Chemical attack kills dozens in Syria, US blames Assad

April 5, 2017

Beirut, Apr 5: A chemical weapons attack in an opposition-held town in northern Syria killed dozens of people on Tuesday, leaving residents gasping for breath and convulsing in the streets and overcrowded hospitals. The Trump administration blamed the Syrian government for the attack, one of the deadliest in years, and said Syria's patrons, Russia and Iran, bore "great moral responsibility" for the deaths.

ChemicalThe Britain-based Syrian Observatory for Human Rights said at least 58 people died, including 11 children, in the early morning attack in the town of Khan Sheikhoun, which witnesses said was carried out by Sukhoi jets operated by the Russian and Syrian governments.

Videos from the scene showed volunteer medics using fire hoses to wash the chemicals from victims' bodies. Haunting images of lifeless children piled in heaps reflected the magnitude of the attack, which was reminiscent of a 2013 chemical assault that left hundreds dead and was the worst in the country's ruinous six-year civil war.

Tuesday's attack drew swift condemnation from world leaders, including President Donald Trump, who denounced it as a "heinous" act that "cannot be ignored by the civilized world." The UN Security Council scheduled an emergency meeting for Wednesday in response to the strike, which came on the eve of a major international donors' conference in Brussels on the future of Syria and the region.

In a statement, Trump also blamed former US President Barack Obama for "weakness" in failing to respond aggressively after the 2013 attack.

"These heinous actions by the Bashar al-Assad regime are a consequence of the past administration's weakness and irresolution," Trump said. "President Obama said in 2012 that he would establish a `red line' against the use of chemical weapons and then did nothing. The United States stands with our allies across the globe to condemn this intolerable attack."

Trump left it to his top diplomat, Secretary of State Rex Tillerson, to assign at least some blame to Russia and Iran, Assad's most powerful allies. Tillerson called on both countries to use their influence over Assad to prevent future chemical weapons attacks, and noted Russia's and Iran's roles in helping broker a cease-fire through diplomatic talks in the Kazakh capital, Astana.

"As the self-proclaimed guarantors to the cease-fire negotiated in Astana, Russia and Iran also bear great moral responsibility for these deaths," Tillerson said.

In a statement, the Syrian government "categorically rejected" claims that it was responsible, asserting that it does not possess chemical weapons, hasn't used them in the past and will not use them in the future. It laid the blame squarely on the rebels, accusing them of fabricating the attack and trying to frame the Syrian government.

The Russian defense ministry said the Khan Sheikhoun residents were exposed to toxic agents from a rebel arsenal hit by a Syrian air strike.

The ministry spokesman, Major General Igor Konashenkov, said in a statement early Wednesday that Russian military assets registered the strike on a weapons depots and ammunition factory on the town's eastern outskirts. Konashenkov said the factory produced chemical weapons that were used in Iraq.

Photos and video emerging from Khan Sheikhoun, located south of the provincial capital of Idlib, showed the limp bodies of children and adults. Some were struggling to breathe; others appeared to be foaming at the mouth.

The activist-run Assi Press published video of paramedics carrying victims, stripped down to their underwear and many appearing unresponsive, from the scene in pickup trucks.

It was not immediately clear if all those killed died from suffocation or were struck by other airstrikes that occurred in the area around the same time.

It was the third claim of a chemical attack in just over a week in Syria. The previous two were reported in Hama province, in an area not far from Khan Sheikhoun.

Opposition activists and a doctor in Idlib said it was the worst incident since the 2013 gas attack on the Damascus suburb of Ghouta that killed hundreds of civilians and which a UN investigation said used sarin gas.

Faced with international outrage over that attack, Assad agreed to a Russia-sponsored deal to destroy his chemical arsenal. His government declared a 1,300-ton stockpile of chemical weapons and so-called precursor chemicals that can be used to make weapons, all of which were destroyed.

But member states of the Organization for the Prohibition of Chemical Weapons have repeatedly questioned whether Assad declared everything. The widely available chemical chlorine was not covered in the 2013 declaration and activists say they have documented dozens of cases of chlorine gas attacks since then.

The Syrian government has consistently denied using chemical weapons and chlorine gas, accusing the rebels of deploying it in the war instead.

Dr. AbdulHai Tennari, a pulmonologist who treated dozens of victims of Tuesday's attack, said it appeared to be more serious than a chlorine attack.

In a Skype interview, he said doctors were struggling amid extreme shortages, including of the antidote used to save patients, Pralidoxem.

