CNN and Time magazine's Fareed Zakaria suspended for plagiarism

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."

Jun 23: US President Donald Trump has issued a proclamation to suspend issuing of H-1B visas, which is popular among Indian IT professionals, along with other foreign work visas for the rest of the year.

Trump said the step was essential to help millions of Americans who have lost their jobs due to the current economic crisis.

Issuing the proclamation ahead of the November presidential elections, Trump has ignored the mounting opposition to the order by various business organisations, lawmakers and human rights bodies.

The proclamation that comes into effect on June 24, is expected to impact a large number of Indian IT professionals and several American and Indian companies who were issued H-1B visas by the US government for the fiscal year 2021 beginning October 1.

They would now have to wait at least till the end of the current year before approaching the US diplomatic missions to get stamping. It would also impact a large number of Indian IT professionals who are seeking renewal of their H-1B visas.

“In the administration of our Nation's immigration system, we must remain mindful of the impact of foreign workers on the United States labour market, particularly in the current extraordinary environment of high domestic unemployment and depressed demand for labour,” said the proclamation issued by Trump.

In his proclamation, Trump said that the overall unemployment rate in the United States nearly quadrupled between February and May of 2020 -- producing some of the most extreme unemployment rates ever recorded by the Bureau of Labor Statistics.

While the May rate of 13.3 percent reflects a marked decline from April, millions of Americans remain out of work.

The proclamation also extends till the end of the year his previous executive order that had banned issuing of new green cards of lawful permanent residency.

Green card holders, once admitted pursuant to immigrant visas, are granted "open-market" employment authorisation documents, allowing them immediate eligibility to compete for almost any job, in any sector of the economy, he said.

“American workers compete against foreign nationals for jobs in every sector of our economy, including against millions of aliens who enter the United States to perform temporary work. Temporary workers are often accompanied by their spouses and children, many of whom also compete against American workers,” Trump said.

“Under ordinary circumstances, properly administered temporary worker programmes can provide benefits to the economy. But under the extraordinary circumstances of the economic contraction resulting from the COVID-19 outbreak, certain non-immigrant visa programmes authorising such employment pose an unusual threat to the employment of American workers,” he said.

For example, Trump said, between February and April of 2020, more than 17 million United States jobs were lost in industries in which employers are seeking to fill worker positions tied to H-2B nonimmigrant visas.

“During this same period, more than 20 million United States workers lost their jobs in key industries where employers are currently requesting H-1B and L workers to fill positions,” he said.

“Also, the May unemployment rate for young Americans, who compete with certain J non-immigrant visa applicants, has been particularly high -- 29.9 percent for 16-19-year-olds, and 23.2 percent for the 20-24-year-old group,” he said.

“The entry of additional workers through the H-1B, H-2B, J, and L non-immigrant visa programmes, therefore, presents a significant threat to employment opportunities for Americans affected by the extraordinary economic disruptions caused by the COVID-19 outbreak,” Trump said.

Trump observed that excess labour supply is particularly harmful to workers at the margin between employment and unemployment -- those who are typically "last in" during an economic expansion and "first out" during an economic contraction.

In recent years, these workers have been disproportionately represented by historically disadvantaged groups, including African Americans and other minorities, those without a college degree, and Americans with disabilities, he said.

The proclamation suspends and limits entry into the US of H-1B, H-2B and L visas and their dependents till December 31, 2020. It also includes certain categories of J visas like an intern, trainee, teacher, camp counselor, or summer work travel programme.

The new rule would apply only to those who are outside the US, do not have a valid non-immigrant visa and an official travel document other than a visa to enter the country.

According to the proclamation, it does not have an impact on lawful permanent residents of the United States and foreign nationals who are spouses or child of an American citizen.

Foreign nationals seeking to enter the US to provide temporary labour or services essential to the food supply chain are also exempted from the latest proclamation.