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Manila, Apr 13: The Asian Development Bank (ADB) on Monday tripled the size of its response to novel coronavirus disease (COVID-19) pandemic to 20 billion dollars and approved measures to streamline its operations for quicker and more flexible delivery of assistance.

The package expands ADB's 6.5 billion dollars initial response announced on March 18, adding 13.5 billion dollars in resources to help ADB's developing member countries counter the severe macroeconomic and health impacts caused by COVID-19.

The 20 billion dollar package includes about 2.5 billion dollars in concessional and grant resources.

"This pandemic threatens to severely set back economic, social, and development gains in Asia and the Pacific, reverse progress on poverty reduction and throw economies into recession," said ADB President Masatsugu Asakawa.

"Our expanded and comprehensive package of assistance, made possible with the strong support of our board, will be delivered more quickly, flexibly and forcefully to the governments and the private sector in our developing member countries to help them address the urgent challenges in tackling the pandemic and economic downturn," he said in a statement.

ADB's most recent assessment released on April 3 estimates the global impact of the pandemic at between 2.3 and 4.8 per cent of gross domestic product. Regional growth is forecast to decline from 5.2 per cent last year to 2.2 per cent in 2020.

The new package includes the establishment of a COVID-19 pandemic response option under ADB's countercyclical support facility.

Up to 13 billion dollars will be provided through this new option to help governments of developing member countries implement effective countercyclical expenditure programs to mitigate impacts of the COVID-19 pandemic, with a particular focus on the poor and the vulnerable.

Grant resources will continue to be deployed quickly for providing medical and personal protective equipment and supplies from expanded procurement sources.

Some 2 billion dollars from the 20 billion dollar package will be made available for the private sector. Loans and guarantees will be provided to financial institutions to rejuvenate trade and supply chains.

Enhanced microfinance loan and guarantee support and a facility to help liquidity-starved small and medium-sized enterprises, including those run by female entrepreneurs, will be implemented alongside direct financing of companies responding to or impacted by COVID-19.

The response package includes a number of adjustments to policies and business processes that will allow ADB to respond more rapidly and flexibly to the crisis. These include measures to streamline internal business processes, widen the eligibility and scope of various support facilities and make the terms and conditions of lending more tailored.

All support under the expanded package will be provided in close collaboration with international organisations, including the International Monetary Fund, World Bank Group, World Health Organisation, UNICEF, other UN agencies and the broader global community.

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."

Brussels/Amsterdam, Apr 16: As the novel coronavirus continues to wreak havoc in the western world since its outbreak in Wuhan last December, researchers believe that the Chinese leadership is trying to absolve President Xi Jinping by using a section of the western media to influence public opinion globally.

"There are clear indications that China is conducting activities in a persistent and systematic manner to influence public opinion-making, academia, think tanks and political decision-making among the member states of the Belt and Road Initiative (BRI) in general and western capital cities in particular," Siegfried O Wolf, Director of Research at Brussels-based think tank South Asia Democratic Front, said.

Some western media say some Chinese officials were secretly aware that they were facing a pandemic from the new coronavirus but allowed Wuhan to host a mass banquet for tens of thousands of people and millions began their annual trip home for the Lunar New Year celebrations.

The pandemic has since then affected 210 countries and territories around the world. Over 2 million people have been declared positive in which over 134,000 lost their lives.

"The frequency and extra-ordinary large scale of Chinese sponsored events in European political hubs, like in Brussels, and the subsequent media coverage can be seen as evidence for Beijing's public diplomacy efforts. However, the rising skepticism within the EU regarding Xi Jinping's development projects and the emerging questioning of Chinese sources funding Free Universities, like the one in Berlin, shows that this strategy produced mixed results so far," Wolf said.

He added, "However, one must also state that these efforts helped China to gain certain leverage among many non-Chinese media, western as well as non-western ones. Today, we can observe that China's political leadership tries to instrumentalise this influence for a major image campaign to distract from the fact that it carries the initial responsibility for the dramatic spread of COVID-19 by holding back key information."

Wolf also said that the current internal dynamics in China, like the shirking of responsibilities by the local authorities, are most-likely part of a twofold strategy. Firstly, there is the strategic component - namely, to reaffirm to the general public that the Communist Party of China is still in full control of the situation. The second strategic pillar is one of 'whitewashing'.

"Concretely, Beijing's obvious aim is to distract the domestic and international attention from the real, but hidden causes of the Coronavirus outbreak and its potential reputational and political consequences for Xi Jinping and his BRI," he stated.

Yoana Barakova, a Research Analyst at European Foundation for South Asian Studies (EFSAS), an Amsterdam-based think-tank, said, "The death of Dr. Li Wenliang, one of the very few medical professionals who tried to warn the world in December 2019 about the looming threat, sparked widespread condemnation around the international community in early February. Yet, little did he know that his legacy would continue much later after his demise, with the emboldened Chinese government trying to cover up its missteps through hardcore censorship after being exposed for undermining and underestimating the initial danger."

The researchers believe that the deterioration in press freedom under Jinping's regime has become more evident in recent days, with local authorities trying to control the state narrative by cosmetically placing media's focus on government's superficial attempts to tackle the crisis.