Most of the fatalities died before they reached hospitals, Tennari said. "If they got to the hospital we can treat them. Two children who took a while before they were lifted out of the rubble died," he said.

Dr. Mohammed Tennari, a radiologist and AbdulHaj Tennari's brother, said Tuesday's attack was more severe than previous ones in the province, most of which used chlorine cylinders.

"Honestly, we have not seen this before. The previous times the wounds were less severe," he said. The doctor, who testified before the United Nations in 2015 about renewed Syrian government use of chemical attacks despite claims it has destroyed its stockpiles, said there was a chlorine smell after Tuesday's attack, but it was mixed with another unknown "toxic gas which causes poison and death."

Mohammed Hassoun, a media activist in the nearby town of Sarmin, where some of the critical cases were transferred, said doctors there also believed it was likely more than one gas. "Chlorine gas doesn't cause such convulsions," he said, adding that doctors suspect sarin was used.

"There are 18 critical cases here. They were unconscious, they had seizures and when oxygen was administered, they bled from the nose and mouth," he told The Associated Press.

Tarik Jasarevic, spokesman for the World Health Organization in Geneva, said by email that the agency was gathering more information about Tuesday's incident. The Syrian American Medical Society, which supports hospitals in opposition-held territory, also said it had sent inspectors to Khan Sheikhoun and an investigation was underway.

Hussein Kayal, a photographer for the Idlib Media Center, said he was awakened by the sound of a bomb blast around 6:30 a.m., and when he arrived at the scene he found entire families inside their homes unable to move, with their eyes wide open and their pupils constricted. He put on a mask, and he and others took victims to an emergency room. He said he later felt a burning sensation in his fingers and was treated for that.

The province of Idlib, which is almost entirely controlled by the opposition, is home to some 900,000 displaced Syrians, according to the United Nations. Rebels and opposition officials have expressed concerns that the government is planning to mount a concentrated attack on the crowded province.

New York-based Human Rights Watch has accused the Syrian government of conducting at least eight chlorine gas attacks on opposition-controlled residential areas during the final months of the battle for Aleppo last year that killed at least nine civilians and injured 200. A joint investigation by the United Nations and the international chemical weapons watchdog determined the Syrian government was behind at least three additional attacks in 2014 and 2015 involving chlorine gas, and that the Islamic State group was responsible for at least one, involving mustard gas.

Late Tuesday, Abu Hamdu, a rescue worker in Khan Sheikhoun, said people were still searching for their family members, nearly 12 hours after the attack.

"People are still very lost," he said.

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Agencies
August 9,2020

When researcher Monica Gandhi began digging deeper into outbreaks of the novel coronavirus, she was struck by the extraordinarily high number of infected people who had no symptoms.

A Boston homeless shelter had 147 infected residents, but 88% had no symptoms even though they shared their living space. A Tyson Foods poultry plant in Springdale, Ark., had 481 infections, and 95% were asymptomatic.

Prisons in Arkansas, North Carolina, Ohio and Virginia counted 3,277 infected people, but 96% were asymptomatic.

During its seven-month global rampage, the coronavirus has claimed more than 700,000 lives. But Gandhi began to think the bigger mystery might be why it has left so many more practically unscathed.

What was it about these asymptomatic people, who lived or worked so closely to others who fell severely ill, she wondered, that protected them? Did the "dose" of their viral exposure make a difference? Was it genetics? Or might some people already have partial resistance to the virus, contrary to our initial understanding?

Efforts to understand the diversity in the illness are finally beginning to yield results, raising hope that the knowledge will help accelerate development of vaccines and therapies - or possibly even create new pathways toward herd immunity in which enough of the population develops a mild version of the virus that they block further spread and the pandemic ends.

"A high rate of asymptomatic infection is a good thing," said Gandhi, an infectious-disease specialist at the University of California at San Francisco. "It's a good thing for the individual and a good thing for society."

The coronavirus has left numerous clues - the uneven transmission in different parts of the world, the mostly mild impact on children. Perhaps most tantalizing is the unusually large proportion of infected people with mild symptoms or none at all. The Centers for Disease Control and Prevention last month estimated that rate at about 40%.

Those clues have sent scientists off in different directions: Some are looking into the role of the receptor cells, which the virus uses to infiltrate the body, to better understand the role that age and genetics might play. Others are delving into masks and whether they may filter just enough of the virus so those wearing them had mild cases or no symptoms at all.

