more than 120 countries.

While doctors and hospitals are not obliged to follow its advice, its recommendation could curb the use of remdesivir.

At the end of October, Gilead cut its 2020 revenue forecast, citing lower-than-expected demand and difficulty in predicting sales of remdesivir.

Widely used

The drug remains, however, widely used in hospitals. It is authorized or approved for use in more than 50 countries and was one of the medicines administered to U.S. President Donald Trump when he tested positive for coronavirus in October.

The European Union signed a one billion euro ($ 1.55 billion Cdn) deal with Gilead for 500,000 courses of remdesivir at 2,070 euros ($ 3,220 Cdn) each, days before the Solidarity results.

The deal does not oblige European countries to buy remdesivir, but governments decided to place large orders even after the Solidarity results, with Germany buying a big stock in November, saying the drug was useful, especially early in the course of the disease.

WATCH | Remdesivir does little to help COVID-19 patients, WHO study says:

A clinical trial by the World Health Organization finds that antiviral medication remdesivir has little or no effect on length of hospital stay or mortality in COVID-19 patients. Dr. Srinivas Murthy weighs in on what this could mean for treating the virus going forward. 2:04

Kesecioglu said there was not enough data available about when remdesivir might be effective or for which patients, leading to the decision to discourage its routine use in intensive care.

This means doctors should use remdesivir only occasionally and not as a standard treatment for COVID-19 patients.

Because of remdesivir’s unclear benefits, the critical care department at the University Medical Center of Utrecht in the Netherlands, where Kesecioglu works, has not used it to treat COVID-19 patients, he said.

Possible side effects

Ten months into the pandemic, a debate continues to rage in the medical industry about which drugs are best to treat hospitalized COVID-19 patients.

Remdesivir has potential side effects on the kidneys, according to data shared by Gilead with the European Medicines Agency, which is assessing its possible toxicity.

Arnaud Hot, head of medicine at Edouard Herriot hospital in Lyon, France, told Reuters that some patients at his hospital had experienced kidney injury and so it was no longer using remdesivir, except in rare cases.

Kesecioglu said convalescent plasma, which is also experimentally administered to some COVID-19 patients despite not having been approved, was also not recommended by ESICM for routine intensive care use, as its benefits were unclear.

He said the potential side effects of convalescent plasma — the liquid part of blood extracted from COVID-19 patients — were also not clear

In contrast, Kesecioglu said dexamethasone was recommended for use in hospitalised patients because there was sufficient information on its efficacy.

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Katy Perry Talks Pregnancy Weight Gain and How ‘Grateful’ She Is for Her Body

Katy Perry Talks Pregnancy Weight Gain and How ‘Grateful’ She Is for Her Body | Entertainment Tonight

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Carrie Underwood Flaunts Killer Summer Body in New Bikini Pic

Carrie Underwood Flaunts Killer Summer Body in New Bikini Pic | Entertainment Tonight

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TFC’s Michael Bradley says Trump doesn’t have ‘a moral bone in his body’

Toronto FC captain Michael Bradley pulled no punches Thursday, lamenting the “zero leadership” south of the border as the U.S. is ravaged by racial unrest.

The longtime U.S. skipper took square aim at president Donald Trump.

“We have a president who is completely empty. There isn’t a moral bone in his body,” Bradley told a media conference call.

“There’s no leadership. There’s no leadership from the president, there’s no leadership from the Republican senators who have sat back and been totally complicit in everything he’s done for the last 3 1/2 years.”

Bradley urged his fellow Americans to speak with their ballot in November, saying it was “impossible to overstate” the importance of the coming election.

“I just hope that people are able to go to the polls in November and think about more than just what is good for them, more than what is good for their own status, their own business, their own tax return. I hope that people can go to the polls and understand that in so many ways, the future of our country and the future of our democracy is at stake.

“We need as many people as possible to understand that at a real level, to think about what four more years with Trump as president, what that would mean, how terrible that would be for so many people.”

