Sky is the limit for India-US relationship: Nikki Haley

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 30: The United States will end its relationship with the World Health Organization over the body’s handling of the coronavirus pandemic, U.S. President Donald Trump said on Friday, accusing the U.N. agency of becoming a puppet of China.

The move to quit the Geneva-based body, which the United States formally joined in 1948, comes amid growing tensions between Washington and Beijing over the coronavirus outbreak. The virus first emerged in China’s Wuhan city late last year.

Speaking in the White House Rose Garden, Trump said Chinese officials “ignored their reporting obligations” to the WHO about the virus - that has killed hundreds of thousands of people globally - and pressured the agency to “mislead the world.”

“China has total control over the World Health Organization despite only paying $40 million per year compared to what the United States has been paying which is approximately $450 million a year,” he said.

Trump’s decision follows a pledge last week by Chinese President Xi Jinping to give $2 billion to the WHO over the next two years to help combat the coronavirus. The amount almost matches the WHO’s entire annual program budget for last year.

Trump last month halted funding for the 194-member organization, then in a May 18 letter gave the WHO 30 days to commit to reforms.

“Because they have failed to make the requested and greatly needed reforms, we will be today terminating our relationship with the World Health Organization and redirecting those funds to other worldwide and deserving urgent global public health needs,” Trump said on Friday.

It was not immediately clear when his decision would come into effect. A 1948 joint resolution of Congress on U.S. membership of the WHO said the country “reserves its right to withdraw from the organization on a one-year notice.”

The World Health Organization did not immediately respond to a request for comment on Trump’s announcement. It has previously denied Trump’s assertions that it promoted Chinese “disinformation” about the virus.

“It’s important to remember that the WHO is a platform for cooperation among countries,” said Donna McKay, executive director of Physicians for Human Rights. “Walking away from this critical institution in the midst of an historic pandemic will hurt people both in the United States and around the world.”

‘ABSOLUTELY CRITICAL’

The United States currently owes the WHO more than $200 million in assessed contributions, according to the WHO website. Washington also gives several hundred million dollars annually in voluntary funding tied to specific WHO programs such as polio eradication, HIV, hepatitis and tuberculosis.

Amesh A. Adalja, a senior scholar at Johns Hopkins Center for Health Security, said that in practice Trump’s decision was unlikely to change the operations of the WHO.

“From a symbolic or moral standpoint it’s the wrong type of action to be taking in the middle of a pandemic and seems to deflect responsibility for what we in the U.S. failed to do and blame the WHO,” said Adalja.

When Trump halted funding to the WHO last month, two Western diplomats said the U.S. suspension was more harmful politically to the WHO than to the agency’s current programs, which are funded for now.

The WHO is an independent international body that works with the United Nations. U.N. Secretary-General Antonio Guterres said last month that the WHO is “absolutely critical to the world’s efforts to win the war against COVID-19.”

When asked about Trump’s decision, a U.N. spokesman said: “We have consistently called for all states to support WHO.”

Trump has long scorned multilateralism as he focuses on an “America First” agenda. Since taking office, he has quit the U.N. Human Rights Council, the U.N. cultural agency, a global accord to tackle climate change and the Iran nuclear deal. He has also cut funding for the U.N. population fund and the U.N. agency that aids Palestinian refugees.

“The WHO is the world’s early warning system for infectious diseases,” said U.S. Representative Nita Lowey, a Democrat who chairs the House Committee on Appropriations. “Now, during a global pandemic that has cost over 100,000 American lives, is not the time to put the country further at risk.”