The Wall Street Journal - 28.03.2020 - 29.03.2020

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THE WALL STREET JOURNAL. **** Saturday/Sunday, March 28 - 29, 2020 |A

Early symptoms include a
dry cough and fever, and some-
times a sore throat, as well as
aches and fatigue. Loss of taste
and smell have also been re-
ported. For most people—
roughly 80% according to re-
ports from China—the
symptoms dissipate in a few
days or weeks. But for some
people, mainly those who are
older or have other medical
conditions, the virus invades
cells in the lungs.
When it moves into the
lungs, it is considered more se-
rious. That could happen two to
seven days after symptoms
start, says Daniel Kuritzkes,
chief of the division of infec-
tious diseases at Boston’s
Brigham and Women’s Hospital.
Once the virus infects the
cells that line the air sacs in the
lungs, viral pneumonia devel-
ops. Shortness of breath is an
indication that the virus is
damaging the inflamed lungs.
And the lungs often face a
two-way assault. There is dam-
age from the virus but a second
equally debilitating response
takes place: The body’s own im-
mune system goes into over-

patterns. Adam Bernheim, a
cardiothoracic radiologist at
Mount Sinai Hospital in New
York, and co-researchers stud-
ied the CT scans of 121 corona-
virus patients from China.
Writing in the journal Radi-
ology, they found a striking pat-
tern: Pneumonia progressed
along the lungs’ outer edges,
seen in gray spots. “A normal
lung is black, because it con-
tains air,” says Dr. Bernheim.
“In coronavirus with pneumo-
nia, air is being replaced by
cells, inflammation, fluid, de-
bris and pus, so it starts to turn
gray or even white.”
The spots developed in some
patients within two days of the
first symptoms and were nearly
universal three days or more
later. Dr. Bernheim says the
pattern is different from gar-
den-variety bacterial pneumo-
nia, which often shows one very
dense white area.
When the lung becomes pro-
gressively more damaged, that
triggers what is known as acute
respiratory distress syndrome,
or ARDS. This typically devel-
ops within seven to 14 days.
There is no therapy for

ARDS, so patients need help
breathing. “The ventilator is
buying time for the lung to re-
pair itself,” says Dr. Garibaldi.
Matthew Arentz, a pulmo-
nary and critical-care doctor at
EvergreenHealth in Kirkland,
Wash., published a study in
JAMA this month looking at the
chest images of the first 21 crit-
ically ill Covid-19 patients in the
Eighty-four percent required
mechanical ventilation and only
four people survived, says Dr.
Arentz. X-rays showed pneumo-
nia in 19 of the 21 patients, all
of whom developed ARDS.
Most of the patients who
died were unable to maintain
adequate oxygen levels due to
diseased lungs. But one-third
developed heart failure.
Some doctors say that
abrupt onset of heart problems
seems to be another distinctive
trait of Covid-19. “We don’t
know if the virus is doing
something to the heart or the
heart may have been stressed
by the patient’s critical illness
because a lot of these patients
are older and have other health
problems,” says Dr. Arentz.


standing of how coronavirus
operates in the body.
It most commonly enters the
nose through those minuscule
droplets, says Steve Lawrence,
an infectious disease doctor at
Washington University and
Barnes-Jewish Hospital in St.
Louis. This is why public-health
experts and governments focus
on social distancing as a preven-
tion strategy. It can also enter
through the eyes or mouth.
Once the virus’s particles en-
ter the body, they begin to at-
tach to a particular receptor on
the surface of cells, usually
starting with those in the mu-
cous membranes in the nose
and throat. Spiky proteins on
the surface of the coronavirus
latch onto cell membranes.
Though most people start
with an upper respiratory infec-
tion, it’s also possible that
deeply inhaled droplets can go
directly into the lungs, says
Brian Garibaldi, an associate
professor of pulmonary and
critical care at Johns Hopkins
University. “It has a special pro-
tein that binds more tightly to
cells in the lower respiratory
tract,” he says.
Wherever it lands, the virus
hijacks cells and starts replicat-
ing, ultimately producing mil-
lions of viral particles that
flood the body. “Like other vi-
ruses it takes over the cellular
machinery of the cell and
makes more copies of itself and
spreads,” says Dr. Garibaldi.
When your immune system
recognizes there’s a new virus
it uses signaling molecules
called cytokines to start calling
in reinforcements to the site of
infection. “Many of those cy-
tokines end up causing a fever,”
says Dr. Garibaldi.
Once the virus has attacked
enough cells in the upper respi-
ratory system, most people will
start to feel symptoms. This
happens on average five days
after being exposed, but it can
be sooner or as many as two
weeks later, studies show.

