Trump impact: Mosques in US receive threatening letters

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."

San Francisco, Mar 14: Microsoft on friday announced that co-founder Bill Gates has left its board of directors to devote more time to philanthropy.

The 64-year-old stopped being involved in day-to-day operations at the firm more than a decade ago, turning his attention to the foundation he launched with his wife, Melinda.

Gates served as chairman of Microsoft's board of directors until early in 2014 and has now stepped away entirely, according to the Redmond-based technology giant.

“It's been a tremendous honor and privilege to have worked with and learned from Bill over the years,” Microsoft chief executive and company veteran Satya Nadella said in a release.

Nadella said Microsoft would continue to benefit from Gates' “technical passion and advice” in his continuing role as a technical advisor.
“I am grateful for Bill's friendship and look forward to continuing to work alongside him,” he added.

Gates left his CEO position in 2000, handing the company reins to Steve Ballmer to devote more time to his charitable foundation.

He gave up the role of chairman at the same time Nadella became Microsoft's third CEO in 2014.

Regularly listed among the world's richest people, William H. Gates was a geeky-looking young man when he and Paul Allen co-founded Microsoft in 1975.

Gates went on to turn his attention from software to fighting disease and other humanitarian challenges with his wife, under the auspices of the Bill and Melinda Gates Foundation.

As the deadly coronavirus has spread worldwide, it has carried with it xenophobia -- and Asian communities around the world are finding themselves subject to suspicion and fear.

When a patient on Australia's Gold Coast refused to shake the hand of her surgeon Rhea Liang, citing the virus that has killed hundreds, the medic's first response was shock.

But after tweeting about the incident and receiving a flood of responses, the respected doctor learned her experience was all too common.

There has been a spike in reports of anti-Chinese rhetoric directed at people of Asian origin, regardless of whether they have ever visited the centre of the epidemic or been in contact with the virus.

Chinese tourists have reportedly been spat at in the Italian city of Venice, a family in Turin was accused of carrying the disease, and mothers in Milan have used social media to call for children to be kept away from Chinese classmates.

In Canada, a white man was filmed telling a Chinese-Canadian woman "you dropped your coronavirus" in the parking lot of a local mall.

In Malaysia, a petition to "bar Chinese people from entering our beloved country" received almost 500,000 signatures in one week.

The incidents are part of what the Australasian College for Emergency Medicine has described as "misinformation" which it says is fuelling "racial profiling" where "deeply distressing assumptions are being made about 'Chinese' or 'Asian-looking' people." Disease has long been accompanied by suspicions of foreigners -- from Irish immigrants being targeted in the Typhoid Mary panic of 1900s America to Nepali peacekeepers being accused of bringing cholera to earthquake-struck Haiti in the last decade.

"It's a common phenomenon," said Rob Grenfell, director of health and biosecurity for Australia's science and research agency CSIRO.

"With outbreaks and epidemics along human history, we've always tried to vilify certain subsets of the population," he said, comparing the behaviour to 1300s plague-ridden medieval Europe, where foreigners and religious groups were often blamed.

"Sure it emerged in China," he said of the coronavirus, "but that's no reason to actually vilify Chinese people." In a commentary for the British Medical Journal, doctor Abraar Karan warned this behaviour could discourage people with symptoms from coming forward.

Claire Hooker, a health lecturer at the University of Sydney, said the responses from governments may have compounded prejudice.

The World Health Organisation has warned against "measures that unnecessarily interfere with international travel and trade", but this has not stopped scores of countries from introducing travel bans.

The tiny Pacific nation of Micronesia has banned its citizens from visiting mainland China altogether.

"Travel bans respond largely to people's fears," said Hooker, and while sometimes warranted, they often "have the effect of cementing an association between Chinese people and scary viruses".

Abbey Shi, a Shanghai-born student in Sydney, said the attitude shown by some of her peers has "become almost an attack on students who are Chinese".

While Australia's conservative government has banished its citizens returning from Wuhan -- the central Chinese city at the epicentre of the virus -- to a remote island for quarantine, thousands of students still stuck in China risk their studies being torpedoed.

"Right now it looks like they have to miss the semester's start and potentially the whole year, because of the way the courses are set up," Shi said.

According to Hooker, studies in Toronto on the impact of Severe Acute Respiratory Syndrome, or SARS -- another global coronavirus outbreak in 2002 -- showed the impact of xenophobic sentiment often lasted much longer than the public health scare.

"While there may be a cessation of direct forms of racism as news about the disease dies down, it takes quite a bit of time for economic recovery and people continue to feel unsafe," she said.

People may not rush back to Chinese businesses or restaurants, and may even heed some of the more outlandish viral social media disinformation -- such as one popular post imploring people to avoid eating noodles for their own safety.

"In one sense you might think the effects lasted from the last coronavirus to this one because the representation as China being a place where diseases come from has been persistent," Hooker said.