‘We all have to be part of that fix’

Referencing racial inequality and social injustice, Bradley added: “If we want any chance to start to fix those things, then Trump can’t be president, it’s as simple as that.”

The 32-year-old Bradley has run through the gamut of emotions while watching the violence and unrest unfold in the wake of the death of George Floyd in Minneapolis while three police officers restrained him — one with his knee on Floyd’s neck.

“I’m angry, I’m horrified, I’m sad and I’m determined to do anything and everything I can to try to be a part of the fix,” he said. “Because it has to end. And we all have to be part of that fix.”

He acknowledged that while he has much to learn on the issues, politicians, policy-makers and businesses have to be held accountable.

Bradley has criticized Trump before. In January 2017, he said he was “sad and embarrassed” by Trump’s travel ban aimed at citizens of predominantly Muslim countries.

Absence of dialogue with league ‘frustrating’

The TFC captain, while happy to see the MLS labour impasse over, noted there had been “some real difficult moments along the way.” That included a threat of a lockout from the league.

Such tactics “did not sit well with the players,” he said.

He also said there had been a frustrating absence of dialogue right from the beginning of talks, which he acknowledged played out against an unprecedented global threat.

“This, at a certain point for me, was about what’s right and what’s wrong in the middle of the pandemic. And the way to treat people and the way that you look after people. I kept coming back to that idea. That we have all put so much into growing the game in North America, at all levels — ownership, league office, executives coaches, players, fans.

“Everybody is important to what we’re trying to do. To try to dismiss any of the entities that I just named would be short-sighted and disrespectful because the game is about everybody.”

WATCH | MLS players ratify new agreement, return-to-play plan:

MLS players have ratified a new collective bargaining agreement that includes a return to play plan. 1:25

He said he would have loved to have seen everyone get on the same page early on and find a way “to cut through the [bull].”

“To just say ‘This is where we are right now. Nobody has a playbook. Nobody has any answers but how are we going to come out better and stronger from all of this? … I think conversations would have carried so much more weight and I think we would have been able to avoid so much of the way certain things played out.”

Training after ankle surgery 

Bradley underwent ankle surgery in January to repair an injury suffered in the MLS Cup final loss in Seattle on Nov 10. His rehab over, he was part of a small group training session Thursday.

“I’m doing well,” he said. “I’m continuing to make progress … At this point physically I feel really good. My ankle feels really good. And now it’s just about training. Getting back into real training in a way that now prepares me for games.”

Toronto FC midfielder Michael Bradley says a compressed schedule at the Florida tournament won’t help injury fears. (Mary Altaffer/Associated Press)

Still, he said injuries are an issue in the league’s return to play given the time that has passed since the league suspended play March 12.

“That is a big concern,” he said. “And it’s not a big concern only amongst players. I know that has been a real topic amongst coaches and sports science staff and medical staff.”

While teams will do everything possible to get the players ready, a compressed schedule at the Florida tournament that awaits teams won’t help injury fears, he said.

“That certainly is a big question. Maybe the biggest question when you get past the initial health and safety stuff of COVID, among players and coaches and technical staff,” he said.

“How are we going to give ourselves the best chance to win, but also do it in a way where guys are at their highest level both technically and physically”

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Learning how the coronavirus affects the body offers clues to fight COVID-19

This is an excerpt from Second Opinion, a weekly roundup of eclectic and under-the-radar health and medical science news emailed to subscribers every Saturday morning. If you haven’t subscribed yet, you can do that by clicking here.

The devastating damage that the novel coronavirus inflicts on the human body can set off inflammatory havoc. As we learn more, doctors are gaining clues to hopefully prevent deaths and improve treatment.

Last December, COVID-19 entered the world stage as a flu-like illness causing fever, dry cough and a sore throat.

Since then, the list of how the illness can present has expanded, and expanded again, to include gastrointestinal symptoms like diarrhea, general aches, loss of taste and smell and serious blood-clotting problems, among others.

Of the more than five million infections globally so far, 2.4 million have recovered.

Most infected people have so few symptoms they are better off at home. The minority of serious infections in patients — mainly those over 65, though no age group is left unscathed — can confound health professionals caring for them.