Continued from page A

she recalled being a tomboy who
rode horses and climbed trees.
After boarding school, she
earned a medical degree at the
University of Sydney in 1946. A
lecture by a missionary inspired
her to find a Christian mission for
her medical work. She met Regi-
nald Hamlin at a Sydney women’s
hospital, where he was the medical
superintendent. He was 15 years
older. They married when she was


he Hamlins worked as gyne-
cologists and obstetricians
in Britain, Hong Kong and
Australia before noticing an adver-
tisement seeking someone to set
up a school of midwifery in Addis
Ababa, the capital of Ethiopia.
They arrived in 1959, expecting to
remain a few years. But their work,
which shifted to a focus on treat-
ing fistulas, became a lifetime mis-
sion for both.
“I believe that Reg and I were
guided here by God,” she wrote.
The transition was rough.
Nights brought the howls of hye-
nas. Dr. Hamlin described them as
“unattractive animals” but added
that they were good at removing
rubbish. The Hamlins drove a sec-

ondhand Volkswagen Beetle and
spent much of their time tangling
with local bureaucrats.
To learn surgical techniques for
fistulas, they wrote to an Egyptian
obstetrician and sought advice
from other authorities in England
and Germany. They also developed
their own surgical techniques and
taught them to other doctors in
Ethiopia and elsewhere.
Hearing of cures, women trav-
eled hundreds of miles, sometimes
on foot, to their hospital. “What a
tragic sight they were,” Dr. Hamlin
wrote. “Offensive to smell, dressed
in rags, often completely desti-
tute.” After being cured, one
woman wanted to kiss the Ham-
lins’ feet.
They befriended and admired
the Ethiopian emperor, Haile Se-
lassie. After he was deposed in
1974, the Hamlins endured a long
period of violence and political
turmoil. Their strategy was to keep
a low profile.
“I am sure we were left alone
because we were a completely free
hospital,” she wrote. “As Reg used
to say, we were true socialists.”
Regular fundraising trips over-
seas allowed them to build larger
and better facilities. Donors in-
cluded World Vision Canada and
Rotary clubs.
When Reg Hamlin died of cancer
in 1993, Catherine Hamlin was
tempted to retire. She said the
hospital gardener took her hand
and pleaded: “Don’t leave us; we’ll
all help you.” She stayed for the
rest of her life and died at her
home in Addis Ababa.
Among many other honors, she
was made a Companion of the Or-
der of Australia in 1995. The Ethio-
pian government presented her
with the Eminent Citizen Award
last year.
Her survivors include a son and
four grandchildren.

 Read a collection of in-depth

1924 — 2020

Gynecologist Healed

Horrific Childbirth Wounds


or decades, few people out-
side Africa knew of Cathe-
rine Hamlin’s mission of
medical treatment for women in
The injuries treated by Dr. Ham-
lin, who died March 18 at the age
of 96, were unimaginable to most
people in wealthier countries: ob-
stetric fistulas, or holes in the tis-
sue between the birth canal and
bladder or rectum. These injuries
typically occur during prolonged
labor, leading to stillbirth, among
women in remote areas lacking
medical care.
Because the injuries leave suf-
ferers leaking urine or feces
through their vaginas, these
women typically become outcasts.
A network of nonprofit hospitals
in Ethiopia created by Dr. Hamlin
and her husband, Reginald Hamlin,
has treated more than 60,
Ethiopian women for these
wounds over the past 61 years, ac-
cording to the Catherine Hamlin
Fistula Foundation. That work con-
The Hamlins’ mission—long
funded by donors in Australia,
Canada and other countries—be-
came widely known in the U.S. in
2004, when Catherine Hamlin ap-
peared on “The Oprah Winfrey
“If men were getting fistulas,”
Dr. Hamlin said during her TV chat
with Ms. Winfrey, “something
would have been done years and
years ago.”
Ms. Winfrey replied: “If a man
had a hole in his penis? You’re
darn right about that.” Ms. Win-
frey made a large donation; many
of her viewers chipped in as well.
Elinor Catherine Nicholson, one
of six children, was born Jan. 24,
1924, in Sydney. Her father came
from a family that prospered in
business, including the manufac-
ture of elevators. In a 2001 mem-
oir, “The Hospital by the River,”


Still, he said, much of the bribery
stemmed from “greedy business-
men trying to get an edge.”
When companies demanded
guidance on how to comply with
the law, Mr. Sporkin was dismis-
sive. “We don’t have guidelines
for rapists, muggers and embez-
zlers, and I don’t think we need
guidelines for corporations who
want to bribe foreign officials,”
he said in 1979.
He went on to serve as general
counsel of the Central Intelligence
Agency in the early 1980s and as
a federal district judge in the Dis-
trict of Columbia from 1986 to

