Kabul awakes to more explosions and heavy gunfire

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."

Houston, Mar 15: Researchers, studying the novel coronavirus, have found that the time between cases in a chain of transmission is less than a week, and over 10 per cent of patients are infected by someone who has the virus, but does not show symptoms yet, a finding that may help public health officials contain the pandemic.

The study, published in the journal Emerging Infectious Diseases, estimated what's called the serial interval of the coronavirus by measuring the time it takes for symptoms to appear in two people with the virus -- the person who infects another, and the infected second person.

According to the researchers, including those from the University of Texas at Austin, the average serial interval for the novel coronavirus in China was approximately four days.

They said the speed of an epidemic depends on two things -- how many people each case infects, and how long it takes cases to spread.

The first quantity, the scientists said, is called the reproduction number, and the second is the serial interval.

Due to the short serial interval of the disease caused by the coronavirus -- COVID-19 -- they said, emerging outbreaks will grow quickly, and could be difficult to stop.

“Ebola, with a serial interval of several weeks, is much easier to contain than influenza, with a serial interval of only a few days,” said Lauren Ancel Meyers, study co-author from UT Austin.

Meyers explained that public health responders to Ebola outbreaks have much more time to identify and isolate cases before they infect others.

“The data suggest that this coronavirus may spread like the flu. That means we need to move quickly and aggressively to curb the emerging threat,” Meyers added.

In the study, the scientists examined more than 450 infection case reports from 93 cities in China, and found the strongest evidence yet that people without symptoms must be transmitting the virus -- known as pre-symptomatic transmission.

More than one in ten infections were from people who had the virus but did not yet feel sick, the scientists said.

While researchers across the globe had some uncertainty until now about asymptomatic transmission with the coronavirus, the new evidence could provide guidance to public health officials on how to contain the spread of the disease.

“This provides evidence that extensive control measures including isolation, quarantine, school closures, travel restrictions and cancellation of mass gatherings may be warranted,” Meyers said.

The researchers cautioned that asymptomatic transmission makes containment more difficult.

With hundreds of new cases emerging around the world every day, the scientists said, the data may offer a different picture over time.

They said infection case reports are based on people's memories of where they went and whom they had contact with, and if health officials move quickly to isolate patients, that may also skew the data.

“Our findings are corroborated by instances of silent transmission and rising case counts in hundreds of cities worldwide. This tells us that COVID-19 outbreaks can be elusive and require extreme measures,” Meyers said.

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."