MH 17 aircraft downing: Netherlands, Australia hold Russia responsible, says Dutch cabinet

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."

Jan 28: China said on Tuesday that 106 people had died from a new coronavirus that is spreading across the country, up from the previous toll of 81.

The number of total confirmed cases in China rose to 4,515 as of Jan. 27, the National Health Commission said in a statement, up from 2,835 reported a day earlier.

The United States warned against travel to China on Monday and Canada issued a more narrow travel warning as the death toll from the spreading coronavirus passed 100, with tens of millions stranded during the biggest holiday of the year and global markets rattled.

Global stocks fell, oil prices hit three-month lows, and China's yuan dipped to its weakest level in 2020 as investors fretted about damage to the world's second-biggest economy from travel bans and the Lunar New Year holiday, which China extended in a bid to keep people at home.

The health commission of China's Hubei province said on Tuesday that 100 people had died from the virus as of Jan. 27, according to an online statement, up from the previous toll of 76, with the number of confirmed cases in the province rose to 2,714.

Other fatalities have been reported elsewhere in China, including the first in Beijing, bringing the deal toll to 106 so far, according to the People's Daily. The state newspaper put the total number of confirmed cases in China at 4,193, though some experts suspect a much higher number.

On Monday, US President Donald Trump offered China whatever help it needed, while the State Department said Americans should "reconsider" visiting all of China due to the virus.

Canada, which has two confirmed cases of the virus and is investigating 19 more potential cases, warned its citizens to avoid travel to China's Hubei province, at the heart of the outbreak.

Authorities in Hubei province are taking increasing flak from the public over their initial response to the virus. Chinese Premier Li Keqiang visited the city of Wuhan, epicentre of the outbreak, to encourage medical workers and promise reinforcements.

Visiting Wuhan in blue protective suit and mask, Li praised medics, said 2,500 more workers would join them in the next two days, and visited the site of a new hospital to be built in days.

The most senior leader to visit Wuhan since the outbreak, Li was shown on state TV leading medical workers in chants of "Wuhan jiayou!" - an exhortation to keep their strength up.

China's ambassador to the United Nations, following a meeting with UN Secretary-General António Guterres on Monday, said "the Chinese government attaches paramount importance to prevention and control of the epidemic, and President Xi Jinping has given important instructions. ...

"China has been working with the international community in the spirit of openness, transparency and scientific coordination," he said.

Guterres said in a statement, "The UN appreciates China's effort, has full confidence in China's ability of controlling the outbreak, and stands ready to provide any support and assistance."

MOUNTING ANGER

On China's heavily censored social media, officials have faced mounting anger over the virus, which is thought to have originated from a market where wildlife was sold illegally.

Some criticised the governor of Hubei province, of which Wuhan is the capital, after he corrected himself twice during a news conference over the number of face masks being produced.

"If he can mess up the data multiple times, no wonder the disease has spread so severely," said one user of the Weibo social media platform.

In rare public self-criticism, Wuhan Mayor Zhou Xianwang said the city's management of the crisis was "not good enough" and indicated he was willing to resign.

The central Chinese city of 11 million people is in virtual lockdown and much of Hubei, home to nearly 60 million people, is under travel curbs.

Elsewhere in China, people from the region faced questioning about their movements. "Hubei people are getting discriminated against," a Wuhan resident complained on Weibo.

Cases linked to people who travelled from Wuhan have been confirmed in a dozen countries, from Japan to the United States, where authorities said they had 110 people under investigation in 26 states. Sri Lanka was the latest to confirm a case.

INVESTORS WORRIED

Investors are worried about the impact. The consensus is that in the short term, economic output will be hit as authorities limit travel and extend the week-long New Year holiday — when millions traditionally travel by rail, road and plane - by three days to limit spread of the virus.

Asian and European shares tumbled, with Japan's Nikkei average sliding 2%, its biggest one-day fall in five months. Demand spiked for safe-haven assets such as the Japanese yen and Treasury notes. European stocks fell more than 2%.

The US S&P 500 closed down nearly 1.6%.

"China is the biggest driver of global growth so this couldn't have started in a worse place," said Alec Young, FTSE Russell's managing director of global markets research.

During the 2002-2003 outbreak of Severe Acute Respiratory Syndrome (SARS), which originated in China and killed nearly 800 people globally, air passenger demand in Asia plunged 45%. The travel industry is more reliant on Chinese travellers now.

