Pakistan in mourning as Peshawar buries its children

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."

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."

London, May 12: British Prime Minister Boris Johnson has warned that a mass vaccine for the novel coronavirus may be over a year away and, in the worst-case scenario, may in fact never be found.

In his foreword to the government’s new 50-page guidance on a step by step easing of the lockdown measures in place to control the spread of the deadly virus, the UK prime minister lays out plans for businesses to gradually start reopening with “COVID-19 Secure” measures of social distancing and for the public to use “good solid British common sense” as the economy is unlocked.

“A mass vaccine or treatment may be more than a year away,” said Johnson, highlighting the work being done in the UK by scientists at Oxford University and Imperial College London towards this mission.

“Indeed, in a worst-case scenario, we may never find a vaccine. So our plan must countenance a situation where we are in this, together, for the long haul, even while doing all we can to avoid that outcome,” he said.

Admitting that a vaccine or drug-based treatment is the only “feasible long-term solution”, he said the UK has accelerated this with “promising” vaccine development programmes and a collaboration between Oxford University and pharma major AstraZeneca was a vital step that could help rapidly advance the manufacture of a Covid-19 vaccine when it is ready.

As part of global efforts, he flagged the GBP 388 million in aid funding for research into vaccines, tests and treatment, including GBP 250m to the Coalition for Epidemic Preparedness Innovations.

“But while we hope for a breakthrough, hope is not a plan,” he said, as he unveiled his plan for starting to lift lockdown restrictions from this week in phases.

Following a televised address to the nation on Sunday night and a statement in Parliament on Monday, the guidance comes into effect in public life across England from Wednesday when people will be allowed one-to-one contact with people other than those they live with, as long as they remain outside and two metres apart.

They are allowed to play sport with a friend or family member from outside their household or socialise with them in the open air for the first time in more than six weeks since the lockdown was imposed.

People are still advised to work from home where possible but start heading into work where necessary, in sectors such as construction and manufacturing, keeping the social distancing norms in place.

Under the step by step plan, by the start of next month non-essential shops will also reopen, with some hairdressers, pubs and cinemas to follow from July. However, as part of a Covid-19 Alert System, if infection rates are seen to be rising again, restrictions would be tightened “possibly at short notice”.

Fines for breaching the new rules will also be increased to GBP 100 and will double for each repeat offence, up to a maximum of GBP 3,200.

Johnson said: "I must ask the country to be patient with a continued disruption to our normal way of life, but to be relentless in pursuing our mission to build the systems we need. The worst possible outcome would be a return to the virus being out of control – with the cost to human life, and – through the inevitable re-imposition of severe restrictions – the cost to the economy. We must stay alert, control the virus, and in doing so, save lives.

“Then, as vaccines and treatment become available, we will move to another new phase, where we will learn to live with Covid-19 for the longer term without it dominating our lives.”

The devolved administrations of Scotland and Wales are putting their own measures in place and keeping the “stay at home” message in place, rather than switch to the new “stay alert” message.

The UK government’s latest messaging has come under attack from the Opposition and other sections of society over a feared lack of clarity for the general public.