Indonesia chooses new capital 'to save' congested Jakarta

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."

Aboard Air Force One, Jan 6: US President Donald Trump threatened sanctions against Baghdad on Sunday after Iraq's parliament called on US troops to leave the country, and the president said if troops did leave, Baghdad would have to pay Washington for the cost of the air base there.

"We have a very extraordinarily expensive air base that's there. It cost billions of dollars to build, long before my time. We're not leaving unless they pay us back for it," Trump told reporters on Air Force One.

Trump said that if Iraq asked US forces to leave and it was not done on a friendly basis, "we will charge them sanctions like they've never seen before ever. It'll make Iranian sanctions look somewhat tame."

United Nations, Jun 19: Half of the world's children -- one billion every year -- are affected by physical, sexual or psychological violence, suffering injuries and death because countries have failed to follow established strategies to protect them, the first report of its kind from the UN has said, with experts noting that the coronavirus-related lockdowns have left far too many youngsters stuck with their abusers.

While nearly all countries (88 per cent) have laws in place to protect minors, less than half (47 per cent) say they strongly enforce them, said the Global Status Report on Preventing Violence Against Children 2020 launched on Thursday.

Because countries have failed to follow established strategies to protect children, about one billion are affected each year by physical, sexual or psychological violence, it said.

"There is never any excuse for violence against children," WHO Director-General Tedros Adhanom Ghebreyesus said.

"We have evidence-based tools to prevent it, which we urge all countries to implement. Protecting the health and well-being of children is central to protecting our collective health and well-being, now and for the future," he said.

The report -- launched by the World Health Organisation, the UNICEF, the UNESCO, the Special Representative of the UN Secretary-General on Violence against Children and the End Violence Partnership -- charted progress in 155 countries against the "INSPIRE" framework, a set of seven strategies for preventing and responding to violence against children.

The report signaled a clear need in all countries to scale up efforts to implement them. It included the first ever global homicide estimates specifically for children under 18 years of age -- previous estimates were based on data that included 18 to 19-year olds.

According to the findings, in 2017, around 40,000 children were victims of homicide.

"Violence against children has always been pervasive, and now things could be getting much worse," UNICEF Executive Director Henrietta Fore said.

"Lockdowns, school closures and movement restrictions have left far too many children stuck with their abusers, without the safe space that school would normally offer. It is urgent to scale up efforts to protect children during these times and beyond, including by designating social service workers as essential and strengthening child helplines," she said.

UNESCO Director-General Audrey Azoulay said during the COVID-19 pandemic, and the related school closures, "we have seen a rise in violence and hate online – and this includes bullying".

"Now, as schools begin to re-open, children are expressing their fears about going back to school. It is our collective responsibility to ensure that schools are safe environments for all children. We need to think and act collectively to stop violence at school and in our societies at large," Azoulay said.

Stay-at-home measures including school closures have limited the usual sources of support for families and individuals such as friends, extended family or professionals.

This further erodes victims’ ability to successfully cope with crises and the new routines of daily life. Spikes in calls to helplines for child abuse and intimate partner violence have been observed, the report said.

While online communities have become central to maintain many children's learning, support and play, an increase in harmful online behaviors including cyberbullying, risky online behavior and sexual exploitation have been identified.

“Whilst this report was being finalised, confinement measures and the disrupted provision of already limited child protection services exacerbated the vulnerability of children to various forms of violence," said Najat Maalla M’jid, Special Representative of the UN Secretary-General on Violence against Children.

Of the INSPIRE strategies, only access to schools through enrolment showed the most progress with 54 per cent of the countries reporting that a sufficient number of children in need were being reached in this way.

Between 32 per cent and 37 per cent of the countries considered that victims of violence could access support services, while 26 per cent of the countries provided programmes on parent and caregiver support; 21 per cent of the countries had programmes to change harmful norms; and 15 per cent of the countries had modifications to provide safe physical environments for children, the report said.

Although a majority of countries (83 per cent) have national data on violence against children, only 21 per cent used these to set baselines and national targets to prevent and respond to violence against children, it added.

The report said about 80 per cent of countries have national plans of action and policies but only one-fifth have plans that are fully funded or have measurable targets. A lack of funding combined with inadequate professional capacity are likely contributing factors and a reason why implementation has been slow.

"Ending violence against children is the right thing to do, a smart investment to make - and it's possible. We can and must create a world where every child can thrive," Howard Taylor of the End Violence Partnership said.