COVID-19 death toll in US could hit 200,000-mark by September: Indian-American professor

Islamabad, Jun 3: Pakistan has reported a record 4,132 fresh cases of the coronavirus in the last 24 hours, taking the total number of infections to 80,463, the health ministry said on Wednesday.

The Ministry of National Health and Services said the new infections were detected after conducting a maximum of 17,370 tests in a day.

Of the total cases, Sindh has so far detected 31,086 patients of the coronavirus, Punjab 29,489, Khyber-Pakhtunkhwa 10,897, Balochistan 4,747, Islamabad 3,188, Gilgit-Baltistan 779 and Pakistan-occupied Kashmir reported 289 patients of the viral disease.

"In total 67 patients died in the last 24 hours, taking the tally of deaths to 1,688. Another 28,923 people have fully recovered from the disease," the ministry said in a statement.

The authorities have so far carried out 595,344 tests in the country.

Officials said that Pakistan has more than 100 labs that can conduct over 30,000 tests per day and the number of daily tests will be gradually increased to the maximum level.

Kuala Lumpur, Feb 4: Malaysia said on Tuesday that India's move to cut back on palm oil purchases is "temporary" and will be resolved amicably between the two nations.

Last month, India restricted imports of refined palm oil and asked importers to avoid purchases from Malaysia after its criticism of actions in Kashmir and a new citizenship law.

"Having long-standing bilateral ties, the two nations will overcome the current challenges, and prevail towards mutual and beneficial outcomes," the Malaysian Palm Oil Council said in a statement, citing Primary Industries Minister Teresa Kok.

Malaysia's push to implement B20 biodiesel starting this month will also help sustain high crude palm oil prices, the statement read.

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."