IMF calls for 'urgent' action by India amid slowdown

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, Mar 4: The UK government has reiterated its concern over the potential impact of the Citizenship Amendment Act (CAA) and said it is continuing to follow the events in India closely.

In response to an urgent question on “Recent Violence in India” tabled by Pakistani-origin Opposition Labour Party MP Khalid Mahmood in the House of Commons on Tuesday, UK’s Minister of State in the Foreign and Commonwealth Office (FCO) Nigel Adams said the UK engages with India at all levels, including on human rights, and also referred to the country's "proud history" of inclusive government and religious tolerance.

"The UK government also have concerns about the potential impact of the legislation (CAA),” said Adams, the Minister for Asia who was standing in for UK Foreign Secretary Dominic Raab, who is on a visit to Turkey.

"It is because of our close relationship with the government of India that we are able to discuss difficult issues with them and make clear our concerns where we have them, including on the rights of minorities. We will continue to follow events closely and to raise our concerns when we have with them,” said the minister.

While Mahmood, who had tabled the urgent question for an FCO statement, described the government response as “facile”, another Pakistani-origin MP Nusrat Ghani called on the government to relay the UK Parliament's concerns to the Indian authorities.

British Sikh Labour MP Tanmanjeet Singh Dhesi said the violence had brought back “painful personal memories” from the 1984 Sikh riots while he was studying in India and fellow Sikh MP Preet Kaur Gill also referenced 1984 in her intervention.

Other MPs sought to highlight the steps taken by the Indian authorities to restore “peace and tranquillity” in Delhi.

“He will be aware that it is not just Muslims who have been killed; Hindus have also been killed as part of the riots,” said Conservative Party MP Bob Blackman.

Scottish National Party (SNP) MP Alyn Smith sought the UK government’s intervention to share best practice around countering the online disinformation campaign being used in India to “inflame tensions”.

“We are in constant contact on these issues, and we know how important this is to Members of Parliament and their constituents, who may have family in the area,” said Adams, in his response.

Jan 13: For the first time in years, the government of India’s Prime Minister Narendra Modi is playing defense. Protests have sprung up across the country against an amendment to India’s laws — which came into effect on Friday — that makes it easier for members of some religions to become citizens of India. The government claims this is simply an attempt to protect religious minorities in the Muslim-majority countries that border India; but protesters see it as the first step toward a formal repudiation of India’s constitutionally guaranteed secularism — and one that must be resisted.

Modi was re-elected prime minister last year with an enhanced majority; his hold over the country’s politics is absolute. The formal opposition is weak, discredited and disorganized. Yet, somehow, the anti-Citizenship Act protests have taken hold. No political party is behind them; they are generally arranged by student unions, neighborhood associations and the like.

Yet this aspect of their character is precisely what will worry Modi and his right-hand man, Home Minister Amit Shah. They know how to mock and delegitimize opposition parties with ruthless efficiency. Yet creating a narrative that paints large, flag-waving crowds as traitors is not quite that easy.

For that is how these protests look: large groups of young people, many carrying witty signs and the national flag. They meet and read the preamble to India’s Constitution, into which the promise of secularism was written in the 1970’s.

They carry photographs of the Constitution’s drafter, the Columbia University-trained economist and lawyer B. R. Ambedkar. These are not the mobs the government wanted. They hoped for angry Muslims rampaging through the streets of India’s cities, whom they could point to and say: “See? We must protect you from them.” But, in spite of sometimes brutal repression, the protests have largely been nonviolent.

One, in Shaheen Bagh in a Muslim-dominated sector of New Delhi, began simply as a set of local women in a square, armed with hot tea and blankets against the chill Delhi winter. It has now become the focal point of a very different sort of resistance than what the government expected. Nothing could cure the delusions of India’s Hindu middle class, trained to see India’s Muslims as dangerous threats, as effectively as a group of otherwise clearly apolitical women sipping sweet tea and sharing their fears and food with anyone who will listen.

Modi was re-elected less than a year ago; what could have changed in India since then? Not much, I suspect, in most places that voted for him and his party — particularly the vast rural hinterland of northern India. But urban India was also possibly never quite as content as electoral results suggested. India’s growth dipped below 5% in recent quarters; demand has crashed, and uncertainty about the future is widespread. Worse, the government’s response to the protests was clearly ill-judged. University campuses were attacked, in one case by the police and later by masked men almost certainly connected to the ruling party.

Protesters were harassed and detained with little cause. The courts seemed uninterested. And, slowly, anger began to grow on social media — not just on Twitter, but also on Instagram, previously the preserve of pretty bowls of salad. Instagram is the one social medium over which Modi’s party does not have a stranglehold; and it is where these protests, with their photogenic signs and flags, have found a natural home. As a result, people across urban India who would never previously have gone to a demonstration or a political rally have been slowly politicized.

India is, in fact, becoming more like a normal democracy. “Normal,” that is, for the 2020’s. Liberal democracies across the world are politically divided, often between more liberal urban centers and coasts, and angrier, “left-behind” hinterlands. Modi’s political secret was that he was that rare populist who could unite both the hopeful cities and the resentful countryside. Yet this once magic formula seems to have become ineffective. Five of India’s six largest cities are not ruled by Modi’s Bharatiya Janata Party in any case — the financial hub of Mumbai changed hands recently. The BJP has set its sights on winning state elections in Delhi in a few weeks. Which way the capital’s voters will go is uncertain. But that itself is revealing — last year, Modi swept all seven parliamentary seats in Delhi.

In the end, the Citizenship Amendment Act is now law, the BJP might manage to win Delhi, and the protests might die down as the days get unmanageably hot and state repression increases. But urban India has put Modi on notice. His days of being India’s unifier are over: From now on, like all the other populists, he will have to keep one eye on the streets of his country’s cities.