Chinese-ruled Hong Kong, which has had eight cases, banned entry to people who had visited Hubei recently.

Some European tour operators cancelled trips to China, while governments around the world worked on repatriating nationals.

Officially known as 2019-nCoV, the newly identified coronavirus can cause pneumonia, but it is still too early to know just how dangerous it is and how easily it spreads.

"What we know about this virus it that transmission occurs through human contact but we are speaking of close contact, i.e. less than a meter," said Jerome Salomon, a senior official with France's health ministry.

"Crossing someone (infected) in the street poses no threat," he said. "The risk is low when you spend a little time near that person and becomes higher when you spend a lot of time near that person."

From loudspeakers on the roof of a Minnesota mosque, the Islamic call to prayer echoed for the first time ever throughout a Minneapolis neighbourhood late on Thursday as the Muslim community there prepared to begin the holy month of Ramadan.

It echoed again on Friday morning and will continue five times a day during the holy month. 

The simple, short call - known as the adhan - marked an historical moment for Minneapolis and major cities across the United States, community members said. While the adhan is commonly broadcast throughout the Middle East, North Africa and other places, for many Muslims in the US, it is only heard inside mosques or community centres.

"There's definitely a lot of excitement," said Imam Abdisalam Adam, who is on the board of the Dar al-Hijrah mosque, from where the adhan will be broadcast.
"Some people see it as historic," Adam told Al Jazeera. "To the point ... that they're not doing it, able to see it in their lifetime." 

Recited by different representatives from mosques around the city, the call to prayer is expected to reach thousands in the Cedar-Riverside neighbourhood in Minneapolis, according to Jaylani Hussein, the executive director of Minnesota's Council on American-Islamic Relations (CAIR).

While Hussein says the community had discussed broadcasting the call for years, it became even more pressing this year when the coronavirus pandemic forced mosques to shut their doors and residents to stay inside. The coronavirus has infected more than 870,000 people nationwide and killed at least 50,000.
"We wanted to touch those individuals who frequent this mosque and this community," Hussein said. "If we cannot be physically together, at least this echo, this voice, this call to prayer can be an extension of us being together at this difficult time. To give some people some solace."
Ramadan - Minnesota.

The Dar al-Hijrah mosque in the Cedar-Riverside neighbourhood of Minneapolis, Minnesota [Courtesy of Abdisalem Adam] 
Ramadan is traditionally a time when Muslims worldwide regularly attend mosques for daily prayers and break their fasts together. But this year, most have been told to pray at home and forgo community iftars in favour of staying safe from the COVID-19 crisis.

Adam, the imam, said while the Muslim community is experience loss this Ramadan, they hope the call to prayer broadcast will create a "semblance of normalcy".

"With the loss of Friday prayers and the regular congregational prayers, we are hoping that this will give a sense of solace and connection to the spiritual needs of community members," he added. 

An avenue to greater investment?

The Cedar-Riverside neighbourhood is a densely populated area of Minneapolis that has historically been an entry point for many immigrants and today is home to large Somali and Oromo communities.

Ramla Bile, a Somali American who lives in a neighbourhood adjacent to Cedar-Riverside, has been active in the community for years. She welcomed the broadcast of the call to prayer, saying it will help people "feel the spirit of Ramadan in a way that is meaningful".

But she also hopes the city of Minneapolis, which provided the noise permit for the broadcast, will make bigger strides to invest in the community in even more tangible ways.

"There's been a lot of need and a lot hurt in the community in light of the COVID-19 pandemic. And then there's the ongoing conversation you've been having," she said, pointing to deep-seated Islamophobia, systemic racism and the need for infrastructure projects like sprinkler systems in high-rise buildings. 

"We need to see greater investments to support the most vulnerable members of our community," Bile said referring to the neighbourhood's elders, undocumented individuals, low-income families and others.

"Right now, we're waiting for a bailout for our micro-businesses who comprise our Somali malls, or a rent freeze for neighbourhood residents," she added.

For CAIR's Hussein and Imam Adam, they hope this Ramadan's call to prayer helps encourage other communities around the US to take similar steps.

"This will hopefully inspire others … to think about what could happen in future Ramadans and beyond," Hussein said.

Adam added that while the virus has devastated communities and upended daily life, it has also shown that "we're in this together".

"It just shows the significance of the global village and how interconnected and interdependent we are as a world community," he said. "I think that there will be a lot of change in our way of life for the better. I hope so."