For killing Indian techie Srinivas Kuchibhotla, US man faces death or life in prison

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."

Dubai, May 5: Tickets on repatriation flights from UAE to India, which start on May 7, could be costlier than regular airfare, and adding to the financial woes of those flying back. Nearly 200,000 Indians in the UAE have registered on the website seeking to return home.

“A one-way repatriation ticket to Delhi will cost approximately Dh1,400-Dh1,650 - this would earlier have cost between Dh600-Dh700 [during these months],” said Jamal Abdulnazar, CEO of Cozmo Travel. “A one-way repatriation flight ticket to Kerala would cost approximately Dh1,900-Dh2,300.”

This can be quite a burden, as a majority of those taking these flights have either lost their jobs or are sending back their families because of uncertainty on the work front. To now have to pay airfare that is nearly on par with those during peak summer months is quite a blow.

Sources said that officials in Indian diplomatic missions have already initiated calls to some expats, telling them about likely ticket fares and enquiring about their willingness to travel.

Although many believed repatriation would be government-sponsored, Indian authorities have clarified that customers would have to pay for the tickets themselves. Those who thought they were entitled to free repatriation might back out of travel plans for now.

Fact of life

But aviation and travel industry sources say higher rates cannot be escaped since social distancing norms have to be strictly enforced at all times. That would limit the number of passengers on each of these flights.

“One airline can carry only limited passengers - therefore, multiple airlines are likely to get the approval to operate repatriation flights,” said Abdulnazar. “Also, airports will have to maintain safe distance for passengers to queue up at immigration and security counters.

“Therefore, it is recommended that multiple carriers fly into multiple Indian airports for repatriation to be expedited.”

The Indian authorities, so far, have not taken the easy decision to get its private domestic airlines into the rescue act. Gulf News tried speaking to the leading players, but they declined to provide any official statements. So far, only Air India, the national airline, has been commissioned to operate the flights.

Air India finds itself in the driver's seat when it comes to operating India's repatriation flights. To date, there is no confirmation India's private airlines will be allowed to join in.

UAE carriers ready to help out

UAE’s Emirates airline, Etihad, flydubai and Air Arabia are likely to also operate repatriation flights to India after Air India implements the first phase of services.

“We are fully supporting governments and authorities across the flydubai network with their repatriation efforts, helping them to make arrangements for their citizens to return home,” said a flydubai spokesperson.

“We will announce repatriation flights as and when they are confirmed, recognising this is an evolving situation whilst the flight restrictions remain in place.”

An AirArabia spokesperson said the airline is ready to operate repatriation flights when the government tells them to.

Travel agencies likely to benefit

Apart from operating non-scheduled commercial flights, the Indian government is also deploying naval ships to bring expat Indians back. Sources claim the ships are to ferry passengers who cannot afford the repatriation airfares.

Even then, considering the sheer numbers who will want to get on the flights, travel agencies are likely to see a surge in bookings since airline websites alone may not cope with the demand set off in such a short span.

Learn from Gulf governments

In instances when they carried out their own repatriation flights, some GCC governments paid the ticket fares to fly in their citizens. Those citizens who did not have the ready funds could approach their diplomatic mission and aid would be given on a case-to-case basis.

Should Indians wait for normal services to resume?

Industry sources say that those Indians wanting to fly back and cannot afford the repatriation flights should wait for full services to resume once the COVID-19 pandemic settles.

But can those who lost their jobs or seen steep salary cuts stay on without adding to their costs? And is there any guarantee that when flight services resume, ticket rates would be lower than on the repatriation trips.

As such, normal travel is expected to pick up only after the repatriation exercise to several countries is completed. UAE-based travel agencies are not seeing any bookings for summer, which is traditionally the peak holiday season.

“Majority want to stay put unless full confidence is restored,” said Abdulnazar. “I expect full normalcy to be restored not until March 2021.

“People have also taken a hit to their income. Without disposable income, you will curtail your travel.”

What constitutes normalcy?

Airfares are expected to remain high, given the need to keep the middle seats empty to practise safe distance onboard.

“We expect holiday travel to resume by October or November - but, the travel sentiment will not go back to pre-COVID-19 levels anytime soon,” said Manvendra Roy, Vice-President – Commercial at holidayme, an online travel agency. “The need to keep the middle seat vacant will add 30-40 per cent pricing pressure per seat from an airline perspective.

“This will make holidays more expensive.”

As for business travel, it will take some time to recover. Corporate staff are now used to getting work done via conference calls. “Companies will also curtail their travel expenditure since their income has taken a hit,” said Abdulnazar.

Tehran, Mar 10: Twenty-seven people have died from methanol poisoning in Iran after rumours that drinking alcohol can help cure the novel coronavirus infection, state news agency IRNA reported on Monday. The outbreak of the virus in Islamic republic is one of the deadliest outside of China, where the disease originated.

Twenty have died in the southwestern province of Khuzestan and seven in the northern region of Alborz after consuming bootleg alcohol, IRNA said.

Drinking alcohol is banned in Iran for everyone except some non-Muslim religious minorities. Local media regularly report on lethal cases of poisoning caused by bootleg liquor.

A spokesman for Jundishapur medical university in Ahvaz, the capital of Khuzestan, said 218 people had been hospitalised there after being poisoned.

The poisonings were caused by "rumours that drinking alcohol can be effective in treating coronavirus," Ali Ehsanpour said.

The deputy prosecutor of Alborz, Mohammad Aghayari, told IRNA the dead had drunk methanol after being "misled by content online, thinking they were fighting coronavirus and curing it." If ingested in large quantities, methanol can cause blindness, liver damage and death.

Iran has been scrambling to contain the spread of the COVID-19 illness which has hit all of the country's 31 provinces, killing 237 people and infecting 7,161.

According to IRNA, 16 out of 69 confirmed cases have died of coronavirus infection in Khuzestan as of Sunday.