The illness can worsen to a severe stage called Acute Respiratory Distress Syndrome, which includes severe lung inflammation and damage. These are often the patients who are admitted to intensive care units and need life support such as ventilation.

Dr. Lynora Saxinger, an infectious disease physician at the University of Alberta, co-chairs a provincial scientific advisory board reviewing how COVID-19 manifests and what it means for reducing transmission and extending treatment beyond current care measures.

“The landscape shifts really quickly,” Saxinger said. “We just want to make sure that we’re not missing [what] could be spreading, because that’s where we’re going to run into trouble.”

Not typical clots

As initial anecdotes about inflammatory-like effects such as blood-clotting complications mounted into a clearer signal for caution, clinicians adapted their care while scientists worked to understand why it happens.

Now, Saxinger said there’s more evidence of clotting damage in both large and small blood vessels. “This virus is doing different things in the body.”

A better understanding of how COVID-19 manifests could inform efforts to reduce its transmission. (Lee Jin-man/Associated Press)

Experts say some of these inflammatory effects look to be unique to this particular coronavirus, which is known as SARS CoV-2.

Dr. Zain Chagla, an associate professor of infectious disease at McMaster University in Hamilton, Ont., said the wide extent of clotting with this virus differs from other infections, including from the deadly SARS and MERS coronaviruses. With COVID-19, the clots occur in veins in the legs and lungs, as well as in arterial ones that cause strokes and can lead surgeons to resort to amputating a patient’s limbs.

Medical researchers have also found tiny clots that damaged tissue throughout the body in hospitalized patients and in autopsies.

Chagla said this means that “from a therapeutic standpoint,” it might be better to give patients a low dose of heparin, an anticoagulant or blood thinner. It’s often used before surgery and in a variety of medical conditions to prevent and treat clots.

Clinical trial researchers are also exploring the use of high-dose anti-coagulants in carefully selected patients, Chagla said.

This week, Health Minister Patty Hajdu announced an accelerated path for clinical trials to help find answers to urgent COVID-19 diagnosis, treatment, mitigation or prevention questions while keeping patients safe.

On Friday, Montserrat Puig of the U.S. Food and Drug Administration and her team published what they called a road map for effective treatment of COVID-19, based on both repurposing existing approved drugs as well as those still under development.

The review, published in Frontiers in Immunology, unravels factors leading to the “cytokine storm” that can rampage in people with severe COVID-19. Cytokines are small molecules released by the body’s immune system to co-ordinate response against an infection or injury, ranging from a mild fever to suspected deaths in the 1918 flu pandemic.

Heparin, an anticoagulant or blood thinner, is used for a variety of conditions, including, at low doses, COVID-19. ( Jeffrey Sauger/Bloomberg/Getty)

Scientists are still working to understand the key events in cells, tissues and the body’s immune system that tips the balance from a normal, protective, “hey, come help” call for reinforcements to an unnecessary, four-alarm call that leads to a life-threatening overreaction.

Puig wrote that potential drugs include those that could block the virus from entering our cells in the first place, antivirals to stop the virus from making copies of itself and therapies called monoclonal antibodies that dampen the haywire response from cytokines.

Inflammatory storm unleashed

People who develop symptoms of COVID-19 do so within 14 days, and it mostly occurs about five days after exposure.

The anticipated subsequent waves of the pandemic mean COVID-19 won’t be one-and-done, said Dr. Lynora Saxinger. (Martin Weaver/CBC)

Saxinger said when patients struggle with congested lungs and poor blood pressure control, it’s often a manifestation of lung inflammation in response to the infection.

She said there’s also an arc to the story of how the disease marches through the body from initial infection to damage to recovery or death.

“The initial infection triggers this body-wide response that is devastating,” Saxinger said. “Then, when the infection itself might be coming under control, it’s almost like you unleash this storm of immune reactivity and inflammation.”

Once the storm is set off, doctors say treating the infection itself is unlikely to help much.

