11 dead, 41 hurt as suicide bombers hit Indonesian churches

Washington D.C., April 21: North Korea's leader, Kim Jong Un, is in grave danger following a surgery this month, according to a US intelligence official with direct knowledge.

Kim recently missed the celebration of his grandfather's birthday on April 15, which raised speculation about his well-being. He had been seen four days before that at a government meeting, according to intelligence reports cited by CNN.

The National Security Council and Office of the Director of National Intelligence have however declined to comment on the matter.

CNN has also reached out to the CIA and the State Department for comment and sought comment from the South Koreans.

Kim's absences from official state media often spark speculation and rumors about his health. North Korea has no free press and is often a black hole when it comes to the country's leadership. Analysts are heavily reliant on scanning state media dispatches and watching propaganda videos for any semblance of a clue.

Kim last appeared in North Korean state media on April 11. April 15 -- North Korea's most important holiday, the anniversary of the birth of the country's founding father, Kim Il Sung -- came and went without any official mention of Kim Jong Un's movements.

Experts are unsure of what to make of Kim's absence from any festivities celebrating his grandfather. When North Korean leaders have not shown up to these important celebrations in the past, it has portended major developments. But it has also turned out to be nothing.

"There have been a number of recent rumours about Kim's health (smoking, heart, and brain). If Kim is hospitalized, it would explain why he wasn't present on the important April 15th celebrations," said Bruce Klingner, a senior research fellow at the Heritage Foundation and former CIA deputy division chief for North Korea. "But, over the years, there have been a number of false health rumors about Kim Jong-un or his father. We'll have to wait and see."

Kim Jong Il's absence from a parade celebrating North Korea's 60th anniversary in 2008 was followed by rumblings that he was in poor health. It was later revealed he had a stroke, after which his health continued to decline until his death in 2011.

Kim Jong Un disappeared from the public eye for more than a month in 2014, which also prompted speculation about his health. He returned sporting a cane, and days later South Korean intelligence said that he had a cyst removed from his ankle.

Hubei, Mar 25: As a bus departed from its terminus at Hankou Railway Station at 5:25 am Wednesday morning, Wuhan started to resume bus service after nine weeks of lockdown.

Apart from a driver, a safety supervisor was also on each bus, whose duty was to make sure all passengers are healthy.
"For those who do not use smartphones, they should bring with them a health certificate issued by the health authorities," said Zhou Jingjing, a safety supervisor aboard bus No. 511 departing from the Wuchang Railway Station complex.
The once hardest-hit city in central China's Hubei Province during the COVID-19 outbreak took unprecedented traffic restrictions on Jan 23. All of its public transport and all outbound flights and trains had been suspended in an attempt to contain the virus within the region.

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."