1,400 tourists caught in cyclonic weather in Andamans

Washington, Apr 28: After nearly three weeks in an intensive care unit in Los Angeles, doctors treating 41-year-old Broadway actor Nick Cordero for COVID-19 were forced to amputate his right leg.

The flow of blood had been impeded by a blood clot: yet another dangerous complication of the disease that has been bubbling up in frontline reports from China, Europe and the United States.

To be sure, so-called "thrombotic events" occur for a variety of reasons among intensive care patients, but the rates among COVID-19 patients are far higher than would be otherwise expected.

"I have had 40-year-olds in my ICU who have clots in their fingers that look like they'll lose the finger, but there's no other reason to lose the finger than the virus," Shari Brosnahan, a critical care doctor at NYU Langone said.

One of these patients is suffering from a lack of blood flow to both feet and both hands, and she predicts an amputation may be necessary, or the blood vessels may get so damaged that an extremity could drop off by itself.

Blood clots aren't just dangerous for our limbs, but can make their way to the lungs, heart or brain, where they may cause lethal pulmonary embolisms, heart attacks, and strokes.

A recent paper from the Netherlands in the journal Thrombosis Research found that 31 percent of 184 patients suffered thrombotic complications, a figure that the researchers called "remarkably high" -- even if extreme consequences like amputation are rare.

Behnood Bikdeli, a doctor at New York-Presbyterian Hospital, assembled an international consortium of experts to study the issue. Their findings were published in the Journal of The American College of Cardiology.

The experts found the risks were so great that COVID-19 patients "may need to receive blood thinners, preventively, prophylactically," even before imaging tests are ordered, said Bikdeli.

What exactly is causing it? The reasons aren't fully understood, but he offered several possible explanations.

People with severe forms of COVID-19 often have underlying medical conditions like heart or lung disease -- which are themselves linked to higher rates of clotting.

Next, being in intensive care makes a person likelier to develop a clot because they are staying still for so long. That's why for example people are encouraged to stretch and move around on long haul flights.

It's also now clear the COVID-19 illness is associated with an abnormal immune reaction called "cytokine storm" -- and some research has indicated this too is linked to higher rates of clotting.

There could also be something about the virus itself that is causing coagulation, which has some precedent in other viral illnesses.

A paper in the journal The Lancet last week showed that the virus can infect the inner cell layer of organs and of blood vessels, called the endothelium. This, in theory, could interfere with the clotting process.

According to Brosnahan, while thinners like Heparin are effective in some patients, they don't work for all patients because the clots are at times too small.

"There are too many microclots," she said. "We're not sure exactly where they are."

Autopsies have in fact shown some people's lungs filled with hundreds of microclots.

The arrival of a new mystery however helps solve a slightly older one.

Cecilia Mirant-Borde, an intensive care doctor at a military veterans hospital in Manhattan, told AFP that lungs filled with microclots helped explain why ventilators work poorly for patients with low blood oxygen.

Earlier in the pandemic doctors were treating these patients according to protocols developed for acute respiratory distress syndrome, sometimes known as "wet lung."

But in some cases, "it's not because the lungs are occupied with water" -- rather, it's that the microclotting is blocking circulation and blood is leaving the lungs with less oxygen than it should.

It has just been a little under five months since the virus emerged in Wuhan, China, and researchers are learning more about its impact every day.

"While we react surprised, we shouldn't be as surprised as we were. Viruses tend to do weird things," said Brosnahan.

While the dizzying array of complications may seem daunting, "it's possible there'll be one or a couple of unifying mechanisms that describe how this damage happens," she said.

"It's possible it's all the same thing, and that there'll be the same solution."

May 12: Several Indians in the US, either on the H-1B work visa or Green Card having children who are American citizens by birth, are being prevented from travelling to India aboard the special repatriation flights being run by Air India amidst the coronavirus-linked global travel restrictions.

According to the regulations issued by the Indian government last month and updated last week, visas of foreign nationals and OCI cards, that provide visa-free travel privileges to the people of Indian-origin, have been suspended as part of the new international travel restrictions.

For some of the Indian citizens like the Pandey couple in New Jersey (name and place changed at request), it's a double whammy. Having lost their H-1B job, they have to go back to India within the stipulated 60 days as required by law. The couple has two kids aged one and six years who are American citizens.

In the wee hours of Monday, they had to return from Newark airport as Air India refused to give their kids a ticket to fly to India along with them, despite them having a valid Indian visa. The young mother and father are Indian citizens.

They said that the officials from Air India and (Indian) Consulate (in New York) were very cooperative.

