'Coronavirus now behaving differently in China's northeast clusters'

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."

London, Apr 22: The UK government on Tuesday announced a 20 million pounds funding for a University of Oxford project working on developing a vaccine against the novel coronavirus, which is now ready for acceleration as it begins human trials from Thursday.

UK Health Secretary Matt Hancock told the daily Downing Street briefing that the Department for Health was “throwing everything” at trying to find a vaccine because it is a critical aspect of the COVID-19 pandemic fight and lifting the strict lockdown measures in place to curb its spread.

Another 22.5 million pounds is being made available to Imperial College London to support its phase-two clinical trials for them to begin the work on a very large phase three trial.

"Normally it would take years to get to this point," said Hancock.

"The UK is at the forefront of the global effort – we've put in more money than any other into the global search for a vaccine. Nothing about this is inevitable. Vaccine production is a matter of trial and error. But the UK will throw everything it has at trying to find one,” he said.

The announcement came as Britain had another major daily leap in the hospital death toll from coronavirus, up by 823 to hit 17,337 on Tuesday.

But the Cabinet minister said the government's plan to control the rapid spread of the virus and prevent the state-funded National Health Service (NHS) from being overwhelmed is working as the number of hospitalisations with COVID-19 was showing a downward trajectory.

In reference to a major issue in the last few weeks of a critical shortage of personal protective equipment (PPE) for doctors and nurses on the frontlines of COVID-19 treatment, the minister said the supply problems are being addressed by actively engaging with thousands of companies, including 159 UK manufacturers.

“We are determined to get people the PPE they need. This is a 24/7 operation, one of the biggest cross-government operation I have ever seen," said Hancock.

Istanbul, Jul 11: Turkish President Recep Tayyip Erdogan announced Friday that the Hagia Sophia, one of the architectural wonders of the world, would be reopened for Muslim worship, sparking fury in the Christian community and neighbouring Greece.

His declaration came after a top Turkish court revoked the sixth-century Byzantine monument's status as a museum, clearing the way for it to be turned back into a mosque.

The UNESCO World Heritage site in historic Istanbul, a magnet for tourists worldwide, was first constructed as a cathedral in the Christian Byzantine Empire but was converted into a mosque after the Ottoman conquest of Constantinople in 1453.

The Council of State, Turkey's highest administrative court, unanimously cancelled a 1934 cabinet decision to turn it into a museum and said Hagia Sophia was registered as a mosque in its property deeds.

The landmark ruling could inflame tensions not just with the West and Turkey's historic foe Greece but also Russia, with which Erdogan has forged an increasingly close partnership in recent years.

'Millions of Christians not heard'

Greece swiftly branded the move by Muslim-majority Turkey an "open provocation to the civilised world".

"The nationalism displayed by Erdogan... takes his country back six centuries," Culture Minister Lina Mendoni said in a statement.

The Russian Orthodox Church was equally scathing.

"The concern of millions of Christians were not heard," Church spokesman Vladimir Legoida told Interfax news agency.

The decision "shows that all pleas regarding the need to handle the situation extremely delicately were ignored," he said.

UNESCO chief Audrey Azoulay said she "deeply regrets" the decision made without prior dialogue with the UN's cultural agency.

The move was also condemned by the US Commission on International Religious Freedom, which said it was an "unequivocal politicisation" of the monument.

Hagia Sophia, which stands opposite the impressive Sultanahmet Mosque -- often called the Blue Mosque, has been a museum since 1935 and open to believers of all faiths.

Transforming it from a mosque was a key reform under the new republic born out of the ashes of the Ottoman Empire.

Sharing a presidential decree which named Hagia Sophia as a "mosque", Erdogan announced its administration would be handed over to Turkey's religious affairs directorate known as Diyanet.

"May we be blessed," he commented. The decree was published on the official gazette.

Erdogan has in recent years placed great emphasis on the battles which resulted in the defeat of Byzantium by the Ottomans, with lavish celebrations held every year to mark the conquest.

Muslim clerics have occasionally recited prayers in the museum on key anniversaries or religious holidays.

"The decision is intended to score points with Erdogan's pious and nationalist constituents," said Anthony Skinner of the risk assessment firm Verisk Maplecroft.

"Hagia Sophia is arguably the most conspicuous symbol of Turkey's Ottoman past -- one which Erdogan is leveraging to strengthen his base while snubbing domestic and foreign rivals," he told AFP.

'Chains broken'

A few hundred Turks carrying Turkish flags gathered outside Hagia Sophia shouting "Chains broken, Hagia Sophia reopened".

Police heightened security measures around the building, according to AFP journalists.

"It's been a dream since we were kids," said Erdal Gencler, an Istanbul resident.

"(Hagia Sophia) finds its true purpose again. We are very excited, proud, and hopeful that there will be beautiful services here," he added.

Fatma, a woman with tearful eyes, said: "Of course I am crying. (Hagia Sophia) belongs to us."

Ahead of the court decision, Justice Minister Abdulhamit Gul shared a picture of Hagia Sophia on his official Twitter account, with a message: "Have a good Friday."

Finance Minister Berat Albayrak, Erdogan's son-in-law, tweeted that Hagia Sophia would be reopened to Muslim worship "sooner or later", referring to a quote from Turkish poet Necip Fazil Kisakurek.

The Council of State had on July 2 debated the case brought by a Turkish group -- the Association for the Protection of Historic Monuments and the Environment, which demanded Hagia Sophia be reopened for Muslim prayers.

Since 2005, there have been several attempts to change the building's status. In 2018, the Constitutional Court rejected one application.

Despite occasional protests outside the site by Islamic groups, Turkish authorities had until now kept the building as a museum.