Air India's first evacuation flight from London to take off today

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."

The President of United States Donald Trump has said that countries like India and China would have much more coronavirus cases than America if they conduct more tests.

“I say to my people every time we test; you find cases because we do more testing. If we have more cases, if we wanted to do testing in China or in India or other places, I promise you there would be more cases you are doing a fantastic job in getting out the swabs,” the US president said on Friday.

Trump said that the US has carried out 20 million tests while compared to America, Germany is at four million and much talked about South Korea is about three million tests. He made the remarks at Puritan Medical Products in Maine, according to Johns Hopkins Coronavirus Resource Center.

The US has reported nearly 1.9 million cases and over 1,09,000 deaths while the total number of coronavirus cases in India and China stand at 2,36,184 and 84,177 respectively, according to Johns Hopkins Coronavirus Resource Center data.

India has so far conducted over 4 million COVID-19 tests, according to the health ministry.

Trump said, “we will be well over 20 million tests. Remember this, when you test more, you have more cases.”

“Puritan is one of the only manufacturers in the world producing high-quality medical swabs that are crucial for rapid testing. And every swab you make at Puritan is proudly stamped with the beautiful phrase made in the USA,” Trump said.

“Thanks to the testing capacity that you are making possible, our country is reopening and our economy is recovering like nobody would’ve thought possible,” he added.

Trump also spoke about the huge unemployment problem the country is currently facing. He said that the economy is now back on track, referring to the latest monthly employment numbers,.

“We absolutely shattered expectations, and this is the largest monthly jobs increase in American history, think of that; that’s a long time,” Trump said

“I think it’s more than double or about double of what our highest was before so this is the largest monthly job increase in American history. And we’re going to have a phenomenal next year. We’re going to have a tremendous couple of months prior to the election on November 3 very, very important date,” the president said.

Keeping an eye on the November 3 presidential elections, Trump is seeking re-election for his second consecutive term. He is pitted against Democratic presidential nominee Joe Biden who in opinion polls is surging several points of Trump.

“It’s going to be a very important election because the only thing that can screw it up is if you get the wrong president and they raise your taxes, and they open up your borders so that everybody pours into our country,” Trump said.

Trump also vowed to bring the American economy back on track, which has been badly hit by the coronavirus pandemic. He reiterated that his administration has built a strong economy in the last three years.

Describing the fight against coronavirus as the greatest national and industrial mobilisation since the World War II, Trump said that his administration has marshaled the full power of the US government and US industry to defeat the invisible enemy.

“It is indeed an enemy. It came from China, should have been stopped in China. They didn’t do that,” he alleged.

The administration, he said, has delivered over 1.5 billion pieces of personal protective equipment to doctors and nurses on the front lines. We slashed the red tape to speed up the development of vaccines.

“And vaccines are coming along incredibly well, wait till you see, and therapeutics. And we partnered at private sector leaders such as Puritan to build the largest and most advanced testing capacity on the face of the earth, like this one,” the US president said.

The Puritan factory in Maine, he said, quickly ramped up the production to produce nearly 20 million foam-tipped swabs each month.

“Then in April, my administration invoked the Defence Production Act to help you scale up even more. Under a USD 75 million public-private partnership, Puritan will soon double production to 40 million swabs per month,” Trump added.

Mar 3: Just hours after the ending of a week-long “reduction” in violence that was crucial for Donald Trump’s peace deal in Afghanistan, the Taliban struck again: On Monday, they killed three people and injured about a dozen at a football match in Khost province. This resumption of violence will not surprise anyone actually invested in peace for that troubled country. The point of the U.S.-Taliban deal was never peace. It was to try and cover up an ignominious exit for the U.S., driven by an election-bound president who feels no responsibility toward that country or to the broader region.

Seen from South Asia, every point we know about in the agreement is a concession by Trump to the Taliban. Most importantly, it completes a long-term effort by the U.S. to delegitimize the elected government in Kabul — and, by extension, Afghanistan’s constitution. Afghanistan’s president is already balking at releasing 5,000 Taliban prisoners before intra-Afghan talks can begin — a provision that his government did not approve.

One particularly cringe-worthy aspect: The agreement refers to the Taliban throughout  as “the Islamic Emirate of Afghanistan that is not recognized by the United States as a state and is known as the Taliban.” This unwieldy nomenclature validates the Taliban’s claim to be a government equivalent to the one in Kabul, just not the one recognised at the moment by the U.S. When read together with the second part of the agreement, which binds the U.S. to not “intervene in [Afghanistan’s] domestic affairs,” the point is obvious: The Taliban is not interested in peace, but in ensuring that support for its rivals is forbidden, and its path to Kabul is cleared.

All that the U.S. has effectively gotten in return is the Taliban’s assurance that it will not allow the soil of Afghanistan to be used against the “U.S. and its allies.” True, the U.S. under Trump has shown a disturbing willingness to trust solemn assurances from autocrats; but its apparent belief in promises made by a murderous theocratic movement is even more ridiculous. Especially as the Taliban made much the same promise to an Assistant Secretary of State about Osama bin Laden while he was in the country plotting 9/11.

Nobody in the region is pleased with this agreement except for the Taliban and their backers in the Pakistani military. India has consistently held that the legitimate government in Kabul must be the basic anchor of any peace plan. Ordinary Afghans, unsurprisingly, long for peace — but they are, by all accounts, deeply skeptical about how this deal will get them there. The brave activists of the Afghan Women’s Network are worried that intra-Afghan talks will take place without adequate representation of the country’s women — who have, after all, the most to lose from a return to Taliban rule.

But the Pakistani military establishment is not hiding its glee. One retired general tweeted: “Big victory for Afghan Taliban as historic accord signed… Forced Americans to negotiate an accord from the position of parity. Setback for India.” Pakistan’s army, the Taliban’s biggest backer, longs to re-install a friendly Islamist regime in Kabul — and it has correctly estimated that, after being abandoned by Trump, the Afghan government will have sharply reduced bargaining power in any intra-Afghan peace talks. A deal with the Taliban that fails also to include its backers in the Pakistani military is meaningless.

India, meanwhile, will not see this deal as a positive for regional peace or its relationship with the U.S. It comes barely a week after Trump’s India visit, which made it painfully clear that shared strategic concerns are the only thing keeping the countries together. New Delhi remembers that India is not, on paper, a U.S. “ally.” In that respect, an intensification of terrorism targeting India, as happened the last time the U.S. withdrew from the region, would not even be a violation of Trump’s agreement. One possible outcome: Over time the government in New Delhi, which has resolutely sought to keep its ties with Kabul primarily political, may have to step up security cooperation. Nobody knows where that would lead.

The irresponsible concessions made by the U.S. in this agreement will likely disrupt South Asia for years to come, and endanger its own relationship with India going forward. But worst of all, this deal abandons those in Afghanistan who, under the shadow of war, tried to develop, for the first time, institutions that work for all Afghans. No amount of sanctimony about “ending America’s longest war” should obscure the danger and immorality of this sort of exit.