Also Read: COVID-19: Top senators urge Trump to temporarily suspend all new guest worker visas, including H-1B

But they could not do anything as their hands were tied by the latest regulation issued by the Indian government, a shocked Ratna Pandey told PTI.

"I would like to urge the Indian government to reconsider their decision on the humanitarian basis," said the Indian national who has lost her job but could not leave the US within the stipulated 60 days to avoid any future visa complications.

She now plans to make an appeal to the US Citizenship and Immigration Services (USCIS) to extend their stay.

Last month, H-1B visa holders, mostly Indians, launched a White House petition urging US President Donald Trump to extend their permissible stay from 60 to 180 days after job loss. However, there has been no decision from the White House so far.

While there is no official statistics of how many Indian H-1B visa holders have lost their jobs, it is believed to be substantial.

The US, due to the coronavirus pandemic, is experiencing an unprecedented unemployment rate and more than 33 million Americans have lost their jobs in the last two months. Given this massive job loss, Indians, who have lost their jobs, are unlikely to get one and thus many would have no other option but to travel back home.

In the case of single mother Mamta (name changed), the situation is graver as her son is just three-month old. Only she was given the ticket and the infant was not allowed to fly along with her because he carried an American passport.

"I would like to request the Indian government to let us fly back home. I don't want to stay in the US any longer," she told PTI hours after being prevented from boarding her hometown Ahmedabad-bound flight from Newark on Sunday.

"I am alone here. I don't have a relative here. It's a difficult situation," she said.

"Vande Bharat Mission is a humanitarian mission. But this is certainly inhuman," said Rakesh Gupta (name changed) from Washington DC.

An H-1B professional, Gupta has lost his job and needs to return to India within the stipulated 60 days. He and his wife, Geeta (name changed) being Indian citizens, received the confirmation of their seats in the flight but have been told that their two-and-a-half-year-old daughter cannot travel with them as she carried an OCI card.

"I don't believe this," he said.

Unlike the Pandey couple and Mamta, who had made the payment of USD 1,361 per ticket for their flight back home, Rakesh has not made the payment. Air India has said that the money would be refunded.

All the three Indian citizens requested the Indian government to help them travel back home by making necessary changes in the current regulations.

As per a recent government notification, all existing Indian visa holders, and visa-free travel facility, granted to OCI card holders who are not in India, have been suspended till restrictions on international air travel remains.

New York-based community leader Prem Bhandari said that the May 5 travel advisory has created multiple painful issues for the OCI card holders in the US and also to Indian citizens who are either on Green Card or H-1B visas and want to travel back home, but cannot leave their kids who are Americans by birth.

"We would like to express our disappointment with the discrimination between OCIs and citizens in respect of entering India at this critical stage when many OCIs have lawfully built their homes, families and businesses in India," Bhandari said in a letter to Union Home Secretary Ajay Kumar Bhalla on Monday.

Jan 23: Hundreds of Central Americans trying to reach the United States were stuck at the Mexico-Guatemala border on Wednesday after the Mexican government beefed up security to meet US demands to contain migrant flows.

Under sustained pressure from President Donald Trump, Mexico's government has adopted tougher measures to reduce the number of people heading towards the U.S. border.

Migrants in Tecun Uman, on the Guatemalan side of the border, were taken by surprise.

"We thought we'd be allowed through just like with the October caravan when they reached Tijuana," said Honduran migrant Ritzy Anabel, who did not give her surname.

"People from Mexico and Guatemala treated them well. But now it's changed because Mexicans don't want (us) to enter."

Many Central Americans migrants heading north are fleeing economic hardship and violence at home. A large caravan of migrants crossed into Mexico and went north in October 2018. Migrants crossing into Mexico earlier this week faced tear gas from security forces, who delivered a firmer response than in previous mass movements at the border.

Even so, about 1,000 migrants, most of them from Honduras, managed to reach Mexican soil on Tuesday. Mexican Foreign Minister Marcelo Ebrard said several hundred of the new arrivals were immediately deported on planes and buses.

On Wednesday, Mexican authorities said that 460 Honduran migrants were deported throughout the day. Other migrants from the group, including families traveling with children, were pondering their next moves.

Honduran Carlos Amador said that while some of his compatriots were returning home, others were hoping for positive news.

Trump has repeatedly threatened to punish Mexico and Central American countries if they fail to clamp down on the migrant flows. That has resulted in a series of agreements aimed at delivering on Trump's campaign promises to curb immigration.

Department of Homeland Security Acting Secretary Chad Wolf called the measures put in place by the Mexican National Guard "effective", adding that dozens of his personnel was on the ground in Central America assisting local immigration and security officials. Trump tweeted: "Sorry, if you come you will be immediately sent back!"