US president pays surprise visit to Afghanistan

Geneva, May 28: The global death toll from the novel coronavirus has risen over the past 24 hours by 5,581 to 349,095, the World Health Organization (WHO) said in its daily situation report.

The number of confirmed cases has increased by 84,314 to 5,488,825, the WHO said.

Most cases of infection are recorded in the Americas (North and South America) - 2,495,924, with 145,810 deaths. While Europe has reported 2,061,828 cases and 1,76,226 deaths so far.

As per WHO tally, the US has the highest number of cases in the world with 1,63,4010 infections.

The global health body declared the outbreak of the new coronavirus a pandemic on March 11.

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."

The death toll in China's coronavirus rose sharply to 425 with 64 deaths on Monday alone while 3,235 new confirmed cases were reported, taking the number of those infected with the deadly disease to 20,438, Chinese health authorities said on Tuesday.

The 64 people who died on Monday were all from the Hubei province, the epicentre of the virus, China's National Health Commission said.

Also, 3,235 new confirmed cases of novel coronavirus infection were reported, a big increase in a day.

Another 5,072 new suspected cases were reported on Monday, said the commission, adding that 492 patients became seriously ill.

The commission said that 2,788 patients remained in severe condition and 23,214 people were suspected of being infected with the virus, a pointer that it is increasingly turning virulent.

The overall confirmed cases on the Chinese mainland had reached 20,438 by the end of Monday, the commission said, noting that a total of 425 people had died of the disease.

A total of 632 people had been discharged from hospital after recovery, state-run Xinhua news agency reported As the virus spreads from human to human, 221,015 close contacts had been traced, with 171,329 others still under medical observation.

By the end of Monday, 15 confirmed cases had been reported in Hong Kong, eight in the Macao and 10 in Taiwan.

The Philippines reported the first overseas death from the virus on Sunday while 148 cases have been reported from abroad.

India has reported three cases of the coronavirus. All the three patients from Kerala recently returned from the affected Wuhan city.

Currently, 647 Indians and seven Maldivians who have been evacuated from Wuhan and Hubei are in 14-day quarantine at a medical camp in Manesar, near Delhi.

As the virus continued to spread at an alarming rate, Chinese President Xi Jinping on Monday warned officials of punishment if they shirked responsibility in tackling the virus outbreak.

On Monday, China has opened a 1,000-bed hospital built in record nine days in Wuhan city and started trials for new drug to contain the virus and is set to open another 1,300 bed hospital next to it on Wednesday.

The ruling Communist Party of China on Monday held its political bureau meeting presided by President Xi to review the steps being taken on various fronts to halt the spread of the deadly virus.

The outcome of the epidemic prevention and control directly affects people's lives and health, the overall economic and social stability and the country's opening-up, Xi said.

"Those who disobey the unified command or shirk off responsibilities will be punished," Xi was quoted as saying by the state-run Xinhua news agency.

Xi said that the party and government leaders supervising them would also be held accountable in severe cases.

Chinese armament firms, including those building aircraft carrier and military aircraft, have postponed planned work in order to concentrate on controlling the risk of coronavirus, state-run Global Times reported.

Noted Chinese health expert Zhong Nanshan has said that based on the fresh evidence, the novel coronavirus, which is spreading rapidly in China and the world, may reach its peak in the next 10 to 14 days, contrary to earlier estimates of climaxing sooner.

This means that the cases would drastically increase in the next two weeks before slowing down.

Also, China has begun clinical trials to test a drug to treat the patients of the coronavirus which till now has no cure.

Currently, patients are being treated with a combination of antivirals and other measures, as scientists race to find a vaccine.

Some reports said drugs to treat HIV too was being tried to treat the patients.

The experimental antiviral drug, Remdesivir, to be tested in field trials is developed by US-based Gilead Sciences. It is aimed at treating infectious diseases such as Ebola and SARS, South China Morning Post reported.

It was given to the first US patient last week - a 35-year-old man whose condition appeared to improve within a day, it said.