The theory that has generated the most excitement in recent weeks is that some people walking among us might already have partial immunity.

When SARS-CoV-2, the technical name of the coronavirus that causes the disease covid-19, was first identified on Dec. 31, 2019, public health officials deemed it a "novel" virus because it was the first time it had been seen in humans who presumably had no immunity from it whatsoever. There's now some very early, tentative evidence suggesting that assumption might have been wrong.

One mind-blowing hypothesis - bolstered by a flurry of recent studies - is that a segment of the world's population may have partial protection thanks to "memory" T cells, the part of our immune system trained to recognize specific invaders. 

This could originate from cross-protection derived from standard childhood vaccinations. Or, as a paper published Tuesday in Science suggested, it could trace back to previous encounters with other coronaviruses, such as those that cause the common cold.

"This might potentially explain why some people seem to fend off the virus and may be less susceptible to becoming severely ill," National Institutes of Health Director Francis Collins remarked in a blog post this past week.

On a population level, such findings, if validated, could be far-reaching.

Hans-Gustaf Ljunggren, a researcher at Sweden's Karolinska Institute, and others have suggested that public immunity to the coronavirus could be significantly higher than what has been suggested by studies. In communities in Barcelona, Boston, Wuhan and other major cities, the proportion of people estimated to have antibodies and therefore presumably be immune has mostly been in the single digits. But if others had partial protection from T cells, that would raise a community's immunity level much higher.

This, Ljunggren said, would be "very good news from a public health perspective."

Some experts have gone so far as to speculate about whether some surprising recent trends in the epidemiology of the coronavirus - the drop in infection rates in Sweden where there have been no widespread lockdowns or mask requirements, or the high rates of infection in Mumbai's poor areas but little serious disease - might be due to preexisting immunity.

Others say it's far too early to draw such conclusions. Anthony Fauci, the United States' top infectious-disease expert, said in an interview that while these ideas are being intensely studied, such theories are premature. He said at least some partial preexisting immunity in some individuals seems a possibility.

And he said the amount of virus someone is exposed to - called the inoculum - "is almost certainly an important and likely factor" based on what we know about other viruses.

But Fauci cautioned that there are multiple likely reasons - including youth and general health - that determine whether a particular individual shrugs off the disease or dies of it. That reinforces the need, in his view, for continued vigilance in social distancing, masking and other precautions.

"There are so many other unknown factors that maybe determine why someone gets an asymptomatic infection," Fauci said. "It's a very difficult problem to pinpoint one thing."

- - -

News headlines have touted the idea based on blood tests that 20% of some New York communities might be immune, 7.3% in Stockholm, 7.1% in Barcelona. Those numbers come from looking at antibodies in people's blood that typically develop after they are exposed to a virus. But scientists believe another part of our immune system - T cells, a type of white blood cell that orchestrates the entire immune system - could be even more important in fighting against the coronavirus.

Recent studies have suggested that antibodies from the coronavirus seem to stick around for two to three months in some people. While work on T cells and the coronavirus is only getting started - testing T cells is much more laborious than antibody testing - previous research has shown that, in general, T cells tend to last years longer.

One of the first peer-reviewed studies on the coronavirus and T cells was published in mid-May in the journal Cell by Alessandro Sette, Shane Crotty and others at the La Jolla Institute for Immunology near San Diego.

The group was researching blood from people who were recovering from coronavirus infections and wanted to compare that to samples from uninfected controls who were donors to a blood bank from 2015 to 2018. The researchers were floored to find that in 40% to 60% of the old samples, the T cells seemed to recognize SARS-CoV-2.

"The virus didn't even exist back then, so to have this immune response was remarkable," Sette said.

Research teams from five other locations reported similar findings. In a study from the Netherlands, T cells reacted to the virus in 20% of the samples. In Germany, 34%. In Singapore, 50%.

The different teams hypothesized this could be due to previous exposure to similar pathogens. Perhaps fortuitously, SARS-CoV-2 is part of a large family of viruses. Two of them - SARS and MERS - are deadly and led to relatively brief and contained outbreaks. Four other coronavirus variants, which cause the common cold, circulate widely each year but typically result in only mild symptoms. Sette calls them the "less-evil cousins of SARS-CoV-2."

This week, Sette and others from the team reported new research in Science providing evidence the T cell responses may derive in part from memory of "common cold" coronaviruses.

