Modi, Obama write first joint editorial

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."

New Delhi, Apr 14: The World Health Organization on Tuesday lauded "India's tough and timely actions" against the coronavirus spread as Prime Minister Narendra Modi announced the extension of current lockdown till May 3.

"It may be early to talk about results in numbers, but a six-week nationwide lockdown to facilitate effective physical distancing, coupled with the expansion of core public health measures such as detection, isolation and tracing contact of coronavirus positive people, would go a long way in arresting the virus spread," said WHO's South-East Asia Regional Director, Dr Poonam Khetrapal Singh.

"Despite huge and multiple challenges, India has been demonstrating unwavering commitment in its fight against the pandemic," she said.

"In these testing times, the action lies as much with the communities as with the authorities and the health workforce," she added.

"It is indeed time for each and every one to contribute their best and together to beat the virus," Dr Singh said.

Modi on Tuesday said the implementation of the lockdown will be strictly ensured in coming days to ensure that the virus does not spread to new areas

The prime minister said a detailed guideline on the implementation of the new lockdown will be announced on Wednesday.

According the Union Health Ministry figures, a total of 339 people have died of COVIOD-19 till date in the country, while the number of infected cases has soared to 10,363 on Tuesday.

A PTI tally of figures reported by various states as on Monday evening, however, showed at least 346 deaths.

There has been a lag in the Union Health Ministry figures, compared to the number of deaths announced by different states, which officials attribute to procedural delays in assigning the cases to individual states.

Kuala Lumpur, Feb 25: The government party led by Interim Malaysian Prime Minister Mahathir Mohamad has rejected his resignation, urging him to continue leading it and the country, now shrouded in political uncertainty.

During an extraordinary meeting held on Monday night, the Malaysian United Indigenous Party (Bersatu) unanimously rejected the 94-year-old Prime Minister's decision, reports Efe news.

Mahathir, the world's oldest head of government, presented his resignation on Monday, later accepted by King Abdullah Pahang, on condition that he continue as Interim Prime Minister until a new government is formed.

That decision caused a domino effect that broke the Patakan Harapan (Alliance of Hope) alliance, formed in 2018 by four political parties that prevailed in that year's general elections.

Bersatu and 11 Popular Justice Party deputies announced their departure from the coalition, although they reaffirmed their confidence in Mahathir as Malaysia's political leader.

"We remain intact and prepared to build a party to face the difficulties," Marzuki Yahya, Bersatu Secretary-General, said after the meeting.

Confusion reigns in the country, with some local media claiming Bersatu and the 11 deputies Justice Party deputies intended to form a new government with opposition parties, including the historic Barisan Nasional coalition, under Mahathir's leadership.

Lim Guan Eng, Finance Minister and coalition member, said in a statement that the chief executive himself had informed him he had no intention of forming a coalition with Barisan, which suffered a historic defeat in the last elections.

A future government will need at least 112 of 222 parliament votes.

Mahathir returned to politics in 2018 heading the Patakan Harapan coalition to defeat his predecessor Najib Razak, marred by the corruption suspicions offenses.

To that end, Mahathir joined Anwar Ibrahim, a former political ally who fell out of favour in 1999 and was imprisoned five years on charges of corruption and sodomy, whom he promised to be his successor in power.