Indian peacekeepers prevented more casualties in S Sudan: UN official

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."

The US Commission on International Religious Freedom (USCIRF) has reprimanded the Imran Khan government for denying food aid to Hindus and Christians in Pakistan amid the coronavirus pandemic and warned that it will trigger an additional crisis due to religious discrimination.

The USCIRF is an independent federal government entity set up by the US Congress to monitor and report on religious freedom in the world.

Pakistan continues to be in the tier one of the USCIRF list of the countries whose record on religious freedom remains abysmal.

In a statement issue on Monday, the USCIRF said it was troubled by the reports of food aid being denied to Hindus and Christians in Pakistan amid pandemic.

Citing one of the examples of religious discrimination, the USCIRF said that in Karachi, the Saylani Welfare International Trust, a non-government organization set up to help the homeless and seasonal workers, has been refusing food aid to Hindus and Christians and providing it only Muslims.

Describing such actions "reprehensible", the USCIRF commissioner Anurima Bhargava said: "As COVID-19 continues to spread, vulnerable communities within Pakistan are fighting hunger and to keep their families safe and healthy. Food aid must not be denied because of one's faith."
One of the USCIRF commissioners, Johnnie Moore warned that if the Khan government continued with such policies, Pakistan would add an additional crisis.

"In a recent address by Prime Minister Khan to the international community, he highlighted that the challenge facing governments in the developing world is to save people from dying of hunger while also trying to halt the spread of COVID-19. This is a monumental task laying before many countries.

"Prime Minister Khan's government has the opportunity to lead the way but they must not leave religious minorities behind. Otherwise, they may add on top of it all one more crisis, created by religious discrimination and inter-communal strife."

The organization which makes foreign policy recommendations to the US President, the Secretary of State, and Congress, urged the Pakistani government to ensure that food aid from distributing organizations is shared equally with Hindus, Christians, and other religions minorities.

Last year, in its annual report, the USCIRF had noted that Hindus and Christians in Pakistan "face continued threats to their security and are subjected to various forms of harassment and social exclusion".

Washington, May 6: The Chinese Army is indulging in aggressive behaviour in the South China Sea and the Chinese Communist Party has ramped up its disinformation campaign to try to shift the blame on coronavirus and burnish its image, US Defense Secretary Mark Esper said on Tuesday.

"While the Chinese Communist Party ramps up its disinformation campaign to try to shift blame and burnish its image, we continue to see aggressive behaviour by the PLA in the South China Sea, from threatening a Philippine Navy ship to sinking a Vietnamese fishing boat and intimidating other nations from engaging in offshore oil and gas development," Esper told reporters at a Pentagon news conference.

Last week, two US Navy ships conducted freedom of navigation operations in the South China Sea to send a clear message to Beijing that America will continue to protect the freedom of navigation and commerce for all nations large and small, he said.

Many countries, Esper said, have turned inward to recover from the pandemic and in the meantime, America's strategic competitors are attempting to exploit this crisis to their benefit at the expense of others.

Responding to a question, he said the Chinese have not been transparent from the beginning on the coronavirus pandemic.

"If they had been more transparent, more open, upfront in terms of giving us access, the reporting, giving us access not to the people on the ground but to the virus they had so we could understand it, we would probably be in a far different place right now. But where we are now is this," Esper said.

China needs to allow the United States in to talk to early patients, Chinese researchers and scientists, and to have access, he added.

Instead, Esper alleged that the Chinese are trying to capitalise on this by promoting their own image that somehow, China is the good guy here.

"Despite everything they did or, more importantly, failed to do, now they want to go out and say well, here's masks. We will give you masks, provide this, or provide that, we will provide you funding. Look at all the good things we are doing," he said.

"Yet, what we know is that they provide masks, they provide supplies. In many cases, it is not good. It does not do what it is supposed to do. It is broken equipment. Also, the strings attached are enormous in many cases. So, they are telling a country you can take these masks, but please, put out publicly how good China is, how great we are doing, et cetera, et cetera," Esper said.

"So there is a number of things they are doing to try and burnish their image. That is just two of them right there," he said.

The Chinese are also doing a lot of strong-arming behind the scenes, Esper said and referred to the war of words between China and Australia. He said he plans to talk to his Australian counterpart later in the day.

"All these activities are going on. It is straight from the Chinese playbook. Once again, it is just a little bit more obvious this time with what they are doing and how they are using a combination of compelling and coercion and everything else to try and shape the narrative and burnish the image of the Chinese Communist Party," Esper said.