Indian-origin father-daughter doctor duo die of coronavirus in United States

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."

Washington, Jun 12: US President Donald Trump is considering suspending a number of employment visas including the H-1B, most sought-after among Indian IT professionals, in view of the massive unemployment in America due to the coronavirus pandemic, according to a media report.

The proposed suspension could extend into the government’s new fiscal year beginning October 1, when many new visas are issued, The Wall Street Journal reported on Thursday, quoting unnamed administration officials.

“That could bar any new H-1B holder outside the country from coming to work until the suspension is lifted, though visa holders already in the country are unlikely to be affected,” the daily reported.

H-1B is the most coveted foreign work visas for technology professionals from India.

Such a decision by the Trump administration is likely to have an adverse impact on thousands of Indian IT professionals. Already a large number of Indians on the H-1B visas have lost their jobs and are headed back home during the coronavirus pandemic.

The White House, however, said that no final decision has been made and the administration is considering various proposals.

“The administration is currently evaluating a wide range of options, formulated by career experts, to protect American workers and job seekers especially disadvantaged and underserved citizens — but no decisions of any kind have been made,” White House spokesman Hogan Gidley said in a statement.

In addition to the H-1B visas, the suspension could apply to the H-2B visa for short-term seasonal workers, the J-1 visa for short-term workers including camp counselors and au pairs and the L-1 visa for internal company transfers, the financial daily reported.

Meanwhile, the US Chambers of Commerce CEO Thomas Donohue on Thursday wrote a letter to Trump, expressing concern over his reported move on temporary work visas.

“As the economy rebounds, American businesses will need assurances that they can meet all their workforce needs. To that end, it is crucial that they have access to talent both domestically and from around the world,” Donohue wrote in a letter to Trump.

According to The Hill newspaper, Donohue said that American businesses need L-1 visa holders, who have a work visa valid for a relatively short amount of time, for necessary expertise.

He noted the importance of H-1B visa holders, who have a work visa valid for multiple years, for various industries, including technology, accounting and manufacturers, the newspaper said.

“Policies that would, for example, impose wide-ranging bans on the entry of nonimmigrant workers or impose burdensome new regulatory requirements on businesses that employ foreign nationals would undermine that access to talent and in the process, undercut our economy’s ability to grow and create jobs,” Donohue added.

Stockholm, Jun 15: Nuclear powers continue to modernise their arsenals, researchers said Monday, warning that tensions were rising and the outlook for arms control was "bleak".

"The loss of key channels of communication between Russia and the USA... could potentially lead to a new nuclear arms race," said Shannon Kile, director of the nuclear arms control programme at the Stockholm International Peace Research Institute (SIPRI) and co-author of the report.

Russia and the US account for more than 90 percent of the world's nuclear weapons.

Kile was referring to the future of the New START treaty between the US and Russia, which is set to expire in February 2021.

It is the final nuclear deal still in force between the two superpowers, aimed at maintaining their nuclear arsenals below Cold War levels.

"Discussions to extend New START or to negotiate a new treaty made no progress in 2019," the SIPRI researchers noted.

At the same time, nuclear powers continue to modernise their weapons while China and India are increasing the size of their arsenals.

"China is in the middle of a significant modernisation of its nuclear arsenal. It is developing a so-called nuclear triad for the first time, made up of new land- and sea-based missiles and nuclear-capable aircraft," SIPRI said.

The country has repeatedly rejected Washington's insistence that it join any future nuclear arms reduction talks.

The number of nuclear warheads declined in the past year.

At the start of 2020, the United States, Russia, Britain, China, India, Pakistan, Israel and North Korea together had 13,400 nuclear arms, according to SIPRI's estimates, 465 fewer than at the start of 2019.

The decline was attributed mainly to the United States and Russia.

While the future of the New START treaty remains uncertain, Washington and Moscow have continued to respect their obligations under the accord.

"In 2019, the forces of both countries remained below the limits specified by the treaty," the report said. But both nations "have extensive and expensive programmes underway to replace and modernise their nuclear warheads, missile and aircraft delivery systems, and nuclear weapon production facilities," it added.

"Both countries have also given new or expanded roles to nuclear weapons in their military plans and doctrines, which marks a significant reversal of the post-Cold War trend towards the gradual marginalisation of nuclear weapons."

The Treaty on the Non-Proliferation of Nuclear Weapons (NPT), a cornerstone of the global nuclear non-proliferation regime, celebrates its 50th anniversary this year.

The number of nuclear arms worldwide has declined since hitting a peak of almost 70,000 in the mid-1980s.

The five original nuclear powers -- Washington, Beijing, Moscow, Paris and London -- in March reiterated their commitment to the treaty.