  1. In one of his most cele-
    brated moments as a judge, he
    elicited testimony by a drug
    dealer in 1989 about supplying
    crack cocaine to Marion Barry,
    then mayor of Washington. Judge
    Sporkin overruled prosecutors
    who tried to suppress that infor-
    During trials, he was known for
    leaning back in his chair and
    seeming to stare at the ceiling or
    even doze. Then he would sud-
    denly strike with a question.
    Stanley Sporkin was born Feb.
    7, 1932, in Philadelphia. His fa-
    ther, Maurice Sporkin, was a law-
    yer who became an assistant dis-
    trict attorney and later a judge in
    the Court of Common Pleas. In a
    2000 interview with the Washing-
    ton Post, Stanley Sporkin recalled
    his father making a ruling in the
    early 1950s that desegregated a
    whites-only swimming pool in
    Philadelphia. “The whole concept
    I had of doing justice came from
    watching him,” he said.
    Mr. Sporkin studied accounting
    at the Pennsylvania State Univer-
    sity, where he graduated in 1953
    with Phi Beta Kappa honors. Two
    years later, he married Judith Im-
    ber. He earned his law degree at
    He trusted his instincts. “By
    and large,” he told the Associated
    Press in 1974, “good ethical com-
    mon sense will give you the right
    answer every time.”
    —James R. Hagerty


SEC Official Cracked

Down on Bribery


tanley Sporkin forced
changes in corporate behav-
ior in the 1970s as a crusad-
ing enforcement chief at the Se-
curities and Exchange
Commission who cracked down
on bribery of foreign officials.
Mr. Sporkin, who died of con-
gestive heart failure Monday at
the age of 88, didn’t accept the
typical excuses for bribery—that
“everybody does it” or “it’s the
only way to win contracts over-
What worried him, Mr. Sporkin
said in 1976, was the effect it had
on young people going into busi-
ness: “They are being trained to
be crooks, trained to falsify re-
cords, trained to pay bribes.”
His crusade was an unlikely
offshoot of the Watergate investi-
gation of the early 1970s. As a

“schnook government worker”
watching congressional hearings
on TV, as he put it, Mr. Sporkin
learned of slush funds used by
companies to make illegal politi-
cal contributions. How, he won-
dered, did companies hide these
payments in their books?
When he became the SEC’s en-
forcement chief in 1974, Mr. Spor-
kin led a probe into slush funds.
His investigators found evidence
that Exxon, Lockheed, 3M and
hundreds of others had made
questionable payments overseas.
The findings spurred Congress
to pass the Foreign Corrupt Prac-
tices Act of 1977, barring compa-
nies from paying foreign officials
to win business.
Mr. Sporkin acknowledged that
U.S. executives operating over-
seas sometimes were subject to
“shakedowns” by foreign officials.

Mr. Sporkin led a probe

that found many firms

had made questionable

payments overseas.


How Virus


Is Probed

A researcher in the epidemiology lab at the Pasteur Institute of Lille examines infected cells. The lab is seeking to determine how the virus acts.


drive, causing more damage.
Some patients’ immune sys-
tems flare up, producing white
blood cells that flood the infec-
tion site in the lungs, causing
damage. They secrete a lot of
cytokines that enhance the in-
flammation, says Dr. Kuritzkes.
“That can make it difficult for
people to breathe. All this fluid

that accumulates and all these
extra cells that don’t belong
there create a barrier for oxy-
gen exchange,” he says.
One feature that distin-
guishes Covid-19 from other vi-
ruses such as the flu is the high
frequency of pneumonia, even
in people with only mildly
symptomatic cases, he says.
Studies of Covid-19 patients
whose lungs were examined
show distinctive and unusual

Spiky proteins on
the surface of the
virus latch onto cell



Former General

Surrenders to U.S.

Retired Venezuelan General
Cliver Alcalá turned himself in to
the U.S. counternarcotics author-
ities Friday, a day after Ameri-
can prosecutors indicted him and
other Venezuelan officials, in-
cluding President Nicolás Ma-
duro, on drug-trafficking charges,
according to four people familiar
with the matter.
Mr. Alcalá waived extradition
and surrendered to Colombian po-
lice before he was flown from Co-
lombia to New York, where he is
expected to collaborate with U.S.
prosecutors building cases against
other Venezuelan-regime figures
accused of having links to narco-
terrorist groups, the people said.
On Thursday, the U.S. unveiled
a $10 million reward for Mr. Al-
calá’s capture for his alleged role
in permitting Colombian cartels to
move cocaine through Venezuela
and converting the country into a
major transit hub in the global
narcotics trade.
Mr. Alcalá, who has repeat-
edly denied drug charges,
couldn’t be reached for com-
ment. There was no immediate
response from the U.S. Drug En-
forcement Agency.
—Kejal Vyas


Central Bank Issues

Emergency Rate Cut

The Bank of Canada issued
an emergency rate cut on Friday
and unveiled plans to expand its
balance sheet in its latest effort
to shelter the economy from the
new coronavirus pandemic and
stabilize rocky financial markets.
The move to lower the bench-
mark overnight interest rate by
half a percentage point, to 0.25%,
brought the key rate to its low-
est level since the global finan-
cial crisis about a decade ago.
The central bank also will ven-
ture into large-scale asset pur-
chases through the acquisition of
Government of Canada securities
and commercial paper. Bank of
Canada Gov. Stephen Poloz said
the rate cut and asset-purchas-
ing programs are intended to
support the financial system so
it keeps on providing credit.
—Kim Mackrael

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