44 killed, 180 injured in Egypt train collision

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."

London, Mar 26: British Prime Minister Boris Johnson has said that the country's NHS risks becoming "overwhelmed" by the coronavirus outbreak and that the situation in Britain is just two or three weeks behind Italy.
"The numbers are very stark, and they are accelerating. We are only a matter of weeks -- two or three -- behind Italy," Johnson said, as reported by CNN.
"The Italians have a superb health care system. And yet their doctors and nurses have been completely overwhelmed by the demand. The Italian death toll is already in the thousands and climbing.
He added, "Unless we act together unless we make the heroic and collective national effort to slow the spread -- then it is all too likely that our own NHS will be similarly overwhelmed,"
"That is why this country has taken the steps that it has, in imposing restrictions never seen before either in peace or war." He said.
The problem reached a crunch point in the UK, which has dramatically increased its response to the virus outbreak this week.
Food banks that provide a lifeline for some of the estimated 14 million in poverty are running low on volunteers, many of whom have been forced to self-isolate, as well as the food itself, which is in short supply following panic-buying.
The UK has confirmed more 9,600 cases of the deadly virus with 460 deaths.
The global tally of cases has crossed 487,000 as on Thursday with 22,030 deaths globally as per the data presented by the Johns Hopkins University.

Washington, Jan 10: It is “highly likely” that Iran shot down the civilian Ukrainian jetliner that crashed near Tehran late Tuesday, killing all 176 people on board, U.S., Canadian and British officials declared Thursday.

They said the fiery missile strike could well have been a mistake amid rocket launches and high tension throughout the region.

The crash came just a few hours after Iran launched a ballistic attack against Iraqi military bases housing U.S. troops in its violent confrontation with Washington over the U.S. drone strike that killed an Iranian Revolutionary Guard general. The airliner could have been mistaken for a threat, said four U.S. officials, speaking on condition of anonymity to discuss sensitive intelligence.

Canadian prime minister Justin Trudeau, whose country lost at least 63 citizens in the downing, said in Toronto: “We have intelligence from multiple sources including our allies and our own intelligence. The evidence indicates that the plane was shot down by an Iranian surface-to-air missile.”

Likewise, U.K. prime Minister Boris Johnson and Australian prime minister Scott Morrison offered similar statements. Morrison also said it appeared to be a mistake. “All of the intelligence as presented to us today does not suggest an intentional act,” he said.

The assessment that 176 people were killed as collateral damage in the Iranian-U.S. conflict cast a new pall over what had at first appeared to be a relatively calm aftermath following the U.S. military operation that killed Iranian Gen. Qassem Soleimani.

At the White House, U.S. president Donald Trump suggested he believed Iran was responsible for the shootdown and dismissed Iran's initial claim that it was a mechanical issue with the plane.

“Somebody could have made a mistake on the other side.” Trump said, noting the plane was flying in a “pretty rough neighborhood."