"The immune system is basically a memory machine," he said. "It remembers and fights back stronger."

The researchers noted in their paper that the strongest reaction they saw was against the spike proteins that the virus uses to gain access to cells - suggesting that fewer viral copies get past these defenses.

"The current model assumes you are either protected or you are not - that it's a yes or no thing," Sette added. "But if some people have some level of preexisting immunity, that may suggest it's not a switch but more continuous."

- - -

More than 2,300 miles away, at the Mayo Clinic in Cleveland, Andrew Badley was zeroing in the possible protective effects of vaccines.

Teaming up with data experts from Nference, a company that manages their clinical data, he and other scientists looked at records from 137,037 patients treated at the health system to look for relationships between vaccinations and coronavirus infection.

They knew that the vaccine for smallpox, for example, had been shown to protect against measles and whooping cough. Today, a number of existing vaccines are being studied to see whether any might offer cross-protection against SARS-CoV-2.

When SARS-CoV-2, the technical name of the coronavirus that causes the disease covid-19, was first identified on Dec. 31, 2019

The results were intriguing: Seven types of vaccines given one, two or five years in the past were associated with having a lower rate of infection with the new coronavirus. Two vaccines in particular seemed to show stronger links: People who got a pneumonia vaccine in the recent past appeared to have a 28% reduction in coronavirus risk. Those who got polio vaccines had a 43% reduction in risk.

Venky Soundararajan, chief scientific officer of Nference, remembers when he first saw how large the reduction appeared to be, he immediately picked up his phone and called Badley: "I said, 'Is this even possible?'"

The team looked at dozens of other possible explanations for the difference. It adjusted for geographic incidence of the coronavirus, demographics, comorbidities, even whether people had had mammograms or colonoscopies, under the assumption that people who got preventive care might be more apt to social distance. But the risk reduction still remained large.

"This surprised us completely," Soundararajan recalled. "Going in we didn't expect anything or maybe one or two vaccines showing modest levels of protection."

The study is only observational and cannot show a causal link by design, but Mayo researchers are looking at a way to quantify the activity of these vaccines on the coronavirus to serve as a benchmark to the new vaccines being created by companies such as Moderna. If existing vaccines appear as protective as new ones under development, he said, they could change the world's whole vaccine strategy.

- - -

Meanwhile, at NIH headquarters in Bethesda, Md., Alkis Togias has been laser-focused on one group of the mildly affected: children. He wondered whether it might have something to do with the receptor known as ACE2, through which the virus hitchhikes into the body.

In healthy people, the ACE2 receptors perform the important function of keeping blood pressure stable. The novel coronavirus latches itself to ACE2, where it replicates. Pharmaceutical companies are trying to figure out how to minimize the receptors or to trick the virus into attaching itself to a drug so it does not replicate and travel throughout the body.

Was it possible, Togias asked, that children naturally expressed the receptor in a way that makes them less vulnerable to infection?

He said recent papers have produced counterintuitive findings about one subgroup of children - those with a lot of allergies and asthma. The ACE2 receptors in those children were diminished, and when they were exposed to an allergen such as cat hair, the receptors were further reduced. Those findings, combined with data from hospitals showing that asthma did not seem to be a risk factor for the respiratory virus, as expected, have intrigued researchers.

"We are thinking allergic reactions may protect you by down-regulating the receptor," he said. "It's only a theory of course."

Togias, who is in charge of airway biology for the National Institute of Allergy and Infectious Diseases, is looking at how those receptors seem to be expressed differently as people age, as part of a study of 2,000 U.S. families. By comparing those differences and immune responses within families, they hope to be able to better understand the receptors' role.

Separately, a number of genetic studies show variations in genes associated with ACE2 with people from certain geographic areas, such as Italy and parts of Asia, having distinct mutations. No one knows what significance, if any, these differences have on infection, but it's an active area of discussion in the scientific community.

- - -

Before the pandemic, Gandhi, the University of California researcher, specialized in HIV. But like other infectious-disease experts these days, she has spent many of her waking hours thinking about the coronavirus. And in scrutinizing the data on outbreaks one day, she noticed what might be a pattern: People were wearing masks in the settings with the highest percentage of asymptomatic cases.

The numbers on two cruise ships were especially striking. In the Diamond Princess, where masks weren't used and the virus was likely to have roamed free, 47% of those tested were asymptomatic. But in the Antarctic-bound Argentine cruise ship, where an outbreak hit in mid-March and surgical masks were given to all passengers and N95 masks to the crew, 81% were asymptomatic.