So, what could help? As physicians report more symptoms, scientists working in parallel are exploring why and how the virus replicates in some tissues and organs so well.

Matthew Miller, an associate professor of infectious disease and immunology at McMaster, is following the scientific advances.

The virus seems to use a receptor called ACE2 to enter human cells. Miller said many groups of researchers are working to understand what cells in our body have active proteins where the virus might be able to replicate and cause disease.

“Knowing what cells a virus is capable of infecting is really important, because it can help us anticipate what types of diseases or what types of symptoms it might cause,” Miller said.

It’s thought that the infectious dose a person is exposed to, as well as minute, genetic differences in the individual and whether they have underlying health conditions (like heart disease or diabetes) all play a role in how COVID-19 manifests.

Understand virus to guide reopening

For now, medical researchers are exploring how ramping up a beneficial aspect of the immune response that cells normally use to kill off a virus could be complemented with “immune modulators” to tamp down overreactions. It’s a delicate balance and timing is key.

Miller said as we learn more about the unique features of SARS-CoV-2, governments and public health officials have been forced to “learn on the fly” and adapt pandemic plans built for a different respiratory infection: influenza, commonly called flu.

“One of the areas that this pandemic has really brought to light is that there’s not enough focus on prevention control measures,” he said.

Countries imposed and eased lockdowns without a firm grasp on what measures work best for this particular virus, leading to differences across the globe and shifting recommendations on wearing masks or physical distancing.

“I think we’re all learning that we don’t understand nearly as well as we should,” Miller said.

WATCH | Why we should expect waves of COVID-19: 

What mathematical simulations tell us about how the COVID-19 pandemic will play in the real world. 5:04

Public health basics like staying home when sick, handwashing and cough etiquette apply to all respiratory pathogens. It’s the specifics that are still a work in progress.

For Saxinger, these knowledge gaps mean that understanding COVID-19 will be a long-term effort.  

“It’s not just going to be a one, we’re done,” Saxinger said. “We are all going to have to figure out the best way to manage people and try to give them the best outcomes possible.”

To read the entire Second Opinion newsletter every Saturday morning, subscribe by clicking here.

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Why COVID-19 may attack the body differently than we think

This is an excerpt from Second Opinion, a weekly roundup of eclectic and under-the-radar health and medical science news emailed to subscribers every Saturday morning. If you haven’t subscribed yet, you can do that by clicking here.

Understanding how COVID-19 attacks the human body is essential to developing an effective treatment or vaccine to stop the global pandemic — but there’s still so much we don’t know about how it can kill us.

As researchers around the world race to understand the illness, they are compiling and sharing their early observations of patients hit by a virus that has sickened more than two million people. The findings are preliminary, but they can help point researchers in the right directions.

They have seen that in severe cases, COVID-19 invades our respiratory cells and triggers an immune system response that targets those infected cells, destroys lung tissue and ultimately clogs our airways, cutting off our oxygen supply. 

That’s when organ failure can also occur, causing severe damage to the kidneys, liver and heart, similar to other conditions like sepsis. 

But they will look to determine whether the virus is targeting and shutting down organs in a new way or just behaving like other infections that cause such common complications.

Why COVID-19 can be so deadly

One key thing to understand about the deadliness of the coronavirus is how it infects the body and how our body responds to fight it. 

Cytokines are small molecules released by the immune system that travel throughout the body to co-ordinate an immune response against an infection or injury — even with something as common as a mild fever. 

But if the immune system overproduces them in response to the infection, they can cause “cytokine storms” that can rampage through the bloodstream and severely damage the body. 

Dr. Douglas Fraser, an ICU doctor at London Health Sciences Centre and a researcher at Western University in London, Ont., has been studying that exaggerated immune response by collecting blood from critically ill COVID-19 patients in an effort to find new ways to treat the disease. 

“The immune response to this particular disease is very different than what we’ve seen in other infected patients that end up in the ICU,” he said. “It’s a unique response and it’s going to require unique therapies.” 

Fraser said his research shows there are different types of cytokines released in the body at unusual times and levels in response to COVID-19 compared with those that are typically found in critically ill patients from more common diseases. 

