At least 84 dead in 'terrorist' Nice truck attack

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."

Pentagon, Jan 25: Thirty-four US troops had been diagnosed with concussions and traumatic brain injury (TBI) as a result of the January 8 Iranian missile attack on two military bases in Iraq housing American soldiers, the Pentagon said.

"Eight service members who were previously transported to Germany have been brought to the US, they would continue to receive treatment in the US either at Walter Reed or their home bases," Pentagon spokesman Jonathan Hoffman told the media on Friday.

Hoffman said that nine service members were still undergoing treatment in Germany, and the rest of the 17 injured troops have already returned to duty in Iraq, reports Xinhua news agency.

Lat week, the US military had said that 11 service members were treated for concussion symptoms due to the missile attacks.

Hoffman noted that the symptoms "are late developing and manifested over a period of time".

In retaliation for the killing of Iranian Major General Qasem Soleimani in an American drone attack on January 3 in Baghdad, Tehran launched over 13 ballistic missiles on the two military bases in Anbar and near the city of Erbil.

US military initially said that no casualty was reported from the Iranian attack. President Donald Trump then downplayed the seriousness of those injures.

"I heard that they had headaches and a couple of other things, but I would say and I can report that it's not very serious," Trump told reporters on Wednesday at a press conference in Davos, Switzerland.

More than 5,000 US troops are deployed in Iraq to support the country's forces in the battle against Islamic State militants.

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.