Strong earthquake shakes eastern Japan

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, Jun 26: The US is reviewing its global deployment of forces to ensure it is postured appropriately to counter the People's Liberation Army, given the increasing threat posed by China to Asian countries like India, Malaysia, Indonesia, and the Philippines, Secretary of State Mike Pompeo said on Thursday.

Mr Pompeo made those remarks in response to a question during the virtual Brussels Forum 2020 of the German Marshall Fund.

"We're going to make sure we're postured appropriately to counter the PLA. We think that the challenge of our times, and we're going to make sure we have resources in place to do that," Mr Pompeo said.
 
The force posture review is being done at the direction of President Donald Trump, as part of which the US is reducing the number of its troops in Germany from about 52,000 to 25,000, he said.

Mike Pompeo said that the force posture would be dictated by the ground realities.

"In certain places there will be fewer American resources. There'll be other places - I just talked about the threat from the Chinese Communist Party, so now threats to India, threats to Vietnam, threats to Malaysia, Indonesia, South China Sea challenges, the Philippines," he said.

"To the extent that that changed, the difference in what the US decided to do impacts adversely a threat some place, it may be that other nations need to step up and take responsibility for their own defense in ways that they hadn't done previously. So, we want to do this in full consultation with all of our partners all around the world, and certainly our friends in Europe," Mr Pompeo said.

President Trump is being criticised for reducing troops from Germany. His critics say that this will increase the threat from Russia to Europe.

Mike Pompeo, however, did not agree with that argument.

It has been a long time since there has been a strategic review of our force posture all across the world. The US undertook that starting about 2.5 years ago, whether that was our forces in Africa, our forces in Asia, the force we have in the Middle East and in Europe, he said.

"We began to say these are often decisions that were made in a different time. Should we reallocate those a different way? Should we have a different composition of those forces? Everyone always wants to talk about ground troops. I get it. I was a young tank officer. You described that. There's nothing I like as much as a good M1 tank.

"But it's often the case that the capacity to deter Russia or other adversaries isn''t determined any longer by just having a bunch of folks garrisoned someplace. So, we really went to back fundamentally relook, what is the nature of the conflict, what''s the nature of the threat, and how should we allocate our resources, whether that''s our resources in the intelligence community, our resources from the Air Force or the Marines and Army," Mr Pompeo said.

Last week, Mike Pompeo criticised the Chinese Army for "escalating" the border tension with India and militarising the strategic South China Sea. He also described the ruling Communist Party of China (CPC) as a "rogue actor".

"Our broad set of allocation of security apparatus, our ability to counter cyber threats, how do we allocate them? What''s the best way to do this? And the decision that you see the president made with respect to Germany is an outcome from a collective set of decisions about how we''re going to posture our resources around the world," said the top American diplomat on Thursday.

Changes in force posture is being taken in consultations with allies and friends, Mr Pompeo said.

"President Trump has spoken to this. (Defense) Secretary (Mark) Esper will be in London today and in Brussels tomorrow. We''ll talk about our plan and how we''re thinking about delivering it," he said.

"But you should understand this, and I hope our European partners will understand this as well. When you see what we ultimately conclude, how we ultimately deliver on the statements of the president made, that they''re aimed squarely at what we believe to be democracies'' fundamental interest and certainly America's most fundamental interest," Mr Pompeo said.

Earlier this month, Mike Pompeo had said that China's actions, be it on the India border, or in Hong Kong or in the South China Sea, were part of the behaviour of the ruling Communist Party in Beijing in the recent past.

China has been fast expanding military and economic influence in the Indo-Pacific region, triggering concern in various countries of the region and beyond.

China is engaged in hotly contested territorial disputes in both the South China Sea and the East China Sea. Beijing has built up and militarised many of the islands and reefs it controls in the region. Both areas are stated to be rich in minerals, oil and other natural resources and are vital to global trade.

​