“What we’re seeing seems to be occurring in all of the very sick patients: those who are requiring the ICU admissions, those who are requiring assistance with their breathing and those that are ultimately dying,” he said.

Kidneys tied to severe complications

Kidney damage was an “important complication” in a preliminary publication of a recent observational study of 287 COVID-19 patients in China, which found almost one in five had some stage of sudden or “acute” kidney injury, putting them at “substantially higher” risk of death.

While it’s not yet known what rate of Canadian COVID-19 patients have acute kidney damage, the majority occurs in severely ill patients, said Dr. Jeffrey Perl, a nephrologist at St Michael’s Hospital in Toronto and an assistant medical professor at the University of Toronto. 

“As people’s blood pressure gets very low from a very massive, overwhelming inflammatory immune response, the kidneys are starved of blood,” he said, adding that it can often lead to the need for a dialysis machine to clean the patient’s blood.

To give an idea of how serious a complication it can be, Perl said the mortality rate for patients who had developed acute kidney injury from SARS in 2003 was 92 per cent, compared to just eight per cent in those who didn’t. 

Toronto General Hospital employee Maria Tanta, left, a recovery room nurse, has her temperature checked by nurse Callie Dunne during the SARS epidemic on April 2, 2003. (J.P. Moczulski/Canadian Press)

Chronic kidney patients are also at higher risk of death with COVID-19 compared to those without pre-existing conditions who are otherwise well, he added. 

“We’re very worried about those patients getting a COVID-19 infection,” he said. “Similar to the elderly population that we’re very concerned about, I would consider these patients another high-risk group.” 

Heart may be ‘directly’ targeted by virus

One essential organ that may be at direct risk from the virus is the heart.

A cohort study published in JAMA last month found almost 20 per cent of 416 hospitalized COVID-19 patients in China had heart damage during hospitalization, putting them at a higher risk for death. 

Recent research from the American College of Cardiology found arrhythmia, or irregular heartbeat, in 16 per cent of patients and acute cardiac injury in 7.2 per cent.

“There’s the possibility and the likelihood that some of the virus might actually get taken directly up into the heart muscle cells and cause that heart injury,” said Dr. Patrick Lawler, a cardiologist and clinician scientist at the Peter Munk Cardiac Centre in Toronto. 

“We hear anecdotes from other people that have had a little bit more experience, unfortunately, with this that really are consistent with the heart suddenly starting to become weak.” 

An observational study of 187 patients hospitalized with COVID-19 published in the New England Journal of Medicine last month found high levels of troponin, which can indicate problems with the heart, in 28 per cent of hospitalized COVID-19 patients in Wuhan, China, which concluded they were at risk of “much higher mortality.” 

A medical worker checks on a patient’s condition at Jinyintan Hospital in Wuhan in central China’s Hubei province on Feb. 16. Emerging research shows the heart may be at direct risk from the virus. One study in China found almost 20 per cent of 416 patients had cardiac issues. (Chinatopix/The Associated Press)

Lawler said the outcomes for COVID-19 patients with cardiac issues are “dramatically worse,” and even though the virus enters through the respiratory system, it can take root in other areas of the body. 

“The heart is really a critical, critical part of what determines whether or not patients are going to recover from this or not,” he said.

Can it help us find a cure?

Lawler is currently looking at the use of blood thinners as a possible treatment for COVID-19 patients, which may prevent the virus from binding to ACE2 receptors — enzymes found in cells throughout the human body that can act as an entryway for coronaviruses. 

He said research suggests blood clots may play a role in organ failure in critically ill patients, so different doses of anticoagulants may prevent that from happening. 

Fraser is also using his research on the “cytokine storm” immune response to COVID-19 to find “targets” to further efforts toward an effective treatment. 

He said there could be multiple components to why different people are susceptible to the virus that range from genetics, to pre-existing conditions to age.

“Once we have an understanding of what’s going on, we can develop therapies, we can develop vaccines,” he said. 

“Then we can get back to a normal life.”

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