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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News Network
March 29,2020

Washington, Mar 29: The number of known coronavirus US cases soared well past 115,000, with more than 1,900 dead, as President Donald Trump said on Saturday he was considering imposing a quarantine on the hard hit New York region.

American healthcare workers in the trenches of the pandemic are appealing for more protective gear and equipment to treat a surge in patients that is already pushing hospitals to their limits in virus hot spots such as New York City, New Orleans and Detroit.

Trump told reporters he could order a quarantine on three states, New York, New Jersey and Connecticut, which between them have recorded at least 64,000 infections and 895 deaths.

He also appeared to soften his previous comments calling for the US economy to be swiftly reopened. Asked whether he thought the United States would restart by Easter Sunday, April 12, Trump replied, "We'll see, what happens."

New York Governor Andrew Cuomo said he had no details on any possible quarantine order for his state, telling a briefing: "I don't even know what that means. I don't know how that would be legally enforceable, and from a medical point of view I don't know what you would be accomplishing."

He said New York was postponing its presidential primary election to June 23, from April 28.

As the crisis deepened, nurses at Jacobi Medical Center in New York's borough of the Bronx protested outside the hospital on Saturday, saying supervisors asked them to reuse personal protective equipment, including masks. Some held signs with slogans including "Protect our lives so we can save yours."

"The masks are supposed to be one-time use," one nurse said, according to videos posted online. "Now, all of a sudden the CDC (Centers for Disease Control and Prevention) is saying that it's fine for us to reuse them. These choices are being made not based on science. They're being made based on need."

One resident at New York Presbyterian Hospital said they were issued with just one mask.

"This is your mask forever. You can bring it home with you. Here's how you can clean your mask," said the resident, who asked not to be named because he was not authorized to speak to the media. "It's not the people who are making these decisions that go into the patients' rooms."

Doctors are also especially concerned about a shortage of ventilators, machines that help patients breathe and are widely needed for those suffering from COVID-19, the pneumonia-like respiratory ailment caused by the highly contagious novel coronavirus.

Hospitals have also sounded the alarm about scarcities of drugs, oxygen tanks and trained staff.

By Saturday afternoon, the US number of cases stood at 115,842 with at least 1,929 deaths, according to a Reuters tally. The United States has had the most recorded cases of any country since its count of infections eclipsed those of China and Italy on Thursday.

BLACK MARKET
As shortages of key medical supplies abounded, desperate physicians and nurses were forced to take matters into their own hands.

New York-area doctors say they have had to recycle some protective gear, or even resort to bootleg suppliers.

Dr. Alexander Salerno of Salerno Medical Associates in northern New Jersey described going through a "broker" to pay $17,000 for masks and other protective equipment that should have cost about $2,500, and picking them up at an abandoned warehouse.

"You don't get any names. You get just phone numbers to text," Salerno said. "And so you agree to a term. You wire the money to a bank account. They give you a time and an address to come to."

Nurses at Mount Sinai Hospital in New York said they were locking away or hiding N95 respirator masks, surgical masks and other supplies that are prone to pilfering if left unattended.

"Masks disappear," nurse Diana Torres said. "We hide it all in drawers in front of the nurses' station."

One nurse at Westchester Medical Center, in the suburbs of the city, said colleagues have begun absconding with scarce supplies without asking, prompting better-stocked teams to lock masks, gloves and gowns in drawers and closets.

An emergency room doctor in Michigan, an emerging epicenter of the pandemic, said he was wearing one paper face mask for an entire shift due to a shortage and that hospitals in the Detroit area would soon run out of ventilators.

"We have hospital systems here in the Detroit area in Michigan who are getting to the end of their supply of ventilators and have to start telling families that they can't save their loved ones because they don't have enough equipment," the physician, Dr. Rob Davidson, said in a video posted on Twitter.

Sophia Thomas, a nurse practitioner at DePaul Community Health Center in New Orleans, where Mardi Gras celebrations late last month fueled an outbreak in Louisiana's largest city, said the numbers of coronavirus patients "have been staggering."

In the nation's second-largest city, Los Angeles Mayor Eric Garcetti said spiking cases were putting Southern California on track to match New York City's infection figures in the next week.

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News Network
July 14,2020

Washington, Jul 14: The United States has the biggest Covid-19 testing programme in the world, better than big countries like Russia, China, India and Brazil, President Donald Trump said on Monday, asserting that America has "just about the lowest mortality rate" due to the disease in the world.

"We have one of the lowest mortality rates anywhere," Trump said at a White House roundtable. More than 34 lakh Americans have tested positive for Covid-19 so far and over 1,37,000 have died due to the disease, both of which are the largest numbers among all the countries.

The huge number of positive cases, the president said, is due to the massive testing efforts undertaken by his administration, more extensive than any other country.

"We test more than anybody by far. And when you test, you create cases. So we have created cases. I can tell you that some countries, they test when somebody walks into a hospital sick or walks into maybe a doctor's office, but usually a hospital. That is the testing they do, so they do not have cases, whereas we have all these cases. So, it is a double-edged sword," he said.

At the same time, the United States has the lowest mortality rate or just about the lowest mortality rate due to the disease in the world, Trump added. "We are doing a great job. We are doing very well with vaccines and we are doing very, very well with therapeutics. I think we are going to have some very good information coming out soon," he said in response to a question.

"But we have the best and certainly, by far, the biggest testing programme anywhere in the world. If you tested China or Russia or any of the larger countries, if you just tested India, as an example, the way we test, you would see numbers that would be very surprising. Brazil too. You know, Brazil is going through a big problem, but they do not do testing like we do," Trump said.

"So we do the testing and by doing the testing, we have tremendous numbers of cases. As an example, we have done 45 million tests. If we did half that number, you would have half the cases probably -- around that number. If we did another half of that, you would have half the numbers. Everyone would be saying, 'Oh, we are doing so well on cases'," he added.

Responding to a question, Trump said what China did to the world should not be forgotten.

"I think what China has done to the world with what took place -- the China plague -- you can call it the China virus, you can call it whatever you want to call it. It has about 20 different names. What they did to the world should not be forgotten," he said.

The trade deal with China that was signed early this year remains intact, the president said. "It is intact, they (China) are buying. Whether they buy or not, that is up to them. They are buying," he said.

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News Network
April 28,2020

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."

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