ADB triples COVID-19 response package to $20 billion

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."

Wuhan, Jan 31: The World Health Organization declared a global emergency over the new coronavirus, as China reported Friday the death toll had climbed to 213 with nearly 10,000 infections.

The UN health agency based in Geneva had initially downplayed the threat posed by the disease, but revised its risk assessment after crisis talks.

suspended or reduced service to China include British Airways, German flag carrier Lufthansa, American Airlines, KLM and United.

Chinese efforts to halt the virus have included the suspension of classes nationwide and an extension of the Lunar New Year holiday.

All football matches across the country also will be postponed, the Chinese Football Association said on Thursday, including games in the top-tier Chinese Super League.

World stock markets tumbled again Thursday on fears that trouble in the "world's factory" would upset global supply chains and dent profits.

Toyota, IKEA, Starbucks, Tesla, McDonald's and tech giant Foxconn were among the corporate giants temporarily freezing production or closing large numbers of outlets in China.

Volkswagen announced Thursday its China joint-venture plants would not start production again before February 9.

US Federal Reserve Chairman Jerome Powell said the coronavirus posed a fresh risk to the world economy.

Throughout China, signs of paranoia multiplied, with residents of some Beijing residential compounds erecting makeshift barriers to their premises.

In one of many similar photos posted online, a man wearing a surgical mask and brandishing a traditional martial arts weapon squatted on a barricade outside a Chinese village, near a sign saying: "Outsiders forbidden from entering".

The crisis has caused food prices to spike, and the central government on Thursday blamed this partly on overzealous preventive measures, issuing a directive banning any roadblocks or other hindrances to food shipments.

Dubai/Washington, Jan 7: Iran's Supreme Leader Ayatollah Ali Khamenei wept in grief with hundreds of thousands of mourners thronging Tehran's streets on Monday for the funeral of military commander Qassem Soleimani, killed by a U.S. drone on U.S. President Donald Trump's orders.

The coffins of General Qassem Soleimani and Iraqi militia leader Abu Mahdi al-Muhandis, who also died in Friday's attack in Baghdad, were draped in their national flags and passed from hand to hand over the heads of mourners in central Tehran.

Responding to Trump's threats to hit 52 Iranian sites if Tehran retaliates for the drone strike, Iran's President Hassan Rouhani pointedly wrote on Twitter: "Never threaten the Iranian nation." And Soleimani's successor vowed to expel U.S. forces from the Middle East in revenge.

Khamenei, 80, led prayers at the funeral, pausing as his voice cracked with emotion. Soleimani, 62, was a national hero in Iran, even to many who do not consider themselves supporters of Iran's clerical rulers.

Aerial footage showed people, many clad in black, packing thoroughfares and side streets in the Iranian capital, chanting "Death to America!" - a show of national unity after anti-government protests in November in which many demonstrators were killed.

The crowd, which state media said numbered in the millions, recalled the masses of people that gathered in 1989 for the funeral of the Islamic Republic's founder, Ayatollah Ruhollah Khomeini. Soleimani, architect of Iran's drive to extend its influence across the Middle East, was widely seen as Iran's second most powerful figure behind Khamenei.

His killing of Soleimani has prompted concern around the world that a broader regional conflict could flare.

Trump on Saturday vowed to strike 52 Iranian targets, including cultural sites, if Iran retaliates with attacks on Americans or U.S. assets, and stood by his threat on Sunday, though American officials sought to downplay his reference to cultural targets. The 52 figure, Trump noted, matched the number of U.S. Embassy hostages held for 444 days after the 1979 Iranian Revolution.

Rouhani, regarded as a moderate, responded to Trump on Twitter.

"Those who refer to the number 52 should also remember the number 290. #IR655," Rouhani wrote, referring to the 1988 shooting down of an Iranian airline by a U.S. warship in which 290 were killed.

Trump also took to Twitter to reiterate the White House stance that "Iran will never have a nuclear weapon" but gave no other details.

'ACTIONS WILL BE TAKEN'

General Esmail Ghaani, Soleimani's successor as commander of the Quds Force, the elite unit of Iran's Revolutionary Guards charged with overseas operations, promised to "continue martyr Soleimani's cause as firmly as before with the help of God, and in return for his martyrdom we aim to rid the region of America."

"God the Almighty has promised to take martyr Soleimani's revenge," he told state television. "Certainly, actions will be taken."

Other political and military leaders have made similar, unspecific threats. Iran, which lies at the mouth of the key Gulf oil shipping route, has a range of proxy forces in the region through which it could act.

Iran's demand for U.S. forces to withdraw from the region gained traction on Sunday when Iraq's parliament passed a resolution calling for all foreign troops to leave the country.

Iraqi caretaker Prime Minister Abdel Abdul Mahdi told the U.S. ambassador to Baghdad on Monday that both nations needed to implement the resolution, the premier's office said in a statement. It did not give a timeline.

The United States has about 5,000 troops in Iraq.

Soleimani built a network of proxy militia that formed a crescent of influence - and a direct challenge to the United States and its regional allies led by Saudi Arabia - stretching from Lebanon through Syria and Iraq to Iran. Outside the crescent, Iran nurtured allied Palestinian and Yemeni groups.

He notably mobilised Shi'ite Muslim militia forces in Iraq that helped to crush ISIS, the Sunni militant group that had seized control of swathes of Syria and Iraq in 2014.

Washington, however, blames Soleimani for attacks on U.S. forces and their allies.

The funeral moves to Soleimani's southern home city of Kerman on Tuesday. Zeinab Soleimani, his daughter, told mourners in Tehran that the United States would face a "dark day" for her father's death, adding, "Crazy Trump, don't think that everything is over with my father's martyrdom."

NUCLEAR DEAL

Iran stoked tensions on Sunday by dropping all limitations on its uranium enrichment, another step back from commitments under a landmark deal with major powers in 2015 to curtail its nuclear programme that Trump abandoned in 2018.

In response, European signatories may launch a dispute resolution process against Iran this week that could lead to a renewal of the United Nations sanctions that were lifted as part of the deal, European diplomats said on Monday.

Diplomats said France, Britain and Germany could make a decision ahead of an EU foreign ministers' meeting on Friday that would assess whether there were any ways to salvage the deal.

After quitting the deal, the United States imposed new sanctions on Iran, saying it wanted to halt Iranian oil exports, the main source of government revenues. Iran's economy has been in freefall as the currency has plunged.

Trump adviser Kellyanne Conway said on Monday that he was still confident he could renegotiate a new nuclear agreement "if Iran wants to start behaving like a normal country."

Tehran has said Washington must return to the existing nuclear pact and lift sanctions before any talks can take place.

The United States advised American citizens in Israel and the Palestinian territories to be vigilant, citing the risk of rocket fire amid heightened tensions. As a U.S. ally against Iran, Israel is concerned about possible rocket attacks from Gaza, ruled by Iranian-backed Palestinian Islamists, or major Iran proxy Hezbollah in Lebanon.

Democratic critics of Trump have said the Republican president was reckless in authorising the strike, with some saying his threat to hit cultural sites amounted to a vow to commit war crimes. Trump also threatened sanctions against Iraq and said Baghdad would have to pay Washington for an air base in Iraq if U.S. troops were required to leave.