The Wall Street Journal - 28.03.2020 - 29.03.2020

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Early symptoms include a dry cough and fever, and sometimes 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 infectious 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 damage from the virus but a second equally debilitating response takes place: The body’s own immune system goes into over-

patterns. Adam Bernheim, a cardiothoracic radiologist at Mount Sinai Hospital in New York, and co-researchers studied the CT scans of 121 coronavirus patients from China. Writing in the journal Radi- ology, they found a striking pattern: 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 pneumonia, 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 pneumonia, 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 pulmonary 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 U.S. Eighty-four percent required mechanical ventilation and only four people survived, says Dr. Arentz. X-rays showed pneumonia 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.

OBITUARIES

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 enter 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 infection, 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 cytokines end up causing a fever,” says Dr. Garibaldi. Once the virus has attacked enough cells in the upper respiratory 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 26.

T

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 mission 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 overseas 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 profiles atWSJ.com/Obituaries

CATHERINE HAMLIN 1924 — 2020

Gynecologist Healed

Horrific Childbirth Wounds

F

or decades, few people out- side Africa knew of Cathe- rine Hamlin’s mission of medical treatment for women in Ethiopia. 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, according to the Catherine Hamlin Fistula Foundation. That work con- tinues. The Hamlins’ mission—long funded by donors in Australia, Canada and other countries—became widely known in the U.S. in 2004, when Catherine Hamlin ap- peared on “The Oprah Winfrey Show.” “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,”

BYJAMESR.HAGERTY

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

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-
mation.
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
Yale.
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

STANLEY SPORKIN 1932—

SEC Official Cracked

Down on Bribery

S

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-
seas.”
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.

FROM PAGE ONE

How Virus

Attacks

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.

SYLVAIN LEFEVRE/GETTY IMAGES

drive, causing more damage. Some patients’ immune sys- tems flare up, producing white blood cells that flood the infection site in the lungs, causing damage. They secrete a lot of cytokines that enhance the inflammation, 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 oxygen 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 membranes.

WORLD WATCH

VENEZUELA

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

CANADA

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

The Wall Street Journal - 28.03.2020 - 29.03.2020

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