Similarly high rates of asymptomatic infection were documented at a pediatric dialysis unit in Indiana, a seafood plant in Oregon and a hair salon in Missouri, all of which used masks. Gandhi was also intrigued by countries such as Singapore, Vietnam and the Czech Republic that had population-level masking.

"They got cases," she noted, "but fewer deaths."

The scientific literature on viral dose goes back to around 1938 when scientists began to find evidence that being exposed to one copy of a virus is more easily overcome than being exposed to a billion copies. Researchers refer to the infectious dose as ID50 - or the dose at which 50% of the population would become infected.

While scientists do not know what that level might be for the coronavirus (it would be unethical to expose humans in this way), previous work on other nonlethal viruses showed that people tend to get less sick with lower doses and more sick with higher doses. A study published in late May involving hamsters, masks and SARS-CoV-2 found that those given coverings had milder cases than those who did not get them.

In an article published this month in the Journal of General Internal Medicine, Gandhi noted that in some outbreaks early in the pandemic in which most people did not wear masks, 15% of the infected were asymptomatic. But later on, when people began wearing masks, the rate of asymptomatic people was 40% to 45%.

She said the evidence points to masks not just protecting others - as U.S. health officials emphasize - but protecting the wearer as well. Gandhi makes the controversial argument that while people mostly have talked about asymptomatic infections as terrifying due to how people can spread the virus unwittingly, it could end up being a good thing.

"It is an intriguing hypothesis that asymptomatic infection triggering immunity may lead us to get more population-level immunity," Gandhi said. "That itself will limit spread."

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Agencies
May 19,2020

Washington DC, May 19: US President Donald Trump has threatened to permanently halt funding for the World Health Organisation (WHO) if it did not commit to improvements within 30 days, and to reconsider the membership of the United States in the global health body.

On Monday, Trump wrote a letter to WHO Director-General Tedros Ghebreyesus that read, "If WHO doesn't commit to major substantive improvements within the next 30 days, I will make my temporary freeze of US funding to WHO permanent and reconsider our membership in the organisation."

Trump had temporarily suspended US' contribution to the WHO last month, accusing it of promoting China's "disinformation" about the coronavirus outbreak, although WHO officials denied the accusation and Beijing said that it was transparent and open.

"The only way forward for the WHO is if it can actually demonstrate independence from China. My administration has already started discussions with you on how to reform the organisation. But action is needed quickly. 

We do not have time to waste," Trump said in the letter.

"I cannot allow American taxpayer dollars to continue to finance an organisation that, in its present state, is so clearly not serving America's interests," he added.

On Monday, the WHO said that an independent review of the global coronavirus response would begin at the earliest and it received backing from China, where the virus was first discovered.

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News Network
March 12,2020

Geneva, Mar 12: For the global economy, virus repercussions were profound, with increasing concerns of wealth- and job-wrecking recessions. U.S. stocks wiped out more than all the gains from a huge rally a day earlier as Wall Street continued to reel.

The Dow Jones Industrial Average dropped 1,464 points, bringing it 20% below its record set last month and putting it in what Wall Street calls a “bear market.” The broader S&P 500 is just 1 percentage point away from falling into bear territory and bringing to an end one of the greatest runs in Wall Street’s history.

WHO officials said they thought long and hard about labeling the crisis a pandemic — defined as sustained outbreaks in multiple regions of the world.

The risk of employing the term, Ryan said, is “if people use it as an excuse to give up.” But the benefit is “potentially of galvanizing the world to fight.”

Underscoring the mounting challenge: soaring numbers in the U.S. and Europe’s status as the new epicenter of the pandemic. While Italy exceeds 12,000 cases and the United States has topped 1,300, China reported a record low of just 15 new cases Thursday and three-fourths of its infected patients have recovered.

China’s totals of 80,793 cases and 3,169 deaths are a shrinking portion of the world’s more than 126,000 infections and 4,600 deaths.

“If you want to be blunt, Europe is the new China,” said Robert Redfield, the head of the U.S. Centers for Disease Control and Prevention.

With 12,462 cases and 827 deaths, Italy said all shops and businesses except pharmacies and grocery stores would be closed beginning Thursday and designated billions in financial relief to cushion economic shocks in its latest efforts to adjust to the fast-evolving crisis that silenced the usually bustling heart of the Catholic faith, St. Peter’s Square.

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