India, Pak ink visa pact; but concern on terror remains

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."

Geneva, Jun 22: The global count of coronavirus cases has surpassed 8.7 million, with 183,020 new cases recorded on Sunday, the World Health Organisation said in its daily situation report.

Over the last 24 hours, 4,743 people died from COVID-19 worldwide, taking the death toll to 461,715 fatalities, according to the report.

The cumulative global toll of confirmed cases has now reached 8,708,008, as stated in the report.

The WHO Regional Director for Europe, Dr Hans Henri P. Kluge, shared that Europe accounts for 31 per cent of COVID-19 cases and 43 per cent of COVID-19 deaths globally.

Dr Kluge highlighted that several countries continue to face increasing disease incidence and that "preparing for the autumn is a priority now at the WHO Regional Office for Europe"

The United States continues to be worst affected by the contagion with the highest count of cases and fatalities -- 2.2 million and 118,895, respectively.

The novel coronavirus was declared a pandemic by WHO on March 11.

Washington/Seoul, Apr 26: A special train possibly belonging to North Korean leader Kim Jong Un was spotted this week at a resort town in the country, according to satellite images reviewed by a Washington-based North Korea monitoring project, amid conflicting reports about Mr. Kim's health and whereabouts.

The monitoring project, 38 North, said in its report on Saturday that the train was parked at the “leadership station” in Wonsan on April 21 and April 23. The station is reserved for the use of the Kim family, it said.

Though the group said it was probably Kim Jong Un's train, Reuters has not been able to confirm that independently, or whether he was in Wonsan.

“The train's presence does not prove the whereabouts of the North Korean leader or indicate anything about his health but it does lend weight to reports that Kim is staying at an elite area on the country's eastern coast,” the report said.

Speculation about Mr. Kim's health first arose due to his absence from the anniversary of the birthday of North Korea's founding father and Mr. Kim's grandfather, Kim Il Sung, on April 15.

North Korea's state media last reported on Mr. Kim's whereabouts when he presided over a meeting on April 11.

China has dispatched a team to North Korea including medical experts to advise on Kim Jong Un, according to three people familiar with the situation.

A third-generation hereditary leader who came to power after his father's death in 2011, Kim has no clear successor in a nuclear-armed country, which could present major international risk.

On Thursday, U.S. President Donald Trump downplayed reports that Mr. Kim was ill. “I think the report was incorrect,” Mr. Trump told reporters, but he declined to say if he had been in touch with North Korean officials.

Mr. Trump has met Mr. Kim three times in an attempt to persuade him to give up a nuclear weapons program that threatens the United States as well as its Asian neighbors. While talks have stalled, Mr. Trump has continued to hail Mr. Kim as a friend.

Reporting from inside North Korea is notoriously difficult because of tight controls on information.

A Trump administration official said continuing days of North Korean media silence on Mr. Kim's whereabouts had heightened concerns about his condition, and that information remained scant from a country U.S. intelligence has long regarded as a ”black box.”

The U.S. State Department did not immediately respond to questions about the situation on Saturday.

Daily NK, a Seoul-based website that reports on North Korea, cited one unnamed source in North Korea on Monday as saying that Kim had undergone medical treatment in the resort county of Hyangsan north of the capital Pyongyang.

It said that Mr. Kim was recovering after undergoing a cardiovascular procedure on April 12.

Since then, multiple South Korean media reports have cited unnamed sources this week saying that Mr. Kim might be staying in the Wonsan area.

On Friday, local news agency Newsis cited South Korean intelligence sources as reporting that a special train for Mr. Kim's use had been seen in Wonsan, while Mr. Kim's private plane remained in Pyongyang.

Newsis reported Mr. Kim may be sheltering from COVID-19, the respiratory disease caused by the novel coronavirus.

Mr. Kim, believed to be 36, has disappeared from coverage in North Korean state media before. In 2014, he vanished for more than a month and North Korean state TV later showed him walking with a limp.

Speculation about his health has been fanned by his heavy smoking, apparent weight gain since taking power and family history of cardiovascular problems.