Musharraf escapes assassination attempt

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."

Canberra, May 21: Australian Prime Minister Scott Morrison and his Indian counterpart, Narendra Modi, are looking forward to deepening the countries' strategic relationship, with both sides expected to sign a range of pacts from defence to trade in strategic sectors amid heightened tensions with China over Beijing's response to coronavirus pandemic.

During a virtual summit, scheduled to take place on June 4, both leaders are expected to ramp up efforts to diversify Australia's export markets and find trusted suppliers of vital products and components, a local newspaper, The Australian reported on Tuesday.

The new agreements will focus on reliable supply chains in key strategic sectors, including medical goods, technology and critical minerals, amid heightened tensions with China over Beijing's response to coronavirus pandemic.

The leaders will seal a new defence agreement allowing reciprocal access to bases and co-operation on military technology projects, while a new education partnership will be on the table to help overcome Australian university reliance on Chinese students.

The talks in terms of strategic convergence, now have greater significance as COVID-19 exacerbates the strategic contest between the US and China, and forces like-minded countries to seek out reliable partners.

Australian farmers could also benefit, with talks underway on expanding agricultural exports to India, including barley, as China throws up new trade barriers, media reports stated.

The virtual summit follows the cancellation of Morrison's planned state visit to India in January due to the bushfires.

Morrison said last year, ahead of his planned visit, that India was "a natural partner for Australia", referring to the countries' "shared values" -- a point of differentiation with China.

Former Department of Foreign Affairs and Trade secretary Peter Varghese, who wrote a landmark report on the bilateral relationship in 2018, was quoted by the newspaper as saying that India would be even more important to Australia in the post-COVID world. "If one of the lessons from COVID is that countries need to spread their risk, then finding new markets or building up existing markets is a crucial part of that," he added.

Varghese noted that India, a member of the Quadrilateral Security Dialogue along with Australia, Japan and the US, was a vital strategic partner to Australia in helping "constrain China's ambitions to be the predominant power".

"That shared objective between Australia and India of not wanting to see the region dominated by China is a key component of building up our geopolitical relationship," he told The Australian.

The summit also follows recent talks between Australian Foreign Minister Marise Payne and Indian counterpart Subrahmanyam Jaishankar on the pandemic response and Australia's call for an independent inquiry, which was overwhelmingly backed at the World Health Assembly on Tuesday.

Australia wants to support India to develop a domestic critical minerals processing industry, which would provide Western nations with an alternative to sourcing the materials from China.

Meanwhile, India has strong expertise as a manufacturer of drugs and medical equipment, while Australia is a centre of biomedical research, opening the possibility for closer co-operation in the key sector, the media reported further.

Melbourne, July 1: Authorities will lock down around 300,000 people in suburbs north of Melbourne for a month from late on Wednesday to contain the risk of infection after two weeks of double-digit rises in new coronavirus cases in Australia's second-most populous state.

Australia has fared better than many countries in the pandemic, with around 7,830 cases and 104 deaths, but the recent surge has stoked fears of a second wave of COVID-19, echoing concerns expressed in other countries.

Globally, coronavirus cases exceeded 10 million on Sunday, a major milestone in the spread of a disease that has killed more than half a million people in seven months.

From midnight, more than 30 suburbs in Australia's second-biggest city will return to stage three restrictions, the third-strictest level in curbs to control the pandemic. That means residents will be confined to home except for grocery shopping, health appointments, work or caregiving, and exercise.

The restrictions will be accompanied by a testing blitz that authorities hope will extend to half the population of the area affected, and for which borders will be patrolled, authorities said. The measures come as curbs ease across the rest of the state of Victoria, with restaurants, gyms and cinemas reopening in recent weeks.

Victoria recorded 73 fresh cases on Tuesday from 20,682 tests, following an increase of 75 cases on Monday. State premier Daniel Andrews warned on Wednesday that the return of broader restrictions across city remained a possibility.

"If we all stick together these next four weeks, we can regain control of that community transmission ... across metropolitan Melbourne," Andrews said at a briefing. "Ultimately if I didn't shut down those postcodes I'd be shutting down all postcodes. We want to avoid that."

Victoria's spike in cases has been linked to staff members at hotels housing returned travellers for which quarantine protocols were not strictly followed. Victorian state authorities have announced an investigation into the matter.

Some other Australian states and territories are preparing to open borders, but applying limits and quarantine measures to citizens of Victoria as the school holiday season gets under way.

South Australia, the country's fifth most populous state, has had just three new cases in the past month. But citing the spike in coronavirus infections, on Tuesday it cancelled its scheduled reopening to other parts of the nation.

New South Wales (NSW), Australia's most populous state, has stopped short of closing its borders to all Victorians, but those holidaying from hotspot areas - not permitted under NSW rules - can be handed a fine of A$11,000 ($7,596) or jailed if they are detected, state authorities said.

The delays reopening internal borders cast doubts over a federal plan to set up "travel bubble" with neighbouring New Zealand that would allow movement between the two countries.