26/11 trial: LeT operations commander Lakhvi gets bail

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."

London: Italy on Friday recorded the most daily deaths of any country since the start of the coronavirus pandemic and Spain had its deadliest day, as British Prime Minister Boris Johnson became the first major world leader to test positive.

Italy reported 969 new deaths, Spain 769 and France 299 as Europe reeled from a crisis that has put millions at risk around the world and threatened a global economic meltdown.

In other grim milestones, AFP tallies showed a total of 300,000 cases now recorded in Europe with more than 26,000 deaths worldwide, and the United States overtook China as the country with the most infections.

Italy showed infection rates continuing a downward trend and Spain said its rate of new infections appeared to be slowing, but other countries were bracing to feel the full impact of the virus's spread.

The World Health Organization's regional director for Africa warned the continent faced a "dramatic evolution" of the pandemic, as South Africa became the latest nation to start life under lockdown and reported its first COVID-19 deaths.

Johnson, whose country has seen more than 14,000 declared coronavirus cases and 759 deaths, said he had developed mild symptoms over the previous 24 hours and was self-isolating after testing positive.

Britain's Health Secretary Matt Hancock also tested positive with mild symptoms.

Europe has suffered the brunt of the coronavirus crisis in recent weeks, with millions across the continent on lockdown and the streets of Paris, Rome and Madrid eerily empty.

In France — where nearly 2,000 people have died -- the government announced it was extending its stay-at-home order until at least April 15. While severe, the 299 new deaths it recorded on Friday was lower than the 365 reported the previous day.

The death of a 16-year-old girl from the virus has particularly shaken France, and shattered the belief of many young people that they are immune.

The girl's mother Sabine told AFP that Julie "just had a cough" at first but deteriorated quickly. She died on Wednesday, less than a week after showing her first symptoms.

"It's unbearable," Sabine said. "We were supposed to have a normal life."

Focus was also turning to the United States, where the number of known infections jumped by 18,000 on Friday, reaching more than 97,000 -- higher than both China and Italy. The US also recorded 345 deaths over the past 24 hours, with a total toll of 1,478.

In New York City, health workers are battling a surging toll of dead and infected at the US epicentre of the crisis, including an increasing number of younger patients.

"Now it's 50-year-olds, 40-year-olds, 30-year-olds," said one respiratory therapist at the Jewish Medical Center in Queens.

They "didn't listen about not going out or protecting themselves and washing their hands", he said.

- 'Afraid and lost' -

The coronavirus first emerged in China late last year before spreading globally, with more than half a million declared cases in 183 countries and territories.

Over the last six days, as many new cases have been diagnosed around the world as in the previous 80 days.

Beijing managed to contain its spread with lockdowns and quarantines and its epicentre Wuhan is in the process of easing severe movement restrictions in place for two months.

Three billion people around the world have been told to stay indoors.

In a historic first, Pope Francis performed the rarely recited "Urbi et Orbi" blessing to an empty Saint Peter's Square.

"Thick darkness has gathered over our squares, our streets and our cities; it has taken over our lives, filling everything with a deafening silence and a distressing void, that stops everything as it passes by," he said.

"We find ourselves afraid and lost," he said, describing the coronavirus as a "tempest".

Health care systems even in the most developed nations are stretched to breaking point and medical workers have been having to make difficult choices.

"If I've got five patients and only one bed, I have to choose who gets it," Sara Chinchilla, a paediatrician at a hospital near Madrid, told AFP.

The WHO's chief Tedros Adhanom Ghebreyesus said the dire lack of protective gear for frontline health workers was one of the most pressing problems in the fight to prevent deaths.

"The chronic global shortage of personal protective equipment is now one of the most urgent threats to our collective ability to save lives," he told a virtual news conference in Geneva.

Lockdowns and other measures are wreaking havoc on the global economy, with fears of a downturn worse than the Great Depression of the 1930s.

"It is clear that we have entered a recession" that will be worse than in 2009 following the global financial crisis, International Monetary Fund chief Kristalina Georgieva said Friday.

Unprecedented stimulus measures have helped markets bounce back after a brutal month, but people around the world are bracing for economic hardship.

The United States reported that 3.3 million people applied for unemployment benefits last week -- by far the highest number ever recorded.

Retail workers in particular have suffered as many countries shutter non-essential business, while airlines and the global tourism industry have been dealt devastating blows.

The fashion industry was the latest hit on Friday, with Paris men's fashion week and haute couture shows cancelled along with Milan men's fashion week.

- Armies of volunteers -

The World Tourism Organization said Friday it expected tourist arrivals to fall by 20-30 percent this year, with losses of $300 billion-450 billion in international tourism receipts.

But there have been rays of hope in the midst of the crisis.

Armed groups in Cameroon, the Philippines and Yemen have moved in recent days to reduce violence after UN Secretary General Antonio Guterres issued an appeal for ceasefires.

And armies of volunteers have emerged in many countries to bring help to the needy, with food deliveries for the elderly, free taxi rides, accommodation for health workers, and even home-sewn face masks.

United Nations, Mar 21: The UN has called on all nations to stop the use of capital punishment or put a moratorium on it, a day after four men convicted of gang-raping and murdering a 23-year-old woman were hanged in India.

Seven years after the rape and murder of the young medical student, who came to be known as 'Nirbhaya', sent shock waves across the country, the four convicts - Mukesh Singh (32), Pawan Gupta (25), Vinay Sharma (26) and Akshay Kumar Singh (31) - were hanged to death on Friday at 5.30 am in New Delhi's Tihar Jail.

Responding to the hanging, UN Secretary-General Antonio Guterres' spokesperson Stephane Dujarric said the world organisation calls on all nations to stop the use of capital punishment or put a moratorium on it.

"Our position has been clear, is that we call on all States to halt the use of capital punishment or at least put a moratorium on this," Dujarric said at the daily press briefing on Friday.

The horrific gang-rape and murder of the physiotherapy intern on December 16, 2012, who came to be known as Nirbhaya, the fearless, had seared the nation's soul and triggered countrywide outrage.

This was the first time that four men have been hanged together in Tihar Jail, South Asia's largest prison complex that houses more than 16,000 inmates.

The executions were carried out after the men exhausted every possible legal avenue to escape the gallows. Their desperate attempts only postponed the inevitable by less than two months after the first date of execution was set for January 22.

The execution of the four convicts brings the curtains down on the case that shook not just India but also the world with the details of its brutality The widespread protests subsequently paved the way for a change in India's rape laws.