Australian PM to ban affairs between ministers and staff

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."

Fifty-six journalists were killed in 2019 and most of them died outside conflict zones, a United Nations spokesperson said.

The number dropped by nearly half from the year 2018, but perpetrators enjoyed almost total impunity, Xinhua news agency quoted Stephane Dujarric, spokesperson for UN Secretary-General Antonio Guterres, as saying on Monday citing Unesco figures.

The figure was published in the 'Unesco Observatory of Killed Journalists' on Monday.

In total, Unesco recorded 894 journalist killings in the decade from 2010 to 2019, an average of almost 90 per year. The number in 2019 was 99.

Journalists were murdered in all regions of the world, with Latin America and the Caribbean recording 22 killings, the highest number, followed by 15 in Asia-Pacific, and 10 in Arab States.

"The figures show that journalists not only suffer extreme risks when covering violent conflict, but that they are also targeted when reporting on local politics, corruption and crime - often in their hometowns," the Unesco said.

Almost two thirds (61 per cent) of the cases in 2019 occurred in countries not experiencing armed conflict, a notable spike in a wider trend in recent years, and a reversal of the situation of 2014, when this figure was one third.

More than 90 per cent of cases recorded in 2019 concerned local journalists, consistent with previous years, it added.

In response to these figures, Audrey Azoulay, the Director-General of Unesco, said: "Unesco remains deeply troubled by the hostility and violence directed at all too many journalists around the world.

"As long as this situation lasts, it will undermine democratic debate."