Modi refrains from raising border issue with Chinese president

Up to 2,241 new cases of COVID-19 have been reported across the globe as of Thursday, bringing the total count to 95,333, according to the latest official data by the World Health Organization (WHO).

Five countries, territories and areas reported COVID-19 cases for the first time in the past 24 hours, the Xinhua news agency reported.

WHO Director-General Tedros Adhanom Ghebreyesus emphasised the importance of implementing a comprehensive approach to mitigate the impact of the virus in a briefing on Wednesday.

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, May 4: Anxious for an economic recovery, President Donald Trump fielded Americans' questions about decisions by some states to allow nonessential businesses to reopen while other states are on virtual lockdown due to the coronavirus.

After more than a month of being cooped up at the White House, Trump returned from a weekend at the Camp David presidential retreat in Maryland and participated in a “virtual” town hall, hosted Sunday night by Fox News Channel, from inside the Lincoln Memorial.

He pushed for an economic reopening, one his advisers believe will be essential for his reelection chances this November.

“We have to get it back open safely but as quickly as possible," Trump said.

The president acknowledged fear on both sides of the issue, some Americans worried about getting sick while others are concerned about losing jobs.

Though the administration's handling of the pandemic, particularly its ability to conduct widespread testing, has come under fierce scrutiny, the president defended the response and said the nation was ready to begin reopening.

“I'll tell you one thing. We did the right thing and I really believe we saved a million and a half lives,” the president said.

But he also broke with the assessment of his senior adviser and son-in-law, Jared Kushner, saying it was “too soon to say" if the federal government was overseeing a “success story."

Trump's impatience also flashed. While noting that states would go at their own pace in returning to normal, with ones harder hit by the coronavirus going slower, he said that “some states frankly I think aren't going fast enough" and singled out Virginia, which has a Democratic governor and legislature.

And he urged the nation's schools and universities to return to classes this fall.

But many public health experts believe that cannot be done safely until a vaccine is developed.

Trump declared Sunday that he believed one could be available by year's end although his own pandemic task force has predicated it could be another 18 months.

Federal guidelines that encouraged people to stay at home and practice social distancing expired late last week.

Debate continued over moves by governors to start reopening state economies that tanked after shopping malls, salons and other nonessential businesses were ordered closed in attempt to slow a virus that has killed more than 66,000 Americans, according to a tally of reported deaths by Johns Hopkins University.

The U.S. economy has suffered, shrinking at a 4.8 per cent annual rate from January through March, the government estimated last week. It was the sharpest quarterly drop since the 2008 financial crisis.

Roughly 30.3 million people have filed for unemployment aid in the six weeks since the outbreak forced employers to shut down and slash their workforces. It was the worst string of layoffs on record.

Larry Kudlow, Trump's top economic adviser, on Sunday predicted a “spectacular 2021” — with “the right set of policies” — on top of a rebound from July through December of this year.

He said on CNN's "State of the Union" that the administration would "pause” to review the effectiveness of trillions in economic relief spending before making any decision on whether additional aid is needed.

House Speaker Nancy Pelosi, D-Calif., said Thursday that state and local governments are seeking up to USD 1 trillion for coronavirus costs, The Senate planned to reopen Monday, despite the Washington area's continued status as a virus hot spot and with the region still under stay-at-home orders.

The House remains shuttered. The pandemic is forcing big changes at the tradition-bound Supreme Court: The justices will hear arguments, beginning Monday, by telephone for the first time since Alexander Graham Bell patented his invention in 1876.

Congressional Republicans are resisting calls by Democrats for emergency spending for states and local governments whose revenue streams all but dried up in recent weeks.

The GOP is counting on the country's reopening and the rebound promised by Trump as their best hope to forestall another big round of virus aid.

The leaders of California and Michigan are among governors under public pressure over lockdowns still in effect while states such as Florida, Georgia and Ohio are reopening.

Michigan Governor Gretchen Whitmer, a Democrat, said Sunday that the armed protesters who demonstrated inside her state's Capitol “depicted some of the worst racism” and “awful parts” of US history by showing up with Confederate flags, nooses and swastikas.

Trump had tweeted “LIBERATE” and named Michigan and other states in mid-April. In a new tweet Friday, he urged Whitmer to “make a deal” with the protesters. “These are very good people, but they are angry.

They want their lives back again, safely!” Trump said.

Despite the opposition of Michigan's Republican-controlled Legislature, Whitmer has extended a state of emergency declaration and directed most businesses statewide to remain closed.

Some people participating in other public protests across the US have not kept their distance from one another and have rallied without masks, not heeding public health recommendations.

Deborah Birx, coordinator of the White House coronavirus task force, called that behavior “devastatingly worrisome.”

She said people will feel guilty for the rest of their lives if they end up infected and unwittingly spread the virus to vulnerable family members.

“We need to protect each other at the same time we're voice our discontent,” she told CNN's “State of the Union.”

An overwhelming majority of Americans support stay-at-home orders and other efforts to slow the virus' spread, according to a recent survey from The Associated Press-NORC Center for Public Affairs Research.

Asked about states that are reopening before they meet benchmarks laid out in federal guidelines she helped write, Birx said the guidelines “are a pretty firm policy of what we think is important from a public health standpoint.”

She added that she and others have made it clear that people must continue practising social distancing, “scrupulous” hand washing and other measures to protect themselves and others.

Fox News Channel said it asked viewers to submit questions about reopening the country on the network's Twitter, Facebook and Instagram accounts for a chance to appear on the rare broadcast from the Lincoln Memorial. Trump spoke from the memorial's steps last July Fourth.